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.

In 2012 the menu of treatment options includes 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)
• Lysteda® (non hormonal medication taken 1st 5 days of period)
• Endometrial Ablation (NovaSure is a 90 second treatment to remove the inside lining of the uterus so it doesn’t grow back)
• Hysterectomy (preferably laparoscopic or vaginal as minimally invasive routes)

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 as 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

Consequently 2 weeks ago several national agencies* announced extended intervals for cervical cancer screening. For women 30 years and older, co-testing with PAP & Hi-Risk HPV every 5 years is preferred to PAP alone, but the later every 3 years is an acceptable strategy. In choosing to make co-testing the preferred strategy, these agencies focused on evidence from multiple randomized clinical studies showing that co-testing has improved accuracy compared with PAP alone. Specifically, co-testing has increased sensitivity (over 99%) for detecting advanced pre-cancer of the cervix. Because of this improved performance, co-testing can be used for screening at less frequent intervals than PAP alone.  Recommendations for other age group are noted in this table:

 
Women with a history of advanced pre-cancer should continue annual screening for at least 20 years

It is very important to emphasize that the revised recommendations do not imply the end of the annual well woman visit. Counseling and education on topics varies by age:

• Adolescents and young women can benefit from counseling on healthy diet, risky behaviors, family planning, and—if they are sexually active—testing for sexually transmitted diseases. The focus for cervical cancer for this age group should be on primary prevention through HPV vaccination.

• Women of reproductive age will benefit from counseling and shared decision making on family planning, and treatment of excess menstrual bleeding.

• Women in the later reproductive years and perimenopausal women will benefit from counseling on the menopausal transition, osteoporosis prevention, and referral for mammography and colorectal cancer screening.

• Both women of reproductive age and postmenopausal women benefit from breast cancer screening and evaluation and treatment urinary incontinence and pelvic floor function.

This visit has always been more than just a “PAP smear,” and the decreased need for cervical screening actually constitutes a minor change to an important aspect of a woman’s health care.

Wishing You Good Health,

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

* U.S. Preventive Services Task Force and the American Cancer Society/American Society for Colposcopy and Cervical Pathology/American Society for Clinical Pathology

• Surgery-free—A simple procedure performed in your doctor’s office in less than 10 minutes
• Hormone-free—Works with your body to create a natural barrier to prevent pregnancy
• Anesthesia-free—No slowing down to recover, and return to normal activities in less than a day
• Worry-free—Since 2002 over half a million women and their doctors have trusted Essure® as the most effective permanent birth control

Hysteroscopic Sterilization is different from the traditional method of surgery called tubal ligation.  There is no cutting into the body.  Instead, your doctor inserts a thin scope through your body’s natural pathway of the vagina and into the uterus, where the openings to the fallopian tubes can be seen.  Micro-inserts are placed into your fallopian tubes blocking them.  Since most women only report mild cramps, you have the choice of having the procedure performed without general anesthesia.  In fact, most women choose to have their procedure performed in the convenience of our office.  Some women experience mild cramps afterwards and all return to their regular activities in less than a day.  The doctors at Women’s Health Specialists were the first to perform Essure® and Adiana® in our community, and serve as instructors for other doctors desiring to learn this revolutionary office-based procedure.

During the first 3 months following Hysteroscopic Sterilization, your body and the micro-inserts work together to form a tissue barrier that permanently prevents sperm from reaching the egg.  During this time, you will need to use another form of birth control.  Then you will have a confirmation test to prove that your tubes are completely blocked and you can rely solely on Essure® or Adiana® for birth control.  Here’s what one of our patient’s says about her experience with Essure.

Unlike birth control pills, patches, rings, injections, and some forms of IUDs, Hysteroscopic Sterilization does not contain hormones that interfere with your natural menstrual cycle.  Your periods should continue in their natural state.  Clinical studies have shown Essure® to be 99.85% effective at preventing an unplanned pregnancy, surpassing traditional tubal ligation, vasectomy, and IUDs.  Consequently, it is not surprising that Hysteroscopic Sterilization is quickly becoming the treatment of choice for women seeking permanent birth control.  Finally, these procedures are usually covered by your medical insurance.  So if your family is complete schedule an appointment to talk to your doctor about more effective contraceptive options.

Wishing You Good Health,

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

PS: More information and videos click on this link: Surgery-Free Permanent Birth Control

You don’t have to let abnormal bleeding interfere with your daily activities. While there is no medication to treat polyps and fibroids, there are procedures to remove them.  If there are numerous fibroids, large ones, or they are located in the middle or outer portion of the wall of the uterus then either myomectomy (removal of just the fibroids), or hysterectomy (removal of the uterus) is necessary.

However, if these growths project into the uterine cavity then they may be removed with a hysteroscope (the insertion of a small scope through the cervical opening into the uterine cavity).  Dilation & Curettage (commonly known as a D&C) has been shown to miss removal of lesions.  Hysteroscopy is the preferred method as it allows visualization and targeted removal: via grasper for small polyps, hot-wire cutting resection loop or morcellation for fibroids.  Hysteroscopic Morcellation uses an instrument inserted through the hysteroscope that rapidly shaves away growths.  Since the system does not use heat it minimizes damage to the inner lining of the uterus, which helps preserve the chances of pregnancy in the future. This device also shortens operative time and enhances safety.

Hysteroscopic procedures are performed on an outpatient basis.   If you have completed your family then your doctor may give you the option of also having an Endometrial Ablation to further reduce or eliminate your menstrual bleeding.  Your doctor will provide specific details regarding postoperative care, but most women return to their regular activities the following day.

At Women’s Health Specialists we are proud that we continue to lead in advancing minimally invasive surgical techniques for women of the San Francisco Bay Area.

PS: Check out Hysteroscopic Morcellation Videos & Brochures

Wishing You Good Health,

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

Ambulance chasing lawyers have found a new victims’ rights to champion.  Not so fast…

The organs in your pelvic cavity—uterus, vagina, bladder and rectum—are held in place by a web of muscles and ligaments that act like a hammock.  When these tissues become weakened or damaged (typically during childbirth, and/or after hysterectomy), one or more of the pelvic organs fall (prolapse) into the vagina.  As a result, the organs may press against the vaginal wall and produce a hernia-like bulge causing discomfort, limiting sexual and physical activity, or impair bladder or bowel function.

Pelvic organ prolapse (POP) currently affects 1 in 11 women and Stress Urinary Incontinence (SUI)—urine leakage with coughing, exercise etc.—1 in 6.  Just as prolene mesh has replaced plication groin hernia repairs so has it revolutionized the urethral sling for SUI over 15 years ago and is similarly changing POP repairs.

While urethral mesh slings have rare complications and have become the gold standard, using larger pieces of mesh for POP corrective surgery has been controversial with setbacks.  The good news is significant evolution has occurred over the past decade with lighter weight prolene mesh that has lowered the risk of exposure to less than 10% (which does require an outpatient, small revision of the mesh that fortunately doesn’t affect restored support).  Contrast this with a 30 40% failure rate of non grafted cystocele (bladder prolapse) repairs, where these women require complete reoperation in a scarred field ripe for complications.  After all these women have poor pelvic ligaments that tore during childbirth creating these vaginal hernias.  Hence, improved success (better than 90%) and longevity of a mesh-augmented repair for women with moderate to severe prolapse becomes a compelling choice.

We have been approached by numerous concerned patients who have been misled by these alarming ads that the FDA recalled mesh products.  This is not true.  The FDA now requires surgeons to communicate about the risks to their patients contemplating POP surgery—with and without mesh augmentation; We have been doing so since we began using grafts years ago.  The FDA has a list of 13 questions that patients should ask their doctor including their experience performing these complex procedures.   It’s only fair that women suffering with prolpase recieve balanced information so they can make an educated decision about surgery, or alternaitives such as a pessary.   It’s unfair to have medicine dictated by greedy lawyers influencing these women into tolerating prolapse and its impact on bowel, bladder, and sexual function.

Wishing You Good Health,

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

PS: Our web site WomensHealthFremont.com has many educational resources including videos to help educate you on SUI, prolapse, and other pelvic health issues

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OCs are contraindicated in several other groups of women.  These include diabetics with end-organ damage (Kidney, eye, vascular); a personal history of breast cancer or estrogen-dependent tumor; active liver disease; a history of blood clots in veins.  Women with mild high cholesterol who do not have other cardiovascular risk factors can be prescribed OCs if their low-density lipoprotein cholesterol is less than 160.  Combined OCs are also contraindicated in breast-feeding women who are within 6 weeks of delivery (Progesterone only pill OK).

Potential side effects of OCs should be discussed with patients considering OC use.  The most common side effects include nausea, headaches, breast tenderness, and breakthrough bleeding which often resolve in first few months.  A more serious, but uncommon side effect of OC use is a small increase in the risk of venous blood clots compared to women who do not use OCs; this risk may be higher in obese women.  This increase is much lower than the risk blood clots associated with pregnancy.

Unplanned pregnancy in women with medical illnesses like those described above can be disastrous for both mother and child.  Other contraceptives may be better suited for these women.  Nevertheless, contraception, while not perfect nor risk free, allows time to optimize medical conditions so as to reduce impact on pregnancy or avoid it altogether if that is what a woman desires.

Wishing You Good Health,

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

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So when should we be concerned?  A recent review of 17 studies was published in the Journal of Obstetrics & Gynecology about the cancer potential of uterine (not cervical) polyps.  Those women with uterine polyps and abnormal bleeding or in menopause only have a 5% chance of cancer.  Fortunately we can easily remove polyps by hysteroscopy to send to the lab for analysis (inserting a thin scope into the uterine cavity similar but more accurate than an old fashioned D&C).  It’s low risk, relatively painless, and requires no recovery time other than the day of the outpatient procedure.  Even if malignancy is detected, most of the time the prognosis is excellent when confined to a polyp as hysterectomy is curative.

Bleeding between periods? Heavy periods? Menopausal bleeding?  Come see us today… Modern gynecologists conveniently offer ultrasound in their offices where they can enhance detection of small intra-uterine growths by placing water in the uterus (Sonohysterography), or alternatively perform hysteroscopy.

Wishing You Good Health,

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

PS: We’re now part of the Washington Township Medical Foundation

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A recent article published in the Journal of Obstetrics & Gynecology found a number of disturbing patterns regarding overuse of HPV testing.  First, approximately one quarter of the surveyed clinicians ordered both high-risk and low-risk HPV tests.  Testing for low-risk HPV offers no benefit to patients because these HPV types are unrelated to potential cervical cancer (though they can cause warts).  Second, approximately 60% of the doctors reported routine testing for HPV for women under the age of 30, despite guidelines that strongly recommend against such testing because most occurrences of HPV in this age group have proven to be transient.  80% of women will contract HPV and most will clear it in short order thanks to their immune systems—just like a cold virus.  Third, many practitioners are co testing (PAP & HPV) annually and biannually rather than triannually as recommended. Finally, high volumes of unnecessary PAP tests are being performed on women who receive no benefit from cervical cancer screening, such as hysterectomized women without a cervix, and young women who are not yet sexually active and thus have never been exposed to the HPV virus.  It was estimated that more than half of the 75 million Pap tests performed in the United States in 2010 were probably outside of guidelines and therefore unnecessary.

National guidelines for high-risk HPV DNA testing for the following indications:

1. Conditional HPV testing of women if they have a borderline abnormal PAP.  This is appropriate for women undergoing screening in their 20’s.  If the HPV is positive then further evaluation by her gynecologist is necessary.
2. HPV testing should be used routinely in an addition to a PAP in women aged 30 years and older.  Women who test negative for both HPV and PAP are then screened at an extended interval of no less than 3 years because it excludes cervical cancer with an accuracy of over 99%.  If women test positive for HPV then they are either rescreened in one year, or if their PAP is also abnormal then they undergo further immediate evaluation—called Colposcopy.
3. HPV testing at 12-month follow-up visits for women who had previous pre-cancerous cervical changes or recent abnormal screening.

Here is a summary of cervical cancer screening:

Confused?  Just remember it is very important that you have a yearly gynecologic exam irregardless of how often your PAP test is performed. After all, there is more of you to care for than just your cervix.

Wishing You Good Health,

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

PS: We’re now part of the Washington Township Medical Foundation

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While the average age of menopause is approximately 51, it can occur anytime in your 40’s and up to age 55.  Likewise women start perimenopause months to years beforehand.  Irregular periods are a hallmark of perimenopause, reflecting your ovaries waning ability to produce female hormones in an orderly seqeunce. Most of the time, this is normal and nothing to be concerned about. However you should see your doctor if bleeding is too heavy, too often, or too prolonged.

Women may also begin to experience menopause-like symptoms, such as hot flashes, sleep distrubances, and vaginal dryness. Inconsistent hormonal fluctuations of estrogen and progesterone are responsible for the changes during perimenopause:

• Menstrual irregularity:  As ovulation becomes more erratic, the intervals between your periods may vary longer or shorter, flow may be scanty to profuse, and you may skip periods. Early perimenopause is defined as a change in menstrual cycle length of more than 7 days. Late perimenopause is characterized by two or more missed periods and longer intervals between periods.
• Hot flashes and sleep problems:  About 75% of women experience hot flashes, most commonly during late perimenopause. The intensity, duration and frequency vary. Sleep problems are often due to hot flashes or night sweats, but sometimes sleep becomes erratic even without them.
• Mood changes:  Some women experience mood swings, irritability or increased risk of depression during perimenopause. Sleep disruption from hot flashes may contribute to  these symptoms. Conversely, perisistent daily mood changes may also be caused by factors unrelated to the hormonal changes.
• Vaginal and bladder problems:  When estrogen levels diminish, vaginal tissues may lose lubrication, elasticity, and thickness making intercourse painful. Initially vaginal lubricants should be tried for sex, but if discomfort perists then vaginally applied estrogen can be restorative.  Low estrogen levels may also increase vulnerability to bladder infections. Loss of bladder control may become more prevelent and can be successfully treated.
• Decreasing fertility:  As ovulation becomes irregular, the ability to conceive decreases. However, as long as you are having periods, pregnancy remains a possibility. So  to be safe contraception should be utilizeed until you have gone 12 months without a period.
• Changes in sexual function:  During perimenopause, sexual arousal and desire may diminish. But for most women who had satisfactory sexual intimacy before menopause, this will continue through perimenopause and beyond.

Some women seek medical attention for their perimenopausal symptoms.  Possible therapies include:

• Oral contraceptives:  Birth control pills are often the most effective treatment to relieve perimenopausal symptoms because they use female hormones to create regularity—even if a women does not need them for birth control. Ultra low-dose pills can regulate periods, reduce hot flashes and vaginal dryness without weight gain.
• Progesterone therapy:  If a women has irregular periods, but cannot use oral contraceptives, then cyclic progesterone therapy (10 to 14 days each month) usually regulates periods that occur afterwards. Some women with heavy bleeding during perimenopause prefer the convenience of a progesterone containing intrauterine device—Mirena® IUD—which lasts 5 years.
• Endometrial ablation:  Endometrial ablation provides permanent relief from peristent heavy bleeding some women experience during perimenopause. During the procedure, the inside lining of the uterus is removed using a device that cauterizes it.  It takes 90 seconds and can be conveniently performed during an office visit.  It effectively reduces menstrual flow or ends it in over 90% of patients.

Finally, making healthy lifestyle choices may help ease some of the symptoms of perimenopause as well as promote good health as you age. These choices include:

• Good nutrition:  Because the risk of osteoporosis and heart disease increase at this time, a healthy diet is more important than ever. In addition, remember to consume calcium-rich foods or take a calcium supplement (1200mg) that also supplies vitamin D (600 units).  Be mindful that alcohol and caffeine may trigger hot flashes.
• Regular exercise:  Regular physical activity helps prevent weight gain, improves sleep, strengthens bones, and elevates mood.  Exercise for 30 minutes or more on most days of the week.
• Stress reduction:  Practiced regularly, stress-reduction techniques, such as meditation or yoga, can be particularly helpful during the menopausal transition.

Many women find the perimenopause perplexing.  Hopefully a little information goes a long way helping you understand and navigate this transition.

Wishing You Good Health,

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

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