Joey Wahler (Host): They're the center of a woman's reproductive system. So, what are the keys to maintaining healthy ovaries? Our guest, Dr. Asif Luqman, an OB-GYN with Jefferson Healthcare.

Host: This is To Your Health, a podcast from Jefferson Healthcare. Thanks for listening. I'm Joey Wahler. Hi, Dr. Luqman. Thanks for joining us.

Asif Luqman, MD: Hi, Joey. Thank you for having me.

Host: Great to have you aboard. So first, remind us in a nutshell, please, exactly what the ovaries are and what they do.

Asif Luqman, MD: That's a great question. So, your ovaries are essentially endocrine glands and they produce hormones. They do a variety of different things. They are known to produce estrogen and they also produce androgen, which is the testosterone equivalent. They are essentially keeping a lot of the maintenance that is appreciated going on. And eventually, they slow down and they take a break around menopause and some of those hormones taper down.

Host: So, what are some of the symptoms? And we'll talk about menopause and some of the things that may happen prior to menopause in just a moment or two. But what are some of the symptoms that may indicate you have an ovarian issue in the first place?

Asif Luqman, MD: The symptoms that we're looking for, especially in that perimenopausal era, is a lot of times they can be systemic, which means that you're feeling them throughout your system. So, they're not necessarily pelvic, pelvic-oriented. So, a lot of people will feel hot flashes, a lot of people will have heavier bleeding and that's not that something's wrong with their ovaries as opposed to they may be changing their modus operandi. But prior to that, if someone has pelvic pain, if there is a discomfort, that could be indicative of something else going on anatomically, like a big ovarian cyst. And those are things that warrant you going to see a physician and just having them assess you fully.

Host: How about menstruation irregularities, like heavy periods? How common is that and how much of an issue might that be?

Asif Luqman, MD: That's a very common issue, and that actually typically happens at two points in a person's life. Usually when you're approaching entry into your menstrual cycle, so when you're in your teenage, early teenage years, a lot of those periods are going to be very sporadic and irregular. And the same principle applies as you are exiting your menstrual phase of life. And so when you're approaching perimenopause, you're going to have a similar thing happen where you're going to have irregular periods, your periods may be more drawn out, you may have them in between two different periods. And the reason for that is there is such a thing as anovulatory bleeding. And so, what happens is your bleeding sort tends to take its cue from where you are at your cycle and your cycle sort of is based on your ovulation. And so when that starts to taper down, there is a point in your life where your menstrual cycle gets a little confused and you start having irregular bleeding.

I have the an analogy that I use, the best way can explain this in a very simplistic turn. So if you, for this analogy, think of the uterus like a brick oven and estrogen is stacking those bricks up. Every time you have an ovulatory cycle, there's a cyst that occurs that lets out that egg, and cyst stays back it produces progesterone. And in this analogy, progesterone is the foreman and the cement layer. The foreman tells estrogen that's enough bricks, and the cement layer stabilizes those bricks. And essentially, when you don't have an ovulation cycle, the foreman and the cement layer don't exist, but estrogen does and it's laying those bricks out all willy nilly. And a lot of times without that feedback from progesterone, those bricks are toppling randomly, and that's that sporadic bleeding you have as you approach menopause because your ovulatory cycle is sort of tapering away.

Host: So, some of the things you're describing are normal, for instance, when menopause is coming on. But then, there are other things that can occur in the ovaries that represent an issue. So, how do you diagnose whether there's an ovarian problem or not when someone reports symptoms to you? How do you go about telling what's going on?

Asif Luqman, MD: So, that's a very nuanced approach. And so, depending on the symptoms, a lot of times we'll start with a physical examination. I'm palpating or feeling for any object or cyst that's palpable, but also we use the aid of imaging. So, a lot of times, for those patients, I'll get an ultrasound to see if there's an anatomical issue that may be causing an issue. For example, if someone comes in with a lot of pain, there may be a big cyst and that cyst, if it's big enough, it can sort of twist on itself and take the ovary with it. That's called ovarian torsion. That's an emergency. So, that's something that we would assess through imaging and physical examination and also just assessing the patient's discomfort.

Other times, when we're concerned about certain things like cancers, we can pursue tumor markers. However, I will give you a pretty big caveat. There is no screening per se for something like ovarian cancer. A lot of times, what we do is we look for anatomical hints such as fluid in the pelvis or a big mass that looks complex. And those are the little hints that we have as to looking further. And then at the very end of it, a lot of times we need to do surgery to go in there and get a sample of tissue.

Host: I'll ask you more about potential ovarian cancer in a moment. First, you've talked a bit about perimenopause which, by the way, I always thought was called premenopause. And so in researching and preparing for this chat of ours, I learned something already going in, which is it's perimenopause. What advice do you have for women that are entering perimenopause so that they know whether what's happening is "normal" and, of course, healthy.

Asif Luqman, MD: That's a great question. So if things are changing, and I see this the most in the age group between 45 and 50, if you think things are changing, your menstrual cycle is changing, you're feeling there are other systemic symptoms that we talked about earlier, like hot flashes or something along those lines, it's important to get fully assessed. And the reason I say that is that you may think that this is perimenopausal abnormal bleeding, but we should also rule out other things like endometrial cancers and things like that. I want you to listen to your body. And if you think something's wrong, come in have it checked out. And if it is perimenopause, there are ways to mitigate those symptoms such as hormone replacement therapy such as birth control. So for example, an IUD, you know, a lot of times is a great way to stop that irregular bleeding. So, there are things we can do to help.

A lot of my patients will come in after suffering for years, because they think that menopause is just around the corner. The average age of menopause in this country is 51. 4, but that doesn't mean that that's going to be you. There are people that hit menopause way later than that, and so that's a long time to suffer. And it can be dangerous if you're bleeding a profuse amount.

Host: So, what foods, vitamins, supplements help a woman to promote healthy ovaries?

Asif Luqman, MD: I think everything in moderation is key. I don't think there's anything particular that you need to do to help your ovaries per se. But there are supplements as you go through life that are important to help mitigate some of the effects that can happen as your ovaries start tapering down on the estrogen production that they normally do.

A good example is calcium and vitamin D. As you get to perimenopause and then menopause thereafter, one of the things that happens is your estrogen will start tapering down that puts you at higher risk for osteoporosis. And for us to have a healthy life, you have to have healthy bones. And the best way to do that is make sure that you're getting enough calcium in your diet and enough vitamin D. And a lot of times in conjunction with that, I urge healthy living, like weight-bearing exercises, those are the things that I would recommend.

Host: Gotcha. A few other things, I mentioned earlier we'd come back to the subject of potential ovarian cancer. How worried should women be about ovarian cancer and what would be some warning signs that that may be present?

Asif Luqman, MD: One of the things that I urge people do are speak to family. I feel as though that today especially, women's health and the OB-GYN health of an individual is something that's a taboo topic. The best way to keep yourself safe, especially for something like ovarian cancer, which a of times is genetically passed down, is to know if there is ovarian cancer in the family. So, ask questions. Make those Thanksgiving family gatherings a little uncomfortable, it's okay. But also, listen to your body. So if you think that there's something interesting happening where you feel as though there's bloating, and you feel as though there's a pelvic discomfort, don't relegate it to, "Oh, it's probably my diet. Come in. Make sure you see a GYN or someone that's doing pelvic exams at least every year and have a conversation. The best to keep yourself safe from ovarian cancer is educate yourself and making sure you do your due diligent screening. However, there is no actual screening test for ovarian cancer aside from listening to those bodily symptoms that may or may not occur. And that's good to have an annual examination every year.

Host: So if someone does have ovarian cancer, as it turns out, what are some of the treatment options for them?

Asif Luqman, MD: That's a great question. So, one of the things that we often will do is we will have you see a GYN oncologist. And based on where you are in that progression of that cancer, the treatments vary from radiation to chemotherapy to surgery. That is a very scary part of someone's life. But if we are able to catch things early enough, a lot times we could have successful treatment. But you have to sort of be on top of those symptoms and make sure that you're getting assessed if you are concerned.

Host: And so in summary, what would you say to women that are like, "Well, I feel a little something that seems out of the ordinary now and then, but I don't want to be an alarmist and go running to the doctor for no reason, because you know, as well as anyone, there are people out there that think that way, unfortunately, aren't there?

Asif Luqman, MD: Yes. And to those people, I say, that's what we're here for. As physicians, our role is not just to fix problems, it's to prevent them. The best way we can do that is to see you regularly and to be able to educate you regularly. Because a lot of times, the symptoms you may be experiencing are very simply, you know, explain. And other times, they may be foreboding of something that is far more dangerous. And the only way to know is to have conversation. So, you're not bothering anyone by coming in if you're concerned. In fact, we want to be on top of things so that if something is in the early stages, we can help you fix it and at least guide you in some of the healthy living that can actually help with future problems that may occur.

Host: Absolutely. So folks, we trust you're now more familiar with maintaining good ovarian health. Dr. Asif Luqman, very valuable information. Thanks so much again.

Asif Luqman, MD: Thank you for having me.

Host: And to schedule an appointment with Dr. Luqman, please call 360-344-0403. Again, 360-344-0403. If you found this podcast helpful, please share it on your social media. I'm Joey Wahler. Thanks again for joining us for To Your Health, a podcast from Jefferson Healthcare.