The species of yeast most commonly involved  is called Candida.  The most common strain, Candida albicans, usually responds to over-the-counter anti-fungals such as Monistat and Gyne Lotramin or their more affordable generic equivalents.  Other strains are more resistant and may require prescription strength medication.

Should a woman suffer multiple times a year with Candida Vaginitis then a recent study demonstrated an anti-fungal regiment may suppress these frequent, bothersome recurrences.  It utilizes a tapered schedule of the prescription drug Diflucan.  This regimen resulted in 77% of patients relapse free at the end of one year.

Keep in mind that not all itching is due to yeast but may be dermatitis or another ailment.  You can prevent yeast infections by making sure that your genital area stays as dry as possible and can “breathe.” For example wear cotton, not nylon, underwear, and avoid tight-fitting pants and panty hose.  Change out of a wet swimsuit right away. Nevertheless if you’re plagued with frequent yeast infections schedule an appointment with us.

Wishing you good health!

Women’s Health Specialists
2299 Mowry Avenue, Suite #3C
Fremont, CA 94538
510.796.7057
www.WomensHealthFremont.com

• 58% with excess menstrual bleeding have not discussed it with a health care provider
• 82% of women who discussed heavy menses had to initiate the dialog
• 62% waited more than one year, and 1 in 5 waited more than 5 years to discuss it with their doctor

These women have been labeled “Silent Sufferers.”  Another study reported that only 5% women recalled that their doctor inquired about menstrual bleeding patterns as part of their annual physical exam; whereas 38% of these physicians reported doing so; Why the discrepancy?  A classic study in 1966 compared a woman’s perception of their menstrual flow to actual measurements.  Surprisingly, half the women with heavy menstruation rated it as normal or light.  So asking a straightforward question “Is your period normal?” fails to reveal many who are afflicted.  Hence, these women suffering with excess menstrual bleeding are left unidentified, and consequently tolerating their embarrassing condition.

In a study published in the British Journal of Medicine, 1 in 5 women responded “yes” to the question, “Does your period disrupt your life?”  Notice the question is not judging whether the amount of bleeding is normal or not, but rather focuses on impact on lifestyle.
So lifestyle questions are the key to opening the door to solutions for these women.  Treatments target the inside lining of the uterus, since bleeding originates from sloughing this tissue.  The good news is there are often alternatives to hysterectomy (the removal of the uterus):

• Hormonal therapy (Birth control pills or progesterone minimize growth of the inside uterine lining)
• Progestin IUD (The Mirena® Intra-Uterine Device only delivers progesterone to the uterine lining, so less side effects)
• Endometrial Ablation (NovaSure is a 90 second treatment to remove the inside lining of the uterus so it doesn’t grow back)

At Women’s Health Specialists we offer women the convenience and efficiency of a complete work up for abnormal uterine bleeding in a single office visit that includes a pelvic ultrasound, hemoglobin, and endometrial biopsy if indicated.  We can then promptly proceed to treatment options that you’re comfortable implementing.  This saves time, expenses, and most importantly lessens anxiety.

Wishing you good health!

Women’s Health Specialists
2299 Mowry Avenue, Suite #3C
Fremont, CA 94538
510.796.7057
www.WomensHealthFremont.com

The vagina is very estrogen dependent, without it the tissues often become thin and dry.  Then during intercourse friction creates discomfort.  Consequently, vaginal dryness and pain with intercourse have become more problematic with the dramatic decline in the use of systemic hormone replacement therapy.  Estrogen thickens the vaginal lining and increases natural secretions. 

While not all menopausal women experience vaginal dryness, there are solutions to help those that do.  First, there are over the counter vaginal moisturizers and lubricants for intercourse that may suffice (often displayed  near condoms at retailers).  Alternatively, consider utilizing low dose vaginal estrogen.  Topical preparations such as Premarin® and Estrace® creams or Vagifem® tablets are FDA approved remedies.  A recent study demonstrated that a new lower dose of ½ gram of either estrogen cream inserted into vagina just 2 nights each week is effective.  This does not change serum levels of estrogen, so it’s effects are confined to the vagina.  This is also true for Vagifem®.  A good pneumonic to help women remember is, use it every Wednesdays and a weekend night.  It may take about a month before symptoms initially improve.  Finally, women usually need to continue using vaginal estrogen to achieve the benefits.

While estrogen won’t correct a waning sex drive it can make sex more comfortable.  A little estrogen can make an improvement in the quality of menopausal women’s life.  Please don’t wait until your annual exam to seek help.

Wishing you good health!

Women’s Health Specialists
2299 Mowry Avenue, Suite #3C
Fremont, CA 94538
510.796.7057
www.WomensHealthFremont.com

No one knows exactly what causes irritable bowel syndrome.  The walls of the intestines are lined with muscles that contract and relax as they move food through your intestinal tract.  Normally, this occurs in a coordinated rhythm.  But if you have IBS the contractions may be stronger and last longer than normal, like a spasm.

If you have IBS you are probably sensitive to stimuli that does not bother other people.  Triggers may include:

Foods:  For instance, chocolate, milk and alcohol might cause constipation or diarrhea.  Carbonated beverages and certain fruits and vegetables may lead to more bloating and discomfort in some people with IBS.
If you experience cramping and bloating mainly after eating dairy products, food with caffeine, or wheat products, the problem may not be IBS.  Instead, your body may not be able to tolerate the sugar (lactose) in dairy products, caffeine, or the gluten in wheat flour.

Stress: If you’re like most people with IBS, you probably find that your symptoms are worse during stressful events.
Symptoms such as onset after age 50, weight loss, vomiting, rectal bleeding, or fever are red flags that should prompt you to visit your doctor for evaluation.

Because it’s not clear what causes irritable bowel syndrome, treatment focuses on the relief of symptoms so that you can live your life as normally as possible.  In most cases, you can successfully control mild symptoms of irritable bowel syndrome by learning to manage stress and changes in your diet and lifestyle such as:

Fiber supplements: Taking fiber supplements such as psyllium (Metamucil) or methylcellulose (Citrucel) with fluids may help control constipation.

Anti-diarrheal medication: Over-the-counter medications such as loperamide (Imodium) can help control diarrhea.
Eliminating high-gas foods: If you have bothersome bloating or are passing significant amounts of gas, your doctor may also ask you to cut out such items as carbonated beverages, salads, raw fruits and vegetables, cabbage, broccoli and cauliflower.

Stress reduction: Exercise, meditation, yoga, and counseling with a therapist can be helpful.

If these measures prove unsuccessful, your doctor may recommend prescription medications.  Fortunately, most people with IBS find their symptoms improve as they learn to control the condition.

Wishing you good health!

Women’s Health Specialists
2299 Mowry Avenue, Suite #3C
Fremont, CA 94538
510.796.7057
www.WomensHealthFremont.com

Multiple studies have demonstrated that observation of a painless cyst, even in menopausal women, is the prudent course.  In one study of women over 50, 70% of “simple” cysts resolved spontaneously within 6 weeks, and of the 220 women with persistent ones, none developed cancer after an average follow-up of nearly 7 years.  This information should help allay fears and decrease the need for unnecessary surgery.  For those with persistent cysts annual surveillance with repeat testing is appropriate, or sooner if worrisome symptoms, like persistent pain or bloating appear.

Sometimes to help us decide on the clinical course, we obtain a blood test called CA 125.  When the level is in the normal range, it adds reassurance that it is wise to wait, especially in older women.  Unfortunately, the CA 125 is falsely elevated in about 70% of premenopausal women with cysts because of confounding benign pathology such as fibroids or endometriosis.  Conversely, about 50% of women with stage I ovarian cancer have a negative test.  Therefore, it is far from the perfect tumor marker.

So, remember ovaries make cysts for a living.  Most cysts can be watched and resolve without surgery.  And even when surgery is necessary, it can often be performed using a minimally invasive approach called laparoscopy with button hole sized incisions and less than a week of recovery.

Wishing you good health!

Women’s Health Specialists
2299 Mowry Avenue, Suite #3C
Fremont, CA 94538
510.796.7057
www.WomensHealthFremont.com

However, recommendations differ for women at increased risk for ovarian cancer.  In women carrying breast cancer genes, known as BRCA, multiple studies have demonstrated that prophylactic removal of the fallopian tubes and ovaries improves overall survival as well as reducing cancer specific mortality due to both breast and ovarian malignancies.  An 80% reduction in cancer risk in a recent major study makes compelling evidence to offer this intervention to at risk women once they have completed childbearing.  A different study reassures us that offering estrogen short term to these women after their surgery alleviates distressing premature menopause symptoms like hot flashes, night sweats, and vaginal dryness, without compromising the reduction in risk of developing breast cancer.  In most cases, this operation can be accomplished via outpatient, minimally invasive laparoscopy, which results in less pain and allows most women to return to regular activities within one week.

So if you are at average risk for breast or ovarian cancer then hold on to your ovaries.  If you have a mother or sister with breast cancer, then suggest to them to get BRCA tests.  If your family member is a BRCA carrier then you should also be tested.  If you are negative then be reassured you are at average risk.  However if you are a BRCA carrier then you should consider prophylactic surgery to lower your risk of developing cancer.

Wishing you Happy New Years & a Healthy 2009!

Women’s Health Specialists
2299 Mowry Avenue, Suite #3C
Fremont, CA 94538
510.796.7057
www.WomensHealthFremont.com

Women’s Health Specialists offers the only all female obstetrcian group in the Fremont area.  Few experiences are as rewarding as delivering babies. This begins with conception planning, extends through prenatal visits, and culminates in a healthy birth. Every woman has her own expectations about how she envisions her birth experience. Our goal is to make this a memorable event.

Washington Hospital contains the modern Birth Center, which offers facilities allowing “natural” and high-risk births. Women travel from all around the San Francisco Bay Area and the central valley to deliver their babies here. The Intensive Care Nursery, managed by Stanford’s Lucille Packard Children’s Hospital, is prepared to care for sick infants.

Won’t you feel more comfortable being cared for exclusively by compassionate women doctors?

Sometimes serious underlying ailments exist, but the majority of the time anxiety or other issues are responsible.  Prescription sleep aids, used on a short term basis of less than a month, or episodically can be quite helpful according to sleep specialists.  Likewise low dose estrogen works wonders especially for menopausal night sweats and hot flushes, removing the inciting event to sleep disturbances and hence their consequences.  Women often return commenting, “I feel like myself again.”  We initiate hormone treatment at the lowest effective dose, and if using pills take them at bedtime to take advantage of peak blood levels.

Nevertheless, many menopausal women desire to manage insomnia “naturally.”  Here’s a list of suggestions to help you:

• Maintain a regular sleep and wake schedule, including weekends
• Establish a regular, relaxing bedtime routine (warm bath, reading, listening to music)
• Create a sleep “sanctuary” that is dark, quiet, comfortable, & cool
• Use your bedroom for sleep and intimacy (no TV)
• Finish eating at least 2‑3 hours before your bedtime
• Exercise regularly, but complete your workout at least 4 hours before bedtime to unwind
• Avoid caffeine, nicotine, and alcohol close to bedtime
• Put your worries away at bedtime (acknowledging that you’ll deal with them the next morning)
• If you can’t sleep within 20 minutes, get up and go to another room; return when drowsy
• Avoid naps.  If you must nap, limit it to less than 30 minutes, and complete it by early afternoon

Commonly doctors often focus their efforts on life threatening conditions or ones they know are straight forward to treat.  Nevertheless, if these insomnia interventions do not help you awake feeling rested, then you should see your primary care physician.  Sleep quality impacts quality of life.  They can help you get consistent, quality sleep so you can awake to meaningful days. 

Wishing you good health!

Women’s Health Specialists
2299 Mowry Avenue, Suite #3C
Fremont, CA 94538
510.796.7057
www.WomensHealthFremont.com

PS: With our recent installation of a electronic medical records system on our computers, we may have missed sending you a reminder for your annual well woman examination.  If it’s been over a year since your exam or you’re unsure, then please contact our office to schedule your appointment before the end of this year.

Wishing you good health!

Women’s Health Specialists
2299 Mowry Avenue, Suite #3C
Fremont, CA 94538
510.796.7057
www.WomensHealthFremont.com