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|Category: Gynecologic/Women's Health Concerns|
Managing Anxiety: The Basics
Rachel Hagerty, MA, Limited License Psychologist
Rochester Hills, Michigan
[We’re welcoming our local friend and Psychologist, Rachel Hagerty, as our guest blogger on Managing Anxiety, a common condition affecting many of us at some point in our lives. Rachel will share some useful, self-motivated techniques in managing the symptoms of anxiety. We’ll be sharing these techniques in a 2-part series. Take it away, Rachel!]
In our lives we experience a multitude of events; some thrilling, others difficult, life altering and ordinary. From navigation through life changes, to finding balance between our home and personal life, or maintaining our sense of self while fulfilling many other roles our daily lives can be very challenging and demanding. So if you are finding yourself burning the candle at both ends and feeling like you’re being pulled in too many directions at once, believe me when I say you’re not alone.
According to the National Institute of Mental Health website, anxiety disorders effect 18.1% of the adult US population with the average age of onset at 11 years old.
Consistently dealing with large amount of stress can lead to symptoms of anxiety that could possibly lead to depression-like feelings as well. It’s a rather slippery slope; one that many people tend to find themselves facing.
Whether teenagers discuss it with their parents or not, they are likely to feel some aspect of social pressure regarding the initiation of sexual activity. In counseling our teenage girls, I try to get them to assess their own attitudes regarding their readiness for sexual activity, as well as their understanding of the potential consequences of engaging in sex, like risks for stds, pregnancy and social stigmata.
I love giving them my “It’s your Choice” talk, encouraging them on the option of abstinence, or waiting on sex. I want them to understand that the decision to engage in sex, is just one of the many decisions they’ll have to make for themselves, and that making a ‘good decision’, means understanding the risks of the behavior.
Dense breast tissue is an independent risk factor for breast cancer, both increasing our risk of breast cancer and decreasing the sensitivity of mammography to detect breast cancer. Increased breast density, as identified by mammography, can negatively impact the ability of mammography to detect breast cancer. Further, women with dense breast tissue have a 3-5 fold increased risk for breast cancer, over those without significant breast density.
“My husband wants me to discuss my lack of interest in sex”… As Gynecologists, this is a patient concern not unfamiliar to us. Has low sexual desire been a concern for you in your relationship? Would you ever consider the use of a medication for its improvement? Well I’d hope that most of my patients would want to first examine the possible reasons for low libido, even if their answer is ‘yes’ to trying a medication for it.
But herein lies the concern. Defining the sources of low libido in women is not easy. Research tells us that nearly 4 in 10 women experience some degree of female sexual distress at some point in our lives. The definition of Female Hypoactive Sexual Disorder is made by conditions characterized by loss of sexual desire, impaired arousal, difficulty in achieving orgasm, or sexual pain, with low desire and sexual pain being the most common.
The stages of female sexual arousal have been well studied, and fairly well defined, since the 1960’s with research done by Masters and Johnson. However, the components of female sexual desire remain complex. Sexual desire in women is likely a multi-factor phenomenon, involving biologic, psychologic and social factors, which can elude clear delineation.
Are you a woman still using douching as a method to ‘clean’ your vagina? If you are, you’re not alone. Studies say that up to 1 in 4 women use douching. But it’s time to kick the habit! Despite some cultural beliefs that douching ‘cleans’ the vagina, the truth is that douching may actually increase our risks for vaginal infections. The vagina is well equipped with a natural balance of good bacteria, and needs no ‘cleaning’. Douching can disrupt this balance of protective bacteria, and increase the chances for overgrowth of infectious bacteria, thus increasing our chances for vaginal infection.
When considering a woman’s contraceptive options, IUDs bear discussion. Some women have familiarity with IUD use, others have “heard of them”, but don’t have a real concept of how they’re used or how they work. An IUD (Intra-Uterine-Device) is a contraceptive device placed inside the uterus, in an in-office procedure, that generally takes less than 5 minutes for your doctor to insert. Pregnancy prevention occurs by a ‘foreign body’ inflammatory reaction that occurs based on the metal or plastic frame (T-shaped, about the size of an open paperclip) and by the local effect of the medication released by the IUD (either copper or progesterone.) This ‘inflammatory reaction’ likely creates a toxic environment for sperm (spermicidal), as well, likely inhibits implantation.
Have you heard the theory that antibiotic use can lessen the effectiveness of your birth control pill? Though there is some truth to this theory, it’s fortunately NOT true for most commonly prescribed antibiotics.
Pharmacologic studies evaluating hormonal levels during antibiotic use have shown decreased hormonal levels (leading in theory to potential decreased effectiveness) with only one type of antibiotic, Rifampin (an anti-tuberculosis medication) whose use is fairly uncommon. Women taking this particular antibiotic should not rely on their hormonal birth control (OCP, DepoProvera, or implant) solely for contraception during its use. Use of a non-hormonal form of back-up birth control is recommended in these women.
Other antibiotics have NOT been proven to affect the pharmacologic levels of hormonal contraception. Some of the more commonly used antibiotics, metronidazole, ampicillin, tetracycline, doxycycline, ciprofloxacin, or diflucan have not shown to decrease oral contraceptive levels in pharmacologic studies.
For women taking antibiotics (other than Rifampin) with birth control pills, back-up contraception is therefore, not required.
If you are sick, requiring antibiotic use or not, considerations for decreased effectiveness of your birth control pill may be due to missed pills, or due to vomiting, in which case back-up birth control would be recommended.
The truth is, we’re all at different stages of our lives as women. Several of my friends, sisters, and I are at this very interesting time in our lives, the menopausal transition, and yes, just beginning to meet, “Ms. PeriMenopause” for the first time ourselves. Our 40-50 yo ‘girl-talk’ usually ends up with some discussion around the topics of hot flashes, or how much more difficult it is now to lose weight.
But what’s less often spoken of amongst my friends, are the symptoms of mood swings and irritability, which can also be symptoms of the peri-menopausal transition. Have you seen yourself go from ‘zero-sixty’ in irritability (or anger), or get easily tearful over things that you know before wouldn’t have upset you so easily? Well I certainly have. Hopefully this bit of information will help you to understand some of the hormonal and emotional shifts that can occur in the perimenopause, giving us some control over that feeling of our ‘raging’ hormones...
In a recent ruling from the Hobby Lobby case, The Supreme Court has ruled that ‘for-profit’ businesses can now evoke the religious rights disclaimer regarding contraceptive coverage. This means that non-religious business can now forgo the previous ACA mandates requiring contraceptive (no co-pay) coverage for women, an exception previously afforded only to religious based business with objection to this mandate for religious reasons. According to a recent article in Medscape.com, “The Court ruled 5-4 that closely held corporations, or companies with a small group of shareholders, may refuse to cover methods of contraception that they oppose for religious reasons.”
In the last few years, the guidelines on the required frequency of cervical cancer screening (Pap smear) have changed, and more recently, even the importance of your Yearly/Annual Pelvic exam has been up for debate amongst established medical societies. The American College of Obstetricians and Gynecologists, ACOG, recently released their rebuttal statement, reconfirming their support for the importance of the Annual Pelvic Exam. Their statement was made in response to the recently released article from the American College of Physicians supporting the contrary, recommending against the annual pelvic exam in asymptomatic women, thus bringing into question the utility of the exam.
‘Tis the season for high school graduations, and thus that (sometimes dreaded) question for graduates, "What are you gonna do?" Though college bound, I can still remember that question being pretty awkward for me, because I had no real clue of what my career interests/aspirations were. I found that a simplistic answer, like “business”, seemed to satisfy most of those that asked, though I barely even had a clue of what a focus in “business” really meant. If not for a great career counselor at my university helping to identifying my strengths in math/science, and directing me towards potential careers stemming from those interests…you wouldn’t know me as Dr. Hall!
Losing weight can be a challenge for many of us. For those of us that exercise regularly, further weight loss can also be frustrating. When beginning your commitment to a diet and exercise program to lose weight, it seems initially the weight does come off in manner that can be fairly satisfying.
But for those of us that have already been committed to healthier food choices, and regular exercise, the challenges of (further) weight loss can continue. It’s not uncommon to hear exercising women relate the difficulties of losing any more weight. And for me, like others, we may watch the scale actually start to ‘increase’ despite regular exercise and healthy food intake! I’ve had to reach back to my medical references to feel some sense of comfort for why this may be happening.
Though my career as a trained Ob/Gyn physician gives me expertise in Women’s Reproductive Health conditions, across the board, the most common medical condition I see regularly is obesity, and women struggling with weight loss management. In this 2014 upcoming year, I’ve decided to focus, both personally and professionally, on the emphasis, education, and support of weight loss, in my online work and with patients in the office.
According to the CDC, obesity affects nearly one third of all Americans, and is a known risk factor for common health conditions including hypertension, diabetes, and cardiovascular diseases. From a Reproductive Health perspective, we also know obesity to be linked with obstetrical complications, irregular menstrual cycles, and both breast and uterine cancers.
Insurance changes, high deductibles, and faulty marketplace applicability are just a few of the burdensome changes invoked as a result of the ACA. Despite the many changes we’re sure to see in our insurance plans, keep in mind that many of the currently available preventive health screenings not only will continue to be available, but importantly, will be covered at no cost to you (no deductible and no co-pay,) by the ACA mandates. Annual Pap smear screenings, mammograms, contraception, and vaccinations will be covered by most insurance plans as a “No-fee Preventative benefit”, even if you participate in a high deductible plan.
Whether you find yourself needing to purchase insurance on the marketplace, or not, it’s possible that you may find changes in your current insurance coverage, such as the institution of higher deductibles. Studies show that participants of high deductible plans are less likely to utilize health services, even those services that are covered at ‘no cost’.
Hi all, I wanted to discuss something that plagues a lot of women with pelvic pain, and that is endometriosis. Many of you know what that is. For those of you that are not familiar with it, please referred to previous post on this blog.
Traditionally, endometriosis is diagnosed via laparoscopic surgery. We can see the active lesions and cauterize them. Once the lesions are cauterized the pain will improve. It is well known that these lesions typically have a dark brown or "chocolate" color appearance. However, it is now agreed that these lesions have a wide range of colors depending how active they are. Some of these are clear which is difficult to see with traditional laparoscopy.
I'm hearing of women losing weight with the HCG injections, and I decided to look into it. While Dr. Sheri Emma, Creator of the Dr. Emma's HCG Protocol claims that this 'crash' diet allows you to loose weight while maintaining muscle, other researcher have shown the HCG injections to be no more beneficial than saline-water/placebo injections for weight loss. The HCG diet plan usually involves severe calorie restriction (500-1500 cal/day), and it's this significant caloric reduction that's likely responsible for the weight loss, rather than the HCG injections themselves. Dr. Emma quotes, "Remember, HCG does not make you loose weight - the diet makes you loose weight!"
Keep in mind, the safest and most healthy way to loose weight is still by moderate calorie restriction & Exercise! :)
Suzanne Hall, MD
Eastside Gynecology Obstetrics
Our busy lives as working women, mothers, wives, girlfriends, sisters, daughters and friends leave little time for ourselves. I'm trying to learn the importance of "Me Time", of which I'm learning to equate with a "balanced" life. I love being a "giver", but we can't forget to take time for ourselves, to rejuvenate and rest.
Check out my guest post on WhattoExpect.com on finding my "Me Time"...
Suzanne Hall, MD
When is the right time to start ‘the talk’ with teens about sex-related issues…how to say No -or- how to protect themselves against pregnancy and STDs if they are, or considering, sexual activity? Some studies do suggest that parents may underestimate their teen’s sexually activity. According to the CDC, among U.S. high school students surveyed in 2011, 47.4% have already had sexual intercourse.
As the health providers in our practice, we want to provide health guidance regarding responsible sexual behaviors, for both teens who are and who are not sexually active. We’ve developed a new campaign in our office to encourage health habits for teens, called “i-ProMiss Health.” Our teen patients will receive a personal wallet-sized card –a ‘personal health promise contract’-to sign (and keep with them) after considering their own personal decisions regarding the health related issues of abstinence, condom use, healthy eating and exercise. The personal wallet card will be accompanied by an “i-ProMiss Health” rubber band bracelet as a personal reminder token.
Hopefully our teens (and parents) appreciate it!
In the recent several years, public health initiatives have been underway to increase public awareness of the prevalence of the HPV (Human Papilloma Virus) among the sexually active population, it’s health consequences of genital warts and cervical cancer, and the recommendations for Gardasil, one the available vaccines effective in the prevention of HPV. How much do you know/understand about HPV?
Test your knowledge of HPV here, with this simple quiz:
1. Of sexually transmitted infections, the most common is:
- – HPV (the Human Papilloma Virus)
- – HSV (the Herpes Simplex Virus)
- – HIV (Human Immunodeficiency Virus)
2. The HPV virus is spread by:
- Genital contact, most commonly through sex
- Oral-genital contact
- Straight and same-sex partners
- All of the above
3. The HPV is the cause of most cases of both genital warts, and cervical cancer?
4. The majority of cases of HPV infection cause no (visible) signs of infection at all, and are cleared by our body’s own immune system?
5. The HPV is a ‘newly’ discovered virus, linked with genital warts and cervical cancer?
6. The HPV vaccines are more than 90% effective in preventing genital warts and cervical cancer in femalefemafemifemales vaccinated before their sexual debut?
(See next page for answers...)