Focus 580; Womens Health

Good morning welcome to focus 580 the morning talk program My name's David Ensor. Glad to have you with us. We are also pleased to have back here on the program Dr. Susan Tripp and she is an obstetrician and a gynaecologist. She also teaches the Med School here in Abana champagne. And once a month always on a Monday she is here on focus 580 to talk about women's health. She usually comes prepared to talk about a few things that might be new or in the news but also she is here to answer your questions now. Whenever we have physicians on the program I try to warn people the beginning of the program that obviously we can't diagnose over the phone. There are some things that the doctor just can't do because she can't see you. However we don't I don't want to discourage anybody from calling we do these programs to help you. Add to your health knowledge and it might be a place to start to get some basic information and of course if you have concerns you pursue them need to pursue them with your own doctor or with a doctor who can see you. But questions are certainly welcome here in Champaign Urbana 3 3 3 9 4 5 5. We do also have toll free line that's good anywhere that you can hear us and that is eight hundred. 2 2

2 9 4 5 5 3 3 3 W I L L and toll free 800 1:58 W while I'm well thanks very much for being here this morning. I know there are some things that you probably would like to talk about. There was one story that I came across and perhaps people have seen that I thought certainly it would be a good thing to ask you about this was a story that was just on the front page of The New York Times just last week and it's based on a study that was published in The Journal of the American Medical Association where a couple of physicians were looking at national data on Pap testing and hysterectomy and they looked over 10 years and what they found was that there was many as 10 million women who had hysterectomy and a serious this is important and no longer had a cervix. Who were still getting pap tests. And I think that they're making the argument that there's really you know there's no particular reason for them to do that that's an additional expense and there's no reason for them to have the test if they don't have

sex now. It is possible that there are women who have had hysterectomies and still do have a cervix and quite a bit there for them you would say Oh yes. But I guess I want to what you what you think about that. Well as you know that the pap smear was invented about 60 years ago something like that by Dr. George happened on it. Is it. It's become a nickname for just a screening test for cancer of the cervix but it actually is technically a test that can be used in a variety of different ways. And obviously for these women who have had hysterectomies they are getting a cervical pap they're getting a virtual Pap test. And there are cells to collect and you can technically perform that test and there are specific reasons that some of these women should still have some pap smear testing. But the general principle has probably now been proven well enough in the literature that. If you have not had any cervical dysplasia or cancer and are at low risk for

ever developing cancer and have no symptoms whatsoever that post hysterectomy for unrelated reasons say for instance if you had had uterine fibroids or an Dimitrios or something that was completely unrelated to cervical disease these women probably can safely abandon actual pap smear testing now. Again it starts getting into the concept that some patients will say I've had a pap test and what they mean is I've had a pelvic exam and this study that was talked about in The New York Times was a retrospective study where they talk to patients and said Have you had a pap test. And patients who said yes they mark them down as yes. And some of these patients may in fact have only had a pelvic exam. But we know based on the way medicine is practiced that there are probably too many women post hysterectomy still having Pap tests. But we do also want to point out that.

Worldwide there are about 450000 cases of cervical cancer diagnosed each year and probably two hundred fifty thousand women die of cervical cancer worldwide each year and also in the United States there are about 13000 cases of cervical cancer diagnosed each year and 4000 women die. And the idea behind pap smear testing is that we would identify pre invasive disease and get it treated and cured before it becomes invasive cancer. So to that extent we fractionated the number of women that are ever diagnosed with cervical cancer so pap smear testing of the cervix in general has been wildly successful. And I think the article did talk about the fact that we've done such a good job of tracking and helping to prevent cases of cervical cancer that they think one of the reasons people keep getting pap smears is you're just so enthusiastic. Talked about the ability of this test

to prevent cancer. That that they just keep getting their Pap tests. So that in general it's important to remember exactly what you said. If you've had a hysterectomy you should get a consultation with your healthcare provider and say am I someone who is still at risk for a disease that pap smear test can pick up in the reason that pap smear test post hysterectomy can still pick up diseases that the vagina the lining of the vagina can undergo some of those same pre cancers and cancerous changes as the cervix and also in the process of doing a hysterectomy. It is possible to leave microscopic collections of cervical cells so you want to find out if you were at risk. If you've had your cervix removed. If you have still have a cervix are you still at risk. Do you need pap smears and we've been talking and I know. In some of the other shows about some of the new ist

guidelines regarding pap smears in women with a cervix and basically if you have our lowest person you have a neck bigger over the age of 30 you have a negative HPV test and a negative. I have had three normal pap smears. You could possibly even go to every two to three year screening so even people still having screening tests do not need them as often as other women. And finally is there a reason she you should be getting pelvic examinations that apart from the pap smear itself. Now one thing also is most insurance companies tag pap smear testing to the fact that you're female and of a certain age group. And most insurance companies haven't changed the way they reimburse for Pap smears post hysterectomy. I think that will change we know that Medicare for instance only pays for screening pap smears every two years if there's no other indication for it. So I think that will also change and also the article I think also talked about. I'm not

I read the actual original study and they're the authors conclusions I'm not sure of if it went into this in the in the New York Times but they talked about the fact that. That internally some doctors groups have performance measures they have to lead to live up to. So for instance there their office may track the numbers of patients they had and the numbers of pap smears those patients had performed and they maybe warrant being separated out in performance measures by where whether the patient had a hysterectomy or not. So I think there that as we get to a more rational policy for patients post hysterectomy we will see the numbers of pap smears sporadically decline and on hysterectomy patients. One of the things that I was wondering about is when you're making the decision to have that surgery or to perform that surgery how do you decide whether or not you're going to leave the cervix well.

To some extent it was very popular to leave the service years and years and years ago and then we had an epidemic of abnormal pap smears and we still were seeing a number of cervical cancers but we were seeing a lot of pre cancer of the cervix which we still have an epidemic of pre-cancer the cervix and I can get back to talking about that in a second. But because of that the recommendations in the in the 70s and 80s and early 90s was pretty much always take the cervix. If you're having a hysterectomy in removing the rest of the uterus but there began to be some literature out of Europe regarding sexual function post hysterectomy and maybe leaving the cervix would enable you to have better sex post hysterectomy. Also we do have women who have prolapse of the vagina or dropping of the tissues of the vagina after hysterectomy. And it was thought that if you leave the cervix you're less likely to have to cut through or disrupt any of the supporting structures of the pelvic floor which is like a giant sling essentially.

And by doing that they thought that women would have less problems with. Bladder and incontinence and things like that post hysterectomy if you just leave the cervix and just take the top part of the uterus. We also began to develop certain techniques to be able to to leave the cervix and still have laparoscopic type surgeries. So it became popular again in the mid to late 90s to leave the cervix more often but probably I would say of women getting hysterectomy in the United States today and this is just a pure guess. I haven't read a recent article about it. I would probably say only maybe one to two percent maybe as high as 5 percent but I don't think so have their cervix left after hysterectomy. So almost no one. And it is important to know what your surgery was and I do a lot of research studies I talk about a lot of them and I was doing one research study recently that was a it was a simply a survey study but of the patients that were

entered into the survey study we needed to know whether they had ovaries or they didn't have ovaries and whether they had a uterus or they didn't have a uterus and this study required me to quote unquote prove it. And that meant Ideally I would have a copy of the operative report in the pathology report. And so I was calling. Many many like other communities we have people that that had their surgeries in other communities and I was calling big cities around our community to try to get pathology reports an operative notes that were more than 10 years old. And I discovered it was it was hard to get I couldn't couldn't obtain these these pieces of information on on all of my patients that that I needed to so I could enter some of these patients in the study and it was really unfortunate and it reminded now that we're talking about it was something that I did want to bring up and tell patients that you know it's not a bad thing to at least keep a copy of your app note a copy of your pathology report for

yourself because doctors aren't required nor are hospitals required to keep records permanently. And. Sometimes you may not have access to those pieces of information. Welcome interesting. Our guest this morning is part of focus 580 Dr. Suzanne troop and she is an obstetrician gynecologist she's on the program once a month. It's always a Monday and we talk about women's health. So questions are welcome could be on this or just about anything else that has to do with her area practice here in Champaign Urbana 3 3 3 9 4 5 5. That's the number to call. We do also have a toll free line good anywhere that you can hear us that's eight hundred to 2 2 9 4 5 5. This is an area of Madison where we've really been talking a lot and I think I've also mentioned this before on previous shows about how it's not only the fact that we've done a good job of. Getting the word out that you need to get your pap smears and it's very true that for patients who undergo pap smear screening their chances

of ever getting cervical cancer is relatively extremely low and many of the cases that we do diagnose in the United States were people who never did get a recent pap smear. But it's also very important to than do the follow up testing. And when when a patient gets an abnormal Pap smear she often will need a follow up test or a biopsy to determine if there's something really wrong or if it's just inflammation or infection or perhaps her hormonal status. And the follow up test is usually called Call pasta pate and then once we do a biopsy and we determine if there are pre-cancerous changes then the common method of curing those pre-cancerous changes has been to remove parts of the cervix and those removal operations could be done with a laser. The past they were often done with Crile surgery which is a freezing. And nowadays we we do a procedure called a leap which is a nickname for large loop.

Excision procedure and. It's done with essentially just a small electrified wire in a portion of the cervix which contains They have normal cells is actually physically removed and we do a good job of curing dysplasia with this. But we do a bad job of a couple of things number one. We're we've done more and more these procedures on very young people teenagers even and people in their early 20s prior to childbearing. And we are now very concerned that too many of these sleep procedures done on very young people might hamper their chances of successfully achieving or continuing pregnancies so the current thinking is to delay some pap smears. In other words. Don't necessarily need to diagnose these conditions in the very very young because so many do spontaneously resolve also to observe more than just immediately operate so rather

than immediately take someone to one of those surgeries after her abnormal Pap smear perhaps follow her over the course of six months or even a year in some cases before recommending surgery. And then of course lastly which is my favorite solution is to try to prevent these diseases altogether and to that end we've been working on vaccine studies and I think I talked about a vaccine study that we were involved with that was done on much younger patients patients in the 16 to 23 age to try to prevent picking up the human papillomavirus which we think is is the actual cause of the of most of the cervical cancers that develop. And we're currently involved in recruiting patients healthy patients. In the 24 to 45 age group that will be treated with the same vaccine. And I think in the last show I was talking about a press release from

another company that is working on a similar type of vaccine that doesn't target as many of the HPV types as some of the vaccines that have been tested like the one we test in the younger age group. But that seems to be the what the the thinking is to prevent many of these abnormal pap smears. So that some of these issues like getting too many pap smears and so forth will start to go away as we change the whole spectrum of the disease and make it much more rare. OK. Well again there people have questions 3 3 3 9 4 5 5 toll free 800 to 2 2 9 4 5 5 says our monthly visit with Dr. trippin and whatever's on your mind as long as it's with if it's within the the topic women's health you can give us a call. Well will you come and have a couple things that you want to be talking about what what's on your list. Well there's there's still quite a bit out there on hormone replacement therapy. And

I think there will be for a long time because it's become such a controversial subject and and and and no matter where I go and what group of ladies I end up talking to whether it's a patient her friends or her neighbors. It seems like people have a lot of questions on hormone replacement therapy and and people will always walk up to me and say things like should my mom take hormones or something like that and I I'd still like to think of a question like that. As you know what should my 6th move in the chess game be. I mean kind of have to know what the first five moves are. We talk a lot about that kind of targeting. Different individuals and what they need and it's really so controversial still. Our goal is to live as healthy and happy in with our wits about us as long as we possibly can. And there's still a lot of evidence out there that as women

move through the perimenopause the time right before menopause into menopause which by the official definition of menopause is one year with no period and into post menopause what each individual person needs in that stretch really highly varies so that in the peri menopausal time is mostly when people start experiencing irregular periods and the beginnings of hot flashes. But that is the time when people experience the biggest complaints in terms of their sleep and I start hearing a lot of complaints about weight gain. And of course we have a problem with weight gain in our population in general and there was just a new estrogen estrogen and weight gain study it was done in mice and my patients are always saying when you're just trying to study up on weight gain and we always look at it with all the studies that we're doing but so far I haven't actually found a compound or a study to be involved with that I've really felt was the right answer

but. It was interesting some some researchers were trying to blame the weight gain at the time Anna Pozen thyroid dysfunction. And we do find find women with more thyroid dysfunction at this time but they still think that somehow estrogen modulators both the amount you eat the type of food you eat the amount of weight you put on and where you put on that weight. So it's pretty fascinating that they think that estrogen may still be beneficial and I think I talked about some of these studies literally years and years ago that they said that some women who take hormones and menopause maintain a better waist to hip ratio so they stay like pairs smaller waist relative to bigger bottoms hips and so forth as opposed to the Apple configuration where you have a big waist thinner legs and we think that that pair configuration actually is better in terms of heart disease and so they were starting to.

Try to prove all this in mice. Well bit difficult but specifically they were looking at various types of estrogens even selective estrogen receptor modulator type compounds. The designer type estrogen and they were finding that of the mice that were treated with estrogen actually they they mate they were the skinnier mice so we'll see about that. So don't blame all your weight gain on on on just after 10. Also there was another article about hormone replacement therapy and heart disease and specifically looking at transdermal hormone therapy. In other words the patches and there was some evidence that the patches do not control the homocysteine level as well. That's a metabolism of folate one of the B vitamins and this study was specifically saying that patch users may not in fact be. As successful at preventing heart disease as as younger

women who are tried on estrogen so this whole heart disease and hormone therapy topic is still just wide open. But still when I when I answer specific questions about hormones I pretty much tell patients that it would be important to you to reduce your risk of heart disease by by lowering your weight and increasing your exercise and reducing smoking. What we use a hormone therapy for is to improve your sexuality to improve your sleep to reduce your hot flashes to reduce Vachel dryness to improve some of the consequences of dryness like like urinary complaints and those kinds of things are still very well treated by hormones. And what we're trying to understand is what type of hormone is the best what dose is the best what combination is the best is the best combination with the progesterone and if so would it be a natural

progesterone is the best combination with. A testosterone or are you somebody that can be handled by estrogen alone. So we're involved with one study that is specifically looking at patients who aren't satisfied with their current hormone therapy and not getting relief of all the the things that they're supposed to do with taking their hormone therapy and looking at a different type of estrogen and whether estrogen alone or estrogen and male hormone combinations are going to be the right type at their peak. Let me ask you a basic question again we've talked about this so many times about menopause. The average if I'm remembering now the average age for medical laws is 51 and a half. Yeah. And I always say fifty one point four thirty one point four Ok ever go lightly out of it and menopause is defined as one year no periods. Correct right. OK. The the period of the peri menopause that is the period that comes before that where you may see some of that

experience some of the same same signs as you say your beginnings of hot flashes you may be having sleep problems you may be having irregular periods and stuff like that. How long a period is a period of time is that while there were some new study. Were a bunch of experts got together and they came up with what they call the straw classification trying to define that period of time and they had had a two year period lead in a one year period before that with with lesser symptoms but some studies show that some women in that period of time can actually be as long as 60 years. But for most people a couple years couple of years. Is there some benefit in the I guess there's also sort of an issue have we talked about this before too. To if to do have a firm diagnosis if that's the right word to use to find out where the woman is in peri been applause what you'd have to do is you'd have to do some tests you'd have to check hormone levels. It would be a lot of trouble it would be expensive so

probably nobody here ever really does that. But it is there if if you had We're pretty sure that you were into perimenopause and if you were at the right time age wise. Is there some benefit or I mean when would you when would you say that if you would least want to talk about your doctor about the possibility of hormone replacement when you would want to have a conversation. Well I think that you bring up a really good point and that's exactly one of the current to llamas that some obstetrician gynecologist and some primary care doctors find themselves in because five years ago we really believed that hormone replacement therapy would help prevent cardiovascular disease and we also believed which we know it still does protect your bones. There was evidence that it could protect you against Alzheimer's there's evidence that it could help protect you against specular degeneration of the eye there was evidence that it could help actually improve your teeth. It there's evidence which there still is that it would reduce colon

cancer. So our thinking was that virtually everybody would benefit from hormone replacement therapy. So doctors started to suggest the idea in the early 40s and start questioning their patients about any change in their menstrual cycle and boom as soon as there were some signs and symptoms that there would be a change there was. A good starting point to discuss that conversation. Well now with the current thinking being what it is basically the current thinking amongst a certain group of experts and now the experts seem fairly well split into the sort of the hangover estrogen evangelists than the others. And they they're most of the current thinking is now if you really are having no actual symptoms and no actual act of problems then you don't really need to have a discussion about hormone replacement therapy. But if you're having any menopausal symptoms if you're having

decreased sex drive if you're having a change in your menstrual cycles then. You should do both of those things you were talking about one get an accurate diagnosis is this peri menopause or something else going on. And to what else would I rationally do about it. And then of course we've got the whole group of patients between the ages of their late 40s and their early 70s who are still on hormone replacement therapy either because of indications or because just their physician had started them on it with the belief that they were going to do better than nature they were trying to be natural trying to do better the nature of. And that group now has to have the discussion Do I really still need it and if so what type what dose and for how long. And one of my alternatives. There are a lot of alternatives. There are alternatives for treating sleep disorders there are alternatives for treating fragile dryness there are alternatives for treating the bladder. They're all trying to turn it it's for treating the bone. So you kind of need an evaluation.

Well just to add to redness out and we have a caller we'll get right to it could be. I'm going to match a lot of women who. Are approaching that POS who had heard the recent news about the studies showing there could be a lot of problems associated with hormone replacement when say well I don't have anything to do with this is there. Again I know you've always been very careful to say this is a decision that has to be tailored individually to a particular one. Sure you gotta sit down you've got to get you've got a good medical history and you've got to talk about OK what is it we're trying to do here there's no one size fits all approach but having said that I mean it would you still make the argument that for for some women some period of hormone replacement perhaps a year's worth two years where something like that might have benefits and the potential risks would be small small enough so that the potential benefit would outweigh the risk. Oh absolutely. And I think that the literature supports

that and when they say short term they start saying less than five years. But we we now are approaching to some extent that slippery slope that OK now we're getting into our fourth and fifth year and maybe the patient is just now maybe she started that in her late 40s and maybe she's just now reaching the natural age of Menippus and trying to get her off the hormone therapy is just going to cause a resurgence of some of those same symptoms and so five years is short term use doesn't even seem rational for some patients but. The other side is that when we talked about hard prevention we were talking about people in their late 40s early 50s starting on hormone therapy and when help Women's Health Initiative talked about heart harm they took women in their late 50s early 60s and tried to reverse a preexisting heart disease. Well that was a primary prevention. So we're still left with a little bit of a gap in terms of really knowing all the facts that are going to eventually factor

into those individual discussions but there's no doubt about it. If there's somebody that is not having any hot flashes and everybody in her family lives for a long time and she has no bone disease and has no problem with her sexuality and so forth and so on she doesn't need hormones to fight and even need to discuss it. But for women who are starting to have what we kind of have termed the menopausal syndrome and that is some of the side effects I was talking about. Then she should at least discuss the potential risk benefits and I think that there are actually many women that will still find that there is an important respond afit ratio due to trying the hormone therapy for short periods of time. OK. We have a call here in Charleston. Let's talk with them. It's Lie number one. Hello. Hi. I have a question that bladder infection. And I know that with increased sexual activity new partners the odds on getting a bladder infection pretty good. So anything that

you can do preventively I mean other than drinking a lot of water I think weighing urinating after sex or any of those things that you can do it would help reduce the incidence of bladder infection. 1. Well all of the things you say are perfectly good solutions to reducing your chance of getting bladder infections for people who get recurrent bladder infections usually that is not enough. And someone who's had several infections and we usually say three or more within one year she might actually be a candidate to taking a very low dose of add an antibiotics. Usually we use the time kinds of antibiotics we call broad spectrum so they would they would hit a lot of different types of bacteria that you could pick up. And usually that the types that are kind of old fashioned antibiotics that are usually very expensive and you just take one each night after intercourse and that helps to prevent infections doesn't prevent them

completely but it does help to prevent the other things says that in cranberries and blueberries there are substances that help us fight off bacterial infections. And you can either drink cranberry juice or blueberry juice or now they have cream or a pill simply bury pills. So whatever you can get ahold of in your local grocery store pharmacy or natural health food store. Those all actually work as well. And the final pieces is whether or not you should have sex with condoms. Of course condoms are a very important solution to preventing certain types of sexually transmitted diseases and helping to prevent other types of infections we unfortunately know that condoms really don't pretty much do anything to prevent picking up human papillomavirus which is not a virus that can cause a bladder infection but it's always important when talking about condoms kind of put them in perspective. And

yet women who have sex with condoms either the male condom or the female condom but of course more more more couples are using condoms. They are more prone to getting infections very early. Unfortunately that's true. OK. You mention the rhodos an about X which you would just take after sex it's time. Did those have side effects of that causing diarrhea. I mean well like any antibiotics some people can have side effects like that but ideally you would get something low enough dose that you yourself tolerate There are few different ones that we use and in the United States none of them are over-the-counter although they are in some countries but it be it have to be something that you have to get a prescription from your healthcare provider for. OK and those are those you would just take like after sex he would be taking it every single day while you have sex every day you would be taking it every single day but most people just take it on the days that they have intercourse and

what the other thing is is that. Do you have to do this or rest your life. I do have patients that have done this for literally decades but it may be something where you could do it for a few years and then if you weren't getting infections try to discontinue that. The other thing is what you use for lubricants and saliva is a lot higher counting bacteria than just things like K-Y jelly or slippery stuff. There's about 15 different brands out there of lubricants for intercourse and actually that probably reduces your chance of infection more than just using flava. OK thank you very much. All right other questions are welcome 3 3 3 9 4 5 5. Toll free 800 to 2 2 9 4 5 5 Our guest is Dr. Suzanne troupe and she's an obstetrician and gynecologist. She also teaches at the med school here in Abana champagne once a month always a Monday she's here. We talk about women's health and your questions are welcome. Just for a second I want to go back to the to the hormone replacement in the menopause question and I'm

wondering if you have a woman who is let's say a woman who is 50 and is pretty confident that she's in pre menopause and getting close to menopause and she makes this decision to go for the hormone replacement. So if we say that. So say she's going to be on we say that she's going to be on short term she starts when she's about 50 so here now at about 55 say five years later we say OK now is the time to stop when she stops. What happens is she going to. Is she going to start to experience some of the same same stuff that she would have five years earlier if she had didn't start taking the hormones. Well remember the results from the Women's Health Initiative have just been trickling in over the past couple of years. And so we have not seen large groups of patients that we have tried to remove off hormone replacement therapy until very recent times. It seems that based on a few small studies that have been done and a lot of clinical Behrens by a gynecologist who prescribe

hormone replacement therapy that older patients patients in their 70s have really no trouble stopping their hormones patients in their 60s don't typically have a lot of difficulty stopping their hormone therapy. But patients in their mid 50s often will have a resurgence of their symptoms and require a lot of careful management. So the current thinking is number one perhaps treat with the lowest effective dose so don't always get all your patients up to these high doses of hormones that we used to use and that that will be easier. Secondly we need a lot more slowly. And thirdly. It's still important for patients who get to this point and feel they still do need that their AP to understand that even though these studies show that the risks were greater than what we thought the risks are still small. So that when they talked about say heart attacks they had 30 out of 10000 women in one group and only 37

out of 10000 in the group using hormones so we're only talking seven extra women out of 10000. So it's important to remember that the risks are still small. OK let's I think we have the caller from Charleston maybe you want to follow OK. It's ok I will go. We'll go back OK here get real quick airlines here. Hello. Hi thank you. How do you know I have. How does one know whether or not you can still get pregnant if you're a menopausal age. You're still having periods. But you may not be obvious learning right I mean correct birth control is recommended. Well that's a really good question spontaneous pregnancy after the age of 46 is pretty rare so that the kinds of birth control do not have to be as effective so that it's spermicides and condoms that sort of thing are very effective in in that age group. We also have to remember in the United States about one third of people are already sterile by that age either because their husbands had a vasectomy or their partner or they themselves have had a tubal ligation now we

have this new method of sterilization. Sure the word little coils are inserted in an office setting under local anesthesia and it's great. I really think it's going to really catch on so it'll probably be even higher percentage. There are studies that can be done to see if you're still obviating but also in the late 40s many women start having irregular periods and can be very well controlled in terms of their irregular bleeding by hormone birth control pill so even though they may not necessarily need that much contraceptive protection it the birth control pills can do other things help help control bleeding from fibroids and we know that about one third of women in their late 40s have fibroids so it's probably best again Don as individual consultation. Thank you very much. Let's go back to let's see Champaign one number one. Hello. I have a question about yeast infections and I know that if you you can prevent

them by wearing cotton underwear and things like that. And I wondered if you had in mind. Well actually the Condor wear thing hasn't been shown in research to work. But I still tell patients it and it's in every article and every Glamour magazine where there are you know those types of women's magazines that write up yeast infection. We think that about one in four women carries the yeast organisms around and that it's things that get your system out of balance. So if you change your pH are ph supposed to be very acidic and frequent intercourse can actually slightly reduce the Ph. If something's gone gone wrong with your immune system like you're diabetic or something's different about your immune system that you're pregnant. Things like that can can increase your chance of getting yeast infection a little bit more con. Common with condoms more common if you have frequent partners. But most likely in most patients the secret to controlling the infection is getting it properly diagnosed and properly treated

and treated in till it's eradicated. And some of the over-the-counter medicines don't cover all the yeast organism as well as things that you can get by prescription so that if you've treated a couple of times some of the things that you can do is get into the doc to really make sure that the infection that you are self treating is gone and that will probably do more than all the other home remedies eating yogurt and even using plain yogurt Fadhli and a lot of the other kinds of recommendations voiding dishing things like that. Really in most of the studies haven't really been shown to work very well. Yeah. To southern Illinois this is our next caller on our line number four. Hello do you know of. Any studies that have been done on natural hormone replacement therapy like I come pounding pharmacists with wild yam.

While there have been a few studies but not a lot wild yam is a contains a substance that can be in the laboratory processed to a type of progesterone and it's usually the natural hormones that are compounded for estrogen. Usually start with soy based or compounds like that. And most studies of hormone therapy talk about their effectiveness and their and their effectiveness relative to the amount of hormone that you are taking are being given. And some of the compound good medications can be formulated to mimic what what is available. But some of them are fine tune to a degree that's not been shown in traditional research to make much difference. Sing it for hot flashes and it's been really effective and I was

just wondering why it has. Well I guess it has to be compounded for a person's physical need. But I was also wondering when you go through menopause I know a lot of friends that have had thyroid problems. Do you address that when a person is going to if they have a hypo thyroid that can cause more extreme than a POS problems. Well hypothyroidism which means an inactive thyroid gland is relatively easily diagnosed by blood testing and with the available thyroid medication says supplements it's relatively easy to control and keep a person's level within what we consider a normal physiologic range. So the patients who have number one been diagnosed number two have achieved a certain stability on their thyroid medicine. We don't think

that in fact that should affect their their man a pause too much. It is number one possible to not have been diagnosed yet so it's important for women as they age to get some sort of systematic screening. It's also important if you are having symptoms that can be symptoms of low thyroid even if they mimic the symptoms of menopause to be sure and get yourself your thyroid screened. And so certainly treating with hormone therapy when you when you've misdiagnosed and you should be treating with thyroid fibroid hormone therapy. It's a big difference there. So that's important. And also any additional medicines that you take can throw off the dose and the and the control from any other medicine so it's important to get your thyroid levels checked as you become menopausal and start on hormone therapy. And that way any individual woman could keep under better control. What do you recommend.

For the fire it is a pity the free T3 end and key for it to be checked or there are other thyroid gland makes a hormone called thyroxine and it usually circulates in the blood as well as a certain chemical form called T4 but T3 is a little bit more active. So if you are actually going to measure the amount of thyroid circulating in your blood we usually do measure T3 senti force. For anyone who is getting screened for thyroid disease we think that the most sensitive easy quick inexpensive accurate ones greening test is something called a TSA agent and that stands for thyroid stimulating hormone and it's a pituitary hormone that is secreted in response to whatever the thyroid gland is producing so that if our thyroid gland is producing a normal amount of thyroid hormone the DSH level be normal. If our thyroid is over producing. Thyroxin then the

TSA chief levels very very low. So that would be a signal for hyperthyroid NFR thyroid gland is not producing enough hormone at all. Then the TSA chief level rises so it would be greater than you would expect so that that first screening test is usually done with the TSA each. And then if you've been diagnosed or you're being maintained on thyroid hormone we do use these other measures along with some some other very sophisticated measurements of Barad function to follow and see if that their P is adequate. What do you think about the phase of temperature and people taking morning to see if their temperature is below normal every morning before rising meaning for control of their thyroid to ice. It can be it can be important if. If you're still not being adequately controlled or you have a difficult case or you're having symptoms but it's usually not for Slyne recommend that there p

are. It's not something that that most general say primary care physicians or primary care gynecologist would probably recommend that you follow but occasionally endocrinologist to use that test Thank you. All right thanks for the call. We have about maybe 0 2 3 minutes left in this part of focus with doctors who's in troop and somebody wants to go real quick we can get them in otherwise some of the things that you won't mention. Yes it was an interesting report about vegetarians and pregnancy and I was kind of I mean very strange report. We've talked before about our feet approaching test screening and it's a marker for certain types of birth defects but some pregnant moms will have abnormal tests where there's actually nothing that we've determined that is abnormal about the pregnancy. And it turns out that some vegetarians are very low in vitamin B 12 levels which we know because that that is one of the vitamins that that you can get from

eating meat. And if you're not careful to plan your diet you can run into minor deficiencies. And they were seeing that some vegetarians had abnormally high percentage of these false positives on this alpha protein test screening for Down's patients. And they linked it to low be 12 so it's kind of interesting. So it just gives us one more insight as to you know what could possibly be wrong if the test was abnormal but we haven't determined that there's anything wrong with the pregnancy. Try to get one more caller here one one. Hello. Good morning. Yes I have. And it crosses that song dreamland man up at 14. Well there are certain genetic heritage as that go through menopause early. It's also possible to get viral infections that cause premature menopause. Of course in the United States removing the ovaries or having prior ovarian surgery is also a common cause of premature

menopause and those those on the most most common types we find that women who undergo we call premature ovarian failure actually about one fourth of those patients will go back into regular cycling even after being diagnosed. Maybe not accurately diagnose they were thought that they were completely in men a pause but they just had a transplant low production of hormone and they really hadn't completely crossed through and that's probably more common than do anything to try not to have a person that I'm talking just she didn't. Good Month to you. 140. Yeah well it can happen. And she certainly is somebody that can undergo a blood hormonal testing to determine if that is what in fact is going on. And she'd also be somebody that would be at risk for premature bone thinning and premature heart disease so she would benefit by talking to her health care provider about what she can do to prevent some of those consequences as she ages.

I mean you said why you know infection means what are you going mom sort of favors. And of course chemotherapies there are other causes but nobody but it can happen. OK thanks a lot. I think you will there and we will have to leave it for this time around with promise that again next month. Dr. Tripp will be back with you again Suzanne for openness an obstetrician gynecologist who also teaches you by med school hairband champagne once a month here on the program to talk about women's health. Thanks very much. Thank you.