Adolescent women’s health: when to see a doctor and what to expect

Adolescence, simply defined, is the state or process of growing up… sounds easy enough. One’s body knows what to do: eat, sleep, drink and one day, as if by magic, it wakes up and is different. But, what about those other changes, the ones we’re not so eager to discuss; changes in mood, acne, menstruation. Is this normal? Though the simple answer in most cases is yes, there are many topics and questions a healthcare provider familiar with adolescent women’s health can help to address.

While there is no set age or reason to begin routine care with a women’s health professional, the American Congress of Obstetricians and Gynecologists recommends adolescents establish care between the ages of 12 and 15. By initiating this relationship early in one’s reproductive life, patients and physicians are more easily able to bridge communication barriers, particularly regarding the sensitive issues which arise in the course of care for adolescent women.

Unfortunately, the fear of one’s first gynecologic visit deters many young women from going to the doctor. A visit to a gynecologist does not necessarily mean a pelvic exam will be performed. In fact, a first visit is sometimes just a good chance to talk about health, healthy behaviors and answer questions a young woman may not feel comfortable asking anyone else. Initial visits can include a pelvic exam in certain situations. This may involve an external exam only or a gentle internal exam depending on a patient’s health history or concern.

In addition, there are many situations in which an adolescent woman may seek care for a specific problem or need. Common reasons to consult with your women’s health professional are: concerns regarding the menstrual cycle, pain in the pelvic region, overall sexual health, or questions about normal growth & development.

In recent years recommendations have changed for immunizations and routine health screening in the adolescent population. It is recommended that all young women be administered a HPV vaccine series. HPV (human papiloma virus) is the main cause of abnormal pap smears. The HPV vaccine is recommended between ages 11-12, though can be given up to age 26. Though the vaccine will not protect against all forms of HPV, it does offer protection against the two most common forms of high-risk HPV which cause cervical cancer.

In the case of heavy or irregular menstruation, there exists a broad spectrum of normal for young women. This is especially true of the first one to two years following menarche (a woman’s first period.) In the adolescent patient, the interval between periods may fall outside of the typically accepted normal range due to ongoing development of hormone producing centers in the brain.

Frequently missed school or participation in sports due to heavy menstrual bleeding or pelvic pain should be discussed with a physician. Any woman experiencing bleeding so heavy as to prompt evaluation in an Urgent Care facility or Emergency department, should be followed up by a thorough evaluation in her doctor’s office.

The Many Faces of Estrogen

A major health concern for women after menopause is the risk of heart attack and stroke. Throughout the last decade, Hormone Replacement Therapy (HRT) has been used to treat menopausal symptoms and help prevent cardiovascular disease. Now, there is a large body of evidence that has shown that women who take HRT are also at a lower risk of heart disease.

In the first 5-10 years after menopause, estrogen is actually effective in preventing cardiovascular disease. It is in this group that HRT can make a difference. This concept was discovered in the first and only prospective, double blinded, placebo controlled study of HRT in older women, called the Women’s Health Initiative Study (WHI). This was a controlled study designed to test the hypothesis that HRT is beneficial in preventing heart disease in women. Primarily studied were older women, well past menopause.



Because this was such a large study, the data was analyzed by looking at many aspects of women’s health. The issue of breast cancer is paramount in women’s concerns for their immediate and long-term health. Recently, the data from the WHI showed that there was less breast cancer in the group of women who only took estrogen and not both hormones (estrogen and progesterone). However, this is not necessarily the answer. Many observational studies suggest that there is an increased risk of breast cancer when estrogen is used over a long period of time. This risk is reduced after about five years of discontinuing use. The risk of breast cancer is higher in those women who use both estrogen and progesterone daily.

The key is to speak with your health care provider in order to individualize HRT to the individual situation:


  • If a woman has symptoms that are affecting the quality of her daily life at work and/or at home, there are many options for her to manage her symptoms. Some of these include better handling of stress, and avoiding hot drinks, coffee, alcohol, spicy foods and carbohydrates.
  • For women who need hormone replacement and who still have their uterus, a patient specific combination of estrogen and progesterone should be considered.
  • Women who do not have a uterus should not take progesterone because of the increased risk for breast cancer with daily use.


Advantages of HRT

Lower risk of cardiovascular disease (when started around the time of menopause), improvement in bone strength, symptom improvement, lower risk of colon cancer, and improved bladder and vaginal health.

Disadvantages of HRT

Increased risk of cardiovascular disease (if started well after menopause), and increased risk of breast cancer if used for an extended period of time.


With the help of your health care provider, use the lowest amount of estrogen and progesterone as needed to control symptoms of menopause, and stop its use when symptoms abate. Exercise, breast monitoring, and controlling alcohol intake will lower the risk of breast cancer. A healthy diet, exercise, monitoring cholesterol and not smoking will lower the risk of cardiovascular disease.

Empower Yourself in the Fight against Breast Cancer

October is Breast Cancer Awareness Month, and an opportunity for us to consider ways in which women can empower themselves when facing the possibility of this disease. A woman can make lifestyle decisions for prevention, choose to access early detection methods for diagnosis, and understand her options if diagnosed with breast cancer.

With respect to prevention, it can be as basic as diet and exercise choices. We know that diets focused on richly colored vegetables and fruits, low in saturated fats, and limited to one alcoholic drink per day can lower risk of developing breast cancer. Maintaining an ideal body weight and exercising just 30 minutes five days per week is also beneficial. If you are unsure about the use of hormone replacement therapy, meet with your primary care physician or gynecologist to discuss the pros and cons in your particular situation. For those women with a strong family history of breast cancer, ask your primary care physician about the need to see a breast surgeon or genetics counselor about more aggressive ways to manage potential higher risks.


There has been some debate in the press recently regarding the usefulness of mammograms. It is important for women to know that the American Cancer Society, American Society of Breast Surgeons, and the American College of Radiology continue to recommend that women of average risk begin screening mammography at age 40. This recommendation is based on many studies that have shown screening mammography improves survival from breast cancer, and that newer digital mammography is more effective in younger women with dense breasts than the older film mammograms, leading to earlier detection. Patients diagnosed at an earlier stage are less likely to require mastectomies and chemotherapy, and have improved survival rates. You may be advised to start screening at an earlier age if you have other risk factors, including a strong family history. In some patients, there may be additional tests available to help with early detection. If you feel a mass, you should seek an evaluation with your primary care provider regardless of your age. While there is still debate about recommending self-breast exams, I continue to advocate them for women who feel comfortable performing them. Many women in my practice found their own breast cancer with a thorough self- breast exam.

If you are facing a diagnosis of breast cancer, here are some things to remember:

  1. Most women have early stage disease, which is often curable.
  2. There are effective treatment options available for all stages of breast cancer. Discuss options for seeking care with your health care provider.
  3. Each woman’s treatment plan needs to be planned carefully and individualized. When looking for a surgeon, inquire if they focus their practice on treating patients with breast disease. Most surgeons who focus on the most up-to-date treatment of breast cancer also partner with medical oncologists, radiation oncologists, pathologists, radiologists, nurses, reconstructive surgeons, social workers, and research coordinators in a team approach to offer cohesive, compassionate and exemplary care to each and every patient.


In the end, you should feel that your team of physicians and other care providers partner with you and your loved ones to obtain the best outcomes possible.

Understanding Diabetes and Common Risk Factors

Diabetes means there is a build-up of sugar, or glucose, in the blood stream. Glucose is the body’s primary source of fuel and is needed in all cells in order for all systems to work. Insulin is a hormone in the blood stream that works like a key to open cells to allow glucose to enter. If a person doesn’t make enough insulin, or if the body doesn’t use insulin correctly, the result will be high blood glucose, or diabetes. Understanding the different types of diabetes, the risk factors, and ways to reduce risk are important because if not controlled, diabetes can lead to serious complications such as heart disease, blindness, kidney disease and nerve damage.



The most common forms of diabetes are type 1, type 2 and gestational.

Type 1:


  1. Usually discovered soon after it develops due to a severe lack of insulin that happens in a short amount of time.
  2. Leads to symptoms such as extreme thirst, frequent urination, blurry vision and unintentional weight loss, which are usually severe enough to cause a person to see a doctor quickly.
  3. Treatment: taking insulin and learning to adjust your diet to keep the blood glucose levels in a safe range.


Gestational diabetes


  1. Develops during some pregnancies when pregnancy hormones interfere with how insulin works. Too much blood sugar in the mother can cause complications in the baby.
  2. There are usually no symptoms, so every woman should be screened during routine pre-natal care.
  3. Treatment: usually diet control, although some women need medication as well.


The most common type of diabetes is type 2, when blood sugar levels rise over time resulting from a lack of insulin or insulin not working correctly. Eventually, when the blood glucose level gets high enough, people may feel extra tired or may have vision changes. Unfortunately people who rarely see a doctor for routine lab work may go years having diabetes without even knowing it.

Risk Factors for type 2 diabetes


  1. Family History: having a blood relative with type 2 diabetes
  2. Ethnicities at greater risk: Hispanic, African American, Latino or Asian
  3. Being overweight
  4. A lack of physical exercise


While some risk factors such as family history or ethnicity can’t be changed, studies show that people who control their weight and are physically active can significantly reduce their chance of developing type 2 diabetes. In 2002, the Diabetes Prevention Program study concluded that people who were overweight and had slightly increased blood glucose levels sharply decreased their risk of developing type 2 diabetes after following a reduced fat diet and exercise program. The study participants who lost between 5 and 10% of their weight and were able to maintain 150 minutes per week of physical activity had their blood glucose level return to normal.

What should you do to reduce your risk for type 2 diabetes?


  1. Eat a diet rich in fruits and vegetables, lower in fat – especially animal fat – and including moderate amounts of whole grains. The USDA Healthy Plate ( is a great tool to show how to balance food choices in a healthy way. You may also consider seeing a dietitian to help you plan a healthy diet.
  2. If you have any risk factors for type 2 diabetes, it’s is important to talk to your doctor about getting regular screenings. Because most people won’t have any specific symptoms right away, the only way to know if you have high blood sugar is with a simple blood test.
  3. Discuss your weight and physical activity with your doctor


Managing Your Care with the IHA Patient Portal

At IHA, my fellow providers and I are always looking for new ways to improve the patient experience. One of the patient-focused tools IHA offers is the IHA Patient Portal, which is your web-based link to our electronic health record (EHR) that allows you as a patient to be more proactive about your health and physician visits.

First, we all know that “phone tag” is a frustrating and time-consuming game to play and no one wants to wait for a response to come by “snail mail.” The great thing about the Patient Portal is it provides another way for you to communicate with your physician and their office. Additionally, it provides a method for us as physicians to communicate effectively with you. Not only are patients able to view new messages from their physician or physician practice, but they can also view lab results within days of testing, request medication refills, view their statements and pay their bill online. Plus, it is available 24 hours a day, allowing you to view and manage your health information day or night, at your own convenience.

Another great benefit is the security features in place. No health information is sent via email. When a message is sent from the doctor’s office, you receive an email stating you have a new message from IHA and are directed to the IHA Patient Portal to review. As a physician, I can communicate with my patients any time of day and feel confident that they will get the information and understand it clearly. For example, I can prescribe a complicated treatment regimen, or review the potential side effects of a medication and feel comfortable that the information will not get lost in translation. The portal provides a great benefit to patients and doctors alike. Coming in 2012 are the added features of on-line appointment requests and the account manager, which will allow you to manage your family’s health information all under one single account.

The enrollment process takes just a few steps to complete, and the benefits of being enrolled in the IHA Patient Portal are well-worth the time. For more information or to enroll visit the IHA Patient Portal.

Hypertension and High Blood Pressure

As a patient you may have heard the term hypertension before, which is really just another word for having high blood pressure. However, hypertension is a real concern affecting roughly one third of the adult population in the United States.

Blood pressure is recorded as two numbers – the first representing the pressure when the heart is beating (systolic), and the second pressure during the relaxation of the heart (diastolic). So why are these two numbers so important? Blood pressure represents the pressure in the arteries that supply nutrients to the organs. Too much pressure in any system is harmful long-term. We measure blood pressure at rest to determine if a person has hypertension, or if the hypertension is controlled. Individual readings (no matter how high) do not predict immediate risk of stroke and do not require emergency treatment; rather averages of multiple readings indicate blood pressure control.



But why is hypertension such a big concern? Hypertension is highly associated with vascular diseases such as diabetes, stroke, kidney failure, coronary heart disease and congestive heart failure. The best way to prevent a stroke is to control hypertension by controlling blood pressure. Hypertension treatment also decreases the risk of other vascular diseases and risk of heart attack.

Some things to consider:


  1. The treatment of hypertension has noticeably improved over the past several decades. The current treatments usually result in once-a-day drugs that have rare, minor, and reversible side-effects. These drugs have no side-effects for most people. Many of these drugs are generic and can cost as little as $10 for a three month supply. There are several classes of medications. The majority of patients need more than one class of drug to control their hypertension, however there are many agents with two or three drugs in one pill.
  2. If you have hypertension, you also need to control your other risk factors for ‘hardening of the artery’ diseases such as heart attack, stroke and peripheral vascular disease. Areas to work on include quitting smoking, exercising more, controlling your cholesterol and limiting your salt intake. Remember, salt is found in many common foods such as luncheon meats, soups, catsup, ham and cheese.
  3. If you have hypertension, your physician will most likely recommend you purchase a home blood pressure monitor. They are easy to use and very accurate. I recommend taking your blood pressure in the morning and before dinner after about three to five minutes of sitting, and then record the readings. You should take your blood pressure twice daily for a month after your blood pressure medicine has been added or changed. Monthly readings are sufficient if your blood pressure is controlled. I suggest taking your blood pressure on the first day of each month. Don’t forget to bring in these readings for your health care provider.


Strokes are life-changing and debilitating. Don’t ignore controlling your hypertension as it is a truly silent killer that can be prevented by easy treatment.

Controlling Your Cholesterol

Over 1 in 6 Americans have high cholesterol, a risk factor for heart disease which is the leading cause of death in both men and women in the U.S. That is one of the many reasons why every September is National Cholesterol Education Month.

Let’s first answer the question “What is cholesterol and why is it important?” Cholesterol is a waxy, fat-like substance that is made in the liver and found in food. It is an important part of the body’s cells needed for health, but it can be dangerous at high levels. When there is too much cholesterol it can build up on the walls of blood vessels, leading to narrowing of the vessel and blockage of blood flow, possibly leading to a heart attack or stroke.



After understanding the risks caused by high cholesterol, it is important to ask, “What can I do to prevent high cholesterol?” High cholesterol does not cause symptoms and is caused by both things we can control (diet, lack of exercise, being overweight) and things we can’t control (genetics). The first step to controlling your cholesterol is discussing these factors with your doctor and, if appropriate, having your cholesterol levels checked.

Your health care provider will check the levels of a few different kinds of cholesterol in your blood:


  1. The type of cholesterol that clogs the arteries is low density lipoproteins (LDL), or “bad” cholesterol. ideally your LDL score would be <130 goal=”” varies=”” by=”” risk=”” li=””>
  2. Another type of cholesterol, high density lipoproteins (HDL), helps to remove LDL from the blood stream. This is “good” cholesterol and its score should be >40.
  3. A third type, triglycerides, is a type of fat that is in the blood stream and stored in fat cells throughout the body. This is also “bad” and the score should be <150.


The next step in managing high cholesterol is making changes to your lifestyle. These include eating a low fat diet (<35% of calories should come from fat), and eating plenty of fiber. Not all fat is bad, however. Unsaturated (but not trans) fats may lower your LDL and raise your HDL. It is also important to maintain a healthy weight and exercise regularly.

Unsaturated Fats: Avocados, Olive Oil, Peanut Oil

High Fiber: Whole grain bread/cereals, dried fruits, vegetables, legumes

Sometimes these lifestyle changes are not enough. If that is the case, there are medications that can help lower your cholesterol. Your doctor can discuss how to make these healthy lifestyle changes and if medication is needed.

It is flu season once again

Flu vaccination can be scheduled as soon as flu vaccine arrives, usually around August, and can continue into late spring.

Flu vaccine is indicated for everyone over 6 months of age, each year.

It is especially important for those at high risk of receiving complications from the flu to get vaccinated. Please click here for the CDC recommendations.


Receiving a vaccine each year is important because coverage from the vaccine only lasts for about 1 year.

This year’s vaccine is the same as last year, it covers against 3 – strains of the flu, including the 2009 H1N1, but you need to receive a dose this year to protect you this year!

Ask your provider if your child younger than 9 years of age needs to receive 2 doses of vaccine this year, for those that only receive one dose but require 2, it may only be 50-60% effective.

Let’s look forward to a healthy 2011-2012!

Getting the Whole Grain Your Body Needs

September is National Whole Grain Month – perfect timing for planning healthy back-to-school meals and snacks.

Eating a diet rich in whole grain foods can decrease your risk of heart disease, cancer, diabetes, obesity and digestive disorders. The USDA’s Dietary Guidelines 2010 recommend that adults eat at least 3 full servings of whole grains per day and that kids eat at least 2 to 3 servings. A full serving provides 16 grams of whole grain at a time.



Most people have heard of whole grains and know they are healthy but, in reality, the average American eats less than one full serving of whole grains per day. Many foods that look and sound healthy, such a “multi-grain” cereal or “high fiber” bread may in fact be refined grains. A grain, whether it’s wheat, corn, rye or barley to name just a few, has several layers called the germ, the endosperm and the bran. When the entire grain kernel is left in a product, it is considered a “whole” grain. When a grain is “refined,” the bran and the germ are removed, along with most of the fiber and about half of the other key nutrients. Some of the nutrients and fiber can be added back, which makes the food “fortified,” but the whole foods with the original nutrients intact are the foods that provide the most benefit. Consumers need to look for the words “100% whole grain” or the stamp of the Whole Grain Council on labels to be sure to get the best choices. The words “100% whole grain” mean that there are at least 16 grams (a full serving) of whole grain, while the Whole Grain Council stamp by itself means at least 8 grams (1/2 serving) of whole grain.

How can a person get all the whole grains they need? It’s as easy as starting the day with oatmeal or a slice of 100% whole wheat bread, having whole grain rye or wheat crackers with your soup or salad for lunch, and having whole wheat pasta or brown rice for dinner. Kids can enjoy a bowl of whole grain oat cereal for breakfast, a sandwich made with 100% whole wheat bread for lunch, and a snack of popcorn or half of a 100% whole grain English muffin with pizza sauce and a sprinkle of cheese for an afternoon snack.

The following list gives a few suggestions for full servings of whole grains. Try to get at least 3 servings per day.


  • 1/2 – 1 cup cooked oatmeal, quinoa, barley, brown rice or whole wheat pasta.
  • 1 serving of crackers such as Triscuit™ or Rye Krisp™.
  • 1 slice of 100% whole wheat bread, a 100% whole wheat mini bagel or a 100% whole wheat English muffin.
  • 3-4 cups of popcorn.


Considering Holistic Medicine

Health consumers are confronted with lots of choices when considering how to maintain or improve their health. Many of these options might be considered “alternative” to traditional western medicine, or could be thought of as “holistic.” Holistic health care is sometimes described as care that addresses body, mind, and spirit, and seeks a healthy balance. For the interested consumer, evaluating strategies which they might not find at their local doctor’s office or hospital can be challenging.

The spectrum of holistic strategies is very wide. The most commonly used in the US are manual therapies such as chiropractic and massage, supplements such as herbs and nutrients, stress management tools like meditation, and traditional healing tools which may be thousands of years old like acupuncture. Surveys have shown that Americans utilize such approaches in large numbers. They may find out about such options from friends, relatives, the internet or their usual health care providers.


Research into the effectiveness of holistic therapies is being funded and overseen by the National Institutes of Health, and careful reviews are being written and made available online by other health professionals. Still navigating the world of holistic therapies can be difficult and confusing.

Here are some things to consider if you are contemplating something new.

  1. It is always prudent to consult your usual health care provider when contemplating nontraditional strategies. Although most holistic approaches to health care are safe, there may be risks such as combining herbs with medication. At the very least, it is good to keep your health care provider in the loop – you might also educate them in the process!
  2. Doctors are trained to “first do no harm.” This principle applies to any therapy. It is up to you to communicate about your experience to your provider, holistic or traditional. Trust your experience – can you tell that the therapy is helping? If so, that’s great. If not, perhaps it is not for you.
  3. Finally, there is no substitute for living well. Eating nutritious food in moderate quantities, getting more physical activity, working on your relationships, and cultivating a positive attitude are all very powerful and holistic strategies.