Wednesday, June 25, 2014

Rewire, Regain, Refocus, Renew: Menopause a Different Way!

Many women experience changes in their bodies in their 40s and 50s that seem to impact every part of their lives. They tell us they don’t feel like themselves. They tell us about unexplained weight gains, hot flashes, loss of interest in sex and forgetfulness. All of this is new – and very unwelcome. For many women, they believe there is only one choice: endure it and put up with a new normal. In years past it was called “The Change.” We believe in changing the way women experience “The Change”.

Are you suffering from hormone imbalance?

Take a look at this list and check which ones describe you and how you feel:

  • Anxiety
  • Irritability
  • Fatigue
  • Depression
  • Lack of Interest in Sex
  • Loss of Muscle Tone
  • Loss of Memory
  • Osteoporosis
  • Hot Flashes
  • Night Sweats

If you checked two or more, chances are you’re experiencing the impact of menopause. You are not alone. For many women, there is a great solution: Bio-identical hormone replacement therapy.

Isn’t all HRT the same?

In a word: NO.  Let me explain:

For many years I have struggled to balance the controversies regarding hormonal therapy with the significant and life disrupting symptoms suffered by women with hormonal imbalance. Not only do the symptoms negatively impact a woman’s life, the health concerns from hormonal imbalance are just as significant. For years, the only option has been pharmaceutical HRT.  Pharmaceutical drug therapies often are not bio identical, offers a one size fits all approach and provides hormones in a non-physiologic way.  Women’s bodies are not designed to receive huge bolus doses of hormones at once but rather slow constant release of small amounts of hormones based upon the bodies physiologic activity at the time.  I thought there had to be a better way to approach the problem and the solution.

A totally different approach.

I have found a therapy option that I feel to be safe and extremely effective to help women suffering from hormonal issues. SottoPelle Therapy® is an all-natural bio-identical hormone replacement therapy. (Often, women have heard about bio-identical HRT through TV talk shows and assumed it was a “Hollywood Thing.” It’s not.) SottoPelle therapy is administered with a pellet that allows for a continual release - the key to improving brain and muscle function. The method isn’t new. There’s more than 70 years history of its use in England and Australia. Other delivery methods result in sporadic, or a “roller coaster,” effect in the delivery and release of hormones within the body. These methods include pills, patches, injectables, and creams.

In addition, with SottoPelle, the dose for each woman is calculated based on specific factors about her and her blood analysis. This results in achieving physiologic hormonal balance - something research has shown is absolutely vital to good health and well-being. Of all hormonal replacement modalities, only pellet therapy can provide this balance 24 hours a day, 7 days a week.

Isn’t the "Change of Life" (menopause) natural?

Yes. It is very natural. Menopause occurs when the ovaries are deplete of the follicles that produce female hormones. It is usually marked in women by the cessation of menstruation.  The symptoms of menopause - hot flashes, loss of sex drive, decreased energy, loss of concentration insomnia, and vaginal dryness - can start 8-10 years before menopause actually starts. This time period before menopause is called Peri-Menopause. So, in most women the symptoms of menopause will start 8-10 years BEFORE menopause actually starts and continue 5-10 years AFTER menopause starts. Busy women with active and healthy lives can have significant disruptions in their life for upwards of 20 years!! Yes Menopause is natural, but so is appendicitis, cancer or diabetes. No one would ever suggest that these natural processes should not be interrupted by modern medicine.  Likewise a women suffering from the symptoms of menopause deserves help.

The goal is to help women suffering from the symptoms of menopause to live a better life.  It’s about providing the right care at the right time for the right patient.  Women going through menopause without significant symptoms do not need therapy.  However for those with lifestyle disruptions, therapy can be a quality of life saver.  One of my favorite quotes from a patient was “I went from existing to living”.  That quote summarizes the point so succinctly.

Why exist when you can LIVE!

SottoPelle Bioidentical Subcutaneous Pellet therapy is just one way to help achieve this.  Achieving proper hormone balance together with proper nutrition and exercise is the key to aging gracefully for women.  It rewires your desire, regains your focus and refuels your drive.  We are pleased to offer this option at Minnesota Women’s Care.  Get the facts.  A new life is a consultation away.

Melvin Ashford, M.D.

Saturday, June 7, 2014

Female Urinary Incontinence: No Laughing Matter

Female incontinence is not a laughing matter. 

Female incontinence is so common among women 40 and over, people crack jokes about it. But, if you’re among the women who suffer from female incontinence, it’s really not funny. Nor are you suffering alone. It’s estimated that more than 40% of women over 40 experience some kind of urinary incontinence.

Incontinence is a condition that can really impact the quality of life for some women – making them fearful of leaving home or engaging in social activities. At Minnesota Women’s Care we make it clear to our patients that there is no need to suffer from urinary incontinence. There are treatments available that work. There’s hope and there’s help.

About Female Incontinence: Types and Causes 

Not all urinary incontinence is the same nor is it always caused by the same thing. It is more common during pregnancy, after childbirth and in post-menopausal women, but that’s not the rule. It can happen to any woman at any time.

Most women experience one of these more common types of incontinence alone or in combination: 

Stress Incontinence: Indicated by leaking of small amounts of urine while coughing, sneezing, exercising or other movements. It is often caused by a weakening of the pelvic floor muscles – the muscles that hold the bladder in place. When the pelvic floor muscles weaken or have been damaged, urine leaks from the bladder into the urethra during certain movements. Stress incontinence can also be caused by bladder prolapse – sometimes called “fallen bladder” - when the bladder descends into the vagina to varying degrees.

Overactive Bladder (Urge Incontinence): Indicated by leaking of urine at unexpected times in response to abnormal bladder contractions. Sometimes Overactive Bladder (OAB) can present without actual leakage. Some women suffer from frequent or urgent urination caused by muscle spasms in the bladder.

Mixed Urinary Incontinence: The most common type of incontinence Women with this suffer from a mixture of several forms of incontinence. Often both stress incontinence and Overactive Bladder. 

Female Incontinence: Four Things to Do Right Now 

First of all, wearing pads or special undergarments is not a solution. Our objective is to get to the root of your incontinence issues – not just to cope with the symptoms. Depending on your situation, these four solutions may have an impact on your symptoms:

Pelvic Muscle Exercises: These simple exercises – called Kegels – are used to strengthen the muscles near the urethra. Taking a few minutes each day to do these exercises can help to reduce or cure stress leakage. Ask your healthcare provider to help you isolate the correct muscles if you’re unsure.

Weight Loss: If you are overweight, the extra weight can cause bladder control problems. Talk with your health care provider about a diet and exercise program to help you lose weight.

Dietary Changes: Certain foods and drinks can cause incontinence, such as caffeine (in coffee, soda, chocolate), tea, and alcohol. You can often reduce incontinence by restricting these liquids in your diet.

Timed Voiding or Bladder Training: These techniques may help you to train your bladder to hold urine better. In timed voiding (urinating), you fill in a chart of when you urinate and when you leak urine. From the patterns that appear in your chart, you can plan to empty your bladder before you would otherwise leak.

Female Incontinence: Effective Treatments for Women 

If diet and exercise do not alleviate the symptoms, we offer a range of treatments depending on your particular needs and choices. This includes:

Urostym Pelvic Floor Rehabilitation System: This system provides biofeedback that assists patients with localization of the pelvic floor muscles necessary to strengthen the pelvic floor and provides direct electrical stimulation of the pelvic floor muscles to help strengthen them. It also helps to assess the pelvic floor function to guide therapy. We have found this helpful for women who thought they were performing Kegels, but had not isolated the correct muscles.

Intone: This new product, provided by our office for women to take home, provides biofeedback, electrical stimulation, measurement of the degree of “squeeze”, and a log of the patients exercise results. The device is used daily for 12 minutes for 9 weeks, then twice a week. During office visits, we connect the patient’s Intone device to the office computer and are supplied a detailed report of how often they exercised and how effective the routine was. This allows us to offer better coaching to improve results.

Cystoscopic Botox Injections: Though recently approved by the FDA for bladder use in the treatment of OAB, many physicians, including myself have been using this for years based upon sound evidence of the procedure’s safety and efficacy. Approximately 80% of women treated with Botox injections in the bladder with have resolution of the uninhibited bladder contractions resulting in urge symptoms and incontinence. The procedure is not permanent. The effect of Botox will last 6-9 months in most patients. Consequently it needs to be repeated. However for the woman living attached to the bathroom and suffering from embarrassing uncontrollable urinary leakage this is acceptable. This can be performed in our office or the surgery center.

Urgent PC: During this in-office procedure, a small needle is placed near the ankle to stimulate the tibial nerve. It results in satisfactory symptoms improvement for 60-80% of women. The needle placement is not painful as the need is very fine “acupuncture size”. After 12 weekly treatments maintenance treatments are performed every 1-4 months dependent upon the patient’s return of symptoms.

Interstim: This implanted device is like a pacemaker for the bladder. Once implanted, the device will work for 5 – 10 years before the battery needs to be replaced. The implantation occurs in two stages. First we’ll determine if the device will significantly improve your symptoms. If it does, we proceed with stage two. For patients who are unable to tolerate medications, Interstim has provided dramatic symptom relief.

Urethral Bulking: This procedure involves insertion of a filler product, often collagen into the urethral opening to narrow the opening of the bladder. This can be an effective option for those experiencing symptoms from Stress incontinence but is not a treatment for urge incontinence.

Medication: Certain medications can reduce many types of leakage and new drugs are frequently introduced for the treatment of OAB. One such new development is Myrbetriz, a drug that works by relaxing the bladder wall. It can be used in combination with other medications.

Female Incontinence: Surgical Treatments 

There’s been much controversy of recent about the use of mesh to repair bladder issues. Let's clarify: there is a tremendous difference between using a small amount of mesh for a sling procedure to stop urinary leakage and using more mesh for prolapse repairs. Sling procedures for the treatment of stress incontinence are considered gold standard therapies and were not called into question with the FDA letter regarding mesh. The letter was primarily pertaining to use of larger sheets of mesh for vaginal repairs secondary to prolapse. As noted above there are several other options for stress incontinence that do not require surgery. However in many patients a sling surgery is the most appropriate.

Female Incontinence: The Bottom Line 

Incontinence Therapy is an individualized decision after discussion with a physician. A board certified Female Pelvic Medicine and Reconstructive Pelvic Surgeon (urogynecologist) is the best to help guide a patient through this decision. There are 10 in the state of Minnesota. I am proud to say that I am one and can offer my patients the most current help available.

More than anything, I want women to understand this: You do not need to suffer with urinary incontinence. The impact it can have on your daily life – and on the life of your family – is much too great. There are many treatments available and they work.

Melvin Ashford, M.D.