Women’s health issues

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Thank you President Obama for your wise words on healthcare reform

Wednesday, June 24th, 2009

Yesterday, at President Obama’s news conference, a reporter asked whether adding a “public option” – an option that allows people to buy health insurance from the government instead of private insurers – would, as insurers claim, drive them out of business.

The president answered:

“Why would it drive private insurers out of business?… If they tell us they’re offering a good deal, then why is it that the government, which they say can’t run anything, suddenly is going to drive them out of business? That’s not logical.”

As a physician who has seen the ever-escalating costs of health insurance hurt my patients, I have to say, I agree with the president wholeheartedly.

A public option won’t drive insurance companies out of business. But lack of good, affordable healthcare options is forcing people to delay necessary medical care. That means that people are often sicker by the time they see a doctor. Sometimes, it means, by the time they see a doctor, it’s too late for us to help them. That’s a national tragedy.

We must turn the debate away from how to safeguard the insurers’ profits to how to safeguard our families.

I sincerely hope that the politicians and lobbyists will stop playing with people’s lives for the sake of the almighty dollar and, instead, think of the public good and pass real health reform.

– Yvonne Thornton, MD, MPH

Posted in General health news, Health care policy, Women's health issues | 2 Responses »
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Pregnancy and the pill

Tuesday, June 16th, 2009

For many women, taking the pill is more a matter of delaying pregnancy until the time is right rather than preventing it all together.

So, the big question becomes, how long after you stop taking the pill can you expect to become pregnant? No two women are alike but, generally speaking, pregnancy is possible the next time you ovulate. You may ovulate within two weeks after finishing up your last package of birth control pills. So, theoretically, you could become pregnant almost immediately. However, as we all know, there are many variables. Some couples try for years to become parents without success.

It almost seems an unfair trick of the heavens that it’s sometimes the women who don’t want to become pregnant who easily do.

That means, if you’re dead set against pregnancy, and you stop the pill, you need to begin another form of contraception immediately. I actually recommend that my patients begin using an alternate contraceptive before getting off the pill so they get into the habit of using it.

Otherwise, you may have to get into the habit of changing diapers.

– Yvonne Thornton, MD, MPH

Posted in Contraception (birth control), Menstruation, Women's health issues | No Responses »
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“Is it hot in here – or is it just me?”

Friday, June 12th, 2009

If you’ve ever gotten a hot flash, you know how odd it can feel. Usually, hot flashes don’t have a major impact on a woman’s life but some women suffer more than others. About 80 percent of women experience hot flashes and night sweats, which are short bursts of intense heat of the face and neck. Usually they begin in the early years of the transition to menopause and peak one or two years after the last menstrual period, remain for several years and then resolve over a period of time. I’ve had patients come in to see me feeling downright miserable due to pre-menopausal and menopausal symptoms. Some complain of waking up dripping wet at 2:00 a.m. with night sweats or feeling like tiny bugs are crawling all over them.

These symptoms will pass as your hormone levels adjust but what do you do in the meantime? Other than buying a small hand fan, there’s no single answer. Treatment has to be individualized for each woman. Avoidance of triggers, such as cigarette smoking, hot beverages, foods containing nitrites or sulphites, spicy foods and alcohol, may  help limit hot flashes. Blood pressure medications have been prescribed off-label with some success. SSRIs (selective serotonin reuptake inhibitors) such as Prozac® and Zoloft® or antidepressants such as Effexor® (venlafaxine) also offer relief.  Oral estrogens or transdermal estrogen patches have been found to be very effective in reducing the incidence and the intensity of hot flashes.  However, if estrogen is used, unless you have had a hysterectomy, an additional hormone, progesterone, must be added to the estrogen in order to decrease your risk of developing uterine cancer.  Relaxation techniques, such as deep slow breathing, may also help with hot flashes.

Some women think first of herbal remedies such as dong quai, evening primrose oil or red clover. However, I discourage my patients from using herbs as they’re often ineffective. Soy (a phytoestrogen or plant estrogen) has been touted as a remedy for hot flashes.  However, there is no conclusive evidence  for its benefit and there are no long-term safety studies. If you are convinced that you want to go the herbal route, I strongly urge you to discuss these remedies with your doctor beforehand. Don’t assume that because you get it over the counter, it’s safe. Herbs are not regulated through government health agencies and can have potent unintended effects, and may interfere with other medications or cause harmful interactions.

– Yvonne S. Thornton, MD, MPH

Posted in Hormone replacement therapy, Menstruation, Women's health issues | 1 Response »
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Oprah and medical advice

Thursday, June 4th, 2009

Let me start by saying that I love Oprah. And I am forever grateful to her for having me on her show because appearing on Oprah helped me introduce my memoir, The Ditchdigger’s Daughters, to a huge audience. I’m sure it contributed to making my book a bestseller.

All that said, I have to agree with this Newsweek article. The authors argue that the medical advice given by some of the guests on The Oprah Winfrey Show is dubious at best, especially the claims about bio-identical hormones made by celebrities with no medical knowledge or training.

– Yvonne S. Thornton, MD, MPH

Posted in General health news, Hormone replacement therapy, Women's health issues, Women's health news | No Responses »
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My study on obesity and pregnancy in the news

Wednesday, June 3rd, 2009

I’m pleased to see that the media is getting the word out: obese pregnant women should be eating healthier diets and limiting their weight gain.

In the past few days, I’ve been interviewed by a number of news organizations about the study. You can see some of the reports at the following links:

WebMd

The Atlanta Journal-Constitution

Science Daily

The Los Angeles Times

and Health Day

– Yvonne S. Thornton, MD, MPH

Posted in Childbirth & delivery, Media appearances, Pregnancy, Women's health issues, Women's health news | 1 Response »
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When are irregular periods or spotting cause for concern?

Friday, May 29th, 2009

Are your periods coming at different intervals than in the past? And, if so, should you worry?

That depends.

Some women have regular periods every two months. Others have regular periods every 21 days. So, if your periods aren’t on a 28-day schedule, it may not be a problem at all, as long as it’s regular for you. And your cycle’s schedule may change over time. In your 20s, you may menstruate every 30 days, then every 33 days in your 30s. In  your 40s, the intervals could change again. There’s no one-size-fits-all cycle.

If you’re used to getting your period every 28 days and it’s now 45 days without a sign of menstruation, the first thing you should do is to see your gynecologist.  A blood test (not urine testing) for pregnancy would probably be ordered.

But what if you haven’t been sexually active? Ask yourself, what else in your life has changed? Have you been on a starvation diet? Undergone some very stressful event? If so, mention these changes when you discuss your menstrual cycle with your doctor.  The menstrual irregularity may be the first sign of thyroid dysfunction, or other metabolic or endocrine disorders.

The “take home” message here is that you should always be sure to keep an accurate menstrual calendar every month so you can tell your doctor when your period started, when it ended, when you had intercourse, and when you have spotting.

Speaking of spotting between periods, sometimes it’s a sign of a problem but often it’s not. Certain women will spot right in the middle of their cycles, when they ovulate. This sort of spotting can be perfectly normal. There’s even a German name for it: mittelschmerz,  But, if it continues, even in the middle of your cycle or if you’re spotting at odd intervals, like three days after your period ends, it’s time to make a gynecologist’s appointment.

– Yvonne Thornton, MD, MPH

Posted in Menstruation, Women's health issues | No Responses »
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Those scary “ask your doctor” commercials

Friday, May 22nd, 2009

You know the ones. The narrator tells you that, if such and such happens to you, say, you get two eyelashes caught in your eye per week, you may have eyelash-balding disease (okay, I’m making this up but, you know what I mean). Often, the commercial is about some disease you’ve never heard of before. Or maybe, it tells you about a new medicine for a health concern you already have.

Should you “ask your doctor” to write a prescription for the “medicine-of-the-month”?

Maybe a few other questions should be answered first. Has the narrator of the commercial examined you? Factored in whether the trade-off between symptomatic relief and side-effects is worth it? Compared it to your current prescription and determined, based on your health history, that this is a superior choice?

Well, of course not. The narrator is an actor, paid to convincingly read a script that is meant to do one thing only: sell stuff.

So, think twice before responding to direct-to-consumer advertising about prescription medications. When it comes to marketing these new drugs, the “consumer” should be the physician, who has knowledge of your health history and needs, as well as specialized training and understanding about the potential benefits and risks of drugs. The drug company has a vested interest in selling you their product. And remember that we’ve seen significant consequences with former “medicines-of-the-month,” such as Vioxx or Phen-fen.

If you’re concerned about a symptom, or if your current medication isn’t working as well as you’d hoped, make an appointment with your doctor. Ask your doctor about side-effects including how a medicine interacts with other prescriptions or nutritional supplements you are taking or if your medical history precludes its use.

Remember, you can’t diagnose yourself based on a commercial or an article in a magazine (or a blog post, even one written by a doctor).

So, go ahead, ask your doctor. Just be sure to ask the right questions. Don’t simply ask for a prescription based on what you saw on TV.

– Yvonne S. Thornton, MD, MPH

Posted in Women's health issues | 1 Response »
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Can you use the “morning after” pill as your main form of contraception?

Wednesday, May 20th, 2009

Some women wonder whether, since the morning after pill (a.k.a. “Plan B”) can prevent pregnancy, they can take it whenever they have intercourse and skip other forms of contraception.

Here’s the short answer: No.

Okay, now for the longer answer. Plan B delivers a wallop of hormones – at least twice the amount that you’d get in a high dose birth control pill. We doctors just don’t know what effect such a massive dose of hormones might have on a woman’s body over time, including an increase in the risk for blood clots and strokes. That’s because there have been no studies done on using the morning after pill as anything but a one-shot emergency contraceptive.

If you try to use Plan B as ordinary contraception, you will be, in effect, going into the “do-it-yourself” research business, with yourself as chief guinea pig. You’ll be risking your health while not developing a responsible approach to birth control. There are plenty of effective, tested contraceptives on the market. Use this medicine only for the purpose it was intended to serve.

– Yvonne S. Thornton, MD, MPH

Posted in Contraception (birth control), Women's health issues | No Responses »
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