A focus on women's health

Tue, May 31st 2016, 11:24 AM


According to Dr. Carroll, an OB/GYN, the gynecologist plays an important role for females and for the most part serves as a female's primary care doctor.

Women tend to be better than men about seeking medical attention when they don't feel well, but there is still a cross section that tries to get away with only scheduling an annual trip to the gynecologist. If you are one of those women, you may be missing out on other screening tests, conversations and tell-tale signals that allow for early detection and intervention.

Dr. Pamela Carroll an OB/GYN says the gynecologist plays an important role for women, and for the most part serves as a woman's primary care doctor.

"Gynecologists play a unique role in a female's life, because we see you throughout the different stages of your life -- in her 20s the female goes to the gynecologist to get her pill so that she does not experience any unwanted pregnancies; in her 30s the female is thinking about marriage, stops taking the pill and has children; and in her 40s and 50s she speaks to her gynecologist about topics such as vaginal dryness, too much bleeding or chronic pelvic pain -- and for that reason most people choose to have their gynecologist as their primary care doctor," said Carroll at the recent Doctors Hospital distinguished lecture series.

She addressed menopause and breast health with the women. Dr. Carroll said the only silly question is the one a female won't ask.

She said one of the common complaints she gets from women in the older age bracket is menopause, which is said to occur around age 52, but can happen earlier or later. But she said premature ovarian failure is a condition some women face where they experience menopause before the age of 40.

While many women look at menopause as "the kiss of death", after hearing horror stories from women who have gone through it, Dr. Carroll said menopause does not have to be a crisis for everyone. She encourages her patients to ask their mothers about their experiences with menopause, because, she said, the likelihood is strong that they would have a similar experience.

"You can either have mild symptoms, moderate or you can point-blank have a crisis. Most people experience hot flashes -- you're sitting down having a conversation with your girlfriends, and all of a sudden this bunch of heat rushes up on you, and 90-seconds later you feel cold and you break out. That is one of the most common complaints that women have and is one of the earliest indications that you are menopausal," said the doctor.

As women age, vaginal dryness is an important symptom to be aware of; according to Dr. Carroll, the vagina can become so irritated that it almost feels like sand is in there. Vaginal dryness can increase chances of urinary tract infections (UTI) and can cause bleeding during intercourse, but the condition does not have to be endured.
Dryness can be treated with the use of vaginal estrogen or a cream. Dr. Carroll said she prefers Vagifem tablets, because creams can be messy.

She reminded women that anything that is topical or vaginal does not reach the blood.

"A lot of women are concerned after hearing about the studies about hormone replacement therapy (HRT) causing increased risk of stroke and heart attack, but with the vaginal preparations, you don't have that increased risk, so you can take a vaginal preparation of estrogen without being concerned that you're going to get cancer, or you're going to die of a stroke or heart attack from hormone replacement therapy. If you are really anti-hormone, you can use other products like KY Jelly or Astroglide gel. I recommend my patients use the Astroglide gel, which is over the counter as it's like syrup, while KY Jelly is cakey and very thick."

Insomnia is another issue that women cope with due to menopause; she said this could be related to the fact that women have more night sweats during menopause.

Importance of estrogen for women
According to Dr. Carroll, estrogen is a female's youth hormone. It is important because it protects women from getting heart attacks; it is the reason why women usually don't have heart attacks before the age of 50 -- unlike men.

"Estrogen keeps your breasts perky; it keeps your vagina moist; keeps your skin tight; keeps your hair from dropping; and estrogen is also good for the bone," she candidly told the women. "The primary thing that's gone with menopause is the estrogen, so I'm only concerned about replacing the estrogen."
Women who have had hysterectomies have needs that have to be met a little differently during menopause.

"If you have a uterus, I have to give you progesterone and estrogen, because if I give you estrogen alone I'm increasing your risk of cancer," she said. "It's important when you have the discussion with your gynecologist that I'm sure they know if they did a hysterectomy on you or not, and they will be able to tell you if you just need the estrogen, or the estrogen plus the progesterone."

For those who do decide to take hormone replacement therapy (HRT), the doctor said it should only be given for a period of three to five years. Those with a history of breast cancer, or some other form of cancer, can use a non-hormonal replacement therapy, like Exeffor.

"If you're having the hot flashes, the mood swings, the irritability, the insomnia -- you have the non-hormonal options, so no hormones, no increased risk of stroke and heart attack, and then you have the hormonal options, which work the best because you're replacing what's lost and then you have the preparations for things like vaginal dryness. I don't give people HRT for the hell of it. I give it because you have a reason, because everything that you take has side effects, and you have to do the balance. That is a discussion you have with your gynecologist, because not everybody needs to take a tablet, and not everybody needs vaginal therapy."

The reality, she said, is that all women will go through menopause, whether it is naturally or via a hysterectomy.

All women, she said, should have an annual Pap smear done until they reach the age of 70 -- the recommendation by the American College of Gynecology.

"If you've had a total hysterectomy where they removed the womb and the cervix; partial hysterectomy where they left the cervix behind, you need a Pap smear until you're 70 per the recommendation by the American College of Gynecology every year. If the cervix is not there, and you had normal paps all your life, you do not need a Pap smear. If you did a hysterectomy, they removed the cervix, but you had abnormal Paps, you need Pap smears every year, because you can get recurrent abnormal cells in the vagina, so you do a vaginal Pap."

Hygiene

Another reason a lot of women come to her office, she said, is because they notice a discharge.

The discharges that cause concern are those that are the result of sexually transmitted diseases like trichomonas, chlamydia and gonorrhea, which cause a very foul scent from the vagina, and can actually cause a woman to develop pelvic infections or pelvic inflammatory disease.

She said there are other discharges like bacterial vaginosis, which gives off a fishy odor. Women can also get yeast infections, which cause itching and are fairly simple to treat. For recurring infections, Dr. Carroll says the American College of Obstetrics and Gynecology has come up with new things to help, because a patient should not take antibiotics every time she has an infection.

"You need to find a more natural way to deal with the situation. What they recommend is after you have intercourse you urinate; you try to wash undergarments separate from everybody else's clothes and separate from your day-to-day clothes. They recommend using something like Ivory or Dreft, because they're hypoallergenic. And everybody knows you can't wear the lacy stuff -- you should wear cotton and white.

Another thing they recommend is probiotics... Probiotics are very good for vaginal infections and also to help with the regularity of your bowel movements. They also recommend not sleeping with underwear on."

Dr. Carroll said pubic hair should be trimmed low and she encouraged the wearing of knee-highs over stockings. For those who insist on wearing stockings, she recommend cutting a hole in the vaginal area to allow the vagina to be a little cooler.

Breast cancer
Dr. Carroll urged the women to be vigilant about their breast health, reminding them that both men and women can get breast cancer.

She said breasts are to be self-examined every month after a period, when they are less sensitive. If the person does not have a period, she can simply pick a time of the month to do her breast exam and make it routine. After a period is also when she recommends having a mammogram.

A high rate of breast cancer in The Bahamas has been linked to the presence of the BRCA 1 and BRCA 2 gene mutation, but Dr. Carroll said only 10 percent of breast cancer is genetic and that 90 percent of breast cancer is multi-factorial.

"They did say that it's diet a little bit, but also they say we have a small gene pool which is one of our problems in a sense that some people marry their fifth cousin, which is doubling of the gene -- you have a woman who has the gene, mates with her distant relative, who has the mutation, you end up with double whammy and end up with a more aggressive form of breast cancer. We have a high rate of BRCA 1 in the country, so that increases your chance of breast cancer, and also increases your chance of ovarian cancer."

In the United States, breast cancer screening in women begins at age 50. Dr. Carroll says she starts patient screening at age 40 when there is no family history. And if she feels "something" during an exam, she sends her patient to do an ultrasound if they are younger.

"The reason the mammogram is done later, is because your breasts have fat and glands, when you do the x-ray film, the fat comes black and the gland is white, so when you are younger you have more glands, when you are older you have more fat. When you are younger, you do an ultrasound; when you are older, you do a mammogram. In The Bahamas they are doing a lot of ultrasounds with the mammograms, because a lot of women in The Bahamas have dense breasts, plus we have a high rate of cancer, so they're being extra cautious about dense areas of the breasts so they can do better looks at the breast tissue. So don't panic when they ask you to do the ultrasound because that's just an additional check for them to be sure that your breasts are normal."

Dr. Carroll said people should not use the excuse that their breasts are lumpy so that they don't have to check; 90 percent of lumps are actually picked up by the patient.

When doing a self examination, the doctor said, no blood should come out of the nipple when squeezed; the skin of the breast should have no rash or dimpling. She said breast cancer feels like a rock.

She also urges against females using powder, especially powder that has talc on any parts of their body, whether between their breasts or in the vaginal area.

"Powder has talc, and talc is a carcinogenic, meaning it causes cancer. Don't put power in the vaginal area, don't put it in the baby's pamper. The pediatrician says to use Vaseline, or nothing at all. If you must use powder, make sure it is talc-free," she said.

The gynecologist also said women should not use feminine washes and they should not douche, which changes the pH of the vagina.

"[Douching] is not healthy. The vagina is self-cleansing. We all have bacteria in our vagina, so you are pushing that bacteria into your womb and increasing your chances of infection. When it comes to your vaginal area and your skin, I prefer hypoallergenic cleansing products like Dove soap," she said.

Shavaughn Moss, Guardian Lifestyles Editor

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