Many of the most common side effects, such as hot flashes and night sweats, for example, are caused by hormonal fluctuations and thus appear primarily during perimenopause; these symptoms usually decrease and eventually disappear at some point after a woman reaches menopause (defined as the absence of menses for more than one year). However, some of the symptoms caused by lower levels of estrogen and progesterone may continue.

One of these longer-term side effects may be menopause-related weight gain.

Some studies suggest that weight gain during menopause is due primarily to the normal aging process rather than the menopausal transition specifically, and many women do not gain weight at all. But menopause does cause a number of physiological changes that can affect weight, including increased fat mass (total body fat and especially visceral fat), decreased muscle mass, and reduced energy expenditure (up to an 8% decrease in resting metabolic rate).

These changes in body composition and metabolism can represent an unwelcome new reality for some women who never before had a tendency to gain excess weight. And for those already struggling with their weight, especially women with obesity, these additional challenges can further increase the risk of weight-associated health conditions.

Hormone- and weight-related physiological changes

Menopause leads to a decrease in the body’s production of both estrogen and progesterone. While the loss of progesterone affects weight partially through increased water retention, the decrease in estrogen levels has more widespread and lasting effects. For example, loss of estrogen can weaken the brain’s “fullness” signals, increase susceptibility to binge eating and reduce energy expenditure (calories burned both at rest and during activity).

“Normal” hormone-related metabolic slowing during menopause is sometimes compounded by the presence of subclinical hypothyroidism, which also decreases energy expenditure. Estrogen and thyroid hormones interact and affect each other in a variety of ways, and subclinical hypothyroidism often remains undiagnosed because many of the symptoms (such as fatigue, sleep disturbances and mood swings, for instance) are instead attributed to the menopausal transition. One study found subclinical hypothyroidism to be present in 18% of perimenopausal women. According to my endocrinologist colleague, Dr. Leon I. Igel, “Immediate treatment might not be warranted, but thyroid levels should be monitored closely, as subclinical hypothyroidism may be a precursor to overt hypothyroidism.”

Menopause-related hormonal changes are also associated with insulin resistance, which leads to higher levels of blood sugar and increased fat storage. This creates something of a vicious circle, as visceral fat promotes further insulin resistance — which in turn raises the risk of type 2 diabetes and cardiovascular disease, two of the most widespread and serious weight-related health issues.

Treatment options

So how do we treat menopause-related weight gain? Perhaps counterintuitively, hormone replacement therapy, one of the most common treatments for many menopause symptoms, has not been shown to affect weight significantly (causing neither gain nor loss). We do have other options, however, and weight gain is not inevitable.

Diet and physical activity are bedrock components of any weight management program, but to overcome the body’s resistance to weight loss — particularly when it comes to treating people with obesity — these lifestyle elements must be part of a comprehensive approach. This means not only providing ongoing support and assistance to foster sustainable lifestyle change, but considering the full range of underlying factors and potential treatment tactics, including medical interventions.

Insulin resistance can be counteracted with a wide variety of eating plans; low-carb and Mediterranean diets, for example, have proven effective. The most important strategy is to find a way of eating that is sustainable, so it becomes part of a long-term healthy lifestyle change rather than a temporary measure that will be abandoned at the first sign of difficulty. This means the food must be both tasty and satisfying, and the plan can’t feel too restrictive or rigid.

Physical activity also helps reduce insulin resistance and support weight loss. The ideal activity plan combines aerobic exercise, which burns calories and improves cardiovascular health, with resistance training, which builds muscle and reduces fat. Again, sustainability is key: physical activity should be enjoyable and fit in with the individual’s lifestyle and schedule constraints — it doesn’t necessarily need to involve traditional “exercise” or going to the gym.

Women whose weight doesn’t respond to changes in diet and physical activity and who have a BMI over 30 kg/m² or over 27 kg/m² with comorbidities may benefit from anti-obesity pharmacotherapy. On- or off-label medications — such as metformin, liraglutide, phentermine/topiramate, naltrexone/bupropion, and semaglutide — can help counteract the effects of insulin resistance. As an adjunct to lifestyle modifications, these medications can help surmount some of the hormonal, metabolic and neurobehavioral mechanisms (manifested as plateauing or the development of cravings, for example) the body has evolved to prevent weight loss.

________

This important contribution by Medika author Dr. Saunders was co-authored by Leon I. Igel, MD, FACP, FTOS, DABOM. Dr. Igel is an Assistant Professor of Clinical Medicine at Weill Cornell Medical College, and an Attending Endocrinologist at New York-Presbyterian Hospital/Weill Cornell Medical Center. He is Director of the West Side division of the Comprehensive Weight Control Center, as well as the former Program Director for Weill Cornell’s Obesity Medicine and Obesity Medicine/Bariatric Endoscopy fellowships. Dr. Igel is board certified in Internal Medicine, Obesity Medicine, and Endocrinology, Diabetes & Metabolism.

The post Managing Menopause-Related Weight Gain appeared first on Medika Life.

Catching herpes is not the end of the world. Here are 18 facts to help us all cope with this frustrating infection.

Social media is full of misinformation. Our friends may not offer fact-based advice. We need to know the facts about genital herpes.

1. Herpes affects about 1/5 of adults. (20%)
2. It is spread through close skin contact, typically during sexual activity.
3. You cannot catch herpes from toilet seats, hot tubs, or any other objects.
4. Once exposed to the virus, herpes never leaves your body; however, not everyone who is exposed will develop symptoms
5. The most common symptoms of an active herpes outbreak are small, fluid-filled blisters on the genitals, buttocks, or mouth. They typically are very painful and may burn.
6. You may experience flu-like symptoms (fever, muscle aches, fatigue) a few days before the lesions develop. These are called prodromal symptoms.
7. The first herpes outbreak is typically the most painful and typically lasts longer than recurrent outbreaks.
8. About 90% of people who have an initial herpes outbreak will develop a subsequent outbreak.
9. We diagnose herpes by two methods — either by a skin culture or by blood work. Typically both are used together in addition to a physical exam. The skin culture can only be done when you have an active lesion. A positive result confirms the diagnosis of herpes, but a negative result does not rule it out. The blood work will show us if you have been exposed to herpes in the past but may not confirm if a genital lesion is an active herpes outbreak
10. There is no cure for herpes, but we can treat the symptoms with antiviral medication.
11. You do not have to take medication for the rest of your life. Many people only take medication during active outbreaks.
12. Daily Suppressive therapy is a great option for those who have frequent outbreaks.
13. If you have frequent recurrent outbreaks, you can take the antiviral medications daily to help suppress future outbreaks.
14. Recurrences tend to be triggered by stress or a weakened immune system.
15. A healthy diet and regular exercise can help to reduce stress and boost your immune system, decreasing your chances of recurrence, but not eliminating them.
16. If you develop herpes during pregnancy, we can prevent an HSV outbreak with antiviral medication.. You can still deliver your baby vaginally if you do not have an active herpes outbreak at the time of delivery.
17. You should not be sexually active if you have an active outbreak, as you will transmit the virus to the other person.
18. Using a condom can reduce the risk of transmission, but does not protect against all cases.
19. Herpes cannot be cured, but the symptoms can be treated.
20. With the use of medications, most patients are able to lead a normal, healthy life despite the diagnosis.

The post Genital Herpes: 20 Important Facts We All Need to Know appeared first on Medika Life.

A hysterectomy is a surgery to remove theuterus. Hysterectomies are performed for a variety of gynecologic conditions such as uterine fibroids, heavy periods, endometriosis, chronic pelvic pain, uterine prolapse and gynecologic cancer. 

During a hysterectomy, the uterus is removed. Obgyns often recommend fallopian tube removal (bilateral salpingectomy) to reduce the risk of ovarian cancer. Some women will also need the removal of the ovaries (oophorectomy). Hormonal changes only occur when the ovaries are removed.

Gynecologists perform hysterectomies through a variety of techniques. The size of the uterus, surgeon experience, the patient’s body type, and the prior surgical history help determine the proper surgical approach. Techniques include:

1. Vaginal hysterectomy
2. Abdominal hysterectomy 
3. Laparoscopic hysterectomy 
4. Laparoscopic-assisted vaginal hysterectomy 
5. Robotic hysterectomy robotic

What are the advantages of robotic hysterectomy?

Contrary to the name, robots do not perform the surgery. A human gynecologic surgeon attaches a surgical system to intraabdominal ports. While sitting at a surgical console, the surgeon controls the robotic arms while monitoring the surgical field in a 3D view..

Through 4–5 small incisions, the surgeon detaches the uterus from the surrounding tissues. Robotic surgery is a minimally invasive surgery that allows for faster recovery, reduced pain, and shorter hospital stay.

The American College of Obgyn acknowledges this type of hysterectomy’s growing popularity but recommends robotic hysterectomy be reserved for more complex cases that can not be safely completed through other minimally invasive techniques.

Experienced robotic surgeons prefer the precise control of the surgical arms allowing complex cases to be completed in a minimally invasive fashion. Patients benefit from small incisions, a short hospital stay, and a faster return to work, exercise, and everyday activities.

How long will I be in the hospital?

Surgeons perform robotic hysterectomies as an outpatient procedure or as an inpatient surgery with an overnight stay. Various factors, such as the patient’s underlying health status, surgical complexity, and physician preference, help determine the surgical plan.

Most robotic hysterectomy patients are able to leave the hospital much faster after a traditional abdominal hysterectomy. 

Can family visit me?

A trusted family member should drive you to and from the hospital or ambulatory surgery center for a robotic hysterectomy. Families are welcome to stay with you before and after surgery. Hospital visitor policies for overnight stays vary from region to region due to the Covid-19 pandemic.

Does my procedure require an anesthetic?

Laparoscopic robotic surgery requires general anesthesia meaning patients will be temporarily put to sleep. The surgeon may also inject a local anesthetic into the incisions to decrease postoperative pain.

What’s the procedure when I check-in?

Most surgeries will involve a preoperative visit with your surgeon to go over the procedure’s risks and benefits in detail. Your surgeon answers questions regarding your upcoming surgery. The surgical consent form is reviewed, signed, or updated with any changes.

Because robotic hysterectomies will eliminate the possibility of child-bearing, your doctor will ask questions to make sure you are confident you will not want children in the future.

In most settings, patients will receive a preoperative phone call by a nurse or medical assistant one to two days before surgery. If any blood work or preoperative testing is required, it will be scheduled and confirmed.

After arrival at the hospital or Ambulatory Surgery Center, the staff will guide you to the preoperative holding area to change into a surgical gown and store your valuables. You will meet the nursing team who will provide care during your stay. An IV will be placed at this time.

The anesthesia team will come to interview you and answer questions. Typically your surgeon will also come and review any last-minute questions.

What happens in the operating room?

After the preoperative evaluation, the team will guide you to the operating or procedure room. You will move from the mobile bed to the operating table. Once you are positioned comfortably and safely, the anesthesiologist will give you medication through your IV to help you go to sleep.

The OR nursing team will cover your body with sterile drapes and prep the abdomen for surgical sterility. The team then performs a “surgical time-out.” A surgical safety checklist is read aloud, requiring all surgical team members to be present and attentive.

The gynecologic surgeon will insert a speculum into the vagina to allow visualization of the cervix, the opening of your uterus located at the back of the vagina.

Once the speculum is in place and the cervix visualized, the surgeon inserts a device called a uterine manipulator into the cavity of the uterus. This step facilitates the surgeon’s ability to safely operate and avoid injury to surrounding tissue such as the bladder, rectum, intestines, and ureter.

The surgeon will mark the surgical sites with a small marking pin. A small camera is inserted through an incision into the belly button. Air inflates and distends the abdomen to allow visualization of the pelvis. Three or four secondary ports are placed to allow the robotic arms to function. 

The robot is then positioned over the body and attached to the ports. The laparoscopic camera is positioned to show the pelvic anatomy. Small instruments are passed through the additional ports. Scissors are attached to one robotic arm and a grasping device in the other. This allows the surgeon to operate with both hands. 

The surgeon then moves away from the patient to the surgical consult to control the robot. 

As the surgeon takes her seat, she adjusts the camera and robotic arms’ position to begin the surgery.

Many surgeons recommend complete removal of the fallopian tubes (bilateral salpingectomy) at the time of surgery as this technique reduces the risk of ovarian cancer.

The fallopian tubes are located and grasped with one instrument. Using the other hand, the surgeon clamps and cuts the tubes from the adjacent anatomy.

The surgeon travels down the sides of the uterus freeing it from the connecting tissues. The round ligament and utero-ovarian ligaments are clamped, cauterized and then cut. At each step, the surgeon will take precautions to control and avoid bleeding. 

Towards to lower end of the uterus lies important anatomy. The surgeon will separate the bladder from the lower uterine segment to allow visualization of the cervix. 

The surgeon will focus attention on the uterine arteries. These two blood vessels are the main blood supply to the uterus and travel over the ureters, which are the tubes connecting the kidney to the bladder. 

Once the uterine arteries are controlled, the surgeon can safely separate the uterus from the vagina. 

The surgeon makes a circular incision just below the cervix freeing the uterus. The uterus is delivered through the vagina and sent to the pathologist to analyze the tissue. 

The surgeon then sews the edges of the vagina closed to form the vaginal cuff. 

The surgeon examines all of the surgical sites for bleeding. When safe, the Obgyn removes the operative ports and sews the surgical incisions closed. 

Once the procedure is complete, the surgical team completes a post-procedure review. All instruments and equipment are counted and verified. When finished, the anesthesiologist will begin to wake the patient up for transfer to the recovery room.

How long will I be in the operating room?

Once the patient enters the operating room, a series of safety steps must occur. This process takes about 20 minutes.

The operative time for robotic hysterectomy varies. The surgeon’s experience, surgical technique, patient body type, uterine size, and patient’s previous surgeries are all factors.

In general, patient should expect 1–2 hours of total operative time.

When can I go home?

Postoperative recovery time will vary from person to person. Some surgeons will recommend an outpatient procedure while others prefer an overnight stay. The patients underlying health status, surgical complexity and physician preference are all factors. 

To be able to go home, each patient must meet specific discharge criteria. The patient’s vital signs must be stable. The patient must be alert, oriented, and able to walk with assistance. Postoperative nausea, vomiting, and pain must be controlled as well as confirmation of no postoperative bleeding.

The nursing team will go over discharge instructions, and the plan for postoperative pain management options will be confirmed.

What is the usual recovery time

Most women should be able to return to normal daily activities within a few weeks of surgery. The nursing team will help patients walk and move around a few hours after surgery to reduce blood clots’ risk, improve lung function, and expedite bowel function return.

Most patients will require pain medication like NSAIDs and narcotics for a time. Many experience discomfort in the right shoulder due to air irritating the nerves of the diaphragm.

Light bleeding, spotting, and brown or black discharge is common and expected. Sanitary napkins are safe to use.

What aftercare is required?

You should speak with your physician regarding the resumption of exercise and sexual activity. Most can return to basic activities in one to two weeks. Sexual activity is typically restricted for 6–8 weeks to allow the vaginal cuff to heal.

Your doctor will schedule a postoperative examination 1–2 weeks after the procedure to evaluate the incisions.

Danger Signals to look out for after the procedure

You should call your doctor if you experience heavy vaginal bleeding, fevers, severe nausea or vomiting, worsening abdominal pain, or the inability to pass gas.

If you experience heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over 24 hours, call your physician. After any surgery, contact your physician if you meet any of the following criteria:

• Pain not controlled with prescribed medication
• Fever > 101
• Nausea and vomiting
• Calf or leg pain
• Shortness of breath
• Heavy vaginal bleeding
• Foul-smelling vaginal discharge
• Abdominal pain not controlled by pain medication
• Inability to pass gas

What preparations should I make for aftercare at home?

Robotic procedures require very little postoperative care. Keep the incisions clean and dry. Sexual activity should be avoided until cleared by your doctor. One may resume a normal diet the day of surgery and begin light exercise the day after the procedure or when you feel ready.

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins, and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

Still have questions?

Read through any existing comments in the section below and if you still need information on this procedure please do leave your questions in the comments section.

The post Preparing for: Robotic Hysterectomy appeared first on Medika Life.

An endometrial biopsy is a simple office-based procedure where a doctor removes a small amount of tissue from inside the uterine cavity. This tissue is called the endometrium. To find out if any abnormal cells are present, the doctor must sample the endometrial tissue to be tested and evaluated under a microscope.

An endometrial biopsy is used to diagnose or rule out endometrial cancer or precancerous changes in the tissue called endometrial hyperplasia.

Women with postmenopausal bleeding, heavy periods, irregular periods, or abnormal findings on a sonogram may be candidates for this procedure. Most often, an endometrial biopsy is performed as part of the evaluation of abnormal uterine bleeding, but it also is used in cases of infertility.

What does this procedure involve?

The gynecologist inserts a thin, flexible tube called a pipelle into the uterine cavity through the cervix’s opening called the cervical os. Using negative pressure, the doctor pulls a small amount of endometrial tissue into the pipelle for sampling. The procedure takes only a few minutes and causes mild cramps.

Where is an endometrial biopsy procedure performed?

Gynecologists perform endometrial biopsy procedures in an office setting.

Can my family visit me?

Endometrial biopsies are performed in a medical office setting. The vast majority of patients will be able to drive themselves to and from the procedure. Some may prefer a trusted family member to bring them. 

Does my procedure require an anesthetic?

Anesthesia is not typically required for an endometrial biopsy procedure. Some physicians spray a topical anesthetic directly onto the cervix. Occasionally, gynecologists provide local anesthesia via a paracervical anesthetic.

A paracervical block is an anesthetic technique done by a gynecologist to numb the uterus. Medication is injected into the cervical tissue to reduce pain during surgery.

Some gynecologists recommend oral medication to reduce anxiety

What’s the procedure when I check in?

Most procedures will involve a preoperative visit with your surgeon. The risks and benefits of the procedure will be discussed in detail and questions regarding your procedure are discussed.

The consent form is reviewed, signed, or updated with any changes.

Because an endometrial biopsy is performed in an office setting, the experience will feel like a normal office visit. After checking in, you will be taken to a procedure room. The medical assistant will prepare the room and provide a gown or leg coverings. When all is prepared, your surgeon will come and review any last-minute questions.

What happens in the procedure room?

Your surgeon will help position your legs into the stirrups. A speculum is placed into the vagina to allow visualization of the cervix, the opening of your uterus located at the back of the vagina.

Once the speculum is in position to allow visualization of the cervix, the procedure will attempt to pass a small pipelle through the cervix into the endometrial cavity. If the cervical os (opening) is too narrow, then the doctor will attach an instrument called a Tenaculum to the top of the cervix to stabilize the uterus. Then, they will use a small tool to dilate the cervix wide enough for the pipelle to enter. 

Once the pipelle is safely inside the uterus a small amount of endometrial tissue is pulled into the tube for sampling. 

These cells are sent to a pathologist for evaluation. 

After the biopsy, the speculum is removed and the procedure is complete. Some patients will experience mild bleeding, spotting or a brown, coffee-ground vaginal discharge over the next few days.

How long will I be in the procedure?

Once the patient enters the procedure room a series of safety steps must occur.

An endometrial biopsy procedure takes approximately 2–5 minutes. This includes the surgical time as well as accounting for positioning, the speculum insertion, a paracervical block anesthetic, and removal of the instruments

When can I go home?

After an office-based endometrial biopsy procedure, patients may go home after getting dressed as long as you are feeling normal.

Post-procedure recovery time will vary from person to person.

Endometrial biopsy procedures require a minimal amount of recovery. Patients may leave as soon as the procedure is complete.

AFTERCARE AND RECOVERY QUESTIONS

What is the usual recovery time

You should be able to resume all work and household activities on the same day as your procedure. You should expect to feel a little vaginal soreness for 2–3 days. Mild uterine cramping is also common.

• Some patients will require mild pain medication like NSAIDs.
• It is wise to wear a sanitary pad for a few days as you may experience vaginal spotting or dark vaginal discharge.
• You will be instructed to abide by pelvic rest for approximately 1–2 days. This includes no douching, no sex, and no tampons.
• You should call your doctor if you experience heavy vaginal bleeding, fevers, or worsening abdominal pain.

What aftercare is required?

Most women should be able to return to normal daily activities the same day. You should speak with your physician regarding the resumption of sexual activity. Typically, the recommendation is to avoid vaginal intercourse for 1–2 days.

You should not use tampons for 1–2 days after the procedure to reduce the potential risk of infection.

Light bleeding, spotting, and brown or black discharge is common and expected. Sanitary napkins are advised.

Your doctor will schedule a postoperative examination to review the pathology report findings. If any abnormalities are found on the biopsy, your doctor will discuss the next steps

Danger Signals to look out for after the procedure

After an endometrial biopsy procedure, we expect light spotting and vaginal discharge.

If you experience heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over time beyond 24 hours, call your physician. After any surgery contact your physician if you meet any of the following criteria:

• Pain not controlled with prescribed medication
• Fever > 101
• Nausea and vomiting
• Calf or leg pain
• Shortness of breath
• Heavy vaginal bleeding
• Foul-smelling vaginal discharge

What should I pack at home?

Nothing special is required after an endometrial biopsy procedure. A supply of sanitary napkins will help keep your clothing clean.

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins, and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

Still have questions?

Read through any existing comments in the section below and if you still need information on this procedure please do leave your questions in the comments section.

The post Preparing for an Endometrial Biopsy appeared first on Medika Life.

We ran a simple and easy test to see if she carried the genetic mutations associated with an increased risk of breast cancer. Her test results indicated she was a carrier. Now she faced some difficult decisions. Should she undergo a prophylactic mastectomy or take a chance and have one more child. 

Many women know breast cancer runs in their family. They live in fear, wondering if they will also develop cancer. Some have heard about testing for the breast cancer genes, but are unsure how to pursue this option. 

Men and women with a family history of cancer may qualify for genetic testing to help make life-saving decisions. 

What are the breast cancer genes?

Genetic mutations in BRCA 1 and BRCA 2 are linked to an increased risk of breast cancer. Although the names sound similar, these two genes are not related at all. BRCA1, first identified in 1990, is on chromosome 17. BRCA2, identified in 1994, is located on chromosome 13.

Other gene mutations are linked to various cancers, but BRCA mutations are the most common and most well-known. 

Mutations in these two genes not only increase the risk of breast cancer but other cancers as well. BRACA 1 and 2 mutations increase the risk of ovarian and pancreatic cancer. 

A BRCA1 mutation can increase the risk of cervical, uterine, and colon cancer, while mutations on BRCA2 can increase stomach, gallbladder, bile duct cancer, and melanoma.

Mutations in the BRCA 1 and 2 genes change the function of the cells containing them. These genes are known as tumor suppressors. When functioning normally, their job is to create proteins to suppress cancer and help maintain cell growth.

When deleterious mutations are present, cells have the potential for unchecked growth leading to an increased risk of cancer.

Do I have the BRCA 1 and 2 genes?

Everyone has two copies of these genes. All of our cells contain genes holding our body’s genetic code. We all have BRCA 1 and 2 genes. The increased risk of cancer comes when we have a mutation in the gene. 

Gene mutations alter the genetic code inside of cells. Certain mutations change the function of cells. 

We inherit our genes from our parents. One copy comes from our mother and the other from our father. When we inherit one gene mutation from a parent, every cell in the body will possess one mutated copy of the gene and one normal copy.

People with no abnormal BRCA mutations have the lowest risk. One copy of a mutated gene increases cancer risk, but the other gene promotes tumor suppression. 

When two mutated copies are present, the lifetime risk of cancer increases to a dangerous degree. 

Because harmful mutations may be inherited from either our mother or the father, our complete family history is the best indicator of a potential mutation. Physicians will evaluate the maternal and paternal family cancer history to determine the risk level and the need for testing.

Doctors evaluate for specific risk factors:

• Breast cancer diagnosed before age 50 years
• Cancer in both breasts in the same woman
• Both breast and ovarian cancers in either the same woman or the same family
• Multiple breast cancers in the family
• Two or more primary types of BRCA1– or BRCA2-related cancers in one family member
• Cases of male breast cancer
• Ashkenazi Jewish ethnicity

Certain ethnic groups are also at a higher risk of having these mutations, including those with Ashkenazi Jewish backgrounds. Ashkenazi Jewish people have as high as a 1 in 40 chance of possessing a harmful BRCA1 or BRCA2 mutation.

How much does my cancer risk increase if I have a mutation?

Recent breast cancer statistics suggest that 1 in 8 women will develop be breast cancer in their lifetime. Approximately 60 percent of women who have inherited these harmful gene mutations will develop breast cancer. By age 70, the risk of breast cancer for mutation carriers is:

• 55–65 percent for BRCA1 carriers
• 45–55 percent for BRCA2 carriers

IIt’s essential to remember the following:

• Not all breast cancer is due to these genetic mutations. 
• Scientists’ best estimates suggest that only 5 to 10 percent of breast cancers are due to the mutations of BRCA1 and BRCA2.
• Not every woman with a harmful mutation gets cancer. 
• Not all women with the mutation will develop breast cancer, but more than half of them will, and many at an earlier age than the average diagnosis.

Testing For BRCA1 and 2 mutations

Genetic testing for these mutations is available for those who qualify. Thanks to the Affordable Care Act, insurance coverage is guaranteed if an individual meets testing criteria. But only about 2 percent of the general population will meet the strict testing guidelines.

Blood or saliva is collected for genetic testing in a doctor’s office to be sent to a testing company. It can take several weeks to receive the results. 

Genetic counseling both before and after the test is highly recommended. Learning about the presence of a cancer mutation can be emotionally and psychologically challenging. It is crucial to speak with an expert who can guide patients through the implications and possible options..

What are my options if I am a BRCA mutation carrier?

Women who do test positive have options. It is important to speak with a specialist well-versed in genetic counseling. The management is highly dependent on the patient’s age and family planning status. 

Patients will start an individualized cancer prevention plan. This often includes a twice-yearly clinical breast exam combined with Breast MRI and mammograms alternating every six months. Monthly breast self-examination may be encouraged.

Some may qualify for annual CA-125 blood tests combined with transvaginal ultrasound for ovarian cancer prevention. Young patients may be started on oral contraceptives to reduce the risk of ovarian cancer. 

BRCA 2 carriers will be referred for annual skin evaluation to monitor for melanoma. 

Some women may choose to freeze their eggs to preserve their fertility later in life. Egg preservation is an available option for carriers not ready to have a baby now, but who want to keep their options open.

Some women may choose risk-reduction surgery. The breasts and surrounding tissue can be removed to reduce the risk of breast cancer. This procedure is called a prophylactic bilateral mastectomy. Bilateral prophylactic mastectomy reduces breast cancer risk by 95 percent in women with a BRCA 1 mutation and 90% in a BRCA2 mutation carrier.

Ovarian cancer risk-reduction surgery is called a prophylactic bilateral salpingo-oophorectomy. The fallopian tubes and ovaries are surgically removed. Ovarian cancer risk decreases by 90%, and breast cancer risk reduces by 50% after removing the fallopian tubes and ovaries.

Removing the ovaries causes surgical menopause. Hot flashes and night sweats are two of the most common and frustrating menopausal symptoms.

Why is genetic testing important?

People with a strong family history of cancer often worry about getting cancer. Parents worry they may have passed on harmful genes to their children. 

Getting tested is simple and easy for those who meet testing criteria. When we find a negative test, indicating the mutation is not present, a weight of worry comes off the patient’s shoulders. 

When we find a positive test indicating a harmful mutation is present, we can individualize a cancer prevention plan to encourage early detection and prevention. Genetic testing can be a key step to a long and healthy life.

The post Here’s What You Need to Know About BRCA 1 and 2: The Breast Cancer Genes appeared first on Medika Life.

She left with life-changing news.

Exam, mammogram, and biopsy

Her breast cancer was confirmed, and she disappeared. We made phone calls, left messages, and sent certified letters to no avail. In medical terminology, we call this “lost to follow up.” She ghosted us.

We continued our pursuit. Months later she returned. She did not follow up with the breast surgeon or Oncologist. She didn’t like them. Her family had other opinions.

She was angry.

I could feel it.

This was life or death

I would like to say I encouraged her to seek treatment, but I didn’t. I pushed her to get help. Not a gentle nudge but a shove. It was intervention time. I spoke the cold, hard truth. The goal was to break the dangerous cycle of denial. After relentless encouragement, she promised to go.

The resentful look in her eyes told a different story.

She was not ready.

She just wanted to leave.

Surgery, chemotherapy, and radiation

I saw her a few months later. My intervention worked. She had bilateral mastectomies and removal of the lymph nodes. She was undergoing chemotherapy and radiation. She was still angry.

She resented me.

I knew it.

I reminded myself her care was all about her. This moment was not about me. My job was not to be liked but rather to help her get well. In desperate times, patients focus their frustration on what they can control. Patients need a place to channel their feelings and rage. My job that day was to be the target.

Fear manifests as anger. She was furious and frustrated.

But she was alive.

Three years later we meet again

She came to see me yesterday. With a huge smile on her face, she embraced me in a giant bear hug. She held the hug a little too long. She grabbed both my hands and squeezed them tight. We locked eyes. She said, “thank you.” She appreciated my fight to get her treatment.

Then, with a beaming smile, she told me her cancer was back.

My heart sinks

After three years of remission, her breast cancer came back. The metastatic disease has spread to the chest, lungs, and brain. It is inoperable. She is restarting chemotherapy. She qualified for an experimental protocol with a 2–3% survival rate over three years.

I am rarely speechless. I can not talk. Tears fill my eyes. I try to fight it.

I am the doctor she trusts to take care of her. I am losing it.

What? No? Not possible. That can’t be true. She has a teenage son.

Quickly, I process her reveal. Inoperable metastatic cancer. Experimental protocol. 2% survival rate.

I stop fighting my emotions. I cry. I manage to say, “I am so sorry.”

She looked me in the eye and said “But I am ok”

She explains she came today just to see me. She wants me to know she “is good.” Her spirits are great. This was the best she felt in years. It took a long time for her to get to this place of acceptance.

She has found joy in living.

She shares her story. In the past, she blamed me for finding her cancer. She was frustrated every office ended in bad news. She resented me for forcing her into treatment. She was furious she had cancer.

Now, she is at peace. She is thankful. She appreciates all that I did. She needs me to know she is no longer angry. She has accepted her fate. She has found a happy place. She is loved.

My eyes glisten with tears. Her eyes glimmer with joy.

I am in awe of her strength, her will, and her compassion. We finish our visit with another hug.

It was my turn to hold the hug too long.

Afterthoughts

I think about her often. I try to shake the memory. I can’t. She was closing the open loops. Seeking resolution.

When I think about her, I smile.

My heart fills with admiration and gratitude. I am thankful she blessed my life. I am thankful she came to see me. For 15 years, I had the honor of being her doctor.

She found her happy place.

I will find mine knowing the true reason for her visit was to say “Goodbye.”

The post How a Breast Cancer Patient’s Strength Inspires Her Doctor appeared first on Medika Life.

One hundred fifty-eight million Americans are now under some type of quarantine, and cabin fever is kicking in. Staying home and being alone is harder than we thought.

Endless hours of Facebook passes the time, but we are growing tired of cat pictures on Instagram. Alerts from Snapchat grow tiresome. We have worn out Netflix and Candy crush is getting old.

People may be tempted to check out a favorite dating app like Tinder, Bumble, or Grinder seeking some companionship.

Now is not the time to swipe right.

Covid-19 Basics

Coronavirus is a new virus. This means the human race has never been exposed. We have no baseline immunity or protective antibodies. We do not have a vaccine or effective medication to treat it. We are all susceptible to becoming sick with Covid-19.

Covid-19 is spread through person-to-person contact via respiratory droplets. Droplets first spread through coughing, sneezing, and respiratory particles. These particles get on our clothes and hands. We then pass the virus through handshakes, hugging, kissing, and other close human contacts.

Each one of us and every item we touch is a potential transmission source. Evidence now reveals people are highly infectious before they begin to show symptoms. To protect ourselves and each other, we must limit close contact with others.

As much as we don’t want to hear it, sex counts as close human contact.

Can we have sex?

Clear cut guidance on sexual contact is unclear. Much is unknown regarding Covid-19 transmission. Sexual contact involves close contact. Respiratory droplets are transmitted through saliva, mucous and physical touch.

If you and your sexual partner are following social distancing guidelines and sheltering in place together, then there is no evidence you should avoid sex. If your partner is showing symptoms such as cough, sneezing, sore throat, fever, or any other viral symptoms then sexual contact should be avoided.

Early in the pandemic, the CDC stated that Covid-19 has not been found in semen, vaginal or cervical secretions. It has been found in feces. Analingus should be avoided. Recent studies show Covid-19 has been detected in semen. The question of sexual transmission of Sars-Cov-2 is back on the table.

Healthcare workers must make adjustments. Healthcare workers may be exposed at work making us potential asymptomatic carriers. Social distancing from the health-care worker is likely warranted. This means changes in sexual practices are necessary.

Some healthcare workers choose to shower, wear a mask, and avoid kissing during sex. These steps seem reasonable, but there is no clear cut scientific guidance to indicate if this is safe or not.

You are your safest sexual partner

New York City public health has released a public service guide to sex during the pandemic. The message is,“You are your safest sexual partner.” There are no restrictions on masturbation. You can not give yourself Covid-19.

Mashable reports a sudden spike in sales for sex toys and aids. Given the unknowns regarding Covid-19, self-stimulation is likely the safest option.

For those who choose to ignore guidelines

We all must take the proper precautions to keep each other safe. For those who decide to disregard the guidelines, please use condoms, birth control, and consider PrEP therapy.

PrEP stands for pre-exposure prophylaxis. PrEp therapy is a prescription antiviral medication to prevent HIV infection for those at risk. When taken daily, PrEP is highly effective at preventing the acquisition of the HIV Virus. It can reduce the risk by 99%.

Sheltering in place

We all must do our part to prevent the spread of Coronavirus. Sheltering in place will not work if only some of us follow the guidelines.

We will succeed if we all do our part. We are in this together.

Do I still need condoms?

Safe sex practices with latex or polyurethane condoms are recommended unless you are in a monogamous relationship with a trusted partner. Condoms should still be used even if you are on PrEP as it does not prevent gonorrhea, chlamydia, syphilis, trichomoniasis, HPV or any other STD.

What to do if you feel sick?

As testing availability increases across the country, we will see an increase in the number of cases. Many more will experience symptoms. It is tempting to go to a hospital or urgent care facility for testing. For the vast majority of patients, an ER visit is a wrong move with potentially catastrophic consequences.

Only those experiencing severe symptoms, such as difficulty breathing, need in-person medical evaluation.

Each patient who presents to an ER exposes other patients and medical providers to the infection. Once exposed, the medical provider is quarantined and removed from duty. We are seeing doctors and nurses getting sick all over the country. We need as many doctors, nurses, and hospital staff to care for those in need as possible.

The post Is Sex Safe During the Covid-19 pandemic? appeared first on Medika Life.

Every woman suffering from the effects of uterine fibroids deserves to know all of her options. Removing fibroids is not always the answer. While Obgyn physicians are comfortable discussing surgical treatment options, many doctors do not discuss all the alternatives.

Uterine fibroid embolization can be an excellent choice for the many women with fibroids who want to avoid surgery and keep their uterus. This minimally invasive alternative effectively treats fibroid with minimal downtime and recovery. 

Uterine fibroids are one of the most common gynecological conditions with many available treatment options. Educating yourself is a key step to allow you and your doctor to make a joint decision together on the best approach.

I want to keep my uterus. What are my options?

What are uterine fibroids?

Uterine fibroids are benign noncancerous tumors affecting women. Fibroids, also called leiomyomas, are groups of cells that form into a ball of muscle in the walls of the uterus. Up to 80% of women will develop one or more uterine fibroids during their lifetime.

Uterine fibroids behave in strange ways. They may grow slowly or quickly, or they may simply stay the same size throughout a woman’s life. Some women will develop more fibroids while others will not.

Many women are unaware they have fibroids, while others suffer unbearable symptoms. Heavy menstrual periods, pelvic pain, cramping, frequent urination, constipation, painful intercourse, and back pain are common complaints. 

Hysterectomy and myomectomy are not your only option to treat fibroids. 

Women with fibroids who want to avoid surgery and keep their uterus need to know about uterine fibroid embolization. UFE is an important option, but your Gynecologist may not mention it. 

What is a uterine fibroid embolization?

Uterine Fibroid Embolization (UFE) is a minimally invasive procedure to shrink or destroy uterine fibroids. Although fibroids are a common gynecologic condition, this procedure is not done by a gynecologist. 

Instead, this safe and highly effective non-surgical treatment is performed by an interventional radiologist.

To perform a UFE, the doctor inserts a small catheter into an artery in the arm or leg. The doctor injects a substance called IV contrast to project the blood supply onto a video screen via X-ray technology. 

The thin, flexible catheter is then advanced to the location of the fibroid. Small particles called polyvinyl alcohol are pushed through the catheter to block the blood flow to the fibroid. 

Starved of their blood supply, the fibroids shrink and die. 

UFE advantages

UFE has several advantages over hysterectomy and myomectomy.  

1. General anesthesia is not required.
2. No surgical incisions are needed. 
3. There is no blood loss. 
4. Treats adenomyosis. 
5. All fibroids may be treated at the same time. 
6. Minimal downtime and recovery. 
7. Can treat a fibroid of any size. 
8. A viable option for those with a medical condition prohibiting major surgery.

Disadvantages of UFE include:

1. Fertility effects. The long term effects on fertility are not completely understood. While some studies show an increase in fertility, others studies show negative effects. UFE is not typically recommended for women who would like to get pregnant in the future. 
2. Fibroids are not removed. While UFE shrinks and treats the tumors, it does not remove them from the body. 
3. Infection. The risk of infection is quite low but there is a possibility of delayed infection during the first postsurgical year. 
4. The potential need for retreatment. 
5. Not recommended for all types of fibroids. 

All procedures have risks

The risks of UFE is low but include:

1. Infection. The infection risk is low but is a serious, potentially life-threatening complication of UFE. In rare cases, hysterectomy is needed to treat an infected uterus. 
2. Premature menopause. 
3. Amenorrhea. Some women experience a loss of menstrual cycles after UFE. 
4. Pelvic pain. Pain and cramping are rare, but in some cases may persist for the first few months after the procedure. 

Why didn’t my Gynecologist mention UFE? 

Not all gynecologists discuss UFE as an option for uterine fibroids. Some doctors are not aware of UFE. Many have had little to no clinical experience with the procedure. Other Obgyns may have had a negative experience with interventional radiology referrals in the past. 

UFE is a highly specialized procedure and some geographic areas may not have access to a local Interventional radiologist. 

In my experience, I have found UFE to be a safe and effective option for women with fibroids. I am not trained to perform the procedure so I had to educate myself on the risks, benefits, and tremendous value UFE offers. 

Our practice refers patients to Dr. Suzanne Slonim at the Fibroid Institute of Dallas.

The post UFE: Treating Uterine Fibroids without Losing Your Uterus appeared first on Medika Life.

Structure

The ovaries are covered on the outside by a layer of simple cuboidal epithelium called germinal (ovarian) epithelium. This is actually the visceral peritoneum that envelops the ovaries. Underneath this layer is a dense connective tissue capsule, the tunica albuginea. The substance of the ovaries is distinctly divided into an outer cortex and an inner medulla. The cortex appears more dense and granular due to the presence of numerous ovarian follicles in various stages of development. Each of the follicles contains an oocyte, a female germ cell. The medulla is a loose connective tissue with abundant blood vessels, lymphatic vessels, and nerve fibers.

Oogenesis

Female sex cells, or gametes, develop in the ovaries by a form of meiosis called oogenesis. The sequence of events in oogenesis is similar to the sequence in spermatogenesis, but the timing and final result are different. Early in fetal development, primitive germ cells in the ovaries differentiate into oogonia. These divide rapidly to form thousands of cells, still called oogonia, which have a full complement of 46 (23 pairs) chromosomes. Oogonia then enter a growth phase, enlarge, and become primary oocytes. The diploid (46 chromosomes) primary oocytes replicate their DNA and begin the first meiotic division, but the process stops in prophase and the cells remain in this suspended state until puberty.

Many of the primary oocytes degenerate before birth, but even with this decline, the two ovaries together contain approximately 700,000 oocytes at birth. This is the lifetime supply, and no more will develop. This is quite different than the male in which spermatogonia and primary spermatocytes continue to be produced throughout the reproductive lifetime. By puberty the number of primary oocytes has further declined to about 400,000.

Beginning at puberty, under the influence of follicle-stimulating hormone, several primary oocytes start to grow again each month. One of the primary oocytes seems to outgrow the others and it resumes meiosis I. The other cells degenerate. The large cell undergoes an unequal division so that nearly all the cytoplasm, organelles, and half the chromosomes go to one cell, which becomes a secondary oocyte. The remaining half of the chromosomes go to a smaller cell called the first polar body. The secondary oocyte begins the second meiotic division, but the process stops in metaphase. At this point ovulation occurs. If fertilization occurs, meiosis II continues. Again this is an unequal division with all of the cytoplasm going to the ovum, which has 23 single-stranded chromosome. The smaller cell from this division is a second polar body.

The first polar body also usually divides in meiosis I to produce two even smaller polar bodies. If fertilization does not occur, the second meiotic division is never completed and the secondary oocyte degenerates. Here again there are obvious differences between the male and female. In spermatogenesis, four functional sperm develop from each primary spermatocyte. In oogenesis, only one functional fertilizable cell develops from a primary oocyte. The other three cells are polar bodies and they degenerate.

Ovarian Follicle Development

An ovarian follicle consists of a developing oocyte surrounded by one or more layers of cells called follicular cells. At the same time that the oocyte is progressing through meiosis, corresponding changes are taking place in the follicular cells. Primordial follicles, which consist of a primary oocyte surrounded by a single layer of flattened cells, develop in the fetus and are the stage that is present in the ovaries at birth and throughout childhood.

Beginning at puberty, follicle-stimulating hormone stimulates changes in the primordial follicles. The follicular cells become cuboidal, the primary oocyte enlarges, and it is now a primary follicle. The follicles continue to grow under the influence of follicle-stimulating hormone, and the follicular cells proliferate to form several layers of granulose cells around the primary oocyte. Most of these primary follicles degenerate along with the primary oocytes within them, but usually one continues to develop each month. The granulosa cells start secreting estrogen and a cavity, or antrum, forms within the follicle. When the antrum starts to develop, the follicle becomes a secondary follicle. The granulose cells also secrete a glycoprotein substance that forms a clear membrane, the zona pellucida, around the oocyte. After about 10 days of growth the follicle is a mature vesicular (graafian) follicle, which forms a “blister” on the surface of the ovary and contains a secondary oocyte ready for ovulation.

Ovulation

Ovulation, prompted by luteinizing hormone from the anterior pituitary, occurs when the mature follicle at the surface of the ovary ruptures and releases the secondary oocyte into the peritoneal cavity. The ovulated secondary oocyte, ready for fertilization is still surrounded by the zona pellucida and a few layers of cells called the corona radiata. If it is not fertilized, the secondary oocyte degenerates in a couple of days. If a sperm passes through the corona radiata and zona pellucida and enters the cytoplasm of the secondary oocyte, the second meiotic division resumes to form a polar body and a mature ovum

After ovulation and in response to luteinizing hormone, the portion of the follicle that remains in the ovary enlarges and is transformed into a corpus luteum. The corpus luteum is a glandular structure that secretes progesterone and some estrogen. Its fate depends on whether fertilization occurs. If fertilization does not take place, the corpus luteum remains functional for about 10 days; then it begins to degenerate into a corpus albicans, which is primarily scar tissue, and its hormone output ceases. If fertilization occurs, the corpus luteum persists and continues its hormone functions until the placenta develops sufficiently to secrete the necessary hormones. Again, the corpus luteum ultimately degenerates into corpus albicans, but it remains functional for a longer period of time.

The post The Ovaries appeared first on Medika Life.

Anatomical Structure

The uterus is a thick-walled muscular organ capable of expansion to accommodate a growing fetus. It is connected distally to the vagina, and laterally to the uterine tubes.

The uterus has three parts;

• Fundus – top of the uterus, above the entry point of the uterine tubes.
• Body – usual site for implantation of the blastocyst.
• Cervix – lower part of uterus linking it with the vagina. This part is structurally and functionally different to the rest of the uterus.

The Cervix

The cervix is the lower portion of the uterus, an organ of the female reproductive tract. It connects the vagina with the main body of the uterus, acting as a gateway between them.

The cervix is composed of two regions; the ectocervix and the endocervical canal. The ectocervix is the portion of the cervix that projects into the vagina. It is lined by stratified squamous non-keratinized epithelium. The opening in the ectocervix, the external os, marks the transition from the ectocervix to the endocervical canal.

The endocervical canal (or endocervix) is the more proximal, and ‘inner’ part of the cervix. It is lined by a mucus-secreting simple columnar epithelium. The endocervical canal ends, and the uterine cavity begins, at a narrowing called the internal os.

Functions of the cervix

The cervix performs two main functions:

• It facilitates the passage of sperm into the uterine cavity. This is achieved via dilation of the external and internal os.
• Maintains sterility of the upper female reproductive tract. The cervix, and all structures superior to it, are sterile. This ultimately protects the uterine cavity and the upper genital tract by preventing bacterial invasion. This environment is maintained by the frequent shedding of the endometrium, thick cervical mucus and a narrow external os.

Histological Structure

The fundus and body of the uterus are composed of three tissue layers;

• Peritoneum – a double layered membrane, continuous with the abdominal peritoneum. Also known as the perimetrium.
• Myometrium – thick smooth muscle layer. Cells of this layer undergo hypertrophy and hyperplasia during pregnancy in preparation to expel the fetus at birth.
• Endometrium – inner mucous membrane lining the uterus. It can be further subdivided into 2 parts:
  • Deep stratum basalis: Changes little throughout the menstrual cycle and is not shed at menstruation.
  • Superficial stratum functionalis: Proliferates in response to oestrogens, and becomes secretory in response to progesterone. It is shed during menstruation and regenerates from cells in the stratum basalis layer.

Ligaments

The tone of the pelvic floor provides the primary support for the uterus. Some ligaments provide further support, securing the uterus in place.

They are:

• Broad Ligament: This is a double layer of peritoneum attaching the sides of the uterus to the pelvis. It acts as a mesentery for the uterus and contributes to maintaining it in position.
• Round Ligament: A remnant of the gubernaculum extending from the uterine horns to the labia majora via the inguinal canal. It functions to maintain the anteverted position of the uterus.
• Ovarian Ligament: Joins the ovaries to the uterus.
• Cardinal Ligament: Located at the base of the broad ligament, the cardinal ligament extends from the cervix to the lateral pelvic walls. It contains the uterine artery and vein in addition to providing support to the uterus.
• Uterosacral Ligament: Extends from the cervix to the sacrum. It provides support to the uterus.

Vascular Supply and Lymphatics

The blood supply to the uterus is via the uterine artery. Venous drainage is via a plexus in the broad ligament that drains into the uterine veins.

Lymphatic drainage of the uterus is via the iliac, sacral, aortic and inguinal lymph nodes.

The post The Uterus appeared first on Medika Life.