Category: Greenville Women’s Clinic Blog

Having a baby is a big deal, and the birth of a baby can trigger many powerful emotions, from excitement and joy to fear and anxiety. But it can also result in something unexpected — depression.

Mothers often have a lot of different feelings and emotions in the weeks and months after they give birth. These feelings can change often, going from happy to sad to worried to scared and back again. These emotional changes are commonly known as the “baby blues.”

Many new moms experience the “baby blues” after childbirth. Baby blues can begin within the first two or three days after delivery, and could last up to two weeks. Common symptoms of the baby blues may include:

• Mood swings
• Crying spells
• Anxiety
• Difficulty sleeping
• Sadness
• Irritability
• Feeling overwhelmed
• Reduced concentration
• Appetite problems

However, some new moms may experience something more severe and longer-lasting, a form of depression commonly known as postpartum depression. Postpartum depression isn’t a flaw or a weakness; sometimes it’s simply a complication of giving birth.

Postpartum depression may be mistaken for the “baby blues” at first, but the symptoms are more intense, last longer and eventually interfere with your ability to care for your baby and handle other daily tasks. Symptoms usually develop within the first few weeks after giving birth, but may begin later — up to six months after birth.

Signs and symptoms of depression after childbirth vary, and they can range from mild to severe; some symptoms may include:

• Depressed mood or severe mood swings
• Excessive crying
• Difficulty bonding with your baby
• Withdrawing from family and friends
• Loss of appetite or eating much more than usual
• Inability to sleep (insomnia) or sleeping too much
• Overwhelming fatigue or loss of energy
• Reduced interest and pleasure in activities you used to enjoy
• Intense irritability and anger
• Fear that you’re not a good mother
• Feelings of worthlessness, shame, guilt or inadequacy
• Diminished ability to think clearly, concentrate or make decisions
• Severe anxiety and panic attacks
• Thoughts of harming yourself or your baby
• Recurrent thoughts of death or suicide

Contact your doctor immediately if your signs and symptoms of depression have any of these features:

• Don’t fade after two weeks
• Are getting worse
• Make it hard for you to care for your baby
• Make it hard to complete everyday tasks
• Include thoughts of harming yourself or your baby

If you’re feeling depressed after giving birth, you may be reluctant or embarrassed to admit it. But, it is important to talk with your doctor about all of your postpartum symptoms. If you have postpartum depression, prompt treatment can help you manage your symptoms — and enjoy your baby.

If you’re experiencing any of the symptoms of “baby blues” or postpartum depression, you should call Greenville Women’s Clinic and schedule an appointment with your doctor today. We are here to listen to any of your concerns or worries after giving birth.

Did you know that heart disease is the number one killer of women, causing one in three deaths each year? That’s about one women every minute! The latest findings from the American Heart Association also report that:

• around 44 million women in the U.S. are affected by cardiovascular diseases
• 90% of women have one or more risk factors for heart disease
• fewer women than men survive their first heart attack
• the symptoms of heart attack can be different in women vs. men
• 80% of heart disease events may be prevented by lifestyle changes and education

These finding are alarming which is why it is important for women to live a healthy lifestyle that positively influences their heart. Heart disease doesn’t appear overnight; it is the result of many years of heart-unhealthy choices. Here are a few tips that can help you live a more heart-healthy lifestyle.

1. Eat More Fruits and Vegetable

To give your heart the nutrients it needs to function optimally, it is important to eat a diet full of fruits and vegetables. Beans and legumes are a smart choice for a heart-healthy diet.

2. Get Active

Daily physical activity is a great way to live a healthier life. Just 30 minutes of exercise, five times per week can lower your risk of heart disease, stroke and diabetes.

3. Control Your Cholesterol

It is important to control your cholesterol to give your arteries the best chance to remain clear of blockages. Cholesterol is a waxy substance that our bodies use to make cell membranes and some hormones. But, when you have bad cholesterol it combines with white blood cells to form plaque in your veins and arteries. This plaque causes blockages that lead to heart disease. Ask your doctor for tips and diet ideas to help lower or maintain your cholesterol.

4. Manage Your Blood Pressure

High blood pressure is another major risk factor for heart disease, along with bad cholesterol. When you maintain a blood pressure within healthy ranges, you reduce the strain on your heart and arteries. If you have high blood pressure, also known as hypertension, it means that blood flows with too much force and puts pressure on your arteries, stretching them past their healthy limit and causing microscopic tears. To repair these tears, our bodies form scar tissue which can trap plaque and form blockages, blood clots and hardened arteries. If you have or are at risk of high blood pressure, ask your doctor about measures you can take to reduce it.

5. Stop Smoking

Those who use tobacco products have a higher risk of developing cardiovascular diseases. If you smoke, the best thing you can do for your heart is to quit. Smoking damages your entire circulatory system and increases your risk for hardened arteries and blood clots. Whatever it takes for you to stop smoking is worth it. Ask your physician for tips and advice on how to kick this unhealthy habit.

There are many other ways to live a heart-healthy lifestyle. We encourage you to ask your doctor at Greenville Women Clinic’s for advice on how to reduce your risk of cardiovascular diseases. As we mentioned previously, education is also important in preventing the disease. Share the information and tips you have learned with your friends and family and let’s all have healthier hearts!

Don’t become a statistic.  Know your numbers.  As we enter the month of February, it is time to put your best red dress on to help raise awareness and celebrate all the efforts to stomp out heart disease in women.  Please pay attention as what I am about to share with you can and will save lives, a life that could be your own.  Heart disease is the #1 killer for women, next to cancer however in recent studies they are now racing in a dead heat.  Do you know where you stand in this race?  It is a race you can hopefully sit out, so please read on. 

Heart disease represents just one of the 3 forms of cardiovascular disease that can adversely affect women.  In fact, the same process that causes a heart attack can also lead to stroke in the brain or body with serious lifelong disability and death.  We know women are different than men when it comes to cardiovascular disease.  It is a fact that women are not as easy to diagnose as men.  It is imperative to know your body well and to be your own advocate to evade the misdiagnoses that can occur due to our gender differences.  Are you at risk or ever experienced a heart attack?  Do you know for sure?  The fact is that about 35% of all heart attacks that occur in women go unnoticed or unreported.  It is not that we are oblivious or too busy; it is that we do not have the same symptoms as men.  We do not get that vice grip or elephant on your chest pain like our male counterparts.   We may instead experience extreme nausea with mild chest discomfort often mistaken as heartburn or a terrible stomach bug.  A woman will more often have pain in her neck, jaw or arms when a heart attack is happening.  A heart attack may even be as subtle as new onset of extreme fatigue, where family, work or stress may mistakenly be rationalized as to why one feels so badly.  Bottom line, unless you keep up with your well women’s health and numbers you may not ever know until it is too late.    

As women, our ovaries protect our cardiovascular health when it comes to that golden hormone produced called estrogen.  Up until about the age of 50 to 55, we have our angel wings, and estrogen helps promote the good cholesterol, called HDL that fights off the bad.  Bad cholesterol, being LDL, is what can block the vital vessels in our brain, heart or body resulting in a stroke or heart attack.  After age 50 to 55, when we officially enter menopause, the change of life, we are then a sitting duck!  Careful ladies, this is not just about menopause, as we know issues in our youth can lead to what happens later.  We know women who experience complications in pregnancy like high blood pressure or diabetes are certainly at risk for heart disease when they are older.  Further, medical conditions like obesity, high blood pressure, diabetes, polycystic ovarian disease, autoimmune disorders and even improper use of birth control or hormone replacement therapy can be a risk factor for a heart attack or stroke.  It is time that we take a stand, as we know the path it takes to fight and overcome this battle.   

Let’s talk numbers.  The American Heart Association has identified 7 areas that you should know and keep track to decrease your risk of heart disease or stroke. 

Absolutely no smoking!  I tell my patients to choose another bad habit!  I would rather you have that dark chocolate or glass of wine than a cigarette.  We know smoking accelerates the fatal process leading to heart attack or stroke. 

Get your physical activity.  Exercise can be wherever you choose as long as you get that heart pumping! I advise my Patients you can do whatever you want as long as you can sing a song and break a sweat – it is that great aerobic zone that trains your heart. 

Follow a heart healthy diet.  You should eat as much fresh fruit, vegetables and lean protein you can.  If it is in a box or doesn’t expire, then you don’t want it!  Processed foods are terrible for our health when it comes to heart disease and cancer prevention.    

Maintain a normal body weight.  Talk to your health care Provider to know where you stand. 

Control of cholesterol.  Have your levels checked now. 

Monitor your blood pressure.  High blood pressure damages your heart and body as it places undue stress on the blood flow and creates havoc on its way. 

Control your blood sugar.  High blood sugar and diabetes is known to damage every cell in our body.  Ask to be screened to know where you stand. 

Sounds easy enough?  In our present American culture, it has not proven to be so easy.  The fact is over 86-million Americans are affected by heart disease in some way and as a result, one person dies every 40-seconds in the United States.  We know what we need to do so save ourselves, but we somehow continue to fall prey to this disease. 

Get to your health care provider now and start the conversation.  Get your well women’s exam.  Ask to know your numbers and take this quiz as the life you save could be your own.  Go to https://www.goredforwomen.org/ for more information.  If you know your numbers, please plug them into this calculator and bring to your health care provider today.    http://www.cvriskcalculator.com/

Do you know your birth control options?  Contraception is currently a hot topic in our political and social media world.  With the election of President-elect Donald Trump, the threat of an appeal to Obamacare immediately brings focus whether access to contraception will remain.  Would access to contraception be a target of the appeal or would it be inadvertently taken away in the aftermath of a repeal of Obamacare as a whole?  There are many unanswered questions and this uncertainty is driving this heated discussion across the country.  We as Obstetrician Gynecologists support access to contraception for any person who desires this measure in their life.  Access should be open to all persons regardless of health insurance status.  You may be thinking, “Why would anyone want to argue about birth control?  If someone wants to avoid pregnancy, it is their own prerogative, right?”  Well, since the late 1800s, birth control and politics have had nothing less than an inflammatory relationship.  No matter your stance or political or religious beliefs, be informed and be a part of the conversation. 

Obamacare has opened the door to well woman’s visits and access, to what I call a buffet of contraceptive options. Under the Affordable Care Act, a physical exam and birth control consultation is considered a preventative service.  It is therefore offered without having to pay a copay for these services.  Mind you, there are grandfathered, religious and short-term health insurance plans that are exempt and result in out of pocket costs.  For the majority, it is estimated that Obamacare has afforded women nearly 50% savings in their birth control expense and has been said to equate to 1.4 billion dollars.  There are officially as follows:

• Sterilization surgery

• Surgical sterilization implant

• Implantable rod

• Copper intrauterine device

• IUDs with progestin (a hormone)

• Shot/injection

• Oral contraceptives (the pill), with estrogen and progestin

• Oral contraceptives with only progestin

• Oral contraceptives, known as extended or continuous use that delay menstruation

• The patch

• Vaginal contraceptive ring

• Diaphragm

• Sponge

• Cervical cap

• Female condom

• Spermicide

• Emergency contraception (Plan B/morning after pill)

• Emergency contraception (a different oral medication named Ella)

Thanks to Obamacare, we now have a buffet of options to discuss with women and have been able to take cost concerns off the table.  When exploring a Patient’s contraceptive needs, I advise them that choice depends on personality and lifestyle.  I often say, “You may find that you try one, but you may try them all until you decide which option works best for you.” 

With Obamacare, the category of “implantable” birth control has lifted barriers to this more effective option.  The intrauterine device and implantable rod placed in the arm are known as LARCs – long-acting reversible contraception.  They are proven to be 99% effective in preventing pregnancy.  Compare this to pills and condoms which prevent pregnancy only 92% of the time.  The use of LARC has increased from 2.4% to 11.6% of all women using contraception from 2002 to most recent studies as of 2013.  Once placed, the rod and IUD can provide effective birth control for 3-5 years depending on the device chosen.  The cost of the device is well over $1000 and with Obamacare is now completely free.  If and when it is time to remove the device, it may be replaced with a new one or removed at any time to become pregnant right away.  Why wouldn’t every woman choose such a reliable and modern device?  It is a “set it and forget it,” until one is ready to pursue a pregnancy.  Prior to Obamacare, cost was a major barrier, but now it is lack of awareness and a historical bias that has hindered the rise in women choosing a LARC.  The implantable devices of decades past resulted in serious side effects and consequences and were removed from the market.  The LARC devices we have at present have proven safety but the reputation of devices past have left distaste among older generations who may be influencing the present. 

With the current political climate and uncertainty of contraceptive coverage, however calls to question what happens if contraceptive coverage is eliminated or the cost increases?  Social media has seen thousands discussing this topic.  Some are asking, “Should I hurry and obtain a LARC to have long term contraception before Obamacare is repealed?  But if I do, what happens when I want or need it taken out?  What would be the cost to me?”  We cannot answer many questions as it stands now, but in my present knowledge, I counsel Patients that a LARC is a great choice per its effectiveness to prevent pregnancy and from a cost perspective long term if even Obamacare was lost.  The removal of a LARC device without insurance coverage averages around $300.  If you keep the device in place for more than one year, it averages to equal the cost of birth control pills that one would have paid for that year.  If you keep the LARC in place even longer, then costs are clearly in favor of choosing a LARC at this time. 

When it comes to contraception, I counsel Patients on a daily basis that no choice is a wrong choice.  It is what is best for you, your situation and fertility plans.  With Obamacare, there is a buffet of contraceptive options, however if access if called into question over the coming years, it may be wise to consider your long-term goals and options.  When choosing a LARC, it is ideal if there are no immediate plans for fertility.  No matter your current life stage, stay tuned and be informed to support all women.  We pray the landscape of the future maintains contraceptive access for all. 

The holidays provide joy and happiness for many. Time off from work, quality time with family and annual traditions generate feelings of warmth and love. But it also can activate many negative emotions for some people. There are many causes for this collection of symptoms that has come to be known as the “Holiday Blues.”

Causes

Decreased exercise

People tend to not exercise as much during the holidays, which can contribute to depression.

Having trouble sleeping

Due to the increase in traveling, scheduling and time spent with family and friends, some people get less sleep than normal. This could lead to a decrease in positive emotion and motivation.

Emotions of lost loved ones

While spending time with family can be very enjoyable, sometimes it can produce the opposite effects. Being around close friends and family can lead to remembering a loved one that has passed away.

Overeating and overdrinking

The holiday festivities can involve indulging in food and alcohol. When either one of these things is consumed at a high rate, it can have adverse effects on one’s physical and mental health.

Stress

Examples of this can be financial,  dealing with schedules, planning and

returning to one’s hometown.

Unrealistic Expectations

It’s easy to get excited about the holidays, but when reality sets in, you can find yourself feeling disappointed. Whether it’s someone not getting as excited about their gifts as they were, or a party not going as expected, it’s possible the holidays won’t live up to what your idea of a perfect holiday was supposed to be.

Seasonal Affective Disorder (SAD)

This can be related to shorter days and a lack of sunlight.

Symptoms

Negative feelings

This could be in the form of depression, sadness and discouragement feeling of hopelessness

Loss of interest

This could be a decrease of interest in things once found pleasurable.

Eating more or less than usual

Negative emotions can lead to binge eating or a suppression of appetite.

Weight gain or loss

Because of the possibility of an increase or decrease in appetite, weight fluctuation could follow.

Sleep deprivation

Because of the effects depression can have on falling asleep, sleep deprivation can be a resulting symptom.

Lack of energy

This could be the result of a lack of sleep and a change in daily habits and nutrition intake.

Withdrawal from others

There could be many causes for this. It could be the loss of a loved one or the recoil of proximity due to emotional comfort.

Difficulty thinking clearly

A decrease in sleep and straying from a normal routine can lead to a difficulty focusing and thinking clearly.

Treatment

Spend time outdoors

Studies have shown that being outside can help with depressive traits. The natural air, the sun and the calming natural beauty of the great outdoors can ease the mind and help fight causes of depression.

Limit eating out of boredom or downtime

This will help with overeating. Find something else to do during this time.

Keep healthy sleep habits

Stay on track with normal routines and habits. This will keep your physical and mental health by staying on a normal rhythm.

Plan accordingly

By planning your travel and other holiday logistics, it takes some of the stress away from what should be an enjoyable time of the year.

Exercise

Exercise releases brain chemicals that calm the mind. It also reduces immune system chemicals that can worsen depression.

Find proximity balance

Finding the right amount of time to spend alone will help you relax your mind and body.

Sometimes people can confuse the Holiday Blues with SAD. While both can exist at the same time, it is important to talk to your doctor if symptoms persist. He or she can help you find a treatment that is appropriate for you.

This month I wish to share with you a book that every woman should have in their library, as it carries a mission near and dear to me – The V Book by Dr. Elizabeth Gunther Stewart. Can you guess the topic? You got it…our lady parts. Dr. Stewart provides an owner’s manual, of sorts, teaching women about their vulva and vagina. Page 1 of the book says it all, “Your private parts shouldn’t be private to you.” She is very clear that this is not a “cocktail party conversation,” but a topic you should feel very comfortable to explore and communicate. You should be able to talk about your vulva and vagina just as you freely speak about your blood pressure and heart rate. It is no argument that our culture, family dynamics and life experiences do certainly dictate the relationship we have, or lack thereof, with our body. As a female, we all know each of us have a vulva and a vagina but history and evolving cultures have either photo shopped it out or sent it mainstream. There seems to be no happy medium. I, join Dr. Stewart’s mission and goal, to empower women to know their bodies, to be informed and to speak the language of our intricate anatomy with utmost certainty and confidence. The vulva and vagina have a topographic landscape just as any map. It is vital that one learns the changes that take place with each stage of life, the appropriate vulvovaginal care and when and how to communicate any concerns, needs or uncertainties. The vulva and vagina are very important to our overall health and wellness. So listen up my Sisters…

First let’s talk about anatomy. Do you know your vestibule from your fourchette or your labia majora from your minora? The vulva and vagina are complex organs, with orchestrated form and function. This V-organ and its individual components function as a living biosphere, swirling with hormones, functional glands and transitory passengers of various bacteria and yeast. The interplay of this community is certainly influenced by one’s age and stage in life, just as we are influenced by the time of year and our weather pattern. It is a dynamic environment and must be monitored. This is no different than the way we currently promote self-breast awareness and performing our own breast exams. I challenge you to go to the mirror and practice your V-awareness. Learn what your vulva looks like, as no two vulvae are created alike. As you transition through each life stage, be aware of the changes that occur. The vulva and vagina are very different when compared across puberty, pregnancy and menopause. Take heed of each life stage, its needs and that which keeps the vulvovaginal environment in balance. Appropriate daily V-care depends on this knowledge to promote vulvovaginal health.

I receive numerous calls daily regarding discharge, pain and irritation. Depending on your age as well as style of V-care, the etiology can vary widely. Many women perceive vaginal discharge as abnormal. Unless it is malodorous or causing irritation, it can be entirely normal with respect to age, day of the menstrual cycle or even pregnancy status. Bottom line, no matter the condition, the treatment varies and not always easily treated over the counter, over the phone or without a pelvic exam. When it comes to the vulva and vagina, when she is angry, she stalks. When she is ignored, she persists. We all know that she will NOT be ignored! Pain or irritation can be a warning sign of infection or even cancer. If symptoms persist or do not improve with initial treatment, please seek medical evaluation to determine the source of your symptoms.

No matter your age or life circumstance, it is important to know how to best care for your vulva and vagina. This is a buzzing industry, whether it be at the drug store, on-line or provided by aesthetic services. You can spend a small fortune. Although the pleasant scents, frills and treatments seem like a perfectly relaxing way to indulge, the regret comes in the aftermath! The vulva and vagina thrive with specific requirements. There is a balance of tissue integrity, environmental demands, and hormones, bacteria and yeast. Depending on the treatment, this balance may be upset and sends such symbiotic relationships into raging conflict. This conflict brings about opportunistic infection, irritation and pain. Daily V-care can be as simple as using water, wearing cotton, avoiding perfumes, dyes or soaps and listening to the changing needs of your vulva and vagina.
I challenge you to consider your vulvovaginal health. It is a matter of good health, wellness and ensuring a danger sign does not go unnoticed. Please seek out the references I have offered below. As always, you are welcome to come see me as your Vulvovaginal Healthcare Advocate!

Reference:
“The V Book “– A Doctor’s Guide To Complete Vulvovaginal Health. Elizabeth Gunther Stewart, M.D. and Paula Spencer.
Vulvovaginal Health. The American College of Obstetricians and Gynecologists.

My name is LaDena Renwick Tilley.

I fought breast cancer twice and I won!! I was first diagnosed with breast cancer in 1999 and had a lumpectomy with chemotherapy and radiation. I was 30 years old. Then, in 2013, I was diagnosed again and had a bilateral mastectomy. I never thought in a million years that I’d be going through it again.

This last battle was the hardest due to the fact that both of my breasts were being removed, my body was being transformed. As a woman having breasts is part of our womanhood. If it wasn’t for my FAITH IN GOD and the support of my loving, incredible husband, family, friends and my Greenville Women’s Clinic family I couldn’t have gotten through it.  

Having breast cancer did affect me, mentally and emotionally. I allowed myself to grieve because I was experiencing a loss, but then I thought if my FAITH is going to be authentic then it must be tried. Always remember that doubt sees obstacles, but FAITH sees the way. I had to learn that my breasts don’t define me as a woman, for a phenomenal woman isn’t defined by her physical appearance, but by the content of her spirit and she doesn’t allow her flesh to overrule the righteousness of GOD that is destined in her life. Her beauty lies within.

Whenever we hear the word cancer it brings fear upon us but allow courage to take center stage so that fear has no place in your life. My experience with breast cancer has been one of self-growth and assurance.

Assurance that I am more than a conqueror, a warrior, a victor and not a victim. I’ve grown in love, patience, peace and strength and learned how to thrive in the midst of troubled times. Every survivor of breast cancer is a CEO, which is a CHOSEN EMPOWERED OVERCOMER, therefore we must be prayerful daily, humble in our living and a service to others.

I salute all those who have lost the fight, are fighting or will be fighting this disease. 

May I say to you, be determined to fight with LOVE, DIGNITY, and DILIGENCE!! When I look in the mirror I am reminded of the battle that I fought, but more importantly the VICTORY that I’ve WON!!! The road to recovery has been a long one, but as Maya Angelo said “I wouldn’t take nothing for my journey,” I am so Blessed to be a two-time survivor.

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During the month of October when you make a donation to Greenville Women’s Clinic to provide financial assistance to local breast cancer survivors in need of post-mastectomy care with Avila Physical Therapy -OR- share a story or image related to breast cancer month or a survivor and tag Greenville Women’s Clinic in the post on Facebook you’ll be entered into a drawing to win one of the following items donated by The Spa at Merle Norman:

• 25-minute Swedish Massage
• A Signature Hydrating Manicure
• You and up to 3 Guests receive a Hydrating Body Treatment in the Grotto and use of all spa amenities
• Additional prizes will also be available!

Depending on your Facebook privacy settings, you will need to be sure to share the post using the setting “public”, you may also share the picture directly on our page.

Have you heard about the current debate over breast cancer screening? It is a hot and heated topic. We are all at risk for breast cancer, even our male counterparts. Our risks increase with our age. Well, ladies, age is the current debate. What age is best to start breast cancer screening if you have no family history or risk factors?

Let’s look closely at this debate. This has come about due to the new recommendations by the U.S. Preventive Services Task Force (USPSTF). This task force is now recommending that a woman starts her routine breast cancer screening NOT at age 40, but ten years later, meaning at age 50. To be clear, this is if you have no family history of breast cancer or risk factors like dense breast, history of chest radiation or other medical concerns. The recommendation also states that mammogram screenings not be done annually but every 2 years unless medically indicated otherwise. The reason behind this is that the benefit of a mammogram increases with age and the evidence supporting mammograms truly finding cancer starts at age 50. You may be feeling mixed emotions at this thought, especially if breast cancer has hit close to home.

The USPSTF was created in 1984 as an independent panel of national medical experts who volunteer to review current healthcare practices and then compare this to our evolving knowledge of evidence-based medicine. Based on this review, this panel then makes recommendations that aim to improve the health of all Americans through screening, counseling or primary care medical services offered. Our U.S. Congress has authorized this panel to convene annually to present any needed recommendations to affect change to improve our healthcare practices. The topic at present for them is now breast cancer screening. The Panel believes that the evidence supporting the practice of performing mammograms prior to age 50 in the general population may not warrant the risks to women of a younger age. They now recommend that mammograms done between the ages of 40 to 49 be done after a discussion between Patient and Health Care Provider any then only perform every 2 years. This is a direct contrast to the recommendations by the American College of Obstetrician Gynecologists (ACOG). ACOG recommends that a mammogram be done starting at 40-years old and continue annually. USPSTF has also found that the evidence supporting mammograms after age 75 is “insufficient to assess the balance of benefit and harm.” According to ACOG, it is again a decision between Patient and Provider, as we know the risk of breast cancer does increase with age.

In Medicine, we work hard to keep Patients safe no matter the task at hand. We are constantly assessing the balance of risk and harm, hoping the odds favor true benefit rather than harm. The most common harm that a mammogram could impose on a woman prior to age 50 is an inaccurate result. You may have received that dreaded call, “Ma’am we need you to return for additional imaging.” If an initial mammogram is not conclusive, then additional tests and procedures must follow. For example, if a 40-year old woman is told her mammogram is concerning for breast cancer, she then goes on to have more imaging and ultimately a breast biopsy. The biopsy shows normal breast tissue. The initial mammogram was therefore wrong. Could this biopsy have been avoided? Did this biopsy cause harm? Does this cause unnecessary anxiety or added discomfort to a woman? What are the overall costs to society? Bottom line, is it all worth it? This is the argument. The battery of tests and procedures following this initial inaccurate screening result leads to major costs to our healthcare system.

I can tell you, there is a great divide in medical opinion about how and when breast cancer screening should be done in the United States. As an Obstetrician Gynecologist, our national organization, The American College of Obstetrician Gynecologists, has held firm, that at present, we believe it is best to start breast cancer screening at age 40 for ALL women. We also feel it is a personal decision and discussion between you and your healthcare provider, and the decision to start annual mammograms even sooner is based on your family and medical history. I feel strongly that the present debate might also place our personal choices, access to screening and medical insurance coverage in jeopardy. Many commercial insurance carriers do alter their coverage based on recommendations like that of the USPSTF It is therefore so important that we remain knowledgeable and an active voice in this debate.

Let me show you some of the evidence for breast cancer that we know at present. Unless you have a family history of breast cancer, we all have a 1 in 8 risk of developing breast cancer in our lifetime. Meaning, think of you and 7 other of your girlfriends. One of you will develop breast cancer in your lifetime. If you have a family history, the chances are even higher. To make this even more real to you, let’s look at the evidence.

The lifetime risk of breast cancer by age is as follows:

• In our 20s, 1 woman in 1,760 has a chance of breast cancer.
• In our 30s, 1 woman in 220 has a chance of breast cancer.
• In our 40s, 1 woman in 69 has a chance of breast cancer.
• In our 50s, 1 woman in 42 has a chance of breast cancer.
• In our 60s, 1 woman in 29 has a chance of breast cancer.

Do you see how age and our risk of breast cancer relate? If we delay breast cancer screening until age 50 and then only perform a mammogram every other year, how many women would be affected by a missed or delay in diagnosis of their breast cancer? It is important to discuss and consider this debate, not just from a personal perspective, but to help educate and advocate for all women and our health. Breast cancer screening is proven to play an important role in diagnosing breast cancer early, and therefore improving a woman’s chances for survival through early treatment and ultimately a cure. The pain to lose a loved one from a completely detectable and survivable cancer cannot be described.

You have the power to be a part of this ongoing debate and the time is now. One would think it is only logical to find breast cancer fast and find it early, right? Well, unfortunately with this and really any cancer screening, it is not so simple. It is a matter of evidence-based medicine, meaning we track hard evidence about current medical practices and patient outcomes. This information is then used to apply a recommendation or practice, which is best for the entire population. It is not just a matter of medicine sadly, but of access, effectiveness, cost and certainly insurance coverage. The guidelines for insurance coverage follow recommendations created by our national organizations and governmental guidelines. It is therefore important to be a part of the conversation as decisions are made.

For our current debate over breast cancer screening, you may become involved by contacting your local government representative, discussing with your healthcare provider and the U.S. U.S. Preventive Services Task Force has invited you to participate and voice your opinion by going to their website: www.screeningforbreastcancer.org

Abnormal uterine bleeding is a common problem in women’s health. It may present as bleeding that is excess in volume or that occurs at an unexpected time. When a woman sees her physician to evaluate the cause of the abnormal bleeding, the explanation will fall into one of two categories. The first category is an imbalance of hormones (dysfunctional bleeding) that may be treated with hormones such as oral contraceptives or progesterone. The second category is an anatomic change involving a new growth of tissue in the uterus, such as polyps or fibroids (benign muscle tumors), or less commonly, cancer that can develop in the uterine lining. The evaluation may include a pelvic exam (with a pap smear if one has not been done recently), lab work including a pregnancy test, complete blood count, and occasionally hormone tests that check the function of the thyroid and pituitary glands. Pelvic ultrasound is a very useful test, showing the anatomy of the uterus and ovaries. A sonohysterogram is a procedure in which sterile saline is advanced through the cervix into the uterine cavity during the ultrasound. This allows a detailed image of the uterine cavity and may reveal small changes in the lining. An endometrial biopsy may be performed to assess for pre-cancers, cancers, or infection within the lining of the uterus. This specimen is then sent to the pathologist for evaluation. If the pathologist sees evidence of cancer, the treatment plan will include urgent consultation with a cancer specialist and surgery that includes a hysterectomy and cancer staging procedure.

Most often, the abnormal bleeding is found to be due to a benign cause. If cancer has been ruled out, benign growths in the uterine cavity can be removed through an out-patient surgical procedure called hysteroscopy, where a fiber-optic device inserted through the cervix can be used to remove abnormal tissue and restore the uterus to a healthy condition. In cases of dysfunctional bleeding where hormonal treatment does not resolve the problem, a good surgical option is endometrial ablation, a minor procedure where the uterine lining is destroyed. For many women, endometrial ablation is a good alternative to hysterectomy due to the rapid recovery and conservation of normal anatomy.

In summary, abnormal uterine bleeding is a common problem that can be evaluated and managed by hormonal or surgical treatment, depending on the findings. Women who develop abnormal bleeding should promptly see advice from their health care providers for timely diagnosis and appropriate treatment.