A Vulvar "Rash" You Can Ignore If you Want

Sometimes it begins as a small spot, you may have thought it was a rash. But it's actually a skin condition called vitaligo. Its simply depigmentation. Not harmful, in some the skin color differences are certainly not dramatic. The darker natural skin color as in this patient does make it more visible. If the area is symptomatic in any way, or progressing a biopsy can be done, but usually the diagnosis is made by looking.Most women, can ignore it for the most part, and if it doesn't change and the look isn't bothersome to you, particularly in the vulvar area, it's not thought to be harmoful and so you can ignore! Pigment treatments, steroids, various creams like calcineurin inhibitors,vitamin D, pseudocatalase creams,or  hydroquinone. If that hasn't worked light therapy has worked.

An excellent organization devoted to helping women with this condition and providing answers is on line at National Vitaligo Foundation

Hair Loss? 'Tis Not (Usually) this Season!

Most of our gyno patients with new onset of hair loss present with simple alopecia: to hair loss without permanent destruction of the hair follicle. Srtess, seasonal loss (warm months), or most commonly just normal loss with exaggeration due to poor treatment of the hair. Pulling, tugging, brushing, braiding, toweling, pretty much all touching will cause us to shed hairs. First just be nice to your hair, then get in there and see if the scalp is healthy, finally, get some quick hormone checks like a basic thyroid and menopause check. If none of those are yielding any answers it's time to go in for the full differential diagnosis. In the differential diagnoses are some fairly intimidating conditions: anagen effluvium, androgenetic alopecia, chemical alopecia, folliculitis (mild), inherited disorders of the hair shaft, telogen effluvium, alopecia areata, and traumatic alopecia. Your gyno might be able to help, or your dermatologist. Don't just "brush" it off to no big deal, hair loss can actually be a symptom of other underlying issues and if it goes on long enough, everyone deserves at least a brief check up.

Hips For Birthing?

Truthfully, your gyno probably cannot tell much until you become pregnant because your pelvis does open up once you begin making certain hormones during a pregnancy. 

When is More better: More Babies?

Maybe it just comes from getting it right. Maybe it comes from some other unknown factor. Over 5 million women were just studied in the largest study of stillbirths that has ever been reported and the results appeared in the November issues of this year's American Journal of Obstetrics and Gynecology. Did you realize that women who have not had a child are at least 60% more at risk to have a stillbirth as a woman who has had one.

Top News Stories of 2008

The end of the year is approaching. Top Ten Lists will be uppon us. Plaque vs the Vessel, yep, it's not just the cholesterol: Time List #2 . And this was a trial that Women's Health Practice Participated in!

Women's Health By the Numbers: 76

The lower your heart rate is the healthier you are. To a point yes. So no absolute, but generally speaking the lower your rate the fewer heart attaches and strokes you are likely to have. This was showin g in as secondary analysis of the Women's Health Initiative "WHI" study. The women who had heart rates under 76 were the least likely to have a cardiovasular event. Interestingly this fact persisted whether you are a diabetic or not a diabetic and accross ethnic groups. It was even more predictive for women in their mid 50s than women in their mid sixties.

Older Moms, How old is too old?

Moms in the US are getting older, and surprisingly to many, this has proved wiser in ways as well. Women over 35 are more likely to have a career, to have had a planned pregnancy, to be in a social and psychological frame for pregnancy and there in lie the primary advantages.

There are challenges, so one has to be wiser when approaching this decision. Miscarriage rates, already relatively high (1/6) climb to ½ for the mid forty pregnant mom. While the scientific approach to age related fertility is to assess a woman’s ovarian age, rather than their chronologic age, there is a fairly direct association between aging and conception rates. Women in their 30s and older are more likely to have uterine fibroids, endometriosis or other gynecologic conditions that if remain untreated can affect fertility. Fertility testing and treatments are usually covered by insurance after “year of trying” but physicians caution that women over the age of 35 trying to have a baby start their infertility testing if they aren’t pregnant within 6 months of trying as about a third of women over 35 will have fertility issues, and over half over 40 will have difficulty conceiving. All fertility treatments, including inseminations and in vitro fertilization (IVF), decrease in effectiveness as moms get older. For IVF for instance the percent of embryo transfers leading to births decreases from almost 50% in women under the age of 35 to 15% for women of 41 to 42 and only 6% for women aged 43-44.

The association with age and chromosomal birth defects is relatively well recognized, and the statistics are fairly dramatic. A woman’s statistical risk of having a trisomy 21 (Down’s Syndrome) child if delivering at age 20 is about 1/2000, by age 25 that climbs to 1.1250, by age 35 about 1/400, by age 45 1/30 and by age 49: 1/10. AMA mothers (physician initials for Advanced Maternal Age), have increased risks of structural defects in their children as well, and congenital anomalies including heart, lung and other organ defects are the leading cause of infant death in the US.

Older moms are more likely to have twins. They are also more likely to have triplets, but that’s mostly due to fertility treatment. The increased rates of twinning is specifically due to age related double ovulations. Other pregnancy problems are common as well, including gestational diabetes, which AMAs are twice as likely to develop, and having a thromboembolism (blood clot), already a serious problem, accounting for 15% of all maternal deaths, is more common in women over 35. Direct pregnancy effects on the fetus as mothers get older include placental problems like placenta previa (placenta is implanted over the cervix), is twice as likely when you are pregnant in your thirties and about three times as likely as in your forties,. Prematurity (babies born prior to 37 weeks) and stillbirth which is the direct consequence of poor placental feeding of the developing fetus.

There is also a concern that older mothers are penalized in their general health care when pregnant. They less likely to have mammograms (concerns regarding radiation to the fetus if already pregnant and not current on tests) so less likely to have a breast cancer diagnosed early, less likely to receive effective medical or surgical treatment of their condition, in spite of the well meaning care of some of their health care providers.

So how old is too old, like everything in medicine, the adage is, it’s all relative. Risks are greater. Definitely physicians don’t advise waiting if you can make your mind up earlier, as you can see risks go up fairly rapidly. And what do we advise, well, not so much more or less than what we advise for younger women planning to get pregnant. And lastly, have sex, age related decline in sexual activity leads to part of the decreased conception rates, now that’s a prescription that might even be more popular than an apple a day!

Headache Types and Your Pills

Gyno Gab Says most women get headaches. The most accurate classification system for headaches is the International Headache Society (IHS) . Almost 3/4th of all HA are just a tension headache: both sides of the head hurt, steady, no throbbing, mild to moderate. Could be a bit of mild nausea, but no vomiting and could be a bit of light or sound sensitivity, but not both. Migraines: one side of your head, usually the eye or above the eye, and and these are moderate to SEVERE. Often in a set of them one after the other, with or with out treatment, you rebound into another headache, that's called a cluster. And with migraines lots of associated eye or nasal symptoms. Will be preceded by a premonition with may have a set of symptoms that can range from food cravings to depression or fatigue or just neck stiffness, or a variety of other symptoms. Those with auras the symptoms are neurological, usually visual. So zigzag lines, or spots before your eyes. Risks of stroke in young women are low,and with or without migraines still low, but migraines with aura might be one of the more significant predictor of stroke, and might double one's risk. And if we add birth control pills onto this already doubled risk, the risk may double again if you have aura. So the general recommendation: if you have migraines with aura, and are over the age of 35 then find another birth control: don't use pills. Menstrual migraines, different issue. For lots more in depth detail go to the newest issue of Contraception, Issue 80 pg 417, 2009.

When to schedule date nite?

Checking your calendar as to when to schedule date nite? Babysitter, check. Night off of work, check. Jeans shortened at cleaners, check. But how about when your sex drive will be peaking? This may vary from woman to woman. If you aren’t on pills you may notice that your sex drive is at the highest when your testosterone levels are peaking, that would be in the third week of the cycle. For women with PMS, well, about a third of you have sexual dysfunction anyway, maybe check with your gyno first and get some of that cleared up!

So You think Your Not...

FAT? Get the Facts before you brag, brag, brag about all that muscle. Simple body fat analysis can give you that % of lean body mass vs body fat. And then we can talk. And what's important on a diet: maintaining that lean body mass while you loose fat, and loose abdominal fat. So when this gyno gal gets you on a diet we get you on the Lunar Prodigy for a bit of analysis. A few facts are in order to help the plan along!