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.

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....

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. 

SOTTOPELLE HORMONE REPLACEMENT AND PARKINSONS

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

651-600-3035

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 mnwcare.com for more information.

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

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