Your Daughter’s First Gynecology Exam

Patricia
Patricia B. Janicek DNP, WHNP-BC

As a women’s health care provider, one of the most common questions I am asked from mothers of teen girls during an annual exam is “When do I bring my daughter in for her first gynecology exam?”.

The American College of Obstetricians and Gynecologists (ACOG) recommends that girls first see a gynecologist when they are between the ages of 10 and 15. This is an opportunity to transition an adolescent from the pediatric to the adult health care setting in the most non-threatening way possible. A general health exam is usually all that is needed.

What if my daughter isn’t ready to start the transition to adult care by the time she is 15?

Adolescence is a complex period of development that involves distinct developmental transitions. It is importance to recognize that growth in one area (intellectual, physical, or emotional) may or may not correspond with the teen’s chronological age. All teens, on the other hand, are expected to deal with peer pressures associated with their school (social) setting. Thinking in these terms guides the gynecologist in providing a supportive environment to discuss everything from body image to healthy relationships. Understanding that it can be normal to get a period as young as 9 and as late as 15 is importance during this fragile time. It also allows teens to make sense of confusion or challenges that they may face with school or at home.

The first wellness exam in the gynecology office can provide three main purposes:

  1. To provide accurate information and confidential answers to questions regarding her changing body, menstruation, sex, and sexuality.
  2. To learn about healthy lifestyles, sexually transmitted diseases, and pregnancy prevention.
  3. To provide evaluation and treatment for teenagers who experience abnormal vaginal bleeding, painful periods, unusual vaginal secretions, or other problems that may be associated with reproductive health.

I made an appointment for my daughter’s first gynecology exam, but she is refusing to go!

Providing your adolescent daughter with an opportunity to transition to women’s health care may sound like a great idea to an adult but the message received by the “teen brain” can be quite different.

Most teen girls know that their mothers see a gynecologist regularly. It has been stigmatized as a painful rite of passage to endure ones first pelvic exam. It is no wonder that the idea of seeing a gynecologist for the first time can make any adolescent feel nervous, embarrassed, or even scared. Studies show that mothers have the biggest impact on their daughters self esteem. Start by reassuring your daughter that even though there are a lot of different parts of the gynecological visit, the actual physical exam — and the part she might feel most uncomfortable about — doesn’t take long or include very much.

Explaining why the visit is necessary, giving the adolescent a sense of what to expect, and addressing fears are important precursors to this first visit. Reassure your daughter that the visit allows both teen and parent the chance to visit together to further alleviate fears and develop trust. Ask her if she would like you to be in the exam room with her. Whatever your daughter decides, allow her some time alone with the provider. Remember that alone time will allow her to recognize the provider as an objective and knowledgeable person to talk to about any concerns she may have in the future. What a great way for your daughter to develop a relationship with her gynecologist, so that she is comfortable sharing personal information in the future!

My daughter just had her first with the gynecologist, now what?

Congratulations on taking that first step to helping empower your daughter’s journey into women’s health! Once you and your daughter have gone to the first visit, encourage her to talk about the experience (as much as she is comfortable). If she indicates that the provider made her feel uncomfortable, discuss finding a new one. Once she starts, your daughter should continue to go for gynecologic visits every year to keep her informed and healthy.

 

Zika, Our Community, and You

Michelle
Michelle Szymanowski, RNC, MSN, WHNP-BC

Zika in Our Community

As of May 2016, there have only been three identified cases of Zika in the state of Arizona. All three were acquired during travel. As of this time, there have been NO cases of transmission in Arizona. We as a community need to be diligent about keeping it out of our community and avoid any potential outbreak.

What is Zika?

Zika is a virus that has been linked to birth defects if a pregnant woman becomes infected during pregnancy. These birth defects can include microcephaly (a small head), and some sensory deficits such as eye abnormalities. At this time, we do not know the extent of the birth defects as we are still gathering information about babies born to moms who were infected with Zika. Because of both the known and the unknown birth defects that are associated with Zika, all women who are currently pregnant, as well as women who are considering pregnancy, are encouraged to speak with their health care providers to find out how to best protect themselves and their babies.

Zika Symptoms

Recent studies show 80% of people infected with Zika have no symptoms. For those who have symptoms, the symptoms can include fever, joint pain, achiness, and red eyes. Most of these are symptoms similar to many other viral infections. Therefore, it is impossible to diagnose Zika by symptoms alone. There have been no cases reported in Arizona that were acquired here. The three reported cases were all attributed to travel or from having sexual contact with a person who traveled to one of the communities known to be infected with Zika. If you have traveled to South America or the Caribbean two weeks before developing these symptoms, you should contact your healthcare provider. Also, if you have had sexual contact with someone who traveled recently to a community of known infection, you should speak with your healthcare provider.

Preventing Zika Infection

Since Zika is spread through mosquito bites, the best way to prevent infection is to avoid getting bit especially if you are traveling to a Zika infected area. Travelers should check with the Center for Disease Control (CDC) to see if the area they are traveling to is experiencing an outbreak of Zika. (Note: Visit the CDC for the most up-to-date Zika-infected communities, statistics, and information.) If traveling to Zika-infected areas, you should use an insect repellant such as DEET the entire time you are there.

Because 80% of infected individuals will never have symptoms, many people will never know they became infected while on vacation. For this reason, you need to apply insect repellant three times per day for three weeks when you return from vacation to avoid passing the infection on to our mosquitoes. The goal is to prevent transmission of Zika to our mosquitoes.

The list of recommended insect repellents are:
DEET (found in Off!, Cutter, Sawyer, Ultrathon)*
Picardin (Cutter Advanced, Skin So Soft Gug Guard Plus)*
IRS3535 (Skin So Soft Bug Guard Plus, Expedition, SkinSmart)*
Oil of Lemon Eucalyptus (Repel)*- not for use on children under the age of 3
Para-methane-dio (Repel)*- not for use on children under the age of 3
(*Name brands are provided for your information only; we do not endorse any specific products.)

Insect repellent is not safe to use on infants under the age of two months. Consider mosquito netting for infants younger than two months.

Additionally, you can protect yourself by eliminating all standing water around and in your home. The mosquito that carries Zika only needs a capful of water in which to breed. Be sure to remove objects such as children’s toys, pet food bowls, and old tires from your yard and surrounding area. Do not overwater plants in pots. The trays to catch the water can become breeding areas for mosquitoes both inside and outside your home. Protect the interior of your home by using screens on windows and doors that are free of holes and tears.

What about Pregnancy?

Pregnant women should be advised to avoid all travel to Zika-infected communities for the duration of their pregnancy. If their sexual partner travels to these areas, the recommendation is they use condoms (the entire time, every time, from start to finish) for six months. The virus lasts longer in semen than blood. For this reason, we know that men who were exposed can remain infectious for at least 62 days, and possibly longer. Because Zika may last longer and we are unsure of the effects on the fetus, the CDC recommends pregnant women use condoms for the duration of the pregnancy if their sexual partner has traveled to an infected community.

Women who are not yet pregnant and travel to these areas should avoid becoming pregnant for eight weeks even if they are asymptomatic. Men should avoid getting anyone pregnant for six months upon return. Remember, 80% of patients will never know that they were infected when traveling to Zika infected communities, so assume that all travelers were infected.

Together we can all prevent the spread of Zika into our community if we all do our part and educate those around us! For additional information, be sure to visit the CDC and the American College of Obstetricians and Gynecologists.

www.cdc.gov/zika/geo/index.html

http://www.acog.org/About-ACOG/ACOG-Departments/Zika-Virus/For-Patients

http://www.marchofdimes.org/complications/zika-virus-and-pregnancy.aspx

Understanding Healthcare Insurance – 102

Monica Alderman, Chandler Office

Most insurance policies do not cover all your medical costs, but they do help you pay your medical bills.

Your health insurance plan premium is the cost most people pay on a monthly basis. Your premium is the payment you and your employer make to your health insurance company to keep your coverage active.

A deductible is a set amount you have to pay every plan year for your medical bills before your insurance company starts paying.

Example: Your plan has a $1,000 deductible. That means you pay your medical providers yourself for charges up to $1,000 per plan year. Once you reach or meet the deductible, your healthcare insurance plan starts helping to pay your medical bills.

Let’s see how this might look:

Your annual deductible $1,000

X-ray charges $400 (you pay)

New deductible balance $600

Urgent Care visit $150 (you pay)

New deductible balance $450

Specialist office visit $150 (you pay)

New deductible balance $300

ER visit $300 (you pay)

Your deductible is met $0

Coinsurance refers to money an individual is required to pay for services after paying the deductible amount out of pocket. Coinsurance is often specified as a percentage.

Example: You have an 80/20 plan. An 80/20 plan means your insurance plan pays 80% of your qualifying medical costs after you meet your deductible. You are responsible for paying the remaining 20%.

Let’s see how this might look:

Deductible is met $0

X-ray charges $400
80% – insurance $320
20% – you pay $ 80

Coinsurance is different and separate from any copayment. A copayment or copay is a fixed amount paid each time an insured person accesses a qualifying medical service.

Example: You have a $20 copayment for non-routine doctor visits meaning you must pay $20 each time you see your doctor for an illness or a problem. Copayments are different from coinsurance. A copayment may include all services provided at the visit or services provided in addition to the office visit may apply to the deductible and co-insurance in addition to the copayment.

Insurance companies define Primary Care Physicians (PCPs) as Pediatricians, Family Practitioners, or Internists. All other physicians are considered to be Specialists, including OB/GYNs. However, some insurance policies make an exception and include OB/GYNs in their list of PCPs.

Each medical insurance policy is different, and yours may or may not include each of the features discussed above. Always consult you plan document which can be accessed by mail or online, for these details. Contact your insurance company or your employer’s human resources department if you have further questions.

Polycystic Ovarian Syndrome (PCOS)

Jackie
Jackie Johnstone, CNM

So you have heard about it but what is it all about?

PCOS is the most common hormonal disorder among women of reproductive age. It occurs when a woman’s levels of estrogen and progesterone are out of balance which then leads to the growth of ovarian cysts and a multitude of other things.

PCOS has been linked to an increased risk of developing other medical conditions such as insulin resistance, type 2 diabetes, high cholesterol, high blood pressure and heart disease.

The STATS:

*10% women of childbearing age are estimated to have PCOS
*50% of women are undiagnosed
*50% will develop type 2 diabetes or pre-diabetes before the age of 40
*4.3 billion is the estimated cost to the healthcare system to diagnose and treat those with PCOS
*The risk of developing endometrial cancer is increased by 3x
*PCOS is responsible for 70% of infertility issues in women who have difficulty ovulating

Who is at risk?

*Those with a family history.
*Those who have increased insulin levels (increased insulin levels stimulate increased male hormone production)
*Those who are obese, especially if it began before puberty.

What are the signs and symptoms?

* Irregular/no periods
*Excess facial and/or body hair
*Severe acne
*Multiple cysts on the ovaries
*Weight gain or obesity
*Insulin Resistance
* Anxiety/depression

How is PCOS diagnosed?

According to the American Society for Reproductive Medicine there must be 2 of the 3 following signs and symptoms:
1.) Irregular ovulation or no ovulation
2.) Signs of increased androgen (male hormone) levels
3.) Multiple small cysts on the ovaries (this alone cannot diagnose PCOS)

How is it treated?

There is no cure for PCOs but the main focus is to control the symptoms so that the effects of PCOS on the rest of the body are minimal. Measures include: improving insulin sensitivity, restoring normal ovulation and decreasing androgen levels.

The key factors in improving these measures boil down to diet – low glycemic index diet, exercise – increasing physical activity and emotional well-being.

With PCOS, correcting abnormal hormone levels, losing weight and managing cosmetic concerns are key for those not planning on pregnancy. If pregnancy is desired losing weight and promoting ovulation is key! Medications are often used to help regulate periods, control hair loss and acne, as well as help with insulin resistance. Medications can also help decrease long-term complications such as high cholesterol and heart disease.

PCOS is very complex and not always easy to understand but with a little help, it can be managed!

Sexually Transmitted Disease

Guest blogger, Meghan Delaney, WHNP-BC, C-EFM, talks about some of the basics of Sexually Transmitted Disease (STD). It does not just happen to someone else. The statistics are startling so it is important to know what to do if you suspect STDs.

Sexually transmitted diseases are those that are passed from one person to another via sexual contact and include Chlamydia, gonorrhea, syphilis, Human Papilloma Virus (HPV), Herpes Simplex Virus, Hepatitis, and HIV. These diseases can be spread via intercourse but some, including herpes and HPV, can be spread merely by genital contact.

Many STDs can be present without symptoms and, if they remain untreated, can result in long-term health consequences including damage to fallopian tubes leading to increased risk of infertility in the future. As a result, it is recommended that women under the age of 26 get routine annual Chlamydia and Gonorrhea testing as part of their Women’s Wellness exam and more frequent comprehensive STD testing with partner changes.

STD prevention is an important part of maintaining your female sexual health. If you are sexually active, it is important that a condom is used and used correctly with all sexual encounters until you and your partner have both been tested and treated for any STD, if present.

Southwest Contemporary Women’s Care provides comprehensive STD testing, treatment, and counseling. Please call our office to schedule routine STD testing or further discuss safe sex practices with one of our physicians or nurse practitioners.

For more information on STDs, click here to view the CDCs infographic, Sexually Transmitted Infections Among Young Americans.

 

Resources

Centers for Disease Control. (2016). Adolescents and STDs. Retrieved from

https://www.cdc.gov/std/life-stages-populations/stdfact-teens.htm

Centers for Disease Control. (October 2016). Reported STDs in the United States. Retrieved

from https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/std-trends-508.pdf

 

 

Overcoming Fear of Mammography

Patricia
Patricia B. Janicek DNP, WHNP-BC

The American College of Obstetricians and Gynecologists, the American College of Radiology, the American Cancer Society, and the Society of Breast Imaging recommend starting annual mammograms at age 40.   Women who have immediate family members who have dealt with breast cancer should mention it to their physicians to determine if a mammogram should be ordered before age 40.

A mammogram is simply an x-ray of the breast. It has been proven to be the best screening option for early diagnosis of breast cancer. Why, then, do so many women avoid mammograms?  Let’s explore this topic by acknowledging our mammogram fears!

Pain

Some women do find the examination to be uncomfortable, especially if they are premenopausal. Many women do not realize that the pain experienced from compression of the breasts is very brief. Taking x-rays should take only seconds in each view. In fact, the entire exam should take only 15 minutes in total.  There are ways to diminish any discomfort experienced during your exam if you are concerned with having tender breasts.  Schedule your mammogram for the week after your period, and avoid caffeine for 24 hours prior, will help to minimize the discomfort from the compression of the exam significantly.

Radiation

The amount of radiation emitted in a mammogram is very small, less than a standard chest x-ray (.4mSv). To put dose into perspective, people in the US are normally exposed to an average of about 3mSv of radiation each year just from their natural surroundings. This is called background radiation. The dose of radiation used for a screening mammogram of both breasts is about the same amount of radiation a woman would get from her natural surroundings over about seven weeks.

The amount of radiation that touches the rest of the body, called scatter radiation, is minuscule and does not cause any harm. The benefits of mammography clearly outweigh the risks of radiation exposure.

The Unknown

Not knowing what to expect before an exam can be frightening, especially if you’ve been hearing from others or reading online about experiences that other women have had.

Share your concerns with your provider during your annual exam. They can answer questions as well as provide you with information from reliable resources. Share your concerns, especially if you have had previous painful experiences, with your mammographer. Use this time to provide feedback as well.

Possible Abnormal Results

Many women avoid annual mammograms for just this reason. What if they find something wrong? Most findings in screening mammograms are benign; in fact, 90% is considered normal. But fears over a cancer diagnosis can produce overwhelming anxiety for some women. These fears are understandable; however, unfortunately postponing a mammogram over potential bad news can actually prevent early detection of cancer when it is most treatable. Finding breast cancer early reduces your risk of dying from the disease by 25-30% or more. Women are eligible for screening mammograms at the age of 40, or earlier if they are at high risk. So make that appointment, and go.

Solution

Mammography technology has evolved over the years. A 3D mammogram is a more accurate way to screen for breast cancer.  Conventional 2D mammograms provide doctors with a 2D image to evaluate the breast.  Such a view can be limiting due to overlapping layers of tissue, which can sometimes produce unclear results, false alarms, or worse – cancer being missed.

The Genius 3D mammograms deliver a series of detailed breast images, allowing your doctor to evaluate your breasts layer by layer better. Genius 3D exams are FDA approved, and over 100 clinical studies have shown that by using this technology, doctors can screen for breast cancer with much greater accuracy – regardless of a woman’s age or breast density.

Greater accuracy means better breast cancer detection and a reduced chance of being called back for additional screenings. Any woman who is due to have a traditional mammogram can elect to have a Genius 3D exam.  They are covered and paid for by Medicare, as well as a growing number of private insurers.  Again, check with your health insurance provider.

The Genius 3D exam is superior to a conventional 2D mammogram which is why many women are switching. Since 2011, over 8 million women in the US have had a Genius 3D exam.

The 3D experience is comparable to a 2D mammogram. With the latest low dose mammogram technology, the 3D scan takes less than four seconds.  It involves a low dose of radiation that is comparable to conventional 2D exams and is well below the safe level set by the FDA.

Consider the difference between looking at a single sheet of paper versus flipping through a book. That is the difference between viewing a 2D and 3D mammogram.  Radiologists view “slice after slice” of the breast rather than a single image.

In 2014 alone, more than 200,000 women were diagnosed with an invasive form of breast cancer. That is why innovative screening technology that allows for better, earlier breast cancer detection is critical.

Call SWCWC today to schedule your well-woman exam and your Genius 3D mammogram!

What’s the Matter With My Bladder?

Amber
Amber Scrivner, RNC, OGNP

Do you have pain, pressure, urinary frequency, and/or urgency? Are you up several times at night to urinate and have pain with intercourse? Are your urinary symptoms worse with your menstrual cycle? If this sounds familiar, you may have Interstitial Cystitis (IC) or Bladder Pain Syndrome (BPS).

It is estimated that 3.4 to 7.8 million women in the US have symptoms of IC. The number is even larger when factoring the number of men and children diagnosed with IC. It can occur in women of any age and tends to run in families.

The cause of IC is still a medical mystery. Some patients note their symptoms started after a traumatic event. Typical events are falls, car accidents, pelvic surgery, or exposure to chemicals in a swimming pool. Another recent factor is ketamine drug exposure. Ketamine is known to cause bladder ulceration and damage.

IC can be diagnosed with a variety of tests. The Pelvic Pain and Urgency/Frequency Patient Symptom Scale (PUF) questionnaire helps with the diagnosis of IC. A score below 10 typically indicates the patient does not have IC. A PUF score between 10 and 20 is suspicious for IC and above 20 usually indicates IC as a probable diagnosis.

Treatment for IC includes dietary changes, stress management, pelvic floor physical therapy, oral medications, and bladder instillations. Dietary changes are often the first change recommended for patients. Caffeine is one of the worst offenders for patients with IC and the most challenging for patients to give up. Fruit juices, cranberry juice, sodas, tomato-based products, multivitamins, alcohol, chocolate, and artificial sweeteners are all triggers for IC.

A diagnosis of IC can be very challenging and upsetting to patients. However, providers who diagnose and treat IC find it to be very rewarding. It is important to remember you are not alone, and there are many ways to manage a diagnosis of IC.

Call to schedule an appointment with one of our providers.

For additional IC resources, visit:
www.ic-network.com
www.icawareness.com
www.icnsales.com
www.ichelp.org
www.ichelp.org/OnlineSupportCommunity

Human Papillomavirus (HPV)

Holly
Holly Campbell, WHNP-BC

Human Papillomavirus (HPV) is a virus that causes cervical cancer or genital warts. HPV can also cause cancers of the anus and oral cavity and throat. HPV is spread by intimate skin to skin contact, most commonly by sexual intercourse including vaginal, anal, or oral sex. People do not become infected with HPV by touching objects such as a toilet seat. You can develop symptoms from HPV years after being exposed making it hard to know when you first became infected.

It has been estimated that about 75-85% of sexually active adults will acquire HPV infection before the age of 50. This risk increases with the number of sexual partners you have and the number of sexual partners your partner has had. The majority of men and women become infected with HPV for the first time between 15-25 years old.

Most people who are infected with HPV have no signs or symptoms and in most cases, never develop any problems caused by HPV. However, in about 10-20% of women the HPV infection can persist, and in these women, there is a greater chance of developing cervical pre-cancer and cervical cancer. For this reason, routine WWV and pap smears are important to detect any abnormalities early before cancer develops.

As providers we are asked:

• Why should my child get the HPV vaccine?
• Is it safe for my child to get the HPV vaccine?

The HPV vaccine has had long-term studies and has shown to significantly reduce the number of women with pre-cancerous cells and is expected to reduce the number of women who develop cervical cancer substantially.

The HPV vaccine has had long-term studies and has shown no major health risks to the vaccine. Mild redness or swelling at the injection site has been noted. The vaccine is thimerosal-free (mercury derivative).

When is it the right age to vaccinate?

-It is recommended that all girls and women between the ages of 9-26 years are vaccinated
-It is recommended that for boys and men to start age 9-21 years are vaccinated

Remember the best time to vaccinate is before becoming sexually active. However, the vaccine is still recommended for sexually active women who have not received the vaccine or completed the vaccine series and are within the range of age to get a vaccine
Please talk with your provider if you would like more information on HPV or the HPV vaccine.

Sources
Human Papillomavirus (HPV) Vaccine. Beyond the basics. www.UptoDate.com, 2017
Centers for Disease Control and Prevention “What is HPV” www.cdc.gov 12/2016

Does your family’s history of cancer concern you?

Michelle
Michelle Szymanowski, RNC, MSN, WHNP-BC

Generally speaking, cancer is not a common occurrence in most families, but there are some families that have more than their share of cancer. This can be a source of anxiety and stress for some patients, but with the proper testing and management, it doesn’t have to be.

Cancers can be divided into 3 types of occurrences: sporadic, familial, and hereditary:

• Sporadic cancers are cancers that occur randomly or may be environmentally related. This may be a single family member who has had lung cancer related to smoking, cervical cancers related to HPV or a single family member with breast cancer. Sporadic cancers usually happen only to one family member or they may be explainable due to an environmental cause.

• Familial cancers are cancers that run in families but do not appear to be genetic related. These cancers do not seem to be passed from parent to child. They may be from a gene that we are not yet familiar with. They may be from reasons that we do not yet understand.

• Hereditary cancers are cancers that are related to a specific gene. These genes are passed from parent to child. Families with hereditary cancers tend to see the same types of cancers in their families.  Hereditary cancers tend to occur at younger ages in families than what we would expect to see. These cancers can include young breast cancers, young colon cancers or ovarian cancer at any age. Individuals who have these hereditary genes may develop more than one cancer in their lifetime. Additionally, individuals who carry these genes have a 50 percent chance of passing the gene on to each of their children. It is important to identify patients who carry these hereditary genes so that they can be managed according to their individualized needs based on their genetic findings.

Determining which type of cancer pattern that your family has can help determine the best course of care in planning your health management. Genetic testing is an easy way to determine what type of risk you have and can help to determine an individualized plan of care for you to either decrease your risk of cancer or to detect it in its very early stages. Early detection is important because research has shown that the earlier cancers are identified and treated, the better outcome we can expect for an affected individual.

There are 8 types of cancers that we look for in families that may be related to genetics; we call these genes, “clinically actionable”. Clinically actionable means that we have the ability to screen early for these types of cancers, or prevent them all together; it means that there is an action that we can take to manage a patient’s risk. If your family has a history of breast, ovarian, endometrial, colon, pancreatic, gastric, melanoma, or prostate cancer, you may qualify for a test that can determine whether or not your family carries a gene that may increase your risk of developing cancer.

Even if you have a relative who was tested for the BRCA genes and was negative, your family could have a gene that increases your risk. Patients tested prior to 2013 tended to be tested only for one or two genes. Panel testing has now given us the ability to test for additional genes that have since been determined to increase a patient’s risk of cancers. We recommend that anyone who was tested prior to 2013 or is relying on a family member’s test that was done prior to 2013 have a panel test done. It is important to speak to your family members to determine what type of testing they had done and to share that information with your healthcare provider.

Our genes are what make each of us unique; they are a wonderful source of our individuality. They determine our eye color, our gender and sometimes our risk of certain types of cancers. Genes that increase our risk of cancers are not necessarily bad and it doesn’t mean that there is a certainty that a patient will get cancer, but it does help us to determine which patients should be more closely monitored. When a patient and her health care provider knows that she has a gene that increases her risk of certain types of cancers, they can make decisions together that can decrease her risk of these cancers. These decisions can include very simple decisions such as what type of birth control is best for her or what early screening options are available to her. Sometimes they may include more complicated decisions including surgical options.

Knowing a patient’s genetic status can help with medical management and decision making. It can help us determine if it is better for a patient to have an IUD (Intrauterine Device), or use birth control pills for contraception. It can help to determine whether or not she is a candidate for certain types of surgeries such as endometrial ablation, tubal ligations or even hysterectomy. It can also determine what the most effective screening methods and frequency of screenings are that is specific to each patient.

As an example, patients who carry certain genes may need mammograms at age 25 rather than 40, or colonoscopies at age 25 rather than 50. Patients who are at risk for breast cancer may need a yearly MRI in addition to their mammograms. Knowing your genetic status can help determine if you should have these exams earlier than what is recommended for the general population.

Most insurances now cover genetic testing for patients who meet the proper testing criteria. Additionally, there are federal laws in place that protect patients from discrimination. Neither insurers nor employers may discriminate against a patient for having had the test or for having had a positive test result. You cannot be denied insurance or be charged a higher premium for your insurance based on your genetic status.

If you have a family history of cancers or if you are worried about your risk of cancers, please speak to your nurse practitioner or to your physician so that we can help you determine if genetic testing is an option for you.

Hormone Replacement Therapy

Amber
Amber Scrivner, RNC, OGNP

Hormone replacement therapy (HRT) has been a controversial arena but now along with other therapies more options are available. I am a big advocate of HRT, but as with any medications, one has to look at risk versus benefit for each patent. Some patients are not candidates for HRT, and others want a non-hormonal treatment option.

The most bothersome symptoms for menopausal patients are hot flashes, night sweats, and sleep disturbances. These symptoms can be treated with hormonal therapy with estrogen. The goal with estrogen is to use the lowest dose possible to treat symptoms. If you have a uterus, the addition of progesterone is needed to protect the uterine lining. Progesterone also assists with sleep.

Non-hormonal options are also available such as medications that treat depression but are also beneficial in treating hot flashes. One such medication is Paroxetine (Brisdelle). Another non-hormonal option is a plant-based medication, Relizen. Relizen is made from a blend of pollen extract from flowers grown in Sweden.

Lifestyle changes can also be a benefit for patients. Avoid hot rooms, spicy foods, alcohol caffeine, stress, and smoking. Wear clothing that is breathable and layer your clothing. Exercising regularly can help promote more restful sleep. Medication and yoga are great ways to reduce stress. For nighttime sleeping, layer bedding, use fans and keep a froze cold pack under your pillow.

Many women proceed through menopause with no bothersome symptoms. If you are suffering, know that there are many more options available than what our grandmothers or even mothers had for treatment.

Call the office today. I am happy to help you through this journey!