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Gynecologists and Male Patients?

Thursday, December 5th, 2013

Gynecology is, by definition, the branch of medicine that deals with functions and diseases, especially of the reproductive system, specific to women and girls. However, recently, some gynecologists have been looking at this definition as more of a recommendation – and a flexible one at that. For example, a gynecologist at Boston Medical Center has added a new demographic to her patient roster: men.

Dr. Stier and other gynecologists who share her views have started caring for certain men; specifically, those at high risk for anal cancer. Anal cancer is rare, but it can be fatal and it is being seen more frequently, particularly among men and women who are HIV positive. Anal cancer is typically caused by the human papillomavirus (HPV) virus – the same virus that is often blamed for cervical cancer.

Dr. Stier sees mostly women, but last year she treated about 110 men as well. Using techniques she adapted from the ones developed to screen women for cervical cancer, she began screening men for anal cancer.

However, in September, the American Board of Obstetrics and Gynecology mandated that its members limit their practice to women with very few exceptions. In addition, they said that gynecologists were not allowed to perform the procedure Dr. Stier had been performing on men. Gynecologists, who often need their board certification to keep their jobs, cannot ignore directives like this.

Now Dr. Stier’s male patients are upset and her studies are in limbo. And she is not alone – other gynecologists who were engaging in the same practices have found themselves in similar circumstances. Researchers and doctors have asked the board to reconsider, but so far the board will not, pointing out that there are other doctors who could perform the screening procedures on men. The board also reiterates that the field of gynecology was specifically designed to treat women.

Apparently, Dr. Stier and others had not understood how absolute the definition of the field of gynecology was. But the board has drawn the line, emphasizing that its mission is treating women, not dabbling in spin-offs for their potential profitability. The screening process used by Dr. Stier, anoscopy, is not the only procedure in question nor is this the only incident of gynecologists straying from the original framework of gynecology; others had begun providing treatments such as testosterone therapy for men and cosmetic procedures such as liposuction for both men and women.

This trend is changing, however, thanks to the new rules the board posted on its website on September 12.  The new rules are explicit, specific, and outline exactly what gynecology should entail: treatment of women, with treatment of male patients limited to very specific circumstances, such as fertility evaluation, newborn circumcision, and emergency care.

Some doctors are upset by the new guidelines, including Dr. Stier, who is concerned that her male patients won’t get the follow-up they need now that she can no longer see them. However, there is no reason that I can see why the specialty of gynecology should expand into unrelated disciplines. The very reason why we have specialties is so that specific areas of medicine can be studied thoroughly and the treatments we are able to provide kept up to the minute. A gynecologist should specialize in gynecology – delivering babies, taking care of women. Other practices and treatments are important and helpful, but they aren’t gynecology.

– Yvonne S. Thornton, M. D., M. P. H.

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The Importance of Breast Self-Exams

Monday, December 2nd, 2013

Breast cancer is a major topic of interest these days, partly because so many women will eventually get it, and partly because education can make such a huge difference in a given woman’s prognosis. According to the National Cancer Institute, the 5-year survival rate ranges from 98% when the cancer is caught early and has not metastasized to around 24% when it not found until after it has already spread to other parts of the body. This is precisely why screening measures such as breast self-exam, clinical exams by a doctor, and regular mammograms after age 40 are so important.

Breast Self-Exam

Self-exam is the most important and most effective screening method available to women younger than 40 years of age. It is free, takes very little time, and saves thousands of lives every year. No one is as familiar with your own unique breasts as you are, so you can often find changes, thickening, lumps, or skin changes that other people might not notice during an examination.

Examine your breasts during the same time each month – for example, ten days after your period starts. If that is too hard to keep track of, then do the exam on the last day of your period. Before or during your period is not a great time because your breasts may be enlarged, making it hard to determine what you are feeling.

Look at your breasts in the mirror, checking for symmetry. If one of your breasts has always been slightly larger than the other, then this is nothing to worry about. However, if one of your breasts has newly become larger than the other, this is something to get checked out. Look for any changes in the skin, such as dimpling, pitting (like an orange peel), or redness. Look for any retraction of the skin that occurs when you raise your arms above your head.

To feel for lumps or changes inside your breasts, the best place is in the shower because your hands slide more easily over wet, soapy skin. Use your fingers to make concentric circles all over your breast, working your way in toward the nipple, and checking for any unusual lumps and also squeezing the nipple to check for any discharge (there should be none unless you are lactating). Don’t forget to check your armpit for lumps as well. After your shower, repeat this exam lying on your back with your arm raised above your head and lotion or baby oil on your skin.

Why Is Breast Self-Exam Important?

In just a few minutes once a month, you could very well save your own life. Women have many reasons for not performing self-exams. They may be afraid of what they will find (ironically, breast self-exams keep women much safer). They may not think it necessary, since their doctors examine their breasts (but a tumor can do a lot of spreading in a year’s time). Or they may forget or not think about it for months at a time. However, the statistics show the importance of making an effort to remember this.

Clinical screening methods are also important and can catch things that a woman might not be able to feel or see in her own breasts. An annual exam by your gynecologist as well as regular mammograms are important screening tools that save many lives – but neither is as effective or as important as being familiar enough with your own breasts to be aware of a change the moment it happens. If you do feel or see a change in one of your breasts, but your doctor seems to think it’s nothing, don’t worry – he or she is probably right – but do insist on following up with a mammogram to take another look. No one knows your body like you do. You are the expert on your unique body, you are the one responsible for your own well-being, and you are the one in charge of watching for signs of breast cancer and getting medical attention immediately if they do appear.

If you are older than 40 years of age, then a mammogram is the preferred approach to evaluation of your breast (perhaps with an adjunctive sonogram for dense breasts).  A Canadian Task Force concluded that breast self-examination in older women (40-69 years) )should not be performed due to increased anxiety and unnecessary biopsies for benign disease.  However, as I have stated in my women’s health book, “Inside Information for Women”, I believe that breast self-examination has the potential to detect breast cancer that you can feel and still should be recommended.

– Yvonne S. Thornton, M. D., M. P. H.

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Fruit and Vegetable Intake Linked to Lower Bladder Cancer Risk

Thursday, November 28th, 2013

New studies show that a higher intake of fruits and vegetables is associated with a lower risk of bladder cancer in women. One study carried out recently by the University of Hawaii Cancer Center concluded that consuming more fruits and vegetables effectively lowered the risk of bladder cancer in women – worth noting, though, is the fact that no similar decrease in risk was found in men.

Researchers conducted this study to evaluate the relationship among lifestyle, genetic, and dietary factors and cancer risk. Data was collected from over 185,000 adults over a 12.5-year period. Among this group, 581 cases of invasive bladder cancer were diagnosed during the study, with almost three times as many men as women being diagnosed.

After adjustments were made to account for variables that would be related to cancer risk, such as age, researchers concluded that the lowest bladder cancer risk was found in women who consumed the most fruits and vegetables. Specifically, the highest consumption of yellow-orange vegetables and the highest intake of vitamins A, C, and E were the most closely related to lower cancer risk.

Another study had less favorable results, finding little difference in bladder cancer risk among women who consumed more fruits and vegetables, but even this one did find that consuming more cruciferous vegetables was related to a lower risk of bladder cancer. All cruciferous vegetables were found to be beneficial, but broccoli and cabbage in particular were related to a significant decrease in bladder cancer risk.

The findings are not surprising, as researchers have long believed that a healthy diet containing many fruits and vegetables lowers cancer risk. The studies do further solidify this belief, however, although more research is needed to understand the reasons why the benefit of lower cancer risk when consuming larger amounts of fruits and vegetables was found only in women.

In most cases of cancer it is impossible to identify a specific cause, so it only makes sense to do everything you can to prevent cancer from occurring. Eating more vegetables is easy and inexpensive, might help, and definitely won’t hurt. A diet rich in fruits and vegetables is also known to promote overall health and prevent other types of cancer as well.

Signs of Bladder Cancer

Blood in the urine is typically the first sign of bladder cancer. There may be enough blood to change the urine’s color, so if you notice that yours is pink, pale yellow-red, or even darker red, be sure and see a doctor. Often the amount of blood present is small enough that it is only found during urinalysis.

There is usually no pain associated with early bladder cancer, so even if you feel fine, get red- or pink-tinted urine checked by a doctor – even if it is clear the next day. Bladder cancer may also cause more frequent urination, pain or burning during urination, or feeling an urgent need to urinate even when the bladder is empty. Lower back pain is another possible symptom; so is inability to urinate even when the bladder is full.

All of these symptoms can also be signs of less serious diseases, such as non-cancerous tumors, infection, or kidney stones. However, they should all be checked out to rule out cancer and treat the condition that does exist. Bladder cancer, like other cancers, has a much more favorable prognosis when caught early, so don’t hesitate to see a doctor should you notice any of its signs.

– Yvonne S. Thornton, M. D., M. P. H.

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Pregnant Women and Work Concerns

Monday, November 25th, 2013

In 2012, women account for 47 percent of the salaried labor force in the United States (http://www.catalyst.org/knowledge/statistical-overview-women-workplace). It’s only natural that concerns would arise regarding pregnant women and working. Today, many pregnant women plan to work throughout their pregnancies – probably too many. Pregnancy alone places an extraordinary amount of stress on a woman’s body, and it is extremely important to get enough rest. The decision to stop working can be a tough one, financially, emotionally, and socially, but it may be essential to protecting maternal health and the health of the baby.

If a woman cannot stop working or chooses to work despite the risks, she should be aware of safety precautions that must be taken in order to minimize the risks involved. Even if she sits at a desk all day, she must remember to get up and move around regularly, drink plenty of water, and eat a healthy diet – those office fast-food runs aren’t going to cut it. If she stands for an extended time as a supermarket cashier, hairstylist, bank teller, etc, the pregnancy may be at risk for preterm delivery.  Therefore, she must walk around or sit down every hour or so.  Getting enough iron, calcium and protein may help somewhat with fatigue, but women should realize that fatigue is their bodies’ way of telling them to rest, so that’s what they should do.

Pregnant women should take steps to stay as comfortable as possible, including making sure the chairs they sit in are supportive, that they are not standing for prolonged periods of time, and that they are not doing excessive bending or lifting. Heavy lifting and twisting while lifting should be avoided altogether. Exposure to harmful substances should also be avoided.

A pregnant woman who works should seriously consider ways to cut back on activities in other areas of her life. For example, shopping online can create more time for rest. Or, if possible, hiring a service to clean the house or do yard work or enlisting the help of other family members is a good idea. She should also do everything in her power to get enough sleep, including going to bed early and lying on her side with pillows between her knees and under her belly for maximum comfort and to prevent swelling in her feet.

It will also be important to keep stress under control. Pregnant women should do what they can to reduce workplace stress. For example, making to-do lists and prioritizing tasks can help them take the work day one task at a time as well as identify tasks that can be delegated to someone else. Taking a few minutes alone to practice some relaxation techniques several times a day can keep stress at a minimum, as can having someone to talk to about frustrations.

The bottom line is that women should discuss their jobs with their health care providers to determine whether they need to make other arrangements for the duration of the pregnancy. A woman who is at risk for preterm birth should not work, period – she should be focused on resting with her feet up and drinking plenty of water. Although pregnancy is a normal physiologic process, the workplace may be unkind to a pregnant woman and if that is the case, a pregnant woman should seriously consider giving up her job, if at all possible, or at least cutting way back on her hours.

– Yvonne S. Thornton, M. D., M. P. H.

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Women with Eating Disorders More Likely to Have Reproductive Problems

Thursday, November 21st, 2013

According to a Finnish study, women with eating disorders have a greater risk of reproductive problems. Millions of women in the United States alone suffer from eating disorders, and some estimates place the number of women who will have an eating disorder at some point in their lives as high as 10% of the worldwide population. Although eating disorders do occur at most ages and in both genders, they are most commonly diagnosed in women of childbearing age.

The University of Helsinki and the National institute for Health and Welfare carried out the study by examining 15 years of data from over 11,000 women. The startling findings included the fact that women with anorexia were only half as likely as their peers to have children. The study also revealed that women with binge-eating disorder are three times as likely as their peers to have miscarriages.

In addition, bulimics have twice as many abortions as their peers. The exact cause for this was not clear, but it could be that because eating disorders can cause irregular periods; these women may also be inconsistent with contraception use. It’s possible that it could also have something to do with bulimics’ tendency to exhibit impulsive behavior.

Worse still, women with eating disorders continue to have fertility issues even after they appear to have recovered. Women who have ever had an eating disorder, even if they are now recovered, still find it harder to conceive as well as to carry a pregnancy to term.

The study certainly highlights the need for more research on this apparent link, because it’s possible that early recognition and effective treatment for eating disorders may help prevent fertility problems. Currently, only about 1 in 10 people with eating disorders receive treatment. Early intervention and long term treatment may help reduce the ultimate effects of the eating disorder, so increasing the number of those getting treatment is important.

Of course, fertility problems are only one reason why it’s crucial for women with eating disorders to seek treatment, and women should discuss treatment options with their doctors for the physical effects of the eating disorder as well as the psychological and psychosocial effects. Social well-being is just one area of mental health that can be dramatically impacted by an eating disorder. Eating disorders cause numerous physical health problems as well, including problems with heart health, osteoporosis, dehydration or electrolyte imbalances, and tooth decay, to name a few.

People suffering from eating disorders can call the National Eating Disorders Hotline at 1-800-931-2237 for information on treatment and referrals, or they can talk to their doctor about possible treatment options. If you suspect that someone you know has an eating disorder, talk to him or her about it. Eating disorders are serious illnesses that can be life-threatening, so don’t wait to get help.

– Yvonne S. Thornton, M. D., M. P. H.

Posted in Fertility & Infertility, General health news | No Responses »
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The Trouble with Trans Fats

Monday, November 11th, 2013

You are probably aware that trans fats are bad for you. Research confirms this and even shows that in postmenopausal women, higher intake of trans fat is linked to a higher risk of ischemic stroke. In the study, no other types of fats showed the same relationship to ischemic stroke incidence. Interestingly, research also shows that taking aspirin regularly attenuates the risk of stroke even when trans fat intake is high, so you may want to ask your doctor about the wisdom of beginning an aspirin regimen.

The study involved over 87,000 healthy postmenopausal women between 50 and 79 years old and found that, independent of all other factors, including many lifestyle choices, higher intake of trans fats is directly related to higher risk of ischemic stroke. In addition, trans fats have been known to increase a person’s risk of heart disease, high “bad” cholesterol, and diabetes.

If only it were as simple as avoiding trans fats.

Unfortunately, many well-meaning people who read labels diligently and believe they are successfully avoiding trans fats may be in for a surprise. Food labels, it turns out, are disturbingly misleading.

The Food and Drug Administration (FDA) allows food manufacturers to round trans fat amounts down on labels in increments of .5 grams. This means that if a food contains less than .5 grams of trans fats per serving, the label can legally say that it contains none. When you consider that you may consume multiple foods with these misleading labels, and that the amount of each food you eat will often exceed the recommended serving size, you could be consuming a considerable amount of dangerous trans fat – but not have any way to know it.

Because the recommended safe maximum amount of trans fat per day is 1.11 grams, it’s easy to see how you could quickly consume more than this while believing that you are consuming none.

Activists are working to convince the FDA to change its rules on food labels, making it easier for consumers to determine what they are eating and control their intake of trans fats as well as other undesirable ingredients. In the meantime, however, you can make smarter choices by avoiding foods that often contain trans fats, such as commercial baked goods, fried foods, and shortenings.

Also, try this trick for reading food labels: look for the word “hydrogenated” in the ingredient list. The process of hydrogenation (adding hydrogen to vegetable oil in order to keep it from spoiling) creates trans fats. That means that even if the label says the food contains no trans fats, you can be sure that isn’t true if “hydrogenated oil” is one of the ingredients.

You can also avoid these harmful fats by sticking to a diet that contains mostly whole, fresh foods with an emphasis on lean protein and fresh fruits and vegetables, and by avoiding, for the most part, processed, fatty, chemical-laden foods.

– Yvonne S. Thornton, M. D., M. P. H.

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X-Rays and Pregnancy

Monday, November 4th, 2013

Many people are concerned about the effects of radiation from X-rays, such as those used for medical diagnoses. Some people become so worried about this that they refuse even important diagnostic X-rays that they need.

The small amount of radiation emitted by X-rays is actually no more dangerous than naturally occurring radiation, such as that from the sun or when you are flying in an airplane at high altitudes.

Low-energy ultraviolet (UV) rays, visible light, infrared rays, microwaves, and radio waves are all forms of non-ionizing radiation.  Ionizing radiation, on the other hand, is generated through nuclear reactions and can alter chemical bonds. Exposure to ionizing radiation causes damage to living tissue, and can result in mutation, radiation sickness, cancer, and death.

Just remember that diagnostic radiation is measured in millirads, while the concern about harming the fetus or embryo is in rads, specifically more than 5 rads.   That means there is 1000 times less radiation in the average diagnostic chest X-ray and one would need to have a thousand chest X-rays in order to reach one rad.   The National Institute of Child Health and Human Development says that a small amount of X-rays are safe even during pregnancy.  Because the fetus is inside the mother, it does benefit from some measure of protection from the effects of radiation. Pregnant women should, however, make sure that they tell their dentists or other doctors or technicians performing X-rays that they are pregnant so that proper precautions can be taken.   But, receiving an X-ray at a dentist’s office or at the hospital is NOT the same as being exposed to the amount of radiation emitted from Chernobyl or Hiroshima.  People exaggerate the harm of these medical diagnostic X-rays to the detriment of the mother because she may be denied appropriate imaging studies in order to diagnose a medical condition that, in and of itself, may worsen without the knowledge gained from the diagnostic X-ray.

With most decisions you make during the course of your pregnancy, you will want to weigh the risks against the benefits of any particular action and choose the option that is best for you and your baby.  According to the American College of Radiology, “no single diagnostic procedure results in a radiation dose significant enough to threaten the well-being of the developing embryo or fetus.” This statement was made over 20 years ago and it still rings true today.  So, why all the hysteria?  Ignorance and fear of possible lawsuits.  It’s important to remember that with X-rays, often not getting the X-ray will be the more harmful choice. X-rays have been shown to be quite safe, and even if you are still worried about the radiation exposure, keep in mind that your undiagnosed infection, condition, or injury may turn out to be much more harmful and may lead to death.

It is true that there is an abundance of misinformation and dysinformation surrounding the topic of X-rays during pregnancy. With that said, it is a good idea to limit X-rays to those that are imperative. Routine dental X-rays, for example, should wait until after your baby is born, while  X-rays of the lung to rule out tuberculosis or to investigate a troublesome symptom should not be delayed. Remember that X-rays save lives in many cases because of the information they provide for your doctor about your condition.

To reiterate, the fact is that diagnostic X-rays pose no threat to your unborn baby. Especially in the case of one-time X-rays that do not involve the lower pelvis, such as those that image the chest, arms, or legs.  Serial or cumulative X-rays and CT scans are another concern and should be limited during the course of the pregnancy.  MRI’s are not ionizing radiation, but rather powerful magnets which temporarily alter the energy state.

What if you had an X-ray before you knew you were pregnant? Don’t worry. The chance that it caused any harm is infinitesimal.  At that very early stage of pregnancy, the body invokes the “all or nothing” principle.  Either there is no harm at all or the body rejects the abnormal embryo, resulting in a miscarriage (spontaneous abortion).  If you are concerned about X-rays you had early in your pregnancy before you were aware the pregnancy existed, a discussion with your doctor should allay your fears.   Now that you know you are pregnant, be sure your doctor knows it when he or she orders X-rays for any condition. This is important for any treatment a doctor orders such as prescriptions and certain medical procedures as well as X-rays.

Occasionally, a woman may have X-rays to diagnose a mysterious “illness” that turns out to be pregnancy. Fifty percent of all pregnancies are unintended.  Therefore, if you are sexually active, you may be pregnant and you need to discuss that with your doctor before moving on to other diagnostic tests or treatments.

Finally, if your doctor wants you to have X-rays, inform him or her of any other X-rays you may have had in the recent past or before you were pregnant, so that they might be able to look at them instead of ordering new X-rays. This can help you avoid unnecessary X-rays, but again, if you do need X-rays, remember that refusing them is likely to be more detrimental to your health and that of your baby as compared to having an X-ray which could save your life by diagnosing or ruling out the problem.

– Yvonne S. Thornton, M. D., M. P. H.

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WHO Issues New Guidelines Calling for Earlier Treatment of HIV

Monday, October 28th, 2013

HIV (human immunodeficiency virus) infects immune system cells, impairing or destroying their function. In the early stages of HIV infection, there may be no symptoms, but as it progresses, immune system function deteriorates, rendering the person more vulnerable to other infections. AIDS (acquired immunodeficiency syndrome) is the most advanced stage of HIV. Once a person becomes infected with HIV, it usually takes about 10-15 years to develop AIDS. This amount of time can be lengthened even more with antiretroviral drugs.

HIV can be transmitted in several ways, including unprotected sexual intercourse (vaginal or anal), transfusion of contaminated blood, passed from mother to infant during pregnancy, childbirth, or breastfeeding, and through sharing contaminated needles. Over the past 30 years, HIV has claimed over 25 million lives. HIV infection is diagnosed through blood tests than detect the presence of HIV antibodies. While there is no known cure for HIV infection, antiretroviral drugs control the virus and allow many people with HIV to lead productive and healthy lives.

This past summer, WHO (World Health Organization) issued new recommendations for earlier HIV treatment than had been used previously. The new guidelines call for offering ART (antiretroviral therapy) earlier on in the infection. This is in response to new research that shows that when people receive ART earlier, they live longer, healthier lives, and have a lower chance of transmitting the infection to others by lowering the amount of virus in the blood.

The previous guidelines, which were set in 2010, recommended offering ART once the patient’s CD4 cell count fell to 350 cells/mm3 or less. 90% of all countries have adopted these guidelines. However, this year, the WHO changed their recommendation to beginning ART at 500 cells/mm3 or less, before immune system function weakens.

WHO also now recommends providing ART to all children under five years of age, all pregnant and breastfeeding women with HIV, and all people with HIV who are in a relationship with an uninfected partner – regardless of CD4 cell count.

Of course, in spite of advances in treatment and more enlightened recommendations, challenges remain. The number of HIV-positive children receiving ART has not increased as quickly as the number of adults receiving the treatment. Another problem is that certain people, such as intravenous drug users, sex workers, and transgender people often encounter cultural or legal barriers that stop them from getting treatments that are more readily available to others. In addition many people, for various reasons, discontinue treatment. This is a prevalent problem that needs to be addressed.

In spite of these challenges, the fact remains that today almost 10 million people are receiving lifesaving treatments for HIV infection. The goal now is to continue pushing to make treatment available to the over 10 million more who need it, and increase awareness of prevention and treatment methods worldwide.

– Yvonne S. Thornton, M. D., M. P. H.

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Should Your Gynecologist Be Your Primary Care Physician?

Thursday, October 17th, 2013

There is an ongoing struggle between patients, physicians, and managed care plans involving whether gynecologists should be able – or be expected – to serve as primary care physicians to women. Even among each group, there is disagreement on the best course of action. Patients may like the convenience of having only one main doctor. Gynecologists, while acknowledging that they do have adequate training to function as primary doctors, have conflicting preferences, with some believing that they should be primary doctors and others preferring to remain consultative specialists. Managed care plans allow women varying levels of access to gynecologists.

So how can a women decide what is right for her? Many women visit their gynecologists faithfully but never think about an annual physical. Others request physicals from their gynecologists. Still others visit both doctors regularly. The right choice depends on your preferences, the viewpoint of your gynecologist, and the guidelines set by your insurance company. One thing is certain: you need both exams yearly – a gynecological exam and a general physical exam – to promote good overall health and catch any potential problems early.

Why You Need a Yearly Physical Exam

During a physical, your doctor will not only perform a complete physical exam, but also discuss lifestyle habits, order appropriate screening tests, and administer age-appropriate immunizations. Lifestyle issues such as weight and tobacco use are discussed and plans formed for making positive changes.

Depending on your doctor’s style, your physical may include assessment of your vital signs, your family medical history, a heart and lung exam, a dermatological exam, an exam of your head, neck, extremities, and breasts. Blood tests may be ordered to screen for anemia, kidney disease, diabetes, high cholesterol, and other conditions. Depending on your age and history, other screening tests like colonoscopies and mammograms may be ordered.

An internist is experienced in managing high blood pressure, diabetes, high cholesterol, asthma, and other chronic conditions; they may also refer you to a specialist or coordinate your care with specialists you may already be seeing.

Why You Need a Yearly Gynecologic Exam

Regular physical exams are important, but it is equally important to take advantage of the specialized knowledge of gynecologists. When you visit a gynecologist for a well-woman exam, he or she can address issues such as fertility, birth control, sexually transmitted infections (STIs), cancer prevention, and other issues.

Gynecologists are also highly trained in performing pelvic exams and Pap smears, as well as counseling women on various health issues and lifestyle habits. Gynecologists also function as your consultants for major health issues regularly faced by women, now and through every stage of your life. At every age, there is a reason for a woman to see a gynecologist. She may need to discuss contraception, fertility, or genetic testing; she may need a clinical breast exam, a pelvic exam, or STI screening.

You decision about whether to see a gynecologist alone or a gynecologist and an internist depends on your preference, your medical history, your existing conditions, and the willingness of your gynecologist to serve in this role. If you decide to make your gynecologist your primary care physician, make sure he or she knows about this choice and is comfortable with it and willing to function this way.

– Yvonne S. Thornton, M. D., M. P. H.

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Women with Polycystic Ovary Syndrome Often Have Cardiovascular Disease Risk Factors, Too

Thursday, October 10th, 2013

A study published in the Journal of Clinical Endocrinology and Metabolism highlighted the relationship between polycystic ovary syndrome (PCOS) and cardiovascular disease (CVD). Researchers noted that women with PCOS were more likely to have risk factors for CVD. They carried out a study in which evidence-based reviews were provided of studies that examined the risk relationship and to develop guidelines for lessening the risk of CVD.

The study included only other studies where PCOS patients were compared with control patients, and excluded any articles that included unclear PCOS diagnoses or unclear controls. The conclusion of the study was that women with PCOS who are also obese, smoke, or have high blood pressure or impaired glucose tolerance are at risk for CVD. Women who have PCOS and type 2 diabetes are at high risk for CVD.

PCOS is common, affecting 6-10% of women of childbearing age, and is characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovaries. Other symptoms that women may notice to varying degrees include irregular menstrual periods, hirsutism, acne or other skin problems, weight gain (especially around the waist), thinning hair, pelvis pain, sleep apnea, and anxiety or depression. In young women with PCOS, there may be multiple risk factors for CVD, such as metabolic syndrome, type 2 diabetes, abdominal obesity, and high blood pressure. For these women, taking measures to prevent future CVD is an absolute necessity.

If you feel you may have PCOS, talk to your doctor about it. Your doctor will take some steps to see if you really do have PCOS or if another condition is causing your symptoms. Expect your doctor to ask you about your medical history, including your menstrual cycle and any weight changes; perform a physical exam, including blood pressure, waist size, and areas of increased hair growth; a pelvic exam, to check your ovaries for enlargement; a vaginal ultrasound, to further examine your ovaries; and blood tests to check for androgen and glucose levels in your blood.

If you do find out you have PCOS, even though there is no known cure, there are effective treatments that can help you manage your symptoms and prevent further problems. The right treatment for you will depend on your individual symptoms and whether or not you may become pregnant. Goals of treatment include lowering your risk for CVD and relieving your symptoms. A combination of treatments is the most effective route for most women.

The first line of defense against PCOS is losing weight. Eating healthfully and exercising can help you manage your symptoms with great success. Limiting sugars and processed foods will lower your blood glucose levels, improve the way your body uses insulin, and help normalize androgen levels. Even losing 10% of your body weight can make a big difference in irregular periods. If you don’t want to become pregnant, birth control pills can regulate your menstrual cycle, reduce your levels of male hormones, and help clear up your skin.

If you have diabetes, metformin is a drug your doctor may prescribe. It affects the way insulin is processed in your body and lowers male hormone production; it can also relieve many PCOS symptoms such as excessive hair growth, lowering cholesterol levels, and assisting with weight loss. It is important to note that metformin has not been approved by the FDA for treating PCOS, but it is approved and effective at treating diabetes, and studies show that it does, indeed, help with many common symptoms of PCOS.

– Yvonne S. Thornton, M. D., M. P. H.

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