GynoFiles

New information shows that ferritin, a marker of our iron stores, is a very important component of our health. Ferritin has been linked to insulin resistance, atherosclerosis, and bone metabolism. Too much iron is not healthy for our bones, our sexual health, and or livers. So balance is the key, and it is healthy to lower those ferritin levels. Higher ferritin levels accelerate bone loss, leads to osteoporosis and osteoprotic fractures. Feritin is actually a protein that is produced in situations like infection, immune dysfunction, and overall body inflammation. It plays an important role in osteoporosis though the mechanism of inflammation. Ferritin has also been associated with fatty liver disease It's often true that a particular medication is studied in what I would call 'blinders fashion medicine', meaning the medication is studied in a group of women with the condition, and only with that condition. Often medications that might interact are exclusions from the studi...

Hormone therapy is one of the most studied treatments in medicine. The effects of estrogen, the main component in most hormone therapy, are so wide ranging, that it's important that each individual work with a provider to decide if and when to begin therapy, what dosages and formulations to use, when to change, how to monitor, and when to stop. Given that large population studies have only given pieces of advice to providers, often women have been told what they perceive is conflicting advice. Much of the confusion stems from an interpretation of 'risk' and what some perceive as too much risk is viewed as virtually no risk to others. Given that some women are willing to assume more risk than other women, we have to recognize that Women do need to discuss their individual risk factors, and it is going to be the most beneficial if you begin your therapy within the first 10 years after your natural age of menopause, or at least by age 60. A new Revised Global Consensus statem...

The newest data on the Mediterranean diet shows bones are healthier on this diet. This study was published in JAMA on line, and is based on looking at diet components of 93,000+ women in the Women's Health Initiative. In this study women who had the highest adherence to the type of foods in the Mediterranean diet had the lowest risk of hip fracture. Data has also shown that the Mediterranean diet  can protect against breast cancer protection as well as being good for your heart, your kidneys, and your brain.This study was fascinating because it compared just adding a few nuts to your basic diet, or going low fat. But specifically a Mediterranean Diet helped protect against breast cancer in post menopausal white women who were at high risk for cardiovascular disease. The study does have some limitations for what women can apply to their own health. But the data has been accumulating for many years that eating a Mediterranean diet is the best diet for many people. Ther...

Just because you anti-age, you may not necessarily be assuring longer life. It does seem like a reasonable assumption though, so most of us want to know a plan to live longer and live well. No one sure fire longevity plan exists, but here are some basics to consider. The longevity gurus are seeking to live to, at least 150 years young, the rest of us scare if you tell us we’re living much beyond 90, making that much assumed leap that living longer at that age, will not be living well.And then there are financial considerations we can't even imagine. The current theoretical limit of old age for humans is about 120 years old, that’s about the oldest we’ve ever established anyone can live, barring the occasional raised brow as to the actual birth date of some of these older individuals. At the turn of the century before last we lived to about 50, now about 80, 80.8 for women as of the latest statistics. But that reflects more people living from diseases that killed th...

Osteoporosis is the result of many factors, when combined with genetic factors is the end result on your bones potentially making you have chronic pain and fractures. Smoking, hot flashes, and even weight loss can cause bone loss. Many women at risk do not even know they are at risk for bone loss . It may be worse for your bones to have hot flashes than even to smoke! The more a woman had hot flashes the worse (lower) her bone mass was according to a journal of Clinical Endocrinology article written by Dr. Carolyn Crandall of UCLA. 85% of all women report night sweats, and they are due to reduced levels of estrogen.The reasons we should not ignore hot flashes based on bone health has been shown in other studies. Women who have night sweats and hot flashes are also at risk for low bone mass according to the research on 5600 women in the Eindhoven Perimenopausal Osteoporosis study as well as the SWAN study on over 2200 women. What we don't know yet is whether we have to also cure ...

Part of a vigorous life is to have healthy bones. We all want them not only strong but resistant to fracture. We have to take calcium, vitamin D, and should have an overall healthy diet. We have to exercise, and include weight bearing exercise. But is there more too it once menopause starts? Yes, for women, things do change with our bone physiology once menopause starts. The premenopausal woman's ovarian production of estrogen provides a strong drive for that calcium to stay into bones in a greater density. Losing estrogen inevitably causes women to have a dramatically increased bone loss at menopause.  If we look on scans, or at actual bone biopsies like this one, you see the bone structures, on a microscopic level, begin to thin. Thin bones are not as healthy as thicker bones, in most cases. But will that translate into an actual fracture? Young women, who genetically have more stable bones may not have bones that will fracture, as young people may not fall for example. An...

Teen bones are growing, and it's important not to disrupt that process. A significant percent of all of the bone mass is accumulating in the teen years. This is why calcium, avoiding pop (which could interfere with calcium), and getting proper exercise is important to bone health/ But the bone gets calcium by getting one of many hormonal signals that will tell it to take calcium from the blood stream. Birth control hormones are among the type of hormones that do affect bone calcium and bone turn over. The amount of calcium, the amount of Vitamin D (which helps harvest calcium from our food), and the metabolism of bone including the rate bone turns over, affects one's bone health. In order to know accurately what your bone health is it may be necessary to get an actual test of the bone thickness. The bone thickness test is done by a machine (shown here) called a bone densitometer. It's not usually done on  every young individuals, as it should be done on everyone ove...

Chew on these facts about the calcium you need and your overall health. Calcium is healthy for you. Osteoporosis, the bone disease which is the loss of calcium in one's bone until the bone is weakened and at risk for fractures, is a fairly common disease. If you don't lay down enough bone in youth and young adulthood, you will never have bones as strong as they could be. So in youth you need good calcium, as well as a diet that will not block the calcium you are consuming.And taking calcium with soft drink may inactivate the calcium you have taken, so not together!  But regardless of how excellent your calcium intake is and how strong your bones are: through genetics, or weight training or extra calcium; we inevitably lose bone as we age, regardless of our calcium intake. We will lose about 1/2% per year in our late 30s and 40s, by the time we are in menopause we begin to lose 4%/year, and in old age we still lose 2-4%/year. In menopause, the loss of estrogen is responsible fo...

Are you planning to stop at one child? Two? More? Concerned about world population growth? Will your decision revolve around your job? What age should you start? When you want the baby to have a birthday? When the right time is to have a baby is a whole different discussion, and one that is likely to be more social than gynecologic! Many patients don't want to have children at all, and so the answer for them may be: zero is the right number of children. Are their physical concerns with birthing more than one child? We've touched on this topic in lots of posts! Have more babies and you have less chance of breast cancer,  and if you breastfeed your children you are even less likely to have breast cancer. On the other hand, for each child you breastfeed you may decrease your total bone mass (at least during the feeding, some research says if you give it long enough you can recover!) More babies also means less uterine and less ovarian cancer. But the bladder probably suffers, mor...

Hormone therapy can be prescribed in so many forms. There are pills, implants, creams, patches, gels, shots, vaginal rings just to name a few routes of administration. Further more hormone therapy can be of so many compounds: not just estrogen, but testosterone, progesterone, adrenal hormones all may be in the mix of what is prescribed. Most pharmaceutical companies produce hormone replacement therapy that is from synthesized chemical sources, but some also have produced hormone therapies from natural ingredients, such as the yam. Hormone therapy is very tightly regulated when it comes to standard prescriptions therapy that women are used to, but it is also possible to have your gyno write a dosage and formulation that is specifically mixed for you. Most all these mixed products are made from plants such as the yam or soy. This is what is known as bioidentical and also compounded therapy. Compound therapies may be necessary for a very few women, and these formulas have undergone a ver...

Each day as we see patients at Women's Health Practice we spend a lot of time on the thyroid gland, we examine the gland, we test for the brain, pituitary hormones, that control the thyroid, we look at the antiboidy levels, we look at the binding proteins, we spend time discussing the symptoms of over and under active thyroid, we perform ultrasound measurements, and yet its just not very often we have had a chance to talk about it's 'sister' gland the parathyroid, located right along side. The other 'silent sister' is the hormone calcitonin which is actually made in a specific cell type in the thyroid itself. The silence is really on the part of patients and physicians as this gland seems almost forgotten when compared to all the woes of some of the other, better known, glands. The parathyroid gland produces its eponymous parathyroid hormone and calcitonin. And now there is known protein called parathyroid hormone-related protein which is now know to help keep ...

Was the Wicked Witch really melting because of what Dorothy did, or if we waited long enough would the Witch of the West just shrunk away anyhow from ostoeporosis? For many women the loss of height is the first sign of bone loss and a reason your gyno may want to evaluate you more carefully than just looking at your spine. To my physical exam, the Wicked Witch was well on the way to advanced osteoporosis, she was  hunched backed dowager, and how about you? Are you 65, are you white, then I'll wager about 50/50 you've shrunk more than 2 inches and have at least 1 osteoporotic spinal compression fractures you don't know about as you've not been properly tested And osteoporosis can cause more than posture and fracture problems. Are you over 65, did you have gas at least more than a few times you wish you wouldn't have this past week? I'll wager 50/50 you've got a spinal compression fracture some where between the lowest thoracic vertebra and the top few l...

It's fitting in the editorial of the Journal of Clinical Densitometry that Niel Binkley and Michael Lewiecki quote one of the first greatest wobbling politicians of his day. Cicero the Roman statesman, was known as much for changing with the political winds as he was for the eloquence he exposed after these changes of position. And in their writing in the Spring 2011 issue they say “Never go to excess, but let moderation be your guide.” The IOM ( Institute of Medicine ) now says we can recommend Vitamin D intake of 600 IU daily, and blood levels of 20 ng/ml. This is about what I used to suggest to patients about 15 years ago when soon thereafter Vitamin D recommendations began to climb. As with other types of medical recommendations, there are other authorities (and what I do for our practice) that recommend up to 1000 IU, and a blood level of 32 ng/dl. The IOM went on to say that there really no proven benefits to Vitamin D other than for bone health. I agree with the authors ...

Bones, luckily, change very slowly over time. Which is why it takes a long time to detect weaknesses that can increase your fracture risk by x-ray, and it can take very long to predict the success of treatments by this same technology. So we needed a better way, and we think we have found it. Looking at the research studies, we sometimes see only a bit or perhaps no improvement of our bone health by the DXA x-ray studies when administer medication to women with poor bone mass. But what we do see is a suppression of the substances in the urine that are secreted when the bone mass turns over.

Often we can be diagnosed, whatever the condition, without the use of xrays. But in pregnancy we want to avoid unnecessary testing. Radiation exposure over the years increases cancer risks in us, and in the sensitive developing fetus that is more true. The numbers of x rays that would be safe to have in pregnancy is not firmly established. We generally say for dental x rays for instance, shield the baby and you can have the test.  So how safe are x rays? As I said, we don't know exactly, but here's a great table to compare one x ray test to another from one medical organization.

For women with osteoporosis the challenge has been that no one medication both adds bone and prevents bone loss. Most treatments for low bone mass just prevent loss, yet a fairly simple and apparently safe treatment has just been found that may both add bone and prevent loss. This was nitroglycerin ointment and it was studied at the endocrine research unit at the Mayo Clinic. The study was very preliminary and it remains to be seen if this bears fruit in large studies.

We have healthy bones because there is a balance between the bone we form and the bone we resorb thoughout one's life. After the rapid bone gain as infants we gain steadily as children, and then have a spurt in bone mass through our growth spurt a puberty when we put down more bone than we resorb to utilize calcium, and we lose the ability to put calcium back into the bones to keep them as thick as they were in youth. The process of bone development is a process whereby the growth plates are left open so that bones can gain in strength, volume, and length. thus x-rays looking at girls in puberty, their bone age and their hormones can help determine where they are in the process and roughly how tall they will be. Other hormones besides estrogen affect this process. The hormones made as a girl crosses into puberty from the adrenal gland is actually the process of adrenarche, and the maturation of our growth hormone production is called somatarche (which is also the maturing of the...

Mt. Barney National Park, QLD Typical dieting if you’ve kept your calcium and vitamin D up is unlikely to have an adverse consequence to their bones. But women with eating disorders may in fact have consequences to their bone health. The hypercortisolism, in other words the high release of cortisol from the adrenal gland, which is produced by your body in response to stress is thought to be the physiologic reason. The cortisol hormone over secreted can have a wearing away effect on the bone. Fortunately the bone has ability to be healed if you are tested and treated. So if you have been an excessive dieter discuss with your gyno if you should have your bones tested for weakness., have bone markers checked, or your calcium and vitamin D checked. Facts will make us strong. 

1: Essentially a normal Bone density reading, actually over a T score of -1.0 which is less than one standard deviation below the mean of a young adult's bone thickness. This is the equivalent to about a 1/200 chance a woman will have a fracture in the next ten years. 1: Safest number of sex partners (duh?) 1.67 A Breast cancer risk score of the average 65 year old woman in the US, as calculated by the national institute of heath Gail score and since 1/7 women will get breast cancer in the US we all should know our current Gail scores. 1: One Portion of Salmon a Week reduces heart risk

Wedge Fracture of the Spine Stages of Spine Deformity due to Osteoporosis Some women who hunch over are not just hunching, they have a spinal fracture that could be devastating to both your posture and your health. It's not just that we lean over and thus seem shorter, women can loose 2 to 8 inches of height as they age. Why? Two main reasons: Disk compression (the disks between your vertebra) and Osteoporosis. Osteoporosis is a disease of compromised bone strength predisposing an individual to fractures. When the fractures is a compression of a vertebra then it forms a wedge in the spine you get exaggerated bending forward of the back the hump: dorsal kyphosis and the shortened waist and shrunken gut: lumbar lordosis, and there she shrinks! The disks between the vertebral bodies compress and thus exaggerate the two natural spinal curves, more shrinking. It's important to thus diagnose and fight off osteoprosis to preserve your spine: meanwhile posture actually helps as...