- Women’s Health
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- Nurse Barb
It’s important to note that guidelines are just that, guidelines based upon data from large populations, however they may not apply to every woman that you encounter, especially to those who have unique circumstances and let’s face it, are more challenging and more rewarding as we provide personalized, individualized care.
The current American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines for pap smears differ from those of the US Preventive Services Task Force (USPSTF)
The USPSTF guidelines recommend that Pap smears be stopped at age 65 if there have been adequate prior screens, however it’s not clear what the definition is of adequate prior screens.
When women come to my office with any one or all of the following complaints from no periods to excessive bleeding, difficulty losing weight, excessive hair growth and acne or infertility, I see this as an important opportunity to change a woman’s life for the better. Many of these women have seen many other health care providers, who more often than not aren’t able to provide a diagnosis or who may not be able to provide a comprehensive plan of care. Many women with PCOS have symptoms that impact their appearance, their self-esteem, sense of shame and guilt as well as fears of infertility.
Using the Rotterdam Criteria for diagnosis provides an objective starting point for evaluating women. A diagnosis of PCOS can be made if 2 out of the following 3 conditions are met: Signs of hyperandrogenism such as hirsuitism, acne, absence of regular ovulation and/or seeing 10 or more small cysts on 1 or both ovaries with an ultrasound.
It’s estimated that 1.4 million US women will experience abnormal uterine bleeding (AUB) each year. This includes an estimated 50% of women in perimenopause, who have an increased incidence of polyps, fibroids and who are not ovulating which leads to their AUB. In addition, over half of women with heavy menstrual bleeding report that their periods interfere with their lives compared to women with lighter cycles.
The American Congress of Obstetricians and Gynecologists (ACOG) defines Abnormal Uterine Bleeding this way
ACOG Definition of Abnormal Uterine Bleeding (AUB)
Bleeding that requires more than 1 pad/hour for more than 1 day
Bleeding for more than 7 days at a time
Bleeding intervals that are less than 20 days apart
Bleeding in excess of 80 cc a month
– a super tampon or pad can hold approximately 10 cc of blood
Bleeding that causes anemia
Bleeding that leads to disruption in life style
Source: ACOG, Committee Opinion. April 2013 (reaffirmed 2015), number 557.
I just gave a talk to a group of about 75 women at midlife. When I asked for a show of hands for how many women experience urine leaking with a cough, sneeze or laugh, about 1/2 raised their hands.
Yes, about a third to a half of us are having a little pee pee problem. Fear not! There’s an App for that now too!
Strengthening the pelvic floor means you’ll be less like to deal with this possibility.
When I ask my patients to do a Kegel or to try to squeeze their pelvic floor muscles during an exam, it’s clear that only about 1/2 are able to isolate and squeeze the right muscles. Many use their abdominal muscles, many push out and many simply don’t have the sensation. Once we work on how to do the exercises and get women started practicing, most report that their lives have changed, for the better because they aren’t leaking at all or nearly as much.
We’re all busy, so here’s some options to help you stay dry and a surprising option at the end.
At home Kegels! There’s an App for that
For women who want to work on their pelvic floor muscles in the privacy of their own home, here’s a few new options:
Discreet vaginal inserts
Lightweight, small, discreet vaginal inserts that use Bluetooth technology connected to your smartphone so you can see if you’re doing your Kegels correctly. (more…)
Most women know that doing Kegel exercises can help prevent leaking urine, but many are surprised to learn that being able to isolate and strengthen the pelvic floor muscles can also enhance sexual functioning. Really! Strengthening these muscles has the potential to improve sexual sensation, satisfaction and orgasm in women.
It’s never too late
Many of my patients throw in the towel, so to speak, and shrug their shoulders, figuring there’s not much they can do now, and those days are behind them, settling for watching episodes of Outlander.
Studies have confirmed what real women experience – pelvic floor concerns tend to lead to more sexual complaints, from low libido and problems with sexual arousal to inability to achieve orgasm.
“Unfortunately, many women feel that decreased sexual function is an inevitable part of aging,” said Leslie Rickey, MPH, MD, Associate Professor of Urology and of Obstetrics, Gynecology and Reproductive Sciences; Fellowship Director, Female Pelvic Medicine and Reconstructive Surgery, Yale School of Medicine. (more…)
High Tech Kegel Exercises with PeriCoach – I was so excited I tried it myself!
Like many of my patients, Jana* was hesitant and embarrassed when I asked about whether she was experiencing leaking urine. She nodded and told me that it happened a few times a week and while she tried to remember to do Kegel exercises, she wasn’t sure if she was even doing them right.
Jana was also surprised to learn that she wasn’t alone. The fact is that 1 in 3 women will experience leaking at some point in their lives. Women are doing the best they can to adapt to leaking urine. We wear protective pads, visit the bathroom as often as possible and try to remember to do those Kegel exercises.
There’s an App for that!
Recently I heard about a new, easy-to-use at home pelvic trainer and app, the PeriCoach system. It teaches women with real time visual feedback via a Bluetooth connection to their smartphone how to exercise and strengthen their pelvic floor muscles, in other words how to do Kegels and do them correctly.
Women can see how strong their muscle contractions are on their smartphone and track their progress. There’s even a secure portal at my.pericoach.com that women can share with their clinicians so they can both keep track of their progress.
Are you like millions of women who leak urine? Do you know where every bathroom is in a 5 mile radius of your house? Or maybe you wear a pantyliner to catch the little leaks that might occur if you cough, sneeze or laugh? Or maybe you’re like my patient Joan who leaks as soon as she puts the key into her front door. What’s up with that?
You are Not Alone
If any of this sounds familiar, it’s because millions of women will experience some leaking, what we call urinary incontinence, at some point during their lives. This isn’t a topic that most women feel comfortable bringing up, even with their health care providers.
Most of my patients are surprised to learn that they’re not the only ones dealing with this. One patient told me she didn’t want to mention it because she was sure she’d be scolded for not doing Kegel exercises 10,000 times/day. As she said, “I don’t even know if I’m doing them right.”
Women who don’t leak urine are usually younger and have not had any pregnancies. As you can see in this illustration, the bladder is a nice oval shape, is high above the vagina and the the valves or urethral sphincters that stay closed so that you can stay dry. The bladder is held up in place by the pelvic floor muscles.
Eventually, over time, as gravity works it’s not so nice magic on the pelvic floor muscles the bladder can slip down into a curved position where some of the urine can stay in a pool that never quite empties, which can lead to leaking.
Should You Exercise Your Pelvic Floor Muscles?
The pelvic floor is like a small trampoline, it has a little bit of bounce and keeps all the organs in their places with bright shiny faces. Exercising your pelvic floor muscles helps strengthen them and can help women regain control leading to less leaking.
To find out if you need to exercise take this quick quiz
If you answered True to any of these questions, practicing pelvic floor exercises can help you regain more control over your bladder.
How to exercise your pelvic floor
It may be difficult to isolate the muscles of your pelvic floor and to learn how not to use your abdominal muscles to squeeze, hold and then relax. Here’s how you might practice in the privacy of your bathroom. I recommend trying while seated on the toilet.
Sometimes it seems that everything in our bodies suddenly changes after 45. Almost overnight, there appear to be more frequent trips to the bathroom, waking us from sleep and driving women to map out their days based on the proximity of clean bathrooms.
Then, there’s the worry about coughing, sneezing or laughing and the possibility of a little leaking urine and needing to wear pads for protection. Leaking and incontinence describe the same thing.
In addition, many women also start noticing a slight discomfort and dryness around the genitals and in the vagina, and a new need for lubricant when intimate.
If these are some of the changes you’re noticing, you’re not alone. Millions of women at mid-life find that their bodies are changing in ways that few people talk about.
If you think you’re the only one running out to buy more pads for leaking urine, whether it’s occasional or all the time, fear not, about 50%, that’s right half of women over 50 have some leaking!
Take this Quick Quiz to see if you might benefit from treatment
If you answered yes to any of these questions, don’t worry, there’s hope and it may be simpler than you think.
Many women are understandably hesitant to discuss this issue with anyone, not even their girlfriends. Leaking is the ultimate taboo topic in menopause. Study after study shows that most women will not bring up this sensitive issue because they feel uncomfortable, they sense discomfort in their health care providers, and they don’t think there are any decent treatment options. Many women would rather talk about their weight than talk about leaking urine. And we all know how uncomfortable it is to talk about weight.
Not so with my friend and colleague, Dr. Sari Levine, who is passionate about helping women regain their quality of life and says, “A woman should be able to run across the street without leaking. And as doctor, I believe, If there’s something we can do, then we should! Wearing thicker pads shouldn’t be the first option.”
Dr. Levine starts by diagnosing the underlying problem and then when appropriate, steering women toward pelvic floor physical therapy (PT). As she says, “Almost every woman who leaks will benefit form pelvic floor PT.” Women who use Pelvic Floor PT can strengthen their muscles and often will be drier within weeks. For women who ultimately need to consider surgery, the Pelvic Floor PT improves their recovery time and ability to heal.
I’ve been recommending Pelvic Floor Physical Therapy for years and wrote about in my book, The Hot Guide to a Cool Sexy Menopause. Like Dr. Levine, I send my patients to El Camino Hospital’s Pelvic Floor Physical Therapy program. You can learn more here.
Do talk to your health care provider
No matter where you live, there are women’s health specialists and Pelvic floor physical therapists who can help. Do talk to your health care provider about the options and treatments available to you.
Disclosure: I’m working with El Camino Hospital to get the word out about new options and treatments for a variety of conditions so that people can get the information they need to make the best choices for their health or for someone they love.