Dr. Deb

As a child I always prided myself on my memory. I could and still can remember specific childhood events as early as age 2 in vivid detail. Things started to blur during residency when I worked 36-hour shifts but nothing destroyed my memory  (as well as other body parts) like children.
The deep slide occurred after the birth of my twins when I boiled my breast pump after forgetting I left it on the stove.  The toxic smell of burnt plastic required the fire department to come and air out our apartment. That certainly ruined my chances for mother of the year. I realized 2 things. Hot soapy water is sufficient to clean a breast pump and hormones made me stupid. Certainly sleep deprivation had much to do with it but I remember the moment that I stood in the kitchen and realized my fantastic memory had slipped and I knew that it was related to my hormones.  Fortunately, my memory returned but I can’t wait to see what happens when I hit menopause.

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Vasectomies are the one thing that is up with some facilities seeing an almost 50% increase in the procedure.  They attribute the worsening economy and fear of being able to provide as contributing to this trend.

Many wives become sports widows, especially in March with the NCAA Basketball Tournament. Now there is a new trend called Vas-Madness Or Snip City where men actually time their vasectomy during March Madness.

I spoke with local urologist, Dr. Mark Delworth with the Urology Group who told me that they definitely see a spike in vasectomies around any major sporting event, but especially March Madness and the Masters.  Nationally there is about a 10 percent increase for the Tourney.

Most men have young children and can rarely get a pass to sit on the couch and watch TV for 3 days. Most wives are more than willingly to oblige knowing that the burden of birth control is lifted. (Of course I don’t remember a 3-day pass after my cesarean!)

What if you still can’t get him to go to the Dr.? Are there new alternatives for women?

There is a new way to perform a tubal ligation that does not require cutting and a few doctors are performing it in the office.  It is called Essure. The Dr. will place thin coils into the fallopian tubes through the cervix or opening to the uterus through the vagina. The coils will cause scarring and close the tubes in about 3 months.  Women may have some cramping but go back to their normal activities right away.
Both of these methods are permanent procedures. You cannot reverse blockage from Essure and a vasectomy is not readily reversible. They both take about 3 months before they are effective and both require additional confirmation tests.

Are there any options that are reversible?

My personal favorite in the Mirena. It is a device that is placed in the office that stays up in the uterus for 5 years. All 3 of these methods are 99.8% effective. The benefit of the Mirena is that it is reversible so if you change your mind you can easily pull it and be able to get pregnant the next month. It is also effective immediately so you don’t have to wait.

Who should not get permanent sterilization?

Age is the biggest factor in people expressing regret of a permanent birth control method.  I tend to be cautious in people under age 30 but especially under age 25.

The regret rate is also high for women who were not married at the time of their tubal ligation or if it was performed less than a year after delivery.

The other HUGE problem that I see is women tend to have more irregular and heavier periods with age. Whether you have a vasectomy or use Essure, if you have bleeding problems, they are likely to get worse. The advantage of the Mirena is that it has a small reservoir of levonorgestrel that acts locally on the uterus. It cleans out the uterus decreasing bleeding by about 85%. Many women avoid a hysterectomy by using this system.  20% of women will not have a period at all and that is fine because we know why they are not having a period.

To snip or not to snip?  I fully believe that it is about time for the man to step up in contraceptive responsibility. However, if you are under age 30 or have bleeding issues, then you might be better off with the Mirena or another form of contraception. Learn more and talk to you doctor.

Peace,

Dr. Deb

Did you ever feel old overnight?
Where did these wrinkles come from? How come I can’t read without squinting? Why does my family think I am a bitch? Is it hot in here? Why can’t I sleep? When is my period going to come..or stop? Why do I eat the same but gain weight?
Am I crazy?  No, you are just in perimenopause, my dear.
The really crazy thing is when you go to talk to your doctor about it he tells you, ”There is nothing wrong with you” or “You just have to live with it.”
That is simply not true and I think part of the reason why Susan Somers and bioidentical hormones have become so popular. The doctors are not listening, so patients are going to what appears “safe and more natural” which I hate to say, is not necessarily true.
First, what is perimenopause?
Perimenopause may begin as what appears to be increasing moodiness and irritability and is often accompanied by erratic periods, some of which can be quite heavy. The ovaries will also start to wind down in a sporadic manner producing normal estrogen one month and low levels the next. Low levels of estrogen account for most of the symptoms of menopause. These symptoms include hot flashes, night sweats, insomnia, vaginal dryness, decrease in the blood supply to the vagina and thinning of the vaginal mucosa or tissue. These symptoms typically begin in your late 40s but often start as early as mid 30s.
What can I do about it? A lot actually.
The first remedy is lifestyle changes. Your body is telling you, “If you keep putting crap in, you’ll get crap out.” PLEASE CLICK TO SEE MY PREVIOUS BLOG ABOUT LIFESTYLE CHANGES and HERBAL REMEDIES called Hot and Neutered
What can my doctor do to help?
TSH is the most important hormone to check if you are having irregular bleeding, fatigue, weight gain or simply not feeling well. TSH checks your thyroid or your body’s regulator gland. If it is off, your whole body will be off.  It is the most common endocrine problem as we age. Click here to learn more about your thyroid.
Many women will have their FSH checked. This hormone level is not that helpful in treatment. You can have a premenopausal level but still feel awful from hormonal fluctuations. This is the time that many doctors still say nothing is wrong with you, when in fact, everything feels wrong. You can also have a postmenopausal level one-month and back to premenopausal the next. I think it is important to base treatment on symptoms and not the level of this hormone. Read more about FSH.
What about hormone replacement therapy?
If lifestyle changes and herbal remedies do not alleviate symptoms, then many women benefit from hormone replacement therapy. The idea is to replace the hormones that your body is no longer making. The difficulty with perimenopause is that your body is still making the sex hormones, estrogen and progesterone, just at sporadic times and at sporadic levels. You cannot take a test by blood or saliva to match up what your body is supposed to make because this will vary from day to day until you go through menopause completely.
Many women in this time find birth control pills are of great benefit as they even out the hormones. They are strong enough to control the bleeding problems while taking care of the hot flashes as well as preventing pregnancy. Women still can get pregnant at this time. Many women who thought they were in menopause when their period stopped had quite the surprise when told they were pregnant.
What about bioidentical hormones?
Bioidentical is a term that means matching what your body makes. You can get bioidentical hormones from a drug company as well as from compounding pharmacies. I prefer to use the drug company form, as they must be made in FDA regulated laboratory and have rigorous testing.  I am concerned about the lack of regulation in the compounding labs as well as lack of testing of the products. I also am leery of the amount of out of pocket money many of these pharmacies charge, preying on women’s desire to feel younger and falsely touting its safety. The reality is that compounded pharmacies and drugs are not as rigorously tested or regulated as traditional pharmaceuticals but that does not mean they are not of benefit.

Compounded drugs are also very tricky to use in the perimenopausal patient as the hormones are fluctuating. They are often not strong enough to control hot flashes and bleeding. I have used compounded pharmacies, especially for drugs that do not have FDA approval in women yet, like testosterone. It really depends on your symptoms so make sure your doctor will discuss options and don’t settle for, “You just have to deal with it.”
How can medications help mood?
Often times evening out the hormones will even out mood. Some women that don’t want hormones or find they are not enough will benefit from antidepressant medications. Some women do not need to take them everyday and only use them the second half of their cycle. There are many medications such as Sarafem, Lexapro, Wellbutrin and Cymbalta that can help and often times it involves trial and error to find the right one at the right dose.

Learn more about PMS

You are not crazy and these changes are real. It is up to you to take the journey to feeling better. Maximize your lifestyle, minimize your stressors and consider supplements to help you in this discovery.

Learn more about Perimenopause

Dr. Deb

Jill Writes:
My daughter turned 16 in November and still does not have her period. She is very athletic. Should I worry about this?
I remember reading,  “Are you there God it’s Me, Margaret?” when I was about 10. I couldn’t wait to get my period. Now I can’t wait for it to go away.
Seems like when the period starts in a girl is a major news bulletin and there can be a lot of concern if it is not right on time. That time may be dictated by when all of her friends started but the reality is there is  about a 7 year time frame that girls start their period. (more…)