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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.
In modern obstetrics, there is a growing trend in expecting mothers’ request for ‘elective’ Cesarean section (‘Cesarean Section on Maternal Request’.) This ‘elective’ cesarean delivery, is a maternal request for Cesarean section delivery, in the absence of any maternal or fetal need (nor medical indication) for Cesarean section birth. (This particular ‘request’ for Cesarean section refers to a maternal request for a first-time Cesarean delivery… not a request for a repeat Cesarean birth, as in the case of a mother with previous Cesarean Section deliveries.) In the U.S. 2.5% of births are performed by Cesarean section for this request. In my experience, concern and anxiety regarding pain in labor seem to represent the most common reason for this request.
Understandably, for many persons, a new diagnosis of genital herpes may lead to feelings of shock, shame, guilt or embarrassment. Often times, patients are unaware of how common this virus is among the general population. Some studies have shown up to 1 in 5 of sexually active people have been infected with the Herpes virus, whether they’re aware of it or not.
Genital herpes is a treatable condition. Aside from being sexually transmitted, much of the negative stigma around this infection seems to come from the fact that you don’t ‘get rid of’ it, and that recurrences can happen. Herpes is a viral infection (like HPV,) and though the symptoms (a cold sore in the case of oral herpes, or a genital sore in the case of genital herpes) can be treated, the virus itself remains present in our blood stream indefinitely. Even in its dormant state (no symptoms present,) the virus remains detectable by blood test, and can lead to partner-to-partner spread of infection (from asymptomatic shedding of the virus) when no detectable ‘sore’ is present. Gonorrhea and chlamydia, different from the Herpes virus and HPV, are bacteria or bacterial-like infections that are cured with treatment, with no detectable bacteria remaining after adequate therapy (unless the individual is ‘re-infected’.)
Though a diagnosis of genital herpes can be an embarrassing nuisance, it’s actually a newborn baby who’s at the most serious risks from a genital herpes infection. A newborn baby infected with genital herpes is at risk for multi-organ infection, that can be fatal if left untreated. If you are pregnant, with a known history of genital herpes, it’s important to let your healthcare providers know that information. Certain measures (anti-viral medications in the last month of your pregnancy, and performing a Cesarean section if active lesions are present at the time of labor) should be taken, to decrease the risk of spread of infection to your newborn baby.
Is this Depression or PMS? According to ACOG, "Depression and anxiety disorders are the most common conditions that overlap with PMS. About one half of women seeking treatment for PMS have one of these disorders. The symptoms of depression and anxiety are much like the emotional symptoms of PMS. Women with depression, however, often have symptoms that are present all month long. These symptoms may worsen before or during their periods. Your health care provider will want to find out whether you have one of these conditions if you are having PMS symptoms." (posted 7/9/13 by @drsuzyyhall)
Breast/Nipple Discharge? Though most cases of nipple discharge (especially occurring with stimulation or expression of the breast) are benign (non-cancerous), an evaluation/exam by your doctor is usually warranted. (posted 5/28/13 by @drsuzyyhall)
Low Libido? Studies have shown Testosterone supplementation to be effective in treating low libido in menopausal women. While Estrogen Therapy may not directly effect libido, it does promote increased vaginal lubrication, improving vaginal pain with sex. Testosterone supplements are not approved by the FDA for treatment in women. Speak with your healthcare provider regarding safety concerns. (posted 4/3/13 by @drsuzyyhall.)
As an Ob/Gyn physician, it’s not uncommon for me to hear the question from patients, “Am I actually ABLE to conceive?” For some women who are planning pregnancy, as well as for some others who’ve never had a pregnancy (intended or not)…the question, “Can I get pregnant?” may be a looming concern.
Other than actually attaining a ‘positive’ pregnancy test, there really is no other specific test allowing us to know IF a woman CAN actually achieve pregnancy. What we do know is, that for the normal couple (those without risk factors/or a history of infertility, regularly sexually active,) the chances of conception are actually stacked in our favor. In fact, for regularly sexually active couples, there is a 15-25% probability of pregnancy with each menstrual cycle!
It is expected that nearly 90% of sexually active couples, without contraception, would become pregnant (intentionally or not) within one year. The one year mark is typically used in defining those couples with ‘infertility’…the inability to become pregnant, despite frequent, unprotected sex within one year. An infertility evaluation by your health care provider may be initiated at this time, and even earlier (at 6 months) for those women over 35.
Suzanne Hall, MD (@drsuzyyhall)
Eastside Gynecology Obstetrics
Heavy menstrual flow is a common occurrence affecting 10-35% of women, and a common reason for visits to the gynecologist. Though the causes for heavy menstrual periods (menorrhagia) vary, the Novasure endometrial ablation procedure is an excellent treatment option for many women, when child-bearing is completed.
As an Ob/Gyn physician with greater than 10 years of experience performing the Novasure procedure (and with hundreds of satisfied patients having selected the procedure), I thought it may be helpful to discuss common questions from patients considering the procedure as their treatment of choice. Here are my answers to 5 common patient questions regarding the Novasure procedure:
1. How is the procedure performed?/What can I expect from my menstrual flow after the procedure…lighter periods or no period?
The procedure is considered minimally invasive, performed through the vaginal aspect without surgical incisions. The Novasure wand (containing a triangular mesh) is inserted within the uterus, where a short (less than 2 minute) cauterization of the uterine lining occurs. The procedure may be performed in an outpatient surgical setting (with anesthesia) or possibly in your doctor’s office. You should expect to be back to normal activities within a day or so.
Several research studies on the results of the Novasure procedure note over 90-95% patient satisfaction with the procedure. Expected results range from notably lighter menstrual periods (for most patients)…to skipped/or absent menstrual flows (up to 40% of patients.) It’s not possible to predict for patient’s what result they will get, but when questioned overall, most patients are (very) satisfied with the results achieved.
Suzanne Hall, MD, FACOG
50%-90% of pregnant women experience symptoms of ‘morning sickness’ in the early months of pregnancy. These symptoms can range from mild intolerance to certain odors or food, to more significant, daily nausea and vomiting (N/V). Studies suggest that up to 25% of pregnant women experience nausea, 50% experience both nausea and vomiting, leaving only 25% of pregnant women unaffected. In those affected, the symptoms usually manifest by the 9th week of pregnancy.
Much is written and discussed about home/medical remedies for morning sickness, but much less is written/discussed about the (possible) causes for nausea and vomiting in pregnancy (NVP). Though the cause of NVP has not been proven, it has been postulated that NVP is an innate mechanism, presenting as a ‘protection’ for the developing fetus (an inherent ‘aversion’ to substances that could be harmful to the fetus.) Leading medical theories consider the adverse reaction of the ‘hormones of pregnancy’ as potentially causative (in the absence of other intestinal or medical problems that could present with N/V.)
At 15 years old I remember asking myself, “Is this what they mean by menstrual ‘cramps’?” The term ‘cramp’ just seemed too mild to explain the horrid, 1 or 2 day experience, which regularly preceded the start of my monthly period. Back pain, ‘front’ pain, nausea, and sweats…felt more like a suffering from the flu…with an elephant stepping on my back!... than what I’d describe as menstrual ‘cramps’. The usual ‘mother’s home remedies’ like a heating pad, hot tea, or over-the-counter pain reliever, hardly ever seemed to do enough, but I adhered to the regimen every month anyway…What else was I going to do?
As a Gynecologist, I now know the significance of the menstrual ‘cramps’. In our rhythmic, monthly, hormonal cycle, and in response to the rise in our ovarian hormones (estrogen and progesterone), our ovaries form the ‘dominant follicle’, which releases the fertilizable egg for that month. At the same time, the uterine lining develops a thick, shaggy layer (like a shag carpet) to enhance implantation of a fertilized egg (egg fertilized by a male sperm=pregnancy.) On the other hand, if no egg fertilization occurs (no pregnancy), the ovarian hormones decline, allowing for release/shedding of the previously developed thickened uterine lining tissue (representing our ‘menstrual flow’), and the obvious sign of menstrual bleeding.
Did you know that up to 10-15% of pregnancies are affected by hypertension? About 5% of those cases are in women previously known to have hypertension (termed ‘chronic hypertension’), prior to pregnancy. Another 5-8%, develop hypertension within the pregnancy (termed ‘gestational hypertension’ or ‘pregnancy-induced hypertension’.)
Hypertensive disorders are characterized by blood pressures consistently ranging 140/90 or greater. Women with chronic hypertension (existing before pregnancy, or diagnosed before 20 weeks of gestation) may require blood pressure medications to control their blood pressure, even throughout the pregnancy. Those medications should be reviewed with your healthcare provider, to assess their safety in pregnancy, even before conception.
If anyone should know the concerns of choosing pregnancy and childbirth later in life, as an Ob-Gyn physician, having given birth to my first child at 39 yo, I should think I’d be one of them. With my training and experience as an Ob-Gyn physician, I was fully aware of my risks in deciding on childbirth…as a woman of ‘advanced maternal age’. I counsel women on their risks nearly every day.
I already knew that at my age, it may take longer for me to get pregnant. I knew that advancing age is associated with subfertility (prolongation in time to achieve conception,) and I knew this to be related to altered/changing hormonal patterns as we age, leading to suboptimal ovulation. I already knew that there is decreased ovarian reserve (fewer fertilizable eggs remaining in our ovaries) as we age. I also knew that advancing age was associated with a higher risk of miscarriage, most likely related to the poorer quality of aging eggs, and the increased chances of fertilizing an egg containing abnormal chromosomal material...
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Suzanne Hall, MD (@drsuzyyhall)
Check out this amazing 'life-like' computerized graphic video of fibroids from simulated Myosure procedure!
Who really likes going to see the Gynecologist? For some women, it probably ranks right up there with getting a tooth drilled at the dentist, or like nails to a chalkboard. But let’s face it, the gynecologic exam/Pap smear is a necessary part of preventative Women’s Health screening. Whether it’s your first visit, or you’re seeing the Ob/Gyn you’ve known for years, here are a few tips that may help to make your visit go more smoothly…
Prepare your questions/concerns
Make a list of your concerns/questions, include your medical history, medications, allergies, ect…
In that the average patient-physician interaction is 10-20 minutes, it’s helpful when your list of problems/concerns is concise. Know your medical/surgical history, medication allergies, and list your current medications. Think about (or write down) your problem list/symptoms, when they began/worsened, what aggravates/or improve the symptoms, and from a gynecologic perspective, if they’re cycling with your menstrual period. Understand that if your list of questions/concerns is long, we may have to address some of them at a subsequent visit.