Tuesday, September 1, 2015

How Heart Healthy Are You? Tally Your Score

In a new report that was just released from the Framingham Heart Study, Americans are often five or more years older in heart risk than their true age. They use blood pressure, treatment of hypertension, presence of diabetes, smoking, and BMI to calculate a theoretical heart age, and you can see what your heart age is. 
These factors are definitely powerful and actually take into account your cholesterol levels, and exercise as both will effect all of the factors they do use in their heart age calculator. However, other mitigating and adverse factors such as genetic propensity to clotting, hormonal factors, history of pregnancy, weight distribution, depression, and stress may affect these numbers significantly and are not taken into consideration. Once these numbers are calculated, you can receive therapies that potentially reverses the heart aging. If you need a recent BMI or blood pressure reading, come by Women's Health Practice and we can monitor patients easily!
If your Framingham Heart Study risk score is not where you would want it, then come in to gab about it, the fixes may be simpler than you think!

Monday, August 31, 2015

Managing Bleeding During Nexplanon Use

Long acting contraceptive (LARC) methods are staying in the news, and both the best and now, the  newest, contraception available for women. The CDC states that Nexplanon contraceptive is the best contraceptive with the fewest failures. The Nexplanon rod is a progesterone only method with a failure rate of 0.05%. It is used for three years and has etonogestrel as the hormone in the implanted rod. However, one in 10 users of Nexplanon will have bothersome irregular bleeding. In a new study by Colorado researchers they have discovered that giving 2 weeks of oral contraceptives can help stop the irregular bleeding, but it usually recurs after the medication is stopped. Other medications that show some positive effects on bleeding include mifepristone, estradiol, either given with or without also giving doxycycline. There are other side effects that may require management and see your gyno, however there is a site Bedsider.org women may find helpful. We suggest seeing your gyno for a reproductive life plan, and deciding what method is best for you to use depending upon your current plans for pregnancy and birth spacing
!

Sunday, August 30, 2015

Medication Decisions in Pregnancy Clarified, and Continually Updated

Many pregnant women have difficult decisions to make with regard to medications they need to use when pregnant. Medication dosage and effects often change with pregnancy, and there is the question of whether the medication will cross the placenta into the baby, and if so what effects that might cause. Rather than broad categories of risk, the FDA now recommends specific information be given about the known effects of medications in pregnancy and during lactation. A new FDA rule eliminated what used to be the "A,B,C,D,X" categorization. Now the drug descriptions will summarize the risks in humans, animals, and laboratory pharmacological studies during pregnancy. If the drug is not absorbed through the system, it will be labeled as such. Any known effects on breast tmilk, or effects in children will also be given. The labeling will also include when and if pregnancy testing should be done when on the medication. The new information in the label will include recommendations for males as well. The labels will also be updated as new information becomes available. Medications approved after 6/30/2005 will be updated first, older medications have a longer time to comply with the rules and we will see a phasing in of labels.

Saturday, August 29, 2015

Which Medication To Pick For Ovulation Induction: Clomid or Letrozole?

Clomiphene Citrate (most often given as the medication Clomid) and letrozole (the breast cancer treatment Femara) are both effective fertility treatment due to the stimulation of ovulation. This may be given to women who have menstrual cycles and have not yet conceived, or women who have no menstrual periods, even for those who have PCOS. About 60 to 75% of women who are infertile due to no menstrual periods will ovulate when given these relatively low cost medications. They both work by signaling there is low estrogen and thus more hormones are released to increase the number of eggs ovulated. Clomid is a SERM. Selective Estrogen Receptor Modulators (SERMs) could bind to the estrogen receptor to stimulate estrogen properties or to counter them. For fertility we make use of the fact that Clomid medication binds to the surface of cells the pituitary gland and thus pushes the hormonal factors to produce more growth of the follicle that will eventually produce a fertile egg. Because it is so safe and effective many physicians will use it very early on for infertility treatment, in the low dosage, for 1-6 cycles. Letrozole is an aromatase inhibitor, essentially blocking the production of estrogen and making estrogen levels transiently very low . It may be better than Clomid based on some recent studies at the University of Nottingham in Derby, England. Dr. Saad Amer who headed these studies also believed there were fewer fetal anomalies with letrozole than with clomifene, however the rates of birth defects were only slightly higher than the rates of birth defects in women who did not use these medications. When women take these medications potential side effects, other than the side effects of the medication administration, include twining, preterm birth, miscarriage, or tubal pregnancy. Some physicians use very close monitoring of the medications, but others merely recommend timing of sex with ovulation after taking an ovulation medicine. Patients should also discuss with their gyno the fact that Clomid is indicated for infertility treatment, and letrozole for this indication is considered off label.

Thursday, August 27, 2015

Ovarian Cancer Screening Update

Blood test for markers and risk factors for ovarian cancer have been combined to produce a better prediction model for women with ovarian cancer. The new test is called ROMA, and it is available through either LabCorp or Quest Diagnostics.
So if you have been diagnosed with a mass or cyst of the ovary, and are planning surgery, this test may help your gyno plan treatment and prognosis for your condition 

Tuesday, August 25, 2015

Just How Many Lactobacilli Do We Need In the Vagina

Control of yeast infections, and control of bacterial infections means that the healthy bacteria of the vagina have to be present. Women need a lot of Lactobacillus to have a healthy vaginal environment, approximately 1 million bacteria per mL of vaginal fluid! The Lactobacillus is present in much greater concentration than other 'good bacteria which are only present in a concentration of about 1000 bacteria per mL of vaginal fluid.We are currently enrolling a study of medication for vaginal infections. If you are interested, please call the Clinical Research Division of Women's Health Practice at 217-356-3736

Sunday, August 23, 2015

When Trying to Get Pregnant Both Mom and Dad Need to Stop Smoking

In the 1920s it was thought that 'normal' fertility for couples was 100%. Whether it is labeled 'normal' or 'common' we now know that infertility is present in about 10% of couples. and there are some simple fixes that can help couples conceive. If you want a baby, both of you need to put out the cigarettes. Smoking is the least recognized contribution to infertility. Smokers have at least double the rate of infertility based on getting pregnant within one year. About 1/3 of the population smokes. Oddly, recent studies of infertility shows that even passive smoking affects your ability to get pregnant. We have known for a long time that smokers go through an earlier menopause due to earlier depletion of all their viable eggs. This translates in to a 1-4 year earlier menopause. But we now know that baseline FSH (follicle stimulating hormone from the pituitary that elevates permanently
in menopausal women) rates creep up on smokers years before this and in fact the impact on ovulation and thus fertility sets in much earlier. No one has quite worked out if this is due to nicotine or the other products in cigarettes, but it is thought to be the other factors, so perhaps vaping wouldn’t cause as much effect. Sperm counts and parameters in the semen analysis are worse, but no studies actually have proven male infertility due to smoking. But for those with borderline counts, the evidence seems clear enough to at least stop smoking while trying to conceive. Studies of individual genes within sperm have also shown that smoking can cause individual gene damage in sperm. Once a woman is pregnant, smoking increases the chance of early miscarriage. And smokers have 20 times the risk of having a tubal pregnancy than non-smokers. For more information see the 2013 committee opinion of the American Society of Reproductive Medicine on the subject.

Saturday, August 22, 2015

'Morning After' Was Extended to "Mornings After"

For women who have inadequate protection for contraception, they should remember that emergency contraception is available, and effective up to 5 days after your unprotected episode of intercourse. The newest guidelines remind women that ulipristal acetate is both more effective and continues to be effective for up to 5 days after the last episode of intercourse. Copper IUD devices are actually the most effective method of morning after contraception. Pregnancy testing, and examinations for pregnancy do not have to be done before using a method of emergency contraception if used within the guidelines discussed. Although effectiveness is up to 5 "mornings" after, the sooner you take your medication the more likely it is thought to be successful. There are very few medical contraindications to these morning after medications, but as with all medical care, it is ideal to discuss with your own provider to make sure you don't have any special considerations before using medication.

Tuesday, August 18, 2015

What Works For Painful Sex?

Most painful sex is due to the Genitourinary syndrome of menopause, and we now have many strategies that work for this condition. Estrogen works to treat the vaginal changes that occur in menopause. For some women there are only minor symptoms, perhaps dryness, change in odor, or change in discharge. Other women from this syndrome have bladder symptoms, recurrent urinary tract infections, stress incontinence, painful sex, irritating dryness, external symptoms, or itching. Women who have these symptoms in menopause, and now is more accurately called genitourinary syndrome (GUSM) of menopause.  It is commonly caused by the lack of estrogen as women age, and then secondarily this the thinning and deterioration of the surface layers of the vaginal walls, the vulva, the urethra, even the anal region due to these menopausal changes. For the most part your gyno can tell by an examination but are even pap tests to determine if this is the diagnosis, although your gyno can usually dignose with out this test. Sometimes cultures for infection, or microscopic evaluation of the tissue has to be done. Rarely biopsies have to be done to make sure we are treating what we think we are treating.

In the past only topical estrogen products were offered. Mow even non-medical CO2 fractional virtually painless office laser procedures have been gaining in popularity. They require 3 treatments 6 weeks apart, with almost 50% improvement after the first treatment. Over 90% of women will have almost complete relief of painful sex with this non-invasive therapy. MonaLisaTouch.

Generally gynos have recommended nonhormonal moisturizers if you have mild symptoms, and estrogen therapy as the treatment of choice for this condition,  and now we have the new painful sex treatment ospemifene. Ospemifene is a  selective estrogen receptor modulator that makes vaginal tissue thicker and less fragile, resulting in a reduction in the amount of pain women experience with sexual intercourse. Although gynos estimate that virtually all women remaining sexually active into their post menopausal years will have this complaint if not treated by hormone therapy, over half never even bring it up at a medical visit. Because the molecule has beneficial effects on the bone and potentially anti-estrogenic effects on the breast your gyno will be able to determine if this is the best for you given risks of medication as well. Of women with genitourinary syndrome in menopause so a great number of women stand to benefit by considering therapy.

Before therapy you need some evaluation: do you have an infection of the vagina, a bladder infection, or perhaps badder dysfunction that can be detected by urodynamics.  Vaginal estrogen treatments are effective for all of the issues that occur with this syndrome. The doses of estrogen given do not cause estrogen blood levels to differ from women without the vaginal estrogen treatment. Women need to be treated with oral medication for about 3 months for full effectiveness, and there is a warning that the medication can cause thickening of the lining of the uterus which would need to be evaluated. Women experiencing unusual vaginal discharge or bleeding need to see their gyno to see if they have this complication.The boxed warning for ospemifene also states the incidence rates of thrombotic and hemorrhagic strokes (0.72 and 1.45 per 1000 women, respectively) and the incidence rate of deep vein thrombosis (1.45 per 1000 women)."These rates are considered to represent low risks in contrast to the increased risks of stroke and deep vein thrombosis seen with estrogen-alone therapy," the FDA said. Minor side effects can include hot flashes or vaginal discharge.

Making the decision as to whether to take a systemic therapy or to use estrogen therapy is a complex one. Most women will try simple therapies first and do have to consider risks and benefits of alternatives.  Recent web articles have focused on the negative aspects of this therapy, implying that this risk is greater than other therapies.. These articles not only focus on potential risks, but clearly doesn't list percentages of these risks, nor does it do a good job of addressing benefits and or does it do a good job of discussing alternatives and their risks and benefits. As first line in the discussion with your gyno figure out if you indeed need treatment at all. Most women who take therapy are sexually active, but if you aren't and you plan to be, you are still a candidate for treatment. Osphena as a SERM (selective Estrogen Receptor Modulator) has potential benefits on breast tissue and bones. Find out if you have a baseline risk for for blood clots.  All the clinical trials were done without a progesterone, and the risks were very low of lining changes to the uterus. Some physicians may decide to put you on progesterone therapy if you are on Osphena. Even off hormones entirely women have a baseline risk of endometrial cancer. Estrogen therapy used locally is thought to be safer than systemic therapy,for atrophic changes of the vagina and vulva, yet it does have the same package insert risks listed in terms of blood clots and lining changes of the uterus, and thus it's a decision as to which will be best for an individual woman.. 






Friday, August 14, 2015

When Recurrent Yeast Infections Are Really Something Else

Vaginitis is the official term for vaginal infections, and there are many causes, but most are due to yeast, bacterial vaginosis or trichomoniasis. Most of these conditions are straight forward, easy for your gyno to diagnose, and they resolve promptly. On the other hand, there are those who seem to pop up with one infection after another and either fail to find a cause or a treatment, and this was the subject of a review in the December issue of Obstetrics & Gynecology.
The 5 mosst common Diagnoses were actually
1. Contact dermatitis
2. Actual chronic yeast
3. Atrophic Vaginitis
4. Vestibulodynia
5. Physiologic Discharge

First an accurate diagnosis is important as overuse of antibiotics is unhealthy. And won't be effective for conditions such as atrophic vaginitis which could be treated non-medically with CO2 fractional therapy called MonaLisa Touch. If you have struggled with what you think are chronic yeast infections  the authors wanted women to know than normal discharge, contact dermatitis, atrophic vatinitis. and vestibulodynia were often a few causes that women had not considered. One in 20 women with a yeast infection will develop chronic and recurrent infections. Gynos define recurrent and chronic as more than 4 a year. Most yeast infections are due to pesky and pervasive Candida albicans. Some experts say albicans are 95% of those infections we see, others knock that percentage down to only 75%. And random healthy women sampling find that 25% of those women walking into any office at any time will culture positive for yeast. If you try to self diagnose, you’re probably right somewhere between 1/3 and 50% of the time.

So if your symptoms don’t resolve promptly with your goo of choice, inaccurate diagnosis can be the culprit as often as inaccurate treatment. And the first test that may be helpful is the pH test. If the pH is elevated your gyno will think about of other causes: even the presence of semen! It is also possible that hormone levels and cycles are related to the numbers of infections. Women are more likely to get yeast infections in the second half of the menstrual cycle, when estrogen is lower, and progesterone is more dominant. Douching, more a cosmetic than a health practice, doesn’t cause yeast infections. In some studies receptive oral sex causes more yeast infections, and in some studies not, but few studies really culture the partner’s mouths! You can’t always eat your way to a clean vagina either. Dairy diets really haven’t changed the rate of yeast infection in most women. For more information, see us for a gyno check at Women’s HealthPractice. a few new options you may want to consider: probiotic medication and a new antibiotic medication. It is good news for these patients as they typically try many medications and the good news is that they have brought back a sulfonamide cream for chronic yeast.

Thursday, August 6, 2015

Babies are as Excited to Be Born as We Are to See Them!

Healthy baby being born at term, by C-section.

Wednesday, August 5, 2015

The Later You Cross Into Menopause, the Longer You Will Live

There is something about the number of fertile years, and how you use those fertile years that predicts how long you are going to live. If you have a baby later in life, over the age of 33, you are more likely to live long. The later you have your last period prior to menopause, the more total duration of estrogen and this too predicts a longer life, as reported in an article in Menopause Volume 22, No.1, 2015. We used to think that the final menstrual period was genetically programmed, now we know that may not be completely true. Stress, nutrition, life style factors (smoking), all impact on the last menstrual period. So you can improve your longevity, by preserving both your fertility and your ovarian function through healthy living!

Tuesday, August 4, 2015

Educational Event: Introducing MonaLisa Touch and PRP Therapy For Women at Women's Health Practice Auguest 5th, 2015 from 3;30 to 7:30

Women's Health Practice, 2125 South Neil Street, Champaign, Illinois, Bring Sexy Back. Educational Event, Eduction on MonaLisa Touch and PRP therapies, Refreshments, 217-356-3736. Promotional Pricing of Newest Therapies.

Monday, August 3, 2015

Although Numbing Pain Works For Painful Sex, MonaLisa Touch Therapy Can Heal the Cause of the Pain



Painful sex in breast cancer patients is due to the effects of severe lack of estrogen that causes significant vaginal aging and thinning. In many breast cancer patients the effects of low estrogen at the time of menopause compounds the low estrogen effect. If the area is not treated sex becomes impossible. At Women’s Health Practice weadvocate therapy in breast cancer patients to regenerate the lining without havingto use hormones. In the treatments such as with MonaLisa Touch, a non-invasive therapy that treats the source of pain and heals the tissues. In a new study it was discovered that topical liquid lidocaine gel with the use of a lubricant can treat pain with an episode of sex in about 95% of the patients who participated. The study was led by Martha F. Goetsch, MD, MPH, from Oregon Health & Science University in Portland, note. Her study results were presented in 2014 at the annual meetings of the American Congress of Obstetricians and Gynecologists and the North American Menopause Society, as reported by Medscape Medical News. And now their conclusions results were published online July 27 2015 in the Journal of Clinical Oncology. In their study the vaginal cells did not change, the actual tissue atrophy, and the vaginal pH did not change. MonaLisa Touch therapy actually can improve all these parameters with the fractional laser therapy. The lidocaine numbing can treat the pain of penetration sex and the pain of the friction and potential tearing of tissues during sex. The researchers and patients felt this was important as this is something that can be used to prevent pain in episodes of intercourse before other therapies have had a chance to work, or in patients considering other therapies. The research on the lidocaine treatment is considered even more effective if it is combined with estrogen treatment. And in fact it would be a potential benefit in combination with the MonaLisa Touch Therapy as well.

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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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