an open discussion on women's health issues
with Dr. Barbara A. Hrach, MD
Q. WHAT IS THE OPTIMAL CALCIUM INTAKE FOR WOMEN IN DIFFERENT STAGES OF THEIR LIVES?
A. Calcium is critical to proper bone formation and remains critical in maintaining adequate bone density throughout a woman's life. The National Institutes of Health set guidelines for optimal calcium intake as follows: 1200-1500 mg/day for adolescents and young adults (11-24 years); 1,000 mg/day for women between 25 and 50 years; 1200-1500 mg/day for pregnant or lactating women;
and 1500 mg/day for post-menopausal women. For detailed information regarding how to attain optimal calcium intake, refer to the National Osteoporosis Foundation website at www.nof.org.
Q. WHAT IS THE THYROID AND WHY SHOULD I WORRY ABOUT IT?
A. The thyroid is a small, bowtie-shaped gland located in the neck. The thyroid uses iodine to produce hormones which influence the function of every organ in the body. These hormones can easily be tested in the blood. Both an underactive and overactive thyroid gland can have dire consequences on the body. Symptoms of hypothyroidism (underactive thyroid) can include fatigue, cold intolerance, constipation, weight gain, hair loss, and abnormal periods. If left untreated, these can lead to heart problems or coma. Hypothyroidism is the most common form of thyroid function abnormality, affecting as many as 1 in 10 women over the age of 65. Symptoms of hyperthyroidism (overactive thyroid) can include nervousness, insomnia, diarrhea, heat intolerance, and weight loss. Hyperthyroidism can also lead to heart rhythm problems, muscle weakness, and osteoporosis. Because of the prevalence and morbidity associated with thyroid disease, many medical organizations are now recommending a screening during routine physical examinations. Certainly, if you suspect thyroid disease, you should consult with your doctor immediately for testing.
Q. WHAT HEALTH CHECK-UPS AND TESTS DO I NEED AND HOW OFTEN SHOULD I GET THEM?
A. Periodic health check-ups are critical in the prevention and early detection of disease. Young women should be screened for sexually transmitted diseases, cervical and breast cancers, with annual pelvic and breast exams beginning at age 18 or at the onset of sexual activity. Cholesterol screening is initiated at this time as well, and repeated approximately every five years. A woman should receive a baseline mammogram between the ages of 35 and 40, and yearly mammograms after age 40. Colon cancer screening generally begins at age 50 and requires periodic sigmoidoscopy or colonoscopy. We also recommend osteoporosis screening with bone density testing beginning at menopause and periodically thereafter. These recommendations can change based on personal or family histories of disease, so a thorough annual physical exam is recommended.
Q. WHAT IS THE DIFFERENCE BETWEEN A MIGRAINE AND A TENSION HEADACHE? HOW DO HEADACHES RELATE TO THE MENSTRUAL CYCLE?
A. Tension headaches are categorized as musculoskeletal headaches and are thought to be caused from spasming of the muscles surrounding the skull and neck. These tend to feel more like a band around the head and occur frequently during times of tension or stress. Migraine headaches are categorized as vascular headaches and are thought to be caused by dilation (expansion) of blood vessels in the brain, and nerve irritation. These commonly present themselves as unilateral (one-sided) headaches and are often preceded by an "aura" (visual and/or sensory changes). Unfortunately, women suffer from migraines much more frequently than men and often experience migraines around their menstrual cycle. One explanation involves a substance called serotonin, which carries messages in the brain. Lowered levels of serotonin trigger a series of chemical changes in the brain, which result in the dilation of blood vessels. The female hormone estrogen influences serotonin levels- when estrogen levels fall, so do serotonin levels. Estrogen levels drop shortly before the menstrual period and this may explain why some women suffer from migraines during this time.
Q. IS IT TRUE THAT BIRTH CONTROL PILLS ARE GOOD FOR TREATING ACNE?
A. Yes. Acne occurs when pores in the skin become plugged with a mixture of oil and dead skin cells. Bacteria can grow beneath the plugs, causing redness, swelling, and pimples. Certain hormones produced by your body can make skin glands more active, causing them to produce more oil. Birth control pills (oral contraceptives) suppress the production of these hormones, which in turn reduces the formation of acne. Although only a few oral contraceptives have FDA approval for use in treating acne, most of the combined estrogen/progesterone pills demonstrate this effect.
Q. WHAT ARE THE VARIOUS TYPES OF BIRTH CONTROL OPTIONS AVAILABLE AND WHICH IS MOST RELIABLE?
A. Of course, the most reliable form of birth control is abstinence. Hormonal methods involve using medications to prevent ovulation. These include birth control pills (oral contraceptives), Depo-Provera, and Norplant. When taken as directed, these are over 99% effective in preventing pregnancy, but do not offer any protection against sexually transmitted diseases. Emergency contraception, or the "morning after pill" involves taking high doses of oral contraceptives within 72 hours of intercourse, and is 75-88% effective in preventing pregnancy. These pills are now available without prescription, but must be obtained from a participating pharmacist. Barrier methods work by preventing the sperm from getting to, and fertilizing the egg. These include the condom, diaphragm, and cervical cap. Effectiveness varies between 65 and 85%. The condom is the only form of birth control that also protects against sexually transmitted diseases. Spermicides are medications that kill sperm on contact. They are placed in the vagina and work best when used with a barrier method. Used alone, they are less than 80% effective in preventing pregnancy. Intrauterine devices (IUD) are inserted into the uterus where they stay from 1-10 years. An IUD prevents the fertilized egg from implanting into the lining of the uterus and is 99% effective in preventing pregnancy.
Q. AT WHAT AGE SHOULD I START THINKING ABOUT BREAST CANCER?
A. Unfortunately, breast cancer can afflict women at any age. However, that risk increases significantly as we age. By age 50, a woman has a 1 in 50 chance of developing breast cancer and by age 80 that risk increases to 1 in 10. Risk factors can increase a woman's chance of developing breast cancer, and include early menarche (onset of menstruation), late menopause, nulliparity (no children), family history of breast cancer, increased weight, and excessive alcohol consumption. Any detectable breast abnormality should be evaluated by a physician immediately.
Q. WHAT CAN I DO TO PREPARE FOR A PREGNANCY?
A. You should begin by consulting your physician for a complete physical exam including pap smear, breast exam, and screening for sexually transmitted diseases. If you are taking oral contraceptives, it is recommended that you discontinue them several months prior to conception and use another form of birth control until you are ready to conceive. It is also important to begin taking folic acid (1,000 mg/day) to help prevent certain birth defects.
Q. WHAT ARE THE SYMPTOMS OF OVARIAN CYSTS?
A. Ovarian cysts are caused when a follicle within the ovary fails to rupture and release an egg at the time of expected ovulation. Instead of being reabsorbed, the fluid within the follicle persists and forms a cyst. Cysts usually disappear within 60 days without treatment and are relatively common. Symptoms of ovarian cysts can vary from asymptomatic to severe pelvic pain with abnormal uterine bleeding. The sudden onset of pelvic pain can represent a rupture of an ovarian cyst or bleeding into an ovarian cyst. These symptoms should be evaluated by a physician immediately. The development of ovarian cysts can be prevented by taking oral contraceptives, Depo-Provera, or Norplant, all of which prevent follicle formation.
Q. WHAT IS THE TREATMENT FOR POSTPARTUM DEPRESSION?
A. The term postpartum depression describes a range of physical, emotional, and behavioral changes that a new mother experiences following the birth of her baby. Symptoms of this condition can range from mild ("the baby blues") to severe (true postpartum depression or psychosis). The "baby blues" generally last only one to two weeks after delivery and resolves without medical treatment. True postpartum depression occurs in approximately 10% of pregnancies and symptoms can last for as long as a year. This condition is characterized by intense feelings of sadness, despair, anxiety, and irritability, and often disrupts a woman's ability to function. Treatment consists of antidepressant medication, psychotherapy, or a combination of the two.
Barbara A. Hrach, MD is a graduate of Case Western Reserve University School of Medicine and is a diplomate of the American Board of Internal Medicine. Dr. Hrach practices general internal medicine with a focus on women's health issues. She began her career in Santa Barbara at the Sansum Medical Clinic and now enjoys private practice in her office at 216 W. Pueblo Street, near Cottage Hospital. She is also involved in teaching internal medicine residents at the Santa Barbara County Health Clinic. When she's not busy treating patients, she enjoys running, kayaking, mountain biking, and spending time with her family. She is currently accepting new patients. For an appointment, call 805/682.1934.
