In season 8, episode 2 of the Take Good Care podcast, Drs. Guthrie, Williams, and Greene discuss the latest news on hormone replacement therapy for menopause management and answer questions from our patients and listeners!
Transcript
Dr. Mironda Williams:
Welcome to Take Good Care Podcast…
Dr. Deanna Guthrie:
An endeavor that grew out of our love for obstetrics and gynecology.
Dr. Karen Greene:
Our aim and mission is to serve as a source of vital information for women of all races, ages, and walks in life.
Dr. Mironda Williams:
I am Dr. Mironda Williams.
Dr. Deanna Guthrie:
I am Dr. Deanna Guthrie.
Dr. Karen Greene:
And I am Dr. Karen Greene.
Dr. Mironda Williams:
Welcome to our show.
Welcome to another episode of Take Good Care Podcast. I’m Dr. Mironda Williams.
Dr. Deanna Guthrie:
I’m Dr. Deanna Guthrie.
Dr. Karen Greene:
And I am Dr. Karen Greene.
Dr. Mironda Williams:
And we are live and on the air.
Dr. Karen Greene:
I love that.
Dr. Mironda Williams:
So on today’s episode, we are going to do something just a little different. We have tackled menopause and menopause management many times, many times before. But as I’m sure all of you who are listening know, there’s been so much in the media, all medias, about menopause and menopause management, which is great because there’s a lot more discussion that’s being held, and so women are seeking information like never before, which is wonderful. One of the things that happened not too long ago is that the FDA removed the black box warning on estrogen replacement therapy in certain conditions. And that again generated a lot of newer interest in the possibility of women being able to use hormone replacement therapy for menopause management who may not have thought about that before.
So again, we have been gynecology focused physicians for over 10 years. And so we have always been supportive of the use of hormone replacement therapy, its safety, its efficacy, and making sure that we have educated our patients as much as possible, provided information that was science based and also based on best practice medicines. So it wasn’t news to us, but I’m glad everybody else caught up with that. And so-
Dr. Deanna Guthrie:
And they’re still catching up.
Dr. Mironda Williams:
And they’re still catching up. So on today’s episode, we’re going to do things a little bit differently. And we’re going to call this menopause ain’t just hot fleshes. And so we’ve… Which sadly… Well, I shouldn’t say sadly, aging is a beautiful thing. We three are in the menopause-
Dr. Deanna Guthrie:
Space.
Dr. Mironda Williams:
… space.
Dr. Deanna Guthrie:
Thank you.
Dr. Mironda Williams:
We’re in that space.
Dr. Deanna Guthrie:
Journey.
Dr. Karen Greene:
It’s a journey.
Dr. Mironda Williams:
It’s a journey.
Dr. Karen Greene:
It’s a journey.
Dr. Mironda Williams:
It’s a journey, but it can be a joyful journey. It doesn’t have to be a journey where you feel like life is over. And so we have reached out and our patients, who are wonderful and engaged, have sent us in a number of questions about menopause and concerns and issues about menopause, which is so gratifying. Because as we said, patients are now more open to asking questions and seeking information. And so hopefully in the process of us going through and answering these questions, we will answer their questions, but also give you general information about just menopause, hormone therapy, what hormone therapy is, what it isn’t, and some questions as we’ll get along about how long and all of that. So just as a general introduction, as I tell everyone, menopause isn’t a disease state. It is just everyone’s ovaries are going to turn off. Okay? Our ovaries are only programmed to function for so long. And then at some point they say, you know what? We’ve done all we intend to do-
Dr. Deanna Guthrie:
I’m retiring.
Dr. Mironda Williams:
I am retiring.
Dr. Karen Greene:
I’m done.
Dr. Mironda Williams:
And so as our ovaries retire, so do our hormones. So the estrogen and progesterone levels, which are the primary hormones that our ovaries produce begin to decline. Women also produce a small amount of testosterone. It also starts to decline. So everything just starts to decline because the ovaries are no longer making it. And as a consequence of that, a lot of women have some symptoms. There are some blessed few who just stop a period, that’s it-
Dr. Karen Greene:
That’s it.
Dr. Mironda Williams:
… and go on about their merry lives. But I think what we’re finding ladies, and we can comment on this a little bit before we get to the questions, is that they may not have really gone on with their merry lives, because they may have just assumed that what they were dealing with was now normal.
Dr. Karen Greene:
Yes, [inaudible 00:04:45].
Dr. Mironda Williams:
And that now, because there is more conversation just in the general public space on social media, Facebook, Instagram, or Tweeter, Twitter, whatever, all of that, maybe they weren’t so merry. So what do y’all think about that?
Dr. Deanna Guthrie:
I think it’s how mothers talk to daughters and what information that they had-
Dr. Mironda Williams:
Or didn’t have.
Dr. Deanna Guthrie:
Or didn’t have, more importantly. So a lot of women come in not even realizing that, like you said, a symptom is a symptom of menopause and that… And like I said, menopause is a normal transition. It’s not a disease, but every woman’s going to go through it differently and things that you may be dealing with, you don’t necessarily have to continue to deal with it. And it’s not a… I liken it to periods. So there’s some women who, because of how they were brought up or taught, that you just supposed to suffer through your periods. That’s just a path in life-
Dr. Mironda Williams:
It’s a woman’s curse to bear.
Dr. Karen Greene:
Yes.
Dr. Deanna Guthrie:
And not recognizing that, a woman will come in and she’s having probably a very difficult period, but in her mind, that’s just normal.
Dr. Mironda Williams:
That’s just what I do.
Dr. Deanna Guthrie:
So for a week out of the month, she’s almost-
Dr. Mironda Williams:
Incapacitated.
Dr. Deanna Guthrie:
… incapacitated, non-functional, but that’s just what life is supposed to… Same thing with menopause and the severity of your symptoms, that some women breathe through it, and some women are really suffering. So it’s just getting that information to know what should you deal with and what should you not.
Dr. Karen Greene:
And that you have a choice whether to deal with it or not. As you said, when you talk to families and friends and aunts and aunties, and their perception and their experience with menopause, because of a lot of times the language that people use, just like we call our cycles the curse, people want to be over with menopause.
Dr. Mironda Williams:
I forgot about that.
Dr. Karen Greene:
It’s the language that we use and the language that we’re taught. And so I’ll have patients come in and say, “So when is this all over?” And trying to get people to understand that it’s another transition, just like you transitioned into having cycles, now you’re transitioning into not having cycles and the things that go along with it. And they often will reflect on aunts and moms that went through a timeframe where they didn’t talk about anything.
Dr. Mironda Williams:
Suffered in science.
Dr. Karen Greene:
But they knew that something was going on. Mom wasn’t doing well. Mom was suffering. I remember my mom carrying around a fan all the time. She didn’t talk about it. And I had no idea why she was so hot. No idea because there was no conversation. And so having the conversation is the important thing. And so when women come to our office, they know they’re free to talk about just about anything, which is why the questions are just about anything because they feel empowered, which is part of what we do. We want to empower women to ask the questions. If they don’t know the answers or can’t find it from somewhere else, come to us because we are the GYN experts.
Dr. Mironda Williams:
That’s right. And so I want to get to these questions, but just as a highlight too, we are all board certified OBGYNs, but now we focus on gynecology. So as a part of our board certification, we have to annually re-certify, which means we have to do continuing medical education and just continue to learn and make sure that we’re staying up to date. And what I have found, ladies, especially in the last few years… And so we read various different scientific articles and just different things that are presented and we have to answer questions about that. But what I have really enjoyed is the number of current research articles that are being assigned to us to read as a part of our board certification. Most recently, this last year, one that we keep referencing to, and we’ve all highlighted, was a contemporary review of menopausal hormonal therapy because, guess what? There’s a whole lot that has changed. There’s a lot of terminology that has changed. We recognize some things.
And so last year, last season of the podcast, we launched a series called Ask Your GYN. And so we asked our patients to send in questions that they had for their GYN, and then we would answer those questions on our social media platform. So we encourage you to look back at those, and we will continue to do that in this year going forward. And so we sent out an all call for questions to ask your GYN and got back some really great questions. And they all, it was just mostly were about menopause, menopause management, as well as some other general gynecological questions. So we’re going to jump right into these questions because the ladies who sent these in, thank you, keep these questions coming because we are definitely going to continue to answer these questions.
So ladies, let’s just go down the list in the order that we received those. And so Dr. Guthrie, I think you have this first one because there were a couple that kind of all hit the same thing and that is…
Dr. Deanna Guthrie:
And the question is, at what age is a pelvic exam no longer necessary? Well, there is no set age. It depends on your health status and how you feel about continuing to take care of your health. ACOG, our governing OBGYN body that gives us guidelines, they still recommend an annual exam, but it’s how you are living your life, whether or not that annual exam is how you feel necessary. I give as an example, if there is a patient who has multiple medical problems, is living in a nursing home, do we get that woman dressed up to come out and do a pap smear on her… I mean, or a pelvic exam, excuse me. No, because chances are anything found at her health stage in life, she would not want an aggressive treatment. But I see plenty this morning, 83, 85, 90 year old women who are walking, driving themselves, healthy, living their best life, who know for themselves that if there was anything going on in their body, they would want to know and manage it. I had a patient who came in who was 80 and she asked me this very question that day. And when I did her exam, I found a cancerous lesion on her bottom. And she said everyone was telling her, “Girl, you’re 80 years old. You don’t need to have those exams anymore.” So again, it’s how you feel about your health and what you want to do.
Dr. Mironda Williams:
And one that went along with that that was asked several times, do I still-
Dr. Deanna Guthrie:
Need a pap smear.
Dr. Mironda Williams:
[inaudible 00:11:46], yes.
Dr. Deanna Guthrie:
So the person who asked, she was at the gorgeous age of 71, so that was her question. So again, we have our governing body ACOG. The Pap smear is a test for cervical cancer, and the Pap smear screening that we have had in place to pick up early cervical cancer has changed tremendously. In the past 20, 30 years, we are now concentrating on what we know as the likely cause of cervical cancer, which is the human papilloma virus. So you’ll hear the initials HPV. When you do a Pap test, which is just looking at the cells on your cervix and the HPV test together, we’re getting more accurate testing and it has enabled us to space out how often you need to do a Pap spear. So that’s number one.
Also, as we learned how cervical cancer behaves with this HPV virus, we came up with… The age limit to pap smears is technically around age 65. So if a woman at age 65 has had normal Pap smears her entire life, at that point, she does not need to undergo the annual routine screening. Now, if something is ever seen on an exam, we can always do a Pap smear at any time, but just coming in for a regular annual Pap smear, it is not needed anymore after age 65 because of how we know cervical cancer behaves at that point. So there is retirement for Pap smears.
Dr. Mironda Williams:
Or if you had a hysterectomy.
Dr. Deanna Guthrie:
Or if you’ve had a hysterectomy.
Dr. Mironda Williams:
So let’s get to some of these menopause questions. I’m going to start with one, and then Dr. Greene, I think you have another menopause related one. So we had a question to ask your gynecologist. I love this. As a woman of 66 who enjoys bedroom time with my husband, what is the best way to combat vaginal dryness? Well, first of all, shout out to all the sexy 60 year olds. That’s number one. Shout out to the sexy 60s, 70s, electrifying 80s, all of that.
Dr. Karen Greene:
All of that.
Dr. Mironda Williams:
So as we were mentioning earlier, menopause is just a stage where your ovaries are no longer producing estrogen. So the vaginal tissue and as well as all of that tissue in the vaginal area is estrogen sensitive, meaning it can respond to the lack or the withdrawal of estrogen. This can occur most commonly with menopause. Also, women who may be getting treated with chemotherapy and various different things may artificially have their ovaries turned off in essence, and so the estrogen levels decrease and so they also have vaginal dryness, itching, burning. There’s also, now they’ve got a whole term for it, the genitourinary syndrome of menopause. What that means is everything down there dry. Okay? So you can have symptoms that feel like a bladder infection. You’re going to the bathroom all the time, or you can’t go, you can’t empty, and you get checked for a UTI, there’s no urinary tract infection. A lot of times that may be related to the estrogen or the atrophy effect along the urethra or the opening of the bladder. And then along the posterior tissue near where the rectum is, all of that tissue gets dry, irritated, thin, and that can make having sex not feel good, not comfortable.
So we often have a lot of women who come in complaining of decreased libido or not wanting to have sex. And as we talk to them, we find out it may not that they don’t want to have sex, but when they have tried to have sex, it hurts.
Dr. Karen Greene:
It’s not pleasant.
Dr. Mironda Williams:
And so it’s not pleasant. So it’s like you can’t live your full sexy self when things are hurting. How we can combat that is just like we use moisturizers for our face, our hair, and the rest of our body. Thankfully now, because of all of the attention now being turned to this, there are many, many vaginal moisturizers available that are non-hormonal. So sometimes just rehydrating that tissue with vaginal moisturizers that you use on a regular basis, just like you regularly hydrate and moisturize your skin and your hair, the same thing is true with the vaginal tissue. It has to be hydrated on a regular basis. So there are several non-hormonal options.
There are also estrogen vaginal creams, vaginal tablets. There are other ways of giving you estrogen to the vaginal area and to all the tissue in that area, because you’re giving the tissue back what it needs, a little bit of estrogen. The good thing about this topical estrogen is that it only works in that tissue. So for those who are concerned about the estrogen being absorbed into your bloodstream and those kinds of things, which in and of itself is not necessarily a bad thing, but if you have that concern, using that topical or that local application of estrogen also gives the tissue back what it needs and therefore hydrates the tissue so that sexual intercourse is not uncomfortable.
And then there are always vaginal lubricants that can be used at the time. But what I tell patients is if the desert is dry and then you put a drop of water on the desert-
Dr. Karen Greene:
It’s going to not work.
Dr. Mironda Williams:
… it’s still going to be a dry desert. So what we need to do is to develop a regimen of what works for the individual patient to keep the vaginal tissue hydrated, pliable, stretchy, all the things to make your sexy 60s, 70s, and 80s the best ever. And always consult with your own gynecologist or healthcare provider to get specific information. We just want to provide you with general options and information for the things that you can do. But yes, there are things to combat vaginal dryness.
Dr. Karen Greene:
My question is actually along the same lines. What the person asks, I know that menopause can cause an increase in urinary tract infections due to increased vaginal dryness. Even when I don’t have one, I experience burning around the area of the urethra. I’m already on hormone replacement cream with estrogen and progesterone. How can I treat this constant burning? And then how do I know when it’s turned into a UTI? As Dr. Williams referenced, genitourinary syndrome of menopause has to do with all of the things that she described, including the lack of estrogen in the vaginal area. The estrogen affects the vagina, it affects the urethra, it affects the vulva, it affects the bladder. In addition, as women age, the capacity for your bladder decreases. So oftentimes you feel as if you have to go a lot. And when you do go, it burns if you don’t have any estrogen in those areas.
Now for some women who are on hormone replacement, the hormone replacement that they’re on will help with that area. But as we’ve discussed in the past, actually applying estrogen specifically to that area to help with the dryness will help not only with intercourse and make it more pleasurable, but also help with the bladder elasticity so that your bladder doesn’t feel irritated. It doesn’t feel as if it’s always full. It doesn’t always feel like you’re burning. There are patients that will come in with that sensation of it’s just burning down there, it’s just dry down there and it’s really not. It’s just very thin, not very pliable, not very stretchy, and it burns. It burns to the touch, it feels as if it’s red, doesn’t actually look red, but that’s the way it feels. So replacing the estrogen in that area can often make a big difference even if number one, you’re not sexually active, or you’re just having the problem of having the burning externally and feeling as if you had a bladder infection.
The question of, how do I know? So first of all, see your gynecologist, because if you see someone in urgent care, oftentimes they’ll just treat you and that’s really not what you want. You want someone to do an exam, so they can actually assess all the possibilities and say, “This could be a bladder infection, but it also looks like you have genital urinary syndrome of menopause.” Let’s treat that and wait on the culture because what we don’t want to do is keep giving you antibiotic after antibiotic after antibiotic, which then can cause a share of other problems. So the most important message when it comes to bladder infections versus burning and vaginal dryness is talk to your personal gynecologist so that they can do an exam. It is the one place where you have to get naked and we understand that and we respect that, but it is the one place that we actually do have to take a look at those areas so we can make a determination of what’s the next best thing to do.
Dr. Mironda Williams:
Dr. Guthrie, you have a menopause one?
Dr. Deanna Guthrie:
Yes, I do. Person, it just said, “I’d like to learn more about hormone replacement therapy for myself, age 57.” So as we said, it’s a transition that all women are going to go through, and every woman goes through it differently. You can of course talk with, commiserate with your girlfriends, your sisters, your aunties, but your journey is your journey. Also, when you’re hearing about people who, whatever they’re doing for their menopause, it may not be the best thing for you. So as Dr. Williams explained earlier, it’s because your ovaries are producing less and less hormones, and anything that will act like it’s replacement of these hormones will hopefully relieve those symptoms.
There are three main ways that you can treat your menopausal symptoms. You can use natural herbal products that when you take those into your system, they get converted to look like hormones and it may help your symptoms. There are women who medically cannot take hormones for different reasons, whether or not you’ve had a stroke or you’ve had a history of blood clots. So hormone replacement is contraindicated, but there are other medications that where they work in your body will help to relieve your symptoms. A lot of the symptoms of menopause actually originate in the brain. So a hot flash has nothing to do with the temperature outside. You could be in a freezer and have a hot flash, so it’s where estrogen receptors are in your brain. So certain medications that are out that are common can also help menopausal symptoms.
And then there’s taking hormone replacement itself. As Dr. Williams stated earlier in the beginning with the FDA removing the black box warnings, it has opened up I think hormone replacement for a lot of women who were afraid. Also, other physicians recommending it. So primary care doctors would be very, very tentative and almost a lot of them anti-hormone replacement therapy because I’ve had lots of patients where I’ve started them on it and they go to their PCP and the PCP tells them to get off of it. But you have hormone replacement therapy and there are different ways of doing that. You can take pills, we have patches, creams. We were talking about the creams, the vaginal creams. You have creams that you can put on your skin. They have vaginal rings and then also pellets. So there’s a myriad of things that we can do to help your symptoms.
And as Dr. Greene just said, come in and see us. Come go to your provider, have an honest conversation with them, tell them what your symptoms are, because that’s also going to guide how you’re going to treat your symptoms. It’s not a cookie cutter. There’s not one pill that helps everybody all the time.
Dr. Mironda Williams:
And I have one more question here I’ll read, and then ladies, just answer it how you would answer as we do when you see our patients. And again, we are not saying this is the answer for you. We’re giving you information as we see it. Please continue to reach out to your own healthcare providers or come see us. But I thought this was a good question. So this patient asks, “I’ve been taking HRT, or hormone replacement therapy, for five years to resolve hot flashes and to help with bone loss, especially as I have a high risk of osteoporosis.” All those are good reasons to be on a hormone replacement therapy. But the question is, “How long can I be on HRT?” So, and again, just how do you guide patients when deciding about the length of HRT, Dr. Greene?
Dr. Karen Greene:
It’s interesting. I think that my guidance has changed and it had a lot to do with the black box warning because even though we knew that the information that this warning came from was not based in data that made sense and we were prescribing hormones for the last 20 plus years, because patients were always concerned, a lot of times in the past I would tell patients, “Well, take them for five years and then see how your symptoms are. ” Knowing that actually you can take them as long as you’re symptomatic and they’re treating what you need to treat and you’ve not developed any of the risk factors that we say you shouldn’t be on them for. For someone like her that has a risk of osteoporosis, even if she’s not symptomatic, taking the amount that’s going to help her bones is realistic. And there are of course other things you can take for osteoporosis, but there is no timeframe within which you need to stop taking hormones.
Dr. Mironda Williams:
Dr. Guthrie?
Dr. Deanna Guthrie:
I tell my patients there is no designated age where you have to stop taking hormonal replacement. A lot of patients will go to their primary care doctors, and for some reason they’ve been given an age where they have to come off of it. I tell my patients, “This is why you’re not prescribed hormone replacement therapy and you’re given a five-year prescription and we send you off into the sunset.” This is when you’re coming in routinely, annually with your GYN doctor, you’re having the discussion with them. “How are you doing on hormonal replacement? Have your symptoms gotten better?” A lot of people come in and as they’ve gotten older, they’ve been placed on other medication and they want to stop. They’re saying, “I’m tired of all these pills. I want to start decreasing the amount of pills that I take.” Hormone replacement may be one of them. And if you wean off, you don’t want to stop cold turkey, you want to wean off your hormonal replacement, you may not need it anymore for those symptoms that you were having. So there’s not a specific age. It depends on how your symptoms are still occurring, your health status, and whether or not you want to continue taking them.
Dr. Mironda Williams:
And the only thing I’ll add about the question of how long can you take HRT, there’s a wealth of information that’s coming out now due to ongoing research, and we’re starting to see some really exciting information about the positive effect of estrogen replacement therapy for brain health. Again, we’ve talked about bone health with osteoporosis, perhaps even some in terms of being protective of the breast. So there’s starting to be a wealth of data that is coming out that says being on estrogen is a good thing for those individuals that it’s a safe option for. Estrogen in and of itself is not the devil, it’s not bad. There may be other health issues for that individual that limits or kind of puts some constraints and boundaries on what can be done. But in and of itself, HRT or hormone replacement therapy doesn’t have an endpoint per se.
I have another question I’m going to read and then ladies, just how would you answer? The patient asks, “I am 65 years old and currently on an estradiol patch. Is it still possible to add progesterone and/or testosterone, but I have had a hysterectomy?” Dr. Guthrie?
Dr. Deanna Guthrie:
Yes. Yes. You can add those other hormones depending on what your symptoms are, and it depends on if it would be beneficial for you. It’s not just a blanket, “I should be on all three.” Again, this is a discussion you would have with your provider to see what are the risks, what are the benefits, and would you gain anything from adding these hormones to your regimen?
Dr. Karen Greene:
I would agree. Oftentimes when a patient comes in and we’re actually checking hormone levels, if they’re getting benefit from just the estrogen alone, but the progesterone level is a lot lower, we will add the progesterone and talking to your provider and getting an assessment of what your symptoms are actually does help us make a good decision because of all of the research that goes along with the benefits of the individual hormones on not only your symptoms of the hot flashes and the vaginal dryness, but also the brain changes in terms of the mood changes that can go along with those lower levels of progesterone that affect your cortisol levels.
So we really do try to keep up to date on the latest information because it makes a difference to our patients to understand why you should be on this particular one and that we’re not actually looking this little cookie cutter and saying, “This is what you’re on because this is what they say.” We’re actually looking at the data. We’re looking at the research. We’re looking at what the individual patient needs.
Dr. Mironda Williams:
Great. So again, looking at the list, there were some questions that all focused around perimenopause. So maybe we can give just some guidance and understanding because there’s so many terms being tossed around, which we love. We love that there’s a discussion and the terminology, and so we want to make sure that we help to provide guidance on about… There’s people come in, they say, “Well, I’m perimenopausal, or I’m postmenopausal, or I’m menopausal, or I don’t know what -ausal.” So who wants to start with just kind of give people briefly some understanding about why those different terms are abandoned about?
Dr. Deanna Guthrie:
It is funny because they may have asked me a question and I’m talking to them and I’ll say something, “Well, you know you’re menopausal.” “Well, I thought I was post. They told me I was done with all that.” I’m like, “Okay.” So this is where I kind of go into the explanation. It is all a continuum. And so as we’ve stated the ovaries produce less and less hormones as you get older and older. So when you are younger and you’re menstruating every month, you’re premenopausal. If you want to give the definition for that, you’re having regular cycles, your hormone levels are normal. As you are getting closer to the point where you would stop having periods, your hormone levels are falling. And during that time period, you may still be having periods, but you can also have the symptoms that go along with menopause. And so that’s why we called it perimenopause.
Dr. Karen Greene:
Around.
Dr. Deanna Guthrie:
Around. The definition of menopause is when a woman has gone a whole year, and they had to pick an arbitrary time period. When a woman has gone a whole year without a period, then we’re pretty sure you’re done. You’re in menopause.
Dr. Karen Greene:
You can’t have any more babies.
Dr. Deanna Guthrie:
You can’t have more babies. And so-
Dr. Mironda Williams:
Because that’s another issue about perimenopause and contraception.
Dr. Deanna Guthrie:
Yeah, contraception too. So when you go at that whole year without a period, you have become menopausal. And then the way I look at it, after you’ve been in menopause for a period of time, then you can use the term postmenopausal. But it’s all a continuum of the function of your ovaries in producing hormones. Going back to what Dr. Williams said about perimenopause, when you are still having cycles, and even though your hormone levels are falling, pregnancy is not impossible. So we have a lot of patients who have chosen for their life to do a rhythm method to prevent pregnancy, or prayer, or-
Dr. Mironda Williams:
Withdrawal.
Dr. Deanna Guthrie:
… withdrawal. When your periods are more regular, you can time things fairly accurately. But as you get into this perimenopausal period, hormone levels are all over the place, ovulation is all over the place. So you cannot rely on those cycles, those apps. And we’re using apps now. You can’t rely on them in the perimenopausal period.
Dr. Mironda Williams:
Anything to add, Dr. Greene?
Dr. Karen Greene:
I guess when you say that everything’s all over the place, and interestingly enough, some women are more symptomatic when everything’s all over the place and some people are more symptomatic when it stopped altogether, which is why having a conversation and understanding the value of the conversation and the symptoms, over sometimes even the blood work. Because although blood workers can be used to guide a patient or guide us, testing to see if I’m menopausal doesn’t really exist unless you’ve gone in a year without a period. Because in the perimenopausal timeframe where things are going up and down, I can test you today, but if you have a period tomorrow, your hormone levels may say stone cold normal, but you’re sitting there fanning. And I get it because your normal is less than it was before. And I don’t know what it was before. So the whole journey of the menopause, the premenopause, the perimenopause, the postmenopause is something that we stress to our patients so they understand how we’re thinking about the whole process and the symptoms.
Dr. Mironda Williams:
Dr. Greene, did you have another menopausal question that you had already kind of looked at that you wanted to answer? I just wanted to see if we had another menopause question.
Dr. Karen Greene:
No.
Dr. Mironda Williams:
Okay, good. I have one more question. This is so good, we going all day. But there was one really good question I thought, and we will come back with more of this on some additional episodes, but it wasn’t a menopausal related issue, but I think it’s an issue, a question that I really wanted for us to give our thoughts on and our answers to. The patient sent in the question that says, “I’m obese with a lot of belly fat. How are ovaries examined?” And I love this question, and I love this patient for sending this question, because one of the things that we always talk about is how we see patients and we don’t want any patient to exclude themself from care because of any body issue.
And so I thought it was also a very insightful question because ovaries in actuality are not very large. They can sometimes be like a large almond or maybe a small egg, but even on thin individuals, it is not easy to palpate or feel for the ovaries. So when we are doing a pelvic examination on any patient, as it relates to the ovaries, we’re really more trying to determine what we’re not feeling-
Dr. Deanna Guthrie:
Exactly.
Dr. Mironda Williams:
… than what we’re feeling because ovaries are small. So the pelvic examination on any woman, whether it’s a thin woman or a woman that’s fluffy like me, I’m feeling to say, “I don’t feel an ovary more so than I’m saying I’m feeling for your ovaries.” Not feeling an ovary is normal. Feeling an ovary can sometimes mean that there’s a problem because that means that ovary is bigger than usual. Ovarian cancers are horrible for this reason because we still don’t have a really good early screening tool for ovarian cancer like we do for cervical cancer. That’s why the Pap smears are important because it allows us to screen before things get to the cancer stage. Ovary, not so much, but the pelvic examination is important because if I’m not feeling your ovaries, that gives me reassurance as your physician and I can give you reassurance that your ovaries are most likely normal.
Dr. Deanna Guthrie:
[inaudible 00:35:56]. Same thing with ultrasound reports. You’ll get an ultrasound report and it says ovaries not seen. That’s a good thing because that means they’re not enlarged, there’s not a large cyst there. As Dr. Williams says, it’s more so what we’re not feeling than what we are.
Dr. Karen Greene:
And also back to Dr. Williams’ question, I appreciated that the patient asked it because I don’t want someone to not come in because, oh, they can’t feel anything anyway, because I’m fluffy. No, there’s a way we do the exam and her explaining what we’re actually feeling is very important because we want patients to come in and not restrict themselves because of their personal body image.
Dr. Mironda Williams:
Yes. And then just to close out this session of questions and keep them coming, we love it. In our office, one of the reasons, again, we’ve been intentional about how we’ve designed our office and the kind of services that we provide is that we have onsite ultrasound in our office, in our Peachtree City office. We have two office locations, one in Peachtree City, one in Newnan. In our Peachtree City office, we have onsite ultrasonography, we also have onsite mammography. Because if there’s a question, if I think I feel something, I’m not sure if I feel something, let’s just make sure that there’s nothing going on that needs to pursued. We have the ability in our office to go ahead and get an ultrasound done that actually can image those ovaries or not, but it helps to give even more clinical information in terms of what’s going on with the ovaries, uterus, tubes, all of the pelvic organs. But we have that available on site in our Peachtree City office to aid in our clinical evaluation of our patients.
So again, we see everybody. We’ve always seen everybody and we will continue to see everybody, and we make sure that we have everything in our offices, both offices, that are designed to make all patients feel comfortable, welcomed, seen, heard, and valued. Anything else, ladies?
Dr. Deanna Guthrie:
Keep the questions coming.
Dr. Karen Greene:
[inaudible 00:37:57]-
Dr. Mironda Williams:
Yes. We didn’t get through, well, maybe half of them, I don’t even know. We’re going to do more of these, and we’re also going to produce and put out some just individual videos as well, answering your questions, so you don’t have to necessarily wait on the podcast. But continue to watch the podcast.
Dr. Deanna Guthrie:
And Dr. Williams, where can they send their questions?
Dr. Mironda Williams:
I’m so glad you asked that question, Dr. Guthrie. If you go onto our wonderful website at rosagynecology.com, you will be able to see a section on the website, Ask Your Gynecologist, and you can always send us information and questions through that on our website at rosagynecology.com. Again, that’s rosagynecology.com. You can also find us on Facebook, Instagram, all of the social media platforms, YouTube, wherever you get your podcasts. We’re everywhere. Call us, send us a question, mail, we’ll take it. So keep those questions coming and we will do our very best to answer every last one of them because we appreciate your engagement. So until we meet again for the next episode, I’m Dr. Mironda Williams.
Dr. Deanna Guthrie:
I’m Dr. Deanna Guthrie.
Dr. Karen Greene:
And I am Dr. Karen Greene. Take Good care.