Women's Health FAQ
What is menopause?
Menopause is the cessation of a woman’s menstrual cycles. Physiologically, this is when the ovaries stop making estrogen and as a result the lining of the uterus (endometrium) is no longer stimulated to cycle. While most people think of hot flashes as the quintessential menopausal symptom, menopause affects nearly every body organ and system. The average age of menopause is 51 years of age and had been for centuries. A woman born in 1900 had a life expectancy of 44 years. A woman born in 2000, however, has a life expectancy of 86 years. Many of our great-grandmothers never lived to experience menopause or spent few years in that stage of life. Women now spend nearly half of their life in that stage. As a result, maintaining quality of life and a vigorous lifestyle are important. As women mature and begin to experience menopause, it is paramount that they have a physician who understands the physiology and challenges of that stage of life. While a natural process, menopause introduces a whole new set of experiences and physical challenges for a woman.
For menopausal women, does taking hormonal therapy increase the risk for breast cancer?
The concern for a connection between Hormone Replacement Therapy (HRT) and breast cancer is a complex and frequently misunderstood subject. Reports in the media are often sensationalized and misleading. For example: In July 2002 the initial findings of the Women’s Health Initiative (WHI) showed a 20% increase in breast cancers in women taking a combination of estrogen and progestin when compared to the placebo group. In a panic, many women stopped their HRT. Unreported was a group of women taking estrogen alone, which did not show an increase. Seven-year followup, published Fall 2004, actually showed a decrease in breast cancers. Hormone therapy may increase the chance of certain women to have a blood clot or stroke. The choice to start HRT is one that should be individualized and based upon a thorough discussion of risks and benefits. The patient and her physician will explore both her personal and family histories in detail. In addition to treating menopausal symptoms, HRT has been shown to decrease the risk of osteoporosis and colon cancer.
How often are mammograms needed?
It is certainly true that the subject of breast cancer screening can be very confusing. Some medical organizations differ on their recommendations for women between ages 40 and 49. Those supporting yearly mammograms for this age group quote studies showing that a breast cancer can be seen on mammogram 19 months before it can be felt on exam; thus making yearly mammograms prudent. Organizations supporting every other year mammograms in this age group are concerned with the false positive reports that lead to a large number of benign biopsies. Controversy aside, the following screening methods are supported by scientific studies and consensus of expert opinions: 1) Mammograms every 1 to 2 years for women aged 40 to 49. 2) Mammograms every year after 50 years of age. 3) Monthly self-breast exam can be recommended to all women. 4) All women should have a clinical breast exam as part of their yearly physical.
What is Group B Strep Infection?
GBS (group B strep) is one of the many bacteria that usually do not cause serious illness. It may be found in the digestive, urinary, and reproductive tracts of men and women. In women it is most often found in the vagina and rectum. GBS is not a sexually transmitted disease. With pregnancy the bacteria can be passed from the mother to the baby during delivery. Although the chance that the baby will get GBS infection is uncommon, it can be very serious. The infection can cause inflammation of the baby’s blood, lungs, brain, or spinal cord. GBS infection can lead to death in about 5% of infected babies. In order to reduce the risk of the baby getting infected, a culture of the mother is taken between 35 and 37 weeks of pregnancy. If the test results are positive, showing that GBS is present, antibiotics are given during labor to help prevent the baby from acquiring the infection.
What is endometriosis?
Endometriosis is a condition where the lining inside a woman’s uterus is located outside of the uterus, typically in the pelvis or abdomen. It occurs in up to 10% of women. It can cause pelvic pain, painful periods, and pain with physical intimacy. Diagnosis is often based on a woman’s history as told to and discussed with her physician. Definitive diagnosis is made by surgical evaluation with biopsy. Surgical evaluation is often done with laparoscopy. Endometriosis can be treated with medicines such as non-steroidal pain medicines, birth control pills, as well as other forms of hormone therapy. Sometimes surgery is needed to adequately treat this condition. You need to understand that endometriosis is only one of many potential causes of pelvic pain, and you should discuss your pelvic pain symptoms with your physician.
What are the benefits of ultrasounds during pregnancy?
Approximately 70% of pregnant women in the United States undergo an ultrasound as part of their prenatal care. In a low-risk pregnancy with a healthy mom, the ultrasound is used as a screening tool to evaluate the number of babies, the growth of the baby, and the basic anatomy of the baby. It is estimated that 70% to 90% of anatomic abnormalities can be detected with a screening ultrasound. While most anatomic abnormalities cannot be corrected during pregnancy, it is often quite helpful to parents and to the physician to be aware of upcoming problems before the birth. In addition, there are numerous medical conditions that can complicate pregnancy in which an ultrasound may be extremely helpful in evaluating the condition of the baby. These include asthma, thyroid disorders, high blood pressure, diabetes, lupus and others. In these medically complicated pregnancies, ultrasounds can be particularly helpful in monitoring the growth and health of your baby.
How much calcium do I need?
The National Osteoporosis Foundation recommends that adult men and women should get 1000 to 1200 mg of calcium daily. The best sources of calcium are dietary. Calcium is best obtained in dietary products (milk, cheese, cottage cheese and yogurts). Each serving of dairy products contains about 300 mg of calcium. There are many other calcium-fortified foods and drinks. National surveys show that most women and young girls consume less than half of their daily requirement. Since maximum bone density is achieved by age 30-50, this is important for young women, not just menopausal women. The goal should be to prevent osteoporosis, by achieving and then maintaining maximum bone density. For those women who do not consume adequate dietary calcium, good calcium supplements are available. Recent studies have shown that dietary supplementation with both calcium and vitamin D also decreases your lifetime risk for colon cancer. A discussion of calcium intake and other preventative health issues should be an important part of your next annual physical exam.
Why should I be tested for diabetes during pregnancy?
Women who have gestational diabetes – diabetes during pregnancy – are at increased risk for very large infants, difficult labor and deliveries, excessive bleeding after delivery, and cesarean sections. A subset of women with gestational diabetes is at increased risk for stillbirth. For many women with gestational diabetes, high sugar levels can be controlled by diet and exercise alone. Medications such as glyburide and insulin are necessary for another group of women in addition to diet and exercise. Identifying women with gestational diabetes helps obstetricians decrease these risks and long-term complications. It is also important to identify women with gestational diabetes because their babies need to be watched closely for low blood glucose, low calcium and magnesium, breathing problems, and jaundice after delivery.
What testing is available for older moms to diagnose chromosomal abnormalities?
Expectant moms over the age of 35 are at an increasing risk for giving birth to a child with a chromosomal abnormality, such as Down Syndrome. Traditionally, women of Advanced Maternal Age (AMA) have been offered either Chorionic Villus Sampling (CVS) or an amniocentesis. Both of these tests will diagnose 99.9% of chromosomal abnormalities. However, they also have about a 1/300 chance of miscarriage. There is now a non-invasive screening test available. This test is a combination of an early ultrasound to measure the Nuchal Translucency (a fluid collection behind the neck of the baby) and a maternal blood test. This testing can be performed between 11 and 14 weeks of gestation and will detect 90% of babies with Down Syndrome with only a 5% false-positive rate. Additionally, the test will identify 40% of serious heart defects. Moms with a positive screening test may then choose to have an amniocentesis, knowing that the benefits of doing so will probably outweigh any risks. Academy Women’s Healthcare is pleased to be one of only two locations in Southern Colorado where this testing can be performed.
Is incontinence part of the normal aging process?
No, it is not a normal part of the aging process and can often be treated. Urinary incontinence is more common in women than in men. It affects 10-25% of women under the age of 65 and 15-30% of women older than 60. The most common type is urge incontinence. It occurs if the muscle wall of the bladder is overactive. This leads to loss or leakage of urine. Stress incontinence occurs when the pressure inside the bladder (which moves out urine) is greater than the pressure in the urethra (which keeps urine in). It causes loss of urine during coughing, laughing, sneezing, or exercise. A preliminary diagnosis can be made with a physical examination, history, simple office and laboratory tests. Treatment options include physical therapy, behavioral modifications, medications and surgery. Please see your gynecologist to discuss which options are best for you.
What is premenstrual syndrome (PMS)?
Premenstrual symptoms are a common part of the monthly cycle. In fact, at least 85% of women who menstruate have at least one premenstrual symptom. Common symptoms are PMS are depression, angry outbursts, irritability and crying spells. Physical symptoms include: tender breasts, bloating and weight gain, headache, swelling of the hands or feet aches and pains. The symptoms must be present in the 5 days prior to menses and disappear by day 4 after the period stops. Maintaining a symptom diary and meeting with your gynecologist can help you make the diagnosis. Treatment may include diet, exercise, vitamins and supplements, as well as several medications