Hormone Replacement Therapy Study Results
Perimenopausal and Mood
Endometrial hyperplasia is a thickening of the endometrium. The endometrium is the inside lining of the uterus. The thickened lining is not cancer however in some cases it can progress to uterine cancer.
Endometrial hyperplasia is most often seen in menopause when hormone changes are present. It can also occur in pre-menopausal women when certain conditions or risk factors exist. The most common cause is excess estrogen along with low or absent progesterone. This hormone imbalance leads to a thickened uterine lining.
Risk factors for endometrial hyperplasia include:
- Estrogen only HRT (hormone replacement therapy) with uterus present
- Never been pregnant
- Age greater than 35
- Tamoxifen therapy which is given to treat patients with a history of breast cancer
- A history of diabetes or Polycystic Ovarian Syndrome (PCOS)
- A family history of uterine cancer
- Cigarette smoking
The most common symptom is abnormal bleeding. Any bleeding in menopause should be evaluated. Pre-menopausal women may experience heavier or longer periods. Others have spotting or bleeding between periods. Also there are some women that have an abnormal Pap smear.
If you are over 35 with abnormal bleeding or under 35 with persistent bleeding that is not relieved with medication then an evaluation for hyperplasia should be performed. The first step in the process is a pelvic ultrasound to evaluate and measure the thickness of the uterine lining. If the endometrium is thick and/or appears irregular then a sample of the lining is performed to rule out hyperplasia. A sample can be obtained by an office biopsy (endometrial biopsy) or a surgical procedure called a dilation and curettage (D&C).
Endometrial hyperplasia is categorized as simple or complex with or without atypical cells. The risk for uterine cancer increases as the lining becomes more complex or contains atypical cells. Treatment options include hormone therapy with progesterone or surgical treatment with a hysterectomy (remove the uterus). If there are no atypical cells or there is a desire for childbearing then hormone treatment is a consideration. Atypical cells increase the risk of uterine cancer therefore surgery is preferred if a woman is done with having children.
Endometrial hyperplasia is a condition of the uterine lining that can be treated. Prevention is the goal whenever possible. To decrease the risk of hyperplasia. It is recommended to lose weight if you are obese, use birth control if your periods are very irregular or infrequent, and if on HRT be sure to take progesterone if you are taking estrogen and have your uterus.
Kimberly Hartzfeld, DO, FACOG
Perimenopause and Depression
If you’re a woman in your mid- to late 40s, you may be experiencing the symptoms of perimenopause, the span of approximately four years before menstruation totally stops and menopause begins.
Symptoms of perimenopause include:
- Changes in the length of your monthly cycle, the duration of your period and the intensity of your flow.
- Hot flashes and night sweats.
- Decreased libido.
You might be among the 70 percent of women who experience irritability with perimenopause and menopause or the 50 percent who struggle with insomnia during the transition.
You may also be among the 20 percent of women who suffer with significant anxiety and depression during perimenopause.
Why can depression occur during perimenopause? Estrogen levels decline, and estrogen is responsible for increasing the effects of serotonin and norepinephrine in the brain, explained Rachel Spieldoch, MD, gynecologist, and an independent member of the HonorHealth medical staff. “These are important neurotransmitters for regulating mood in your brain.”
While most women transition into menopause without experiencing debilitating mental health problems, she said, a number of factors can cause or contribute to depression or anxiety during this time.
Depression or anxiety may be related to aging or lifestyle and not directly to hormonal changes, Dr. Spieldoch said, but these factors can boost your risk of emotional symptoms during perimenopause.
“It’s thought that perimenopause can exacerbate or cause a relapse of depression and anxiety for people at higher risk but does not cause the disorder,” she said. “Insomnia, health disorders, medication side effects, sedentary lifestyle and poor eating habits, low self-esteem, changes in childbearing status and social stressors such as aging parents, lack of social support or unemployment can all negatively affect the risk for depression and anxiety.”
You’re also at higher risk if you have a preexisting tendency toward anxiety or depression, a history of postpartum depression, an underlying psychiatric disorder, surgical menopause or premenopausal dysphoric disorder (a severe form of premenstrual syndrome), Dr. Spieldoch said. Women with a history of mood disorders related to fluctuating hormone levels prior to menopause are more likely to experience significant symptoms during the menopause transition period, she said.
Several studies suggest that infertility drugs and treatments such as in-vitro fertilization may put women at higher risk for early menopause and mood disorders during perimenopause.
“Onset and exacerbation of schizophrenia, panic disorder and obsessive-compulsive disorder can occur during the perimenopausal period,” she said. “Worsening symptoms for people with underlying bipolar disorder and major depression can also occur during this transition period.”
Childbearing likely is not associated with perimenopausal symptoms, Dr. Spieldoch said.
Managing depression during perimenopause
“Healthy eating habits, cessation of smoking and increased exercise can be beneficial,” said Dr. Spieldoch. To boost your mood during perimenopause she also recommends these lifestyle considerations, activities and medications:
- Meditation and yoga: Studies show these can be particularly helpful with mood during the menopause transition.
- Rule out other health conditions associated with mood changes. Ask your doctor about hypothyroidism or other endocrine disorders, anemia, autoimmune disease, drug addiction, dementia or malignancy.
- Over-the-counter and prescription mood boosters. “St. John’s Wort is a non-prescription herbal supplement that can positively affect depressive mood changes with perimenopause. Antidepressants (most commonly selective serotonin reuptake inhibitors), increase serotonin levels in the brain and are often prescribed during the menopause transition.”
- Hormone replacement therapy. This “has been well studied and can be very beneficial with regard to treating mood changes and insomnia.”
- Other medications for insomnia or hot flashes and sweating.
- Educational groups or reading material can be beneficial for those suffering with adverse mood changes during perimenopause.
Depression and anxiety often resolve with menopause, “at which time hormone fluctuations stop and the low hormone levels stabilize,” Dr. Spieldoch said.
Bubbles and Botox!!
Summertime Stress Tips
Summertime is supposed to be a time of carefree living, fun and sunshine. But, often, this is not the case. Summers can be hectic. For parents, it is the time children may be at home, alone, even though they are still working. Worry about what children are doing can add stress. Days can be filled with extra activities, driving children with little time for yourself!
Vacations, meant to be relaxing, can be filled with stress and worry. The season may have changed, the stressors may have changed, but still your day is filled with worry and anxiety. So how can you control stress and manage anxiety symptoms during the summer?
The following tips may help:
Take advantage of the nice weather and take a walk each evening. This can be family time, enjoying the time together in the fresh air.
Keep plenty of the seasonal fruits and vegetables on hand. Summer is great for peaches, watermelon, berries, grapes, carrots, tomatoes, corn on the cob and an immense array of colorful, healthy fruits and vegetables. Keeping your kitchen stocked with these types of foods will ensure everyone gets plenty in their daily diet.
Breathe deeply. It is difficult, if not impossible, to feel stressed while you are engaged in deep breathing. Inhale slowly, through your nose, counting to three. Exhale through pursed lips, counting to three again. As you practice this, you will be able to do it automatically and feel your stress level decrease.
Spend five minutes a day with no “noise”. Turn off your cell phone, the television and ask everyone to give you five minutes alone. Silence can help calm you down and help you to relax. Be sure you schedule this time into your daily routine rather than just waiting for an extra five minutes to appear.
Take a day trip to help provide you with a “mini-vacation” and let you relax. Sometimes it is good to get away, even if it is just for one day. If you can’t afford even a day trip, take a day to stay home, turn off the phones and do something you enjoy.
Most of all, take time each day to enjoy yourself, spend time with family and pay attention to your own needs.
To help with the stress and fatigue that the extra activities summertime brings, MMG recommends Vitamin B Complex.
B Vitamins, which are well known for keeping energy levels high and improving cognitive performance can have a positive effect. Clinical trials have shown that supplementing with a vitamin B complex can help keep your energy high and your stress low. It can also help to reduce personal strain and depressed feeling when in high stress situations, supporting a feeling of calm and stability. If you want to be more relaxed (and focused!), supplementing with a B complex could be a major help!
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It’s Important to Speak With Your Doctor
Every woman has been there….You’re sitting on the exam table and your gynecologist asks if you have questions or concerns. You do, but you’re also nervous and a little embarrassed about asking very personal questions.
“You should ask your questions – and anything else that’s on your mind – without feeling ashamed,” said Rachel Spieldoch, MD, a gynecologist and laparascopic surgeon in Scottsdale, AZ.
1. Does this look normal?
“This is one of the most common questions women ask,” said Dr. Spieldoch, “and the answer is almost always a resounding yes.” While today’s media can make it seem like women should only look one way, this just isn’t the case. Just as people come in lots of different shapes and sizes, body parts are subject to different interpretations.
However, there can be times where you do have something abnormal going on that needs to be checked out. Skin conditions such as psoriasis, warts, rashes and vitiligo (patches of skin that lose their color) can all affect your nether regions. Lesions, pain, abnormal discharge and any other change should be addressed by a gynecologist.
2. How much “self-love” is too much?
While this may seem like a myth, it is possible to “self-love” too much. This can cause desensitization over time or make it difficult to climax from intercourse with a partner. While it is a normal part of a healthy sex life, if it’s taking over your life or interfering with your relationship, it should be addressed.
3. How can I avoid embarrassment when exercising?
If you’re experiencing leaking when you’re exercising, it’s likely due to stress urinary incontinence. That’s defined as a loss of urine after some type of activity that puts pressure on the bladder, such as:
- Lifting weights
This occurs when the muscles regulating the bladder and urethra weaken. While you may think of this as an older woman’s problem, Dr. Spieldoch said that “around 20 percent of women in their 20s experience it, and a full 50 percent of women have leakage issues.” Contributing factors include:
- Chronic coughing
- Prior pelvic surgery
While stress urinary incontinence is common, you don’t have to live with it. If it’s causing you embarrassment or interfering with your relationships or quality of life, talk to your gynecologist. Nonsurgical treatments have a high rate of success and include a pessary (a device inserted into the vagina to provide support), bladder tampons (same concept), pelvic floor rehabilitation, vaginal laser procedures and Kegel exercises. Kegels can improve symptoms up to 75 percent if you do 40-60 a day. In severe cases, bladder sling surgery may be recommended; it has a success rate of about 85 percent.
4. Are private piercings safe?
Intimate piercings are becoming more common and less taboo thanks to social and cultural influencers. However, it’s normal to have some worries if you’re considering going under the needle. While clitoral piercings are usually considered safe as long as they’re done properly by a professional piercer, they can cause desensitization over time.
They can also increase your risk of sexually transmitted infections. It’s important to avoid intercourse completely while the piercing is healing – which can take four weeks to six months – and that you’re aware of your partner’s sexual history and practice safe sex afterward.
Nipple piercings have been around for hundreds of years and have a more thoroughly documented history. They’re considered to be safe when done by a professional, but they do carry a risk of infection or rejection of the piercing itself.
Rejections are more likely if there’s excessive tugging or pulling on the piercing, or if you have a metal allergy. “Breastfeeding with these piercings is a common concern, but it usually doesn’t negatively impact milk production,” said Dr. Spieldoch. “There are enough milk ducts in and around the nipple that even if a few are damaged from the piercing, it doesn’t affect anything.”
Developing an open, positive relationship with your doctor is an important part of your health. Remember that the gynecologist’s office is a safe, confidential space and nothing is off limits or taboo. It may be embarrassing to you, but it won’t be to your doctor. He or she really has heard and seen it all. Discuss your concerns to see if treatment could help or offer some peace of mind.
Time for a New Year and a Healthy You!
The time for New Year’s resolutions is upon us. For those looking to improve their well-being in 2018, McDowell Mountain Gynecology has a list of five resolutions you can make to address your gynecological health.
Schedule an annual well woman exam.
Annual exams, also known as well woman exams, provide an annual opportunity for you to check in with your gynecologist and get screened for preventable health conditions. Well Women Exams include a breast exam and Pap test, so the appointment should not be put off or ignored. Save time during your next appointment and learn how an annual exam can help prevent cervical and breast cancer.
Vocalize any symptoms or health concerns ASAP
If you experience changes to your period, such as irregularity or change in flow, changes to your breasts or any other symptoms, it’s very important to contact your provider and see if they advise visiting the office for an appointment. Unpleasant symptoms like painful periods and heavy menstrual bleeding aren’t something you should have to put up with, and treatments are available at McDowell Mountain gynecology. Strange symptoms may indicate an underlying but undiagnosed health condition, so it’s still important to visit us.
STD and STI Prevention
Practicing safe sex to prevent an STD (sexually transmitted disease) or STI (sexually transmitted infection) comes down to the decisions every woman makes with her partner. Disease and infections that are transmitted from sexual contact can come from oral and anal sex as well, so it’s incredibly important that you take the appropriate steps to protect yourself. If you have any questions regarding STD screening, treatment or prevention, please call our office to make an appointment.
Family Planning Goals
Perhaps your plans to start a family won’t start taking shape for another couple of years, but if you do wish to start trying for a pregnancy in the next few months, McDowell Mountain Gynecology recommends considering preconception counseling. Preconception counseling walks you through the steps that are important prior to becoming pregnant, including how to evaluate peak fertility times during your ovulation cycle.
McDowell Mountain Gynecology offers the HPV vaccine, Gardisil to help prevent against the spread of HPV (Human Papilloma Virus), which is linked to cervical cancer. The vaccine is recommended by the CDC to young women and men starting as young as 12 – you do not need to be sexually active to receive the vaccine. HPV is spread through intercourse, but even a condom cannot fully protect a person from getting the virus.
The start of a new year is the perfect time to reassess all of your goals, including ones related to healthcare. McDowell Mountain Gynecology is here to help whenever you are ready to reach out. Call us for an appointment at 480.483.9011
Happy New Year! We look forward to taking care of you for a Happy, Healthy 2018!
Breast Cancer Screening
Breast cancer is the most commonly diagnosed cancer in women in the U.S. and the second leading cause of cancer death in American women. It accounts for 30% of all new cases of cancer diagnosed in women. A woman’s lifetime risk of developing breast cancer is 12% (1:8). Breast cancer mortality (death) rates have decreased significantly in the past 50 years. This is attributed to early detection and improvements in breast cancer treatment. Regular screening mammography starting at age 40 y/o reduces breast cancer mortality in average-risk women.
While screening provides improved health outcomes, there can also be adverse consequences. Screening can be harmful through false-positive test results and over-diagnosis of benign lesions. Additionally, cost of testing, anxiety, discomfort/pain, inconvenience, overdiagnosis and overtreatment are potential risks. Many women are concerned about the risk of radiation exposure from routine screening. The risk of radiation induced cancer is 2 per 100,000 women. The potential mortality benefit from early detection is 60 fold the risk of radiation exposure. In other words, the benefit of detecting breast cancer far outweighs any risk from radiation exposure. Balancing the benefits and risks of screening has led to controversy of opinion about uniform guidelines for breast cancer screening.
Breast cancer risk assessment is particularly important for identifying women who may benefit from more intensive breast cancer surveillance. Risk assessment and identification of women at high risk for breast cancer in the office setting allows for adequate referral to health care providers with expertise in cancer genetics and counseling, testing for germline DNA mutations (i.e. BRCA), discussion of risk reduction options, and the opportunity to identify other family members at increased risk.
The main risk factors for breast cancer are female sex and advancing age. Other factors have been found to be associated with increased risk, but most women diagnosed do not have identifiable risk factors. Other risk factors include family history of breast cancer, known gene mutation, prior breast pathology showing atypical hyperplasia or lobular carcinoma in situ, early menarche, late menopause, nulliparity, estrogen and progesterone hormone therapy, ethnicity (i.e. Ashkenazi), obesity, alcohol consumption, smoking, and dense breasts.
Currently self breast exams are no longer considered beneficial. Instead, breast self-awareness is recommended. This is defined as a woman’s awareness of the normal appearance and feel of her breasts. It means that a woman should be attuned to noticing a change or potential problem with her breasts. Additionally, women should be educated about signs and symptoms of breast cancer and advised to notify their health care provider if they notice a change. It is recommended that a practitioner performs a breast exam in intervals of every 1-3 years for women 25-39 y/o and yearly for women 40 y/o and older. A clinical breast exam by a practitioner will detect 2-6% more cases of invasive cancer than mammography alone.
Women at average risk of breast cancer should be offered screening mammography at 40 y/o. If they have not initiated screening in their 40s, they should begin screening mammography no later than 50y/o. Screening should be performed every 1-2 years based on patient health and risk factors. Biennial (every 2 years) screening mammography may be a reasonable option for women after 55 y/o. Women should continue screening mammography until at least age 75y/o. Age alone should not be the basis to continue or discontinue screening. Women should continue screening mammography as long as their overall health is good and they have a life expectancy of at least 10 years.
If you have concerns or questions regarding your breast health, please call today to schedule an appointment with Dr. Rachel Spieldoch or a provider at McDowell Mountain Gynecology at 480-483-9011.