Monday, November 30, 2015

Deciding About Hormone Therapy, Do You Know What Hot Flashes Do To Your Blood Pressure?

Hot flashes secondary to menopause used to be treated ubiquitously. In other words, it was a rare woman in the late 20th century that wouldn't get treatment should she desire treatment. In fact, it was a woman's call as to whether she need treatment. Anyone can blush a bit for lots of reasons, and we can occasionally feel warm when everyone else is cold, or wake up feeling a bit sweating, and pointing this out to your gyno used to get you a prescription fairly easily.  This is discussed in the book  Making Peace With Change. But needing treatment for these symptoms is a discussion on its' own. Hot flashes should be treated if they are moderate or severe, and only rarely should be treated if they are relatively mild. Often this will mean estrogen although many women who are candidates for estrogen are even taking the estrogen they are prescribed. Over a third of women won't take estrogen because they are afraid of adverse side effects. Another group stops treatment because they have gotten adverse side effects. It's interesting to note there may be as many negatives of avoiding treatment as to taking treatment. Blood pressure in one area that this is so. Hot Flashes elevate blood pressure in an article published in Menopause Vol 19 2012. In fact the authors from Canada and Australia in this report noted that for each additional night sweat the blood pressure climbed 2 mm of Hg during the flash. Interestingly there was a drop in blood pressure by 2 mm of Hg for each time a woman had a day time hot flash. Your gyno can help you sort out these various issues, and figure out if this is the right therapy for you.

Sunday, November 29, 2015

When It Comes To Ovaries, Which is Your Good Side and Which Would You Keep If Just Keeping One

Removal of the ovaries at the time of hysterectomy for a woman who is still ovulating puts a woman at risk for certain diseases, while reducing the risk of ovarian cancer by about 98%. It has now been shown that losing both ovaries will  have various negative neurological consequences including increased risk of Parkinson's disease, increase her risk of declining cognitive function and increase her risk of fatal coronary artery disease, decrease her quality of life, and increase her risk of all-cause mortality. . It is true that the risks of these conditions can be reduced by restoring natural estrogen use with the use of estrogen supplementation. But the fears about the risks of estrogen have driven many women away from appropriate estrogen supplementation after premenopausal ovarian removal.  As with other surgical decisions, women need to discuss with their providers their overall health, when making those final decisions regarding whether to elect to remove ovaries at the time of a hysterectomy.Dr Douglas Brown from Mass General Hospital, published in Menopause Vol 21, 2014, has proposed the idea of keeping just one ovary instead of two at the time of hysterectomy. The questions are many, we don't usually discuss whether a woman will need hormones after keeping just one ovary, and we don't discuss whether one ovary is superior to the other, or whether one ovary is more likely to get cancer than the other ovary. We may not know. In the new study he discusses, it showed that the right ovary is just a bit more likely to get ovarian cancer, but endometriosis is a bit more likely in the left ovary than in the right. The right ovary ovulates more than the left, about 65-80% of the time is a woman ovulating on the right alone. And fertility clinics report, according to Dr. Brown, more pregnancies from right sided ovulations, especially with IVF, at over 3 times the rate of pregnancies. The final conclusion is that you should discuss all medical decisions with your gyno as there may be particulars of your personal case to discover.

More on Age of Menopause, See the Book Making Peace With Change

Monday, November 23, 2015

Stepping On The Scale Daily Reduces Your Weigh By 7% Over a Year!

Daily and weekly weigh ins, particularly if incorporated into a weight loss program can help a dieter lose weight. In fact a study of the new weight loss medication Contrave said, it's a huge component. In their controlled study those that got their special scale (with the pep talks and the beeping to make you do it, so no, it wasn't just any scale) lost 7% of their weight over a year. So it does help to do that and we will discuss weighing in often and tracking. Gynos especially like their patients to come weigh in with them. But there are other ways to monitor successful body shaping and health through a weight loss regimen. to checking weight, it's not always the amount of weight on the scales, as everyone knows. And it's not just whether you fit into your jeans. It's exactly how fat you are. We've written a lot about fat distribution, and we've written about getting that fat rearranged, but everyone knows as long as they don't look fat, they are fine, right? Of course wrong. So When you go to the doctor's office are they measuring the right things? How about waist to hip ratios? That will at least tell you whether you are a pear or an apple. But how about the old fashioned calipers to grab your flabby parts. The American Bariatric Society endorses some criteria for obesity, that we are used to and a physician Dr. Eric Braverman, who is associated with Weill Cornell neurological surgery department, but also seems to support some non-substantiated alternative therapies on his website, has reported that a study by his PATH Research of New York's recent study showed that at least 5% of individuals are deemed obese by BMI but are not, and about 37% of Americans are obese, meaning more than 30% of body fat for women, and 25% for men, if accurate DXA measurements are used. Thin women can benefit from getting off only scale measurements and checking their body fat. Typically female athletes have about 5% less body fat than the non-competitive athlete. And If you are less than 22% body fat you might be at risk for ovulation and menstrual disorders. Measurements of BMIs are also categorized by the degree the abnormal BMI risks poor health.  BMI: grade 1 obesity is 30-34.9, a grade 3 is over 40 BMI, grade 2 is all in between. Or  obesity can be determined by the size of your waist over 35 inches. The accurate BMI tests on bone densitometry may be relatively more costly (at Women's Health Practice we try to keep very affordable as most insurance companies won't cover, and charge $25 for our regular dieters) but they are so much more accurate at predicting the waist related obesity. If you insist on being cost effective, get out a measuring tape and check the weight to hip ratio! Women, you should be no more than 0.8! Quit reading, and go do some core work for at least 10 minutes!

Sunday, November 22, 2015

The Best Way to Love Your Skin When You Tan Without Sun Screen

When you want to love your skin, but you also love your tan. You are thinking "sun screen save my skin" or "just lather up the baby oil" one last tan can't hurt, right? Well, bottom line, sun screen will protect your skin from sun damage, however, the saving factor can be using antioxidants within the skin to prevent the damage sun is trying to do to your skin. Your skin story should start like this: 1. Do you have healthy skin, for that you need to have a discussion with a health care provider who understands your body and your skin, 2. Can you persevere the health you have in your skin, for that you need MORE sun defense, not just protection, 3. Can you reverse the damage and reduce your changes of skin cancer, again, back to the professional to discuss and to really understand how to not age your skin or in fact reverse again, or dechronify your skin. The FDA has approved 17 agents for use in sunscreens that will provide SPF. Some are organic or the chemical sunscreens which absorb the UV before it strikes and others are the inorganic literally forming a physical barrier that also works by being strongly reflective. And lots of products have a bit of both. Anti oxidants that you can use when tanning, whether you use sun screen or not, can come in many different formulations,. Call Hada Cosmetic Medicine to get a consultation, and get the therapies that are adaptable to your personal lifestyle.

Historical Gynecological Research With Chimps: Endometriosis, Preeclampsia and Prevention of Hepatitis B

The NIH is retiring chimpanzees and will no longer use them in medical research. So it seems fitting to look back at the many historical breakthrough our brethren primates have given us. Hepatitis B and the devastating consequences of that disease for moms and babies has a vaccine because of a pivotal chimp research in Liberia. 
Since very few species menstruate, very few species get endometriosis or are able to be studied for a cure for endometriosis.Non-human primates and humans are therefore are the only species to be studied if we want to cure endometriosis. The great apes and chimps have also brought us invaluable clues to the invasive placental behavior that causes preeclampsia. We have been analyzing great ape and chimpanzees for genetic clues that may finally solve the puzzle of a cure for preeclampsia. Chimpanzees also appear in the list of classic twin research studies, and a summary can be found on the National Center for Biotechnology Information. These are a few of the more dramatic studies that have helped women. Some researchers want to keep some chimp research going, and hope to provide a happy, healthy collaborative relationship like at Chimp Haven.

Smoking and Urinary Leakage

Another gyno lecture about stopping to smoke, and yes, even cutting back will improve your bladder. But as smoking can cause urinary leakage it's time to let your gyno help you stop smoking. Oddly we even see decreased smoking when we put you on a diet with Contrave, so selecting the right medications for the job can have many favorable effects as well as the favorable effects we intended. First determine the cause of the bladder problems leading to pad usage, and we can help you do that. But bottom line, if you didn't realize why you are having increasing problem with over active bladder, urge incontinence or mixed incontinence disorders, well for those of you who still smoke are all linked to smoking. Of course smokers have more frequent and more forceful coughs too, so the challenge to the bladder integrity is there constantly. Tobacco side products and nicotine lower estrogen, which may also have the long term consequences of weakening your pelvic floor. If you have low estrogen your tissues may have weakened and this is what the procedure MonaLisa Touch is designed to do. So eCigs probably won't help you solve this problem, less nicotine over all improves your bladder, you really should quit! There probably is also a direct link with nicotine and contractions of the bladder wall called detrusor contractions. Studies also reveal that more urinary retention occurs in smokers, and it can be a source of infections and lower abdominal discomfort.   Cystometrics, or some call it urodynamics at can help you make a diagnosis. And some of these changes may be reversed if you decrease or quit. On the other hand, damage to the actual muscles leading to pelvic floor anatomy problems, could be permanent. Yet there are so many solutions to not have to have a surgery or chronic therapy, one is to get the urgent PC overactive bladder treatment first.
If you can't stop, at least get your daughters to learn the dangers of smoking! Wet pants, ok if you just popped out of the pool, otherwise, not good for us!

Saturday, November 21, 2015

The Question is Can A Pigeon Read Your Mammogram Better Than a Computer

Animal behavior never ceases to amaze us, and here is a fascinating piece of gyno news! Pigeons can can find abnormalities a on mammogram.  Of course humans are still better at this task, and the humans needed to actually determine the response of the pigeon, so can we be sure it wasn't the researchers reading into the pigeon behavior. But we can always use a little help from our friends, especially the feathered ones who are willing to puzzle out mysteries!

Stress can prevent pregnancy

Nervous meaning "can I perform" can definitely impact conception. The alarms, bells, whistles, and sticks turning blue, signaling a woman's ovulation can be a fun game just so long. Then it gets to be a straidiscuss sources of stress with your gyno as there are ways she can help you.
n on the sexuality of many couples to the point that artificial insemination of partner's sperm may be necessary to just avoid the performance topic all together! We know that stress produces a variety of hormones that wreak havoc on our endocrine system. These stress hormones can produce derangement in the menstrual cycle, so affect ovulation, and derangement in our blood sugar and metabolism, affecting our weight, throw off our biological clock and affect sleep, so we always thought that there must be a link between cortisol levels and conception.In the late 1990s a research group in Australia looked at levels in epinephrine, norepinephrine and cortisol, and they really couldn't detect differences in those cycles that got pregnant, their study was published in Human Reproduction. But thinking differently one study looked at those having counseling vs those not and those having counseling had better infertility treatment success, so mindful ovulation worked for that small group! In a new study published in Fertility and Sterility looking at couples in Michigan and Texas there again was no difference in the levels of cortisol hormones in the groups who did get pregnant vs the the couples who didn't get pregnant. There was a group of women however that was more likely to conceive if their biomarker alfpha-amylase, measured in saliva, was the lowest. The researchers also found something a bit different about our biologic response to stress. Chronically stressed individuals won't think one day is different than another, but their body will produce stress molecules at a variable rate. And when those stress molecules were the lowest, then in fact there was physiological benefit for conception! Remember it's important to

Friday, November 20, 2015

Be Sure To Take Prenatal Vitamins: Especially if You Are Not Contracepting

Prenatal vitamins are important to begin before pregnancy. Many critical steps in fetal development occur before you even miss a period or get a positive pregnancy test, and its therefore important that you take these vitamins prior to pregnancy.  The two most common neural tube (NTDs) defects in the United State are spina bifida and anencephaly and approximately 4000 pregnancies each year are affected by these serious birth defects. Taking prenatal vitamins with folic acid supplementation prior to getting pregnant can reduce your child's chance of having these birth defect by over 70%, so take at lease 4 mg per day as the critical window of time is very early in pregnancy, in fact there are some creative ways to get the folic acid into your system. Gynos have been telling their patients to take folic acid, not just one dose, but daily, so a new way to get your folic acid in: taking birth control pills! The birth control pills Yasmin and Yaz have now added folic acid and thus become Safryal and Beyaz. It is mostly for birth defect prevention although there are some health benefits for adults. Folic acid and derivatives have been associated with lowering cardiovascular disease (CVD) risk in adults, we still caution use of OCs by those over 35 who smoke (not a candidate to take birth control pills), or in any women with pre-existing risk factors for strokes or other cardiovascular disease, just a bit of folic acid is not going to combat all woes for the adult female! But the extra folic acid is important for a potential developing pregnancy. Folic acid supplementation will also decrease the incidence of lip and palate abnormalities, as well as prevent fetal heart defects. And a new study published in the Feb 13th 2013 JAMA showed that there was an association of folic acid deficiency during pregnancy and higher rates of autism. The CDC has long recommended that women from 15 to 45 (the 'reproductive years') all be on folic acid supplementation, with or without pregnancy. And prenatal vitamins have the appropriate amount of folic acid, so it's a good way to get this into your system. Many organizations endorse the folic acid strategy for lowering birth defects.  American College of Obstetrics and Gynecology recommended periconceptual use of a multivitamin supplement containing 0.4 mg of folic acid. But as always we recommend gabbing with your gyno for specific instructions.

Monday, November 9, 2015

47% Of Pregnant Women Gain Too Much Weight In Pregnancy

Since a new CDC report looked at whether US pregnant women's weight gain and found too many women are not hitting recommended amounts, the question remains what should you do about it? The answer lies in a combination of recommendations. You need to start with your provider and get in mind the normal weight recommendations. The CDC article reviews them:Gain 28-40 if you are underweight, and 25-35 if normal weight, 15-25 if you are overweight and 11-20 if you begin pregnancy with a diagnosis of obesity. This is based on pre-pregnancy BMI. Then discuss with your provider: what is your metabolism really like: do you gain easily, have you recently been on a diet, are pregnancy nutrition requirements going to be difficult for you to eat as they are so different from your normal way of eating. Have you ever been a calorie counter? Did you have to recently give up smoking? Be realistic and discuss a plan with your birth provider so that you can tackle these issues together. For some it may mean pre-pregnancy weight loss. For the 47% it is especially difficult because many struggle with getting in enough exercise during pregnancy as the added demands of appointments and baby planning cut into an already limited schedule around work and family. Pregnancy patients tend to ignore their wrist energy expenditure calculators thinking that calorie counting and energy balance is for 'dieters'. But there are ways to realistically use these devices to track what intakes you need. Bring in your data, discuss when the weight gain should occur (many of the women studied
gain extra weight in the very first trimester) and gab about it with your gyno.

Sunday, November 1, 2015

A Pill for the Healthy to Prevent Being Sick

Yes, pills are used for many healthy individuals to fight off risk, sort of like taking a vitamin. Generally speaking we think of most wellness care as eating better, exercising more, not smoking, and getting better sleep as part of  'therapeutic lifestyle changes.' But that's not enough power to fight off all the ravages of aging, genetics, and environmental damage, so perhaps turning to medication is what is going to be the most effective.

The polypill is one good example of a pill for the healthy to prevent getting sick. It is directed at prevention of cardiovascular disease. And in the September 4th issue of JAMA 2013 it's back in the news, although almost two decades have passed in the efforts to get a polypill that will really work. The polypill was proposed over 10 years ago by Drs Wald and Law in a study in the British Medical Journal, when it was tested the medication included  three half dosage anti-hpertension agents, with other agents including a intermediate-dose statin, a low dose aspirin and folic acid. With the research that was done showing about 80% reduction in heart attacks and strokes in individuals over the age 55 and older.

Too long going to the doc meant getting treated while sick. And now we expect treatment so we do not get sick. Gynos were ahead of the curve in that. Gyno doc visits at least introduced, in a mass market kind of way, the idea of screening for sickness. Our first success with screening with the pap test, although no pill really treated an  abnormal pap, then we began the pregnancy screening concept dubbed prenatal care, but it was pretty much only focused on pre-eclampsia that very specialized version of  high blood pressure in pregnancy at the get go. However, still in the USA most doc visits are aimed at treating the sick, with a mere nod to the concept of staying well or making you a whole lot better.

A wellness visit for women actually focuses on screening for disease, and still needs just a bit of a tweak more to focus on actually making you better. Show up at a normal weight and no obvious medical condition, no one will ever question your diet. Have a low blood pressure at your check up, were you ever told how to keep it there? Probably you have been told your health care provider to avoid secondhand smoke, perhaps a quick reminder about seat belts, wearing sun screen and using condoms. All designed to prevent illness, not to make you “even healthier.” And my favorite be healthier advice best nod to keeping you healthy beyond just exercising,…encourage sex (yes, for adults sex can be extremely healthy). In gynecology we have long touted the non-contraceptive health benefits of taking oral contraceptives, it specifically suppresses both ovulation and the uterine lining tissue, raising the blood counts and improving bone density even in the healthiest of users.

But how about taking this one step further, requiring anyone without contraindications to take at least 10 or twenty years of oral contraceptives? This strategy has been estimated to eliminate 80% of all ovarian cancers. What we have wondered about is this treatment of a pill to prevent ovarian cancer limited to just specific groups of women, or could we get this being effective for many groups of women?

One  new case-control study compared 207 women with hereditary ovarian cancer and a BRCA1 or BRCA2 mutation to 161 of their sisters without ovarian cancer. Any past use of oral contraceptives was associated with a reduced rate of  ovarian cancer by half if the woman got her pills for at least 6 years. And in another study they looked at women who weren't known to have the risky genes but had family members with cancer, and yes, they were protected more than lower risk women. Other small studies confirm the findings across all types of oral contraceptive pills. Only one study in Israeli Jewish women who showed that average patients were protected, but not the ones with the known family risk. But it may have not been as revealing a study because those studied were such a unique group for many reasons. So giving a birth control pill for those healthy women is very effective. What other kinds of pills should the healthy take? And going even farther to ward off disease would be to use pills to ward off high blood pressure and heart disease all together. . Using a pill to treat the entire healthy population, to help ward off disease would indeed be rather radical. But something to Gab about with your Gyno!

Thursday, October 29, 2015

Estrogen and the Brain

Estrogen is a powerful brain hormone and a modulator of neuron signaling in the female brain. Estrogen is beneficial for thought, verbal expression, and verbal memory as well as a host of other brain benefits including the response to stress. The way estrogen may be beneficial on the brain has just begun to be understood. Estrogens are thought to be both neurotrophic, meaning they recruit neurons to a task and neuroprotective, meaning they help the brain cells function well and have longer lives. Estrogens both can affect the membranes of the brain cells as well as the more fundamental function of brain neurons as there are estrogen receptors that are deeper within brain cells. Estrogen similarly interacts with other brain chemicals to help affect these actual brain functions including the cholinergic system which results in effects of brain estrogen on verbal learning and attention.In fact, menopausal women can have better preservation of some brain function if they are treated with estrogen. How all this relates to the male brain is less well understood. The male hormone testosterone gets converted to estrogen, and thus some male brain function may be mediated by the female hormone not the male hormones! So in the future think twice before you use the phrases: think like a girl, or think like a guy!

Wednesday, October 28, 2015

The Uterus Produces Hormonal, Inflammatory, and Immune Molecules

Women think of their female hormones as just estrogen or progesterone; and as only coming from the ovary. We've long known that estrogen is produced at other sites in the body, so it's an over simplification to say that our only female hormones come from the ovary. Some women recognize that our hormones also include testosterone and other 'traditionally' thought of as male hormones, and again, mostly made by the ovaries in a female. Although the uterus doesn't produce any of these hormones, there are over 30 active molecules that produce what can be thought of as endocrine-like functions. The molecules produced by the uterus include lipids, like prostaglandins, cytokines, like tumor necrosis factors and interleukins, and many of the lesser known hormones such as prolactin, relaxin, renin, insulin-like molecules, and a wide variety of growth factors. These functions clearly affect the 'local' uterine activities such as the menstrual cycle and the function of the uterus as a womb when a woman is pregnant, but it's less clear what they do systemically, or what function they may deprive a woman of if she undergoes hysterectomy. Understanding the spectrum of molecules produced, their functions, and their control is one of the main frontiers of gynecologic research.

Tuesday, October 27, 2015

Moms Feed the Babies and The Babies Gift Back Cells To Mom

The role of the placenta is highly complex, and the wonders it works have just begun to be explored. While it is the obvious source of nutrients to the developing fetus, it acts like a conduit spreading fetal cells through the body into mom. It's the source of many health benefits, and perhaps some maternal challenges going forward. An article in in Science Daily explained the origin of the complex term, microchimerism, for the presence of fetal cells in a mom; and would technically cover maternal cells that, through placental passage, come to lodge in the child. We have always know we are more like our mothers than our fathers because the egg contains maternal material that we retain in most all the cells (and probably passed from prehistoric times). And though a pregnancy can take a toll on a mom, the fetal cells the baby infuses into her protect her in subtle ways late into life.Interesting to think about pregnancies that may not have gone to term, but have still left these cellular footprints.

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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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