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Free Educational Seminar - Laparoscopic Hysterectomy
Join us on March 4, April 1, May 6, or June 3 at 7 p.m. at our office in North Scottsdale to find out if you're a candidate for minimally invasive laparoscopic procedures. Call 480.391.3638 to reserve a seat at our free educational seminar.
Free Educational Seminar - Testosterone Pellets
Join us on March 11 or April 15 at 7 p.m. at our office in North Scottsdale to learn more about Testosterone pellets. Call 480.391.3638 to reserve a seat at our free educational seminar.
- Decreased sexual desire
- Diminished vital energy and general sense of well-being
- Decreased sensitivity to sexual stimulation
- Overall decreases arousability and capacity for orgasm
- Thinning of pubic hair
Testosterone is often thought of as a "male hormone," but women produce testosterone as well, and testosterone is an important hormone with a number of functions.
Unfortunately, as we age we make less and less testosterone. Testosterone levels begin to drop in a womans 40's. If ovaries are surgically removed, the drop is often sudden and dramatic.
When you were entering puberty, it was testosterone that stimulated pubic and underarm hair growth. Testosterone also increased oil production of your skin and hair. There are testosterone receptors in the nipples, the clitoris, and the vagina, making these tissues sensitive to sexual stimulation. There are also testosterone receptors in the brain, which play a part in the experience of "falling in love."
Testosterone affects the body in general by making the best use of nourishment for growth and maintenance, and particularly contributing to the health of bones and muscles. Testosterone creates a sense of "well-being" and increases energy levels.
Testosterone is produced by our adrenal glands and by our ovaries. When we approach menopause in our 40's, both the adrenals and ovaries produce less and less, until our levels drop to almost nothing in our 50's. The truth is, we weren't designed to live much beyond 50. In fact, in 1900 the life span of a woman was 50 years. We are living longer, and in order to maintain our health and vitality, we must accept that some hormones may need to be replaced.
Oral testosterone can be helpful, but is not always effective. Testosterone is also available in creams, which work for some women and not others. The most effective method of administration of testosterone is a time-released pellet inserted in the fatty layer of the buttocks. The pellet will usually last 3 months and can be combined with estrogen pellets.
Insertion of the pellets is quick and involves only minor discomfort. A local anesthetic is used and after this takes effect, you will feel only slight pressure. The small nick in the skin heals up readily and you will begin to feel the positive effects within a few days.
In our practice we have hundreds of women who come in regularly for their testosterone and estrogen pellets. They report that they feel great until the pellets begin to wear off anytime from 2 months to 4 months after they are inserted. They describe increased energy, vitality, and sexual desire.
Combining testosterone pellets with estrogen eliminates the need to take estrogen pills or use patches. Also, pellets offer the advantage of steady estrogen levels, eliminating ups and downs which can be problematic.
If you are peri-menopausal or menopausal, particularly if you had your ovaries surgically removed, you may want to consider this option for yourself. Even if you are a breast cancer survivor, testosterone seems to be safe and may improve your life!
We have been thrilled with our new 3-D ultrasound and our office hysteroscope. The 3-D ultrasound allows us to visualize the uterine lining with much more clarity than we could with the 2-D ultrasound. We can identify polyps and fibroids bulging into the uterine cavity, which are a common source of irregular bleeding, spotting, and heavy periods. Polyps and intrauterine fibroids are frustrating in that they do not respond to hormones. They can usually be easily removed, solving a very annoying problem.
If we think we see a polyp on ultrasound, we will recommend an office hysteroscopy. This is an easy procedure in which we insert a tiny flexible scope through the cervix into the uterus. The tip of the scope bends, so it is usually possible to obtain a thorough view of the uterine lining, including polyps and fibroids, within 30 seconds. The procedure is slightly uncomfortable for some women, but the discomfort can be minimized by taking 800 mg of ibuprofen before the procedure.
We are proud to offer this service to our patients as part of our continuing mission to provide the most up-to-date and comprehensive gynecologic care available.
The Flagstaff Humane Association (not a Humane Society) is located between I-40 and Dr. Wilson's home in Flagstaff. That means that Dr. Wilson is compelled to stop by and check the place out frequently. Two months ago she left with Noah, a blue heeler mix, and Teek, a black lab. Teek had been there for 3 months and Noah for 2 weeks.
Flagstaff Humane Association has a relatively high euthanasia rate and the quarters for the animals are nothing short of barbaric. It is heartbreaking to go into the facility and see all of these pleading, innocent faces begging to be let out of their tiny pens. The dogs only get an opportunity to leave their pens twice a day, at best, and for a housebroken dog, this is torture. In fact, Teek had a severe urinary tract infection from "holding it." If they do break down and begin urinating or defecating in their pens, they are no longer desirable as pets, because they are no longer housebroken. They are just simply broken.
Dr. Wilson takes dogs and cats out of this shelter often, so if you are interested in adopting, please let her know. If you are looking for a particular type of animal, she may be able to find it for you.
Please consider adopting an adult animal instead of a puppy or kitten. The shelter people will tell you that everyone wants puppies and kittens, and wonderful mature animals get passed over all of the time. There are many advantages to adopting an adult animal. First, what you see is what you get. You don't have to wonder how big the dog will get to be, etc. Secondly, you don't have to go through housebreaking, which inevitably involves frequent accidents and potentially permanent damage to carpet or furniture. Third, it is simply a good thing to do. Many of these animals come from good, loving homes. Through some circumstance, the people simply could not keep their pet and put it up for adoption. These animals, who were loved and cared for, do not deserve to be euthanized. By adopting these unfortunate animals, you give the animal a second chance and gain a wonderful companion.
There is no longer any excuse for a fractured hip! Bone Density DEXA is painless, quick and easy. Our patients have been quite happy with the easy availability of DEXA in our office.
Any woman who is 50 or over, or has other risk factors for bone loss, should have a bone density DEXA study every 2 years. Heel and wrist scans are obsolete and are not accurate enough. Your insurance will cover the cost of this screening procedure and it is now recommended as a regular screening test along with pap smears and mammograms.
Your results will be given to you immediately, plus Dr. Wilson will review your results along with past DEXA studies, if available, and you will receive a call within a few days with her recommendations.
The advantage of having it done in the office is that Dr. Wilson has your clinical history available and can make a recommendation based on your own personal medical history. She knows what drugs you are on and can advise necessary changes to your regimen.
We are priced lower than any other facility we know of, so if your insurance does not cover a DEXA or you do not have insurance, it is still an affordable test. You are welcome to send your friends, even if they are not patients at this office.
If you are interested in a DEXA study, do not take calcium the morning of the study. It can alter the results of the test.
A recent article in the New England Journal of Medicine confirms what many of us have suspected. After a review of the national Medicare claims database from 1998 through 1999, the authors concluded that "Patients can often improve their chances of survival substantially, even at high-volume hospitals, by selecting surgeons who perform the operations frequently."
Don't be afraid to ask a potential surgeon how many procedures he or she has performed and what the complication rate is. What is at risk, after all, is your health.
There are a few different "morning after pills" available. For years, we have used high doses of birth control pills, but now two drugs designed specifically to be taken after unprotected intercourse are on the market. The first is Preven, which is a combination of estrogen and progesterone. Two tablets are taken 12 hours apart (a total of 4 tablets). This treatment reduces the risk of pregnancy to 2%. The main side effects are nausea and vomiting, which can be minimized if an anti-nausea pill is taken along with the hormones.
A second and better tolerated option is available under the name "Plan B." This drug contains progesterone only, and nausea and vomiting are less common. The risk of pregnancy is reduced to 1%.
Pregnancy rates are lowest if the pills are taken within 12 hours of unprotected intercourse, but still effective if taken up to 120 hours later. If you or someone you know realizes that they have had unprotected intercourse, please call the office for a prescription. Now that we have these options, unintended pregnancies and abortions should be a thing of the past.
The Women's Health Initiative study created quite a shock wave when the estrogen-progesterone arm of the study was prematurely halted due to the significantly increased risk of breast cancer in the treatment group over the placebo group. Now that the water has cleared, many questions are being raised.
First: No one knows whether estrogen/progesterone CAUSED the breast cancers or simply stimulated pre-existing breast cancers to grow more rapidly and thus be detected earlier.
Second: Does ANY estrogen/progesterone combination cause an increased risk of breast cancer or is it specifically premarin/provera, which was the combination used in the study? Specifically, are "natural" hormones safer?
Third: Does estrogen alone cause an increased risk of breast cancer, or is it specifically estrogen combined with progesterone?
A smaller study just released indicates that the answer to the third question is that estrogen alone does NOT seem to cause an increase in breast cancer. So all of those women who have had a hysterectomy and do not need to take progesterone along with estrogen can relax. Answers to the first two questions are not yet available, but should be within the next few years.
Women with a uterus who need estrogen must combine the estrogen with some form of progesterone in order to prevent uterine hyperplasia and potentially uterine cancer. One option for these women is to insert a progesterone-containing IUD which should protect the uterine lining but not expose the entire body, specifically the breasts, to progesterone.
I know that using progesterone cream is a popular thing to do, and some women seem to feel good on it, but I have a concern about all this progesterone exposure and a potential increased risk of breast cancer. No studies have been done to look at this, but I do worry.
Of the 1.3 million cases of cancer that will be diagnosed this year in the US, as many as half could be prevented. Researchers currently are focusing on three areas: diet and exercise, use of supplements and chemopreventive agents, and the use of natural or synthetic substances to reduce the risk of cancer.
Here are some suggestions:
- Eat a low-fat, high-fiber diet with no more than 15 to 20 percent of calories from fat
- Eat at least seven servings of fruits and vegetables a day
- Drink green tea
- Do at least 30 to 60 minutes of moderate-to-heavy cardiovascular exercise four to five times a week
- If you smoke, quit now
- Wear sunscreen with a SPF of 15 or higher whenever you go outside; sun damage in fair-skinned people can occur in just 15 minutes
- Limit alcohol consumption
It is a difficult decision these days to decide whether to take estrogen replacement when you become menopausal. Once you have decided to take it, you then need to decide what form to take it in. I will go through the different forms for you and discuss the pros and cons of each.
Pills have been around for years. Premarin, derived from pregnant mare's urine, is the oldest form of estrogen available to women. We have many brands of oral estrogen and many doses. The advantage of a pill is that it is easy to remember to take it, especially if you are taking other pills regularly. There are, however, a few disadvantages. First, the incidence of thromboembolism (blood clots) is higher in women who use the pill than the patch, pellet, or vaginal ring. Estrogen has been known for years to increase the risk of blood clots slightly, and it seems that the pill creates more of these changes in the clotting system than any other method of administration.
Migraine headaches are frequently improved with estrogen administration, but pills will tend to make them worse. The reason for this is that migraines can be stimulated by ups and downs of estrogen in the system. The patch, pellet, or vaginal ring keep levels steady, while the pill will raise the blood levels significantly just after the pill is swallowed, and then the blood levels drop slowly throughout the day. As the level drops, a migraine can occur. A recent study looked at menopausal women with migraines and found that migraines occur less frequently with higher doses of estrogen patch specifically.
Pills will often need to be taken twice a day in order to keep levels steady. Women who take a pill in the morning often feel tired or depressed in the evening, and may even begin to feel some hot flushes or night sweats. This problem can be solved by taking a lower dose of the pill twice a day.
Many of our patients choose the patch because of the above-mentioned advantages, and because it only needs to be changed once or twice weekly. The pellet is also a popular method of estrogen delivery. Estrogen pellets are placed under the skin of the buttocks every two to three months and release estrogen slowly directly into the capillary system. Often, they are combined with testosterone pellets. Many of our patients prefer this route of administration even though it requires a trip to the office every few months.
A new option for women who need estrogen is the vaginal ring. Women who suffer with vaginal dryness as their main symptom benefit particularly from the ring. The ring releases enough estrogen into the system to successfully treat other symptoms as well.
Whole Body Scans are becoming quite popular. People are paying out-of-pocket for CT scans in hopes of hearing the reassuring news that everything is fine or discovering an early, treatable cancer. Should you do it?
My first concern about these scans is the ENORMOUS dose of radiation (30 times that of a chest x-ray) you are exposed to during one of these scans.
Most cancers tend to appear sporadically after age 50. In order to pick up on a cancer early, one would need to undergo periodic scans, which could expose you to potentially cancer-causing doses of radiation. Don't think for a minute that x-rays don't cause cancer. High doses or repetitive exposure can definitely put you at risk.
CT scans frequently indicate a problem where there is none. For instance, CT scans are notoriously inaccurate when it comes to evaluating the uterus and ovaries. I have at least one patient per week bring me a CT report that describes an ovarian cyst or a uterine abnormality that turns out to be nothing. The extra tests that subsequently result (such as more x-rays or biopsies), can not only be expensive but can carry their own risks.
Some cancers, such as colon cancer, do not typically show up on CT scans when they are early and small. On the other hand, many small tumors are small and will never present a problem. People die with them, not of them.
CT scans may cause these tumors to be aggressively treated when they never would have caused a problem.
CT scanning has undoubtedly saved lives, but I urge you to think twice when you make the decision to have one. Remember that the "Whole Body Scan" providers are not offering this expensive service out of the goodness of their hearts, they are making huge profits.
Copyright ©2004 Dr. Deborah Wilson, eNews Design ©2004 The Rogers Group, Inc.