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Menopausal Hormone Therapy: Understanding 'FDA-Approved' vs 'Bio-Identical' Hormone Options

Confused about Menopausal Hormone Replacement Therapy? Let's discuss the differences in FDA-Approved versus Bio-Identical Hormones...


I often use analogies when explaining concepts with patients in the office.  Though the issue of Menopause/Hormone Replacement Therapy (HRT)  is a complex one,  with many different considerations…We have to start somewhere in grasping the array of options.  Here’s my bit.  In my analogy we’ll start with 3 options:

1) FDA-approved HRT,

2) Bio-Identical HRT

3) Herbal options.

One of the main differences in FDA HRT and Bio-Identical HRT is their derivation.  FDA/HRT may come from plant or animal sources, whereas the Bio/HRT and herbal options come from plant sources only.  I explain to patients, you can take certain plants (mostly soy containing yams) and “squeeze out’’ products  EQUAL  to “human hormones” (there are both FDA-approved HRTs and Bio-identical/HRT options.)  Certain other plants have “plant hormone” with similar qualities, but not equal to human hormone (isoflavones like soy, Siberian rhubarb.)

 


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Yaz/Yasmin...Putting Potential Risks into Perspective

 

The use of estrogen/progesterone containing Birth Control Pills have long been known to slightly increase one’s risk for Venous Thromboembolic  events (i.e., deep vein blood clots.)  Recent reports have put into question additional increased risk by use of BCPs containing the progesterone, dropserinone (Yasmin, Yaz, Beyaz, and their generics.)  Available studies on this issue are inconsistent,  some studies showing a fractional increased risk, others showing no increased risk.  In comparing risks of VTE, the increased risk from any Birth Control Pill (3-9/10,000) is still significantly less than the increased risk of VTE in pregnancy (5-20/10,000), and the immediate post-delivery time period (40-65/10,000)…  According to the FDA’s advisory committee, the benefits of all contraceptive methods still outweigh the risks.

drsuzyyhall

(See WXYZ's interview with Dr. Suzanne Hall on their recent story on Yaz

at http://www.wxyz.com/dpp/news/health/mom-warns-birth-control-killed-her-daughter)

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Is HPV a STD?

Sexually transmitted diseases are generally understood to be transmitted through sexual contact, though implied, is the concept of ‘disease’, generally meaning some visible sign of infection (vaginal discharge, burning on urination, pain or a sore/bump.)  With HPV, there may not be visible signs of infection, you may only learn of it because of an abnormal pap smear result.  HPV is an extremely common virus, the CDC noting that 50% of men and women may get the virus at some time in their lives.  HPV causes genital warts and cervical cancer, and can be detected early on a pap smear, without any noticeable sign of having the infection.  The CDC uses the terms sexually transmitted disease and sexually transmitted infection simultaneously, recognizing that some STD’s may be present even in the absence of any symptom.  So in answering the question is HPV a STD, I’d say it’s a sexually transmitted infection, but the general answer is still YES…condoms everyone!

Suzanne Hall, MD

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Is It Hot?

Is it hot…or is it just me?

Well if you’re experiencing menopause related hot flashes, it’s not just you. Approximately 60-80% of menopausal women have hot flashes.  Hot flashes are described as wave of warmth or heat sensation involving mostly your chest, head, and neck area.  Some women feel a bit anxious with it happens, others may feel their heart beating faster.  For many women the sensation is more intense or may occur mostly at night, thus the term night sweats.  The episode generally resolves on it’s own within 2-4 minutes, but may leave you feeling chills, clammy or wet from the sweat. Night sweats can be especially bothersome because they may interrupt sleep, leading to next day fatigue.  The mainstay of treatment for significantly disturbing hot flashes has been hormone replacement therapy.  Others suggest herbal or plant derived products. There’s so much to discuss regarding menopause, we’ll be covering it over several posts. Look for more on symptoms of menopause, and risk versus benefits of various treatment options in the next few posts…

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A Colorful Explanation of...Endometriosis

I often jokingly comment to my patients, “No matter what our skin color is on the outside, We’re all the same color on the ‘inside’…literally.” And it’s the truth. From an anatomical perspective, our inner organs are all the same color, despite skin color or race!

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Does Tubal Ligation Effect Your Periods

False.  Tubal ligation is the destruction of some portion of the fallopian tubes, for the purpose of sterilization.  Our actual menstrual flow is regulated by the ovaries, and the menstrual flow comes from shedding of the uterine lining…neither of which are affected by the procedure of tubal ligation.  If your periods change over time, investigation involves evaluating the uterus, and hormonal environment (the ovaries)… not the fallopian tubes.

Dr. SuzzyHall

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'How' Will My Hysterectomy be Performed?

Understanding the Routes of Hysterectomy


When you and your gynecologist have decided on hysterectomy as the treatment of choice for your gynecologic diagnosis, there are several routes by which a hysterectomy may be accomplished. A total hysterectomy is the surgical removal of the uterus, and when indicated, the additional removal of the fallopian tubes and ovaries (termed salpingoophorectomy) may be recommended.


There are several routes by which a hysterectomy can be performed. You and your gynecologist will decide on the safest route for your hysterectomy based upon the reasons and clinical circumstances for the hysterectomy, your health history and the surgeon's clinical expertise.

The 4 main routes by which a hysterectomy is performed are abdominally, laparoscopically, Davinci assisted laparoscopically or vaginally. In an abdominal hysterectomy an abdominal skin incision (similar to a cesarean section incision) is made to accomplish the surgery. This route is especially advantageous when large uterine fibroids or significant abdominal adhesions are anticipated, allowing for more exposure to accomplish the surgery safely. Compared with the other minimally invasive routes, abdominal hysterectomy generally requires a longer hospital stay and longer recovery time.

Laparoscopic hysterectomy involves the use of a narrow camera (termed a laparoscope) and surgical instruments placed through small abdominal skin incisions to detach the uterus, which is then most commonly delivered through the vagina. This route may be selected when abdominal adhesions or a moderate-to-large sized uterus are suspected. The advantage with this minimally invasive approach is a shorter hospital stay and faster recovery time, when compared with abdominal hysterectomy. Your surgeon may offer Davinci hysterectomy, an advanced form of laparoscopic surgery, with proposed improved precision, visualization, and technical capabilities, for more complex procedures.

In the vaginal route (termed vaginal hysterectomy) the uterus is completely removed through the vagina, thereby avoiding any abdominal incisions. This route may be selected for a normal-to- moderately enlarged uterus, for pelvic organ prolapse, or when significant abdominal adhesions are not suspected. As with laparoscopic and Davinci hysterectomy, a shorter hospital stay and faster recovery are expected.

Though hysterectomies are the most common gynecologic surgery performed among women in the United States , any surgical procedure has inherent risks. Hysterectomy may be the best choice for your gynecologic condition. Be sure to consult with your physician in understanding the risks versus benefits…and your options.

drsuzyyhall

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