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Archive for the ‘Condition News’ Category

“Return Decision Power to Women” on Hormone Replacement Therapy

Posted in Condition News, tagged , , , on May 15, 2013 | Leave a Comment »

It’s no wonder we’re confused. First it’s good; then it’s bad. Now it’s up to you.

Hormone replacement therapy has had more media makeovers than Liz Taylor, and it continues to grab attention here and there.

The latest, and highly credible, statement on the issue is from an international roundtable of medical experts convened by the Society for Women’s Health Research (SWHR). The purpose of this gathering of experts, which represented various specialties, such as cardiovascular disease, osteoporosis, and cancer, was to take yet another objective and rigorous look at the evidence regarding hormone replacement therapy, and to make recommendations as to its use and safety. The results of this discussion just came out in the Journal of Women’s Health.

This roundtable is a good effort to shed some objective light on the risks and benefits of an issue that’s been hotly debated for over ten years now, ever since the Women’s Health Initiative (WHI) prematurely ended its groundbreaking study of women receiving hormone therapy in 2002 because of a high incidence of breast cancer and cardiovascular complications.

The problem, however, is that hormone therapy (HT) is still the only effective, FDA-approved treatment for menopausal symptoms, such as hot flashes and vaginal changes. Recently two non-hormonal drugs were just nixed by an FDA advisory panel because they were viewed as ineffective.

Ever since the WHI results were released, the pendulum has been swinging wildly with each new medical release or research report. And while this latest SWHR roundtable really moves the chess pieces very little, it does solidly reaffirm positions held by the North American Menopause Society.

(In fact, NAMS had released its latest position statement on hormone treatment barely a month earlier.)

What the roundtable did add, however, is something I strongly advocate: Give women solid information about their treatment options and let them make informed decisions about their own health.

Their findings include:

  • In younger, postmenopausal women with menopausal symptoms, the benefits of HT outweigh the risks;
  • HT is the most effective treatment for osteoporosis and should be considered for the prevention of osteoporosis, especially among at risk women;
  • Contrary to popular misconceptions, HT for early, postmenopausal women does not increase the risk for coronary heart disease (CHD) and may even reduce it;
  • HT does not increase total mortality rates and may, in fact reduce them.

Here’s how the SWHR roundtable puts it: “It’s time to put HT back on the table so that women can discuss with their providers the option of symptom relief and possible long term health benefits.”

Amen to that.

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The Wrong Kind of “Hot”

Posted in Condition News, tagged , , on April 19, 2013 | Leave a Comment »

Now that the FDA advisory panel has pulled the plug on two nonhormonal drugs to treat hot flashes and night sweats, what’s a grumpy, sleep-deprived, sweaty, menopausal woman to do?

For most of us, hot flashes are uncomfortable and inconvenient. For some of us, hot flashes are debilitating and make it hard to sleep or function normally. And except for hormone therapy, no treatment regimen is guaranteed to alleviate them.

So, chalk up yet another inhibitor to sex (as if we needed one). It’s hard to feel “in the mood” when your nightie’s soaked and sweat is running down your back—and this is pre-foreplay.

It may be possible, however, to manage the frequency and intensity of hot flashes with some simple home remedies. For some women, these techniques work well; for others, not so much. As in so much of life, it’s a matter of experimenting until you discover what works for you.

These more natural approaches fall into four categories: lifestyle changes, identifying the triggers, controlling your environment, stress management, and botanical remedies. If you’re bothered—or handicapped—by hot flashes, a combination of these might help. Even if the cure isn’t perfect, your overall health should improve. In the long run, that’s a whole lot better than popping a pill.

Lifestyle changes

A generally healthy lifestyle goes a long way to making you feel better all over. You’ll mitigate other problems, like diabetes and obesity, and you just might find your hot flashes are less frequent and intense as well.

A healthy lifestyle includes

  • A diet of high-quality, fresh fruits and vegetables, whole grains, low in fat and processed foods
  • Regular exercise that gets your heart-rate up and doesn’t injure your joints: brisk walking, swimming, free weights, yoga, tai chi
  • Losing weight, if necessary. You may have put on some menopausal baby fat (haven’t we all?), but be aware that a higher body mass index is related to more frequent hot flashes, according to the North American Menopause Society (NAMS).

Identifying triggers

While hot flashes are maddeningly unpredictable, they often seem associated with certain triggers, which are unique to every woman. Try to identify yours. Common triggers include

  • Caffeine, alcohol, and cigarettes (even passive smoke may be trigger one)
  • Anxiety, stress, and stressful situations
  • Hot drinks and spicy foods. If you’ve ever watched someone eating a habanero pepper, well, that’s enough to give you a hot flash right there.
  • Stress
  • Hot, stuffy, or crowded rooms
  • Activities that produce heat—ironing clothes, washing dishes, strenuous exercise
  • Did we mention stress?

Managing stress

Stress is linked in several studies to more frequent hot flashes, and you can bet they’ll happen at the most inconvenient times. When you’re heating up at a stressful moment, remember that, while embarrassing and uncomfortable, hot flashes aren’t life-threatening or even particularly noticeable to others. A few inconspicuous comfort measures will help you get through the moment, even in tense situations:

  • Breathe. Instead of panicking inwardly, consciously take deep, relaxing breaths.
  • Get up and walk around.
  • Open a window.
  • Try meditation, massage, yoga, relaxation or other therapy.
  • Maintain a sense of humor. You have to admit, the whole thing is kind of funny.

Conrolling the environment

Because the hormonal changes you’re experiencing have temporarily (or not so temporarily) messed with your body’s temperature-regulating mechanism, you can compensate (in part) by controlling the ambient temperature. Some easy ways to do this include

  • Keep the house, especially the bedroom, cool and well-ventilated.
  • Cotton (or fibers that wick moisture away from your skin) is your friend. Use cotton bedclothes and keep a spare pillowcase handy. Or, check out cooling bedsheets like those at DriNights. Keep a clean, cotton t-shirt beside the bed.
  • “Keep a frozen cold pack under your pillow, and turn the pillow often.” (From NAMS)
  • Check out the Dry Babe website for a line of “absorbent sleepwear for hot mamas.” These could lead to a little heated action of their own.
  • Wear clothes in layers that you can shed or add as necessary.
  • Carry a pretty Oriental fan in your purse.

Botanical remedies

Finally, a few botanicals have been associated with relief of hot flashes. Again, research is inconclusive: Some women are helped while others aren’t. But the remedies are relatively safe and free from serious side effects. You could try:

  • Black cohosh. Already commonly used in Europe, this member of the buttercup family may be the most promising herbal treatment for hot flashes.
  • Soy and red clover contain plant-based estrogen, which isn’t as effective and doesn’t work the same way as the estrogen synthesized for hormone treatments. Still, some women say they help.
  • Vitamin E. Again, scientific evidence is scant, but some women say these supplements work for them.

Just because a supplement is “natural” doesn’t mean it’s automatically safe for everyone. Some herbal supplements are quite potent, and others could interact with medication you’re taking or exacerbate a physical precondition you already have. So consult with your doctor or pharmacist before taking botanical remedies.

If you discover a remedy that works for you—please share!

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Nonhormonal Drugs for Menopausal Symptoms Nixed by FDA

Posted in Condition News, tagged , , on April 9, 2013 | Leave a Comment »

So much for WISHes.

Following the approval of Osphena, a nonhormonal drug for vaginal pain, or dyspareunia, an advisory panel for the Food and Drug Administration (FDA) just voted against approving two nonhormonal drugs for the treatment of hot flashes.

Hot flashes, night sweats, and the sleep disturbance that accompanies them affect about 75 percent of perimenopausal women. Often, they are merely inconvenient, but for some women, they are severe enough to affect sleep, sex, and overall well-being. And they may continue for years—long after menopause is over.

However, based on the results of several rounds of clinical trials for gabapentin, a drug already used to treat seizures and nerve damage from shingles, and other trials for paroxetine, an antidepressant (the active ingredient in Paxil), the FDA panel voted overwhelmingly to deny approval.

The panel’s objection to both drugs was that their effectiveness didn’t outweigh the risks and side effects associated with their use. The most common side effects of gabapentine are dizziness and drowsiness. The most common side effects of paroxetine are nausea, sweating, drowsiness, and headache.

According to a recent New York Times article, women in the gabapentine trial experienced an average of 11 hot flashes a day. At the end of 12 weeks, they were down to about 4 per day. But the women on placebos saw almost as much relief—their hot flashes had dropped to about 5 per day. Thus, “women taking placebos in the trials experienced a substantial reduction in hot flashes that the drugs could not beat in any pronounced way.”

Women in the paroxetine trial fared slightly better, but the FDA panel decided that it still hadn’t cleared the bar for approval.

Voices on both sides of the debate are intense.

“They don’t work and cause dangerous side effects,” the consumer advocacy group Public Citizen testified before the FDA panel.

On the other hand, Linda Keyes, one of the panel members who voted to approve the drugs, said that the need for nonhormonal treatment “is high enough that I feel that a very modest reduction [in hot flashes] is still acceptable, assuming the risks are known and carefully watched, which I believe they can be,” according to an article on WebMD.

Obviously, these results are disappointing for women who are looking for a safe, federally approved, nonhormonal treatment for hot flashes and sleep disturbance. Currently, the go-to treatment for these menopausal symptoms is hormone therapy, and many women either can’t take hormones or choose not to because of the risk of stroke and breast cancer.

Both gabapentine and paroxetine are available off-label, and doctors have been prescribing them for menopausal symptoms for years. They, and other off-label options, can still be considered for treatment of menopausal symptoms—yet another reason for a detailed discussion with your health care provider so you’re making the best—and best informed—choices for you.

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So over Contraception? Think Again.

Posted in Condition News, tagged , , , on April 1, 2013 | 1 Comment »

Yeah, I know. You’ve been doing the contraception shuffle for, oh, decades now. Isn’t it “safe” yet? After all, you’re past 40. Maybe you’ve even missed a couple periods.

Not so fast.

You’re in the midst of a very hazardous crossing—those uncertain years between fertility and menopause during which you are less likely to get pregnant, but, make no mistake, you still can!

While women are indeed less fertile after 40, they absolutely can get pregnant. In fact, women can conceive even during perimenopause, when the menstrual cycle is beginning to become irregular.

For some reason, however, women seem to become more casual as they near the goalposts. How else to account for the fact that women over 40 are the least likely to use birth control of any age group, and that their abortion rates are as high those of adolescents, according to a 2008 USA Today article.

In Great Britain, women in their 40s are now called “the Sex and the City generation,” and they, too, have grown careless. In the UK, abortions within the over-40 age group have risen by one-third in the past decade. In the US, 38 percent of pregnancies in women age 40 and older are unplanned. Of those, 56 percent end in abortion, according to this article in HealthyWomen.org.

By the time they reach 40, women are generally old hands at birth control. But at this point in life some reevaluation may be in order. Levels of fertility are decreasing, and hormonal levels are (or soon will be) in flux. Some women may not want to have children; others may want to keep the option open. In any case, an unplanned surprise complicates life really fast.

This is a good time for a conversation about birth control with your healthcare provider, and you may have to initiate it. While you have more options than ever, the best one for you might be different than what worked for you in your 20s.

And just so you know, current guidelines advise that you remain on birth control until one year after your last period, the official definition of menopause. Complicating the picture is the fact that with hormonal forms of birth control, such as the pill, your cycles may be irregular or may stop completely, which masks the onset of menopause. And the withdrawal bleed during the week off the pill isn’t considered a true period.

Birth control after 40 falls into several categories: permanent, long-term or short, hormonal or barrier method. They vary in levels of effectiveness and in the side effects you may experience. And remember that condoms are the only type of birth control that protects against sexually transmitted infections.

Probably your most immediate decision is whether to end childbearing permanently. Tubal ligation is a laparoscopic procedure that happens under general anesthetic in a hospital. There’s also a new, non-surgical option that a doctor can do with a local anesthetic right in the office.  Or, of course, your partner could have permanent sterilization as an outpatient office procedure.

Hormonal types of birth control are very effective, but can have both side effects (bloating, risk of stroke for some women) as well as protective benefits (against bone loss and some forms of cancer, for example).  It is very important to carefully review your health history with your health care provider to select the best option for you.

Short-term hormonal options include

  • Combined estrogen-progestogen pill (COCP). This is “the pill” you are probably familiar with. Since it now has very low estrogen levels, it’s considered safe for women who have no risk factors until age 55.
  • Progestogen-only pill (POP), which is a good option for older women. It must be taken regularly at the same time of day, however.

Long-term hormonal options include

  • Progestogen shot, which is a once-every-8-12-week option.
  • Progestogen implant, in which a tiny rod is inserted in the upper arm. It lasts for three years.
  • Vaginal rings release low dosages of estrogen. The ring is kept in the vagina for three weeks, then removed for a week.
  • A patch, which also releases low dosages of estrogen and progestogen.
  • An IUD impregnated with progestogen, which is highly effective and lasts for years.

The old non-hormonal standbys still include

  • Condom. Again, the only birth control that also protects against STIs.
  • Non-hormonal IUD. Also highly effective and long-lasting.
  • Diaphragm with spermicide, cervical cap, or spermicidal sponge.

Your choice of birth control at this point should be informed and careful. You need a plan to carry you through menopause, and you need to begin the dialog with your healthcare provider.

Since the consequences of ignoring the issue are so life-changing, this conversation ought to begin now!

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FDA Approves Drug for Sexual Pain

Posted in Condition News, tagged , , , on March 19, 2013 | 1 Comment »

Ladies, we have one more tool in the belt.

Last month, the US Food and Drug Administration (FDA) approved a new drug to treat the vaginal and vulvar pain associated with loss of estrogen in older women.

That pain is called dyspareunia, and it’s caused by the changes in the vagina and genitals that occur when we lose estrogen during menopause. As we’ve said (often), our vaginal tissues become thin, dry, and fragile as our estrogen levels decline, which can make sex very uncomfortable. Dyspareunia is common, and it doesn’t get better on its own.

Until now, treatment options have included using moisturizers (regularly) and lubricants (before sex) or replacing estrogen, either topically in the vagina or through hormone replacement therapy.

Now there’s a pill that you take once a day.

Osphena is called a “selective estrogen receptor modulator,” or SERM. Although it’s not a hormone, it works like one in that it affects some estrogen-sensitive tissues, like the vagina and the uterine lining (the endometrium). The vagina will thicken and become less fragile while other tissues, such as the breast, are affected very little.

In a 12-week trial of almost 2,000 women here in the US, the researchers saw a “statistically significant improvement” in the pain level of the women who took it compared with a control group.

Of course, there’s no free lunch when it comes to pharmaceuticals. Some common and less-serious side effects include hot flashes, vaginal discharge, muscle spasms, and sweating. But a few uncommon and more serious side effects include blood clots, stroke, and vaginal bleeding that can indicate cancer of the endometrium.

That’s why the drug comes with a black box warning from the FDA, and why the FDA advises taking it in the smallest amounts and for the shortest time possible.

It’s also uncertain whether the condition will reverse itself once the drug is stopped.

Despite the scary black box, I’m thinking that Osphena gives us another option. It might not be our first choice for long-term use. It still isn’t the magic bullet for all menopausal ailments.

But it might provide a little short-term boost, for example, to make a woman with severe dyspareunia more comfortable until the moisturizers or the topical estrogen kicks in. And until her renewed sex life helps rejuvenate the vagina because sex, in case you forgot, “is beneficial for maintaining vaginal health,” says Dr. David Portman, lead researcher in the Osphena trials for safety and effectiveness.

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Too Tired for Sex? Join the Club

Posted in Condition News, tagged , , , on March 11, 2013 | 1 Comment »

I was sitting in a tiny hut in Mexico talking with a dignified older gentleman. Outside the ramshackle house, the sun shone on the empty desert. The ocean lapped the nearby shore. There was no traffic, no noise, no shops, no phones.

“The Americans, the Germans, and the Japanese are the hardest-working people in the world,” the man said.

First, I was startled that someone in this very remote place would be so astute. Then I wondered: Is this a good thing?

With all our mobile toys, we don’t ever have to stop working in America. We can be connected 24/7. Maybe we can squeeze in a few extra obligations after-hours. Or, we might be caring for parents and children, and sometimes spouses and grandchildren. Even if we’re retired, we’re programmed to run hard and fast.

But look what it’s doing to us. We’re stressed; we’re overweight; and we’re dog-tired.

Sex life? What sex life?

Ian Kerner, a well-known sex therapist, cites a recent study by the National Sleep Foundation in which one-quarter of American couples say they’re often too tired for sex.

Mary Jo Rapini, one of our medical advisors, recalls encouraging a couple to take time for a romantic getaway. “Oh no, who’ll plan that for us?” they asked. Well, “usually the couple enjoys planning these things together,” she said.

“We don’t have the energy,” they responded.

Think of sex as the canary in the coal mine. It’s one of the first things to go when life gets out of whack. But if you ignore that quiet little loss, pretty soon the bigger stuff suffers, like good health and relationships.

If sex is just another obligation, or you’re too tired to even think about it, you need a life/work balance adjustment.

If you don’t have some other physical or psychological problem, such as a thyroid condition, chronic fatigue syndrome, serious relationship issues, or hormonal imbalance, you shouldn’t be too tired for sex.

So, if stress, overwork, overcommitment, and the general pace of life, has killed your libido, consider this:

Allow time for sleep. Right now. Nothing else matters if you’re chronically sleep-deprived. Re-assess your involvements. Try to delegate tasks. Cut back on work. (Doctor’s orders.)

“A good night’s sleep every night—more so than exercise and a healthy diet—keeps our sexual engines humming,” says Barry McCarthy, PhD, a Washington, D.C., sex therapist.

Give yourself an hour to unwind before going to bed in the evening. Turn off the TV and all the other screens. “It’s terrible to have a television in your bedroom, which should just be for intimacy and sleep,” says sex therapist Sherri Winston.

Spend that time relaxing with a book. Share a cup of herbal tea. Cuddle with your honey. Take a bath.

Exercise.  Regular, moderate exercise is part of the work/life balance thing. Can you walk 30 minutes a day? Maybe with your partner? Can you find a gentle workout video? (My favorite now is hot yoga, but I have friends who spend 20 minutes a day with our old pal Jane Fonda.)

Exercise makes you feel better. It helps you lose weight.

And guess what? It helps you sleep better.

De-stress. Yeah, I know this sounds impossible. But you have a choice: You can continue to worship at the altar of overcommitment, at which you will offer up your health, your intimate relationships, and your quality of life.

Or you can bring your life into a healthy balance, and probably live longer—and have a lot more satisfying sex.

Need more persuading? Stress releases cortisol, a hormone that decreases testosterone, of which we women have precious little in the first place. Thus, stress directly hammers our sex drive even before the sleep-deprivation sets in.

Follow your rhythms. If you’re exhausted at night, why not have a little afternoon delight? Or maybe sex in the morning? Testosterone levels naturally rise a little then, so that might be the opportune moment to turn up the heat. Caress and cuddle at night and save the sizzle for the morning.

Just do it. You know how you may not be in the mood, but a little nibble on the ear, a little stroke on the thigh… and, well,… maybe…

Libido is like a puppy. Give it some loving, and it will follow you home. And sex begets more sex. You have to do it to want it.

When I recall the tranquility I felt in that simple hut in Mexico, I wonder if we somehow took a detour on the road to the good life. Maybe we can learn something about simplifying, cutting back, enjoying the little things, and loving each other from people who don’t have many possessions, but who probably sleep very well at night.

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Make a “WISH” for Awareness of Women’s Sexual Health

Posted in Condition News, tagged , , , on March 8, 2013 |

Actually, do more than wish. Be active.

Sign this online WISH petition to add your voice to others advocating for greater attention to women’s sexual health needs. The WISH petition is sponsored by the International Society for the Study of Women’s Sexual Health (ISSWSH), which is a professional organization for those of us who work in the field of women’s sexual health.

The petition supports ISSWSH’s position that “female sexual disorders are valid conditions that warrant assessment, diagnosis and appropriate therapeutic intervention.”

But WISH is more than a petition. It’s an initiative dedicated to bringing “the medical community together with the public to recognize the importance of female sexual health, so that it is no longer considered a ‘lifestyle choice,’” according to MaryAnne McAdams, director of the WISH Initiative. The group even has a Facebook page.

As a professional in the field, I feel strongly about the need for more recognition, more acceptance, more treatment options, more research, and more pharmaceutical options for women who experience sexual dysfunction.

There are many of you. The numbers vary greatly (another area for research, perhaps?), but it is estimated that from 19 to 50 percent of “normal” women experience sexual dysfunction, according to a 2000 article in American Family Physician. Predictably, that number increases when the physician actually asks the patient about her sexual health, which many don’t. (An area for physician education, perhaps?)

As I’ve said before, I’d like companies to develop more pharmaceutical options for women, and I’d like the FDA to consider them seriously and carefully. I know that it’s easier to make a drug to treat erectile dysfunction. I’m well aware that women’s desire/arousal trajectory is complex and multi-dimensional, but the more tools we have in the bag, the more successfully we can treat women with sexual issues.

It’s easier, of course, to fall back on the old “it’s in her head” or “it’s a lifestyle choice” crutch. Thankfully, that attitude is becoming discredited and debunked, but those voices are still around.

“In the last few years, there has been a small, but very loud group who have been given the chance to speak during FDA Advisory Meetings claiming that female sexual dysfunction is a made-up condition and is not ‘real,’” says WISH’s MaryAnne. “The WISH petition may be used as a source of documentation to dispute that erroneous claim.”

As a physician who treats women’s sexual health, I’d like more attention paid to the issue by government agencies, pharmaceutical companies, and my colleagues. I’d like women’s sexual issues to be acknowledged, respected, and treated with intelligence, competence, and sensitivity. And since at some point in your life, you’ll probably experience some lack of libido, difficulty with arousal or achieving orgasm, or some pain during sex, I’m sure this is an important issue to you, too.

If it is, sign the WISH petition. We know size doesn’t always matter, but the number of voices on this topic does count!

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Keeping Things Open

Posted in Condition News, tagged , , , on February 25, 2013 |

Maybe you’re divorced or widowed. Maybe you’ve been single and partnerless for a while. Maybe you found someone after a long dry spell. Or, maybe sex has just been darned painful lately.

Time was, you could count on your vagina to do its job. It just worked. You didn’t have to think about it. But with loss of estrogen you’ve been experiencing lately, that uncomplaining organ begins to act up. And if you haven’t used it lately, it actually begins to shrink and shorten.

Now, if you’ve been on the sidelines, sexually speaking, for a while, you won’t be able to jump back into the game without some preparation. At this point, sex can be surprising, and not in a good way.

After menopause, the name of the game is “use it or lose it.” Furthermore, it’s a lot easier to maintain vaginal health than to play catch-up after ignoring the situation downtown for a while.

As we explain in detail in our recipe for sexual health, when you lose estrogen, the vaginal walls become thin, dry, and fragile. They atrophy. Without regular stimulation, the vagina can become shorter and smaller. It can also begin to form adhesions and stick together. Some cancer treatments exacerbate this process.

We’ve talked about moisturizers, practicing your kegels, using a vibrator or other form of self-pleasuring as part of your sexual health maintenance program.

But another important tool, especially if you’re currently without a partner (or are trying to rehabilitate now that you’ve found someone) is the regular use of dilators.

Say what?

Dilators are sets of tubes, usually made of high-quality, cleanable plastic, that start small (half-inch) and gradually larger (up to an inch and a half). They’re inserted into the vagina in gradually increasing sizes to stretch the vaginal walls, making them open enough (which is called patency) and capacious enough to do their job.

It isn’t quick, but it is effective.

Occasionally, I run across suggestions for homemade dilators that make use of various round objects. Don’t try this. It’s important for all kinds of reasons to use only high-quality dilators that are smooth and easy to hold, that increase in size gradually and consistently, and that can be cleaned well.

You should only use the safest, highest quality product in this important place. If you don’t know where to look, we offer a selection of dilators on our website that we’ve carefully vetted. These will work much better for you than those candles you were eyeing.

Here’s how you use them:

Relax. Take a bath—it makes all those tissues soft and pliable. Lie comfortably on your back with your knees open.

Lubricate the smallest dilator well with a vaginal lubricant.

Gently insert it into the vagina. Keep all those pelvic floor muscles relaxed. Breathe. Push the dilator in as far as you comfortably can.

Hold it there for 20 to 30 minutes. Do this twice a day.

When you can comfortably insert the smallest dilator, graduate to the next largest size.

It can take three months or more to restore vaginal capacity.  Once you’re comfortable with the largest dilator, continue the regimen at least once a week if you aren’t having sex regularly. And don’t forget the moisturizers.

It takes patience and diligence to rehab your bottom, but you can do it. With a little TLC, everything will work as well as it ever did and sex can be every bit as luscious as it ever was.

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This Doctor Still Wants to See You

Posted in Condition News, tagged , , , on February 11, 2013 |

The new medical guidelines and what they mean for you.

Every year, you used to visit your ob/gyn for a Pap test and pelvic exam. Then you’d get your mammogram. Some ladies I know made it a “girlfriends date” and went out to lunch after their mammos.

It was like getting your healthcare seal of approval. All’s well with the world. See you next year.

Now the “guidelines” have changed. You’ve heard that you don’t need these tests every year. In fact, depending on your age and health status, you may not need them any more at all.

Wait, what? Who re-arranged the furniture? What does this mean?

And more to the point: What happens to the girlfriends date?

With a slew of new guidelines from the American Cancer Society and the American College of Obstetricians and Gynecologists (ACOG) and the US Preventive Services Task Force, it’s no wonder you’re confused. One year? Three years? Beginning at what age? Ending when?

These guidelines reflect new thinking and research, not the removal of a time-honored safety net. You won’t be at greater risk—you just may not need the same tests on the same schedule. Also, different professional groups have come to slightly different conclusions about how often these preventive tests should be administered.

So, while it’s helpful to be aware of these changes, it’s also critical to discuss them with your own healthcare provider. Because your healthcare situation is unique, and guidelines are one-size-fits-all, the schedule has to be tailored to fit your specific needs. You and your doctor are the best ones to make that decision.

Here’s what some of the discussion is about.

The value of an annual physical, which ACOG also refers to as a “well-woman visit,” is that your doctor can examine and assess your overall level of health and can check for changes or abnormalities. A regular visit also keeps intact the relationship between you and your doctor. After all, it’s important to trust this person when healthcare decisions need to be made.

During your annual physical, your provider may do a pelvic examination. Herein lies some confusion. A doctor may, and often will, do this exam without a Pap test. A pelvic exam allows the doctor to take a thorough look at your external genitalia and to digitally (yes, with a finger in your vagina or rectum) examine your cervix, uterus, and other internal organs.

In its new guidelines, ACOG recommends an annual pelvic examination in women over 21. But the guidelines also state that, while an annual pelvic exam “seems logical… No evidence supports or refutes the annual pelvic examination or speculum and bimanual examination for the asymptomatic, low-risk patient.”

Translation: in the absence of symptoms, the final decision is up to you and your doctor. Pelvic exams are also important if you have any pain, discharge, bleeding, or change in bowel or bladder function. Your doctor needs to know about any of these issues.

As for the Pap test—you probably know that it only screens for cervical cancer—it’s been a very effective tool in that regard. But many women don’t need screening for cervical cancer anymore—if they no longer have a cervix, if they’ve had several normal pap tests and don’t have a lot of sexual partners.

Be aware, however, that there are other cancers of the genitals and reproductive organs, and I’ve occasionally found them during a pelvic exam: You’d better believe I still recommend an annual physical that includes a pelvic exam for my patients.

The guidelines for mammograms are even more confusing. The American Cancer Society still recommends annual screening after age 40. However, the US Preventive Services Task Force recently revised its guidelines after analyzing data extensively, to screenings every two years for women over 50. Women over 74 no longer need mammograms, according to the Task Force.

Meanwhile, physicians routinely do manual breast exams in their offices. That’s the kneading, palpating exam the doc performs to check for changes and lumps. While ACOG and other organizations still recommend a clinical breast exam every one to three years, the US Preventive Services Task Force says that “current evidence is insufficient to assess the additional benefits and harms of clinical breast examinations….”

So, what’s a woman to do?

Again, talk with your doctor. It’s good to be informed about changing guidelines and protocols. These changes only mean that research is ongoing and the body of knowledge is increasing. But you have unique risk factors, heredity, health issues, fears, lifestyle choices, and preferences. The best way to make sense of the guidelines is to discuss them with your provider in light of your personal situation, and then come to a conclusion that you’re both comfortable with.

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More Sexy Makeover–from the Inside

Posted in Condition News, tagged , , on January 3, 2013 | 2 Comments »

In my last post, I talked about how we construct our body image from childhood experience, media messages, and social definitions of beauty. Body image is the result of our own internal dialog, not how others actually see us. For the new year, I hope we can all remember that beauty is in the eye of the beholder, and that our bodies are amazing.

If you’re working on health, start small. First, use this calculator on the CDC website to assess your body mass index (BMI). This gives you a more realistic picture of where you fall on the scale of avoirdupois. Then, change one thing at a time: walk to the store. Join a yoga class. Go to the gym.

“I don’t look like Jane Fonda,” said a participant in the Psychology Today survey. “I look like a normal 46-year-old woman who has had three children. But my body is beautiful because of all it does for me. I have two eyes that can see, a large nose for smelling, a large mouth for eating and smiling, two hands that can hold and hug, two breasts that have nursed three sons, an abdomen that was home to three babies, two legs that can walk everywhere I want to go, and two feet to take me there.”

Amen to that, Sister.

Focus outward. If you’re shy or socially awkward, you may also be overly sensitive about your looks. (I can relate.) If you focus on yourself rather than on the world around you, you become more critical of yourself. Try to make others feel at ease. “Once I worked on my people skills, I found that I worried less about my appearance,” said one 60-year-old woman in the survey.

Confidence is catching. People who are happy and radiate confidence are attractive, and it doesn’t matter how they look or how old they are.

Here’s a tip: If you don’t feel confident, fake it. Stand tall. “Walk like a queen,” my friend said to me. Think of yourself as attractive and interesting. Make eye contact and talk to others. Practice this until you can do it effortlessly.

P.S. Self-confidence is also sexy!

Be true to yourself. Why worry about conforming to expectations? Who has time for that? Wear what you like. Purple if necessary. Say what you believe. It’s time to let the world get to know that wise, experienced woman you are.

Body image, like our bodies, isn’t static. How you felt about yourself as a teenager or a young woman is obviously different from your body image today. The good news is that older women tend to be more comfortable with their bodies as they age. But the work of improving body image is never done. Perhaps being comfortable when we’re naked with our partner is the truest, most difficult, and most important, test of a rock-solid body image.

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