Monday, December 28, 2015

Atrophic Vaginitis

Atrophic vaginitis is a common problem in postmenopausal women.  It is the result of low estrogen levels in the vagina.  Without appropriate levels of estrogen the “good bacteria” (lactobacillus) counts decline sometimes resulting in elevation of bad bacteria.  This increases the likelihood of recurrent bladder infections.  Lubrication  of the vagina dramatically decreases with lower estrogen levels and the lining becomes thin and inflamed.  This leads to pain with intercourse.  Painful sex is often the leading symptom that prompts women to seek treatment. 

While atrophic vaginitis is most commonly a problem with postmenopausal women it may also occur transiently in breast feeding women.  It could also be a significant problem in women with a history of cancer following chemotherapy or pelvic radiation.  Both result in potential damage to the ovaries.
With declining ovarian function comes declining estrogen levels followed by atrophic vaginitis.

Initially women are able to manage this with :
1.       Vaginal moisturizers (Replens or Vagisil)
2.       Vaginal lubricant (glycerin-free versions of Astroglide, K-Y Intrigue, others)
3.       Vaginal Ph balancing gels ( Refresh, Luvena)

For some women this may be all that is needed.  For many the problem progresses and requires medical therapy.  The most common therapy is local estrogen cream, tablets or an estrogen ring that is placed in the vagina.   Local estrogen therapy is highly effective when used continuously and regularly.  For those who find the current treatment options ineffective or would like to avoid hormones and drugs; there are new and innovative procedures to combat this problem. 

Quick and painless in-office procedures that provide CO2 laser therapy or RF energy to the vaginal tissues to rejuvenate them are now available.  Two such procedures; Femilft and ThermiVA are offered at Minnesota Women’s Care.

Each procedure is provided through 3 short sessions separated 4 weeks apart.  It’s relatively painless and no anesthesia or painkillers are required.  Before a woman is allowed to take part in the procedure she must undergo the customary pelvic exam.  If all checks out alright the procedures can be performed.  They provide energy to the vaginal surfaces that result in increased collagen formation and lubrication.  Most women report decreased pain with sex, more enjoyable sex, decreased urinary leakage and less frequent bladder infections. 

For the woman suffering from this condition following menopause, radiation or chemotherapy Femilft or ThermiVA procedures can be a life line.  To learn more contact us at Minnesota Women’s Care 651-600-3035.

Friday, November 13, 2015

Tribute to Dr. Gino Tutera

Today I received an email from the wife of Dr. Gino Tutera announcing the passing of Dr. Tutera over the past weekend.   I only met Dr. Tutera 3 years ago and our relationship was more professional than personal but I must say that this news is received with great sadness.  This marks the passing of a great man with a big heart and the courage to challenge prevailing ideas in medicine with the right ideas.  He opened my eyes and provided me tools to help women in ways that I never could before.

Despite completing medical school with honors, being the executive chief resident of my obstetrical and gynecology residency program rand scoring in the top 1% in the country on my OBGYN training exams (CREOG);  I NEVER EVER heard of pellet therapy for women until I met Dr. Tutera. 
This is astonishing as hormone pellet therapy has tremendous benefits and has been around for 50 years!!   How could a studious OBGYN resident have not heard about this?  Pellet therapy is one of the most common HRT used in Europe and Australia yet many OBGYNs in the USA have never heard of it.

Dr. Tutera recognized 20 years ago when he started SottoPelle that hormones, vitamins and good nutrition are the key to WELLNESS.  Why wait until a person is sick to help them?  Why not help them when they are well to help them stay well as long as possible?  I thank God for Dr. Tutera and the men and women like him with the courage to think outside of the box.  This courage results in a better quality of life for us all. 

On this very sad day I want to say thank you Dr. Tutera.  Thank you for all that you have done to support the wellness of countless men and women in our country and the world.

Melvin Ashford, MD 

Wednesday, October 21, 2015

New Fertility Assessment Tool

Most women rarely look deeply into their menstrual cycle to understand the mechanics of reproduction. It is assumed that pregnancy will be easy to achieve; but the reality is that a women’s eggs have a finite period of function.  Women are born with all the eggs they will ever have.  This is different from men who make new sperm every day.  With time these eggs will decline in number and function.   The peak period of fertility is in a woman’s 20’s.   A slow decline begins in the early 30’s.   The decline becomes more pronounced after age 35.  Fertility is severely compromised by age 40.
Some women achieve pregnancy using their own eggs after the age of 40, but it is more the exception than the rule.  Quantifying the number and quality of a woman’s eggs for the potential of pregnancy has been very difficulty.  Recently a test combining 5 different tests has shown promise.

Determining the Likelihood of Success: Perfecting the Test

Success on this front had been elusive until fairly recently, when scientists conducted substantial clinical research which combined the capabilities of high-quality laboratory partners with data derived from well-controlled research studies to design the Ovarian Assessment Report (OAR). The OAR provides a comprehensive look at a woman’s unique ovarian reserve by assessing the status of several important reproductive hormones.  An Egg Supply Score  as well as an Egg Quality Score is provided.  This is powerful infomation especially for the woman delaying pregnancy.  For the first time in fertility history, through actionable results and physician consultation, a woman’s current egg supply can now be evaluated in a meaningful way.  Provided women with the power to make appropriate decisions regarding their reproductive plans.

Friday, October 2, 2015

Minnesota Women's Care is Expanding!

Over the next few months there will be a little dust around the office. The expansion will provide much needed space and will allow us to reduce wait times, add additional providers, and make the office visit even more comfortable.

The additional space will allow improved procedure room capabilities allowing more same day procedures to be performed in the office.  This means reduced out of pocket expenses for patients in a safe and more efficient setting.  We'll also be able to hold more patient seminars on site.  Husbands of pregnant wives can learn how to provide therapeutic massage techniques, pregnancy yoga classes will be back in force, women can learn about how to tame menopause and Dr. Ashford will be able to hold his incontinence seminars on site.  Full course and seminar offerings will be emailed to our patients.   We're excited and can't wait to unveil the new space.  More updates to follow....

Sunday, February 8, 2015

Urinary Incontinence: One Simple Solution

Bladder symptoms are a nuisance and significant barrier to social activity for many patients.  For women who are not interested in surgery, medicines or procedures to control their leakage there is another alternative.  Femsoft inserts.    The insert does not cure urinary leakage but for women with episodic leakage in response to activities it may be a God send.  Women you only leak with dancing, running, exercise, horseback riding or other activities are ideal candidates.  Urinary incontinence can be controlled with this discreet insert without much fanfare. 

The Femsoft insert is a small disposable “plug” that the woman inserts into the urethra prior to urinary leakage provoking activities.  When the woman needs to urinate the insert is removed and discarded.  Because the balloon tip is soft and covered in mineral oil insertion is usually painless.   The insert is made of silicone and conforms to the shape of your urethra.  It forms a seal and prevents urinary leakage in response to cough, sneeze, laugh running, dancing, etc.  To remove it the woman simply grabs the end and pulls the device out. 



One simple solution for a difficult problem.   To learn more please call:  Minnesota Women’s Care 651-600-3035. 

Monday, January 19, 2015


Exciting news! Dr. Tutera, the physician who trained Dr. Ashford to perform bio-identical hormone pellet replacement, is seeing great results with early-onset Parkinson’s patients using SottoPelle® hormone replacement therapy. These patients continue to make remarkable strides in a variety of areas.

Parkinson’s patients using SottoPelle® report:
    Reduced progression of symptoms
    Decreased need for certain medications
    Improved fitness and endurance
    Improved balance and coordination
    Increased mobility and flexibility
    Reduced tremor

When Parkinson’s disease (PD) strikes, it causes the failure and death of critical nerve cells in the brain, called neurons. Parkinson’s mainly affects neurons in an area of the brain called the substantia nigra. These particular neurons produce dopamine. Dopamine, in turn, communicates with the part of the brain that controls movement and coordination. As PD progresses, dopamine production decreases. This leaves a person unable to control movement in a normal way. And this inhibits the ability to exercise and maintain fitness.

SottoPelle® hormone replacement – specifically testosterone replacement – allows those with Parkinson’s to once again exercise. It gives them the motivation, endurance and stamina to make headway in physical fitness, just as it does in those without the disease.  In addition to this, the estradiol pellets increases dopamine production and decreases inflammation in the female brain, as does the testosterone in the male brain.

The steady flow uniform supply of needed hormones in the blood stream around the clock for months at a time appears to be beneficial.  Parkinson’s patients using SottoPelle® experience significant improvements in their conditions.  Bio-identical Hormone Replacement with Hormone pellets isn’t a cure-all for the disease, but it can forestall the disease’s progression. This helps patients become more functional with less medication. 

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


Saturday, January 17, 2015

Urologist or Gynecologist for Incontinence?

     Do I go to a urologist or to a gynecologist? Bladder control issues and gynecological issues can, and usually do, overlap. That’s why Dr. Melvin Ashford, OB/GYN sought out certification in both areas. He is now one of the few, board certified, urogynecologists in the state of Minnesota.

Dr. Ashford has been a practicing OB/GYN physician for 12 years. In 2012 he launched his private practice and opened Minnesota Women’s Care in Maplewood, Minnesota to offer his patients a more welcoming environment for their visits. Incontinence and uterine prolapse are two interconnected issues that Dr. Ashford regularly treats with exceptional success.

“One of the saddest things is to have a grandmother who comes and says, ‘I don’t play with my grandkids anymore because I smell like urine,’” says Dr. Ashford. Frequently Dr. Ashford will see patients with serious pelvic floor issues that could have been averted had they seen him sooner. Generally, they’ve delayed the visit because they thought there was nothing that could be done or they thought what they were experiencing was normal.

There are much better solutions than wearing adult diapers according to Dr. Ashford. There are treatments that stimulate the pelvic muscles and strengthen them. Implants can be inserted to control the bladder and get the leakage stopped. Sometimes Botox can be injected in the bladder to stop bladder spasms stop the leakage. There are also surgical procedures that can be done and medications available.

When a situation does require surgery, in the past, you would have two or three doctors operating in the same place where the organs are connected to each other.

“The problem is, when you have issues of uterine prolapse, the bladder and uterus falling down, then you have incontinence,” explains Dr. Ashford. “They are all connected to each other with connective tissue. So what you do to the top of the bladder impacts the vagina, and what you do to the vagina impacts the rectum.”

One doctor would be handling the bladder falling down and another doctor would deal with the uterus. You had two or three doctors doing one surgery. When you combine urology with gynecology, the procedure is more fluid and outcomes are better, according to Dr. Ashford. You have the same person correcting all the defects in the bladder, vagina and uterus at once.

Of course, Dr. Ashford deals with many other issues related to the pelvic area in his practice. He utilizes the most current technology and treatments available. He was one of the first physicians in Minnesota to begin using the da Vinci® surgical robot to perform minimally invasive hysterectomies and treat endometriosis and uterine fibroids. The da Vinci system provides a much faster recovery because it requires much smaller incisions.

Part of what Dr. Ashford does is simply educate his patients on the increasing range of treatments available. Vaginal rejuvenation gynecology is a treatment for those whose vagina has loosened over time. This vaginal tightening procedure helps improve the sensation of intercourse. Recently, they began offering SottoPelle®, a revolutionary form of bio-identical hormone therapy. SottoPelle uses a unique form of low-dose pellet therapy that lasts for 3 months or longer. It is the only hormone therapy that responds when the body needs more, keeping hormone levels more balanced than applications that rely on pills, patches or creams.

When Dr. Ashford launched Minnesota Women’s Care, he had specific vision in mind for his patients; that’s why it is called a “care center” and not a clinic. Appointments are not hurried or rushed. Every patient is warmly welcomed, the same as you would welcome a friend to your home, with the offer of a beverage and comfortable seating and surroundings. Through the Uniquely Catered Pregnancy Program, expectant moms are really pampered - including a mini-massage at each appointment.

When asked what it is about Minnesota Women’s Care that truly sets them apart, Dr. Ashford doesn’t hesitate: “It’s the people that we have working here.”

Dr. Ashford says that nurses, assistants and secretaries frequently stay late or come in early. They go out of their way to do things for each patient and give patients individualized attention. It creates a culture of care that patients recognize as genuine and heartfelt.

Whether your visit to Minnesota Women’s Care is for a routine pelvic exam or to address concerns related to incontinence, menopause or intercourse, Dr. Ashford and his staff will provide you with the most up-to-date treatment available and in a personalized manner that is rare to find in many other clinic settings.

Minnesota Women’s Care is located at 2603 White Bear Avenue North, Maplewood, MN. You can call them at 651-600-3035 for an appointment or visit them online at for more information.