Monday, August 25, 2014

Worried about Tightness?

Millions of women are suffering from vaginal laxity...causing loss of sensation during sexual contact and stress urinary incontinence. For those of you still listening and interested in facing facts and finding solutions.  Ponder the following questions.  Do you:

    1.  Find it challenging to grip your vagina with only your forefinger.
    2.  Notice that your vagina is unable to completely close.
    3.  It is possible to place even more than 3 fingers into your vagina easily.
    4.   Orgasm is harder to attain than previously
    5.   Receive less enjoyment from intercourse
    5.   Find it more difficult to please your partner.

Speaking plainly.  Yes child birth is natural!!!!   However a 6-10 pound baby coming though the vaginal canal naturally causes some damage to the pelvic floor.  The impact is to the nerves, the muscles and the connective tissue.  This is a fact.  Do you have to live with it?  No!  The two components essential to maintaining a tightened vagina are the muscles and connective tissues.  Kegels or augmented pelvic floor exercise offers great options for naturally strengthening the Pelvic Floor.  

However strengthening or better functioning muscles do not always correlate with bulking of the muscle.. We all know of people who work out daily and are in good shape but do not bulk.  Bulking is necessary as well as strengthening for subjective sense of a tightening of the vagina.  Until now the most consistent and reliable method of vaginal tightening has been surgery.  A new in office laser therapy results in shrinkage of the vaginal connective tissue resulting in tightening.  Femilift Laser therapy is an innovative approach to a common issue for many women without surgery or downtime.  We are excited to announce that we are offering this therapy at Minnesota Women's Care.

In addition to the Femilift option, Minnesota Women's Care also offers ThermiVA.  There painless procedure uses RF energy to treat vaginal atrophy and tighten the vagina.  We often times will use both procedures as the overlapping modalities provide even more efficacy.  

I was hesitant to address this topic from fear of backlash from feminist groups.  To be clear, I am not inferring that women should be ashamed of their bodies.  Those who know me know better.  However, I can assure you that if there was some natural occurrence that resulting in a decreased performance for a man in this regard he would be in the doctor’s office the day after it happened.  Why should women just live with it?  Again, I am well aware that some women will be offended by this message.  I’m sorry.  My intent is not to offend but rather to reach out to those women who want to address this issue.  We have solutions and help for those that desire it.   Call us at Minnesota Women’s Care 651-600-3035.  Dr Ashford

Sunday, August 10, 2014

Menopause and Hormones

It has been said that nothing in life is certain except death and taxes.  For women, menopause can be added to that list. By definition, Menopause is when the ovaries have exhausted their capacity and ability to make hormones.  The result of this loss of function for 90% of women is hot flashes, vaginal dryness, emotional ups and downs, moody disposition, lack of focus, difficulty with memory, concentration, decreased sex drive, and a lack of energy.  Many women simply say, “I am not myself”.
Hormones are a vital part of wellbeing and beneficially affect a multitude of pathways in the body.  Imbalances can actually occur in various settings but the most dramatic decline occurs with menopause.  The low estrogen and testosterone levels not only results in an uncomfortable experience, but also bone loss.  This bone loss can lead to osteopenia and increased risk of bone fractures.  Furthermore, it is well known that estrogen increases HDL (good cholesterol) and decreases LDL (bad cholesterol).  Estrogen also has been shown in many studies to decrease atherosclerotic plagues (clogged arteries) and decrease the risk of colon cancer.   Before menopause, women have a lower risk of heart disease than men.  After menopause women’s risk catches up with men.  This suggests a beneficial effect of hormones.

If Hormones are so good what is all the controversy about?

In July of 2002 a study was published called the Women’s Health Initiative (WHI).  The study results indicated an increased risk of Breast cancer in 8/10,000 women.  In addition an increased risk of stroke or heart attack in 7-8/10,000.  Looking at the adverse events together in short this study indicated that women taking oral estrogen and progesterone (prempro) made from horse urine had an increased risk of an adverse event of 0.3% each year of use of Hormonal therapy.  A positive from the study was a finding of a decreased risk of colon cancer by 30%.
These results initially were a jolt to the medical community as prior studies showed a decrease risk of heart disease.  Consequently countless women were told to stop their hormones.  It wasn’t long though before these women came marching back to their doctor’s door demanding relief from the symptoms of lack of hormones.
Further evaluation found 2 major flaws in the Women’s Health Initiative (WHI) Study:
Flaw #1; All of the women in the WHI were given oral estrogen.  Furthermore synthetic oral estrogen made from horse urine.  Studies have shown that transdermal estrogen through subcutaneous pellets, patches, sprays or gels are safer and do not increase the risk of heart attack or stroke as they do not increase clotting factors as oral estrogen does.
Flaw #2: The average age of the women in the study was 63!  These are not the newly menopausal women suffering from symptoms.  The question is whether the very small risk seen for breast cancer, heart attack or strokes was secondary to the hormones OR the age of the patient. 
Another very interesting point is that the all of the above risks in the WHI study were based upon the women taking PREMPRO (estrogen and progesterone from horse urine).  In the SAME study there was another arm.  The other arm of the study was with women taking Premarin (estrogen only from horse urine).  In this arm there was no increased risk of heart attacks, strokes or breast cancer.  In fact the risk of breast cancer in the estrogen only arm trended down!
Good news!  A study released in 2012 called Kronos Early Estrogen Prevention Study (KEEPS) looking at women between the ages of 42-58 found no increased risk of blood pressure, breast cancer, heart attacks, strokes or blood clots. 
The bottom line:  While more studies are needed to provide a definitive answer most women suffering from the symptoms of menopause are likely safe in taking hormone replacement therapy.   Especially if taken for a short period of time.  In most women the vasomotor symptoms resolve by 5-7 years after the start of menopause.  It also does appear that using non oral forms of estrogen may be beneficial.  However with every medical intervention care must be individualized and take into account the individuals medical history.

Menopause is a natural aspect of life.  Why are we bothering with trying to treat it?

Yes. It is very natural.   However, consider this.  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 continues for 5-7 years AFTER menopause starts.  Quick math:  That’s a potential 20 years!  Busy women with active and healthy lives do not want to live with these symptoms for 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. 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. 

Are there alternatives to hormone therapy for menopausal symptoms?

Yes.  There are many alternatives to hormone therapy:  Black cohosh, Soy products, clonidine, and gabapentin are some commonly non FDA approved mentions alternatives.  For some women these work well but for about 70% of women they don’t cut it.
There is only one FDA approved alternative to estrogen.  A SSRI (typically used for depression) called paroxetine was rebranded and approved as Breisdelle for the treatment of hot flashes.  It was shown to be more effective than placebo in the control of hot flashes only.

What are bio identical hormones?  Are they safer?

When most refer to Bio identical hormones they are describing hormones derived from naturally occurring sources, such as yams and soy that are identical in chemical structure as the hormones that are produced naturally by our bodies.  Simply using a hormone chemically identical to natural hormones is not necessarily safer.  However mounting evidence has shown that using bio identical hormones subcutaneously, tailored to the hormonal needs of the individual, and delivered based upon physiologic demand; can be safer that traditional methods.
SottoPelle Bio identical Subcutaneous Pellet therapy is just one way to help achieve this. SottoPelle Therapy® is an all-natural bio-identical hormone replacement therapy administered with a pellet that allows for a continual release - the key to improving brain and muscle function.

In the end, hormone therapy must be individualized depending on the individual’s medical history, symptoms, risk factors and priorities.  Hormones are not poison and for the most part results in life changing beneficial effects for women.  Discussing options with a knowledgeable physician equipped with the tools to provide relief is a must for all women suffering with the symptoms of menopause.  In most cases achieving a proper hormone balance together with proper nutrition and exercise is the key to aging gracefully.

Melvin Ashford, MD
Minnesota Women's Care 
OBGYN and Pelvic Specialty Care Center