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'Women's Health' posts

To Mammogram or Not to Mammogram? A note on recent studies

A Canadian medical research study has recently been published questioning the value of doing screening mammograms on women in their forties. The article has spurred controversy because the results contradict multiple other similar research studies which showed that women in that age group who get regular mammograms actually are spared death from breast cancer more often that women who are not invited to screening.

Some problems with the methods of Canadian study, published in the journal BMJ, were pointed out by a scientist at the University of Washington, Judith Malmgren, who has worked with Swedish Medical Center doctors to see how women in their forties have fared in our system. Click here to read Dr. Malmgren’s letter to the editor of BMJ.

There are two ironic features to the Canadian study. First, the authors say it is okay for women to not get screening starting in their forties “when adjuvant therapy for breast cancer is readily available.” This means that it is okay to diagnose breast cancer later because you can mop up bigger and more advanced cancers with treatment like chemotherapy, radiation and bigger surgery. But at Swedish, we do not think that many women prefer more severe therapy rather than earlier detection.

Secondly ...

4 alternatives to a hysterectomy

There are many reasons women need a hysterectomy.

Some of the most common are:

  • Heavy periods that are not controlled on hormones or an inability to take hormones to control the period.
  • Large fibroids that press on the bladder or the bowel, or are so large they can be felt on the abdomen.
  • Endometriosis (usually if this is requiring a hysterectomy it is due to both pain and bleeding).
There are several treatments to avoid hysterectomy:

  • Uterine artery embolization where microscopic plastic beads are inserted into the uterine arteries to block the majority of blood flow to the uterus.  This causes the uterus to slowly shrink in size.  The uterus may decrease to half of its normal size within 2-3 years.  Initially there is a lot of inflammation of the uterus as it loses its blood supply.  The pain associated with this will usually require ibuprofen and narcotics.  Most women stay in the hospital for overnight, and it is usually about 2 weeks before you are feeling well enough to resume normal activities.
  • Myomectomy, a surgical removal of the fibroids.  There are two ...

What you should know about ovarian cysts

Finding out there is a cyst on the ovary is often a concerning experience for a woman.  Women aren't sure what it means for them or what will need to be done.
 
A woman has two ovaries, which produce eggs, which allow a woman to get pregnant, and produce female hormones.  These hormones cause the lining of the uterus to grow, which then shed (as the period).  Ovaries are actively making hormones and ripening eggs from when the period first starts until when she goes through menopause.  As an egg is ripening in the ovary, several small cysts will form.  These grow to about 2.5 cm, or one inch, and then when the woman ovulates or releases the egg the cyst drains and is gone.  So when a woman has an ultrasound that shows a cyst less than 3 cm it is usually a "follicular" cyst - that is a cyst with a developing egg.  This type of cyst is completely normal and will come and go.
 
Cysts that are  ...

New options for genetic testing in pregancy

Congratulations!  You just found out you are pregnant and so many things start going through your mind.  When you’re not dry heaving or completely exhausted you start planning for your exciting future but in the back of your mind you wonder… how do I know everything is okay with my baby?

We are entering an exciting time in the field of obstetrics that involves less invasive and more accurate options for genetic testing in pregnancy.  ACOG, the American College of Obstetrics and Gynecology, recommends that all women, regardless of maternal age, be offered prenatal testing for chromosomal abnormalities. 

For quite sometime our options for this testing have been somewhat stagnant.  We have offered noninvasive risk profiling that involves a mixture of blood tests and ultrasounds at various times in the first and second trimesters to help evaluate the baby’s risk for Down syndrome or other lethal chromosomal abnormalities.  Depending on how these tests are processed, the sensitivity ranges from 80-95% with about a 5% false positive rate.  They are fairly accurate at identifying babies at higher risk, but can have false positive results (meaning an abnormal result followed by more invasive testing that shows normal results but of course this causes a lot of worry for the patient). 

Obviously we want to be able to offer testing that has a high rate of detection and a low rate of false positives.  More invasive testing is often offered also.  This testing involves removing a sample of placental cells called chorionic villus sampling, or removing a sample of fetal cells from the amniotic fluid called amniocentesis.  These cells are then analyzed for chromosomal abnormalities.  Although these invasive tests are the most accurate, they do carry a small risk of miscarriage or fetal loss. 

Fortunately, new testing has come out on the market called cell free fetal DNA testing.  This is ....

When should I have my first pelvic exam?

A good time to schedule a visit with a gynecologist (or women’s health specialist) is when you first have problems or concerns with menstrual periods, including premenstrual moods, acne around menses, vaginal discharge or any other cyclic discomfort. That appointment will involve a conversation about what is bothering you and may include a pelvic exam or may not.  Likely the doctor will ask you questions and together you will decide whether or not an exam is necessary.

Around age 13, even if you feel fine and are just wondering when you should come in for a routine exam, is a good time to schedule an appointment to discuss your female health, contraception and screening for sexually transmitted infection.  Vaccinations may be recommended if you have not already received routine immunizations. Some of the things that may be discussed include your health history, family health history, your habits with regard to diet and exercise, smoking or any drug use and sexual activities.  Some of these topics are things you may find difficult to discuss with friends and family.  In the gynecologists office we talk about those things all of the time!  Often we give you pamphlets or point to online resources for you.  The conversation is confidential and it is okay for you to remind the health care provider that you wish it to remain confidential. 

What is a pelvic exam and why might I need one?

A pelvic exam is ...

Dozens of Swedish-Affiliated Physicians Recognized as 'Top Doctors' by Their Peers



SEATTLE, August 16, 2013 - Now in its 13th year, Seattle magazine recently published the results of their annual 'Top Doctors' survey in the July issue. As in past years, dozens of Swedish-affiliated (or credentialed) physicians were recognized in the popular issue due to being nominated by their peers.

Additionally, Seattle Metropolitan magazine published the results of its 'Top Doctors' survey in the August issue, in which dozens of Swedish-affiliated (or credentialed) physicians were also featured

 

Breast Cancer Screening Recommendations Revisited

Are you confused about breast cancer screening recommendations? If you are, you are not alone.

Multiple organizations have come out with conflicting studies, data, and recommendations. Those advocating for reduced screening argue that screening does not improve the death rate from breast cancer; that women who have biopsies that are found to be benign suffer significant psychological harm; and that cancers are found that would never cause death.

Significant flaws have been found in these arguments by physicians who have committed their careers to understanding and treating breast cancer. There are multiple problems with the scientific methodology, assumptions, endpoints and analyses used in these critiques of mammogram screening recommendations. One problem is that medical science currently does not have the ability to distinguish between lethal cancers and those that will not cause death. Based on rigorous scientific data, we do know that the best way to improve survival from breast cancer is to detect it before it becomes clinically obvious and to treat it early.

None of the major oncology organizations support the guidelines calling for reduced screening. A letter to the New England Journal of Medicine ....

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