Is it Winter Blues, or lack of Vitamin D?

Feeling more tired than usual lately?  Or are you experiencing unexplained aches and pains? It may be a lack of vitamin D.

Vitamin D is a vitamin your body absorbs primarily through exposure to sunlight on bare skin, but can also be found in some foods and vitamin D supplements. It helps your body absorb calcium, which is why a lack of vitamin D can lead to brittle bones and aches and pains in both children and adults. Vitamin D deficiencies have also been linked to other conditions like high blood pressure and the “winter blues.”

“Vitamin D is critically important to alleviating depression and maintaining healthy bones,” said Dr. Carlos Cardenas, an obstetrician-gynecologist with the Institute for Women’s Health, San Antonio. “Unfortunately, many people don’t get the amount they need.”

People at a greater risk of vitamin D deficiencies are those who spend a good deal of time indoors and those with darker skin, as their skin pigment blocks the absorption of vitamin D. People who are overweight or obese are also at a higher risk for deficiencies, as vitamin D is fat-soluble, which means more is needed for those with higher body weights.

Being in the sun is the easiest way to get your daily dose of vitamin D, but even here in sunny Texas, it can be difficult. Skin protected by clothes during the winter months won’t absorb vitamin D, and neither will skin protected by sunscreen. If you’ve been experiencing unexplained aches and pains, or feeling more tired than usual lately, a simple test can determine if you need to boost your levels.

“Testing for vitamin D deficiencies is done by a blood test, which an OBGYN can order,” Dr. Cardenas said. “Blood tests are the only way to measure the amount of vitamin D in a person’s body. From that point, a treatment course is recommended, whether it’s supplements or increased daily exposure to sunlight.”

Dr. Cardenas emphasizes the importance of a patient talking to their physician about symptoms they’ve been experiencing. “We can only treat the symptoms we’re aware of,” he says. “If a patient doesn’t talk to us about their symptoms, vitamin D deficiencies can be more difficult to identify.”

Nursing mothers should also talk to their OBGYN about taking a vitamin D supplement to support the growth of their baby’s healthy bones.

“Mothers who are exclusively breast-feeding their infants should be taking a vitamin D supplement so it passes on to their baby,” Dr. Cardenas advised. “Otherwise, the baby is more likely to be vitamin D deficient.”

While it’s always important to protect your skin from the sun, getting outside a few times a week for a walk or a bike ride may help to naturally increase your body’s levels of vitamin D.

“Take advantage of the beautiful weather in Texas, even during the winter season,” Dr. Cardenas urged. “It’s more beneficial than you think!”

This Article Originally Appeared on https://www.ifwh.org/en/is-it-winter-blues-or-lack-of-vitamin-d/

A Healthier You in 2016

The new year brings a new opportunity to take charge of your health and live a better life. These three simple resolutions are a great way to start taking better care of yourself in 2016 without having to make major life changes. Remember, investing in your health now will result in many good years to come!

Resolution #1: Be More Active

Physical activity is very important to your overall health and emotional well being. Setting aside just 15-20 minutes to exercise each day lowers your risk of heart disease, diabetes, osteoporosis and cancer and keeps your muscles, bones and joints healthy. But even better, exercise helps you mentally – lowering symptoms of anxiety, depression, stress and menopause.

According to the Centers for Disease Control, 60 percent of women don’t get the amount of physical activity they need. The multiple demands of work and family often leave little time for exercise. The key to keeping up with this resolution is finding creative ways to add some exercise to your daily life. For example, you can use 15 minutes of your lunch break to walk up and down the stairs at work or go out for a walk with your kids after you pick them up from school. Remember: those 15 minutes today can stave off years of health problems in the future.

Resolution #2: Eat Better

Many of us want to start off the new year with a new diet. But be careful which one you choose – popular diets that restrict certain foods or drastically reduce caloric consumption often fail within a few weeks. So how can you successfully eat healthier? By simply making a few small changes such as these:

• Eat four – five small, healthy meals a day instead of three large meals.

• Start your day with a complete breakfast that will keep you full for hours. Try steel-cut oatmeal with fruit, whole-grain toast with peanut butter and a green juice, or scrambled eggs with veggies.

• Incorporate vegetables or greens into every meal – keep your plate colorful!

• Treat yourself to occasional unhealthy foods, like tacos or pizza, but make sure you keep the portions small.

Resolution #3: Be Proactive About Your Health

Many diseases that affect women can be successfully treated if detected early. It’s very important that you develop good communication with your OB/GYN so he or she can have a complete picture of your health history and address any concerns you may have.

Some important exams recommended for women include:
• Breast Cancer Screenings – All well women exams include a breast exam (which is different from a mammogram) to screen for breast cancer. Depending on your age, you might need to have a mammogram every year or every two years. You can read about the new mammogram guidelines here.

• Cervical Cancer Screening – The American Cancer Society recommends that women between 21-29 receive a Pap test to screen for cervical cancer every three years and that women between 30-65 receive a Pap test and an HPV Test once very five years.

• Bone Mineral Density Test – Women over 65 should have this osteoporosis screening at least once. It is also recommended that women begin discussing this test with their OB/GYN once they turn 50. Those who are at a higher risk should be screened earlier.

• Well Woman Exam – We recommend that women obtain a well woman exam at least once a year. This allows your OB/GYN to get a clear picture of your health to catch any problems early.

Now is the perfect time to get 2016 off to a healthy start. Our practice offers nine different locations and more than 30 doctors to choose from to make it convenient for you. You can even schedule an appointment online.

This Article Originally Appeared on https://www.ifwh.org/en/a-healthier-you-in-2016/

Choose an OBGYN Doctor Today

The very personal choice of an OB/GYN (OBG) physician is likely not as difficult as it might seem. There are many online sites and friends/ family to consult on this matter. I will outline some of the considerations that seem to be most helpful below.

• Training and Board certification – although no guarantee of quality , this is usually an easy place to start and readily available both on physician website biographies or online.
• Experience – again no guarantees here, but as in everything in life a little experience does seem to count when your health is concerned. Don’t be afraid to ask about a particular area of professional experience if you are concerned.
• Hospital affiliation(s) – the facility reputation and standing can be just as important if not more so. Readily available online or at the facility website. If pregnant what kind of NICU is available if baby needs special care after delivery.
• Office hours and location – very subjective look for access, parking, safety considerations and if family members or kids are welcome in the office.
• Coverage when the Doctor is away – look at the other members of the practice, their qualifications are important too! Personality compatibility with the group members towards you is a consideration.
• Insurances accepted by the Doctor or group (and the facilities they use!)

So most of the things listed above are to think about BEFORE you come to the office. What about AFTER your visit?

• How did you feel coming into or leaving the office? Good experience? Nervous? Intimidated? You should definitely listen to that inner voice here. Your first instinct is usually correct.
• Did you feel comfortable discussing highly personal information with the Doctor? The staff? Was privacy important to the practice?
• Availability of Doctor after hours? Who picks up the phone? How often is your Doctor on call?
• Office staff. Appearance? Professionalism? Compatibility with your personality? Privacy concerns?

Although this is not an exhaustive list of concerns or a perfect way to choose, it should be a good start. Never forget to ask questions and try to be prepared for all visits yourself as this can be a two way street!

Source : This Article Originally Appeared on https://www.ifwh.org/en/choose-an-obgyn-doctor-today/

Cord blood research continues with promising results

Before you give birth, consider the value of cord blood. After a baby is born and the umbilical cord cut, some blood remains in the placenta and the portion of cord attached to it. Cord blood is one of the fastest growing sources of stem cells used in pediatric transplants, and the medical community uses cord blood to treat at least 80 diseases today.

Since it contains blood-forming stem cells, also called hematopoietic cells, it’s used as an alternative to bone marrow in organ transplants and to treat diseases like leukemia, lymphoma, blood-disorders, and bone marrow failure. With these health benefits in mind, researchers are trying to find ways to make the most of each precious cord blood donation. A new stem cell harvesting technology presented at the 2014 American Society of Pediatric/Hematology/Oncology association gives parents the opportunity to collect twice the number of stem cells from the cord.

According to the American Cancer Society, more than 20,000 stem cell transplants came from cord blood last year, and research on what else cord blood can treat is being conducted every day. Duke University has a trial testing whether these stem cells can repair damaged cells from cerebral palsy and Type 1 diabetes. Other research focuses on cord tissue and whether it can be used to treat lung cancer, Parkinson’s disease, and rheumatoid arthritis.

Parents have the option of storing your child’s cord blood and stem cells to fight future diseases or donating it to our local cord blood bank to help other families who may not have access to it. Moms should talk to your OB/GYN about the benefits of saving your cord blood versus donating it to a public bank and what will work best for your family.

I’ve recommended banking cord blood to some of my patients, but it’s a completely personal decision. When parents ask for my input, I take into consideration the family history, genetic makeup, and whether they already have or plan to have more children.

If you decide to donate your cord blood, be sure to research both private and public storage. As the significance of cord blood research has grown, the number of facilities has increased and unfortunately not all will be reputable. You can also ask your OB/GYN about banks we would recommend based on our experience with them. Methodist Hospital, Metropolitan Methodist Hospital, and North Central Baptist Hospital also participate in the Texas Cord Blood Bank program.

Source : This Article Originally Appeared on https://www.ifwh.org/en/cord-blood-research-continues-with-promising-results/

Uterine Fibroids

As many as 3 out of 4 women will develop uterine fibroids in their lifetime, so it is one of the most common gynecologic conditions seen in our practice. Fortunately, uterine fibroids, or leiomyomas, are noncancerous masses of muscle which develop from the uterine muscle cells. Although fibroids are often called tumors, they are not associated with an increased risk of uterine cancer and rarely develop into cancer.

Doctors are not sure what causes fibroids, but the following are considered possible factors:

• Genetic changes — many fibroids contain changes in genes that differ from those in normal uterine muscle cells.
• Hormones — Estrogen and Progesterone, two ovarian hormones that stimulate development of the uterine lining during each menstrual cycle, appear to promote the growth of fibroids.
• Other growth factors — substances that help the body maintain tissues, such as insulin-like growth factor, may affect fibroid growth.

Any woman of reproductive age may develop uterine fibroids. Other risk factors include heredity and race. If a woman’s mother or sister had fibroids, she is at increased risk of developing them. African-American women are more likely to have fibroids than women of other racial groups. They are also more likely to have larger and more numerous fibroids which develop at a younger age.

Other risk factors include starting first period at an early age, having a diet high in red meat and low in green vegetables and fruit, and alcohol use.

Many women with fibroids have no symptoms, but those that do have symptoms most commonly complain of the following:

• Unusually heavy or painful periods
• Long periods lasting more than seven days
• Spotting or bleeding between periods
• Chronic pelvic pressure or pain
• Pain consistently with intercourse
• Difficulty emptying bladder
• Constipation
• Lower backache or upper leg pains

The absence or presence of symptoms may depend on the number, size and location of the fibroid tumors. Fibroids range in size from seedlings to large masses that can distort and enlarge the uterus. They can be single or multiple, in extreme cases enlarging the uterus so much that it reaches the rib cage. Fibroids can develop deep within the muscular uterine wall, on the surface of the uterine wall, or within the inner uterine cavity.

Uterine fibroids are frequently found on routine annual pelvic exams or incidentally during a prenatal ultrasound. The fibroid tumors that cause no symptoms may not require treatment. Those patients will be followed with regular pelvic exams and pelvic ultrasounds to assure the tumors are not growing or multiplying. If they are, then they are more likely to cause symptoms which warrant treatment.

Treatment may include medications to manage symptoms without removal of the fibroids, or a surgical procedure to remove the fibroids while leaving the uterus in place. This procedure is called a myomectomy, and depending on the size and location of the fibroids, may be performed hysteroscopically (vaginally) or laparoscopically (through small abdominal incisions), or through a single larger incision which is called a laparotomy.

Myomectomy is usually performed for a woman who desires future fertility, and she is advised that she may develop new fibroids in the future. The only proven permanent solution for uterine fibroids is removal of the uterus, or a hysterectomy. This procedure should be reserved for women who are done with childbearing because it ends their ability to bear children. Hysterectomy ends menstrual periods, but it does not cause menopause to occur unless the woman desires to have her ovaries removed at the same time.

Hysterectomies may be performed laparoscopically or with robotic assistance with rapid recovery times. Other cases may require a laparotomy. Radiologists offer uterine artery embolization where small particles are injected through the groin vessels to block the arteries supplying blood flow to the fibroids causing them to die.

Although uterine fibroids are not usually dangerous, they are very common so women should have their annual gynecologic exam done, and see their doctor sooner if they develop unusual persistent symptoms previously discussed. Iron deficiency anemia, infertility, and multiple miscarriages are possible complications associated with fibroids. The earlier a woman’s fibroids are diagnosed, the more treatment options she will have. At this time, very little is known on how to prevent fibroids. The good news is, the management and treatment of fibroids is well established.

Source : This Article Originally Appeared on https://www.ifwh.org/en/uterine-fibroids/

Sexual Changes

Sexuality plays a tremendously important role in women’s lives.   It brings women an ever-evolving source of pleasure, intimacy, personal expression, interpersonal connectedness, and of course, reproduction.  It can be a wonderful part of a healthy relationship, but sometimes it can become a source of frustration, pain, or even become tedious and unfulfilling under certain circumstances.

Changes in women’s sexuality can occur at any point during their adult life.   Many things can impact a woman’s sexuality. I would like to take a little time to discuss some of these and hopefully provide some insight into what may be causes or contributing factors to these changes, and offer some treatment options.

One way to organize the various factors that affect women’s sexuality is by age, but that becomes problematic since most of these can occur at any age.   The following is a list of some of the factors that can have a negative impact on sexual health.

Pain during intercourse can be caused by many things.

Sexually transmitted infections:  can occur at any age, and while some cause no symptoms, most cause pain, sometimes chronic pain that can make sex difficult.

Endometriosis (which is more fully discussed in another “Girl Talk” episode that is archived) is very often a cause of pain during intercourse, especially causing pain in the lower pelvis during intercourse.

Vaginismus is a condition where the muscles at the opening of the vagina can go into spasms and tighten painfully with attempts at penetration.  Sometimes a ‘triggering’ event (something that caused the symptoms to start occurring) can be identified, but sometimes it can begin to happen without any obvious cause.

Interstitial cystitis is a condition of inflammation of the bladder that causes pain during intercourse.

Ovarian cysts, scar tissue “adhesions” from infections or previous surgeries can cause pain; the latter being a very difficult to diagnose and treat.  Uterine fibroids can cause pain in some cases (fortunately, a lot of they time they are small, and don’t cause any symptoms).

Vaginal dryness is a problem that can occur at any time during a woman’s life, but is most often seen during the menopause, when the loss of estrogen causes changes in the vaginal skin that make the skin very dry, and sensitive.  The loss of estrogen causes the vaginal skin to lose it’s ability to lubricate normally and to stretch – which can cause tearing of the skin and burning pain with attempts at intercourse.  Vaginal dryness can occur at younger ages sometimes due to dermatological skin conditions like lichen sclerosus, psoriasis or eczema.  Sometimes vaginal dryness from lack of lubrication or decreased arousal due to the use of oral contraceptive pills, or other hormonal contraceptives.

A history of physical or sexual abuse or trauma, or even emotional abuse can cause problems with pelvic pain, and/or pain during intercourse.

Changes in libido can affect women at any age.

Libido is the desire to have intercourse.  While excessive libido is an uncommon problem, it can occur, and can cause problems for the sufferer, particularly if the woman becomes excessively promiscuous, which can put her at risk for exposure to STDs or cause relationship problems of social stigma.  Decreased libido is a much more commonly encountered problem for women.  One of the biggest concerns can be due to a difference in libido in couples, with one couple wanting sex more often than the other.

Libido is a ‘multi-factorial’ condition, meaning that many things affect a woman’s libido.  While hormones contribute significantly and can often be a cause of decreased or absent libido, they are not the only factor.  Social factors affect women’s libidos as well.  Stress, fatigue, and family responsibilities as well as depression and other health conditions can have a huge effect on a woman’s sex drive.  For most women, being very stressed, or over-tired from working inside or outside of the home (or both) can leave them both emotionally and physically drained and have a negative impact on their libido.  Marital discord almost always has a negative impact on a woman’s sex drive.  Often women don’t desire to have a physical connection with their partner if the emotional connection is strained.  Many medications can have a negative impact on a woman’s libido, including birth control pills, anti-depressants, some blood pressure medications, even some anti-histamines can have a decreasing effect on libido.    Psychological factors are tremendously important in a woman’s sex drive.  A history of sexual abuse, or physical trauma can cause sexual dysfunction involving both libido and pain symptoms for victims.  Poor self-esteem, or body image disorders can leave women feeling undesirable and prevent them from having satisfying sexual interactions.

Changes in a woman’s production of hormones (specifically testosterone and or estrogen) can be a significant contributor to loss of libido.  These hormonal declines (in testosterone production) or imbalances are more commonly experienced as women age, especially from their mid-30’s and often more pronounced in their 40s and beyond.  Once a woman goes through menopause, her body’s own production of sex steroid hormones is very minimal (whether menopause occurred naturally, or due to having her ovaries surgically removed at a younger age) and low testosterone may be a significant contributor to decreased libido.  Before menopause (during something called ‘perimenopause’) many hormone changes occur in women that can have many effects on their lives; decreased libido being just one of those effects.  After giving birth is another time in womens’ lives that testosterone production has been shown to decline.  In the immediate post-partum period for breast-feeding women, their bodies produce minimal hormones, and they are in a period of temporarily suppressed hormones (almost like a ‘mini-menopause’) until they stop breastfeeding and their hormones return to more normal levels.   Even if women don’t breastfeed, having a child can result in lower than previously produced testosterone levels that can impact libido.  Although the exhaustion of having a  newborn (and small children, and, come to that, teenagers) – are also things that can negatively impact a woman’s sexual desire.

Orgasmic dysfunction.

Exact numbers vary by study, but it is estimated that only 25% of women are regularly able to have orgasms during vaginal intercourse.  Up to 10% of women never have orgasms.   It is important for women to know that it is ‘normal’ for them to not have orgasms with penile-vaginal intercourse alone.   For women who have never had an orgasm (or aren’t sure if they have) there are resources available to help them learn how to achieve orgasm.  Sometimes women can lose this ability, due to certain medications (anti-depressants being the most common cause of this), medical conditions, nerve injuries, or even due to hormonal declines.  A careful history by their gynecologist should be able to uncover possible causes and direct treatments.

Source : This Article Originally Appeared on https://www.ifwh.org/en/sexual-changes/

What is Urogynecology?

Urogynecology (official name: Female Pelvic Medicine and Reconstructive Surgery) is a subspecialty within Obstetrics and Gynecology. It is dedicated to the evaluation and treatment of disorders of the pelvic floor in women.

Urogynecologists have completed medical school and a residency in Obstetrics and Gynecology. They become specialists with additional training and experience in the study and treatment of conditions that affect the female pelvic organs. Many have completed formal accredited fellowships (additional training after residency) that focused on the surgical and non-surgical treatment of pelvic floor disorders. We encourage you to feel comfortable asking about the training and expertise (and Board Certification in Female Pelvic Medicine and Reconstructive Surgery) of any doctor caring for you.

So what are the pelvic floor disorders (“PFDs”)? The pelvic floor is a set of muscles, ligaments and connective tissue that provides support for a woman’s pelvic organs (bladder, uterus, vagina, and rectum). The pelvic floor is important in keeping these organs in their proper place as well as in making them function properly.

Women with a weakened pelvic muscles or ligaments may have trouble controlling their bladder and bowels. They can experience leakage of urine, bowel gas or stool, difficulty emptying their bladder or having a bowel movement or overactive bladder. Some women can also feel or see tissue coming out of the opening of their vagina. This can be a prolapsing uterus or vagina (pelvic organ prolapse). It is also possible to experience several of these problems at the same time.

While primary care physicians, general gynecologists and general urologists can start the evaluation and initial treatment of PFDs, if the diagnosis is not clear, if you experience several pelvic floor problems at the same time, if the initial approach has not helped or if a surgery is considered as treatment, we recommend that you are evaluated by a Fellowship-trained Urogynecologist, with Board Certification in Female Pelvic Medicine and Reconstructive Surgery.

Source : This Article Originally Appeared on https://www.ifwh.org/en/what-is-urogynecology/