The Mysteries of Being Female – Your 5 Common Questions Answered

Sometimes being a woman can be challenging.  Hormones go up and down then come and go.  We have this amazing ability to become pregnant and deliver a baby out of an area that starts small and grows to 10 centimeters when fully dilated.  We crave, we cry, we cramp, we clean and we console often all in the same day (sometimes in the same hour). We can carry on four conversations at once while updating our Facebook status, cooking dinner and prepping tomorrow’s suit which makes us wonder why we are tired at the end of the day.  We do all this and yet there are times when our body just does not seem to want to cooperate or suddenly veers off course.  Here are some answers to 5 common medical mystery questions about the female body.

1.       Why do I have vaginal dryness (sometimes or all the time)? There are many reasons to consider but the big ones include: not fully aroused, stressed, other things on your mind, on the birth control pill, on clomid (or other fertility medications known to dry up mucus), history of a LEEP procedure on the cervix due to an abnormal pap smear, decongestants (they do not just dry up the nose), dehydration, and hormone changes.

2.       Why are some periods unlike other periods?  Some women have the “fluke” where their period comes early or late (not pregnant), is really heavy, really light, no cramps, severe cramps…etc and this is different from the normal.  Some women alternate months in that one month is an easier period then the next month is a more symptom heavy period. Remember (as I tell my patient’s), your ovaries are sisters not twins therefore “righty” and “lefty” may produce different hormone levels and create different symptoms. Some months may be a “righty” month and others a “lefty” month.  In addition, high stress, grief, flying, major transition, heavy exercise, weight loss, and hormone changes can all affect how your cycle rolls. 

3.       Am I too young for hormone changes?  Nope.  Hormone changes and imbalance can occur at any age from puberty all the way through menopause.  You may be too young for menopause but that does not mean there are not issues with hormone production.  Women who do not ovulate do not make progesterone and progesterone is typically known as the calming, soothing, anti-PMS, pro-pregnancy hormone.   High estrogen contributes to more PMS-type symptoms, heavier periods, weight gain and tender breasts.  Higher testosterone or testosterone sensitivity may create more acne and increased hair growth on the chin, neck, and around the nipples.

4.       Why are my periods irregular or why do I spot and bleed more than seems normal?  First of all, if you are fully menopausal and have not had a period in 12 months and suddenly you start bleeding, please contact your health care provider as you will need additional work up.  If you are peri-menopausal then expect your once regular periods to become very erratic and unpredictable due to the nature of the ovaries changing.  Other reasons for most all ages include hormone imbalances, fibroids, polyps, pregnancy, thyroid problems, being low in iron, having Polycystic Ovarian Syndrome (PCOS) and being on the wrong birth control pill dose.

5.       Where did my sex drive go?  This is tricky.  Some women do not start out with a thriving sex drive and as they go through hormone changes it begins to wane even more.  Those who are used to a higher drive find themselves perplexed when their mojo is gone.  Sex drive for women is rather complicated as it takes into account hormone balance, arousal, stressors, how many things are on their brain, attraction, confidence…and more.  Certain medications are known to lower drive such as the birth control pill and anti-depressants.  Men typically have an “on/off” switch while women have an entire control panel.  Talk with your health care provider about testing for hormones, thyroid, and energy zappers like iron, Vitamin B12 and Vitamin D.  Focus on your stress response, eliminating what is not a priority, communicating with your partner about what you need (A dinner out? The laundry done? Compliments? Forplay?) and do not be afraid to explore and change things up within your comfort zone.  Perhaps this means new lingerie, the addition of sex toys, erotic readings (grey ties anyone?), more date nights, or a mini-couples vacation.

While being a woman is wonderful and empowering (empowher!), please talk to your health care provider if you recognize some of the symptoms above and suspect your particular symptom is more than just a “fluke.”  There may be some true imbalances that require a little tweaking in order to help you feel your healthiest.

References:

1)      Bachmnan, G., and Santen, R. Treatment of Vaginal Atrophy.  Web.  8 June, 2013.

http://www.uptodate.com/contents/treatment-of-vaginal-atrophy

2)      Shifren, J.  Sexual dysfunction in women: Epidemiology, risk factors, and evaluation.  Web. 8 June, 2013.

http://www.uptodate.com/contents/sexual-dysfunction-in-women-epidemiology-risk-factors-and-evaluation?detectedLanguage=en&source=search_result&search=libido&selectedTitle=3%7E131&provider=noProvider

3)      Welt, C.  Physiology of the Normal Menstrual Cycle.  Web.  8 June, 2013.

http://www.uptodate.com/contents/physiology-of-the-normal-menstrual-cycle?detectedLanguage=en&source=search_result&search=irregular+menstrual+cycle&selectedTitle=12%7E150&provider=noProvider

Pregnant? Consider These Nutrients For Smarter Babies

Pregnancy, especially first-time mothers, can be a daunting time as there is so much conflicting information about what to eat, what to drink, and what supplements to take when it comes to making healthy babies.  There are obvious standards such as a pre-natal vitamin with extra folic acid, quitting smoking and drinking, eliminating most seafood, and stopping most herbal supplements and teas unless otherwise confirmed safe for pregnancy.  However, there are three pregnancy-safe nutrients that may provide additional support to brain development and subsequently smart(er) children.  Remember, before rushing out to buy anything, consult with your health care provider. 

1.       Choline – this water-soluble B-vitamin is critical for brain development and cell membranes.  Recent research in the June 2013 American Journal of Epidemiology found that those pregnant women who consistently ate at 325 mg or more of choline had children with better visual memory skills than those who were not.  Choline is generally considered safe unless taken in extreme dose (10 grams or more) and should not be taken if someone is also on the medication methotrexate.  For those looking to eat their way to healthy levels, food sources include beef liver, wheat germ, eggs, beef, cod, Brussels sprouts and broccoli. 

2.       DHA – otherwise known as docosahexaenoic acid is part of the omega-3 mix with EPA.  DHA specifically has been associated with better brain development as it helps the rapidly growing neuronal cells particularly in the last trimester of pregnancy.  As a result, formula and baby food makers have begun adding DHA into their ingredients to ensure infants and growing children get enough of this healthy nutrient.  When looking to supplement, the DHA content should be at least 300mg and come from a reputable source where the oil is screened for toxins, heavy metals and chemicals.  Be very careful while pregnant when eating the popular omega-3 source – fish such as salmon, sardines and anchovies.

3.       Iron – becoming iron anemic (or low on iron) while pregnant is a common encounter as iron is critical for DNA synthesis and cognitive development.  Most pre-natal vitamins add extra iron as pregnant women should be taking about 30mg per day during these 9 months however if her blood levels drop she may need more.  In food, iron is best found in beef, dark chicken, oysters, black strap molasses, lentils and fortified foods such as cereals.  Some forms of iron cause constipation and intestinal upset which may already be a problem during pregnancy and iron should not be taken within 4 hours of thyroid medication.

As developmental delays and attention deficit disorder continues to climb, talking with your health care provider about additional baby brain development to help make for smarter children.  

References:

1.       Boeke, M., Gillman, M., Hughes, M., Rifas-Shiman, S., Villamor, E., and Oken, E.  Choline Intake During Pregnancy and Child Cognition at 7 Years.  Am J Epidemiol. 2013;177(12):1338-1347.

2.       Higdon J. (updated by Drake, V. and Zeisel, S.) Choline.  Web.  1 July, 2013.

http://lpi.oregonstate.edu/infocenter/othernuts/choline/

3.       Boyles, S. Pregnant? Omega-3’s Essential for Baby’s Brain.  Web.  1 July, 2013.

http://www.webmd.com/baby/news/20040716/pregnant-omega-3-essential-for-babys-brain

4.              4.  Klemens, C., Salari, K.,and  Mozurkewich, E. Assessing Omega-3 Fatty Acid Supplementation During Pregnancy

and Lactation to Optimize Maternal Mental Health and Childhood Cognitive Development.  Clin Lipidology. 2012;7(1):93-109. 

5.              5.   Higdon J. (updated by Drake, V. and Wessling-Resnick, M.) Iron.  Web.  1 July, 2013.

          http://lpi.oregonstate.edu/infocenter/minerals/iron/

Attention Baby Boomers: Get Your Hepatitis C Testing

If you were born between the years 1945 and 1965, the US Preventive Services Task Force (USPSTF) is suggesting a screening hepatitis C test.  To many of you this may sound odd or not applicable however the Centers for Disease Control and Prevention reports that 76% of those with Hep C are baby boomers.  What does this mean for you?

Hepatitis C is a virus that is mostly transmitted through unscreened blood transfusions (screening for transfusions began in 1992), unscreened organ donation, blood transfer through needles (drugs, improper medical or tattoo handling), unprotected sex with someone who has hepatitis C, and from a positive hepatitis C mother to her baby.  It is a stubborn virus in that it can live outside the body at room temperature for up to four days.  The concern with the virus is that it can take years for any symptoms or liver damage to occur leaving many to have contracted the disease and not yet realize it.  Symptoms may also be quite general such as fatigue, right upper abdominal pain, itchy skin, and nausea however as the liver worsens then liver enzymes increase on blood tests.

The main problem with hepatitis C is that it can become chronic over many years leading to liver cancer, liver cirrhosis and liver failure. Testing requires a simple blood test done at your health care provider’s office or lab and is important as many baby boomers may have partaken in risky behavior when they were younger and have since cleaned up their lifestyle and do not feel sick therefore do not think they are affected.  Boomers may have also had a blood transfusion as a child which potentially put them at risk but they do not remember it or have forgotten about the incident.

For those who go on to develop chronic hepatitis, routine monitoring of the liver is important through a liver enzyme blood test and liver ultrasound in order to determine if there is damage or inflammation.  Unfortunately there is no vaccination for hep C and the medication treatments can be very helpful but come with a lot of harsh side effects.  Lifestyle changes to protect liver health are important such as eliminating all alcohol, being very aware of medications and hormones as they are filtered through the liver, eating healthy, clean foods, keeping blood sugar and cholesterol in the normal range and maintaining a healthy weight.  Dietary choices such as leafy greens, broccoli, cauliflower, garlic, onions, dandelion root, milk thistle, beets, artichoke and fiber are all known liver friendly foods.

Do not be a statistic with hepatitis C.  Please talk with your health care provider about getting this simple test and be pro-active with your health.  

References:

1.       Garcia, J.  (2013).  Hepatitis C: USPSTF Recommends All Baby Boomers Be Screened.  Web.  24 June, 2013.   Retrieved from http://www.medscape.com/viewarticle/806836

2.       Centers for Disease Control and Prevention.  (2012).  Hepatitis C FAQs for the Public.  Web.  26 June, 2013.  Retrieved from http://www.cdc.gov/hepatitis/C/cFAQ.htm#statistics

Is Obesity Now Considered A Disease?

Depending on where you look, the definition of a ‘disease’ includes such phrases as a change from the normal state, a state of disorder, an abnormal or pathologic condition of the body, and being in dis-ease.  A disease can be brought about by personal factors, genetics, environmental influences, and lifestyle habits.  Common diseases include autoimmune conditions, hypertension, high cholesterol, diabetes, thyroid problems, cancer, endometriosis, ulcers, acne or more.  As of June 2013, the American Medical Association (AMA) has recognized obesity as a disease which could change the way insurance companies reimburse on prevention and treatment options for weight loss however those that oppose the AMA feel that obesity requires some personal responsibility as well.

According to the Centers for Disease Control and Prevention (CDC), almost 36% of Americans are in the obese category.  The classifications for ‘overweight’ and ‘obese’ are not perfect however the Body Mass Index (BMI) chart is most commonly used as it takes into account height and weight but not bone structure or lean muscle ratio.  A BMI between 18.5 and 24.9 is considered a normal, healthy weight.  Between 25 and 29.9 is in the overweight category and above 30 is officially classified as obese.  To give you an example, a 5’6” woman who weighs roughly between 160 and 185 pounds is considered overweight however if she weighs above 185 pounds then she is obese.  Another example would be a 5’4” woman who weighs between 145 and 175 pounds is considered overweight and if she were over 175 pounds she is considered obese. 

As many in the health field feel that abdominal obesity is more concerning as it means there is increased fat around the key abdominal organs, the waist circumference is gaining popularity when determining overweight, obesity and health risks.  Measure around your abdomen just above your hip bones (not necessarily your narrowest section) and women should be under 35 inches and men under 40 inches.  Higher numbers equals an increased girth which increases the risk for high blood sugar/pre-diabetes/diabetes, high cholesterol, high blood pressure and overall increased risk for cardiovascular disease. 

The overall concern is that excess weight can lead to long term consequences that could be preventable and there is an ongoing national push to get America healthier, reduce the number of obese and overweight adults and children, educate on proper nutrition, eliminate high sugar foods and drinks and encourage regular exercise.  Obesity is costing Americans millions of dollars as it can also cause an increased risk of cancer, joint pain, sleep problems, lethargy and more.  Please do not be a statistic – educate yourself and your family and start making healthy changes today!

References:

1.       Frellick, M.  AMA Considers Obesity A Disease.  Web.  23 June, 2013.

http://www.medscape.com/viewarticle/806566

2.        Centers for Disease Control and Prevention (CDC).  Adult Obesity Facts.  Web.  23 June, 2013.

http://www.cdc.gov/obesity/data/adult.html

3.       Centers for Disease Control and Prevention (CDC).  Defining Overweight and Obese.  Web.  23 June, 2013.

http://www.cdc.gov/obesity/adult/defining.html

4.       National Heart, Lung and Blood Institute.  According to Waist Circumference.  Web.  23 June, 2013. 

http://www.nhlbi.nih.gov/guidelines/obesity/e_txtbk/txgd/4142.htm

Can You Get HPV From Oral Sex?

Famous actor, Michael Douglas, is in remission from having stage IV throat cancer that he at first admitted was due to the human papilloma virus, specifically HPV 16 and oral sex, but of late has recounted that statement stating his particular cancer was due to other reasons.  This has caused a lot of confusion for those wanting clearer answers on the risks associated with oral sex and the transmission of this aggressive virus.

There are several strains of HPV that can be transmitted from one person to another.  Some strains cause genital warts, some cause cervical abnormalities or cervical cancer while others, potentially in Michael Douglas’s case, cause throat cancer.  Most women associate this virus with abnormal pap smear results which is the reason for regular screenings.  It is reported that 50-80% of sexually active people have the HPV virus even with normal pap tests or no symptoms of warts.  The reason for this is that HPV is transmitted from skin-to-skin contact therefore actual intercourse does not have to occur to contract the virus nor does there have to be an exchange of fluids.  Therefore in throat cancer, transmission is through mouth and genital contact.

Throat cancer can be caused from other factors besides HPV such as tobacco (smoking and chewing), alcohol consumption, poor diet high in charred meat/red meat, and certain carcinogenic chemicals.  Symptoms often include a cough, pain in the throat, sensation of a lump in the throat, clearing the throat often, painful or sore tongue, change in voice (usually hoarse or lower voice), difficulty swallowing food or drink, and possibly bleeding in the throat or mouth that is ongoing for several weeks.  Diagnosis is typically done with a scope and biopsy.   Unlike HPV of the cervix which can affect a woman from their first sexual skin-to-skin experience, throat cancer is often diagnosed in those older than 50 and is more common in men.

So what can you do?  Be careful and be selective.  While hormone birth controls and the IUD protect against pregnancy, they do not protect against sexually transmitted infections, including HPV, therefore a barrier method is important.  Consider the HPV vaccine as HPV 16 (the more aggressive form and form often associated with throat cancer) is one of the strains it protects against.  Lastly, continue to have regular cervical screenings and talk with your healthcare provider about additional work up if you are experiencing any of the throat or mouth symptoms for an extended period of time.

References:

1.       Chusteka, Z. (2013).  HPV Oral Cancer: Low Risk for HPV Transmission.  Web.  16 June, 2013.

http://www.medscape.com/viewarticle/805422

2.       Pittman, G.  (2012).  HPV Tied to Throat Cancers.  Web. 16 June, 2013.

http://www.medscape.com/viewarticle/775491

3.       Mayo Clinic Staff.  (2012).  Throat Cancer. Web. 16 June, 2013.

http://www.mayoclinic.com/health/oral-and-throat-cancer/DS00349

4.       American Cancer Societ.  (2013).  Oral Cavity and Oropharyngeal Cancer.  Web.  16 June, 2013.

http://www.cancer.org/cancer/oralcavityandoropharyngealcancer/detailedguide/index

Is Your Anxiety Worse With Menopause?

There are many common symptoms associated with both peri-menopause (the start of the hormonal changes) and actual menopause including hot flashes, night sweats, vaginal dryness, weight gain, increased joint pain, irregular cycles, heavier periods, hair loss, and insomnia.  In discussions with their friends, female family members and health care provider, most women have a general understanding of ‘what’s to come’ when it relates to the big hormonal transition however symptoms such as increased, worsening or new anxiety might be a surprise.  Many women have experienced at least some form of anxiety in their lifetime and find it concerning when those nervous, overwhelm, worry or fretting feelings really ramp up in their forties and fifties. 

Research (and anecdotally in my practice) shows that women who are prone to anxiety before menopause are much more likely to have higher levels as they go through it.  In fact, it is reported that 51% of women between 40-55 years old experience mood swings or anxious type feelings more regularly than when they were in their twenties and thirties.  While there is little research on the subject of “why,” and the reasons are conflicting, there are a few consistent theories that may apply.

As women approach menopause, the need to become pregnant becomes less therefore ovulation becomes less frequent.  Without ovulation a woman does not make (much) progesterone and progesterone is the more calming, soothing, anti-PMS hormone for women.  This leaves estrogen to become more dominant which can cause increased symptoms of PMS, irritation, anger and overwhelm.

This hormonal transition of menopause is often occurring at the same time that life is stressful – Murphy’s law?  Women are juggling family, work, financial, relationship, and world responsibilities while trying to eat healthy, exercise, stay sane and navigate menopause.  This causes a lot of internal stress on the body, particularly the adrenal glands, which leads to feelings of anxiety, irritability, overwhelm and panic. 

Women going through peri-menopause and menopause often experience long periods of insomnia or waking up regularly between 2am-5am.  This leads to more fatigue and less patience causing those low-level feelings of anxiety to worsen.  Everybody feels better after a good night’s sleep as it is restorative to the body.

So, what can be done?  First, recognize that it is a normal (but not fun or fair) part of going through menopause.  Talk to your female family members about their experience and then consult with your health care provider about options (even if temporary) to help you get on the other side of all the transition.  Find coping skills to first recognize what is going on and then how to act/react with yourself and those around you.  Put yourself in time out and take 5-10 minutes for yourself (or more) and just breathe deeply, go for a walk, sit in the sun, read, exercise or close your eyes.  Focus on setting boundaries and saying “no” to things that create more stress and chaos in your life and remember that it is okay to do so.  Lastly, hope that your menopause is short and sweet!

 

References:

1.       Bromberger, J., Kravitz, H., Chang, Y., Randolph, J., Avis, N., Gold, E., and Matthews, K.  Does Risk for Anxiety Increase During the Menopausal Transition?  Study of Women’s Health Across the Nation.  Web.  2 June, 2013.

http://www.medscape.com/viewarticle/803506

2.       The Merck Manual.  Menopause.  Web.  2 June, 2013.

http://www.merckmanuals.com/home/womens_health_issues/menopause/menopause.html?qt=progesterone&alt=sh

3.       Kumari, v., Konstantinou, J., Papadopolous, A., Aasen, I., Poon, L., Halari, R., and Cleare, A.  Evidence for a Role of Progesterone in Menstrual Cycle-Related Variability in Prepulse Inhibition in Healthy Young Women.  Web.  2 June, 2013.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3055354/

What Causes Osteoarthritis?

Many women experience joint pain whether it’s in their knees, hips, fingers or shoulders.  The pain might come and go, be worse in the morning, or feel aching and stiff most of the day.  The diagnosis is typically done with symptoms and possibly an x-ray that shows joint changes.  Arthritis can start as early as the late teenage years/early twenties however more than 50% of people over 65 years old exhibit symptoms of arthritis.  What causes the joints to begin to deteriorate and create arthritis?

1.       Joint injury – Research shows that those who sustained a joint early at a young age are more apt to develop arthritis in that joint at a later age.  As an example, 51% of women developed knee arthritis 12 years after tearing their anterior cruciate ligament (ACL) in soccer.  Many can point back to a car accident, sports injury, broken bone or other trauma when discussing their problem area(s). 

2.       Obesity – Extra weight on the body coupled with daily activities and gravity means more load on the hips, knees, ankles and feet causing those joints to become more strained and inflamed over time plus it increases the wear and tear on the cartilage that leads to osteoarthritis. 

3.       Age – Sorry ladies, aging does take its toll on the joints considering more than 50% of people over 65 have arthritis symptoms (as stated above).  Many women will say “I didn’t have these problems in my 20’s or 30’s!” but over time joint injuries happen, diet/lifestyle choices take effect, genetics kick in, hormones change, weight fluctuates…and suddenly one day women find themselves waking up more stiff and aching.  Those of you who can still go from sitting cross-legged on the floor to a standing position without (much) assistance count yourselves lucky. It will probably change.

4.       Congenital abnormalities – If someone were born with joint problems or cartilage issues, then over time the stress on the joints will cause arthritic changes.  For example, scoliosis in the spine, or one leg shorter than the other will shift the way the body carries itself causing joint problems. 

5.       Endocrine disorders – Diabetics and those with low thyroid hormone are at risk for more joint and cartilage problems that can lead to arthritis.  Women heading into menopause often complain of more joint pain because their estrogen levels are gradually (or suddenly) decreasing. 

What does all this mean?  It means, take good care of yourself!  This is your one body.  Eat healthy, stay hydrated, maintain a healthy body weight, limit sugars and processed foods, and stretch regularly.  Thankfully there are articles here for tips to reduce the symptoms of arthritis if your joints are causing you pain on a regular basis.  Lastly, talk with your health care provider about appropriate work-up and treatment suggestions. 

References:

1.       Sofat, N., Ejindu, V., Kiely, P.  What Makes Osteoarthritis Painful?  Rheumatology. 2011;50(12):2157-2165.

2.       Roos, E.  Joint Injury Causes Knee Osteoarthritis in Young Adults.  Curr Opin Rheumatol. 2005;17(2):195-200.

3.       Kramer, P.  Prevalence and Distribution of Spinal Osteoarthritis in Women.  Spine. 2006;31(24):2843-2848.