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Blog Hiatus

Thursday, May 29th, 2014

Thank you to all my blog readers! Your support is appreciated. I will be taking a break until further notice.  Enjoy your summer and, if you are interested, please refer to my posts over the past five years in my Archives.

– Yvonne S. Thornton, M. D., M. P. H

What Is Endometrial Ablation?

Monday, March 31st, 2014

Endometrial ablation is a procedure in which a layer of the uterine lining is permanently removed in order to reduce or stop abnormal bleeding. The procedure is performed only on women who do not wish to have any more children. In some cases, it is performed in place of a hysterectomy.

The techniques used to perform endometrial ablation vary and include electrocautery, radiofrequency, cryoablation, and hydrothermal procedures, among others. The procedure is performed on women who are experiencing abnormal bleeding (bleeding between periods) or menorrhagia (prolonged or extremely heavy periods). Abnormal bleeding can be so severe in some cases that daily life is interrupted and some women may even develop anemia.

Reasons for abnormal bleeding and menorrhagia include hormone disorders or imbalances, fibroid tumors, polyps, or endometrial cancer. However, as stated earlier, the lining of the uterus is destroyed during ablation and is no longer able to function normally; therefore, bleeding is significantly lessened or even stopped entirely, and it is important to know that the woman also will no longer be able to become pregnant.

Endometrial ablation carries the same risks as any surgical procedure, including infection, bleeding, perforation of the uterine wall, or complications due to medication sensitivities the patient is not aware of (or neglects to inform the doctor of). In addition, women with certain medical conditions should not have this procedure, and these include vaginal infections, cervical infections, pelvic inflammatory disease, weakness of the uterine muscle, abnormal shape or structure of the uterus, and having an IUD in place, among others. In my health book, “Inside Information for Women”, I discuss this technique under “Resectoscopy”.  Endometrial ablation with cautery via a resectoscope or any other modality is a little tricky if the patient ultimately is found to have uterine cancer.  Why?  Because all the evidence regarding the extent of the disease (cancer) is burned away and the physician will have difficulty in staging the cancer, which is important in formulating the best management for a patient with uterine cancer. 

If your doctor and you decide that endometrial ablation may be right for you, your doctor should explain the procedure to you thoroughly and give you a chance to ask any questions you have. If you are to have a procedure that requires general anesthesia, you will be asked not to eat or drink before the procedure, most likely for at least eight hours or after midnight the night before. Be sure to tell your doctor if you may be pregnant, are allergic to any medications, or are taking any prescription drugs or herbal supplements.

Your procedure may take place in a hospital or in your doctor’s office on an outpatient basis. Recovery will depend on the type of anesthesia and the type of ablation used. In general, you can expect to need to wear a sanitary pad for a few days after the procedure, as bleeding during this time is normal. Also for the first few days, you may experience cramping, frequent urination, nausea, and/or vomiting.

Your doctor will probably instruct you not to use tampons, douche, or have sex for at least a few days. Usually restrictions on other activities are also necessary, such as heavy lifting and strenuous exercise. Let your doctor know if you experience fever, chills, severe pain, difficulty urinating, excessive bleeding, or foul-smelling discharge.

This information applies in general to most ablation procedures, but because each woman and situation is unique, the most important thing to remember is to follow your doctor’s specific instructions, and ask any questions you may have.

– Yvonne S. Thornton, M. D., M. P. H.

Supplements No Substitute for Healthy Diet

Thursday, March 13th, 2014

Bad news for vitamin-lovers: it appears they are not helping you prevent cardiovascular disease (CVD). A study carried out by the American Heart Association concluded that “the scientific data [does] not justify the use of antioxidant vitamin supplements for CVD risk reduction,” and that there is no consistent evidence which suggests that consuming micronutrients in higher amounts than those found in a balanced, healthy diet is beneficial in regards to CVD risk reduction.

What’s more, your vitamin supplements aren’t helping you prevent cancer, either, as outlined here by the American Cancer Society. Other organizations such as the Academy of Nutrition and Dietetics and the American Academy of Family Physicians have reported similar findings. 

In most cases, vitamin supplements are not harmful, and the results of the latest research do not mean that supplements offer no benefits whatsoever. But if you are taking them to lower your risk of CVD or cancer, the newest evidence suggests that you are wasting your money.

There is currently no official recommendation on either taking or avoiding vitamin supplements for healthy individuals, with a couple of exceptions. One such exception involves beta carotene, which studies such as this one show can actually increase a smoker’s risk of lung cancer when taken in the high doses found in many supplements. This is in direct opposition to the previously popular belief that high doses of beta carotene were beneficial in cancer prevention.

What has been shown to have a beneficial effect on CVD and cancer risk is nutrition – a diet consisting of mostly vegetables, fruits, whole grains, low-fat dairy, and lean meats, particularly seafood. A diet like this offers plenty of fiber, antioxidants, and Omega-3 fatty acids. These nutrients offer a number of health benefits, including weight control, blood pressure control, and heart disease and cancer prevention. What the new studies show is that if you are hoping that your vitamin supplements allow you a bit more leeway in your diet, you’re shortchanging yourself.

What about Prenatal Vitamins?

It’s important to note that these studies do not mean that women who are pregnant or planning to become pregnant should toss all of their supplements. Folic acid should be taken to help prevent neural tube defects; the prenatal multivitamins prescribed by a woman’s doctor should be taken as directed. Also make sure your doctor knows about any vitamin supplements you are taking, because some can be harmful. High levels of vitamin A, for example, may be linked to birth defects.

And again, just because you are taking a prenatal vitamin – which you should if you are pregnant – does not mean your diet is not important. Healthy, natural foods contain many compounds not found in supplements, so a combination of prenatal vitamins and a healthy diet will help protect your baby as he or she develops.

– Yvonne S. Thornton, M. D., M. P. H.

What You Need to Know about Cervical Cancer

Thursday, February 6th, 2014

Cervical cancer, just as the name implies, forms in the tissues of the cervix, which connects the vagina and the uterus. Generally slow growing, cervical cancer usually does not cause any symptoms. This makes it extremely important to get regular pelvic exams, during which screening tests are done that can find early-stage cervical cancers and even precancerous cells.

Any women can get cervical cancer, but it is typically found in women over 35. There are about 12,000 new cases diagnosed in the United States each year. Almost all cervical cancers are caused by HPV (human papilloma virus), the virus that causes genital warts.

Who Is at Risk?

There are several risk factors that increase a woman’s chances of developing cervical cancer. If you have none of these risk factors, your odds of getting it are very low. These risks include HPV infection (which you may not be aware of, another reason why those pelvic exams are so important); smoking or exposure to secondhand smoke; HIV infection, which can significantly weaken the immune system; certain medications which weaken immune system response; and multiple sexual partners.   

Can Cervical Cancer Be Prevented?

The good news is that cervical cancer is highly preventable. The first step for younger women and girls is to get vaccinated against HPV. Gardasil, a vaccine that prevents HPV infection, protects against the four types of HPV that are responsible for most cervical cancers as well as genital warts (70% and 90% respectively). The vaccine is administered via a series of three simple injections and has very few and mild side effects.

An annual visit to your gynecologist is another excellent way to be sure that, should cervical cancer be present, it is caught in its early and easily treatable stage. It is important for women to realize that even if they haven’t been sexually active recently, they are still at risk for cervical cancer if they have ever had sex. For this reason, continued screening is vital and saves numerous lives every year.

Keep in mind that anyone can lower their risk of various types of cancers by living a healthful lifestyle. Eating plenty of fruits and vegetables, getting enough exercise and enough sleep, and avoiding smoking and other dangerous chemicals are all effective ways to protect yourself and your family.

While cancer cannot always be prevented, it can often be found early and treated. If you haven’t seen your gynecologist recently and it’s closing in on a year (or has been longer than that), make an appointment today. Ignorance is not bliss when it comes to cancer – it’s often a death sentence.

– Yvonne S. Thornton, M. D., M. P. H.

Women with High Blood Pressure Who Smoke Have Greater Risk of Aneurysm

Monday, December 16th, 2013

Subarachnoid hemorrhage (SAH) is a cerebrovascular catastrophe that kills 40 to 50 percent of sufferers. A ruptured intracranial aneurysm is the most common cause of SAH. Sometimes, aneurysms are found and treated before they have a chance to rupture. Furthermore, some aneurysms will never rupture. However, there is no way to tell which ones will and which ones won’t. In addition, research now shows that women who smoke and have high blood pressure are more likely to develop SAH. Twenty times more likely!

This discovery is important because it sheds some light on how to decide whether to treat a person with an unruptured intracranial aneurysm. If we know that a female patient with high blood pressure who smokes is significantly more likely to develop SAH than a male patient with normal blood pressure who doesn’t smoke, and intracranial aneurysms are found in both, then it may be that the woman needs to be treated while the man does not. This is an important step in being able to predict which aneurysms are likely to rupture and which aren’t.

The study also revealed three previously unknown risk factors for SAH: elevated cholesterol levels in men, and maternal history of stroke and previous heart attack in either gender. These results show that the risk factors for SAH appear to be similar to the risk factors for other cardiovascular diseases.

It is already known that lifestyle risk factors have a significant impact on the life expectancy of a person who has survived SAH. Now, it is becoming clear that those same risk factors increase the risk of SAH in the first place. Therefore, quitting smoking and taking steps to lower high blood pressure are especially important in both preventing SAH and increasing life expectancy if it does occur.

Of course, this is just one more item to add to the list of reasons why you should quit smoking. Smoking is a well-known health risk that people can choose not to expose themselves to. Cigarettes contain over 4000 chemicals, at least 400 of which are known toxic substances.

Among the most harmful products in cigarette smoke are tar, which is a carcinogen; nicotine, which is addictive and is thought to increase cholesterol levels and carbon monoxide, which replaces oxygen in your bloodstream. An individual’s overall health risk from smoking depends upon a number of factors, including how much the individual smokes, whether the cigarette has a filter, and how the tobacco has been prepared. More research is needed before it will be clear whether these same factors affect a person’s SAH risk.

As for hypertension, it is known to be potentially damaging to several body systems, including the arteries, heart, brain, and kidneys. Talk to your doctor about your blood pressure and/or smoking to find solutions for lowering your blood pressure, helping you quit smoking, or both.

– Yvonne S. Thornton, M. D., M. P. H.

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.

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.

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.

Recurrent Yeast Infections: Causes, Solutions

Monday, October 7th, 2013

Unfortunately, it seems every vaginal discharge has been diagnosed as a “yeast infection” by the patient and she runs off to the drug store to get an over-the-counter antifungal medication to treat her “yeast” infection when in actuality it may be chlamydia, bacterial vaginosis or trichomoniasis.  The truth of the matter is that every vaginal discharge is NOT a yeast infection and needs to be diagnosed by a physician or a person who is well-versed in microscopy and wet mounts and who is able to tell the difference between a “yeast” infection and other infections that are causing the vaginal discharge.  However, for the purpose of this installment yeast infections and if the yeast infection has been properly diagnosed, the following applies:

If you suffer from recurrent yeast infections, you know how imperative it is to pinpoint an underlying cause, or at least a way to stop the infections from occurring. Yeast infections are not bacterial infections at all, and as such, antibiotics will not cure them and may actually cause them in some cases. Yeast infections are caused by a type of fungus, and therefore a medication or treatment with antifungal properties must be used.

At some point, three out of four women will suffer from a yeast infection; interestingly, between 1980 and 1990 the incidence of yeast infections doubled.  Why?  Because the patient was self-diagnosing and calling every discharge a “yeast” infection and coincidently, that is the time period when anti-fungal treatments  (creams and vaginal suppositories) were allowed to be sold over-the-counter without a prescription. The symptoms include itching, irritation, redness, and a cottage cheese-like discharge. One yeast infection is enough for most women, but many women are unlucky enough to endure them repeatedly. To get a handle on your recurrent yeast infections, first consider what may be causing them.


Despite the fact that most doctors and the American College of Obstetrics and Gynecologists recommend not douching, some 20 to 40 percent of American women do it anyway. It is important to understand that douching is completely unnecessary at best, and at worst, is connected to a host of problems like yeast infections, bacterial vaginosis, sexually transmitted infections, and pelvic inflammatory disease. Douching upsets the balance of vaginal flora and acidity and pushes bacteria farther into the vagina, worsening existing infections rather than helping them. If you douche for any reason other than that your doctor told you to for a specific problem, stop – especially if you have recurrent yeast infections.


The reason why antibiotics can cause yeast infections is not rocket science: antibiotics kill bacteria. That means not only the “bad” bacteria, but the “good” bacteria as well. When the level of good bacteria drops too low, it cannot protect you against fungal infections. Antibiotics are valuable, often life-saving drugs, but they should be reserved for times when no other treatment will work.

Other Causes

Diabetic women are more likely to get recurrent yeast infections. Yeast thrive on sugar, and the elevated blood sugar in diabetics affects the whole body. If you are diabetic and have recurrent yeast infections, getting your blood sugar under control may help. In addition, pregnancy is a condition that makes yeast infections more likely. The dramatic chemical changes in the vaginal area during pregnancy make it hard for your body to keep up. There may also be more sugar in your vaginal secretions, which, similar to diabetes, can encourage yeast overgrowth.

Further Steps You Can Take To Eliminate Yeast Infections

Bathe daily and keep your genital area clean and dry. Use condoms to help you avoid catching or spreading a sexually transmitted infection. Avoiding the use of products like feminine hygiene sprays and fragrances can help, as can using pads instead of tampons (especially scented tampons). Also, your underwear should be cotton; materials like silk or nylon are problematic because they restrict air flow to the area.

Additionally, you will probably need to take a medication prescribed by your doctor in order to cure an acute yeast infection. There are several effective options available today; ask your doctor if you aren’t sure what the best option is. Finally, if none of the above causes apply to you and none of the suggested treatments work, talk to your doctor about the possibility of a more serious underlying issue. For more information, see my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.

Choosing the Right Gynecologist

Thursday, September 19th, 2013

There are many reasons why you might be looking for a gynecologist. Maybe you are looking for a doctor to see for the first time, or maybe things just aren’t working out with your current doctor. Maybe you have moved to a new place and must find a local gynecologist. In any case, this is a decision that should be taken seriously. Friends and family members can be valuable sources of recommendations, but realize that their recommendations are likely to be based on things like whether the doctor is personable and how long they have to wait for appointments, rather than whether the doctor is board-certified or how long they have been in practice.

Board certification is extremely important and a topic that I cover extensively in Inside Information for Women. Terms like “board eligible” or “board active” mean that the practitioner is not board certified. So, the first thing you should check for is current board certification to ensure that you are seeing a qualified gynecologist (or other specialist).

You may also need to check with your insurance provider to make sure that the doctor you are considering will be approved by them. Once you have narrowed your options down to a few conveniently located, board certified gynecologists, see if you can set up a meeting with each one. Your insurance company will probably not cover this meeting, so be prepared to pay out of pocket. If you choose not to set up a preliminary meeting, you can still get some useful information from a receptionist or secretary.

Things You Should Know Before Selecting a Gynecologist

Questions you should ask include how long it takes to schedule appointments if you have a non-routine concern and whether there are times when the doctor can be reached by phone. As this report shows, doctors are busier than ever, so ensuring that the doctor you choose will be available when you need him or her is important. You may want to know where the doctor attended school and completed his or her training. Also, ask which hospitals he or she is affiliated with; this may be especially important if you are planning to become pregnant. Finally, you may also want to know how long the doctor has been in practice. Again, if you can’t meet with the doctor before scheduling an appointment, an administrative person can answer any of these questions.

While the answers to these questions might tell you whether the doctor is competent, they will not tell you anything about your chemistry with the doctor or whether you will like him or her. Keep in mind that a competent doctor is much more valuable than a personable doctor – but if you can get both, all the better. If you really have poor chemistry with your gynecologist, it’s best to make a change – but be sure your new doctor is board certified and otherwise competent and available, not just someone who is located closer-by or smiles more.

– Yvonne S. Thornton, M. D., M. P. H.