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Menopause: Making Peace With Change

Sunday, October 16, 2016

B12 Shots and Your Skin and Other Health Conditions

Vitamins and our nutrition is one of the most important components of glowing and healthy skin. Your skin treatments will always be more effective if you have proper diet. About 40% of adults over the age of 60 and about 30% of adults under the age of 30 will be deficient in B12. Generally speaking: if you are healthy and eat a varied and balanced diet you will have the nutrients you need. But over time, and with dietary issues, imbalances may occur and you may nee testing to see where your deficiencies really are. At Women's Health Practice many vitamin levels can be tested, but testing for B vitamin deficiencies can be helpful in planning diet changes and the need for supplements. Even those who aren't deficient may benefit from a boost of certain  trace minerals and B vitamins and B12 has been used for a variety of treatments including for fatigue and lack of recovery from normal fitness and daily activities.. B12 only comes from animal products: meat and dairy. Vegans are most susceptible to B12 deficiencies and need supplements to avoid the special types of anemia that is due to B12 deficiency. Classically it is thought that most of the deficiency symptoms from B12 are neurological, but there are cases of people going prematurely grey from deficiency as well. A clinical study from the Department of Clinical and Experimental Medicine, Gastroenterology Unit, University of Naples "Federico II" in Italy, and colleagues report their findings in a study published online  in Gut, has discovered that actually treating with B12 helps viral treatments against Hepatitis C. For those with chroni infections of other sorts, including chronic vaginal infections, B12 treatments can help as well. Others are trying these shots to help those suffering from an acute case of herpes, thinking that the same viral boosting fighting power may work for this too. So it's something that could be tried for cold sores and post laser treatment for those who always break out in a herpes infection after skin therapies.

Sunday, October 9, 2016

Ovarian Function After Hysterectomy.:The Test That Can Tell You About The Health Of Your Ovaries

In the newest study of how healthy a woman's ovaries are after hysterectomy concluded that hysterectomy may lead to ovarian damage. The PROOF study showed that they could use the test AMH to determine this, it is a blood test and can help watch your hormone balance over time. . Removal of the ovaries at the time of hysterectomy for a woman who is still ovulating puts a woman at risk for certain diseases, but very importantly it reduces her risk of ovarian cancer by about 98%. It has also 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. All of these diseases add up to much more risk for a woman when she loses her ovaries, even if the remaining ovaries are not as healthy as they were prior to the hysterectomy surgery. . 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. Only about 7% of women take hormone therapy, even those who go through what is a premature surgical menopause. The most common age for a hysterectomy is age 40-45. The natural age of menopause is 51.4 so the average woman who has a hysterectomy with her ovaries taken out loses a decade of ovarian function.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 ovulation, 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.
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

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

Saturday, October 8, 2016

Weight Loss Medications Compared

There are 5 FDA approved weight loss medications: orlistat, lorcaserin, naltrexone-buproprion, phnterimine-topiramate and liraglutide. There are not many research trials comparing these medications. In the June 2016 JAMA issue the medications were compared. The research trials are difficult to do because close to 40% of patients drop out, and thus it's very difficult to apply the groups to an individual patient. At Women's Health Practice we have many patients who have lost in the 30-80 pound range, and some have accomplished their weight loss in 6 months. Although individual patients can lose significant amounts of weight more than what is reported in these studies, as a group most research trials show that these medications help women, average age of 45, lose about 5% of weight over 52 weeks of weight management plan. The process is a slow and laborious, as many individuals need to lose significantly more than that to achieve a heart healthy weight.. However, this pace of weight loss is achievable for a wide range of patients on a wide range of meal plans. Realistically patients on this pace of dieting also are able to celebrate holidays without the set backs that might occur with other types of weight loss. Studies that also include other weight management strategies such as adding metformin or statins or that address hormonal issues such as PCOS can achieve even more success. The placebo group only has about 23% of patients losing at least 5% at the one year mark, where as medication use is associated with at least 75% of patients losing at least 5%. None of these studies have included a group that used CoolSculpting or Kybella treatments to enhance weight loss efforts, which is another strategy those watching their weight can utilize.

Tuesday, October 4, 2016

Gardasil Gets An UpGrade: More HPV Prevention

We may be one step closer to our dream of eliminating cervical cancer. On  the US Food and Drug Administration (FDA) in December of 2015 approved Gardasil 9, a human papillomavirus (HPV) vaccine from Merck that prevents cancers and other lesions caused by nine HPV types, five more than the original Gardasil protected against. There is virtually 100% protection of the HPV type you get in a vaccine if you have not yet been exposed to that vaccine. The first vaccine protected against
 HPV types 6, 11, 16, and 18. Gardasil 9 covers these as well as types 31, 33, 45, 52, and 58. These latter five are currently responsible for roughly one in five cases of cervical cancer. In the earlier vaccine there was some cross protection of other viruses, and since there are 14 HR types of HPV we can project some cross protection there as well. Gardasil is indicated  for girls and boys ages 9-26. Gardasil 9 is given on the same schedule. There is no indication to repeat Gardasil if you have had the earliest version of the shot. And the risks are both low, and unchanged from the first Gardasil vaccination.
As per Medscape web site Gardasil 9 is indicated in females aged nine through 26 years for the prevention of:
  • Cervical, vulvar, vaginal, and anal cancer caused by HPV types 16, 18, 31, 33, 45, 52, and 58
  • Genital warts caused by types 6 and 11
  • Various precancerous or dysplastic lesions of the cervix, vulva, vagina, and anus caused by types 6, 11, 16, 18, 31, 33, 45, 52, and 58
It is also indicated in males aged nine through 15 years for:
  • Anal cancer caused by types 16, 18, 31, 33, 45, 52, and 58
  • Genital warts caused by types 6 and 11
  • Anal intraepithelial neoplasia grades 1, 2, and 3 caused by types 6, 11, 16, 18, 31, 33, 45, 52, and 58.

More information on today's decision is available on the CDC or the  FDA's website .

Thursday, September 29, 2016

Ovarian Cancer Detection Concerns By the FDA

Women and their providers are warned that ovarian cancer screening is not simple, not very accurate yet, and should never replace continued vigilance with respect to symptoms. Ovarian cancer is the quiet cancer: subtle signs are often present and can bring a case to detection. Women who have screening for ovarian cancer are warned by the FDA that there are some tests with false claims and the tests should not be overly interpreted. At Women's Health Practice we want our patients to know that there are ways to prevent ovarian cancer, and for those at risk, we encourage medical discussion to see if in fact you are doing all you can to prevent ovarian cancer. There are still women who can benefit by screening, and evaluating your screening process as new information becomes available is important.

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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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