Not Surprising, but IMPORTANT, being healthy BEFORE you get pregnant improves outcome of pregnancy
July
22 ,
2009
This is the big topic at this year's meeting of the Society for the Study of Reproduction, which is taking place July 18 to 22 at the David L. Lawrence Convention Center in Pittsburgh. That with all the emphasis on the health of women during their pregnancy, we seem to forget the importance of being healthy before you get pregnant and the impact this can have on your future child.
Among the findings reported:
Maternal diabetes and Embryo Development - taking care of your diabetes and getting it controlled reduces the risk of birth defects.
Take Your Vitamins Before Becoming Pregnant - especially folate, but other vitamoins as well are important for early fetalk development. Waiting until you are a few weeks pregnant may be too late to prevent many problems.
Low Protein Diet May Lead to "Jumpy" Offspring - Studies in mice seemed to show that not having enough protein seemed to lead to bigger babies, abnormal growth, cardiovascular disease, high blood pressure and jumpy behavior in their offspring.
Dormant Genetic "Memories" Can Impact Later susceptabilities to disease - changes in the genome that can happen during early development may create "memories in the genome that may remain dormant until an environmental trigger brings them to the surface, modifying risk for disease.
These findings should not come as a surprise. Bottom line, don;t wait until your pregnant to start worrying about living healthy for your baby. Start right now.
Screening for postpartum depression, a controversy?
July
16 ,
2009
Time magazine has a whole report about a "debate" regarding postpartum depression (PPD) screening.
Excuse me for putting in my two cents, but I have been screening for PPD for years, and so have just about every obgyn that I know. The postpartum visit is a perfect time to ask women about their mood symptoms, and I have personally been able to help numerous women through this very serious problem. Many of these women would never have sought help had I not asked.
I can't believe that anyone could possibly object to this. A few simple questions could really save someone from serious harm. I am appalled that some people suggest that this is some sort of ploy by the drug companies. For starters, so many SSRIs (the most common medications given for postpartum depression) are generic anyway, like sertraline and fluoxetine. Furthermore, if the screen confirms the disease, and the drug prescription is appropriate, why shouldn't the drug company make the sale? Isn't that what happens every time we prescribe a medicine for someone who needs it?
Any doctor who fails to ask about PPD is clearly neglecting his/her responsibility to his/her patients. It is no different than taking someones blood pressure. Are we to stop taking blood pressure because the drug companies might make a few dollars selling blood pressure medications? Please, get a life.
Should women really endure more labor pains?
July
15 ,
2009
Apparently, according to a midwife in the UK,, "more women should experience the natural pains of labour unaided by epidurals and other pain-relieving medication."
According to an article in the Observer newspaper on Monday, Dr Denis Walsh, a senior midwife, published author on natural childbirth, and an associate professor in midwifery at Nottingham University, said that:
"...not only do these procedures carry greater medical risk but they interfere with the mother's ability to bond with her baby and deny her the opportunity to experience childbirth as a rite of passage."
"In the west it has never been safer to have a baby, yet it appears that women have never been more frightened of the processes."
I would like to hold back my tongue, but it is difficult. The evidence for the safety of epidurals and other medications is as clear as it can possibly be. The "opportunity" to "experience" chlidbirth yada yada is not at all denied to a woman just because she gets an epidural. I have yet to see any eviedence that women that had epidurals are somehow less effective as Moms than women that did not get an epidural. I have yet to see any evidence that children born to women with epidurals somehow have "bonding" issues with their parents.
I can't believe that someone can write such drivel and get away with it. In my book, anyone who has pain, if there is a medical way to relieve it, deserves to be treated for it. I have seen thousands of incredible women give birth to beautiful babies with and without epidurals. Dr. Walsh needs to get a life.
Minimally Invasive Gynecologic Surgery
July
14 ,
2009
According to a recent article in medical news today, Eighty percent of women who have a hysterectomy have a traditional one, in which a surgeon must make an extensive incision on their abdomen.
According to the article:
"If only these women's gynecologists had been trained in minimally invasive laparoscopic surgery techniques, many of them could have had hysterectomies involving just a few small, keyhole incisions. Also, their recovery time would have also been reduced drastically, permitting them to resume their normal lives much faster.
Minimally invasive surgery, or MIS, involves using laparoscopic tools to view interior organs so that doctors can perform surgery through dramatically smaller incisions. MIS is widespread for many kinds of general surgery for example, over 90 percent of bariatric surgeries are performed that way. However, the utilization of minimally invasive techniques is still relatively uncommon among gynecological surgeons."
I could not agree more. I must say that it is very rare indeed that a hysterectomy today needs to be done through an open inciocsion. I could count on one hand the number of times I needed to do an open hysterectomy in the last year. If you do need a hysterectomy, PLEASE ask your surgeon if he or she feels MIS is appropriate for you. If they say know, find out why.
Bioidentical Hormones - Are they truly identical?
July
13 ,
2009
When someone claims that their product is a bioidentical hormone, they should mean that it truly is identical to the hormone your body produces. However, since each product is made by an individual pharmacy, and there are no official standards which each pharmacy needs to adhere to.
Therefore, it is not at all clear that every product that is marketed as being bioidentical is truly identical to the human hormones it is trying to replace.
There are several different hormones that are generally sold by the compounding pharmacies that sell bioidentical hormones. These include estrone, estradiol, estriol, progesterone, testosterone, dehydroepiandrosterone (DHEA), and cortisol.
These hormones are usually made from soy or yams, and then they are modified in the laboratory to make a molecular structure that is very similar to the hormones made by your own body. If you want something truly bioidentical, you would need to know exactly what your pharmacy is producing. However, since these products are not regulated by the FDA or any other government agency, there is no way to be certain that the medicine you are taking is truly bioidentical.
Bioidentical Hormones - Are they safer than conventional prescription hormone therapy?
July
12 ,
2009
We have devoted so much of this blog last year to the safety and uses of hormone replacement therapy after menopause, so the point of this blog post is not to discuss the safety of hormone replacement therapy. If you would like to read more about the safety of hormone replacement therapy, check out the Sunday posts in the archives from Feb 7, 2008 through March 9, 2009.
The question today is about bio-identical hormones, are they safer than conventional prescription hormones?
This is a very difficult question to answer. Many of the advocates of this type of therapy will tell you that since these hormones are identical to the natural hormones produced y your body, they must be safer. That sounds like a reasonable claim, but it has never been proven to be true.
Not everything that sounds right, is right. the fact is that many of the risks associated with hormone replacement may have nothing at all to do with the exact type of estrogen a person takes. It may very well be that a bio-identical hormone has the same risks as a conventional hormone. In fact, until we have evidence to the contrary, we have to assume that this is the case.
Remember what the risks of hormone replacement are: increased risk of breast cancer, blood clots, stroke and heart disease. There is no reason to assume that the naturally produced estrogens are any less carcinogenic ("cancer-causing") than the synthetic non-bio-identical hormones. After all, most women that get estrogen-responsive breast cancer never took any hormone replacement medications.
On the other hand, there is no reason to believe that it is any more dangerous than conventional prescription hormones either. So while there is no reason to believe it is safer, it is probably not more dangerous either. However, since the dosages are not standardized, it is possible that bio-identical hormone might be given that has a higher dosage than a conventional prescription, which could, at least in theory, expose you to a higher risk.
I recently got several invitations from some compounding pharmacies in my area to prescribe some of their "bioidentical hormones". A compounding pharmacy, by the way, is a pharmacy that makes and mixes their own medications. So I think it's time for me to use this blog to discuss this latest hot topic in obgyn.
Most importantly, we will need to dispel a few myths about these medications. The first myth is that bioidentical hormones are "natural" products. I have encountered many women in my practice that seem to have the impression that these hormones are more "natural" then the hormones that are available by prescription.
Let's talk about what the term bioidentical hormones means. As you already know from our previous discussions, many doctors prescribe hormones to women in menopause to treat the symptoms of menopause. Typically, these are medications that are designed to replace the estrogen and progesterone that used to be made by your ovaries before menopause began.
However, most of the medications available by prescription are synthetic (synthetic = made by people in a lab) forms of these hormones. However, it is also possible to make a molecule that is exactly like the natural hormone which is made by your ovaries. This is a bioidentical hormone.
So are bioidentical hormones natural? That depends on what you think the term natural means. If natural means that it comes from a natural source like a plant, and not from a laboratory, then bioidentical does not mean that it is natural. However, if natural refers to a molecular structure just like the normal human form, then, bioidentical could be called natural.
