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Updates in Women's Health
Beverly London, MD, discusses the latest updates on the status of women's health in this country and how providers can help a women to be her own best health advocate.
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Learn more about Beverly London, MD
Beverly London, MD
Beverly London, MD is a Gynecologist at the Carle Foundation Hospital. She attended and graduated from Pennsylvania State University College Of Medicine in 1993, having over 25 years of diverse experience, especially in Obstetrics/Gynecology.Learn more about Beverly London, MD
Transcription:
Melanie Cole (Host): Expert Insights is an ongoing medical education podcast. The Carle Division of Continuing Education designates that each episode of this enduring material is worth a maximum of 0.25 AMA PRA category one credit. To collect credit, please click on the link and complete the episode’s posttest.
Women have unique health issues and some of the health issues that affect both men and women can effect women very differently. Here to give us a clinical update on women’s health is by guest, Dr. Beverly London. She’s a gynecologist at the Carle Foundation Hospital. Dr. London, explain a little bit about some of the more important health issues facing women today and why women are a unique challenge for providers.
Dr. Beverly London (Guest): Women have special needs in terms of their healthcare and there’s been so many things, just in the last five years that have changed in terms of women’s health. For example, we’re doing Pap smears not as frequently so there’s a lot of miscommunication, misunderstanding about what the well woman or annual exam entails. Before women would come and think we are going to do our Pap and we’re going to have a breast exam, pelvic exam and when we stopped not doing the Pap so often they thought well I don’t need to come, I don’t need to see my gynecologist for another five years, which is not true. There are new guidelines in terms of specifically for the Pap smear but women still need to have their other body parts addressed. They still need a good breast exam to check for breast cancer. They still need a pelvic exam and they can discuss whether they want to do the pelvic with their provider because there’s still a lot of things that we can find in terms of diagnosing any pelvic masses like fibroids, ovarian cysts, polyps on the cervix. There’s a lot of things involved in terms of why women still need to see her gynecologist every year. So some women are under the misconception that they don’t need to go to the gynecologist every year; they still do.
Melanie: So what are some of the major concerns for older women and as providers are working with an increasingly older population, Dr. London, how would you like them to get their patients to tell them everything that’s going on because that would seem to be a challenge as well?
Dr. London: Yes I find that you have to ask patients specific questions because if you don’t bring it up, the patient’s not going to mention it. So if see a patient perimenopausal, menopausal I will specifically ask her are you having any vaginal dryness? Women will tend not to bring that up as a problem. They just assume that it’s normal. I’ll ask for sexual questions. Are you still having the capability to orgasm or have you noticed a decrease in your sex drive? If you don’t ask those questions, the patient is not going to bring it up and a lot of times I’ll know because if I see a patient come with her husband, her husband is coming to ask the question because she may not want to bring it up and address it. So it’s all part of the visit to address all those concerns and as our bodies change as we get older, those are concerns that we may have. We may not produce as much hormone and have hot flashes, night sweats, decreased sex drive, vaginal dryness, urinary issues because of those things, which may make us more prone to urinary tract infections and also other kinds of infections just because the vaginal area/urethra get a lot dryer.
Melanie: Well this certainly is a very large topic and we could talk about so many women’s health issues that providers really need to know about but let’s speak a little bit about things like bone disease because that is again something that women will experience or may experience. What do you want providers to recognize in their patients as far as metabolic bone diseases, women who are at risk for osteoporosis as they enter their menopausal years?
Dr. London: Well some women may, usually we start screening at 65, but based on history, some women we need to screen earlier, so if I have a patient that tells me she has a history of thyroid disease or she’s been on medications related to GI, like the medications in terms of reflux and GERD, those medications can sometimes contribute to bone loss and those patients may need to start being screened earlier for osteoporosis. We also want to know the women’s history – family history especially and her personal history, has she had any fractures that she needs to tell the doctor about. Does she have a strong family history of osteoporosis? One of the biggest factors because you tend to inherit the same type of bone structure as your mother; you may need to be screened for osteoporosis earlier than 65, and like I said medication history is important because there’s medications that can promote bone loss or where we see bone loss earlier and we may need to screen patients earlier for osteoporosis.
Melanie: Speak about some of the current treatments and standard of care, Dr. London, when we’re talking about hormone therapy for women because again, this is a question women ask their providers pretty much every day, and also they’d like to know about alternative therapies when they’re going through menopause, what would you like providers to know about answering those questions and what is the current standard of care?
Dr. London: Well the current standard of care, ever since we went through the women’s health study is that we really need to be careful about prescribing hormone replacement for women, but one of the things that has come out in the last few years, we used to think that menopause was basically a steady state, that once you go through menopause that you have your hot flashes maybe for a year or two and then you’re done. Now we know it’s more of a dynamic thing where a women may have symptoms for one year, not have symptoms for three years, and then all of a sudden the symptoms come back. So we always need to be constantly surveilling to see where she is in terms of her menopause symptoms. There’s a lot of great hormone replacement medications that are out now. We’re using much lower doses than we were before and we also have the option of using compounded pharmacies for those women that don’t fit into the category where traditional hormone replacement does not work for them. They’ve also come out with some great new medications for especially for vaginal dryness. For example, we used to consistently use just vaginal estrogens for dryness. We’ve come out with Vagifem, which is a vaginal tablet that you use twice a week for dryness. We’ve come out with Intrarosa, which is DHEA, another adrenal supplement to use for vaginal dryness as an alternative for vaginal dryness. We have other options for women. We have a large breast cancer population here. Those women have significant vaginal dryness and cannot use traditional hormone replacement with estrogen, those patients are a candidate to use vitamin E supplements and hyaluronic acid for their vaginal dryness so we have options for them outside of the traditional just using estrogen.
Melanie: And now on to breast health as more and more women are concerned about BRCA gene mutations and breast cancer and the treatments are advancing. Where do you want providers to be with their patients as far as recommending mammograms. There’s been some controversy about that and when they should be getting their mammograms or if they have breast density issues whether they should get that whole breast ultrasound. So speak for other providers about what you would like them to discuss with their patients in terms of breast health.
Dr. London: And it depends on where you are in terms of what you want to believe. I follow ACOG guidelines so they definitely recommend screening at 40. In terms of breast cancer and family history, if you have a family history we like to screen that patient 10 years before that family member was diagnosed. So if you have a woman in your office and her mother had breast cancer at 30, we’re screening that patient at 20, 10 years before. You want to identify risk factors and mammogram still a great way to test. Younger patients I may have them do a breast ultrasound as well. We have the option of an MRI of the breast if there’s any question, especially if they have a family history. Patients that have the BRCA mutation and we usually alternate an MRI with a breast mammogram every six months because we want to identify the high risk for breast cancer and we want to screen those patients on a regular basis. So twice a year we’re checking their breasts via imaging to identify their higher risk. What’s good about genetic testing is the cost has gone down tremendously, just in the last year. It used to be that genetic testing was close to $1500 if a patient decided that they were interested in getting testing. Now the labs are as low as $250 if they were self pay, so the cost, which used to be a big issue has decreased tremendously. So I have patients that will come to me, I have two family members with breast cancer, I’d like to do genetic testing, my insurance doesn’t cover it, they can test as a self patient for $250 and get the information that they need.
Melanie: Wrap it up for us Dr. London with your best information for other providers about the latest updates in women’s health and what you want them to know about the unique challenges that women face in the healthcare world today.
Dr. London: I think the biggest challenge that women face are just addressing being able to communicate their concern so really take the time to sit down with them and ask them the important questions. So if a women comes in, I’m having irregular bleeding, tell me specifically what’s going on. How is that bleeding affecting your life? Are you bleeding through your clothing? Are you cramping to the point that you’re not able to have intercourse? Is it affecting it where you’re not leaving the house when that bleeding occurs? Women are so busy that they tend to wait until their symptoms get pretty severe and then they come to see their provider, but we want to ask them those questions, get on top of the problem, so that we can address their concerns and send them for the appropriate diagnostic testing.
Melanie: Thank you so much Dr. London for joining us today and explaining the updates and what’s going on in women’s health. Thank you again. You’re listening to Expert Insights with the Carle Foundation Hospital. For a listing of Carle providers and to view Carle sponsored educational activities, please visit carleconnect.com, that’s carleconnect.com. We hope the information gained will be applicable to your work and life. This is Melanie Cole, thanks so much for listening.
Melanie Cole (Host): Expert Insights is an ongoing medical education podcast. The Carle Division of Continuing Education designates that each episode of this enduring material is worth a maximum of 0.25 AMA PRA category one credit. To collect credit, please click on the link and complete the episode’s posttest.
Women have unique health issues and some of the health issues that affect both men and women can effect women very differently. Here to give us a clinical update on women’s health is by guest, Dr. Beverly London. She’s a gynecologist at the Carle Foundation Hospital. Dr. London, explain a little bit about some of the more important health issues facing women today and why women are a unique challenge for providers.
Dr. Beverly London (Guest): Women have special needs in terms of their healthcare and there’s been so many things, just in the last five years that have changed in terms of women’s health. For example, we’re doing Pap smears not as frequently so there’s a lot of miscommunication, misunderstanding about what the well woman or annual exam entails. Before women would come and think we are going to do our Pap and we’re going to have a breast exam, pelvic exam and when we stopped not doing the Pap so often they thought well I don’t need to come, I don’t need to see my gynecologist for another five years, which is not true. There are new guidelines in terms of specifically for the Pap smear but women still need to have their other body parts addressed. They still need a good breast exam to check for breast cancer. They still need a pelvic exam and they can discuss whether they want to do the pelvic with their provider because there’s still a lot of things that we can find in terms of diagnosing any pelvic masses like fibroids, ovarian cysts, polyps on the cervix. There’s a lot of things involved in terms of why women still need to see her gynecologist every year. So some women are under the misconception that they don’t need to go to the gynecologist every year; they still do.
Melanie: So what are some of the major concerns for older women and as providers are working with an increasingly older population, Dr. London, how would you like them to get their patients to tell them everything that’s going on because that would seem to be a challenge as well?
Dr. London: Yes I find that you have to ask patients specific questions because if you don’t bring it up, the patient’s not going to mention it. So if see a patient perimenopausal, menopausal I will specifically ask her are you having any vaginal dryness? Women will tend not to bring that up as a problem. They just assume that it’s normal. I’ll ask for sexual questions. Are you still having the capability to orgasm or have you noticed a decrease in your sex drive? If you don’t ask those questions, the patient is not going to bring it up and a lot of times I’ll know because if I see a patient come with her husband, her husband is coming to ask the question because she may not want to bring it up and address it. So it’s all part of the visit to address all those concerns and as our bodies change as we get older, those are concerns that we may have. We may not produce as much hormone and have hot flashes, night sweats, decreased sex drive, vaginal dryness, urinary issues because of those things, which may make us more prone to urinary tract infections and also other kinds of infections just because the vaginal area/urethra get a lot dryer.
Melanie: Well this certainly is a very large topic and we could talk about so many women’s health issues that providers really need to know about but let’s speak a little bit about things like bone disease because that is again something that women will experience or may experience. What do you want providers to recognize in their patients as far as metabolic bone diseases, women who are at risk for osteoporosis as they enter their menopausal years?
Dr. London: Well some women may, usually we start screening at 65, but based on history, some women we need to screen earlier, so if I have a patient that tells me she has a history of thyroid disease or she’s been on medications related to GI, like the medications in terms of reflux and GERD, those medications can sometimes contribute to bone loss and those patients may need to start being screened earlier for osteoporosis. We also want to know the women’s history – family history especially and her personal history, has she had any fractures that she needs to tell the doctor about. Does she have a strong family history of osteoporosis? One of the biggest factors because you tend to inherit the same type of bone structure as your mother; you may need to be screened for osteoporosis earlier than 65, and like I said medication history is important because there’s medications that can promote bone loss or where we see bone loss earlier and we may need to screen patients earlier for osteoporosis.
Melanie: Speak about some of the current treatments and standard of care, Dr. London, when we’re talking about hormone therapy for women because again, this is a question women ask their providers pretty much every day, and also they’d like to know about alternative therapies when they’re going through menopause, what would you like providers to know about answering those questions and what is the current standard of care?
Dr. London: Well the current standard of care, ever since we went through the women’s health study is that we really need to be careful about prescribing hormone replacement for women, but one of the things that has come out in the last few years, we used to think that menopause was basically a steady state, that once you go through menopause that you have your hot flashes maybe for a year or two and then you’re done. Now we know it’s more of a dynamic thing where a women may have symptoms for one year, not have symptoms for three years, and then all of a sudden the symptoms come back. So we always need to be constantly surveilling to see where she is in terms of her menopause symptoms. There’s a lot of great hormone replacement medications that are out now. We’re using much lower doses than we were before and we also have the option of using compounded pharmacies for those women that don’t fit into the category where traditional hormone replacement does not work for them. They’ve also come out with some great new medications for especially for vaginal dryness. For example, we used to consistently use just vaginal estrogens for dryness. We’ve come out with Vagifem, which is a vaginal tablet that you use twice a week for dryness. We’ve come out with Intrarosa, which is DHEA, another adrenal supplement to use for vaginal dryness as an alternative for vaginal dryness. We have other options for women. We have a large breast cancer population here. Those women have significant vaginal dryness and cannot use traditional hormone replacement with estrogen, those patients are a candidate to use vitamin E supplements and hyaluronic acid for their vaginal dryness so we have options for them outside of the traditional just using estrogen.
Melanie: And now on to breast health as more and more women are concerned about BRCA gene mutations and breast cancer and the treatments are advancing. Where do you want providers to be with their patients as far as recommending mammograms. There’s been some controversy about that and when they should be getting their mammograms or if they have breast density issues whether they should get that whole breast ultrasound. So speak for other providers about what you would like them to discuss with their patients in terms of breast health.
Dr. London: And it depends on where you are in terms of what you want to believe. I follow ACOG guidelines so they definitely recommend screening at 40. In terms of breast cancer and family history, if you have a family history we like to screen that patient 10 years before that family member was diagnosed. So if you have a woman in your office and her mother had breast cancer at 30, we’re screening that patient at 20, 10 years before. You want to identify risk factors and mammogram still a great way to test. Younger patients I may have them do a breast ultrasound as well. We have the option of an MRI of the breast if there’s any question, especially if they have a family history. Patients that have the BRCA mutation and we usually alternate an MRI with a breast mammogram every six months because we want to identify the high risk for breast cancer and we want to screen those patients on a regular basis. So twice a year we’re checking their breasts via imaging to identify their higher risk. What’s good about genetic testing is the cost has gone down tremendously, just in the last year. It used to be that genetic testing was close to $1500 if a patient decided that they were interested in getting testing. Now the labs are as low as $250 if they were self pay, so the cost, which used to be a big issue has decreased tremendously. So I have patients that will come to me, I have two family members with breast cancer, I’d like to do genetic testing, my insurance doesn’t cover it, they can test as a self patient for $250 and get the information that they need.
Melanie: Wrap it up for us Dr. London with your best information for other providers about the latest updates in women’s health and what you want them to know about the unique challenges that women face in the healthcare world today.
Dr. London: I think the biggest challenge that women face are just addressing being able to communicate their concern so really take the time to sit down with them and ask them the important questions. So if a women comes in, I’m having irregular bleeding, tell me specifically what’s going on. How is that bleeding affecting your life? Are you bleeding through your clothing? Are you cramping to the point that you’re not able to have intercourse? Is it affecting it where you’re not leaving the house when that bleeding occurs? Women are so busy that they tend to wait until their symptoms get pretty severe and then they come to see their provider, but we want to ask them those questions, get on top of the problem, so that we can address their concerns and send them for the appropriate diagnostic testing.
Melanie: Thank you so much Dr. London for joining us today and explaining the updates and what’s going on in women’s health. Thank you again. You’re listening to Expert Insights with the Carle Foundation Hospital. For a listing of Carle providers and to view Carle sponsored educational activities, please visit carleconnect.com, that’s carleconnect.com. We hope the information gained will be applicable to your work and life. This is Melanie Cole, thanks so much for listening.