Women’s Health News

Endometriosis — what it is and what to do about it

by Shazah Khawaja, MD, FACOG

endometriosis pain in woman's abdoment

What is endometriosis?

Endometriosis is a chronic gynecologic disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus in other parts of the abdomen. As a condition that occurs in 6–10 percent of women of reproductive age, endometriosis represents a significant health problem for millions (maybe as high as 6.5M) of U.S. women.

If you’re still reading, you’re probably one of them, or you may know someone who has had to deal with these common endometriosis symptoms:

  • Painful periods (dysmenorrhea).
  • Pain during intercourse.
  • Pain with bowel movements or urination.
  • Excessive bleeding.
  • infertility.
  • Other symptoms, which may include fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.

Clearly, this is not a fun list. The symptoms or clinical manifestations of endometriosis are variable and unpredictable in both presentation and course. It can vary greatly from woman to woman.

One thing to keep in mind is that the pain associated with endometriosis may not correlate with the stage of the disease. In other words, a woman experiencing significant endometrial pain may not necessarily be in a deep stage of the disease, and the opposite may also be true for someone else. There may be some association with the depth of infiltration of endometrial lesions. Painful defecation during menses and painful sexual intercourse are the most predictable symptoms of deeply infiltrating endometriosis.

According to U.S. Department of Health & Human Services’ Office on Women’s Health, other health problems women experience with endometriosis can include, allergies, asthma, chemical sensitivities, autoimmune diseases (these can include multiple sclerosis, lupus, and some types of hypothyroidism), chronic fatigue syndrome and fibromyalgia.

There is some good news: Endometriosis isn’t a fatal disease. In some cases, endometrial cells create cysts that can rupture and bleed. While this is serious and may sound a bit like cancer, endometriosis isn’t cancer. However, ovarian cancer does occur at higher than expected rates in women with endometriosis. Some studies suggest that endometriosis increases this risk, but it’s still relatively low, according to Mayo Clinic. Although rare, another type of cancer — endometriosis-associated adenocarcinoma — can develop later in life in women who have had endometriosis.

Who is likely to get endometriosis?

Endometriosis usually develops several years after the onset of menstruation (menarche). Signs and symptoms of endometriosis often end temporarily with pregnancy and end permanently with menopause, unless you’re taking estrogen.

Endometriosis is especially common among women in their 30s and 40s, but I’ve also treated patients in their 20s that had the disorder. Statistically, it is racially neutral, meaning there appears to be no racial predisposition to endometriosis. Research suggests a familial association of endometriosis. Patients with an affected first-degree relationship have a seven- to ten-fold increased risk of developing the disorder.

How do we diagnose endometriosis?

A definitive endometriosis diagnosis can only be made by a diagnostic laparoscopy procedure. Your doctor will then order a histology (a study of the microscopic structure of tissues) of the lesions removed during the surgery.

Before recommending a diagnostic laparoscopic procedure, your doctor will talk to you about your symptoms and do or prescribe one or more of the following to find out if you have endometriosis:

  • Pelvic exam.
  • Imaging test (ultrasound or MRI).
  • Prescription medicine. If your doctor does not find signs of an ovarian cyst during an ultrasound, he or she may prescribe:
    • Hormonal birth control (which may help lessen pelvic pain during your period).
    • Gonadotropin-releasing hormone (GnRH) agonists, which block the menstrual cycle and lower the amount of estrogen your body makes. GnRH agonists also may help pelvic pain.

If your pain gets better with hormonal medicine, you probably have endometriosis. But, these medicines work only as long as you take them. Once you stop taking them, your pain may come back.

How do you treat endometriosis?

There is currently no cure for endometriosis, but several different treatment options can help manage symptoms and improve your chances of getting pregnant. Talk to your doctor about your treatment options.

It is important to note that the best course of action for you will be greatly informed by whether you are or wish to remain fertile. Other important factors include your age, how severe your symptoms are and how severe the disease is.

Endometriosis treatments will vary depending on whether the focus of your care is for pain or more for fertility concerns. For pain, there are three possible approaches:

  • Pain medications (NSAIDS, opioids).
  • Hormone therapy (birth control pills, progesterone, progestin, GnRH agonists).
  • Surgical treatment (laparoscopy, others).

Endometriosis is different for every woman. My colleagues and I at our practice, NCMA Women’s OB/GYN Center, first seek to treat the whole person, rather than address presenting symptoms only. In many cases, we will recommend laparoscopy to remove growths as a way to also improve fertility in women who have mild or minimal endometriosis.

Although studies show improved pregnancy rates following this type of surgery, the success rate is not clear. For some, we recommend in vitro fertilization (IVF) as the best option to improve fertility.

Even though the use of hormones in IVF is successful in treating infertility related to endometriosis, other forms of hormone therapy are not as successful. The American College of Obstetricians and Gynecologists does not recommend using oral contraceptive pills or GnRH agonists to treat endometriosis-related infertility. The use of these hormonal agents prevents ovulation and delays pregnancy, so this risk means you and your doctor must be on the same page about your risks and health goals.

The hormones used during IVF do not cure endometriosis lesions, which means that pain may recur after pregnancy and that not all women with endometriosis are able to become pregnant with IVF. The relationship between the extent of disease and the degree of symptoms, the effects on fertility, and choosing the best treatment, remains a challenge for many patients.

For more information, the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development offers excellent information on endometriosis treatment options.

Shazah Khawaja, MD, of NCMA Women’s OB/GYN Center

Shazah Khawaja, MD, FACOG, is a physician with NCMA Women’s OB/GYN Center in Santa Rosa, Calif.

When it comes to hormone therapy, you have options

Menopause care may include hormone therapy treatment

Your body’s hormone levels go through significant changes during the menopause transition, and resulting hormonal imbalances can create uncomfortable physical symptoms and mood swings. Fortunately, hormone therapy (HT) enables menopausal women to substitute for the hormones that are reduced during this transition to relieve symptoms and achieve long-term health advantages. Our physicians will talk with you about the risks and benefits of hormone therapy to help you find the options that best fit your individual body and lifestyle.

In recent years, the media has spotlighted menopause and HT helping to increase general awareness, but it is still important to filter the available information in the context of scientific-based research and peer-reviewed evidence from medical professionals.

Quick facts:

  • The term “hormone therapy” covers both traditional hormone therapy (HRT) and natural (bioidentical) hormone replacement therapy (BHRT), as well as estrogen and combined estrogen/progesterone treatment.
  • BHRT makes use of hormones that are identical to human hormones, and HRT makes use of synthetic hormones that have a slight physical variation to bioidentical hormones, but serve the similar purpose of replacing hormones lost during menopause.
  • Nearly all modern hormone medications are derived from the same plant sources.

Your physician at NCMA Women’s OB/GYN Center will personalize your HT treatment after accounting for various health benefits and risks based on your symptoms and lifestyle. Not all women will be candidates for HT, and medications and other health factors can affect eligibility.

Learn more about hormone therapy from National Institutes of Health.

Chemotherapy no longer required in 70 percent of breast cancer cases

New study says no chemotherapy needed to treat common breast cancer

A 21-gene test performed on tumors could enable most patients with the most common type of early breast cancer to safely forgo chemotherapy, according to a landmark study published in the New England Journal of Medicine.

Loyola Medicine oncologist Kathy Albain, MD, is among the main co-authors of the study and a member of the clinical trial's steering committee. First author is Joseph Sparano, MD, of Montefiore Medical Center in Bronx, N.Y. The study was published in conjunction with its Sunday, June 3 presentation at the plenary session of the American Society of Clinical Oncology 2018 meeting in Chicago.

"With results of this groundbreaking study, we now can safely avoid chemotherapy in about 70 percent of patients who are diagnosed with the most common form of breast cancer," Dr. Albain said. "For countless women and their doctors, the days of uncertainty are over."

Dr. Albain, the Huizenga Family Endowed Chair in Oncology Research at Loyola University Chicago Stritch School of Medicine, has conducted research with the 21-gene test and also used it in her practice for years.

The test examines 21 genes from a patient's breast cancer biopsy sample to determine how active they are. The tumor is assigned a "recurrence score" from 0 to 100; the higher the score, the greater the chance the cancer will recur in distant organs and decrease survival. If patients with higher scores receive chemotherapy, this risk of recurrence will be significantly reduced, enabling more patients to be cured.

Previously, the challenge doctors and patients have faced is what to do if a patient has a mid-range score. It was uncertain whether the benefit of chemotherapy was great enough to justify the added risks and toxicity. Previous studies demonstrated that patients with low scores (10 or lower) did not need chemotherapy, while women with high scores (above 25) did require and benefit from chemotherapy.The new study examined the majority of women who fall in the intermediate range of 11 to 25.

The study enrolled 10,273 women who had the most common type of breast cancer (hormone-receptor positive, HER-2 negative) that had not spread to lymph nodes. Researchers examined outcomes of the 69 percent of patients who had intermediate scores on the 21-gene test.

Patients were randomly assigned to receive chemotherapy followed by hormonal therapy or hormone therapy alone. Researchers examined the chemotherapy and non-chemotherapy groups for several outcomes, including being cancer free, having cancer recur locally or to distant sites in the body and overall survival.

For the entire study population with gene test scores between 11 and 25 — and especially among women aged 50 to 75 — there was no significant difference between the chemotherapy and no chemotherapy groups. Among women younger than 50, outcomes were similar when gene test scores were 15 or lower. Among younger women with scores 16 to 25, outcomes were slightly better in the chemotherapy group.

"The study should have a huge impact on doctors and patients," Dr. Albain said. "Its findings will greatly expand the number of patients who can forgo chemotherapy without compromising their outcomes. We are de-escalating toxic therapy."


Story Source: See this article on Science Daily: "More breast cancer patients can safely forgo chemotherapy: Study." ScienceDaily. ScienceDaily, 3 June 2018. www.sciencedaily.com/releases/2018/06/180603193614.htm. Materials provided by Loyola University Health System. Study published in the New England Journal of Medicine.

Focus on health risks for new mothers for Preeclampsia Awareness Month

May is Preeclampsia Awareness Month and NCMA Women’s OB/GYN Center joins with the Preeclampsia Foundation to help raise awareness. This year the foundation’s efforts are on postpartum preeclampsia as 97 percent of maternal deaths related to preeclampsia and other hypertensive disorders of pregnancy occur within just six weeks of delivery, a time when most new mothers might think the danger has passed.

A woman can develop preeclampsia after her baby is born, regardless of whether she experienced high blood pressure during her pregnancy. With such alarming statistics related to postpartum preeclampsia, it very important that a new mother remain vigilant and continue to monitor her heart health and blood pressure even after delivery.

Understanding preeclampsia

Postpartum preeclampsia is a serious condition related to high blood pressure. Women who have just delivered a baby are most at risk, although it has no effect on the baby. There is no known cause for preeclampsia to manifest in pregnant women. In many cases, women diagnosed with preeclampsia see symptoms abate following delivery, but the Preeclampsia Foundation emphasizes that ‘delivery is not a cure’. In some cases, symptoms begin during pregnancy, but some patients may not be symptomatic until after the baby is born. Postpartum preeclampsia most commonly occurs within the first seven days after delivery although new mothers remain at risk for up to six weeks following delivery.

Know the warning signs

Early diagnosis and being vigilant to symptoms followed by quick response is imperative to saving lives. Symptoms include (and can be complicated by lack of sleep, postpartum depression and/or simple lack of awareness about the signs):

  • nausea
  • swelling in hands/feet
  • severe headache
  • seeing spots or other vision changes
  • shortness of breath

When a patient thinks they are experiencing warning signs of postpartum preeclampsia, the first thing to do is go to the Emergency Department, request to be seen by an OB, and report that they have recently given birth. The first seven days after delivery is when women who experience preeclampsia are at highest risk. Effectively controlling high blood pressure is key to avoiding very serious health risks that include; seizures, stroke, organ damage and sometimes death.

About NCMA Women’s OBGYN Center

Our provider team of expert OB/GYN physicians, certified nurse midwives, family nurse practitioners, and medical assistants provides unmatched care to patients in our region. As women proudly serving women, we understand the needs and expectations of our patients. For more information, visit our website or call 707-579-1102.

The Women’s OB/GYN Medical Group of Santa Rosa focuses on Heart Health for February

With February being Heart Health Awareness Month the Women’s OB/GYN Medical Group seeks to expand on the American Heart Association’s (AHA) focus on heart health. Dr. Tara Bartlett, D.O. shares some tips on what women need to be on the lookout for, along with some ideas for staying healthy.

With February being Heart Health Awareness Month the Women’s OB/GYN Medical Group seeks to expand on the American Heart Association’s (AHA) focus on heart health. In this article the group shares some tips on what women need to be on the lookout for, along with some tips for staying healthy.

According to the AHA women may have a slightly lower incidence of cardiovascular disease (35 percent compared to 37.4 percent for men) but they are more likely to die from cardiovascular disease than are men. As many as one out of three deaths among women are attributed to heart disease. Perhaps the most alarming statistic is the one that puts 90 percent of all women in the crosshairs for having one or more risk factors for heart disease or stroke.

It’s all about healthy living

There is some good news in the world of facts about women and heart health – 80 percent of heart disease and stroke events could be prevented simply by making a few lifestyle changes. Becoming educated about cardiovascular disease is also important. At the top of the list of increasing a woman’s chance of surviving cardiovascular disease is learning the signs and symptoms of heart disease and heart attacks before they happen. Among the things women can to do get and stay heart healthy includes: taking up a healthy diet of whole foods (avoiding processed alternatives), keeping weight at a normal BMI level, getting plenty of exercise (at least 20 minutes a day), controlling high blood pressure if you have it, avoiding excess salt and not smoking.

Fitness is a factor for women of all ages, and even more significant for those who have known risk factors for heart disease and stroke. Making specific lifestyle changes is one of the most effective ways to maintain a healthy heart.

Signs to watch out for

When it comes to heart attacks, a cardiovascular event can be very different for women when compared to what men experience. Women’s symptoms tend to be much milder and less specific than men’s and may include seemingly innocuous symptoms such as fatigue, sleep problems, indigestion and weakness in the arms. Some women experience a sense of foreboding for no apparent reason. These symptoms are often missed, or dismissed, by women and misdiagnosed by health care professionals.

There has been quite a bit of discussion lately about the fact that women are often treated less aggressively by medical professionals once they’ve had a heart attack. They are also reportedly less likely than men to receive medications that prevent future heart events such as beta blockers, statins and ACE inhibitors.

When women are empowered to understand the signs and symptoms of cardiovascular disease, they have a greater opportunity to be proactive about their own healthcare. It’s more important than ever for women to be educated about heart disease, as it’s the leading cause of death for both women and men in this country.

About Women’s OBGYN Medical Group

The provider team of expert OB/GYN physicians, certified nurse midwives, family nurse practitioners, and medical assistants provides unmatched care to patients in our region. As women proudly serving women, we understand the needs and expectations of our patients. For more information call (707) 579-1102 or visit the website.

Risk of heart disease goes up with breast cancer treatment

Some breast cancer therapies can damage the heart and healthcare providers should carefully monitor breast cancer treatment effects on the heart. Breast cancer survivors, especially older women, are more likely to die from cardiovascular diseases such as heart failure rather than breast cancer.Some breast cancer therapies can damage the heart and healthcare providers should carefully monitor breast cancer treatment effects on the heart. Breast cancer survivors, especially older women, are more likely to die from cardiovascular diseases such as heart failure rather than breast cancer.

Breast cancer patients may be at an increased risk of cardiovascular diseases including heart failure and may benefit from a treatment approach that weighs the benefits of specific therapies against potential damage to the heart, according to a new scientific statement from the American Heart Association published in its journal Circulation.

The statement is an overview of what we currently know about risk factors common to both heart disease and breast cancer, the potential heart damage from some breast cancer treatments, and suggested strategies to prevent or minimize the damage. Breast cancer survivors, especially older women over the age of 65, are more likely to die from cardiovascular disease than breast cancer, underscoring the importance of effectively managing heart disease risk factors during and following cancer treatment.

“Any patient who is going to undergo breast cancer treatment, whether they have heart disease at the beginning or not, should be aware of the potential effects of the treatments on their heart,” said Laxmi Mehta, M.D., chair of the writing group for the new scientific statement. “This should not deter or scare patients from undergoing breast cancer treatment, but should allow them to make informed decisions with their doctor on the best cancer treatment for them.”

During cancer treatments, patients should pay attention not only to their breast health, but also to their general health, including their heart, said Dr. Mehta, who is director of the Women’s Cardiovascular Health Program and an associate professor of medicine at The Ohio State University in Columbus, Ohio.

For example, some cancer treatments, such as HER-2 targeted therapies, can cause weakening of the heart muscle, a condition known as heart failure. HER-2 is a specific type of breast cancer. In some cases, the reduction in heart function is temporary and cessation of the treatment and/or the addition of heart medicines can improve function. But in some breast cancer patients, heart failure can be permanent. Because of this, the early development of heart failure can signal a need to slow down and/or alter a patient’s breast cancer treatment because of the risk for worsening the condition or the development of permanent heart failure.

Some small studies suggest that administering common chemotherapy agents in new ways may reduce heart disease risks. Doxorubicin is a chemotherapy drug used in breast cancer therapy that can lead to the damage of heart cells. Studies have shown that when doxorubicin is administered slowly, rather than all at once, patients may have a lower risk of heart failure.

In addition, a drug called dexrazoxane that could reduce cell damage has recently been approved for patients with metastatic breast cancer who receive high doses of doxorubicin. More studies will need to be done to confirm whether the results of the smaller studies are seen in larger groups of patients.

Other treatments, such as radiation, can affect the heart arteries and cause the development of coronary artery disease or blockages. Some breast cancer treatment agents, such as anthracyclines, can result in abnormal heart rhythms that in some patients are benign but in others can lead to life-threatening heart rhythms. And, some treatments — like antimetabolites — can cause spasm of the heart arteries, which can cause chest pain symptoms but could lead to heart attacks as well.

Heart disease and breast cancer share a number of risk factors, including advanced age, poor diet, family history, physical inactivity and tobacco use. The fact that these diseases share some risk factors suggests that there are lifestyle choices, primarily diet and exercise, that could help decrease the risks of developing both diseases. Healthcare providers should monitor a woman’s heart health before, during and after breast cancer treatment.

Adherence to a number of ideal heart health behaviors or factors from the American Heart Association’s’ Life’s Simple 7 is associated with a trend towards a lower incidence of breast cancer. Life’s Simple 7 includes being physically active, achieving and maintaining a healthy body weight, eating a healthy diet, avoiding tobacco, maintaining healthy levels of blood pressure, cholesterol and blood sugar.

“Fortunately, with the advances in breast cancer treatment, there has been a growing number of survivors. However, during and after the treatment of breast cancer, having optimal control of heart disease risk factors is important, because older breast cancer survivors are more likely to die of heart disease than breast cancer,” Dr. Mehta said. “And that’s why Life’s Simple 7 is important for all patients with and without breast cancer.”

Although there are an estimated 47.8 million women in the U.S. who are living with cardiovascular diseases and approximately 3 million breast cancer survivors, many people regard breast cancer as the primary threat to women’s health. It is important to recognize the overlap of heart disease and breast cancer as both entities impact survival.

Story Source: Read this article on Science Daily: American Heart Association. “Breast cancer treatments may increase the risk of heart disease: American Heart Association scientific statement.” ScienceDaily. ScienceDaily, 1 February 2018. www.sciencedaily.com/releases/2018/02/180201085812.htm.


The Women’s OB/GYN Medical Group strives to better the lives of all women with a holistic approach to women’s health. Call for an appointment today: (707) 579-1102. Visit our website: www.womensobgynmed.com

Recent study reveals reproductive risk factors of heart disease and stroke for women

Dr. Lela Emad of the Women’s OB/GYN Medical Group talks about a new study while emphasizing that healthcare providers need to be vigilant about screening women for cardiovascular disease.

Dr. Lela Emad of the Women’s OB/GYN Medical Group talks about a new study while emphasizing that healthcare providers need to be vigilant about screening women for cardiovascular disease.

Research containing new data on risk factors for heart attack and stroke comes from a very large study of more than half a million men and women of up to the age of 69 who were recruited between 2006 and 2010. Ultimately the health of 267,440 women and 215,088 men was tracked over the course of the study, or until participants had their first heart attack or stroke, whichever came first. None of the participants had cardiovascular disease when they entered the study. From this, more than 9,000 cases of cardiovascular disease were recorded, a third of which were in women.

Highlights of the study found higher risk factors for women who experienced:

  • periods starting before age 12 (10% increased risk)
  • early menopause (33% increased risk of cardiovascular disease, 42% of stroke)
  • pregnancy complications (up to 44% higher risk depending on factor)
  • Hysterectomy (12% cardiovascular disease, heart disease 20%)

This study was large, and the researchers determined a range of potentially influential factors (see full results here).

“This study is particularly important for healthcare providers,” explains Dr. Lela Emad of the Women’s OB/GYN Medical Group of Santa Rosa. “Routine screening for cardiovascular issues is something we do for our patients and something we might be able to target better now, given this new information. This is something every healthcare provider needs to be aware of.”

Heart Disease: a serious health factor for women

The American Heart Association says cardiovascular diseases and stroke cause one out of three deaths in women every year, killing approximately one woman every 80 seconds. An estimated 44 million women in the U.S. are affected by cardiovascular diseases. A whopping ninety percent of women have one or more risk factors for heart disease or stroke and fewer women survive heart attacks then do men.

More than 5 million people in the United States suffer from heart failure, less than 50 percent of those with heart failure live a full five years following diagnosis. The deadly duo of heart disease and stroke are among the most prevalent and costly health complications today. Heart disease or stroke wreak havoc on people’s lives measured in increased medical bills, lost wages and decreased quality of living.

  • 5 million heart attacks and strokes occur every year in the United States
  • 800,000 deaths occur from heart disease each year, a total of 1 in every 3 deaths – about the same number as die from cancer, respiratory disease and accidents – combined
  • 150,000 of deaths from heart disease occur in people under age 65
  • $320 billion in health care costs and lost productivity were attributed to heart disease and stroke in 2011

The top five ways to manage heart disease include; controlling high blood pressure (with the help of a healthcare provider), a daily routine of physical activity (at least 20 minutes per day), eat whole foods (avoid processed alternatives), avoid excess salt and quit smoking.

“Fitness is a factor for women of all ages, and even more significant for those who have known risk factors for heart disease and stroke,” says Dr. Emad.  “Lifestyle changes such as exercising, dieting, quitting smoking and cutting back on caffeine are all examples of the most effective ways to maintain a healthy heart.”

About Women’s OBGYN Medical Group

The provider team of expert OB/GYN physicians, certified nurse midwives, family nurse practitioners, and medical assistants provides unmatched care to patients in our region. As women proudly serving women, we understand the needs and expectations of our patients. For more information call (707) 579-1102 or visit our website.

 

Healthy Lifestyle Choices to Ensure a Lifetime of Breast Health

In this article Dr. Shazah Khawaja MD  of the Women’s OB/GYN Medical Group of Santa Rosa focuses on empowering women for Breast Cancer Awareness month by highlighting breast cancer prevention strategies.

We believe that when a woman understands the facts about breast cancer she becomes empowered to take the necessary steps towards prevention. Breast health.During October’s National Breast Cancer Awareness Campaign, The Women’s OB/GYN Medical Group is focusing on empowerment through knowledge leading to healthy choices. “We believe that when a woman understands the facts about breast cancer she becomes empowered to take the necessary steps towards prevention. By working to detect the disease in its early stages, a woman is able to make lifestyle changes to reduce the odds of developing the disease in the first place,” explains Dr. Shazah Khawaja, MD, Obstetrician & Gynecologist.

Despite decades of pursing an all-out cure and national efforts aimed at education and prevention, breast cancer remains the most common cancer among women in the United States, second only to skin cancer. Today millions of women are surviving the disease, thanks in part to early detection, improvements in treatment and by enacting healthy lifestyle choices.

The First Step in Staying Healthy

Experts agree that the key to not only surviving a breast cancer diagnosis, but to thriving for years afterwards is early detection followed by early treatment. Routine breast exams and general awareness of how to maintain breast health are both important elements in staying healthy. Practitioners at the Women’s OB/GYN Medical Group encourage routine screening including regular self-breast exams, breast checks during annual gynecologic exams, and screening mammography – all approaches that help to detect breast problems early-on.  “I routinely tell my patients that when we have the opportunity to catch and treat breast problems early, we have a better shot of ensuring the treatment will be successful,” says Dr. Khawaja.

Understanding Breast Cancer Risks for Better Outcomes

Although a having a higher risk for developing the disease may be frightening, it is also true that women who have one or more risk factors for developing breast cancer, never actually develop the disease. With increased awareness about the risk associated with certain factors – particularly those that revolve around lifestyle choices that can be changed – women of all risk levels can become empowered to make better choices.

Some risk factors such as age, genetics or race obviously cannot be changed. Other factors including environment, can also be difficult to modify. While some factors influence risk more than others, a person’s risk for developing breast cancer can change naturally due to aging and by making certain changes in habits and daily practices.

According to the American Cancer Society there are several factors that can affect a woman’s breast cancer risks including:

  • Having children after age 30 (shown to increase the risk of breast cancer in some cases).
  • Birth Control (oral and injectable contraceptives stand out in studies as contributors to breast cancer).
  • Alcohol consumption (the more consumed, the higher the risk).
  • Weight (women who carry extra pounds have a higher risk for developing breast cancer, primarily due to the higher insulin levels that accompany obesity).
  • Smoking (evidence suggests a link between smoking and breast cancer risk, particularly in premenopausal women).

Known Factors that Lower Risk:

Researchers continue to pursue the link between diet and breast cancer risk and many studies actually indicate that diet does play a role. More and more studies cast a wary eye towards red meat consumption, and there is an increased risk associated with high-fat diets, which perpetuates weight gain and obesity (a known breast cancer risk factor).

There may be sure way to prevent breast cancer as of yet, but there are things women can do to help lower the risk. A short list of actions includes;

  • Breast Feeding – for women who breast feed for 1.5 to 2 years studies suggest that there may be some benefit in reducing breast cancer risk
  • Physical Activity – a growing body of evidence indicates that a person’s risk of developing almost any cancer, particularly breast cancer is reduced by adopting a daily routine of physical activity. For example, as little as 1.25 hours of moderate physical activity per week may reduce the risk by up to 18 percent according to some studies.
  • Limit dose and duration of hormone therapy – Combination hormone therapy for more than five years is known to increase the risk of breast cancer. If you and your healthcare provider decide that the benefits of short-term hormone therapy outweigh the risks, use the lowest dose possible.

How OB/GYN Providers Can Help

Self-check breast exams are easy to perform in the home and should be conducted monthly in addition to annual breast exams with a physician at Women’s OB/GYN Medical Group. Depending on a patient’s age and individual health, we may recommend a more frequent interval of regular check-ups with a health care provider. And of course, if you suspect a breast health problem contact a provider immediately.

About the Women’s OB/GYN Medical Group

Women’s OB/GYN Medical Group’s staff of physicians include; Lela Emad, MD, Shazah Khawaja, MD, Amita Kachru, MD, and Susan Logan, MD along with two new providers; Tara Bartlett, D.O and Melissa A. Seeker, M.D. Together, these doctors share a unique whole-body approach to medicine as they strive to find the underlying causes of a woman’s health problems, rather than simply treating the symptoms. The expanded team of health professionals including Certified Nurse-Midwifes and Nurse Practitioners is committed to both alleviating short-term ailments and maximizing long-term health. The Women’s OB/GYN Medical Group strives to better the lives of all women with a holistic approach to women’s health. To learn more visit our website or to call for an appointment dial (707) 579-1102.

BMI determines risk of heart disease in middle-aged women

A woman’s race and where on her body she packs on pounds at midlife could give her doctor valuable clues to her likelihood of having greater volumes of heart fat, a potential risk factor for heart disease, according to new research.

BMI determines risk of heart disease in middle-aged women

A woman’s race and where on her body she packs on pounds at midlife could give her doctor valuable clues to her likelihood of having greater volumes of heart fat, a potential risk factor for heart disease, according to new research led by the University of Pittsburgh Graduate School of Public Health.

The findings, published online today in the journal Menopause, show that black women who put on fat around their midsection during midlife are more likely to accumulate fat around their hearts, whereas white women’s risk of fatty hearts is higher when they add weight all over. The results echo the findings of a Pitt Public Health study three years ago in men.

BMI determines risk of heart disease in middle-aged women

“Excess fat around the heart, in both men and women, is an evolving risk factor for heart disease. But how can clinicians see it at a regular physical? They can’t without a special heart scan,” said senior author Samar El Khoudary, Ph.D., M.P.H., associate professor of epidemiology at Pitt Public Health. “This study, coupled with our previous study in men, gives doctors another tool to evaluate their patients and get a better sense of their heart disease risk. It also may lead to suggestions for lifestyle modifications to help patients lessen that risk.”

El Khoudary and her team evaluated clinical data, such as CT scans and blood pressure, on 524 women from Pittsburgh and Chicago enrolled in the Study of Women’s Health Across the Nation (SWAN). The women were in varying stages of menopause, averaged 51 years old and were not on hormone replacement therapy.

The bottom line on BMI and heart disease

After accounting for the potential health effects of lifestyle and socioeconomic factors, such as smoking, alcohol consumption and financial strain, the researchers determined that, not surprisingly, the more fat a women carries overall, the higher her risk for a fatty heart.

However, white women with higher body mass indexes, or BMI, which is a measure of overall body fat, had significantly more heart fat, as measured by a CT scan, than black women with the same BMI. BMI determines risk of heart disease in middle-aged women

For black women, the levels of heart fat were greater if they carried more fat in their midsection, as measured by a cross-sectional CT scan, compared with white women with the same volume of fat in their midsection.

El Khoudary’s team found that the heart fat black women with larger waistlines accumulate is closer to their hearts than the fat the white women with higher BMI’s accumulate. Fat close to the heart secretes inflammatory markers directly to the heart tissue and produces a greater detrimental effect as it expands.

“We’ve now come to very similar conclusions that show excess abdominal fat is worse for both black men and women, and a higher BMI is worse for white men and women when it comes to their odds of having more fat around their hearts,” said El Khoudary, who noted that the current analysis could not assess changes over time. “There is something going on here that warrants further investigation to determine why it is happening and what tailored interventions doctors may prescribe to help their patients lower their risk.”


Story Source: Materials provided by University of Pittsburgh Schools of the Health Sciences. Note: Content may be edited for style and length.

Read this article on ScienceDaily: University of Pittsburgh Schools of the Health Sciences. “Risk of a fatty heart linked to race, type of weight gain in middle-aged women.” ScienceDaily. ScienceDaily, 2 August 2017.


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Malaria drug may prevent Zika virus from infecting fetus

Studying pregnant mice, researchers at Washington University School of Medicine in St. Louis found that Zika virus manipulates the body's normal barrier to infection, and that hydroxychloroquine, a malaria drug related to chloroquine, interferes with this process, protecting the fetus from viral infection.Zika virus infects the fetus by manipulating the body’s normal barrier to infection, according to a new study of pregnant mice. Moreover, the study showed that a drug that interferes with this process protects the fetus from viral infection. That drug is already approved for use in pregnant women for other medical purposes.
Devastating consequences of Zika virus infection are suffered in the womb, where the virus can cause brain damage and sometimes death.

Studying pregnant mice, researchers at Washington University School of Medicine in St. Louis have learned that the Zika virus infects the fetus by manipulating the body’s normal barrier to infection. Moreover, they showed that a malaria drug that interferes with this process protects the fetus from viral infection. That drug already is approved for use in pregnant women for other medical purposes.

“We found that the malaria drug hydroxychloroquine effectively blocks viral transmission to the fetus,” said senior author Indira Mysorekar, PhD, an associate professor of obstetrics and gynecology, and of pathology and immunology. “This drug already is used in pregnant women to treat malaria, and we suggest that it warrants evaluation in primates and women to diminish the risks of Zika infection and disease in developing fetuses.”

The findings are published July 10 in The Journal of Experimental Medicine.

In late 2015, doctors in Brazil began to notice a surge in the number of babies born with microcephaly, or unusually small heads, an indicator of neurological damage. The epidemic soon was linked to the mosquito-borne Zika virus, which was spreading through the tropical parts of the Americas. Doctors advised pregnant women to avoid mosquito bites by wearing bug spray and long-sleeved clothing, but had little other advice to offer. There were, and still are, no drugs or vaccines approved for use in pregnant women to protect them or their fetuses from Zika infection.

The developing fetus is uniquely vulnerable to damage from infection, so the body mobilizes robust defenses to keep microbes from ever reaching the fetus in the first place. The placenta is the last line of defense. Mysorekar and others have shown that a process known as autophagy — the cellular waste-disposal pathway by which cells grind up debris, unwanted organelles and invading microbes — is an important part of the formidable placental barrier to infection. However, previous studies by Mysorekar and others have shown that Zika not only can invade the placenta, but multiply there.

To learn more about how Zika breaches the placenta, Mysorekar, postdoctoral fellow Bin Cao, PhD, and colleagues infected human placental cells with Zika virus. They found that exposure to the virus activated genes related to autophagy.

However, when the researchers treated the cells with drugs to ramp up the autophagy pathway, the number of cells infected with Zika virus increased. Drugs that suppressed autophagy resulted in fewer placental cells infected with Zika virus. In other words, the virus multiplied and spread more effectively when the researchers dialed up the barrier response, and performed more sluggishly when they dialed it down. The virus seemed to be doing a form of microbial martial arts, turning the body’s weapons to its own advantage.

Mysorekar and colleagues verified these findings using mice whose autophagy response was hobbled by low levels of a key autophagy protein. They infected two groups of pregnant mice with Zika: one in which the autophagy process was disrupted and the other in which it worked normally.

Five days after infection, the mothers with a weak autophagy response had about the same amount of virus in their bloodstreams as the mice with a normal response. However, in mice with a weak autophagy response, the researchers found 10 times fewer viruses in the placenta and the heads of the fetuses and less damage to the placentas.

“It appears that Zika virus takes advantage of the autophagy process in the placenta to promote its survival and infection of placental cells,” Cao said.

Since hydroxychloroquine suppresses the autophagy response, the researchers questioned whether it also could protect fetuses against Zika.

To find out, they repeated the mouse experiment using only mice with a normal autophagy response. Female mice at day nine of pregnancy were infected with Zika and then dosed with hydroxychloroquine or placebo every day for the next five days.

Following treatment, the researchers found significantly less virus in the fetuses and placentas from the mice that had received hydroxychloroquine. In addition, these placentas showed less damage and the fetuses regained normal growth. Both the untreated and the treated mothers had about the same amount of Zika virus in their bloodstreams, indicating that hydroxychloroquine was able to protect fetuses even when the virus was circulating through the mother.

Although hydroxychloroquine has been used safely in pregnant women for short periods of time, the researchers caution that further studies are needed before it can be used in pregnant women to fend off Zika. Pregnant women living in areas where Zika circulates may need to take the drug for the duration of their pregnancies, and the safety of hydroxychloroquine for long-term use is unknown.

“We would urge caution but nevertheless feel our study provides new avenues for feasible therapeutic interventions,” said Mysorekar, who is also co-director of the university’s Center for Reproductive Health Sciences. “Our study suggests that an autophagy-based therapeutic intervention against Zika may be warranted in pregnant women infected with Zika virus.”

The Women’s OB/GYN Medical Group strives to better the lives of all women with a holistic approach to women’s health. Call for an appointment today: (707) 579-1102. Visit our website: www.womensobgynmed.com


Story Source:

Materials provided by Washington University School of Medicine. Original written by Tamara Bhandari. Note: Content may be edited for style and length.


Journal Reference:

  1. Indira Mysorekar et al. Inhibition of autophagy limits vertical transmission of Zika virus in pregnant mice. The Journal of Experimental Medicine, July 2017 DOI: 10.1084/jem.20170957

Read this article on ScienceDaily: Washington University School of Medicine. “Malaria drug protects fetuses from Zika infection: Treatment prevents virus from crossing placenta to infect fetus, mouse study shows.” ScienceDaily. ScienceDaily, 10 July 2017. www.sciencedaily.com/releases/2017/07/170710091702.htm.