Mar
28
Early Menopause?
Filed Under Women's Health News
The absence of menstrual periods for a minimum of one year is the hallmark of menopause. Premature ovarian failure (POF) is the term usually used to describe women entering menopause before the age of 40. Surprisingly, about 25% of these women may ovulate and some even conceive after the diagnosis is made, so some specialists suggest that it may be more appropriate to refer to this as “primary ovarian insufficiency”.
Semantics aside, 5–10% of women who complain of absent or irregular periods, or infertility have POF. Many display intermittent or persistent symptoms of estrogen deficiency (hot flushes, night sweats, emotional lability, and painful sex due to vaginal dryness).
In general, evaluation is warranted for any young woman with fewer than nine menstrual periods per year or missing three or more consecutive menstrual cycles. Once excluding pregnancy, measurements of hormones FSH TSH and prolactin levels are indicated. If the FSH is significantly elevated above 30 it should be repeated with an estrogen level (decreased below 50) to prove POF.
Since autoimmune disease is the most frequent cause of POF, screening for other types like thyroid abnormalities and diabetes should also be performed. Periodic bone density testing will assess for early bone loss that these women are at risk of developing.
Hormone therapy addresses symptoms such as hot flushes, night sweats, vaginal dryness, and also slows bone loss (The findings of the Women’s Health Initiative study do not apply to women with POF). It is important to remember that young women with diminished ovarian function typically require more estrogen than do postmenopausal women to alleviate similar symptoms. Although combination oral contraceptives (OCs) provide higher levels of estrogens then are required, OCs may be more emotionally acceptable and simplify compliance. Additionally, 1,200 to 1,500 mg of calcium each day, preferably with added vitamin D, is recommended for bone health.
Finally these women often need emotional support and resources such as the International Premature Ovarian Failure Association (www.POFsupport.org) or Rachel’s Well (www.rachelswell.com). Additonally abundant general menopause information on our webiste.
Wishing you good health,
Women’s Health Specialists
2299 Mowry Avenue, Suite #3C
Fremont, CA 94538
510.796.7057
www.WomensHealthFremont.com
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Feb
14
Pelvic floor disorders, including urinary and fecal incontinence as well as prolapse, affect 1 in 4 non‑pregnant women. Not surprisingly, the incidence increases with age from 10% in their 20’s to almost 50% in their 80’s, and also with bodyweight. Specifically, 1 in 6 women report concerns about bladder control. A recent study reported that incontinent women spend on average $900 per year on protective pads or laundry. Yet, most afflicted women remain silent because of embarrassment.
Kegel exercises are the foundation of most pelvic floor rehabilitation programs for incontinence, yet are challenging for women to perform long term. 
Over the past decade, synthetic urethral slings have become the gold standard for surgical correction of stress urinary incontinence (SUI), which is when a person loses urines with activities like coughing, sneezing, laughing, or lifting. Because these outpatient, minimally invasive procedures improve or resolve over 85% of cases and allow women to return to regular activities in just a few days, they have become very appealing solutions for women, whether busy mothers or elderly adults.
Alternatively, Renessa is an office-based treatment that shrinks the collagen around the urethra for women with SUI. It is an excellent solution for women who have not finished having babies or wish to avoid the operating room. Afterwards, over half the women report a 50% reduction in the number of incontinent episodes, and 45% are dry on pad testing.
An abundance of over active bladder (OAB) medications are now available to treat the most common cause of urinary incontinence. These women classically experience leakage after urgency or without exertion as is typical of SUI. Helping women understand reasonable goals, like improvement by an objective measure, such as discipline use of a one-week bladder diary (70% in one study), and empowering them about dose escalation during the first month of treatment; have been shown to improve compliance with continuing with these medications.
Finally, a woman tolerating prolapse symptoms, such as a bulge in her vagina, or difficulty voiding or defecating; may be interested to learn that a pessary or vaginal reconstructive procedure are solutions. The success rate and durability are significantly enhanced by using synthetic grafts that work like a hammock to support the bladder.
However little can be done to improve a women’s quality of life until a she voices her concerns about these embarrassing problems to her doctor.
Wishing you good health,
Women’s Health Specialists
2299 Mowry Avenue, Suite #3C
Fremont, CA 94538
510.796.7057
www.WomensHealthFremont.com
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Jan
20
Implanon® has been FDA approved for over three years and remains underutilized as one of the most effective hormonal contraceptives ever developed. It is a flexible plastic rod the size of a matchstick that is inserted under the skin on the inner side of a woman’s upper arm. Implanon® contains a progestin called etonogestrel, also found in some birth control pills. Implanon® prevents pregnancy for three years by several mechanisms of action: Inhibiting ovulation, altering cervical mucus to reduce sperm migration, and changing the inner lining of the uterus so it’s unreceptive to egg implantation. The chance of getting pregnant is very low (less than one pregnancy per 100 women who use Implanon® for one year).
Because Implanon® contains only progestin and provides up to 3 years of protection without daily, weekly, or even monthly action, it is well-suited for:
- Women who wish to or need to avoid estrogen (e.g. minimizes attributable side-effects of nausea, headaches, and blood clots)
- Teens who find adherence to a contraceptive regimen difficult
- Current Depo-Provera® users looking for greater convenience & avoiding adverse effects on bone density
- Healthy adult women who desire the convenience of long-term protection
- Women who are breastfeeding
The most common side effect of Implanon® is a change in a woman’s menstrual periods. While menstrual periods may be irregular and unpredictable, there is usually less bleeding, and some women will have no periods. A few women also gain weight.
Implanon® must be removed after three years when the implant runs out of hormones. It also can be removed anytime beforehand if the woman wants to become pregnant, where the ability to conceive returns quickly. In conclusion, most women are satisfied with Implanon®, citing its long duration, high efficacy, and convenience.
PS: We have extra H1N1 vaccine and wish to invite you & your husband to schedule an appointment before the end of flu season in late March
Wishing you good health,
Women’s Health Specialists
2299 Mowry Avenue, Suite #3C
Fremont, CA 94538
510.796.7057
www.WomensHealthFremont.com
Share this newsletter with those you care about… sisters, mothers, friends
