Category Archives: Women’s Health

Women’s Health Review: Mammogram Guidelines

Mount Sinai Health System (May 31, 2023) – When and how often to have a screening mammogram is a choice you must make. Different expert groups do not fully agree on the best timing for this test.

Before having a mammogram, talk to your provider about the pros and cons of having the test. Ask about:

  • Your risk for breast cancer
  • Whether screening decreases your chance of dying from breast cancer
  • Whether there is any harm from breast cancer screening, such as side effects from testing or overtreatment of cancer when it’s discovered

Mammography is performed to screen women to detect early breast cancer when it is more likely to be cured. Mammography is generally recommended for:

  • Women starting at age 40, repeated every 1 to 2 years. (This is not recommended by all expert organizations.)
  • All women starting at age 50, repeated every 1 to 2 years.
  • Women with a mother or sister who had breast cancer at a younger age should consider yearly mammograms. They should begin earlier than the age at which their youngest family member was diagnosed.

Mammography is also used to:

  • Follow a woman who has had an abnormal mammogram.
  • Evaluate a woman who has symptoms of a breast disease. These symptoms may include a lump, nipple discharge, breast pain, dimpling of the skin on the breast, changes of the nipple, or other findings.

Infographic: Why Women Have High Risks Of Stroke

Stroke in U.S. Women by the Numbers

One in 5 women will have a stroke. About 55,000 more women than men have a stroke each year.

Stroke is the No. 3 cause of death in women. Stroke kills over 90,000 women a year.

Among women, Black Women have the highest prevalence of stroke.

Talk to your health care provider about how to lower your risk and use the American Heart Association/American Stroke Association prevention guidelines:

Stroke risk increases in women who:

  • Are pregnant. Pregnant women are three times more likely to have a stroke as women of the same age.
  • Have preeclampsia. This dangerous condition of high blood pressure during pregnancy doubles stroke risk later in life.
  • Take birth control pills. These can double the risk of stroke, especially in women with high blood pressure.
  • Use hormone replacement therapy. It doesn’t lower it, like once thought.
  • Have migraines with aura and smoke. Strokes are more common in women who have migraines with aura and smoke, compared with other women.
  • Have atrial fibrillation. This quivering or irregular heartbeat can increase stroke risk fivefold. After age 75, it’s more common in women than men.

Stroke risk decreases in women who:

  • Talk to their health care provider to determine safest medication if pregnant with high blood pressure.
  • Discuss with their health care provider low-dose aspirin guidelines starting in the second trimester (week 12) to lower preeclampsia risk.
  • Get their blood pressure checked before taking birth control pills and monitor every six months.
  • Don’t use hormone replacement therapy to prevent stroke if postmenopausal.
  • Quit smoking if they have migraines with aura.
  • Get screened for atrial fibrillation if over age 75.

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Reviews: Menopausal Hormone Therapy Risks

Cleveland Clinic – The American College of Cardiology’s Cardiovascular Disease in Women Committee released guidance on hormone therapy, with a focus on caring for women with a risk of heart disease. Leslie Cho, MD, explains what women should know about hormone therapy, and options available for women with heart disease risk factors.

Medicine: A Historical Look At Breast Cancer

Breast cancer is best looked at from the historical perspective, as did Lindsay Fitzharris in the December 3, 2022 issue of the Wall Street Journal.

Can you imagine having breast cancer in the mid 1800s before the germ theory was developed? 50% of all surgeries died of severe infection at that time.  Before the development of anesthesia, of course, cancer removal was extremely painful as well. Even if the patient escaped dying from infection, the one size fits all  often meant removal of some chest wall muscles, leading a gaping wound.

Today, prophylactic breast imaging (mammography) often discovers the cancer at a very early and treatable stage.

Searching the cancer cells for rogue genes and surface markers often shows the way to better treatment; no longer does one size fit all.

Sometimes the breast lump is removed with minimal surgery and radiation is used, often yielding better results than the old time radical mastectomy.

Surgery itself is often aided by tissue biopsy, and now, with “intelligent” knives, gases from the surgical cut, using mass spectrophotometry, can tell the surgeon whether the tissue being cut is cancerous or normal.

Immunization methods are in development which will help your immune system to conquer any residual cancer, and “smart” T cells can be used to attack cancer cells directly.

Breast cancer Is still the most common cause of cancer deaths in women, even with all of the modern developments. Early detection is very beneficial, as with Breast self-examination and regular mammograms as prescribed by your doctor.

Extra care should be taken in families with certain genetic markers like like the BRCA gene.

—Dr. C.

Women’s Health: Risks & Treatment Of Menopause

As levels of estrogen, a crucial chemical messenger, trend downward, women are at higher risk for severe depressive symptoms. Bone loss accelerates. In women who have a genetic risk for Alzheimer’s disease, the first plaques are thought to form in the brain during this period. 

February 4, 2023

About 85 percent of women experience menopausal symptoms. Rebecca Thurston, a professor of psychiatry at the University of Pittsburgh who studies menopause, believes that, in general, menopausal women have been underserved — an oversight that she considers one of the great blind spots of medicine. “It suggests that we have a high cultural tolerance for women’s suffering,” Thurston says. “It’s not regarded as important.”

Even hormone therapy, the single best option that is available to women, has a history that reflects the medical culture’s challenges in keeping up with science; it also represents a lost opportunity to improve women’s lives.

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COMMENTS:

The New York Times, Sunday magazine, posted an article by Susan Dominus entitled “the vicious cycle”, in which was a long discussion of the disease burden of menopause. It is well worth reading.

“Forever Feminine” was a book by Robert Wilson, in 1966, which promoted hormone treatment for “enjoyment of sex” in menopausal women. The use of estrogen skyrocketed.

Alarming research in 1975, which linked estrogen usage to endometrial cancer, halted the rise of the drug’s popularity.

Without hormonal treatment, the many symptoms of  menopause were devalued and quietly suffered by women.

The medical profession has been slowly recovering from whiplash. New, better controlled research is being done and slowly a more nuanced approach is being taken. Women with a history of heart attack or stroke are still generally advised against hormonal therapy, but many others are being given birth control pills, which is a combination of estrogen and progesterone.

The average age of menopause is approximately 50 years of age, but symptoms can anticipate menopause by several years. An elevated FSH is the usual laboratory test to indicate perimenopause.

Early menopause can be associated with a decreased lifespan, increased likelihood of osteoporosis, cardiovascular disease and dementia, and is often treated with hormonal therapy. A delayed menopause is less likely to be treated with hormonal therapy, because of increased risk.

There are a lot of risk factors to be balanced against the symptoms involved, such as hot flashes and the entire panoplay of symptoms indicated in the infographic.

Some day, artificial intelligence will be used in order to make more explicit the benefits and risks involved. Until that time, the patient suffering from premenopausal or menopausal symptoms should find a Doctor Who would actually listen to her, a difficult task these days.

—Dr. C.

Women’s Health: How To Ease & Manage Menopause

National Institute on Aging – Menopause is a point in time 12 months after a woman’s last period. The years leading up to that point, when women may have changes in their monthly cycles, hot flashes, or other symptoms, are called the menopausal transition or perimenopause.

The menopausal transition most often begins between ages 45 and 55. It usually lasts about seven years but can be as long as 14 years. The duration can depend on lifestyle factors such as smoking, age it begins, and race and ethnicity. During perimenopause, the body’s production of estrogen and progesterone, two hormones made by the ovaries, varies greatly.

The menopausal transition affects each woman uniquely and in various ways. The body begins to use energy differently, fat cells change, and women may gain weight more easily. You may experience changes in your bone or heart health, your body shape and composition, or your physical function

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BMJ Podcast: Diagnosis & Management Of Heart Failure – Dr. Carolyn Lam

In this episode of the Heart podcast, Digital Media Editor, Dr James Rudd, is joined by Professor Carolyn Lam, a world expert in heart failure from the University of Singapore and the National Heart Centre, also in Singapore.

They discuss updates in the diagnosis and management of heart failure, including wearables, biomarkers, the 4 pillars of therapy, and how and why there has historically been an under-representation of women in heart failure trials. This episode is sponsored by an educational grant from the Boehringer Ingelheim-Lilly Alliance. The sponsor has no influence over podcast content, the selection of speakers or any associated educational material.

Professor Carolyn Lam is a Senior Consultant from the Department of Cardiology and Director of Women’s Heart Health at the National Heart Centre Singapore, having pioneered the first Women’s Heart Clinic in Singapore.  Academically, she serves as a tenured Full Professor at the Duke-National University of Singapore, having also graduated from the Standford Executive Programme in 2015, and obtained a PhD at the University Medical Centre Groningen, the Netherlands in 2016. In the field of MedTech, Prof Lam is co-founder of Us2.ai, an award-wining startup dedicated to the automation of the fight against heart disease by applying artificial intelligence to echocardiography (ultrasound of the heart). 

Prof Lam is a world-renowned specialist in heart failure (particularly heart failure with preserved ejection fraction [HFpEF]). Her work in the PARAGON-HF and EMPEROR-Preserved trials led to the first FDA-approved treatment for HFpEF and the first robustly positive clinical outcomes trial in HFpEF to-date, respectively. She leads several multinational global and regional clinical trials, and has received numerous prestigious awards and global recognition for her work. Her recent appointments on the 2021 European Society of Cardiology Heart Failure Guidelines Task Force, and as International Honorary Fellow of the Heart Failure Society of America 2021, attest to her contributions in both cardiology and research fields. 

Prof Lam is a proud recipient of the National Medical Research Council (NMRC) Senior Investigator Clinician Scientist Award in 2020, and served as the Founding Programme Lead of A*STaR’s Asian neTwork for Translational Research and Cardiovascular Trials (ATTRaCT) and Principal Investigator of ASIAN-HF (a multinational study across 11 Asian countries). In 2019, She initiated the Asian Diabetes Outcomes Prevention Trial (ADOPT), an ongoing trial involving 5 countries and aimed at reducing the cardiovascular adverse outcomes of diabetes in Asian patients.

She has published with over 350 articles in major high impact journals including New England Journal of Medicine, Journal of the American Medical Association (JAMA), Lancet, Circulation, and European Heart Journal; and has been recognised as a World Expert by Expertscape’s PubMed-based algorithms (top 0.1% of scholars writing about Heart Failure over the past 10 years; Heart Failure: Worldwide – Expertscape.com). Besides being an Associate Editor for Circulation (top Cardiology Journal) and European Journal of Heart Failure, she is also the lead author of the chapter on HFpEF for Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 12th Edition – the award-winning textbook trusted by generations of cardiologists for the latest, most reliable guidance in the field.

Women’s Health: Finding A Lump In Your Breast (JHM)

Johns Hopkins Medicine: What To Do When You Find a Lump in Your Breast? Breast imaging radiologist, Emily Ambinder discusses common questions one may have when discovering a lump in the breast.

Video timeline: 0:03 Why do lumps form in the breast? 026 What are the different types of lumps? 0:55 Can breast lumps form because of physical impact? Could those lumps become cancerous? 1:23 What do i do if i have found a lump? 1:47 What makes breast imaging at Johns Hopkins different? 2:01 What is a mammogram? 2:29 What is a breast ultrasound? 2:53 What else do I need to do if I have a lump?

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Women’s Health: Benefits Of An Endometriosis Diet

If you have endometriosis, you’re all too familiar with the heavy periods, pain and nausea it can cause. Eating these foods might help control the pain and make all the difference.

Chapters: 0:00 Introduction 0:10 What is endometriosis? 0:45 Eating the right foods can help the body fight inflammation 1:01 Fiber rich foods 1:41 Omega-3 fats 2:10 Monounsaturated fats 2:30 Magnesium and zinc 3:25

It’s always important to eat good, healthy food Resources: The Best and Worst Foods for an Anti-Inflammatory Endometriosis Diet – https://cle.clinic/3VeYzyG

Endometriosis: Symptoms, Causes, Treatment & Tests – https://cle.clinic/31ntZLx

Prevention: The Benefits Of Well-Woman Exams

For women and people assigned female at birth (AFAB), taking care of your health requires more than an annual physical. You should also visit a women’s health specialist — like an Ob/Gynmidwife or nurse practitioner — each year to keep healthy. More than just a checkup for your breasts/chest and reproductive organs; well-woman exams can also help you develop rapport with a women’s health specialist. 

“Well-women exams are important for a number of reasons. No. 1 is that they help you to establish care with a specialist so that if there is a problem down the road, you have a provider that you know and feel comfortable talking to,” says Ob/Gyn Amanda Elbin, MD

That comfort level is important, too, especially because many of us may not feel comfortable talking with just anyone about issues “down there.”  

Read more at Cleveland Clinic