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Women’s Health

Breast Health

All women 20 years of age and older should perform breast self-exam (BSE) each month, two to three days after your period, or on the same date each month if you no longer have periods. Monthly BSE helps you learn the way your breasts normally look and feel and allows you to notice changes. If you should find a lump or thickening in or near your breast or under your arm, a change in the size or shape of your breasts, a discharge from your nipple that occurs without squeezing or a change in the color or feel of the skin on your breasts, areola or nipple (dimpled, puckered or scaly), this should be reported to your health care provider for further examination. A clinical breast exam by an experienced physician should be a part of every yearly health exam for women 20 years of age and older.

Women 40 years of age and older should have screening of their breasts every 1-2 years depending on personal and family history and any other personal risk factors, to screen for breast cancer. A mammogram has generally been recommended for most women but additional imaging with sonography may be necessary if breasts are very dense. A breast MRI may be indicated if there is evidence of increased personal breast cancer risk. Mammography is a low dose X-ray that shows the inside of your breasts. During a mammogram, two smooth, plastic plates are placed around one of your breasts to flatten your breast tissue. Flattening your breast provides the best exam using the lowest dose X-ray. Two or more X-rays will be taken of each breast. If you have periods, have your mammogram during the week after your period when your breasts are less tender.

Some have recommended other screening methods due to concern about repeated radiation exposure to breast tissue over a woman’s lifetime with mammography. Thermography is just such a tool. While this technology has been widely utilized and recommended by some providers as a substitute for mammography, we do not have comparative data to support substituting thermography in place of mammography for routine breast cancer screening. Some women have opted for less frequent mammograms if they are low risk choosing to have breast thermography performed annually in between. While this may be a reasonable compromise, more data is needed.

Fertility

Infertility is defined as failure to achieve pregnancy within 12 months of unprotected intercourse or therapeutic donor insemination in women younger than 35 years or within 6 months in women older than 35 years. It affects up to 15% of couples.

An initial fertility workup should include a comprehensive review of the medical history, physical examination, and additional focused testing for both partners. For the female partner, tests will focus on ovarian reserve, ovulatory function, and structural abnormalities. Imaging of the reproductive organs provides valuable information on conditions that affect fertility. Imaging modalities can detect tubal patency, pelvic pathology and assess ovarian reserve. Men should have semen analysis performed as well.

Infertility is a significant source of stress for couples and can have devastating effects on relationships.  Unexplained infertility may be diagnosed in as many as 30% of infertile couples. At a minimum, patients should have evidence of ovulation, tubal patency, and a normal semen analysis confirmed.

At Willowbend Health & Wellness we understand that exposure to environmental toxins before and during pregnancy have a dramatic impact on fertility and pregnancy outcome. We offer testing to identify toxic exposure and micronutrient deficiency along with solutions to address them once identified. Dr. Gee recommends all couples actively participate in a total body detoxification program prior to attempting pregnancy. We offer many options to accomplish this goal.

Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age. Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs.The exact cause of PCOS is unknown. Early diagnosis and treatment along with weight loss may reduce the risk of long-term complications such as type 2 diabetes and heart disease.

Signs and symptoms of PCOS often develop around the time of the first menstrual period during puberty. Sometimes PCOS develops later, for example, in response to substantial weight gain. Signs and symptoms of PCOS vary. A diagnosis of PCOS is made when you experience at least two of these signs:

  • Irregular periods. Infrequent, irregular, or prolonged menstrual cycles are the most common sign of PCOS. For example, you might have fewer than nine periods a year, more than 35 days between periods and abnormally heavy periods.
  • Excess androgen. Elevated levels of male hormone may result in physical signs, such as excess facial and body hair (hirsutism), and occasionally severe acne and male-pattern baldness.
  • Polycystic ovaries. Your ovaries might be enlarged on ultrasound and contain follicles that surround the eggs. As a result, the ovaries might fail to function regularly.

PCOS signs and symptoms are typically more severe if you are obese. There is good evidence to support  integrative options to evaluate and treat the symptoms of PCOS as well as the underlying contributors. If you have concerns about your menstrual periods, if you are experiencing infertility or if you have signs of excess androgen such as worsening hirsutism, acne, and male-pattern baldness, please contact us to schedule a consultation.

PMS/PMDD

Pre-Menstrual Syndrome (PMS) is a condition that affects a woman’s emotions, physical health, and behavior during certain days of the menstrual cycle, generally just before menses. PMS is a very common condition. Its symptoms affect more than 90 percent of menstruating women. It must impair some aspect of your life for your doctor to diagnose you. PMS symptoms start five to 11 days before menstruation and typically go away once menstruation begins. The cause of PMS is unknown, although many researchers believe that it is related to a change in both sex hormone and serotonin levels at the beginning of the menstrual cycle.

Levels of estrogen and progesterone increase during certain times of the month. An increase in these hormones can cause mood swings, anxiety, and irritability. Ovarian steroids also modulate activity in parts of your brain associated with premenstrual symptoms. Serotonin levels affect mood. Serotonin is a chemical in your brain and gut that affects your moods, emotions, and thoughts.

Twenty to 32% of women report moderate to severe symptoms that affect some aspect of life. The severity of symptoms can vary by individual and by month and can include abdominal bloating or pain, sore breasts, acne, food cravings, constipation, diarrhea, headaches, fatigue, irritability, changes in sleep patterns, anxiety, depression, or emotional outbursts. A consultation is in order if physical pain, mood swings, and other symptoms start to affect your daily life, or if your symptoms do not improve with intervention.

Pre-Menstrual Dysphoric Disorder (PMDD) is a condition similar to PMS that also happens in the week or two before your period starts as hormone levels begin to fall after ovulation. PMDD causes more severe symptoms than PMS, including severe depression, irritability, and tension. PMDD affects up to 5% of women of childbearing age. Many women with PMDD may also have anxiety or depression.

Symptoms of PMDD vary from person to person, but can include moderate to severe irritability, depression, anxiety, panic attacks, mood swings, lack of interest in daily activities and relationships, difficulty thinking or focusing, fatigue, food cravings or binge eating, or insomnia. They often include physical symptoms as well, such as cramps, bloating, breast tenderness, headaches, and joint or muscle pain

Researchers do not know for sure what causes PMDD or PMS. Hormonal changes throughout the menstrual cycle may play a role. A neurotransmitter called serotonin may also play a role in PMDD. Serotonin levels change throughout the menstrual cycle. Some women may be more sensitive to these changes. You will need to keep a calendar or diary of your symptoms to help your doctor diagnose PMDD.

Functional medicine offers integrative options for evaluation to diagnose underlying imbalances that may be contributing to your symptoms including neurotransmitter and hormonal imbalances.

FIBROIDS

Uterine leiomyomata, or fibroids, are very common, affecting approximately 70% of women at some point in their lives. However, many cases go undiagnosed, increasing the probable incidence. In general, genetics and ovarian hormone exposure are the known antecedents for the development of fibroids. The heavy bleeding associated with fibroids can cause anemia, fatigue, and pain. Women with uterine fibroids report a decreased quality of life, difficulty getting diagnosed, and concerns about available treatment options. Often, women with fibroids want to avoid hysterectomy and seek alternatives. However, in the US, uterine fibroids are the top indication for hysterectomy.

Factors that predispose women to fibroids are not yet well understood, but research has identified that modifiable lifestyle factors and antecedents play a role. Obesity, increased blood pressure, high serum lipids and metabolic syndrome can increase the risk of fibroids, suggesting a cardiometabolic connection. Low vitamin D levels increase risk for symptomatic fibroids. In addition, cytokines show different seasonal variance in women with and without fibroids, suggesting that a highly inflamed immune system may play a role in fibroid formation.

African-American women are much more likely to develop uterine fibroids, so they report more severe symptoms related to their fibroids. Toxins also likely play a role in the development of fibroids, including exposure to air pollution. One large-scale, longitudinal study demonstrated that exposure to high amounts of air pollution correlated with an increased risk of fibroids.

Heavy metals, persistent organic pollutants (POPs), and possibly PCBs are also correlated with uterine fibroid development. Estimates are that at least 23% of child-bearing women are exposed to three or more toxicants above the level of known safety. Critical windows of exposure may affect long-term hormonal patterns, especially pre-menarche exposures. A significant, dose-dependent connection between hair relaxers and fibroid risk also suggests that some African-American women may be exposed to more and different chemicals than many white women.

From a Functional Medicine perspective, fibroids likely indicate hormonal imbalance, and several lifestyle interventions can assist in treatment, including improved nutrition, reduced exposure to toxins (particularly xenoestrogenic toxins), and anti-inflammatory interventions (including botanicals and lifestyle interventions). Regular detoxification to optimize hormonal balance will likely be of benefit. For the many women who suffer from fibroids but wish to avoid hysterectomy, these low-harm therapies may provide the relief they seek.

When these measures do not provide adequate control of uterine fibroid symptoms, there are a number of minimally invasive surgical options that are now approved and available to treat women with uterine fibroids. These procedures offer the option for women to preserve their uterus and its normal function. Outpatient surgeries like Acessa Radiofrequency uterine fibroid ablation performed with laparoscopic assistance, Sonata Radiofrequency fibroid ablation performed with hysteroscopic assistance, MR-guided Focused Ultrasound Surgical fibroid ablation or Uterine Artery Embolization that may be an option for some women.

Dr. Gee has been recognized as a thought leader for her contributions to advancing these options for women through clinical research investigation and routine surgical offering. She has more than 35 years of experience treating women with complex uterine fibroid disease both surgically and medically. Dr. Gee provides second opinion and consultation about all uterine fibroid treatment options so schedule your consultation today.

ENDOMETRIOSIS

Endometriosis is a condition when the tissue that normally lines the inside of the womb (the endometrium) is found in other places in the body, for example in the fallopian tubes or ovaries. Sometimes endometrial tissue can be found in more distant locations such as the intestines, lungs or joints.

During a normal menstrual cycle, hormonal changes cause the endometrial tissue to shed, and it exits the body through the vagina. In endometriosis, the misplaced endometrial tissue is also affected by these hormonal changes. It too starts to break down and bleed, but there is no exit route for the old tissue to leave the body. This leads to irritation, inflammation and pain as the immune system tries to clear the misplaced tissue. The main symptoms of endometriosis include very painful or heavy menstruation, pain during sex, bloating, lower back pain, bowel changes especially around menstruation, and infertility.

Doctors still do not know exactly what causes endometriosis but there are many theories. Some scientists have suggested that the endometrial tissue migrates backwards through the fallopian tubes. The theory is that this can then settle elsewhere in the pelvic cavity or travel via the blood and lymph to more distant body sites. Others have suggested that stem cells lining other body cavities or organs turn into endometrial cells. Likely under the influence of certain hormones or toxins. In both situations there must also be altered functioning of the immune system, stopping it from recognizing the misplaced tissue or from effectively removing it. Inflammation likely plays a significant role here.

In addition to being very painful and uncomfortable, endometriosis can also lead to fertility problems. The constant inflammation around the areas of misplaced tissue can lead to the formation of scar tissue. Sometimes the scar tissue develops in a way that causes two structures to become stuck together. This is called an adhesion. These adhesions can block the passage of an egg through the fallopian tube or cause the womb to become misaligned. Endometriosis on the ovaries can also cause the development of chocolate cysts. These are blood filled sacs on the ovaries that can interfere with normal ovulation.

There is no cure for endometriosis so medical treatment focuses on managing the symptoms. In most cases, the standard treatment for endometriosis is painkillers and hormones. Frequently, the oral contraceptive pill or other hormonal contraceptive methods are recommended as these can make the menstrual cycle lighter and less painful. In severe cases, surgery can be used to remove the endometrial deposits. However, it is common for endometriosis to reappear in 45% of cases.

Dr. Gee has extensive experience treating women with varying stages of endometriosis both medically and surgically. She has been involved in many clinical research trials involving now approved treatment options for women with otherwise uncontrolled symptoms. She brings this experience to her now more integrative care approach to further reduce the need for repeated surgical procedures.

Functional medicine takes a more holistic view of endometriosis. A typical support protocol will include steps to balance female hormone levels and support the hormone detoxification pathways, support the immune system, work on gut health to ensure a balanced microflora as this directly influences the immune system, remove any foods that might be contributing to inflammation and reduced immune surveillance, assess any environmental exposures that might be contributing to the endometriosis, and put in place an anti-inflammatory diet and supplement protocol. Dr. Gee provides second opinion and consultation about all treatment options for endometriosis so schedule your consultation today. 

PERIMENOPAUSE

Perimenopause refers to the time period that begins when the ovaries begin to decline in function. It continues until menopause, which is defined as the total cessation of menstrual flow for an entire year. Many women think of perimenopause as a “change of life” or “transition period.”  During this transition period, hormones can wildly fluctuate and may cause serious distress. Before you move forward in seeking relief for your perimenopause symptoms, it is important to acknowledge a number of facts about this stage in your life.

  • The average length of perimenopause is 4 years, lasting up to 10 years in some women.
  • On average, women enter menopause from perimenopause around the age of 51.
  • Women who are perimenopausal may still become pregnant, since there is on average 5- to 10-year period between the beginning of a decline in ovarian function and the cessation of menstruation.
  • Perimenopause is a time period associated with a high risk of mood disorders, including anxiety, depression and insomnia.
  • Not all women experience all the symptoms of perimenopause to the same degree, and symptoms vary among women.
  • Treatment of perimenopausal symptoms may include medications, hormone therapy and lifestyle changes, such as diet, exercise and quitting smoking.

Symptoms of perimenopause can begin as early as 10 to 15 years before menses completely stops. Women in their late 30’s, 40’s and early 50’s may transition in and out of a perimenopausal state many times before they finally enter menopause. If you are currently experiencing symptoms such as irregular periods, heavy bleeding, hot flashes, sleep disruption, headaches and weight gain – or any other extreme emotional distress, you may be relieved to know that these are all common signs of perimenopause

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