Speaking of Women's Health
The Speaking of Women's Health Podcast is excited to bring you credible women's health information from host and Executive Director, Dr. Holly L. Thacker. Dr. Thacker will interview guest clinicians discussing relevant women's health topics and the latest news and tips.
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Speaking of Women's Health
Choosing and Seeing a Doctor at Midlife
Are you tired of feeling like you're navigating menopause or perimenopause alone, armed only with contradictory advice and sensationalized headlines? Dr. Holly Thacker, Director of the Center for Specialized Women's Health at Cleveland Clinic, is here to change that.
In honor of October being World Menopause Month, we are replaying this first episode of Dr. Thacker's podcast series based on her book, "The Cleveland Clinic Guide to Menopause."
In Chapter 1, Choosing and Seeing a Doctor at Midlife, Dr. Thacker addresses a fundamental truth often overlooked in women's healthcare: there are no one-size-fits-all solutions. What works perfectly for your neighbor might be completely wrong for you. This personalized approach extends to finding the right healthcare clinician who understands that women's health concerns are rarely black and white. She offers practical guidance on identifying red flags in healthcare interactions and selecting a physician who specializes in midlife women's health.
Ready to reclaim control of your midlife health journey? Join Dr. Thacker throughout World Menopause Month as she continues this series with more episodes on menopause. Remember—it's your body, your hormones, and your choices.
Welcome. This is a special edition of the Speaking of Women's Health podcast. I am your host, dr Holly Thacker, and I'm also the author of the book the Cleveland Clinic Guide to Menopause Everything you Need to Know to Thrive During Menopause. So I'm beginning the first of a podcast series of this book. This book was published and I'll be updating it along the the way by Kaplan Publishing in New York.
Holly L. Thacker, MD:Some of the reviews I'll read to get you interested and I'll be doing one chapter at a time so you can listen to the whole book or just, based on the titles of the chapters, you know, listen to the ones that you're interested in. So this was from Dr Elizabeth HB Mandel, who is an associate professor of the Department of OBGYN at the University of Virginia and she was on the North American Menopause Consumer Education Committee. Her quote about this book is midlife women who are feeling betrayed by the unpredictability of their bodies and overwhelmed by conflicting claims of the media will find clarity and empowerment in the pages of this book. Dr Thacker demystifies menopause by using simple language to explain how the decline of estrogen levels can manifest itself as a broad array of symptoms, and she offers practical strategies for coping with these symptoms. The author acknowledges that each woman's approach to menopause with a unique set of challenges genetic risk, surgical history, medical history, family stressors and she invites the reader to explore different options for meeting these challenges. This is an empowering message for all ages. The next review is by Sylvia Morrison, a marketing executive. Dr Thacker is the quintessential physician advocate for women and our health. Her advice is sound, thorough and easy to follow. Dr Thacker empowers you to make good choices at so many levels. And then finally, dr Wendy Klein, associate Professor of Medicine, obgyn at the Virginia Commonwealth University School of Medicine, and was a Deputy Editor of the Journal of Women's Health states quote the Cleveland Clinic Guide to Menopause is rich with practical, scientifically grounded advice for healthy living. It's filled with sound strategies for dealing with the challenges of aging gracefully. This is a must-read book that will help empower women during midlife.
Holly L. Thacker, MD:Okay, so let's begin the Cleveland Clinic Guide to Menopause and I dedicated this book. It's my pleasure to dedicate this book to you, the reader, and now the listener, and to thousands of women I've had the privilege of treating during my years of practice in interdisciplinary women's health. I am so glad to begin podcasting this book. My middle son, emerson, told me four or five years ago that I needed to get right involved in podcasting and I knew that I should. But I'm so glad to be getting around to doing it.
Holly L. Thacker, MD:And part of the reason why we decided to start to podcast at Speaking of Women's Health, our nonprofit, which you can visit at speakingofwomenshealthcom, is because we did have a medical grant from Estellas and Bayer to help educate physicians and nurses and pharmacists about vasomotor hot flashes in women and some exciting research and some potential upcoming options and products that we're expecting on the market in 2023. So I have done three types of podcasting. One is for laywomen. That includes a lot of great information that we have on our website, which has social media and free treatment guidebooks and breaking health news and recipes. So please visit speakinginwomenshealthcom news and recipes. So please visit speakingofwomenshealthcom, the Medical CME podcast, which is for free medical credit for physicians, advanced practice providers and other folks in the healthcare arena. Many of our women listeners also enjoy listening to those interviews of prominent physician experts.
Holly L. Thacker, MD:So the third series is podcasting this book and it was published in 2009. It's now February of 2023. And instead of writing a third book, because this is actually my second book, instead of writing a third book, because this is actually my second book. I've worked on the website regularly and updated that almost on a daily basis, and so that's why I never really felt the need to write a book. And even though this book was published in 2009, and there's been a lot of scientific advances, new treatment options, most of all, the basic information about perimenopause, menopause, hormonal therapy issues that affect women at midlife really are pretty similar, and the nice thing about podcasting is I can just update this as we go. So I'm going to start with the introduction and chapter one, which is choosing and seeing a doctor at midlife.
Holly L. Thacker, MD:So my introduction is so you're a woman facing midlife and you care about your health. So you read the headlines and you tune into news programs, and if you miss the story of the day, you can count on a friend to fill you in. Or perhaps you get a news feed continuously on your cell phone. Get a news feed continuously on your cell phone. So daily so-called cutting-edge reports that spout the latest findings on women's health breakthrough medications, warnings about therapy, new weight loss fads, breast cancer rates they just seem to be talking to you. So midlife can be a good time to take stock of your health and feel invigorated and plan for your second adulthood.
Holly L. Thacker, MD:For many women, it's just a marvelous time, but other women spend midlife barely staying afloat, frantically, dog paddling in a sea of turbulent symptoms that affects their work, their health, their sleep, mood, sex life and happiness. And if that wasn't enough, they also have to deal with a barrage of mixed messages. You might hear that new research indicates new low-fat diets won't prevent heart disease. Or maybe you hear that avoiding all carbs will not help you lose weight. Or that all hormone therapy is dangerous. That's not true. Or those vitamins you're taking are worse. One day your prescription's a medical miracle, the next day it's a killer. Talk about frustrating.
Holly L. Thacker, MD:If this were true, or even partly accurate, being a woman today would be quite the risky business, but this should be the best time in history to be a midlife woman, thanks to the availability of so many safe and effective options for staying in great health. Instead, though, I see droves of women suffering because of alarmist reports that have scared them away from proven, safe, effective therapies, and they're receiving erroneous information and not as much support from their health care clinicians as they would like. I see women weeping from fatigue after they've gone off hormone therapy because sheet-soaking nighttime hot flashes have robbed them of sleep and left them exhausted. I see depressed women brought in by their husbands because the sex drives vanished or that they're enduring random panic attacks that make them feel like they've lost control over their lives. I've seen women who've stopped effective osteoporosis therapies because they're petrified their jaw is going to drop off. But in my then it was 20 years. Now it's 30 years of practicing medicine with a focus on midlife women's health and menopausal hormone therapy. I haven't seen things as bad as they've been post-women's health initiative and that report was released in 2002, and I just did a podcast about the 20th year anniversary. So my daily contact with women and doctors and students in training have shown me that too many people, both in and out of the medical field, have received mixed messages about women's health. But in spite of this, the specialty field of women's health and collaborative health care has really come alive. I established our Center for Specialized Women's Health at the Cleveland Clinic in April of 2002. That was just three months before the headlines were exploding with the exaggerated reports of the so-called dangers of hormone therapy. When we opened the center, I launched a for her telephone hotline 216-444-4HER, which is 4437, which women could call with questions, concerns, make appointments and have several options.
Holly L. Thacker, MD:And health, whether it's holistic health, menopausal health, bone health. Many people are still deprived of really crucial information that could mediate their needless suffering and correct the distorted media claims and imprecise research surrounding women's midlife health issues. So this book provides that missing information. In the following chapters, we're going to focus on vitality, health maintenance, hormones, hormone therapy, sleeping problems, cancer prevention, bone health, depression, panic attacks, heart health, sexual health and the truth about vitamins and supplements, as well as talk about some cutting edge therapies for women's midlife concerns. So if you've picked up this book or you're listening to this podcast, chances are you'll recognize the struggles that some of my patients share as they cope with midlife.
Holly L. Thacker, MD:I hope that I can help dispel distorted media claims and inaccurate interpretations of research that misled and confuse women and their doctors. Most of all, I hope reading this book or listening to this book will give you peace of mind and offer sound, practical information to help you regain control of your health during midlife. After all, it's your body, your hormones and your choices. By the way, that was the title of my first book. So by listening to this book, you're taking the initiative for better health and renewed vitality. So congratulations, you are on your way Getting answers.
Holly L. Thacker, MD:Each stage of life brings new changes and gives rise to new questions. We need answers that will help make our transitions smoother and guide us into maintaining a good quality of life. Unfortunately, we are many times misled. The headlines don't spell out the whole story and even in-depth reports can leave out critical research conclusions or just jump to a conclusion to create media hype. We've certainly seen a lot of that in the last few years during this COVID pandemic. The existence of so many variables can affect whether the results of the research study even apply to you, and like I've always said to my residents, fellows and medical students, is that one study is just a piece of the puzzle. It's not the whole entire picture, and you need a lot of pieces of the puzzle before you can see the big, bigger picture, much less complete it. So there's no doubt that sometimes the media can be helpful.
Holly L. Thacker, MD:News programs, magazines, internet websites make us realize how much information is out there and how many people are committed to finding answers that women can live the healthiest, happiest and longest lives possible. Many findings are inspiring and more research is always on the way, but the truth remains. Most women are confused, and who can blame them? What's the real story? Whom can you trust to give you answers when those answers are constantly changing? Within the pages, you will find information on the following Controlling menopausal symptoms. The truth about vitamins and supplements. Diet and exercise to boost energy. Bone health basics. Myths and facts about hormone therapy. Helping your heart in midlife. Preventing cancer and other diseases. Recharging your sex life. Improving your vitality, longevity and quality of life.
Holly L. Thacker, MD:Women's health specialists like myself and others at the Cleveland Clinic Center for Specialized Women's Health have dedicated our career to studying, researching and treating women's health issues With so tight a focus. Such doctors are better able to see that big picture because we have more of the puzzle pieces, and the Cleveland Clinic guides are designed to help you fit all these pieces of the puzzle together for your life. We are all women, but we are all different, and you don't need a physician to tell you that we're all different. Just look at your mother and sisters and girlfriends and colleagues. It should come as no surprise that there's no one-size-fit-all prescription that will calm raging hormones or restore balance during a time of life when change is the only constant.
Holly L. Thacker, MD:It is a fundamental truth in women's health that there isn't a simple yes or no answer for every question, including is hormone therapy a solution for every woman? Can you tell whether or not you'll get a difficult menopause or perimenopause? Tell whether or not you'll get a difficult menopause or perimenopause? Should you keep taking birth control in early menopause? Are antidepressants a good idea? How can you stop hot flashes and get a good night's sleep? Are there hysterectomy alternatives? Can I get my sex drive back the way it was? Is surgery the best answer for a leaky bladder?
Holly L. Thacker, MD:The media likes to categorize everything as just good or bad, but with women's health this isn't just quite simple and possible. The only rules that apply to everyone is don't smoke and wear your seatbelts, and that's about it. Even with diet and exercise, vitamin supplements, health recommendations vary from person to person. We all need a little something different to look and feel our best. Using information gathered during the physical exam routine test that can range from blood pressure readings to mammogram to bone density is like playing a card game Everyone gets a different hand because everyone's issues combine differently. The key is to develop a strategy based on the cards you're dealt. That's why it's critical to find a physician experienced in treating these midlife women's health issues. It's also important to know the information you should have about your own health and what questions you should ask. What treatments are available, both medical and holistic, that will enable you to maintain a vital lifestyle. You need to build your knowledge. Invest in yourself by getting the straight facts about you, not your friend, not your neighbor or mother or colleague A strange disconnect.
Holly L. Thacker, MD:When women come to see me the first time, they're usually eager to request the most complex, recently touted medical test, but sometimes they don't seem to know the basics of everyday preventive health and there's sometimes a disconnect between what women really need and what they ask for. For example, I have women that ask for that CA-125 blood test that monitors for ovarian cancer. This may be a helpful tool in evaluating how a woman is responding to cancer treatment, but it's not a good screening test for ovarian cancer because it yields a high rate of false positives and it also can miss early cases of ovarian cancer. And sadly I've seen many otherwise healthy women who had their healthy ovaries removed because that CA-125 test was elevated, not because of cancer but because of common, relatively benign conditions like fibroids or endometriosis. And it baffles me when the same patient who asked for non-diagnostic ovarian cancer testing doesn't even know the symptoms of the disease which she could be looking for.
Holly L. Thacker, MD:Though subtle, there are signs you can watch for Pelvic pain, discomfort, pressure, changes in bowel movements such as frequency and consistency, changes in urination or sudden urgent need to urinate, pain during sexual intercourse, abdominal pain, swelling or a full or bloated feeling, persistent fatigue, weight gain around the abdomen, along with either sudden weight gain or sudden weight loss. Many women don't know how to listen to their bodies. We haven't been trained in this relatively simple yet important art. In addition, we haven't been given reliable information. For example, did you know that using the hormonal oral contraceptive pill for five years can dramatically reduce your risk of getting diagnosed with ovarian cancer? Or that pregnancy and breastfeeding also reduce this risk? Do you know it's been estimated that several cancer disease risks could be reduced by 70% or more simply by optimizing your vitamin D levels? This is not to say that all women should take the birth control pill or get pregnant or dose themselves without supervision.
Holly L. Thacker, MD:On vitamin D. Remember there are no absolutes in women's health, vitamin D. Remember there are no absolutes in women's health. Many educated women, even some who are physicians, are not even aware of cancers and other diseases in which they have influence over. The point is that, while many patients ask for tests they've heard about on the internet, like CA-125, that are not usually helpful, many times they neglect crucial basic guidelines for good health. This book will give you the information you need to do everything that you can to ensure your own good health and vitality, and then you'll be in the best position to make use of the screening test and the therapeutic treatments that your doctor and you believe will help you live a long life.
Holly L. Thacker, MD:It's all about the choices. They say that knowledge is power, but I'd like to make the case that the right knowledge is power. When we understand our options, we can make better choices. We can gain control over our health, feel good about ourselves as our bodies change and mature, and enjoy our relationships with friends and family more fully. My goal is to share with you what we really know about menopausal process, to dispel myths about treatments like hormone therapy, and to discuss the many ways you can maintain good health and improve areas of concern.
Holly L. Thacker, MD:Midlife is the beginning of a time when most women can focus on their passions. You've spent years raising children or caring for a spouse or family member, or maintaining a career, being a best friend, sister and active community member. Now it's time to take care of you, and I am your host, dr Holly Thacker. I'm the director of our Center for Specialized Women's Health at the OBGYN and Women's Health Institute at the Cleveland Clinic, and I am a professor of both medicine and OBGYN and reproductive biology, and I am the executive director of Speaking of Women's Health, our website speakingofwomenshealthcom, and I am the fellowship director for our specialized women's health fellowship. So moving on to chapter one. It so moving on to chapter one choosing and seeing a doctor at midlife.
Holly L. Thacker, MD:So, women, we are just naturals when it comes to sharing. When we listen, we really hear, and when we talk, we express our deepest worries and greatest joys and form real connections with our best friends, our sisters, mothers, co-workers and neighbors. Our male counterparts might call these verbal exchanges chatter, but we women know better and because we're so practiced in reaching out and discussing personal issues, of course we're able to find the right support we need when we're worried about our health, right? Well, not exactly so. Does this case scenario sound familiar? This is Ellen. I haven't slept an entire night in ages because these hot flashes and night sweats. If this keeps up, I don't know how I'm going to manage to keep my job. And with my daughter's wedding coming up in three months, not to mention my mother's knee replacement, I'm not sure there's going to be enough of me to go around. I wonder if hormone therapy would help. So I decided to ask my next door neighbor. After all, she's already been through this.
Holly L. Thacker, MD:Well, judy said she never took hormones during menopause, since their safety seemed questionable. And she doesn't seem any worse for the wear. She seems happy and healthy and the way she and her husband behave. You think they were honeymooning Now in my bedroom. On the other hand, yes, emotional support is just what women need. In fact, there's research to show that women with strong friendships and support systems recover from illness better than women who are more isolated. You simply cannot put a price tag on the value of human connection and empathy. Hearing and affirming me too, from a best friend might be just the thing that pulls you out of a funk, but that's not all you need. The right answers for your neighbor may not be the right answers for you. Judy never took hormones and yet she enjoys a great sex life Nonetheless, hormones may alleviate your menopausal symptoms, as they did for Ellen, allowing her to fully participate in her daughter's wedding preparations, support her mother after major orthopedic surgery, sleep better and therefore perform better at work and, just as important, ignite some of that missing mojo in the bedroom.
Holly L. Thacker, MD:So go ahead and talk with friends and family, get emotional support that you need, but when you're seeking medical advice, don't leave your doctor out of the picture. After all, mother, even your mother, doesn't always know best. But where can you find a doctor you can trust, one who's knowledgeable about the ins and outs of women's health at midlife? I wrote this book in large part because I was so dismayed that smart women were seeing otherwise good doctors who gave them inaccurate information about all their women's health options. I cannot stress strongly enough the fact that women are different. We have different needs from those of men, children and even one another, and during the time from peri to post-menopause, starting at around age 40, from peri to postmenopause, starting at around age 40, we may need a physician specialist who can address the concerns unique to us.
Holly L. Thacker, MD:Question is my OBGYN enough? Many women obtain all or most of their women's specific health care from their OBGYN. It seems to make sense on the surface. After all, obgyns specialize in women's health, don't they? But depending on the nature of their medical practice, primary care doctors and OBGYN physicians may or may not focus specifically on the health concerns of midlife women. Some women's health specialists, such as North American Menopause Society, credentialed specialists, may have some knowledge, experience or resources that you need, and you can certainly go on menopauseorg and then put in your zip code and find a list of practitioners who have at least taken a basic test on menopause and shown interest in this field. So whom should you trust with your health? Well, it all depends. Should I see a specialist?
Holly L. Thacker, MD:If you have significant peri or postmenopausal symptoms, such as panic attacks, hot flashes, sexual dysfunction, problems that disrupt your life or serious health disorders like osteoporosis, you may want to consider making an appointment with a physician who specifically concentrates on women's health during midlife. His or her practice should encompass a knowledge of menopausal and hormone therapy, bioidentical and otherwise bone health, osteoporosis evaluation, sexual health, gynecologic services available on site, such as pelvic exams and pap smears, urinary incontinence evaluations, mammograms and breast health, breast health risk assessment, as well as holistic expertise and options in nutrition, exercise and mood disorders. Because menopause is a normal life stage. Some women imagine that they must be weak if they need extra help, but this isn't further from the truth. After all, pregnancy and delivery are natural life stages and most women seek professional support, education and sometimes even medical intervention during these stages. So it's especially important to see a women's health specialist if you have a personal or family history of breast or ovarian cancer, you've experienced blood clots, you've had previous adverse reactions to medications, you have a personal or family history of hormonal upheaval, or you've been told that you need a hysterectomy and have no other options that are presented.
Holly L. Thacker, MD:Strong women take control of their health, and that means seeking specialists who can provide the support and treatment options needed. And just because someone says they specialize in women's health or hormone therapy doesn't mean they actually have the credentials. And there are, unfortunately, shady people in the field that have seized on the opportunity to profit from women's misery and confusion opportunity to profit from women's misery and confusion. So be wary of any of these so-called professionals who sell you supplements, concoctions and so-called individualized, compounded hormones that they directly profit from, all the while claiming falsely reassuring you that their personalized therapies are totally risk-free and totally natural. When something sounds too good to be true. It usually is. So what can I expect from a good physician? Many women hit their emotional and physical peaks at midlife and they breeze through menopause. Some make such a seamless transition they don't even realize that they have gone into menopause. But most of these women I see are not quite this lucky. Their lives have been thrown off balance as they enter midlife. Take Cheryl Well, cheryl's husband of 23 years brought her in for an appointment.
Holly L. Thacker, MD:He didn't know what else he could do to support his wife. She was quote falling apart. You'd never know it from just a casual glance. Her appearance was flawless, she was dressed in elegant pantsuit and she looked quite healthy, but her eyes told a different story. Once in my office she described the symptoms she was experiencing, and they turned out to be worse than what most women experience. Escalating mood swings abruptly noseosedived into emotional crashes, making her feel out of control. Her hot flashes were so sudden and substantial that she would find herself completely soaked in sweat, having to change her bedsheets. Her sex life was suffering tremendously because her vagina had virtually shriveled up, and this was particularly upsetting to her because she and her husband shared a deep love and had previously had an enjoyable sex life. As she was telling me all of this, she broke down and sobbed. It turned out that Cheryl's previous doctor had prescribed hormone therapy to restore hormonal balance and control her symptoms, and the treatment worked well. But the doctors later pulled her off the drugs in response to those controversial reports in the medical and lay press that so-called infamous women's health initiative. For Cheryl, stopping the treatments was the worst choice possible.
Holly L. Thacker, MD:So red flags, be wary if your health care clinician imparts absolutes. Women's health issues are never black and white. Answers to critical questions such as the following depend on the individual when should I get a mammogram? What kind of breast imaging is best for me? Is hormone therapy the only answer to treating menopausal symptoms? Is my depression due to menopause? These questions do not always have simple yes or no answers. Every woman needs individualized options, education and support. So if your doctor gives you a simplistic answer, move on. You deserve better. Granted, cheryl's case is somewhat extreme. The severity of her complaints are uncommon, but to one degree or another, many women experience similar symptoms. So no matter what physician you choose, she or he should be thorough and caring in discussing and exploring your symptoms, whether these symptoms are serious or more moderate.
Holly L. Thacker, MD:During an initial appointment with a woman at midlife, I ask a lot of questions. This allows the patient to frame and express her concerns and difficulties. I tend to ask questions in layers, first touching on the health history and then progressing specifically to menopausal symptoms. If these symptoms seem especially disruptive, I dig even deeper. From these questions and an exam I can generally spot indications if a woman is suffering unnecessarily. So I ask about what was the age of your first menstrual period? When did you give birth to your first child? If you had a child, did you breastfeed? If you had a child, have you had any breast biopsies? What are the results? Do you have a family history of any breast or ovarian cancers or are there any cancer syndromes in the family? When did you have your last thin prep pap with HPV human papilloma virus testing? What's your cholesterol ratios, fasting blood sugar? Have you had a mammogram or any kind of colon cancer screening? Have you had a bone density, had a colon cancer screening? Have you had a bone density? If you're menopausal, what is your history? When did your period stop? And if you had an ablation or you have a Mirena intrauterine system, did you get yearly hormone checks to find out when you went into menopause. Have you had any abnormal bleeding?
Holly L. Thacker, MD:What conventional or alternative treatments, such as vitamins, herbs and supplements, are you taking? What are your sleep patterns like? Do you have trouble falling asleep or staying asleep when you wake up, do you fall asleep quickly? Do you have any trouble breathing or snoring loudly? Do you notice any shortness of breath during the day? Do you have any heart palpitations? Do you experience hot flashes or flushing? Is the vaginal genital area dry or irritated? Have you noticed any changes in your skin, nails, hair? What about changes in bowel movement or bladder function? How's your sex life? What's your mood and energy like on most days? Have you lost pleasure in activities you previously enjoyed? Do you feel anxious or depressed? Do you notice if your anxiety or depression changes in relationship to your menstrual cycle? Do you have a personal or family history of fibroids or hormone problems? Have you ever experienced postpartum depression or severe premenstrual syndrome, pms? Ever have a history of any bipolar disorder or mania? A patient's answers to these questions help separate some classic menopausal symptoms from medical conditions, psychiatric problems or lifestyle issues, such as being under stress, from raising teenagers and caring for aging parents or having excessive pressure at work. And it can be challenging to tease out what symptoms are hormone-related from those caused by mental health or environmental stressors. An exam and questions such as these are an excellent start.
Holly L. Thacker, MD:Routine tests and screenings. When caring for a woman in midlife, a physician should perform some tests and screenings. When caring for a woman in midlife, a physician should perform some tests and screenings. If you've chosen a new physician, getting what is called baseline scores on these tests may help your physician establish what's normal for you. Knowing what scores you have allows the physician or nurse practitioner to track improvements or declines over the months or years in between your visits. We do have an appendix on preventive health practices and other tips for midlife women. So what are some of the tests you might want to consider?
Holly L. Thacker, MD:A mammogram it's a screen for breast cancer. A diagnostic mammogram is ordered if you or your physician identify a specific change or abnormality in the breast, because it may involve spot views or magnification views and it may include ultrasound or three dimensional views, and the breast radiologist is present during a diagnostic test. Now many women get called back for a diagnostic test after having the standard two-view screening test. Please do not panic if this happens to you, because it happens to a large percent of women and for many it's just a breast imager's way of getting a better picture of the breast. Digital mammography may make a better choice for women who are menstruating or have denser breasts, as the image can be clearer and the three-dimensional or have denser breasts, as the image can be clearer and the three-dimensional tomograms may have less false positive callbacks, but they do entail more radiation.
Holly L. Thacker, MD:How often? Well, some groups say every year, starting at 40. Others say, if you don't have a personal or family history, you could get a baseline at 45. It's probably best to get a mammogram after you've had your period or after you've taken progesterone, because progesterone, while it protects the uterus, it's more stimulatory to the breast, and this is the second half of your menstrual cycle, right before your period, right after you've ovulated.
Holly L. Thacker, MD:Bone density test why? Well, it can measure the density of your bones, how much calcium is in your bones, and provide early signs of osteoporosis. And some of the newer testing which we have in our center includes trabecular bone scoring, which actually looks at the bone architecture and categorizes your bone architecture as either normal, partially degraded or degraded. Well, how often should you get a bone density? Well, within two years of menopause earlier, for patients with a family history or those who've previously broken or fractured bones. After age 40, those women who smoke or have had low calcium and low vitamin D intakes, people who have been on prednisone or glucocorticoids, those on long-term anticonvulsants, those with strong family histories of osteoporosis. If any blood relative of yours has had a hip fracture even at an advanced age, you need to convey this information to your physician.
Holly L. Thacker, MD:Colonoscopy to screen for colon cancer it's usually started now, at age 45. We used to do it. Colon cancer it's usually started now at age 45. We used to do it at 50, but because there's been an increasing incidence in colorectal cancer in younger people, we're starting sooner. There's also stool genetic coligard testing for those that don't have a history of polyps and do not have a family history, if they choose not to have colonoscopy.
Holly L. Thacker, MD:Blood pressure I think that anyone over age 50 should have their own blood pressure cuff and have it validated at their doctor's office to make sure it correlates with the doctor's sphingomomometer. High blood pressure increases the risk of stroke and heart attack, two of the most common causes of morbidity and mortality in women over age 65. And a good majority of women over age 55 have hypertension. How often should you get your blood pressure taken? At least once a year with your physician and at least monthly by yourself at your home if you have high blood pressure and you can generally purchase a home blood pressure monitor at any drugstore and the digital monitors that go around your bicep, upper arm muscle work the best. I don't really like the ones that are around the wrist.
Holly L. Thacker, MD:Cholesterol Well, why do you want to know your cholesterol? Because high cholesterol can be linked to heart disease, hardening of the arteries, stroke and obesity. If your levels of cholesterol are borderline elevated, you might want to ask for a cardio CRP or ultrasensitive CRP, which can measure inflammation levels. However, if you're on any oral hormones, be them hormonal contraceptives or menopausal hormone therapy, orally, the ultrasensitive CRP test will be falsely elevated and not helpful. Orally, the ultrasensitive CRP test will be falsely elevated and not helpful, and it can be alarming to your doctor or cardiologist, if they don't know this fact, that the oral hormone therapy, by going through the liver, does cause this as an epiphenomenon.
Holly L. Thacker, MD:Fasting blood sugar why? Well, you want to detect your blood sugar and identify signs of diabetes, and we like to do this at least every three years, starting by age 45. Or earlier, if you've had gestational diabetes or you've had a baby over nine pounds or you've had weight gain or a family history of diabetes or any signs of any insulin resistance. Tsh thyroid stimulating hormone. Why do we do this? To detect thyroid dysfunction, which is very common. One in eight women have thyroid problems. How often should you get this? At least every five years or sooner for patients with recently elevated cholesterol, new menstrual disorders, new mood problems and those that have thyroid problems need to be monitored more frequently, at least every year.
Holly L. Thacker, MD:Human papilloma tests and thin prep pap test and the pelvic exam. Why? Well, to detect HPV, which is the most common sexually transmitted infection, and some of these strains of the virus, especially 16 and 18, can cause cervical cancer. Other strains can cause genital warts. That being said, 80% of women by age 50, even if they've only had one partner and used condoms, can still have had exposure to HPV. It's very, very ubiquitous. If you've always had normal pap smears all of your life and negative HPV and your mother did not take DES, you might be able to discontinue regular pap smears at age 65 because the at-risk area of the cervix, the opening of the cervix, is no longer susceptible to HPV infection. However, if you haven't been regularly screened, or if you have HIV, or if you've had abnormal PAPs and HPV in the past or leaps or colposcopies, you may need to screen it longer.
Holly L. Thacker, MD:All women, regardless of age or condition or sexual activity, should continue at least with every two or three year pelvic exams. And I can't tell you the number of women I see who've had hysterectomy and they say oh, my gynecologist says nothing's left, I don't need to come in, you still have a vulva, a vagina, a pelvic floor, musculature, perianal area, rectum. So periodic exams, which many times can be taken care of by a well-trained and qualified women's health nurse, practitioner or physician assistant, should be periodically continued. So in terms of starting pap smears, we used to start them earlier, at the age of sexual activity or by 21, but many of these paps are abnormal because of HPV. So many physicians wait until age 24, unless there's symptoms or problems.
Holly L. Thacker, MD:Once you're 30, we like to combine the thin pap along with the HPV DNA test, and some are just advocating only for the HPV DNA test. But I'm not a fan of this. I think the co-testing is very important and if you're under age 30 and you've had an abnormal pap. It needs to be tested reflexively for HPV and regardless of your age, you should be tested every three years after your initial test. But if you carry the high-risk HPV or you've been exposed to DES, you'll need more frequent paps. And unfortunately, age is notwithstanding and a lot of women have been told they only need it every five years so they don't see the gynecologist and that's not a good idea If they didn't get a good specimen, if there was HPV that wasn't 16 or 18, you still need evaluations.
Holly L. Thacker, MD:And younger women women with symptoms do need still their yearly gynecologic exams. As a woman gets older and is over age 65, if she's been screened for cervical cancer and has never been positive, then going to every two years is generally considered standard and that's usually what Medicare will cover. And if you've had a hysterectomy for benign, non-cancerous reasons, you don't need a pap smear of the cervix because the cervix is not present, but you still need the exam. And if you were exposed to DES diethylstilbestrol, which was given years ago to women to prevent miscarriage, unfortunately that could have very negative effects on the cervix and vagina of those women that were in utero. You must continue with your yearly PAPs, even if your HPV is negative. So I recommend getting a clean bill of health, including an exam, thin prep, pap, cervical cultures if indicated, particularly if you've changed sexual partners, and in our Center for Specialized Women's Health we have a terrific, fabulous women's health nurse practitioner who is very adept at doing this, and many times patients will see me and see her on the same day and if they're due for their bone density, get that all combined.
Holly L. Thacker, MD:So what should you know about HPV? Well, it's very common. It's a sexually transmitted disease caused by the human papillomavirus. There's over 100 types of HPV and more than 30 of them spread through sexual contact. Women who get HPV often don't know they have it because the symptoms can be silent. Like I said, as many as 80% of all women have been exposed to HPV by age 50. Luckily, in most people the infection could clear without problems. However, poor nutrition, low vitamin D levels, cigarette smokers or people just genetically who cannot clear the infection, are at risk for cervical cancer, vulvar cancer and even potentially anal cancer.
Holly L. Thacker, MD:Genital HPV can be spread by skin-to-skin contact. There doesn't have to be an exchange of body fluids like there is with HIV transmission, and unfortunately, condoms do not prevent all HPV transmission and those that have the high-risk strains of HPV may have abnormal tests, and those with low-risk types can have minor abnormalities in a pap smear or might have general awards. And although HPV is usually harmless, some types can cause cervical cancer if not detected in time. Having regular pap smears is the best way to ensure that any precancerous changes to the cells will be caught and treated early. And you always want to get results. Don't assume no news is good news. You should get copies of those results. I just can't believe how so many people have more information about their pet health or their car updates than their own personal health, so you really need to be proactive about it. If a woman has a normal pet but is persistently positive for HPV strains, I definitely recommend they get a colposcopy, which is a microscopic view of the cervix, to allow for direct observation of the cervix for examination and biopsy of any suspicious areas. This procedure can take place in the doctor's office.
Holly L. Thacker, MD:In 2006, gardasil was the first cervical cancer vaccine, which affects four strains of HPV and it's offered to girls ages 9 and older up to the age of 26. And there's a series of three injections over six months and has recently been extended to males and females up to the age of 45. The immunization is generally completed within six months prior to sexual activity. But even if you've had the HPV vaccine, even if your partner's had it, you still need regular gynecologic exams and periodic pap smears. And HPV has been associated with other cancers, such as throat cancer, anal cancer, lung cancer, penile cancer and possibly even some forms of breast cancer. And it was first approved for females in the United States, but later was extended to males as well.
Holly L. Thacker, MD:So, on the record, maintaining your own file my final suggestion on making the most of your physician visit is to give you an assignment. A great way to stay in charge of your own health is to keep your own detailed medical file at home, just like you maintain financial records or details on when your car was last serviced. Please, please, keep your own medical file. And if you don't have your files on hand, you're like most patients, even doctors and nurses, who don't have their cholesterol level. They don't know how many units of vitamin D they're taking, whether they had one or both ovaries removed, whether they had a full hysterectomy or not, and this information is vitally important, especially if you switch physicians, move to a new city, and while we have technology and online medical records, we all have to take responsibility for keeping hard copies of medical records, particularly surgical reports, pathology reports, and I think it's good for you to be involved in keeping track of your markers of health. And you never know when there'll be issues with networking, computer viruses or the transmission between different health systems, so maybe some of these practices are already a habit for you.
Holly L. Thacker, MD:A lot of women weigh themselves once a week. They know when they're going to get their menstrual period. Some people write it down on a calendar or track it on an app. So why should you bother to keep a health file? Well, weight and height can determine your body mass index, which can be a factor in determining your risk for certain conditions like heart disease and diabetes. Even if you're not worried about pregnancy, knowing the dates of your past menstrual cycle can help you and your health care clinician determine whether you've started into perimenopause.
Holly L. Thacker, MD:Designate a special file where you can keep your records. Pick out a pink folder, make it hot pink or something that stands out and listed below is the information you should collect. Keep it handy Don't stick it behind other files or in the bottom of a drawer and bring your folder with you when you see your physician. Take the time before the appointment to review your latest records and be sure to note questions and concerns you have. Bring in medications, supplements with you. Pictures are not nearly as helpful because you can't see everything on the bottle the lot number, the expiration date. Keeping track of your records allows you and your physician to plan the optimum course of prevention and treatment together.
Holly L. Thacker, MD:Well, what should I put in my file? I suggest you compile important statistics that you keep at hand. Weigh yourself once a week and list that. We all know that scale will tip after an indulgent weekend or during a certain time of the month. Even throughout the day, our weight can fluctuate several pounds during the week. So weigh yourself in the morning and please don't let the numbers determine your mood or your dinner plans. Why is weight important? Well, the higher your BMI, generally speaking, the higher disease risk, cholesterol, blood pressure and diabetes risk. Also, it can make arthritis worse. It can contribute to obstructive sleep apnea, gallbladder disease and several cancers. Ultimately, weight gain can affect the quality of life, including the way you feel and look each day.
Holly L. Thacker, MD:Height Unfortunately, most of us do shrink with age and height, but not in weight. How many inches we lose can be a sign of our skeletal bone health. Weak bones of lower bone density eventually translate into osteoporosis or more full-fledged bone loss. That can result in painful fractures, which can curtail lifestyle and even lead to death or nursing home placement. So get in the habit of measuring yourself, at least yearly, and generally we do it in the morning, because you tend to be taller in the morning and losing for a woman up to 1.5 inches of height can be normal just from losing some of the disc space.
Holly L. Thacker, MD:Bmi, body mass index. Unfortunately, we women are more prone to weight gain than men because female hormones at higher doses can promote the female fat deposition, because we are the sex that carries children. What's more is muscle mass is lost, especially after age 40, in a process known as sarcopenia, and it can be replaced with body fat. So the older we get, the harder we have to work to keep off the fat because our metabolism slows down. Bmi is a reliable indicator of body fat in many women not all. Certainly athletes, males, people that have very dense bones and high musculature can have a high BMI, but in general, for most people it's a very helpful calculation.
Holly L. Thacker, MD:To calculate your BMI. Take your weight in pounds and divide your height squared and multiply by 703. So if you're a woman who's 5'5 and you weigh 155 pounds, you divide the weight by the height squared and you get your BMI, which is 26, which is borderline In general. If your BMI is less than 18.5, you're underweight. If you're 18.5 to up to 25, you're normal. 18.5 to up to 25, you're normal. Once you're 25 to 27, you're in that borderline category. Over 27 to 29.9, bmi is overweight and 30 and over is obese. So this mythical woman who's five foot five and 155 pounds is not overweight, but she's kind of teetering and it might be important to focus on healthy eating, maybe some intermittent fasting, maybe focusing more on weightlifting to build muscle or maintain muscle as opposed to the aerobic activity which can increase appetite.
Holly L. Thacker, MD:But BMI does have limits. Athletes, individuals that are very muscular, will have a high BMI. My three sons are all athletes and they all have BMIs of 30, which would be considered obese, and yet they have probably 11% or less of body fat because you can see their muscles. So it's not for everyone. Following trends and patterns are important. Sometimes we do body fat analysis by submerging in water to calculate a fat percentage. Our bone density machine can also calculate lean body mass and total body fat. Sometimes we do this when women don't have enough body fat and therefore they can't maintain menstruation and fertility.
Holly L. Thacker, MD:So know your family history. You can't choose your genes, but you can take steps to mitigate your risk of cancer diseases and other medical conditions that run in your family. If your mother had breast cancer, your risk of getting it is greater than a woman without a family history. It also helps if you know things like the age your mother was when she entered menopause. Did your grandmother have a broken hip from osteoporosis? Or maybe it was just a hip replacement because she had osteoarthritis a different condition. So the more you know, the more you can help control your future health.
Holly L. Thacker, MD:Vitamins, supplements and prescriptive medicines Know exactly what you're taking and bring those bottles in. Many women don't mention herbal remedies or non-prescription treatments, but you should, because they can have significant impact on medications, health conditions and even the effects of anesthesia if you're having surgery. So please speak up about these. Fasting lipid levels. Cholesterol ratios can change before and right after menopause. The same goes for blood pressure. Knowing your cholesterol is important to identify risk for heart disease, diabetes and stroke your physician can give you a referral to a laboratory to test your lipids Blood pressure.
Holly L. Thacker, MD:The guideline for women is about 115 over 75, and many of my patients exceed this. I recommend checking your blood pressure in the morning, as it tends to be a bit higher. Wait at least 30 minutes after having coffee or caffeine. Check your blood pressure under different circumstances, such as when you're relaxed or 30 minutes after exercise or when you're feeling anxious or tense. If you continue to log high blood pressure readings, do not wait for an annual checkup to do something about it. What does my blood pressure reading actually mean? Well, a healthy heart beats in a predictable cycle and it contracts and relaxes, so you get a systolic and a diastolic level. Some people have elevations of both. In either case, it's very important to control high blood pressure and it's important to not make excuses like well, you know I'm stressed or I don't like seeing the doctor, so there can be other complaints that people have. But if it's elevated it can lead to stroke, heart failure, kidney failure, hemorrhages in the blood vessel or peripheral vascular disease. If your blood pressure is 120 over 80, that's not normal, that's prehypertension. So shoot for 115 over 75 or less.
Holly L. Thacker, MD:Please keep results of tests such as your last bone density. Many insurances will only cover it every 24 months. When was your most recent mammogram? Many insurances require it to be 366 days from the last mammogram. Do you have your blood level results? Other records? What screenings have you had for cancer? Do you have a durable power of attorney and advanced health care directives. And so you're ready to roll. Now you know what you need to do to find a doctor, what questions to answer, what tests that you need, what to expect and how to keep track of your health information. So you have the knowledge and the tools and you're ready to be a full partner in your health care. So you have been in the Sunflower House with your host and author, Dr Holly Thacker. Thanks so much for joining us. Please subscribe to our podcast on any of the channels and give us a rating, and please be sure to join me back in the Sunflower for chapter two symptoms of menopause.
