Oct
8
Sometimes it’s the little things that can make a big difference. Here are 7 practical, evidence-based recommendations you and your docotr can impliment now to improve contraceptive care:
- Do not require a pelvic examination before prescription of an oral contraceptive
Both the World Health Organization and the American College of Obstetricians and Gynecologists recommend doctors consider a pelvic exam optional before prescribing an oral contraceptive (OC). This removes a barrier to care for a patient who may fear it, postponing the exam to the near future when she may be more comfortable with her health care provider. - To encourage continuation, begin now
Starting OC pills immediately—instead of waiting for the Sunday after the next menstrual period can improve the short-term continuation rate (Use condoms as back up for first cycle if >7 days since the beginning of your last period). - Provide more, not less—Dispense at least 3 to 6 months of an OC
This results in a lower discontinuation rate. One study showed that dispensing a 12-month supply of OCs reduced unplanned pregnancies by 30% and abortions 46% (why aren’t health insurers listening to this?). - Move away from every-day regimens
Forgetting to take your pills? Consider a non daily method, such as Ortho Evra® patch (weekly) or vaginal Nuva Ring® (monthly). - Make a case for long-acting reversible contraceptives
IUDs and the skin implant Implanon® as first-line contraception more often—convenient, removes user errors, and much more effective ( 1% vs. 5% pregnancy rate with OCPs) - Emphasize non contraceptive benefits
Hormonal contraception reduces acne, menstrual flow and cramps. Counter false fears about weight gain or lingering effects on subsequent fertility. - Preemptive prescribing “Morning after pill”
If you are a sexually active woman using nothing, withdrawal, or condoms then ask your doctor for a prescription for emergency contraception—Plan B® or Ella. You can fill the prescription and keep it at home in case of unprotected sex.
Finally, let us reassure you that every method of birth control is safer for them then the risk of complications during pregnancy—after all this is the “disease” we are trying to prevent.
Wishing You Good Health,
Women’s Health Specialists
2299 Mowry Avenue, Suite #3C
Fremont, CA 94538
510.796.7057
www.WomensHealthFremont.com
Office hysteroscopic sterilization with permanent tubal inserts (Essure & Adiana) is well tolerated and takes less than 10 minutes. It avoids the risks and recovery of a tubal ligation, side effects of general anesthesia, and the expense and anxiety of a trip to the operating room.
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Sep
8
With the frequent use of transvaginal ultrasound, CT scans, and MRIs; the diagnosis of uterine polyps has increased. Endometrial polyps are small growth from the inner lining of the uterus. They occur in menstruating and postmenopausal women, and in some cases are thought to be related to unopposed estrogen and medications like tamoxifen. Some women are asymptomatic at the time of diagnosis; whereas others experience abnormal bleeding patterns such as spotting between periods, heavy menstrual bleeding, or postmenopausal bleeding.
So when should we be concerned? A recent review of 17 studies was published in the Journal of Obstetrics & Gynecology about the cancer potential of uterine (not cervical) polyps. Those women with uterine polyps and abnormal bleeding or in menopause only have a 5% chance of cancer. Fortunately we can easily remove polyps by hysteroscopy to send to the lab for analysis (inserting a thin scope into the uterine cavity similar but more accurate than an old fashioned D&C). It’s low risk, relatively painless, and requires no recovery time other than the day of the outpatient procedure. Even if malignancy is detected, most of the time the prognosis is excellent when confined to a polyp as hysterectomy is curative.
Bleeding between periods? Heavy periods? Menopausal bleeding? Come see us today… Modern gynecologists conveniently offer ultrasound in their offices where they can enhance detection of small intra-uterine growths by placing water in the uterus (Sonohysterography), or alternatively perform hysteroscopy.
Wishing You Good Health,
Women’s Health Specialists
2299 Mowry Avenue, Suite #3C
Fremont, CA 94538
510.796.7057
www.WomensHealthFremont.com
PS: We’re now part of the Washington Township Medical Foundation
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Aug
9
The discovery that persistent cervical infection by sexually transmitted high-risk human papillomavirus (HPV) causes virtually all cervical cancer has led to revolutionary advances in cervical cancer prevention, including HPV vaccination for young women and HPV testing.
A recent article published in the Journal of Obstetrics & Gynecology found a number of disturbing patterns regarding overuse of HPV testing. First, approximately one quarter of the surveyed clinicians ordered both high-risk and low-risk HPV tests. Testing for low-risk HPV offers no benefit to patients because these HPV types are unrelated to potential cervical cancer (though they can cause warts). Second, approximately 60% of the doctors reported routine testing for HPV for women under the age of 30, despite guidelines that strongly recommend against such testing because most occurrences of HPV in this age group have proven to be transient. 80% of women will contract HPV and most will clear it in short order thanks to their immune systems—just like a cold virus. Third, many practitioners are co testing (PAP & HPV) annually and biannually rather than triannually as recommended. Finally, high volumes of unnecessary PAP tests are being performed on women who receive no benefit from cervical cancer screening, such as hysterectomized women without a cervix, and young women who are not yet sexually active and thus have never been exposed to the HPV virus. It was estimated that more than half of the 75 million Pap tests performed in the United States in 2010 were probably outside of guidelines and therefore unnecessary.
National guidelines for high-risk HPV DNA testing for the following indications:
- Conditional HPV testing of women if they have a borderline abnormal PAP. This is appropriate for women undergoing screening in their 20’s. If the HPV is positive then further evaluation by her gynecologist is necessary.
- HPV testing should be used routinely in an addition to a PAP in women aged 30 years and older. Women who test negative for both HPV and PAP are then screened at an extended interval of no less than 3 years because it excludes cervical cancer with an accuracy of over 99%. If women test positive for HPV then they are either rescreened in one year, or if their PAP is also abnormal then they undergo further immediate evaluation—called Colposcopy.
- HPV testing at 12-month follow-up visits for women who had previous pre-cancerous cervical changes or recent abnormal screening.
Here is a summary of cervical cancer screening:
Confused? Just remember it is very important that you have a yearly gynecologic exam irregardless of how often your PAP test is performed. After all, there is more of you to care for than just your cervix.
Wishing You Good Health,
Women’s Health Specialists
2299 Mowry Avenue, Suite #3C
Fremont, CA 94538
510.796.7057
www.WomensHealthFremont.com
PS: We’re now part of the Washington Township Medical Foundation
Share this newsletter with those you care about… sisters, mothers, friends
