Gynecology

Hot Flashes and WTF Moments: Navigating Perimenopause in Your 40s

Christina Haag, APRN

Ah, your 40s.  The decade where you’ve finally figured out how to say no without apologizing, you own more leggings than jeans, and you’ve accepted that “going out” now means leaving the house by 5 p.m.  But just as you start feeling semi-sorted, your body decides to throw you a hormonal curveball called perimenopause—aka nature’s not-so-subtle reminder that she still runs the show.

Let’s talk about it.  Because while everyone warns you about menopause, no one quite prepares you for its chaotic little sister: perimenopause, the transitional phase that can begin as early as your late 30s and likes to party well into your 40s.

The Hormone Rollercoaster from Hell

First, the hormones.  Estrogen and progesterone start doing a weird on-again, off-again thing like a couple that definitely should’ve broken up years ago.  One month you feel fabulous, the next you’re crying because your toast burned and obviously this means your life is falling apart.  Mood swings become so unpredictable, even your cat is keeping a safe distance.

Periods: Choose Your Own Adventure

Perimenopause turns your cycle into a twisted game of “Guess When I’ll Bleed!”  One month it’s a light whisper of a period.  The next, it’s Niagara Falls and you’re Googling “how much blood loss is too much before I go to the ER?”  Oh, and PMS?  That now stands for Perimenopausal Mood Storm, and it comes with bloating that rivals third-trimester pregnancy.

Hot Flashes and Night Sweats: The Unwanted Guests

There’s nothing like waking up at 2 a.m. in a puddle of your own sweat to make you question your life choices.  Your partner, wrapped in blankets, is shivering while you’re flinging off sheets like a deranged rotisserie chicken.  Daytime hot flashes?  They hit mid-meeting, mid-coffee, or mid-sentence—often while you’re trying to seem like a composed adult.

The Brain Fog is Real

Remember when you could multitask like a boss?  Yeah, not anymore.  Now you walk into rooms and forget why, lose your phone while you’re holding it, and find your sunglasses in the fridge. It’s not early-onset anything—it’s just your brain on estrogen withdrawal.

Libido: Missing, Presumed Napping

Your sex drive may be taking a sabbatical.  It’s not that you don’t want intimacy—it’s just that sleep sounds better, bras feel like a personal attack, and frankly, you’re too busy trying not to stab someone over loud chewing.

So, What Now?

The good news: you’re not alone.  Millions of women are quietly sweating through Zoom calls, stockpiling pantyliners, and crying over dog food commercials right along with you.  Talk about it.  Laugh about it. Rant if you need to.  And most importantly, get support—whether that’s from friends, a health professional, or a decent fan.  Ready to tame the hormonal chaos?  Click here to make an appointment  and let our menopause specialists work their magic.

Perimenopause may be a bit of a dumpster fire, but you, my friend, are still absolutely on fire. Just… bring a towel.

Gynecology

Looking for a new OBGYN provider in Bedford?

We are excited that you are considering Bedford Commons OBGYN for your healthcare.  We know it can be difficult to change providers or meet someone new.  To select the provider who is right for you, check out our provider videos on our website.  All of our providers are currently accepting new patients.

When you are ready to set up an appointment, you can schedule most appointments using our online scheduling or by talking with a patient care specialist by calling  603-668-8400.  If you’re newly pregnant or need immediate care, please be sure to call us.

Although having your records isn’t required to make an appointment, it can be very helpful to have a copy of your last GYN office visit, your last pap test, and any routine labs that you have had within the last year.  To facilitate this process, complete an online medical records release for your previous healthcare provider.  Click here to complete the medical records release.

Bedford Commons OBGYN accepts most major health insurance plans.  However, it is important for you to verify whether we accept your specific health plan at the time you schedule an appointment.  We may require a referral for certain plans.  Please note that we do not currently accept the Anthem BCBS Pathways Plan from the New Hampshire Marketplace.

We have offices in Bedford, Windham, Manchester, and soon will open a location in Londonderry, NH!  In addition, we are anticipating our Derry location to reopen in Summer 2023!  We look forward to seeing you at a location that’s convenient for you.

If you have questions about becoming a new patient, please feel free to give us a call 603-668-8400.  We would love to meet you!

Gynecology

Breast Density – What does it mean?!?

Dr. Kristen Bannister

Mammogram reports now frequently include a notation of breast density and a disclaimer that this may reduce the ability of the mammogram to detect cancer.  Naturally this is a bit alarming

First of all, it is important to realize that dense breast tissue is not abnormal.  Almost half of women have dense breast tissue and women with dense breasts do NOT have an increased risk of dying from breast cancer. The term itself is a term that describes how your mammogram image looks, not how the breast tissue feels on exam.  It is the relative amount of black (fat tissue) on the image to white (glandular tissue) on the image.

Increased density is more common in women who are younger, on hormones, have a higher weight,  with history of previous pregnancies and those who have used tamoxifen or have family history of dense breasts. There is also subjective differences in assigning breast density, meaning different radiologists may interpret the image differently.

The scale that defines the breast density is called Bi-Rads and categorizes women into 4 groups:

  • A – Almost entirely fatty
  • B – Scattered areas of fibroglandular density
  • C – Heterogeneously dense (may obscure small masses)
  • D – Extremely dense (lowers the sensitivity of mammography)

For most purposes, the term “dense breasts” refers to either heterogeneously dense or extremely dense breasts (categories C or D).

Denser breasts have a few implications.  First, it may obscure the detection of a mass in the breast.  Second, it does slightly increase the risk of developing breast cancer. For these reasons it is important not to ignore the classification, but it is equally important not to over inflate the significance of it.

While studies have shown that breast ultrasound and MRI can help find some breast cancers that can’t be seen on mammograms, they can also show more findings that are not cancer. This can lead to more tests and unnecessary biopsies. Additionally, the cost of an ultrasound or MRI may not be covered by insurance.   So really the trick is figuring out who needs additional imaging because they have increased breast cancer risk and who “just has normal dense breasts”.

There are several online tools that can help estimate your risk of breast cancer such as https://bcrisktool.cancer.gov/.  In general, these models do not take breast density into account, but can still guide the decision how to follow up after a mammogram with this finding.

  • A woman with <15% risk of breast cancer, then no additional screening is recommended regardless of breast density.
  • A risk of 15-20% is a gray zone, with most organizations recommending a shared decision with your provider. Additional imaging with MRI or ultrasound may be an option, but neither modality is routinely covered by insurance for this risk category in most states.
  • With a risk >20% most groups recommend supplemental testing. Frequently women with higher cancer risks will be referred to a specialty breast care center to determine the best management options.

Regardless of risk, there are lifestyle factors which can decrease your chances of developing breast cancer.  Exercise and limiting weight gain, especially in the postmenopausal years, a low-fat diet, limiting alcohol intake and not smoking have all been shown a lower breast cancer rate. Screening modalities can be different as well.  Digital tomosynthesis, or 3D mammography, may be more sensitive for women with dense breasts and pick up more cancers than traditional 2D mammograms.  Most women who have had 3D imaging do not need further imaging because of dense breasts.

Gynecology

What is a DO?

Throughout my training and career, this question has certainly come up more than once. Now, more than ever, with the topic of DO physicians making news and headlines (all press is good press, right? Not necessarily…) are we presented with the opportunity to educate and share exactly what “DOing” is.

DO stands for Doctor of Osteopathic Medicine whereas MD stands for Doctor of Medicine.  Like MDs, Doctors of Osteopathic Medicine are fully licensed physicians who can practice in all areas and specialties of medicine.  We practice evidence-based medicine, using the latest science and technology.  During our medical school training, like MD students, the first two years are centered around classroom learning, and the last two gaining clinical experience in various specialties during clinical rotations.

Many DOs sit for the same licensing exams as MDs (USMLE) during medical school in addition to their osteopathic licensing exams (COMLEX).  The field has grown 300% (wow!) in the last three decades, currently making up 11% of the physician population.  In addition, 42% of actively practicing DOs are female!

In many circumstances, patients may not even notice a difference between their DO or MD physicians.  Where DOs differ is the underlying philosophy that is incorporated in our medical school training.

The hallmark of Osteopathy emphasizes a “whole person” approach (a person is a unit of “body, mind and spirit”).  We are trained that the person and body is whole and interconnected, and each body system affects the other.  DOs have an additional 200 hours on top of general medical school curriculum that focuses on Osteopathic Manipulative Treatment (OMT).  OMT is a hands-on approach, where we learn in depth musculoskeletal exam and treatment of musculoskeletal dysfunction, which may be related to visceral (other body systems/organs) or somatic (musculoskeletal) causes.  While not every DO uses OMT in their day to day practice, this inherent philosophy of treating the person as a whole is how osteopaths are trained to approach each and every patient.  Many of my MD colleagues approach their patients with a similar view due to their compassionate personality, but this philosophy is not part a focus their medical school curriculum.

One of the best parts of being a DO, like all differences, is being able to bring a different perspective to the table.  I am proud of my training and where it has led me (here at BCOG!)!

Gynecology

Flu Vaccine – coming to Bedford Commons OBGYN October 1, 2020!

Christina Haag, APRN

“Ouch, that hurt!  Why did you do that?!?” — that’s what my 5 year old daughter yelled at the nurse giving her the flu vaccine last year.

In the midst of the current COVID-19 pandemic, it’s easy to forget the flu season is just around the corner.  Or maybe you haven’t forgotten because you have seen signs advertising the flu vaccine at many national pharmacy chains.  I think I saw my first flu vaccine advertisement at the end of July, more than 2 months before the onset of the flu season!

The Center for Disease Control (CDC) recommends the flu vaccine every year for everyone 6 months of age and older.  It is especially important this year given the overlap of symptoms caused by COVID-19 and the flu.  Getting your flu vaccine is one of the best ways to protect against the flu.  Although the flu vaccine is currently available at many pharmacies, the CDC recommends waiting until late September to get vaccinated because getting the vaccine too early may cause reduced protection against the flu later in the flu season.

As we have been so focused on COVID-19, I think it is important to remember that last year, more than 410,000 Americans were hospitalized due to the flu and more than 24,000 people died from the flu.  Although wearing a mask can help prevent the flu, the best way to protect yourself is to get the vaccine.

At Bedford Commons OB-GYN, we will begin to offer the flu vaccine to our pregnant patients starting October 1, 2020.  We recommend the vaccine for all of our patients but due to a limited supply, we are only able to offer the vaccine in our office to our obstetric patients.  For our non-obstetric patients, we would recommend heading to your primary care or a local pharmacy to get vaccinated.

Click here for more information from the CDC about this year’s flu vaccine.

Gynecology

Hormone Replacement Therapy (HRT) – Is it for me?

Dr. Danielle Albushies

What’s in your hormone therapy? (The facts about bioidentical hormones)

As your gynecologists, we know you are interested in bioidentical hormones.  We can prescribe such hormones and we are interested in talking to you about your menopausal symptoms.

Prior to 2002, HRT (hormone replacement therapy) was widely prescribed to treat menopausal symptoms and was once prescribed for prevention.  The WHI, or Women’s Health Initiative, was started to study HRT’s effectiveness in lowering the risk of heart disease and other medical conditions in women ages 50-79.  In 2002, the Women’s Health Initiative study was paused because of the increased risk of breast cancer, heart attack, stroke and blood clots seen in women on estrogen and progesterone.  In turn, there was an abrupt decrease in prescriptions for HRT.

Since then, women’s health providers have been able to make better sense of this data and can have a meaningful discussion with our patients about the many benefits of HRT as well as the risks.

There are many women who benefit from HRT and there are many forms of HRT.  Over the last few years I have seen more and more women come to their annual or for a consultation other than for menopausal symptoms, after having seen another provider to obtain compounded bioidentical HRT.

A bioidentical treatment is a plant derived compound that is chemically similar or structurally identical to those produced by the body.  There are bioidentical hormones approved by the FDA.  I get it that my patients are not excited to use hormones that are sourced from the urine of pregnant horses found in a commonly prescribed form of estrogen.  There are options for bioidentical micronized estrogen and progesterone that are monitored by the FDA.

As the compounded forms of hormone therapy are not regulated, a patient is ultimately unaware of the purity, potency or quality of the product used.  I also see many women having their hormone levels checked which is not necessary.  Let me discuss each issue further.

Many compounded hormones use combinations of the 3 types of estrogen produced by our bodies: estriol, estradiol and estrone.  Estriol is the weakest of the estrogens and is often used in the highest amount in compounded hormones.  However, estriol is less bioactive so to get the improvement in symptoms, there is the risk of overdosing on this estrogen.   Estradiol is more bioactive, is bioidentical, and is included in the options approved by the FDA.  Such options have doses that are stable and well-studied.  High doses of any estrogen can lead to the risk of cancer of the uterus and blood clots. For women with a uterus on estrogen in doses high enough to treat hot flashes, progesterone is needed to protect a woman from the risk of cancer of the uterus.  Compounded progesterone that comes from certain wild yams may not be bioavailable, so a woman may not be receiving the protection the uterus needs.

As far as hormone testing, steroid hormones do not meet the criteria for requiring individualized testing.  Steroid hormones have a large range of levels that lead to a desired effect.  These hormones are not directly eliminated by the kidneys in our urine and they are metabolized by our GI tract.  There are no known therapeutic and toxic concentrations base on large studies of blood levels.  Furthermore, checking salivary levels do not provide a representation of blood levels.  Salivary levels depend on a patient’s diet, time of day and the specific estrogen being tested. When I prescribe HRT, I do not check hormone levels.

When a patient needs HRT I discuss the FDA approved options that make sense for her individualized history.  I prescribe the lowest dose that provides benefit.

Thanks for your time and I encourage you to talk to your provider if you are interested in learning more about HRT.

Gynecology

Anal SEX: What You Need To Know

Dr. Kristen L. Bannister

As with any sexual topic, what is “normal” really is in the eye of the beholder. Anal sex involves inserting the penis through the anal sphincter. The anal area has a lot of nerve endings and, for some, is very erogenous. It is estimated that 5-10% of sexually active, heterosexual women engage in anal sex. For these couples it is “normal”. That being said there are unique health risks to be aware of and precautions to be taken.

The anus is a tighter entrance and lacks lubrication that is present in the vagina. This combination increases the risks for tears. Commonly these are small tears throughout the skin or thin mucosa. Adequate lubrication can help decrease this. On rare occasions, significant trauma can occur if the colon wall is perforated.

Beyond the pain the tears cause, they significantly increase your risk of contracting an STD (such as HIV, hepatitis or herpes). Studies have shown a 30% increased risk of HIV infection compared vaginal intercourse. HPV also increases the risk of anal warts and anal cancer. For women who regularly practice anal intercourse it is not unreasonable to do a rectal pap smear in addition to the routine cervical pap smear.

Aside from STD-type infections, the anal area has a high count of bacteria from feces. This puts partners at increased risk of infection. Likewise, vaginal or oral sex after anal penetration increases risk for infection. If you notice a discharge or pain in the days after engaging in anal sex, you should be evaluated by your physician.

The anal sphincter is a muscle intended to keep stool inside. Over time, penetration of the sphincter can lead to weakening or damage to the muscle. This can lead to problems with gas or stool incontinence. Just like the vagina, the anal sphincter can be strengthened with Kegel exercises.

It is also important to realize you can still get pregnant practicing anal sex. Sperm can find their way into the vagina and to a readily awaiting egg.

So bottom line – yes, anal sex is OK if it is consensual, but take the following precautions:

  1. Wear condoms to prevent STD and pregnancy
  2. Use copious lubrication to decrease pain and trauma
  3. Avoid vaginal or oral sex after anal intercourse
  4. As with any sexual practice, if it is not enjoyable, tell your partner and stop.
Gynecology

April is STD Awareness Month

With STDs continuing to rise in the United States, it’s important to know the facts. April is STD Awareness Month, a perfect time to get informed on what can be a silent health risk, even leading to death.  Here’s what you’ll want to know:

  • The Centers for Disease Control and Prevention (CDC) estimate there are more than twenty million new STD (chlamydia, gonorrhea, and syphilis) infections in the U.S. each year.
  • While curable with antibiotics, many cases go undiagnosed and untreated. Consequences of this can be severe, including infertility, ectopic pregnancy, stillbirth, increased HIV risk, even death.
  • Certain groups are at increased risk, including sexually active women under 25.

The CDC currently sponsors four STD Awareness Campaigns:

  • GYT: Get Yourself Treated is for young people to understand the myths and misconceptions surrounding STDs and to learn about appropriate testing and treatment.
  • Test. Treat. Three simple actions by patients and healthcare providers can protect the health of the individual, their partner, and patients at large. First, have open and honest discussions with each other. Second, get tested or recommend appropriate testing. Finally, get or prescribe treatment.
  • Syphilis Strikes Back focuses on the prevention, diagnosis, and treatment of this potentially deadly disease which can impact pregnant women and newborn babies, among others.
  • Treat Me Right encourages patients to be proactive about taking care of their health and ask providers for what they need while equipping providers with critical communication and health information to treat their patients right.

Talk with your healthcare provider about your risk for STDs and any tests they might recommend. For more information from the CDC, go here.