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July 2011 Issue
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SPECIALTIES

Menstrual irregularities

If you are experiencing any of the symptoms listed here, contact Premier Care for Women and we will develop a treatment plan especially for you. Menstrual problems do not have to disrupt your life.

Pre-menstrual Syndrome (PMS)

If you are suffering from monthly PMS we will assist you in developing a plan to improve your PMS symptoms. After ruling out any serious conditions we can recommend a variety of treatments and lifestyle changes including medication, dietary changes, supplementation, exercise and lifestyle modifications that can greatly improve your quality of life.

Contraception

There are a variety of contraceptive choices or birth control methods to choose from. We can discuss the options with you and determine the method that is right for you.

Here are some of the choices:

These services require an examination and prescription, but you and your physician can discuss other non-prescription options such as:

Menopause

Menopause can be a time of emotional and spiritual renewal for many women, but for some, uncomfortable physical symptoms can interfere with this time in a woman's life. Premier Care for Women provides comprehensive care to help women in menopause and in the pre- or peri-menopausal stages to stay healthy and feel their best.

Menopause is defined as the stage of life when a woman's menstrual periods stop occurring regularly and eventually cease. Menopause is considered to be complete after a woman has not had a menstrual period for one full year.
Many women begin to experience symptoms during pre- or peri-menopause, the transitional phase before menopause when a woman's hormonal levels start to change, causing the decrease of estrogen and progesterone. Most of the unpleasant symptoms associated with menopause are caused by the decline in estrogen levels.

Menopause can occur any time between the ages of 40 and 55. The average age is 51. Premature menopause may occur in women under 40 if there is ovarian failure due to disease or if surgery to remove the ovaries is performed.

Symptoms of Menopause

The following are common symptoms of menopause, but not all women may experience them. Some women who do have symptoms may find them severe, while others may not be bothered by them at all.

Treatment for Women in Menopause and Peri-menopause

At Premier Care for Women, your physician will partner with you to create a treatment plan based on your preferences that takes into account your age, current health, medical history, and current symptoms,. Treatment options may include:

Diagnostic testing for women in menopause and peri-menopause may include:

With Hormone Replacement Therapy (HRT), menopausal and peri-menopausal women are prescribed a combination of estrogen and progesterone either in pill form, transdermal skin patches, vaginal inserts or as a cream. For many women, HRT provides much desired relief from severe menopausal symptoms. At Premier Care for Women, your physician will help you understand the benefits and risks of HRT and help you make the right decision.

Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy (HRT), also known as ERT (Estrogen Replacement Therapy) is medication containing one or more female hormones, most commonly estrogen, progesterone or testosterone. Some women receive estrogen-only therapy (usually women who have had their uterus removed).

HRT is most often used to treat symptoms of menopause such as "hot flashes," vaginal dryness, mood swings, sleep disorders, and decreased sexual desire. This medication may be taken in the form of a pill, a patch, or or a vaginal insert.

Menopause Symptoms and HRT

During menopause, the amount of estrogen produced by a woman's ovaries drops. These naturally occurring, low estrogen levels may cause symptoms that include hot flashes, sleep problems, mood swings, and vaginal dryness.
Within a few weeks of taking HRT most women begin to get relief from hot flashes, sleep irregularities and vaginal dryness. Short-term therapy of between two and four years still appears to be safe at this time.

Menopause and Heart Disease

Estrogen helps decrease "bad" cholesterol and increase "good" cholesterol in the bloodstream. Because lower levels of "bad" cholesterol and higher levels of "good" cholesterol are associated with a decreased risk of heart disease, researchers thought that HRT should lower risk by changing these levels.
However, recent studies have shown that this may not be the case. HRT should not be given strictly for the prevention of high cholesterol or heart disease. Rather, lifestyle changes and medications to lower cholesterol and control blood pressure are recommended for those conditions.

Menopause and Blood Clots (Thromboembolic Disease)

There may be an increased risk of blood clots from taking estrogen. Generally, this risk has been associated with the use of oral contraceptives that contain high doses of estrogen. It is further increased for women who smoke cigarettes.

Menopause and Osteoporosis

A woman's body produces less estrogen during and after menopause which can adversely affect bone strength.

Women should not take HRT solely for prevention of osteoporosis.

Other lifestyle changes, such as adding an exercise regimen to your routine and not smoking, may help in the prevention and treatment of osteoporosis as well.
In addition, there are some medications available specifically for prevention and treatment of osteoporosis. These include risedronate, calcitonin, etidronate, and alendronate.

Menopause and Breast Cancer

There may be an increased risk of breast cancer found in women taking combination hormone therapy. No increased risk of breast cancer is found in women who are taking estrogen alone.

Menopause and uterine/endometrial cancer

Taking estrogen alone causes the lining of the uterus to grow, significantly increasing the risk of cancer for women who take estrogen. Progestin, however, conteracts the effect of the estrogen by decreasing the lining of the uterus.. Most doctors will prescribe progestin to counteract the effect of the estrogen.
No difference in endometrial cancer rates have been found between women taking HRT and those who are not.

Menopause and Colon Cancer

New findings indicate that the risk of colon cancer may be lower in women who take estrogen/progestin.

Menopause and Gallstones

Several studies have shown that women who use estrogen/progestin therapy may be at increased risk of developing gallstones.

Menopause and Depression

Studies have shown that women who suffer from common vasomotor symptoms of menopause, mood swings, and sleep problems benefit from HRT in the overall quality of their life. However, there is no scientific evidence that HRT is helpful in the treatment of major depression.

Menopause and Alzheimer’s disease

Studies have not shown that HRT slows down the symptoms of help delay Alzheimer's. disease. Studies are ongoing as to whether there is any benefit to HRT with regard to other memory loss.

Side Effects from HRT

As with all medications, there are side effects associated with HRT. Some women taking HRT may experience water retention, bloating, nausea, breast soreness, mood swings, and headaches. Changing the dosage or the form of HRT may help to alleviate these side effects. Some women have irregular bleeding when they start taking HRT, but changing the dosage often eliminates this side effect.

Summary of Risks/Benefits

The WHI study shows relatively small increases in the risk of heart disease, breast cancer, blood clots, and stroke to an individual woman. However, when the entire population of postmenopausal women and the number of years a woman may be on HRT are considered -- the number of strokes, heart attacks, breast cancer cases, and blood clots appears to outweigh the protective effect of HRT on bones. Some women may still wish to consider HRT for short-term treatment of menopausal symptoms. The key is to weigh the risks associated with taking HRT against a particular woman's risk of heart disease or osteoporosis without taking HRT. Every woman is different. Therefore, your entire medical history should be evaluated individually when considering HRT.

Forms of HRT

HRT is available in various forms, including pills, patches, creams and vaginal inserts. Your health care provider will start you on a regimen that is best suited for you. It may be necessary to try more than one regimen before finding the one that works best for you.

Other Medications

Additional medications may be recommended for some women with severe symptoms from menopause, or women who are at very high risk for osteoporosis or heart disease. One of these supplemental drugs might be testosterone, a male hormone given with estrogen to relieve severe hot flashes.

Lifestyle Changes

In addition to taking HRT, there are other things that can help women adjust to the changes in life during menopause. Eating healthy foods and getting regular exercise will also help to decrease bone loss and maintain healthy heart muscle.

Contact your doctor

It is important to have regular checkups with your health care provider when taking HRT. If you have continual vaginal bleeding during HRT, or for any other unusual symptoms, call your health care provider.

Annual PAP and GYN exams

A yearly pelvic exam and Pap smear is incredibly important for your health. Pap smears are early detectors of cervical cancer. Your physician will collect cells from your cervix to determine the presence of infection, inflammation, and most importantly, abnormal cells that may indicate cervical cancer. Your physician at Premier Care for Women may recommend a repeat Pap smear to ensure accuracy if your Pap smear indicates an abnormality. Your physician may recommend one or all of the following treatment options:

Regular Pap smears and pelvic exams can detect pre-cancerous conditions early, increasing the likelihood of successful treatment.

The National Cancer Institute advises women who are sexually active or who have reached 18 years old to have yearly pelvic exams and Pap smears. This is a healthy habit that you should continue throughout your life, regardless of age. If you have had a hysterectomy, consult your physician as to whether or not you need regular Pap smears.

Mammograms and Breast Self-Exams

Premier Care for Women provides comprehensive breast care. A breast exam is an integral part of your yearly exam. Diagnostic services may be required such as biopsy or ultrasound in addition to mammograms.

How to Perform a Monthly Breast Self-Exam

While a breast exam is a part of your yearly exam, we encourage you to follow the American Cancer Society's guidelines for monthly breast self-exams for women 20 and older. The American Cancer Society also recommends:

The best time to perform a monthly breast self-exam is two to three days after your menstrual period ends. If you no longer menstruate, choose a date you'll remember, such as the 15th of each month.

First Look for Any Changes

Become familiar with how your breasts usually look and feel. Stand in front of a mirror and look for any changes while in the following positions:

Examine each breast for anything out of the ordinary, such as puckering, dimpling, or scaliness. Also check for any distortions or discoloration, such as redness, irritation, ulcers, and sores that do not heal properly, or changes in any moles. Next, inspect each nipple for any changes in size, shape, color, or location. Make note of any flattening, dimpling, indentation, retraction, or discharge.

Next, Feel for Any Changes

Lie on your back and place a small pillow or folded towel under your shoulder. You may use lotion or powder to help your fingers glide easily over the skin. Feel your breast tissue by pressing your three middle fingers in small, overlapping areas. Be sure to examine your whole breast. Take your time and follow a definite pattern, such as up and down lines or strips. With one arm raised, start in the underarm area and move your fingers downward little by little until you reach the area below the breast. Then move your fingers slightly toward the middle and slowly move back up. Go up and down until the entire area is covered, from collarbone to just below the breasts and from armpits to breastbone. You can do this exam either lying on your back or standing in the shower. Repeat this procedure for each breast. Report any breast changes, lumps, or knots to your physician immediately.

Infertility

Premier Care for Women offers the most advanced and successful treatments for infertility, including the following:

Tubal Ligation (also known as sterilization surgery)

Tubal ligation is the surgical procedure commonly known as "tying the tubes". A woman's fallopian tubes transport mature eggs from the ovary to the uterus approximately once a month. When sperm travels from the uterus through the fallopian tubes toward the ovary, it may encounter a mature egg -- and fertilization may result. Tubal ligation permanently sterilizes a woman by preventing transport of the egg (ovum) to the uterus, and by blocking the passage of sperm up the tube to the ovulating ovary where fertilization normally occurs.

Tubal ligation is done in the hospital or outpatient surgical clinic while the patient is under anesthesia. One or two small incisions are made in the abdomen (usually near the navel), and a laparoscope (a device similar to a small telescope on a flexible tube) is inserted. Using instruments that are inserted through the laparoscope, the fallopian tubes are coagulated (burned), sealed shut with cautery, or with a small clip placed on the tube. The skin incision is then stitched closed. The patient is able to return home a few hours after the procedure.

Tubal ligation may be recommended for adult women who are certain that they wish to prevent future pregnancies (permanent sterilization). Keep in mind that tubal sterilization is not a trivial surgical procedure, and that it carries some risk.

Tubal ligation is not recommended as a temporary or reversible procedure -- it is considered a permanent form of birth control. The operation can sometimes be reversed if a woman later chooses to become pregnant. However, this requires a major surgical procedure. Following tubal ligation reversal, about 50% to 80% of women eventually become pregnant.

Essure

Couples looking for permanent contraception now have a new option other than tubal ligation or vasectomy. Premier Care for Women can offer Essure, a non-surgical procedure for women that involves placing small coils in the fallopian tubes. Over time, scar tissue develops around these coils, which blocks the fallopian tubes and prevents conception. An incision is not required and after the procedure patients can go home or back to work.

The Essure procedure requires general anesthesia. During the procedure, doctors use a thin, telescope-type instrument called a hysteroscope and insert it through the cervix to reach the fallopian tubes. A camera on the end of the scope allows them to see into the uterus. Doctors place a small, soft coil in the fallopian tube, where it expands and fills the tube. Doctors then move to the other side to place another coil in the other tube. The entire procedure takes less than 30 minutes.

While the procedure itself is quick, it takes longer for the scar tissue to develop and permanently block the tubes. Women must use another form of contraception for at least three months. They also need to return 12 weeks after the procedure to have a special x-ray to confirm that the tubes are closed.
Studies show that at three months, 96 percent of women’s tubes are closed and 100 percent are closed at six months. In clinical trials involving more than 600 women, there were no pregnancies following the procedure. As with other birth control methods, the Essure system is not expected to be 100 percent effective; however the manufacturer cites a 99.8 percent effectiveness rate in two years of follow up.

Endometrial Ablation

An excellent technique for decreasing menstrual flow without a hysterectomy. There is no effect on the ovaries and, therefore, no need for hormone therapy. An ablation procedure is performed as an outpatient surgery, with patient's returning home the same day, and without the need for an abdominal or vaginal incision.

Uterine Prolapse (also referred to as Pelvic relaxation or Pelvic floor hernia)

The falling or sliding of the uterus from its normal position in the pelvic cavity into the vaginal canal. The uterus is normally supported by pelvic connective tissue and the pubococcygeus muscle, and held in position by special ligaments. Weakening of these tissues allows the uterus to descend into the vaginal canal. Tissue trauma sustained during childbirth, especially with large babies or difficult labor and delivery, is typically the cause of muscle weakness. The loss of muscle tone and the relaxation of muscles, which are both associated with normal aging and a reduction in the female hormone estrogen, are also thought to play an important role in the development of uterine prolapse. Uterine prolapse occurs most commonly in women who have had one or more vaginal births, and in Caucasian women.

Other conditions associated with an increased risk of developing problems with the supportive tissues of the uterus include obesity and chronic coughing or straining. Obesity places additional strain on the supportive muscles of the pelvis, as does excessive coughing caused by lung conditions such as chronic bronchitis or asthma. Chronic constipation and the bearing-down associated with it causes weakness in these muscles.

Symptoms may include the following:

Treatment of Uterine Prolapse

A vaginal pessary (an object inserted into the vagina to hold the uterus in place) may be used as a temporary or permanent form of treatment. Vaginal pessaries come in many shapes and sizes, and they must be fitted for each woman individually. Vaginal pessaries are effective for many women with uterine prolapse, however, depending on the extent of the prolapse and vaginal wall relaxation, pessaries may be of little or no use. In addition to the limits of their use in treatment there are other drawbacks. Pessaries may cause an irritating and abnormal smelling discharge, and they require periodic cleaning, usually done by the physician. In some women they rub on and irritate the vaginal mucosa and in some cases may erode and cause ulcerations. Some types of pessaries may interfere with normal sexual intercourse by limiting the depth of penetration. If the woman is obese, attaining and maintaining optimal weight is recommended. Heavy lifting or straining should be avoided.

There are some surgical procedures that can be done without removing the uterus, such as a sacral colpopexy. This procedure involves the use of surgical mesh for supporting the uterus.

Most surgery should be deferred until symptoms are significant enough to outweigh the risks. The surgical approach depends on:

When indicated, a vaginal hysterectomy is performed. Any sagging of the vaginal walls, urethra, bladder, or rectum can be surgically corrected at the same time.

Laparoscopic Hysterectomy

Laparoscopic assistance in the removal of the uterus allows for a shorter hospital stay and a quicker recovery than after an abdominal hysterectomy. Very small incisions are made in the abdomen and specialized instruments are used to perform the operation. This approach may be useful for individuals with history of endometriosis, fibroids or a need to evaluate the ovaries. Patients usually go home in one day after surgery and are able to resume normal activities after four weeks.

Abnormal Pap Results

Getting a yearly pelvic exam and Pap smear is the most important thing you can do for your health and well being. Pap smears are early detectors of cervical cancer. If your Pap smear results indicate an abnormality, your physician at Premier Care may indicate any or all of the following treatment options:

Pelvic Pain

If pelvic pain is caused by any of the following, your physician will want to develop a treatment plan for you:

Depending on the cause of your pelvic pain, treatment options may include:

At Premier Care for Women we can help you alleviate or manage pelvic pain by identifying the causes and developing a personalized treatment plan. Some pelvic pain is normal and is related to monthly ovulation or related to pre-menstrual conditions. However, if pelvic pain has become a chronic, annoying disruption in your life, this could indicate a more serious condition. Pelvic pain that comes on suddenly or is severe could indicate a serious condition such as a ruptured tubal pregnancy or appendicitis. Seek emergency medical treatment immediately

Sexually Transmitted Diseases (STDs)

At Premier Care for Women we provide treatment for all sexually transmitted diseases (STDs) We hold the confidentiality of our patients in high regard.

STDs are infectious diseases that are transmitted through sexual contact. Some of the most common STDs are:

Other conditions that may also be sexually transmitted are:

STDs may not cause any symptoms at first, and some STD symptoms may imitate other diseases. Also, some STDs can be passed from a mother to her baby either before or during birth and can be life threatening to the baby. If you suspect that you have symptoms of an STD, or if you believe you have been exposed to an STD, call our office for an appointment today. Prompt treatment can often prevent future, potentially more serious complications.

Prevention of STDs

Sexually active women can protect themselves by taking precautions such as these:

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