Thursday, July 2, 2015

Testosterone, Estrogen, B12, Thyroid? You Need All To Improve Brain Function


Your memory as good as it should be? Think it's also a hormonal issue? Our brain chemistry values do flop around during the menstrual cycle. And dramatic changes in our brain functions including memory have been associated with menopause.  Want to test your brain power? How do you do it? That is a whole science in and of itself, but gynos are given a few clues. I can tell you that obvious road blocks still hold: did you get a good night sleep before your test, did someone just text you before your test, do you care about the test? These things all being optimal for you will help you perform better. And then again, you can study for these tests! You may have trained for a specific type of memory test, for instance,  some puzzle players might do best on the “Finding As” test…you quickly cross out all the words with a as possible. There are memorization tests which test recall of short or longer lists of mundane items. There are tests that favor the visual and the artistic of us, asking that you recreated a line drawing from memory.Did you know your B12 levels and your thyroid levels will affect your memory. So can medications, watch out this flu season for cold medications, antihistamines can throw off your memory as well as your blood pressure! Hormones and your memory is also important if you have recently had your ovaries removed. According to some research you have a better memory if you begin hormones soon enough. After years into menopause though, it's hard to show that estrogens have any different effect than no treatment with estrogen as age has such a powerful influence, but it may be that hormones can affect Alzheimer's as well.Testosterone therapy helps with verbal fluency and even improves spacial and visual tasks as well as reported in a study by Davis from Melbourne Australia in her 2014 study.

Tuesday, June 30, 2015

How to Treat BV Infections

Bacterial Vaginosis (BV) infections can be treated with either oral or vaginal metronidazole, oral or vaginal clindamycin, or oral tinidazole. All are only available by perscription. However, ultimately the cure is establishing the normal healthy vaginal environment. A healthy environment is really due to normal pH and normal numbers of the good bacteria. Various ways of restoring the pH are possible without antibiotic use. Both the use of Osphena and estrogen might be able to restore pH in menopausal women. However in both premenopausal wen and menopausal women the MonaLisa Touch treatment can do this without medications at all. 

Thursday, June 25, 2015

Shop for Causes

Are you wanting to donate to breast cancer research or another cause, there are many options on line and Goodsearch is one.

Tuesday, June 23, 2015

Are You on the Right Birth Control Pill, or Should You Switch?

How we select a pill for a patient to start on, and how we select the pill you should continue on is a very complicated topic. Choosing the right pill for you, however, has certain key elements. Virtually all oral contraceptives have been thought to have  identical effectiveness. If you take the pills faithfully, ovulation is suppressed, and failure rates are quite rare. Based on published data, about 2-3 women out of a hundred taking the pill for a year will become pregnant. Pills from the 70s and 80s that have published rates of only 1 person in a hundred getting pregnant is based on old studies. We have had a bit of pregnancy rate drift in the past few years, and women today have higher pregnancy rates than we used to in the past (obesity?). So, in truth gynos don’t assign pills based on effectiveness, they will all work for you! Since the 1970s safety has driven most of the dosing and type of hormone changes in the pill, and safety is always the first concern. Again, all birth control pills are extraordinarily safe and few women cannot take OCs. But safety is enhanced by selecting the lower doses. Non-contraceptive benefits should now drive many pill decisions for you and your gyno. One of the first concerns is cycle control, and control of menstrual cramps. Another important concern is PCOS effects. Another important concern is prevention of gynecologic cancers and ovarian cysts. Prevention and treatment of endometriosis. A new concern is one for bone health, as we have had lower dosages of the pill, we may need to think in terms of slightly higher doses for some young teens as they are accruing bone mass. Are you suffering from PMS, acne or heavy bleeding? These medical concerns can be addressed by selecting the right pill for you. Side effects are our second concern. If you don’t like the pills you are taking you won’t stay on them, and you may be at risk for unplanned pregnancy. Side effects can also be managed, and pill switching is sometimes necessary.Time to come in and discuss with your gyno.

Friday, June 19, 2015

Monday, June 15, 2015

Stopping Hormone Therapy Has More Potential Side Effects Than Resurgance of Hot Flashes

Many women are being under treated for hot flashes according to the North American Menopause Society. As a result of no treatment, inadequate treatment, and treatment discontinued earlier than it should be women are suffering from a variety of health effects, including depression. According to the May 27 JAMA Psychiatry online report depression can recur when postmenopausal women discontinue their estrogen therapy, according to results from a randomized clinical trial.
"Some women are at risk for developing depression after hormone therapy (HT) discontinuation, and the presence of a past depression during perimenopause increases that individual risk," Dr. Peter J. Schmidt, from the National Institute of Mental Health, Bethesda, Maryland,was quoted to say in a Medscape report. The numbers of women suffering just because of inadequate hormone therapy is not known. But if you are experiencing hot flashes or other menopausal symptoms in menopause, please see your health care provider to help decide if any treatment is indicated.
The risk of depression increases up to three-fold in women going through menopause, and it is very important to not let clinical depression go without treatment.

Sunday, June 14, 2015

Is Exercise Making Your Breasts Sag, Your Joints Ache, Your Bones Weaken?

It's tough to know how exercise is going to translate into health for all your body parts, and ultimately end up with the right weight reduction and body shaping while maintaining healthy bones, breasts and waist. Both are possible, but some fine tuning may be necessary. Your physician's exercise goal for you is to maintain enough exercise to be vigorous, have better cardiovascular health, to lessen risks of strokes and blood clots, to think better, to sleep, to have better sex, to feel better, keep your weight in the healthiest range it can be, and finally perhaps to look better! While all those benefits can be obtained, for long term sustaining of those benefits you have to look at exactly the relationship between exercise and nutrition to realize the weight loss and body shaping benefits.

1. Breast health with exercise means wear enough support to prevent jostling, and enough padding to prevent bruising.

2. Weight loss is not going to be possible if you balance that extra energy expenditure against calorie intake because you are hungrier. Are you eating more just because you exercise? Watch those hidden calories when cooking, shopping or snacking. For those trying to lose weight, you still have to cut your calories when you exercise unless you dramatically increase your exercise.

3. Bone health can be tricky, diets heavily leaning towards severe calorie restrictions and too much protein have been associated with bone losses of up to 10%, that may be difficult to regain if you have to keep your calories low. Get a consultation, sometimes bone turnover can be determined with testing.

4. Some overall weight changes can have to do with the body composition. Fat weighs less than muscle, and if you are not losing on the scale, but your clothing is fitting better you can possibly be gaining muscle faster than you are loosing fat. You can miss estimate how much body fat you have if you are just judging by your look, or your outfits or even with over the counter pinch tests. Only accurate measurements of your fat and muscle mass will tell you that, and if you go by the scale or inaccurate measurements you may have been just plain dehydrated when you weighed?

5. Are you improving your body composition? The type of exercise you do will affect if you are actually able to make the changes mentioned above, so you may have to switch up the routine.

6. Are you body shaping, when it comes to the last few pounds Coolsculpting may help achieve six-pack definition and slimmer thighs if genetically you always keep a few pounds there.

7.. Do you ever switch up your exercise routine so that your getting the most benefit, like everything else, once we get used to a routine we probably are able to accomplish it more efficiently, but in this case efficiently means with fewer calories being burned.

8.. Weight loss is difficult through exercise alone as we just mentioned. Many people overestimate calories burned during exercise and underestimate their calories consumed. Weight loss comes down to burning more calories than you consume. One pound of fat contains 3500 calories for some, but 4000 calories for others . To loose one pound, one must burn 3500 (4000) more calories than consumed. That means cutting at least 500 calories per day to loose one pound per week. Be patient! If weight loss is your goal, recognize the weight loss probably won’t come off with exercise alone. Try keeping a food diary to keep track of what goes in, it may surprise you!

9. Running can be hard on joints especially knees. Make sure you have good technique with a smooth gait, proper shoes with a good sole, and during the day good posture,

10. Use measurements as much as the scale. Healthy weight means healthy waist to hip ratios. We all know that muscle weighs more than fat. Even though the scale may show a higher number, building muscle increases metabolism, so you burn more calories throughout the day. If you would like to see more results with weight loss, continue strengthening exercises to build muscle while increasing your aerobic exercise to burn more calories.

11. Resistance training alone will not firm underarms but there are treatments that can work such as the PelleFirm Body Treatment at Hada Cosmetic Medicine.

 12. We can not measure the success of our exercise program through the results seen on the bathroom scales. Don’t let the scale dictate how good you feel about exercising. If you are looking for additional measurements of success, ask you doctor about testing body fat composition, as well as blood pressure, blood sugar, your cholesterol, and your pulse rate. You may have lots of health benefits of exercise beyond your bathroom scale. You may be gaining weight but decreasing fat! You therefore may also measure your success in inches lost. Don’t be too hard on yourself and stay objective about the changes in your body and the benefits exercising has on your bone density, cardiovascular system, mood, and body composition.

13. Our bodies become more efficient at a particular activity the more we do it. This may mean the same activity will burn fewer calories after your body has adapted to it. Try switching up your routine to continue gain fitness, loose weight, and keep your exercise regimen fun.

14. Guidelines vary the 2008 Federal Guidelines for exercise is at least 150 minutes a week of moderate-intensity aerobic physical activity. The Institute of Medicine suggests 60 minutes a day which is 420 minutes per week of moderate-intensity activity is the only way to prevent obesity! Harvard School of Medicine broke the tie with a 2010 JAMA publication stating that while the Feds are on the right track to prevent chronic diseases, ,the IOM guidelines were best for weight control.

Saturday, June 13, 2015

Non-Hormonal Vaginal Health Treatment: It's A Shocker


Non-hormonal vaginal health is the current buzz word. While estrogen therapy is fast, effective and safe for vaginal health through perimenopause and menopause, and the SERM Osphena appealing because of the benefits beyond vaginal health, it's the alternatives that are gaining traction current. The most shocking news yet is the finding that SSRI treatment can be beneficial for vaginal health. Since the introduction of Prozac, a medication that alters serotonin for the treatment of depression, there has been an expansion of the use of all of serotonin modulators for the treatment of a variety of conditions including sexual function, smoking cessation, and pain syndromes. When used in a study of hot flash treatment it was found that a short eight week course venlafaxine improved the vaginal dryness and pain of intercourse of sex and that it was even better than low dosage estrogen in this trial. Just improving mood and having more sex is also beneficial for vaginal health, so do not discount that fact.  In other studies using the similar medications of sertraline, paroxetine and escitalopram in the dosages for hot flashes sexual function was not negatively affected. But, for the most part these medications have not been studied in a rigorous way for their effects on the various components of sexual function. But serotonin reuptake inhibitors are known to be effective for various pain syndromes and we do have serotonin receptors through the body, including in the genital tissues. So treatment with these compounds for menopausal symptoms may the newest way to improve vaginal dryness, but there are still substantial numbers of women who prefer non-medication treatments. For this group, MonaLisa Touch vaginal rejuvenation is the best option.

Wednesday, June 10, 2015

New Types of HPV Tests and Why to Have Them

The high risk kind of human papillomavirus (HPV) are associated with 90-100% of cervical cancers and over 90% of anal cancers. We know that testing the anal region may be as important as testing the cervix and the vagina, but who and when to test is a very complex subject, and this post won't cover everything you will need to gab with your own gyno about.  Guidelines can be found in many organizations on line, such as the US Preventative Task Force, or the ASCCP. a question that comes up frequently is what about the "field effect" (the urethra, the clitoris, the anus, as well as the cervix and vagina and vulva) of the disease? Do you need actual pap tests of areas other than the cervix? USPT guidelines do recommend anal pap tests for HIV men who have sex with men, and for HIV women with prior cervical caner. The anal pap smears often will not get cells (about 13% of the time accordin to Dr Lamme et al in Obstetrics and Gynecology), so it may have to be repeated.  How about HPV tests of these areas? Almost two thirds of women will have a positive HPV test of this area if they have cervical HPV disease, but exactly what to do if that test is positive. HPV tests may be more sensitive in screening for disease that has spread from it's initial place, but we do not know this yet, much work needs to be done. Women will ask if they have not ever had anal sex is it possible to get anal HPV disease, and the answer is that yes, it seems to be possible because the disease affects the epithelium (surface) tissues of the entire area, and probably can be passed by touching. When we do studies and pap test the cervix and the anal region about half the patients who do test positive for anal HPV and cervical HPV will have disease with the same time of HPV type in both places according to the March 2011 issue of the Female Patient . It is not clear who should yet have this pap smear test of the anal area, and a new journal article points out how common anal infection is in women with cervical disease. Their study showed that those at risk of developing cervical cancer, women with high-grade cervical dysplasia may have an elevated risk of anal cancer," lead author Jacqueline Lammé, MD, from the Department of Obstetrics Gynecology, Naval Medical Center, San Diego, California, and colleagues write in an article published in the August issue of Obstetrics &; Gynecology. Women with persistent rectal , like itching might benefit, by a test for anal pap or anal HPV as well as some other tests, but generally we think of HPV is a disease without symptoms.While itching may be a simple hemorrhoid or irritation it is important to see your gyno to be evaluated.

Tuesday, June 9, 2015

New STD Testing Recommendations From the CDC

The CDC just updated guidelines on STD testing. Gynos are the ideal provider to help sit you down and discuss STD's and to help you plan testing, retesting, and treatment. In some cases we treat women who are known to have had a high risk exposure. In other cases we recommend preventions, such as vaccines, condoms, and spermicide. Your age, your overall health, and specifically your vaginal health could put you at risk for contracting STDs, and at risk for worse complications from an STD that you do contract. The guidelines were very detailed and contain many recommendations covering situations of those who have the most risk, usually stemming from the women who have sex with multiple partners or many lifetime partners. One caveat about the new STD guidelines, they specifically address pap smear testing that may not go along with the plan your gyno has for you specifically. Risk assessment discussions are also a reason to continue annual visits with your gyno.


Monday, June 8, 2015

Your Annual Menopausal Health Visit May Benefit From a Different Type of Pap Smear

Gynos are reminding women that yearly visits for menopausal health are still recommended although the content of those visits has changed. Women who are low risk for cervical cancer may be eligible for less frequent cervical pap smears than every year. Women post hysterectomy, no longer need cervical screening, but if they are at risk they may need cancer tests of the vagina. A test for the health of the vaginal wall, the Vaginal Maturation Index Pap tests can also be used to judge your vaginal sexual health. This is the test is abbreviated as the Maturation Index. A Maturation Index is not a cancer test, but it is a type of pap smear that doesn't report out cancer or precancerous changes, but specifically reports on the percentage of healthy superficial cells the walls of the vagina. The Maturation Index is performed by using a swab and placing it in fluid.  It is an analysis of the vaginal wall cells from epithelial layer of the vagina. 100 cells are evaluated and the proportion of the parabasal cells (the lower most layer that sits on the top of what is called the basement membrane), the intermediate and the superficial cells. Prior to menopause, if you have a normal healthy vaginal wall you will have somewhere between 40-70/100 intermediate cells and about 40-60/100 superficial cells, and essentially no parabasal cells. If you have early menopause, and a bit of estrogen, you may start having some parabasal cells when your matOsphena exerts and estrogen like effect on the tissue and is effective at normalizing the maturation index. The MonaLisa and Femilift vaginal CO2 therapies also have been shown in biopsies to be able to normalize the vaginal maturation index. Women who are responding well to estrogen therapy for vaginal problems in menopause should have the healthy maturation index of a young women. If your symptoms are persistent, and your maturation index has not improved, considering what therapy would work for your maximum effectiveness.
uration index is evaluated. Once women are fully in menopause, and the vaginal walls become atrophic, thin and dry, the test can confirm that this is indeed the physiologic changes of menopause and a women may have as many as 65/100 cells as parapaasal cells, and only 5/100 superficial cells. Medical therapy, and sexual activity improve the Maturation Index results. The traditional therapy has been hormonal. Coconut oil and other soothing vaginal treatments do not fundamentally improve the tissue.

Sunday, May 24, 2015

Objectively Speaking How is Your Sex Life?

Judging sexual health is a complex topic. If you think you're happy, essentially your gyno will think you are happy as well. But if your gyno wants answers to just how happy you are with your sex life she is going to want facts. One simple ways that a gyno measures your sexual function is the questionnaire developed study with Raymond Rosen, Ph.D. at Robert Wood Johnson Medical School as the lead investigator. And what they developed was a simple set of questions about some of the most important aspects of your sex life  desire, arousal, lubrication, orgasm, satisfaction and pain and it's available on line as the FSFI . If you would like to take the quiz,you can do that and if you'd like to improve these aspects, it may be time to gab with your gyno as there are many new therapies available, including creams for orgasms, new vaginal treatments including DHEA creams, non-hormonal safe vaginal rejuvenation, and no reason to not bring up sex for discussion!


Saturday, May 23, 2015

G spot? G region? New Therapies to Improve Sex Take This Into Consideration



Women universally will state the act of being loved, being hugged, and engaging in all types of cuddling and hugging is the pinnacle of sex and that actual orgasm itself, a nice culmination; but oddly not the ultimate joy in the bedroom. The master scientists of sex have ‘come around’ to that which women knew for centuries libido and orgasmic medical issues as one entity with a common physiology. Improving your desire for sex, improves the arousal, improves the bliss of sex, and improves the orgasm. Improving orgasms can improve the desire for sex.  First of all very few women will never have had an orgasm, but if you do not have orgasms, check with your gyno to see if there is a treatable condition. If you are determined that you do not have anything medically wrong, there may be various treatments. One has been the PRP treatment of the clitoral area, one is improvement of the vaginal tissue, and the other is treatment of the G spot also termed the g area or g region. This area can be improved with PRP treatment. The vaginal walls can also be rejuvenated with fractional CO2 laser therapy.

Friday, May 22, 2015

Fixing Labial Fusion

Surgery for labial fusion can correct cases not cured by traditional therapy
Traditional therapy has been estrogen treatment, but surgery can correct the severe form of labial fusion to restore normal anatomy. In this case the fusion was interfering with urination so the patient had chronic vaginal infections. There is evidence that proper vaginal therapy, and restoration of normal vulvar and vaginal mucosa can prevent the anatomic changes seen in this patient below from ever occurring.
When estrogen gets low and untreated labial fusion can occur, often estrogen therapy alone is not enough to fix this condition

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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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