Womens Health Associates Blog

Empowering Women Through Health

IS ROBOTIC HYSTERECTOMY RIGHT FOR YOU? Information from Jen Roelands, M.D. October 17, 2012

Filed under: Gynecological Surgery — womenshealthassociatesblog @ 6:39 pm
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A hysterectomy is removal of a women’s uterus. It is a common procedure done by women who have heavy periods, fibroids, severe pelvic pain, endometriosis or pre-cancerous changes in the uterus. There are several ways to perform a hysterectomy.  Traditionally, it has been performed through a large incision 10-12cm in size. But now there are Minimally Invasive Techniques including laparoscopy and robotics that allow a surgeon to perform the hysterectomy through an incision the size of a dime. Why should patients have MIS (minimally invasive surgery)?

  • Faster recovery (2 weeks vs 6 weeks) back to work
  • Overnight in hospital vs 2 nights
  • Less pain
  • Smaller incisions for those who are prone to infection
  • Less blood loss
  • Fewer complications

                  Why robotic hysterectomy over traditional laparoscopy? Robotics are essentially advanced laparoscopy. The robot allows the surgeon to perform more difficult procedures. The advantages include:

  • Better camera (3D with 1080 resolution)
  • Surgeon can sit decreasing fatigue
  • 360 degree motion with wrists compared to 180 degrees
  • Smaller instruments.

                Who is a good candidate for robotic hysterectomy? Almost everyone is a good candidate. It is especially good for patients who have scar tissue, overweight, or who have not had children. If you are interested in viewing a robotic hysterectomy, please click here http://www.youtube.com/watch?v=1tcDGcHWPzY.

If you are interested in having a robotic hysterectomy, and live in Mid-Missouri, call Women’s Health Associates, Inc. at 573-443-8796 and schedule an appointment with Jennifer Roelands, M.D.  To schedule an appointment with a qualified Da vinci surgeon outside of Mid-Missouri, visit http://www.davincisurgeonlocator.com/en/profile/surgeon/78740.



Filed under: Hormones — womenshealthassociatesblog @ 9:43 pm

At menopause (around age 55) estrogen production declines by 40-60% depending on your body fat content.  However, Progesterone levels drop to zero at menopause.  Thus most menopausal women are even more estrogen dominant than perimenopausal women.  This is one of the reasons that women’s risk of breast cancer goes up with each year of life.  It does not decline after menopause.  So why do some women have sufficient estrogen levels after menopause, but have estrogen deficiency symptoms?  In order to respond to estrogen you must have adequate estrogen receptors on your cells (sort of like satellite dishes on your roof).  You do not make adequate estrogen receptors without progesterone.  Thus, many menopausal women are estrogen-dominant, but relatively estrogen-resistant.  The medical establishment, not realizing this, often treat menopausal symptoms with high doses of synthetic estrogen (such as Premarin) which override the defective receptors.  Now these women become REALLY estrogen-dominant.  While on the subject of synthetic estrogens such as Premarin, it is worth mention that the dominant estrogen in this product is Equilin (obviously of horse origin).  One dose of Equilin takes almost two weeks for your body to eliminate.  It is easy to see how daily oral administration could lead to very high tissue levels over time.                   

 There are three human estrogens:  Estradiol, Estrone, and Estriol.  Estradiol is the strongest and some of it converts into Estrone.  Estrone has a mid-range strength, but is felt by some authorities to have more cancer causing attributes than Estradiol.  Estriol is the weakest estrogen and is more water soluble than the others.  It has the least propensity for cancer stimulation and some experts feel that it decreases breast cancer risk.  It used to be thought that Estriol was produced only during pregnancy but recent studies show it is produced at high levels throughout the menstrual cycle. 

Testosterone is produced in women and men.  Men produce ten times more than women and thus it is usually called a male hormone.  Testosterone is anti-inflammatory and vital for men and women.  I do not believe that Testosterone is the cause of prostate cancer.  Prostate cancer is related to elevated systemic inflammatory change and the increased conversion of  Testosterone into Estradiol by the aromatase enzymes found in excess visceral fat (especially beer/wheat belly).  Testosterone is responsible for muscle mass, ambition, sex drive, and positive outlook, for example.  

Following childbirth some women lose some of their Testosterone production from the interstitial cells of the ovary.  Most hormonal contraception causes suppression of Testosterone.  This can lead to fatigue, depression, and decreased sex drive.  The usual explanation for these symptoms is stress and depression related to child rearing, marriage, work etc.  The most common treatment suggested is counseling or antidepressant therapy with meds that can often cause more sexual dysfunction, weight gain, and fatigue.  While stress issues are very real in our society, testosterone deficiency (and hypothyroidism) is very real and should be evaluated before blaming stress.  

In my next blog, I will discuss how I use these “Tres Amigos” to treat perimenopausal and menopausal  women who suffer from symptoms of hormonal imbalance.


THE HORMONE DIARIES-VOLUME 2-LOS TRES AMIGOS by William Trumbower, M.D. November 9, 2011

Filed under: Hormones — womenshealthassociatesblog @ 6:59 pm
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Bioidentical HRT usually involves three hormones:  Estrogens (estradiol & estriol), Progesterone, and Testosterone.   Estrogens are wonderful hormones.  They are responsible for development of feminine traits and are thus essential for sexual attraction and reproduction.   Estrogens  are necessary for brain function and involved in mood control.  The down-side to estrogens is that they are pro-inflammatory growth hormones.  Their message to the cells in your body is to “grow baby grow”!  Thus they tend to be associated with weight gain, blood clots, and cancer.  Estrogens are balanced by Progesterone.  Progesterone is an anti-inflammatory, anti-growth hormone.  So while estrogens are telling your cells to grow (especially breast cells), progesterone is telling your cells to grow up and be mature (sounds like me talking to my kids when they were teens).  Mature cells are much less likely to spin out of control and become cancerous.  Mature cells die when they are supposed to (a process called apoptosis).  Remember, cancer cells are immortal.  They are like vampires that can out live you and kill you too!  I like to think of Progesterone as the wooden stake in the heart of the vampire breast cancer cell.             

As women enter the perimenopause (around the age of 35), their Progesterone production begins to decline.  This is due to anovulatory cycles and inadequate luteal phase progesterone production causing an increase in fertility problems as women age.  Perimenopausal women become Progesterone deficient ( Estrogen dominant).  Estrogen production in the perimenopause becomes erratic with both higher and lower levels during the cycle.  These changes cause the common perimenopausal symptoms such as weight gain, fatigue, decreased sex drive, abnormal bleeding, and cyclic moods (PMS).  Estrogen dominance is also an issue in uterine fibroids and endometriosis.   Remember, Dr. Katharina Dalton, the inventor of the term PMS, recommended progesterone suppositories for the treatment of PMS.  I spent a week with Dr. Dalton inLondon in 1985 learning about her theories.  She came to Columbia and presented two talks.  One was a private talk for physicians only.  Two doctors attended; myself and a family physician no longer in private practice.  The other presentation was for the general public and was at the Ramada Inn.  Well over 500 attended and many were turned away for lack of room. 

Check back for the continuation of Volume 2 of Dr Trumbower’s Hormone Diaries where he discusses more about the “Tres Amigos” and what happens to estrogen production at menopause.




Filed under: Birth Control Options — womenshealthassociatesblog @ 1:11 pm
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                I think that the birth control pill generally gets a bad reputation.  We see lots of commercials late at night touting all the bad things that can happen when you are taking them and who is to blame.  When is the last time anyone told you the good things about the pill?  As with any medication, there are risks associated with taking combination oral contraceptives, and there are also benefits that extend beyond the prevention of pregnancy.

                There are many different combination birth control pills.  They all have similar composition with estrogen and a type of progesterone.  The progesterone component and the dose of hormone varies between pills and accounts for why some pills work better for some people than for others.

                The pill is often prescribed for problems with menstruation.  Taking birth control decreases the amount of blood lost each month and decreases cramps better than any other medication.  It makes the menstrual cycle more predictable and more manageable for many women.  Taking the pill continuously or using a 24 day pill is often used to treat PMS symptoms as well.  Another problem for some women is menstrual migraines.  These are often treated using a special formulation that adds back estrogen during a women’s period to decrease the frequency and severity of headaches.

                Hormonal imbalances are also treated using the pill.  The hormones in the pill lead to changes in the production of proteins in the blood that bind testosterone and other compounds.  This change results in lowered effects from testosterone and decreases acne and dark hair growth some women have on their faces and chests.

                Other uses for the pill include the treatment of gynecologic disorders, such as uterine fibroids and pelvic pain.  Many women with endometriosis are treated successfully using the pill, as are women with recurrent ovarian cysts.

                As with any medication you need to consider the benefits taking it compared to the risks.  For many women with menstrual or gynecologic problems the pill remains a great resource.



Filed under: Birth Control Options — womenshealthassociatesblog @ 8:52 pm
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Birth control pills, or oral contraceptives, are one of the most commonly taken prescription medications in women in our country.  In addition to preventing pregnancy, there are other benefits to taking them.  As with any medication there are side effects and risks as well.  In recent years we have seen a lot of media attention on the risk of breast cancer associated with hormone replacement therapy, but there has not been very much on the risk of cancer with birth control use.

There have been many observational studies over the years trying to determine the effect of using OCs on overall cancer risk.  When all types of cancer are combined there is a decrease in the overall cancer risk in women who have ever used OCs.  This decrease is likely due to a substantial decrease in uterine and ovarian cancer in women who take the pill.  Studies have consistently shown that using OCs decreases the risk of ovarian cancer.  Overall the risk is one-third less for women who currently use or have used OCs in the past.  What is most impressive is that the protection lasts for up to 30 years after stopping the pill and all doses of the pill provide the same protection.  Uterine cancer is also decreased in women on OCs, the risk of uterine cancer while on the pill is almost half of what it would be off.  The relative protection can last up to 15 years in some studies.

The effect of the pill on the risk of breast and cervical cancer is more controversial. 

There may be an increase in cervical cancer in women who have taken OCs. Many studies show an increase in cervical cancer that continues as long as the pill is continued.  When the pill is stopped, the risk returns to baseline levels.  Interestingly, women who are negative for HPV (the virus most often associated with cervical cancer) do not have an increase in the risk when using OCs, leading to the conclusion that the pill may interact with the growth of HPV already present.

There have been several studies on the risk of breast cancer in OC users and the results are conflicting.  Several population studies have been done and show no increase in the risk of breast cancer later in life for women who have taken OCs.  The only study that showed an increase looked at women who took high dose OCs (in the 1970’s) AND had a strong family history of breast cancer.  This may indicate that for women of average risk there is no significant increase, but in women who carry the BRCA1 or BRCA2 gene (or who have a strong family history-a mother or sister affected) the risk increases.

Overall, these risks and benefits likely balance out for women of average risk.  In women with a family history of breast or ovarian cancer the circumstances may need to be discussed in more depth with a provider.  It is important to remember that all these risks estimates are pretty low, not doubling or tripling risk.  Another thing to keep in mind is that we increase and decrease our risks of cancer and other chronic diseases everyday, not just in medication choices, but in lifestyle choices as well. 


BIRTH CONTROL PILLS — PART ONE by Kim Morse, M.D. September 27, 2011

Filed under: Birth Control Options — womenshealthassociatesblog @ 2:30 pm

When birth control pills were first developed the goal was to prevent pregnancy.  Since that time the medical community has uncovered many non-contraceptive benefits to the pill including less blood loss, less pain as well as the prevention of certain types of ovarian and uterine cancers.  When they were first developed the pills were meant  to mimic an average woman’s cycle of 28 days.  It was thought that a woman would be more accepting of the pill if she had what appeared to be a ‘normal cycle’.  Over the years the pill has changed, as has the reasons for prescribing them.  Overall, today’s birth control pills are much lower dose and better tolerated than those of the past. 

As the reasons for giving the pill have changed, so has the way they are taken.  For years, gynecologists have been having women ‘skip periods’ for medical reasons by rearranging the way they take their regular birth control.  In the past few years the pharmaceutical companies have jumped onto this wagon and started packaging pills for this specific purpose leading women to wonder, “Is it safe to skip my period?”

When talking about the way birth control pills work most  people are referring to a combination pill, one that contains both an estrogen and progesterone component.  These pills mimic the normal hormones produced by the ovary and suppress ovulation to prevent pregnancy.  They also contain less estrogen then most women normally produce and a low but stable amount of progesterone unlike the variation seen in the natural cycle.  This combination of hormones makes it possible to suppress ovarian function while keeping the lining of the uterus thin and healthy. 

Women who are not on a birth control pill do need to have a menstrual cycle at least four times each year to prevent abnormal growth of the lining of the uterus.  Women who are on birth control are keeping the lining thin and healthy by taking the medication and have no medical need to have a period. 

There are now several pills out that lengthen the time between periods (such as Seasonale), or try to eliminate periods altogether (Lybrel).  Newer formulations are meant to shorten the period to 1-2 days but frequently result in no noticeable bleeding at all.  The biggest side effect seen in women taking extended cycle pills is spotting that typically resolves with time.  The good news is that a woman can use any low-dose pill to skip periods after consulting with her physician.

When birth control pills were first introduced it took several years for women to accept them as safe and effective.  Now the next step is for women to accept the manipulation and even elimination of the menstrual cycle is a safe alternative and even added benefit of the pill.

This is the first in a two part series.  Check back for “Part Two: Birth Control Pills and the Risk of Cancer.”



LET THEM EAT CHEESE By KIM MORSE, M.D. September 2, 2011

Filed under: Pregnancy — womenshealthassociatesblog @ 2:03 pm

Recently I’ve noticed an increase in questions regarding food precautions and recommendations during pregnancy.  I’ve had many patients ask me if it’s safe for them to eat nachos while they are pregnant.  The answer is yes.  I started looking at where this misconception stems from and thought that a quick review of what the American College of Ob-Gyn and the FDA recommends would help clear things up.

Listeria monocytogenes is a bacteria that can be found in soil, water, sewage plants and food.  It is considered an important public health problem due to the fact that infection with this bacteria most often occurs in people with a weakened immune system- such as pregnant women, newborns, the elderly and people on chemotherapy.  In this population the infection can have severe consequences. 

Symptoms of infection with Listeria usually include diarrhea or other gastrointestinal symptom followed by fever, body and muscle aches.  The symptoms usually develop one to a few days after eating the contaminated food.  It is diagnosed by blood testing.  Treatment with antibiotics cures the infection and can prevent pregnancy complications so it is important to contact your physician if you develop these symptoms or have consumed food known to be contaminated

The actual risk of contracting Listeria in the United States is quite low.  The incidence given by the CDC is 3 per 1,000,000 (.3/100,000).  Reported cases were down 38% in 2010.  Of the cases reported, 16% occurred in pregnant women.  Of those pregnant women 28% were Hispanic.  This leads many to believe that the most common source of infection is soft, non-pasteurized Mexican cheeses like queso fresco and queso blanco.

As with any bacteria that is naturally present in our environment, it is impossible to completely eliminate the risk of infection.  There have been reports of Listeria isolated from many types of food including contaminated vegetables, hummus, even milk contaminated after pasteurization. (In other countries it has been isolated from soft serve ice-cream, but not in the US).  Common sense food safety guidelines and avoiding high-risk foods are the best ways to avoid infection.

Food safety guidelines include washing all utensils and surfaces used in preparation of raw meats and storing uncooked meats separately from vegetables and cooked foods. 

Foods considered high-risk include unpasteurized soft cheeses, such as brie, feta, or queso blanco.  Cold deli meats and uncooked hotdogs are also considered to be high risk unless they are cooked before eating.  All hard cheese (like cheddar), semi-soft cheese (like mozzarella) and pasteurized cheeses are completely safe.

Most feta and brie that is made in the United States has undergone the pasteurization process- just check the label.




 The great news is that most nachos are made with monterey  jack or cheddar.  If there is any doubt, just ask the cook.  Now you can just sit back and enjoy your meal.