What is mammography?

A mammogram is a low dosage x-ray film of each breast that is carefully evaluated by a radiologist. Mammography can reveal both harmless and cancerousgrowths when they are too small to be felt by you, or your physician. The American Cancer Society endorses mammography, along with yearly physical examinations and monthly self-examinations, as the most effective means of detecting breast cancer at its earliest and most treatable stage. Generally, mammography can reveal benign and cancerous growths before you or your physician can feel them. If detected at the earliest stage, breast cancer has a five-year survival rate of over 95 percent, as small breast cancers are more treatable and can be removed before they spread to other parts of the body.


Breast cancer is the most common form of cancer in American women. Unfortunately, 70% of women have no identifying risk factors. The American Cancer Society recommends mammography as a life saving tool for screening women without symptoms for breast cancer.


What can I expect during the exam?

The simple, routine exam usually takes 15 to 20 minutes. Each breast is gently compressed during the examinations and a low dosage X-ray film is obtained for the radiologist to evaluate.


Although the compression may be slightly uncomfortable for a very short period of time, good compression is essential for the radiologist to see all the tissue inside the breast. The radiologist needs to be able to examine all breast tissue, including the tissue along the chest wall and underneath the armpit. After carefully positioning your breast on the mammography machine, the technologist will compress your breast for about 5 seconds to obtain the x-ray image. You can anticipate having at least 2 views per breast.
You may be called back for additional views, but it should be noted that these studies usually confirm normal tissue. With the development of new technology (CAD, Computer Aided Detection), we are able to improve care to our patients yet we will continue to provide results in a prompt, timely fashion.


What is Computer Aided Detection (CAD)?

Lakeside offers Mammography with CAD. Because some breast cancers blend into breast tissue and cannot be seen in a screening mammogram, Radiology Regional Center uses computer-aided detection, or CAD, for every mammogram we perform. Our CAD system assists the radiologists in investigating your films to find minute breast tissue irregularities. This highly sensitive software dramatically increases our physicians' ability to identify subtle abnormalities and more importantly, potential breast cancers in earlier stages.
CAD acts like a "Spell-Checker" for medical images and assists radiologists by highlighting areas that warrant a second review. This system is the first FDA approved computer-aided detection system for screening and diagnostic mammogram.


Call (405) 936- 1530 for more information or to schedule a Lakeside Mammogram.

For one reason or another many women seem to need a little push when it comes to having valuable health screenings performed. For this reason Lakeside Women’s Hospital is encouraging you to schedule a colonoscopy. As most people know, a colonoscopy is an evaluation of the lining of the colon to check for medical problems such as bleeding or the presence of cancer. It is the method of choice for screening patients at high risk for colon cancer. To schedule a “Gentle Colonoscopy” call: (405) 936-1065

KNOWING THE SCOPE OF THINGS
Are you nervous about having a colonoscopy?  You are not alone.  The thought of going through the procedure can be a little unsettling, even though you know it is for your own good.  Most people say it is the anticipation and preparation prior to the procedure that is worse than the procedure itself.  Colorectal cancer is the second leading cause of death in the United States for women and men combined, so it is imperative that we work together to intensify our efforts to inform you about the ways to proactively protect your
health against this largely preventable disease.

What is a colonoscopy?

A colonoscopy is a procedure that enables your doctor to examine the lining of the colon (large bowel) for abnormalities by inserting a lubricated flexible tube that is the thickness of your finger into the anus and advancing it slowly into the rectum and colon.

What Preparation is required?

The colon must be completely clean for the procedure to be accurate and complete. INSTRUCTIONS: For all colonoscopy patients:

1. Don’t eat food or drink with red or purple coloring three days prior to exam.
2. Bring your insurance card on admission to facility.
3. Do not wear or bring any jewelry on the day of your procedure.
4. Wear comfortable loose clothing, (pajamas, jogging suit, etc.).  Wear flat shoes.
5. Arrange to be accompanied by an adult who will accept responsibility for you and to drive you home.  We STRONGLY encourage that person to remain at the facility during your procedure and be responsible for discharge instructions.  Have an adult stay with you for about six hours after the procedure. IF YOU ARE ALONE, YOU ARE NOT ALLOWED TO TAKE A TAXI, BUS, AND OR WALK HOME ETC.  IF YOU DO NOT HAVE SOMEONE TO ACCOMPANY YOU HOME YOUR PROCEDURE WILL HAVE TO BE RESCHEDULED.
6. Do not drive a car, operate machinery, or make important legal decisions after the sedation.
7. PLEASE NOTIFY NURSE ON ADMISSION TO PRE-PROCEDURE AREA THE COLOR AND CONSISTANCEY OF BOWEL MOVEMENTS.

What about my current medications?

Most medications must be continued as usual, but some can interfere with the preparations or the examination.  It is best to inform the physician of your current medications and allergies to food and/or medicine.
1. STOP any diet or herbal supplements 2 weeks prior to exam.
2. STOP taking iron and multivitamins containing iron 5 days prior to exam.
3. STOP taking anti-inflammatory pain medications 5 days prior to exam.  (Ibuprofen or Motrin, Naproxen or Alieve, Aspirin or Aspirin containing products such as Alka-Seltzer etc.) IF IN DOUBT ABOUT ANY OF YOUR MEDICATIONS ASK YOUR PHARMACIST ABOUT ANY PRESCRIBED OR OVER THE
COUNTER MEDICATIONS.
4. If you are on anticoagulant (BLOOD THINNERS) therapy such as COUMADIN, PLAVIX, WARFARIN etc. please consult your PRIMARY PHYSICIAN to see if you are able to stop this medication for 5 days prior to the procedure and notify Lori at 405-936-1546 IMMEDIATELY.
5. If you are adiabetic, please let us know when scheduling your procedure with Kathy Vogt.  Contact your PRIMARY PHYSICIAN for specific instructions for monitoring your blood sugar and dosing instructions for your medications and notify Lori at 405-936-1546 IMMEDIATELY.
6. FROM YOUR GROCERY STORE PURCHASE:
     a. Clear liquids, such as water, tea, coffee, 7-Up, ginger ale, apple or white grape juice, Jell-O and/or Popsicles (NOTHING WITH RED OR PURPLE COLORING), clear soup or broth.  DRINK LOTS OF CLEAR FLUIDS.  THE KEY TO A SUCCESSFUL PREPARATION IS DRINKING PLENTY OF CLEAR LIQUIDS TO STAY HYDRATED AND PREP YOUR BOWEL.
     b. Use hemorrhoid ointments or creams on your skin to create a barrier to minimize irritation from frequent bowel movements and wiping.   Flushable hemorrhoid wipes are available for use instead of toilet paper.

What to expect during the preparation?

For a colonoscopy, you need to clear your colon of all obstructions and we do mean all.  The key to a successful bowel preparation for a colonoscopy is following the clear liquid diet and medication dosing instructions.

What can be expected during a Colonoscopy?


Once you arrive at our center, a nurse will greet you, ask you to change into a hospital gown, ask you to sign a consent form, and start an IV.  Next, the doctor will meet with you to answer any questions and to review the procedure with you. When you are ready, the nurse will bring you to a private procedure room and have you lie on your left side. We will make sure you are comfortable with a pillow and warm blanket. The nurse will place nasal oxygen and several monitoring devices on your body.  This equipment will allow us monitor your heart rate, blood pressure, and oxygen level during the colonoscopy. This is routine for all patients. Once you are ready, you will receive sedative and pain medication through the IV. This medication will bring you into a state called “conscious sedation: which means you should not feel or remember the procedure. This should be the last moment you will remember for a while.  You will need to remain at our facility for approximately one hour after the procedure or until the sedative wears off. While you are in this relaxed sleepy state the doctor inserts a thin, flexible tube, about the size of your little finger into your rectum and gently eases it into your colon. The tube is equipped with a tiny video camera that transmits a clear picture to a TV monitor, allowing the doctor to visualize the inside of your colon. Imagine your colon as flat as an empty balloon; the doctor inflates it enough to visualize the wall of your colon for abnormalities or polyps.   The colonoscopy takes approximately 20 to 60 minutes on average, time could vary depending on the success of the bowel prep or if any specimens are obtained.

If any abnormal tissue or small polyps are detected the doctor can remove all or part or it by using a tiny instrument that is passed through the scope.  The biopsy or polyp (specimen) is sent to a lab for evaluation.  You should not feel any pain, the inner lining of the colon does not contain any pain sensors.

What happens after the Colonoscopy?


After the exam, you are taken to our recovery area where you monitored until you awaken and tolerate fluids. Most people feel well rested after waking up; some stay drowsy for several hours after discharge.  You may experience some bloating, passing gas, and cramping intermittently through out the day. This should disappear quickly after you start ambulating, we encourage you to pass the gas and not hold it in.

The doctor will visit with the person who accompanied you to the hospital and the nurse will review discharge instructions with them.

A copy of your colon report and discharge instructions will be given to you at discharge.

AGAIN, you many not remember anything for several hours after being medicated. Most patients do not remember the recovery area at all and very few remember the ride home.

RESULTS OF BIOPSIES WILL BE AVAILABLE IN 7 TO 10 BUSINESS DAYS.   The total time at our facility is approximately 2-3 hours. REMEMBER THIS IS AN ESTIMATE


What are the possible complications of a colonoscopy?


One possible complication is a perforation or tear through the bowel wall that could require surgery. Death is a remote possibility with any interventional procedure. Bleeding may occur from the site of a biopsy or polypectomy. It is usually minor and stops on its own or can be controlled through the colonoscope. Rarely blood transfusions or surgery is required. Other potential risks include a reaction to the sedatives used and complications from heart or lung disease. Localized irritation of the vein where medications were injected may cause a tender lump lasting for several weeks, but this will go away eventually. Although complications after colonoscopy are uncommon, it is important for you to recognize early signs of any possible complications.  Please contact the doctor who performed the procedure if you notice any of the following symptoms:

• Severe abdominal pain, to touch or movement
• Fever over 101F and/or chills
• Rectal bleeding of a half a cup of more (bleeding can occur several days after the polypectomy)

Colonoscopy and polypectomy are generally safe when performed by doctors who have been trained and are experienced in
these endoscopic procedures.

Heart disease isn't just a man's disease.

Heart attack, stroke and other cardiovascular diseases are devastating to women, too. In fact, coronary heart disease, which causes heart attack, is the leading cause of death for American women. Many women believe that cancer is more of a threat, but they're wrong. Nearly twice as many women in the United States die of heart disease, stroke and other cardiovascular diseases as from all forms of cancer, including breast cancer.

The American Heart Association has identified several factors that increase the risk of heart disease and stroke. The more risk factors a woman has, the greater her risk of having a heart attack or stroke. Some of these risk factors you can't control, such as increasing age, family health history, and race and gender. But you can modify, treat or control most risk factors to lower your risk.


What are the risk factors for heart disease and stroke that you can't control?

Increasing age — As women grow older, their risk of heart disease and stroke begins to rise and keeps rising with age.

• Sex (Gender) — Men have a greater risk of heart attack than women, and they have attacks earlier in life. Each year about 60,000 more women than men have strokes, and about 60 percent of total stroke deaths occur in women.
• Heredity (family history) — Both women and men are more likely to develop heart disease or stroke if their close blood relatives have had them. Race is also a factor. Black women have a greater risk of heart disease and stroke than white women. Compared with whites, African-American men and women are more likely to die of stroke.
• Previous heart attack or stroke or TIA — Women who've had a heart attack are at higher risk of having a second heart attack; 43 percent of women ages 40 and older who survive a first heart attack will have another heart attack or fatal coronary heart disease within five years, and 22 percent who survive a first stroke will have another within five years. A transient ischemic attack (TIA or "mini-stroke") also is a risk factor and predictor of stroke.

What risk factors can be modified, treated or controlled by focusing on lifestyle habits and taking medicine, if needed?

• Tobacco smoke — Smoking is the single most preventable cause of death in the United States. Smoking is a major cause of cardiovascular heart disease among women. Women who smoke have an increased risk for ischemic stroke and subarachnoid hemorrhage. Constant exposure to others' tobacco smoke (secondhand smoke) at work or at home also increases the risk, even for nonsmokers. Women smokers who use birth control pills have a higher risk of heart attack and stroke than nonsmokers who use them.
• High blood cholesterol — High blood cholesterol is a major risk factor for heart disease and also increases the risk of stroke. Studies show that women's cholesterol is higher than men's from age 55 on. High levels of LDL (low-density lipoprotein) cholesterol (the "bad" cholesterol) raise the risk of heart disease and heart attack. High levels of HDL (high-density lipoprotein) cholesterol (the "good" cholesterol) lower the risk of heart disease. Research has shown that low levels of HDL cholesterol seem to be a stronger risk factor for women than for men.
• High blood pressure — High blood pressure is a major risk factor for heart attack and the most important risk factor for stroke. Women have an increased risk of developing high blood pressure if they are obese, have a family history of high blood pressure, are pregnant, take certain types of birth control pills or have reached menopause. African-American women have higher average blood pressure levels compared to Caucasian women.
• Physical inactivity — Various studies have shown that lack of physical activity is a risk factor for heart disease and indirectly increases the risk of stroke. Overall, they found that heart disease is almost twice as likely to develop in inactive people than in those who are more active. When you're inactive and eat too much, you can gain excess weight. In many people overweight can lead to high blood cholesterol levels, high blood pressure, diabetes and increased risk of heart disease and stroke. The American Heart Association recommends accumulating at least 30 minutes of physical activity on most or all days of the week.
• Obesity and overweight — If you have too much fat — especially if a lot of it is located in your waist area — you're at higher risk for health problems, including high blood pressure, high blood cholesterol, high triglycerides, diabetes, heart disease and stroke.
• Diabetes mellitus — Adults with diabetes have have heart disease death rates that are two to four times those of adults without diabetes. People with diabetes often have high blood pressure and high cholesterol and are overweight, increasing their risk even more. 

What other factors contribute to the risk of heart disease and stroke in women?

• High triglyceride levels — Triglyceride is a common type of fat in the body. A high triglyceride level often goes with higher levels of total cholesterol and LDL, lower levels of HDL and increased risk of diabetes. But scientists don't agree that it's a risk factor for heart disease by itself. Research suggests that having high triglycerides may increase the risk for women more than for men.
• Excessive alcohol intake — The risk of heart disease in people who drink moderate amounts of alcohol (an average of one drink for women per day) is lower than in nondrinkers. However, it's not recommended that nondrinkers start using alcohol or increase the amount they drink. Excessive drinking and binge drinking can contribute to obesity, high triglycerides, cancer and other diseases, raise blood pressure, cause heart failure and lead to stroke. Pregnant women should not drink alcohol in any form.
• Individual response to stress — Research hasn't yet defined the role stress plays in the development of heart disease. People respond differently to situations they find stressful. Unhealthy responses to stress may lead to other risk behaviors like smoking and overeating.

Definition

Osteoporosis, which means "porous bones," causes bones to become weak and brittle — so brittle that even mild stresses like bending over, lifting a vacuum cleaner or coughing can cause a fracture. In most cases, bones weaken when you have low levels of calcium, phosphorus and other minerals in your bones.
A common result of osteoporosis is fractures — most of them in the spine, hip or wrist. Although it's often thought of as a women's disease, osteoporosis also affects many men. And aside from people who have osteoporosis, many more have low bone density.
It's never too late — or too early — to do something about osteoporosis. You can take steps to keep bones strong and healthy throughout life.

Symptoms

In the early stages of bone loss, you usually have no pain or other symptoms. But once bones have been weakened by osteoporosis, you may have osteoporosis symptoms that include:

• Back pain, which can be severe if you have a fractured or collapsed vertebra
• Loss of height over time, with an accompanying stooped posture
• Fracture of the vertebrae, wrists, hips or other bones

Causes

The strength of your bones depends on their size and density; bone density depends in part on the amount of calcium, phosphorus and other minerals bones contain. When your bones contain fewer minerals than normal, they're less strong and eventually lose their internal supporting structure.


The process of bone remodeling

Scientists have yet to learn all the reasons why this occurs, but the process involves how bone is made. Bone is continuously changing — new bone is made and old bone is broken down — a process called remodeling, or bone turnover.

A full cycle of bone remodeling takes about two to three months. When you're young, your body makes new bone faster than it breaks down old bone, and your bone mass increases. You reach your peak bone mass in your mid-30s. After that, bone remodeling continues, but you lose slightly more than you gain. At menopause, when estrogen levels drop, bone loss in women increases dramatically. Although many factors contribute to bone loss, the leading cause in women is decreased estrogen production during menopause.

Your risk of developing osteoporosis depends on how much bone mass you attained between ages 25 and 35 (peak bone mass) and how rapidly you lose it later. The higher your peak bone mass, the more bone you have "in the bank" and the less likely you are to develop osteoporosis as you age. Not getting enough vitamin D and calcium in your diet may lead to a lower peak bone mass and accelerated bone loss later.


What keeps bones healthy

Three factors that you can influence are essential for keeping your bones healthy throughout your life:

• Regular exercise
• Adequate amounts of calcium
• Adequate amounts of vitamin D, which is essential for absorbing calcium

Risk factors

A number of factors can increase the likelihood that you'll develop osteoporosis, including:

• Your sex. Fractures from osteoporosis are about twice as common in women as they are in men. That's because women start out with lower bone mass and tend to live longer. They also experience a sudden drop in estrogen at menopause that accelerates bone loss. Slender, small-framed women are particularly at risk. Men who have low levels of the male hormone testosterone also are at increased risk. The risk of osteoporosis in men is greatest from age 75 on.
• Age. The older you get, the higher your risk of osteoporosis. Your bones become weaker as you age.
• Race. You're at greatest risk of osteoporosis if you're white or of Southeast Asian descent. Black and Hispanic men and women have a lower, but still significant, risk.
• Family history. Osteoporosis runs in families. For that reason, having a parent or sibling with osteoporosis puts you at greater risk, especially if you also have a family history of fractures.
• Frame size. Men and women who are exceptionally thin or have small body frames tend to have higher risk because they may have less bone mass to draw from as they age.
• Tobacco use. The exact role tobacco plays in osteoporosis isn't clearly understood, but researchers do know that tobacco use contributes to weak bones.
• Lifetime exposure to estrogen. The greater a woman's lifetime exposure to estrogen, the lower her risk of osteoporosis. For example, you have a lower risk if you have a late menopause or you began menstruating at an earlier than average age. But your risk of osteoporosis is increased if your lifetime exposure to estrogen has been deficient, such as from infrequent menstrual periods or menopause before age 45.
• Eating disorders. Women and men with anorexia nervosa or bulimia are at higher risk of lower bone density in their lower backs and hips.
• Corticosteroid medications. Long-term use of corticosteroid medications, such as prednisone, cortisone, prednisolone and dexamethasone, is damaging to bone. These medications are common treatments for chronic conditions, such as asthma, rheumatoid arthritis and psoriasis. If you need to take a steroid medication for long periods, your doctor should monitor your bone density and recommend other drugs to help prevent bone loss.
• Thyroid hormone. Too much thyroid hormone also can cause bone loss. This can occur either because your thyroid is overactive (hyperthyroidism) or because you take excess amounts of thyroid hormone medication to treat an underactive thyroid (hypothyroidism).
• Selective serotonin reuptake inhibitors (SSRIs). Research published in 2007 showed lower bone mineral density among both men and women currently using SSRIs compared with study participants not taking these antidepressants. However, these results don't necessarily mean that SSRIs cause bone loss or osteoporosis. More research is needed to fully understand the association between SSRI use and low bone density. Evidence does not currently indicate that you should stop using SSRIs because of concerns about bone loss.
• Other medications. Long-term use of the blood-thinning medication heparin, the cancer treatment drug methotrexate, some anti-seizure medications, diuretics and aluminum-containing antacids also can cause bone loss.
• Race. You're at greatest risk of osteoporosis if you're white or of Southeast Asian descent. Black and Hispanic men and women have a lower, but still significant, risk.
• Family history. Osteoporosis runs in families. For that reason, having a parent or sibling with osteoporosis puts you at greater risk, especially if you also have a family history of fractures.
• Frame size. Men and women who are exceptionally thin or have small body frames tend to have higher risk because they may have less bone mass to draw from as they age.
• Tobacco use. The exact role tobacco plays in osteoporosis isn't clearly understood, but researchers do know that tobacco use contributes to weak bones.
• Lifetime exposure to estrogen. The greater a woman's lifetime exposure to estrogen, the lower her risk of osteoporosis. For example, you have a lower risk if you have a late menopause or you began menstruating at an earlier than average age. But your risk of osteoporosis is increased if your lifetime exposure to estrogen has been deficient, such as from infrequent menstrual periods or menopause before age 45.
• Eating disorders. Women and men with anorexia nervosa or bulimia are at higher risk of lower bone density in their lower backs and hips.
• Corticosteroid medications. Long-term use of corticosteroid medications, such as prednisone, cortisone, prednisolone and dexamethasone, is damaging to bone. These medications are common treatments for chronic conditions, such as asthma, rheumatoid arthritis and psoriasis. If you need to take a steroid medication for long periods, your doctor should monitor your bone density and recommend other drugs to help prevent bone loss.
• Thyroid hormone. Too much thyroid hormone also can cause bone loss. This can occur either because your thyroid is overactive (hyperthyroidism) or because you take excess amounts of thyroid hormone medication to treat an underactive thyroid (hypothyroidism).
• Selective serotonin reuptake inhibitors (SSRIs). Research published in 2007 showed lower bone mineral density among both men and women currently using SSRIs compared with study participants not taking these antidepressants. However, these results don't necessarily mean that SSRIs cause bone loss or osteoporosis. More research is needed to fully understand the association between SSRI use and low bone density. Evidence does not currently indicate that you should stop using SSRIs because of concerns about bone loss.
• Other medications. Long-term use of the blood-thinning medication heparin, the cancer treatment drug methotrexate, some anti-seizure medications, diuretics and aluminum-containing antacids also can cause bone loss.
• Breast cancer. Postmenopausal women who have had breast cancer are at increased risk of osteoporosis, especially if they were treated with chemotherapy or aromatase inhibitors such as anastrozole and letrozole, which suppress estrogen. This isn't true for women treated with tamoxifen, which may reduce the risk of fractures.
• Low calcium intake. A lifelong lack of calcium plays a major role in the development of osteoporosis. Low calcium intake contributes to poor bone density, early bone loss and an increased risk of fractures.
• Medical conditions and procedures that decrease calcium absorption. Stomach surgery (gastrectomy) can affect your body's ability to absorb calcium. So can conditions such as Crohn's disease, celiac disease, vitamin D deficiency, anorexia nervosa and Cushing's disease — a rare disorder in which your adrenal glands produce excessive corticosteroid hormones.
• Sedentary lifestyle. Bone health begins in childhood. Children who are physically active and consume adequate amounts of calcium-containing foods have the greatest bone density. Any weight-bearing exercise is beneficial, but jumping and hopping seem particularly helpful for creating healthy bones. Exercise throughout life is important, but you can increase your bone density at any age.
• Excess soda consumption. The link between osteoporosis and caffeinated sodas isn't clear, but caffeine may interfere with calcium absorption and its diuretic effect may increase mineral loss. In addition, the phosphoric acid in soda may contribute to bone loss by changing the acid balance in your blood. If you do drink caffeinated soda, be sure to get adequate calcium and vitamin D from other sources in your diet or from supplements.
• Chronic alcoholism. For men, alcoholism is one of the leading risk factors for osteoporosis. Excess consumption of alcohol reduces bone formation and interferes with the body's ability to absorb calcium.
• Depression. People who experience serious depression have increased rates of bone loss.

Tests and diagnosis

Osteopenia refers to mild bone loss that isn't severe enough to be called osteoporosis, but that increases your risk of osteoporosis. Doctors can detect osteopenia or early signs of osteoporosis using a variety of devices to measure bone density.

• Dual energy X-ray absorptiometry (DEXA) - This is the best test method and is quick, simple and gives accurate results. It measures the density of bones in your spine, hip and wrist — the areas most likely to be affected by osteoporosis — and it's used to accurately follow changes in these bones over time.
• Ultrasound
• Quantitative computerized tomography (CT) scanning
  

Should you have a test?

If you're a woman, the National Osteoporosis Foundation recommends that you have a bone density test if you aren't taking estrogen and any of the following conditions apply to you:

• You're older than age 65, regardless of risk factors.
• You're postmenopausal and have at least one risk factor for osteoporosis, including having fractured a bone.
• You have a vertebral abnormality.
• You use medications, such as prednisone, that can cause osteoporosis.
• You have type 1 diabetes, liver disease, kidney disease, thyroid disease or a family history of osteoporosis.
• You experienced early menopause.

Definition

Vaginal dryness is a common problem for women during and after menopause, although inadequate vaginal lubrication can occur at any age. Symptoms of vaginal dryness include itching and stinging around the vaginal opening and in the lower third of the vagina. Vaginal dryness also makes intercourse uncomfortable. A thin layer of moisture always coats your vaginal walls. Hormonal changes during your menstrual cycle and as you age affect the amount and consistency of this moisture.

Symptoms

Signs and symptoms of vaginal dryness include:

• Dryness
• Itching
• Burning
• Pain or light bleeding with sex
• Urinary frequency or urgency

As many as four in 10 women who have reached menopause experience signs and symptoms related to vaginal dryness.

When to see a doctor

Make an appointment with your doctor if you have vaginal burning, itching or soreness or painful sexual intercourse that doesn't improve with self-care measures, such as using a vaginal moisturizer or water-based lubricant. Most vaginal lubrication consists of clear fluid that seeps through the walls of the blood vessels encircling the vagina. When you're sexually aroused, more blood flows to your pelvic organs, creating more lubricating vaginal fluid. But the hormonal changes of menopause, childbirth and breast-feeding may disrupt this process.

Causes


A variety of conditions can cause vaginal dryness. Determining the cause is key to helping you find an appropriate solution. Potential causes include:

Decreased estrogen levels -Reduced estrogen levels are the main cause of vaginal dryness. Estrogen, a female hormone, helps keep vaginal tissue healthy by maintaining normal vaginal lubrication, tissue elasticity and acidity. These factors create a natural defense against vaginal and urinary tract infections. But when your estrogen levels decrease, so does this natural defense, leading to a thinner, less elastic and more fragile vaginal lining.
Estrogen levels can fall for a number of reasons:

• Menopause or perimenopause
• Childbirth
• Breast-feeding
• Effects on your ovaries from cancer therapy, including radiation therapy, hormone therapy and chemotherapy
• Surgical removal of your ovaries
• Immune disorders
• Cigarette smoking

Medications - Allergy and cold medications, as well as some antidepressants, can decrease the moisture in many parts of your body, including your vagina. Anti-estrogen medications, such as those used to treat breast cancer, also can result in vaginal dryness.

Sjogren's syndrome -In this autoimmune disease, your immune system attacks healthy tissue. In addition to causing symptoms of dry eyes and dry mouth, Sjogren's syndrome can also cause vaginal dryness.

Douching - The process of cleansing your vagina with a liquid preparation (douching) disrupts the normal chemical balance in your vagina and can cause inflammation (vaginitis). This may cause your vagina to feel dry or irritated.

During menopause, your ovaries decrease production of the female hormones estrogen and progesterone. This decline in hormones puts a permanent end to menstruation and fertility, but it can also cause hot flashes, mood swings, vaginal dryness and urinary problems. The solution? For decades, doctors routinely eased these symptoms with hormone replacement therapy — medications containing female hormones to replace the ones the body is no longer making. And it was widely believed that boosting estrogen levels after menopause could also ward off heart disease and osteoporosis, while improving quality of life and keeping women young.

Then, in 2002, a large clinical trial called the Women's Health Initiative (WHI) reported that hormone therapy actually posed more health risks than benefits for women in the clinical trial. As the number of health hazards attributed to hormone therapy grew, doctors became less likely to prescribe it. And up to two-thirds of women on the therapy discontinued its use, often without talking to their doctors.


Today, there's plenty of confusion about hormone replacement therapy, which is now commonly called hormone therapy. The truth is that hormone therapy is not the magical cure for aging that it was once believed to be, but it's still the most effective treatment for unpleasant menopausal symptoms for most women. If you're facing menopause, learn more about the benefits and the risks of hormone therapy.


What are the benefits of hormone therapy?


Estrogen remains the most effective treatment for relief of troublesome menopausal hot flashes and night sweats. It can also ease vaginal symptoms of menopause, such as dryness, itching, burning and discomfort with intercourse. Long-term hormone therapy for the prevention of postmenopausal conditions is no longer routinely recommended. But women who take estrogen for short-term relief of menopausal symptoms may gain some protection against the following conditions:

• Osteoporosis. Studies show that hormone therapy can prevent the bone loss that occurs after menopause, which decreases the risk of osteoporosis-related hip fractures.
• Colorectal cancer. Studies show that hormone therapy can decrease the risk of colorectal cancer.
• Heart disease. Some data suggest that estrogen can decrease risk of heart disease when taken early in your postmenopausal years. A randomized, controlled clinical trial — the Kronos Early Estrogen Prevention Study (KEEPS) — exploring estrogen use and heart disease in younger postmenopausal women is under way, but it won't be completed for several years.

For women who undergo menopause naturally, estrogen is typically prescribed as part of a combination therapy of estrogen and progestin. This is because estrogen without progestin can increase the risk of uterine cancer. Women who undergo menopause as the result of a hysterectomy can take estrogen alone.

What are the risks of hormone therapy?

The Women's Health Initiative found that women taking the combination estrogen-progestin (Prempro) used in the study had an increased risk of developing certain serious conditions. According to the study, over one year, 10,000 women taking estrogen plus progestin compared with a placebo might experience:

• Seven more cases of heart disease
• Eight more cases of breast cancer
• Eight more cases of stroke
• 18 more cases of blood clots

Based on these numbers, the increased risk of disease to an individual woman is small. However, the overall risk to menopausal women as a group became a substantial public health concern. In addition, researchers found that women taking combination estrogen-progestin had an increase in abnormal mammograms. The higher number of false-positives — signs of possible breast cancer that ultimately prove inaccurate — was probably due to estrogen, which increases breast tissue density.


For women taking estrogen alone (Premarin), the WHI found no increased risk of breast cancer or heart disease. But researchers did find that over one year, 10,000 women taking estrogen compared with a placebo might experience 12 more cases of stroke and six more cases of blood clots in the legs, plus an increase in mammography abnormalities. This last point is important, because women who take estrogen or combination estrogen-progestin therapy may need more frequent mammograms and additional testing.


Who should consider hormone therapy?

Despite the inherent health risks, estrogen is still the gold standard for treating menopausal symptoms. For women who experience moderate to severe hot flashes or other menopausal symptoms, the benefits of short-term therapy outweigh the potential risks.
Data surrounding hormone replacement therapy can be scary and confusing. But the absolute risk to an individual woman taking hormone therapy is quite low — possibly low enough to be acceptable to you, depending on your symptoms. Talk with your doctor about your personal risks.

Who should avoid hormone therapy?

Women with breast cancer, heart disease or a history of blood clots should not take hormone therapy for relief of menopause symptoms. Women who don't suffer from menopause symptoms should not take hormone therapy for preventing memory loss or strokes. Instead, talk to your doctor about other medications you can take or lifestyle changes you can make for long-term protection from these conditions.

If you take hormone replacement therapy, how can you protect yourself from the added risks?

Recent analysis of the WHI data and other trials suggests that there are several ways to reduce the inherent risks of hormone therapy. Talk to your doctor about these strategies:

1. Time it right. The risk of hormone therapy causing heart disease is not significantly raised in women under age 60. In fact, some studies suggest that estrogen may protect the heart when taken early in your menopausal years.
2. Minimize the amount of medication you take. Use the lowest effective dose for the shortest amount of time needed to treat symptoms. On the other hand, don't be scared to continue treatment as long as you have debilitating menopausal symptoms.
3. Find the best delivery method for you. You can take estrogen in the form of a pill, patch, gel, vaginal cream or slow-releasing suppository or ring that you place in your vagina. If you experience only isolated vaginal symptoms, estrogen in a vaginal cream, tablet or ring is usually a better choice than a pill or a skin patch. That's because estrogen applied directly to your vagina is more effective at a lower dose than is estrogen given in pill or skin patch form.
4. If you haven't had a hysterectomy and are using oral or skin patch hormone therapy, you will also need progestin, which is available in a pill, combination pill, vaginal gel, intrauterine device or combination skin patch. Your doctor can help you find the delivery method that offers the most benefits and convenience with the least risks and cost.

What can you do if you can't take hormone therapy?

Women shouldn't have to suffer through menopause. You may be able to manage your menopausal symptoms by making healthy lifestyle choices. In fact, your doctor may recommend that you change your exercise or eating habits before you try medication. If lifestyle changes aren't providing enough relief from bothersome symptoms, there are many medications besides hormone therapy to relieve discomfort.

How do I know if my period is normal?

During your menstrual cycle, your body prepares for the possibility of becoming pregnant. During the first half of your cycle, estrogen and progesterone hormone levels rise and thicken the lining of the uterus to protect the egg released by an ovary each month. If an egg is fertilized, it will embed itself into the new thick lining of your uterus. However, if no egg is fertilized, your body sheds the excess lining over the course of several days in the form of menstrual blood or, your period.

What causes my heavy periods?

There are many potential causes for heavy periods, such as hormone imbalances, fibroids and polyps, infections, and bleeding disorders.

• Hormonal imbalances occur when a woman is not producing the right balance of estrogen and progesterone. It is very common, especially when a woman begins or ends her reproductive years. This imbalance may also be caused by the wrong combination of hormone therapy.
• Fibroids and Polyps are abnormal growths or tumors inside the uterus. These may be removed if they are causing uncomfortable symptoms.
• Infections of the uterus or cervix can be serious and cause symptoms including excessive bleeding. Infections are commonly treated with antibiotics.
• Bleeding Disorders that impair blood clotting (thickening of the blood to slow or stop its flow) are serious disorders that need medical attention. If you think you have this disorder, it is important to see your doctor as soon as possible.

Higher risk candidates for heavy periods include

• Women who are overweight  
• Women who have hormonal imbalances
• Women who have never been pregnant
• Women with thyroid problems or diabetes
• Women over 35

Heavy Bleeding for prolonged periods 

A new ablation procedure is available to help women with heavy or prolonged periods - It’s more common than you think. Every year about 650,000 American women have surgical hysterectomies because they have heavy or prolonged periods. - Now there is an alternative - Endometrial ablation offers an effective alternative to hysterectomies. It is often chosen when other medical treatments have failed or are otherwise undesirable. This procedure involves the removal of the lining of the uterus, which is the source of the bleeding. According to recent studies, most women feel that endometrial ablation relieves the problem with their period. 9 out of 10 of women who have this procedure are satisfied with the results. After the procedure, the women who were satisfied with it reported lighter periods or normal periods. Some women said that their periods stopped completely after endometrial ablation.

To find out more about endometrial ablation call 936-1000 or schedule an appointment with one of the Lakeside Physicians