February is American Heart Month. Please read the following article from acog.com to learn how to protect your heart health and understand your risks for heart disease. This is such an important topic as 1 in 3 women over the age of 20 will die of cardiovascular disease. There are many modifiable risk factors ladies, let's take control of our heart health and live happier, healthier lives! ~Lisa
For Release: February 10, 2010
Women's Heart Health Takes Center Stage in February
Washington, DC -- Despite strides in raising awareness of cardiovascular disease as the leading cause of death and illness among women, heart disease is still under-recognized, under-treated, and under-diagnosed in women. During American Heart Month, The American College of Obstetricians and Gynecologists encourages women to learn how they can protect their heart health.
Heart disease killed more than 432,000 US women in 2006—roughly one woman per minute. Women over age 20 have more than a one in three chance of dying from cardiovascular disease.
Long considered a man's disease, awareness efforts have helped many people understand that heart disease is very much a women's disease. It often manifests differently in men and women making the signs harder to recognize and delaying diagnosis in women. And while heart disease kills more women than men in the US, vast disparities still exist in the care of women with heart disease, their treatment after cardiac events such as heart attack, and their representation in clinical trials.
More women today know about the factors that increase their risk of heart disease, including diabetes, obesity, high cholesterol, and high blood pressure. Unfortunately, these conditions are on the rise among American women. According to the American Heart Association, an estimated 11.5 million women in the US are diabetic; more than half of white, black, and Hispanic women (58%, 80% and 78% respectively) are overweight or obese; 48% of women have borderline high cholesterol; 39% of women have high blood pressure; and many women (50% white, 64% black, and 60% Hispanic) are sedentary and get no physical activity.
Heart disease is largely preventable and individual efforts can make a difference. Ob-gyns are encouraged to discuss heart disease with their patients, the health problems that may contribute to it, and steps to improve their heart health. Women who know their health indicator numbers—such as body mass index (BMI), waist circumference, blood pressure, and blood cholesterol and sugar levels—are better equipped to tackle personal risk factors and work with their doctors to improve them.
Healthy lifestyle habits play an important role in reducing the risk of heart disease. Women should aim to consume a diet high in fiber and low in saturated fats, cholesterol, and refined carbohydrates. They should also get 30 to 90 minutes of exercise on most days of the week and quit smoking.
For more information on heart disease, go to www.americanheart.org.
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Saturday, February 20, 2010
Tuesday, February 16, 2010
No sex drive
Q: I am 29 years old, married, have three kids (ages 2, 4 and 5 1/2) and have no desire for sex. Do I have a hormone imbalance? What can I do to improve my sex drive?
A: Low sex drive is a common problem among women. It is particularly common in women with young children and women who are post menopausal. I will focus this discussion on women with young children since that is your demographic. In women with young children I think fatigue plays a large role. I've had many women tell me after chasing children around, having children climb all over them and "need" them all day they are exhausted. She climbs into bed at the end of a long day and her husband wants attention and sex and she just feels depleted and feels like one more person "needs" something from her.
Some women have a hard time transitioning from "multitasking mom" to "romantic lover". My theory is that women need to warm up emotionally in order to warm up physically. A woman needs talk, touch, kissing and laughter. Once she is feeling connected emotionally the physical desire follows. Women also need adequate rest. In our hierarchy of needs sleep comes before sex. That may not hold true for men. I recommend women who are busy get adequate help with the household chores, children, etc. If, for example, a woman and her husband can share in the responsibility of meal prep and clean up, and bathing and putting the children to bed more time can be spent relaxing and connecting. I think it's important for couples to have alone time without their children. Activities such as date night can help couples keep a close connection. If schedules are so hectic that sex needs to be scheduled that is acceptable, too. To make it fun and exciting take turns coming up with new things to try. Communication is very important in relationships and especially important with regards to your sexual relationship.
I've had women report withdrawing affection because they feel like a loving gesture such as kissing, hugging, giving a back rub, etc. is mistaken for an invitation for sex. In fairness to our partners those can also be acts of foreplay so communicating what you want and need is important. It is very important for you and your partner to be able to communicate your needs without feeling judged. Compromise may be necessary so after discussing what you both want and need figure out how to meet in the middle. Focus on win-win.
There are times when testing hormone levels may be appropriate. Other factors that may affect sex drive, sexual response (ability to lubricate, climax, etc) and overall sexual health can be things such as medication, overall health of the relationship, history of abuse, general physical and emotional health and so on. If you are having sexual problems it is worth discussing with your healthcare provider. ~Lisa
A: Low sex drive is a common problem among women. It is particularly common in women with young children and women who are post menopausal. I will focus this discussion on women with young children since that is your demographic. In women with young children I think fatigue plays a large role. I've had many women tell me after chasing children around, having children climb all over them and "need" them all day they are exhausted. She climbs into bed at the end of a long day and her husband wants attention and sex and she just feels depleted and feels like one more person "needs" something from her.
Some women have a hard time transitioning from "multitasking mom" to "romantic lover". My theory is that women need to warm up emotionally in order to warm up physically. A woman needs talk, touch, kissing and laughter. Once she is feeling connected emotionally the physical desire follows. Women also need adequate rest. In our hierarchy of needs sleep comes before sex. That may not hold true for men. I recommend women who are busy get adequate help with the household chores, children, etc. If, for example, a woman and her husband can share in the responsibility of meal prep and clean up, and bathing and putting the children to bed more time can be spent relaxing and connecting. I think it's important for couples to have alone time without their children. Activities such as date night can help couples keep a close connection. If schedules are so hectic that sex needs to be scheduled that is acceptable, too. To make it fun and exciting take turns coming up with new things to try. Communication is very important in relationships and especially important with regards to your sexual relationship.
I've had women report withdrawing affection because they feel like a loving gesture such as kissing, hugging, giving a back rub, etc. is mistaken for an invitation for sex. In fairness to our partners those can also be acts of foreplay so communicating what you want and need is important. It is very important for you and your partner to be able to communicate your needs without feeling judged. Compromise may be necessary so after discussing what you both want and need figure out how to meet in the middle. Focus on win-win.
There are times when testing hormone levels may be appropriate. Other factors that may affect sex drive, sexual response (ability to lubricate, climax, etc) and overall sexual health can be things such as medication, overall health of the relationship, history of abuse, general physical and emotional health and so on. If you are having sexual problems it is worth discussing with your healthcare provider. ~Lisa
Tuesday, February 9, 2010
hormone patch
Q: I have been using a bioidentical hormone cream with a combination of estrogen and progesterone. I feel great but don't like the inconvenience of applying the cream twice a day and the expense (my insurance does not cover the cost). I was talking to a friend who uses a bioidentical patch (Vivelle Dot) that her insurance pays for. She is also using a compounded progesterone capsule. She pays for the progesterone out of pocket but says it is very inexpensive. Do you have patients who are using Vivelle and are they happy with it? Does the patch stick well?
A: Yes, I prescribe Vivelle Dot regularly and have been very happy with it. If my patients are happy, I'm happy! Patients seem to like the convenience and effectiveness of Vivelle. It is much smaller than a generic estradiol patch and adheres better. On a rare occasion I will run into someone who has to discontinue using it due to an allergic reaction to the adhesive. Otherwise I've had no complaints! ~Lisa
A: Yes, I prescribe Vivelle Dot regularly and have been very happy with it. If my patients are happy, I'm happy! Patients seem to like the convenience and effectiveness of Vivelle. It is much smaller than a generic estradiol patch and adheres better. On a rare occasion I will run into someone who has to discontinue using it due to an allergic reaction to the adhesive. Otherwise I've had no complaints! ~Lisa
Saturday, February 6, 2010
Infertility question...
Q: I am having a difficult time getting pregnant. Do I need to make an appointment with you? Should I bring my husband to the appointment? What should I expect at the appointment?
A: Yes, an appointment is an appropriate first step in evaluating fertility problems and I encourage you to bring your husband. The appointment will usually consist of a discussion (history) and a physical.
I will start by asking questions about your health history, such as:
General: General health, Past obstetric, medical and surgical history; medications and allergies.
Menstrual history: age of onset, regularity and pain. If you have painful or irregular periods what tests, procedures or surgeries have been performed to work up the pain or irregularity? They might include things such as hormone testing (including thyroid function tests), pelvic ultrasound, hysterosalpingography (HSG), laparoscopy, hysteroscopy, etc? Have you been given a diagnoses that might affect fertility such as polycystic ovarian syndrome, endometriosis, uterine malformation, pelvic inflammatory disease or history of sexually transmitted infections? Have you had problems with facial acne, dark hair growth or weight gain? Do you have PMS or any other problems associated with your cycle? How long have you been trying to conceive?
Ovulation: can you tell when you ovulate, have you documented ovulation using an ovulation predictor test or basal body temperature charting? Have you tried any treatments for infertility (such as Clomid)?
Intercourse: do you experience pain with intercourse? If so, is it with initiation (vaginal pain) or deeper inside (like something is being hit)? do you understand when you should be timing intercourse when you are trying to conceive?
Contraception: What forms of birth control have you used and when did you discontinue use? Some medication (such as Depo Provera) may cause a short term delay in fertility (up to 18 months after stopping use).
Preconceptual meds/vaccines/counseling: Have you been taking a prenatal vitamin with folic acid (for atleast two months preconceptually) to decrease the risk of open neural tube birth defects? Have you had chicken pox or the vaccine for chicken pox? Have you had two MMR vaccines? If not, checking titers and/or giving vaccines are appropriate before trying to conceive.
Genetic/Obstetric history: Do you have a family history of genetic disorders that you want preconceptual counseling for prior to becoming pregnant? Any risk factors for a high risk pregnancy (i.e. personal or family history of blood clots, gestational diabetes, high blood pressure, obesity, preeclampsia or other pregnancy or birth complications?
Mental health: History of depression, anxiety or other mental health disorders? Past/current treatments? How are you and your husband coping with the fertility issues you are experiencing?
Questions specific to your husband's health:
General health including medical and surgical history and medications. Do you have a history of diabetes, hypertension or depression? Are you taking medication for any of those conditions? Do you have any problems with erection or ejaculation? Do you have any lumps or pain in your scrotum (around your testicles)? Have you ever been diagnosed with a varicocele or hernia? Have you fathered children? Any past illness that resulted in high fever? Any recreation that may cause heat to testicles such as frequent use of hot tub or avid bicycling? Do you use steroids (i.e. testosterone), elicit drugs, alcohol and/or caffeine?
I will examine you (need current exam/pap) and order diagnostic tests as indicated by the history and physical.
I will encourage you to test for ovulation if you have not prior to the visit and I would recommend a semen analysis on your husband. I may consider ordering a HSG to rule out uterine abnormalities and/or blockages in your fallopian tubes. Please start or continue taking a prenatal vitamin with 800-1000 mcg of folic acid daily.
After the initial work up (history, physical and diagnostic tests) we will meet again and discuss your treatment options. This is an exciting time but it can become very stressful. If you get frustrated with the process please schedule an appointment, call or email me. Communication is very important and the speed with which we proceed is largely up to you and your husband. If, at any time in this process, you want a referral to a fertility specialist (Reproductive Endocrinologist) I would be happy to make a referral for you. I am here for you and your family. I appreciate the opportunity to help you achieve your pregnancy goals. ~Lisa
A: Yes, an appointment is an appropriate first step in evaluating fertility problems and I encourage you to bring your husband. The appointment will usually consist of a discussion (history) and a physical.
I will start by asking questions about your health history, such as:
General: General health, Past obstetric, medical and surgical history; medications and allergies.
Menstrual history: age of onset, regularity and pain. If you have painful or irregular periods what tests, procedures or surgeries have been performed to work up the pain or irregularity? They might include things such as hormone testing (including thyroid function tests), pelvic ultrasound, hysterosalpingography (HSG), laparoscopy, hysteroscopy, etc? Have you been given a diagnoses that might affect fertility such as polycystic ovarian syndrome, endometriosis, uterine malformation, pelvic inflammatory disease or history of sexually transmitted infections? Have you had problems with facial acne, dark hair growth or weight gain? Do you have PMS or any other problems associated with your cycle? How long have you been trying to conceive?
Ovulation: can you tell when you ovulate, have you documented ovulation using an ovulation predictor test or basal body temperature charting? Have you tried any treatments for infertility (such as Clomid)?
Intercourse: do you experience pain with intercourse? If so, is it with initiation (vaginal pain) or deeper inside (like something is being hit)? do you understand when you should be timing intercourse when you are trying to conceive?
Contraception: What forms of birth control have you used and when did you discontinue use? Some medication (such as Depo Provera) may cause a short term delay in fertility (up to 18 months after stopping use).
Preconceptual meds/vaccines/counseling: Have you been taking a prenatal vitamin with folic acid (for atleast two months preconceptually) to decrease the risk of open neural tube birth defects? Have you had chicken pox or the vaccine for chicken pox? Have you had two MMR vaccines? If not, checking titers and/or giving vaccines are appropriate before trying to conceive.
Genetic/Obstetric history: Do you have a family history of genetic disorders that you want preconceptual counseling for prior to becoming pregnant? Any risk factors for a high risk pregnancy (i.e. personal or family history of blood clots, gestational diabetes, high blood pressure, obesity, preeclampsia or other pregnancy or birth complications?
Mental health: History of depression, anxiety or other mental health disorders? Past/current treatments? How are you and your husband coping with the fertility issues you are experiencing?
Questions specific to your husband's health:
General health including medical and surgical history and medications. Do you have a history of diabetes, hypertension or depression? Are you taking medication for any of those conditions? Do you have any problems with erection or ejaculation? Do you have any lumps or pain in your scrotum (around your testicles)? Have you ever been diagnosed with a varicocele or hernia? Have you fathered children? Any past illness that resulted in high fever? Any recreation that may cause heat to testicles such as frequent use of hot tub or avid bicycling? Do you use steroids (i.e. testosterone), elicit drugs, alcohol and/or caffeine?
I will examine you (need current exam/pap) and order diagnostic tests as indicated by the history and physical.
I will encourage you to test for ovulation if you have not prior to the visit and I would recommend a semen analysis on your husband. I may consider ordering a HSG to rule out uterine abnormalities and/or blockages in your fallopian tubes. Please start or continue taking a prenatal vitamin with 800-1000 mcg of folic acid daily.
After the initial work up (history, physical and diagnostic tests) we will meet again and discuss your treatment options. This is an exciting time but it can become very stressful. If you get frustrated with the process please schedule an appointment, call or email me. Communication is very important and the speed with which we proceed is largely up to you and your husband. If, at any time in this process, you want a referral to a fertility specialist (Reproductive Endocrinologist) I would be happy to make a referral for you. I am here for you and your family. I appreciate the opportunity to help you achieve your pregnancy goals. ~Lisa
Tuesday, February 2, 2010
Initially I plan to post twice weekly blogs (Saturday and Tuesday). I will choose a question or two to answer as well as providing informational pieces to cover commonly asked questions. I especially enjoy covering topics that can be a little complicated. I want to offer insight from my clinical experience. Trial and error can be a great teacher! I'm sure I have learned as much (or more) from the things that have not worked as the things that have. I have bonded with many women and found a few of my closest friends just by doing what I do. I can't tell you how blessed that makes me feel! I am beyond excited about this! Thank you so much for supporting my dream! ~Lisa
Monday, February 1, 2010
Here is why...
After answering thousands of questions from hundreds of my patients in the clinic setting, I realized there is a real need for doing what I love...providing simple answers to perplexing and sometimes complicated questions on topics such as hormone therapy, infertility, polycystic ovarian syndrome, sexual dysfunction and weight management. I am told regularly that I am the first health care provider to take the time to answer questions and explain things in an honest, caring, easy to understand way. I think half the battle is finding someone who will take the time to listen and offer follow through; someone who is willing to offer encouragement and see the process through even if it means going to plan B, C, D or whatever it takes! My inspiration for the blog is the wonderful opportunity to share my passion for being a health care resource to women. I want to be able to provide this service to many women, many more than time would ever allow for in the clinic. ~Lisa
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