[Music] good evening and welcome to doctors on call I'm Dr Mary Owen associate dean of Native American Health and director of the center for American Indian and minority Health at the University of Minnesota medical school I'm also a family physician for the Fondulac band of Lake Superior chipa I'm your host for our program tonight on women's health and Fe female answers the success of this program is very dependent on you the viewer so please call in your questions tonight or send them in ahead of time to our email address ask pbsn north.org the telephone numbers can be found at the bottom of your screen and our panelists this evening include Dr Michael cassine an obstetrician gynecologist at asentia Health Dr Sandy Stover a family medicine physician and faculty member at the medical school duth and Dr Addie vtorial a family physician with Aspirus St Luke's Clinic our medical students answering the tonight are Jessica Crossen from Hugo Minnesota Danielle Santos from Smithtown New York and Brook Wilson from Prospect Illinois and now on to tonight's program Women's Health and female cancers welcome you three thank you for having us so we don't have our um audience questions yet though the students tell me they have plenty so until then what are what's something that you'd like the audience to know today about female health or Women's Health female cancers well I'm I'm a very big fan of the vaccination for human papala virus the HPV vaccine just because it's one of those things for cervical cancer that's really decreased the amount of of of cancers that impact Women's Health and ability to um have pregnancies go to go easily at at delivery time it's also that particular virus also seems to be increasing the risk for colon cancer as well as some of the throat cancers were seen at younger ages than we saw 20 years ago okay and I I don't think people are as necessarily as aware of that and it's rather it's not quite as new as it used to be HPV vaccine we've had it for how long now 15 years maybe 20 I was in medical school yeah since you were in medical school okay I think the big thing has been the the stretch in years it used to be considered just to up to into your 20s but now the vaccine is still very valuable for folks as they get even up to 40 great I think what I'd like people to know is that we focus a lot of our female Healthcare on sort of the reproductive years and and the younger patients but actually the majority of things that can adversely affect Women's Health happened beyond that so don't forget about yourself as you know you're raising your children and you're getting into that age where you no longer may see your OBGYN or you're delivering provider that there are lots of things to screen for test for and address as you age how often should women be going in for exams or Healthcare at least well I typically recommend that most women over 50 go in every year um and before that I I think it depends on what your risk factors are you know whether there's obesity or other family factors at play but at least every two years okay but one year at 50 basically is what you're coming anything to add Dr Cassie yeah I um as Addie said there there seems to be a a time period where women essentially between the ages of 35 to 50 when they're done having children that they kind of are lost to care okay and and we know um first of all that the the number one killer of women is heart disease um and that's obviously something that screen for in all the primary care visits um of course breast cancer screening is very important as being the most common cancer um and then you know lung cancer and skin cancer and colar rectal cancer um are all very common cancers um that that can show up um in younger women and we are seeing that uh more frequently yeah right some things are changing so timely question should I be doing monthly self- breast exams Dr Cassie uh so that that is uh is a very good question um and we were taught them in medical school and then uh for a while they were going away from them um my opinion is that it's a free exam and if women know what they're feeling for and if they examine themselves regularly they will feel a change so um I I don't think that there's any harm to doing it um and like I said it may find something um that you may have missed so we I mean in in younger women we typically recommend self-awareness so that would be knowing what your normal is knowing how that varies throughout your menstrual cycle and then knowing how to identify what is abnormal at any point great this is a good question um at one time I think it's changed for generations of women but how do I do I need to and how if I do how do I clean my vagina I think that is actually really good question because it has varied what the recommendations and what some of the popular um websites or other information might say but the vagina is built in to maintain an environment or we call it a biome where the bacteria that are in there are in good balance and there are things that that can affect that balance being ill or being on antibiotics or both uh can change the pH to enough that you can have a yeast infection or other things but what what has been clear over time is that some of the vaginal washes that were popular for a while actually reduce that that nice balance that keeps things um it's kind of like this this will s kind of funny but like like a healthy garden you know if you if you have the things growing in there in the right environment you're you're going to have that stay healthy and not have unexpected growth of of other bacteria or other things like I would agree less is more um with this and so you wash you know your normal skin like you would wash your skin to reduce the amount of bacteria and fungus and yeast and other things that grow on us but you don't necessarily you know wash the inside of your vagina with a soap or detergent much like we would use toothpaste on our teeth but we're not necessarily cleaning our mucosal tissue inside our mouth either yeah there there is there's no indication for the douche I think is a right something to know okay it's why they're not sold as much anymore it's not supposed to smell like flowers no has a smell well there's the new spray too which is also kind of bothers me a little bit in that that there are normal smells that and it can cause other problems like bosis right yep just like bubble bath sometimes for some women right here's a here's a question what are some critical aspects or I'm sorry don't let me put these glasses on folks what are some critical aspects of maternal Health that new mothers should be aware of start with you Dr cassine um well I think the biggest thing um is awareness like Addy had said with um with changes in your body because a lot of women don't know that they're pregnant for a long time um nausea vomiting fatigue and breast tenderness are the most common symptoms um and knowing that um and having those changes uh would prompt a woman to maybe take a pregnancy test um once once a woman determines if she's pregnant or not um I think accessing prenatal care um and thankfully we live in Minnesota where pregnant patients are covered uh even if they do not have insurance and we have two wonderful systems here in duth uh two two nice hospitals to to choose from um that accessing prenatal care um really sets the patient up for Success so um the one thing I would say is be aware and you know access prenatal care as soon as you as you know that you're pregnant yeah and I would say um that's a time when when you know you are pregnant to call your primary doctor before you've established someone that you're going to deliver your baby with to say I'm on medicines are these safe for pregnancy what should I be doing for supplementation of folic acid or multivitamins what are my risks for gational diabetes how can I you know keep a healthy lifestyle so that it betters the success of my baby and myself throughout this and a lot of primary doctors deliver babies yep y thanks yes we do lots of us yes you do I want to follow up on something that you said though i' I've one thing that I've noticed through time is a lot of um is uh with prenatal visits that some people are fearful of going in to see the doctor for whatever reason but that's a time you know it's not about judging our patients for whatever else is going on in their life it's really about a time that we're there to take care of them so it's good for them and baby no matter what's going on well and even with anticipatory thinking in that time when you may want to be getting pregnant is that's a great time to to talk with someone about staying healthy and going on prenal vitamins for those early weeks when the baby is is just Waring yeah and and our goal is to support that pregnant person where they're at and so we're not there to be punitive we know that people get in relationships and become pregnant that are not successful or healthy relationships and it's our time to support that woman as and we know that people drink alcohol and U and when they don't know that they're pregnant so it is um it really needs to be a non-judgmental time excellent I think you'd all three be good doctors for this um Dr uh Stover what's the significance that's good question what's the significance of a positive HPV result I'm a 35-year-old woman with a positive HPV HPV result my doctor mentioned an HPV vaccine y should I get it so that is a great question because HPV is quite common and there it's it's in the wart family it's not the same kind of warts we get in our hands it's a different you know cousin to some of those wordss but that particular there's a there's a couple of variations on the HPV virus that are more likely to lead to abnormal gross that can become a cancer um we found that with the vaccine itself even if you've already gotten HPV getting the vaccine can help you because there's some cross reactivity with those different subtypes and so the vaccine is real helpful and then what's important is as well as getting regular checks for psmears and rechecking the HPV to see if it's active our bodies are amazing and the HPV virus can come into a steady state as many other viruses do that we come in contact with but the vaccine can help that as well as regular monitoring to make sure that we can nudge it uh away from potential for for developing something like a cancer and I tell all my patients you know especially in their 20s expect an abnormal result at some point and don't worry about it address it follow up on on it but don't necessarily view it as something that is going to turn into something bad that's the purpose of screening is to find at risk conditions so that we can initiate monitoring of those things yeah seems like the theme of the night is communication talk with your doctor and we can help reassure you in a lot of cases almost all cases So speaking of reassurance and and help do you have any advice I'm going to go to you Dr cassine do you have any advice for women with a new cancer diagnosis about how to engage with the healthc care system yes um as uh Dr Victoria said the the primary care providers are fantastic and and that they are really are the quarterback of the medical team um we have keep inviting this guy on the show huh we have a a number of fabulous Women's Health uh providers at both um facilities U asentia and Aspirus and and other Healthcare places other Healthcare places too fondel Fondulac sorry I was thinking to actually like the oncologist but um yes um reach out to a provider and they will know what to do or if they don't know what to do they will figure it out or figure out um who to send you to that then can figure it out um I think when you hear cancer you assume you know terminal disease and really bad um outcomes and interventions and that's not you necessarily the case uh especially when found early um a lot of canc can be treated yeah good anything to add I think there's also good communities that that the some of The Navigators within the systems particularly for more common cancer like breast cancer can help um develop some of those um support groups that can also help walk that path with you and so I I think it it is a team again and and having your primary care quarterback I like that idea um is is helpful um they know you well and they'll follow you past that cancer and continue to understand how that impact your life and I think probably the worst thing you can do if you suspect you have cancer or you do have a cancer is to ignore it and kind of fear that discussion and treatment because we see so many women who you know they're over 60 and they have vaginal bleeding out 10 years after their period and they sort of you know worry but they don't address it and we can address these things early so we actually have to treat women in a less invasive manner this sounds exactly like what we tell our students Sandy if you think there's a problem come talk to us and then we can help you through it same with patients what were you going to say um I was going to say um kind of piggyback on Dr vtori is any any postmenopausal bleeding should be addressed so if a woman has gone A Year Without a period and then has vaginal bleeding they need to be seen yeah um the evaluation is pretty straightforward and if you do have cancer the uterus it's in general very treatable so it's one that if you address it early it really does affect the outcome Y and then is one of those cancers that we are seeing increase because we do see some factors like obesity make the bleeding and the cancer more likely or common there are also reasons for bleeding that may not be cancer but are equally important to treat and that has that can have to do with menopause and some of the dryness that can occur in the vagina can so not all bleeding is bad but all bleeding should be checked out to help um manage the the body's ability to support itself yeah no reason to sit in fear ex these questions that you're having good so Dr vorio should I make any dietary changes as I age to maintain bone health and muscle mass I think the the most important thing is start as early as you can because we know that you were born with a certain bone density and then throughout our life we have a cycle of estrogen and progesterone with our menstrual cycles and that's your time of peak bone building so um from the time you know you're 12 or 13 and get your period until you're in your late 40s or early 50s that is when we build all of our bones and then after that we actually see the body sort of naturally take calcium and other minerals from our bones and we see less bone density over time so the best time to start building bones is earlier um we want all people to consume adequate calcium um that doesn't mean you have to take a supplement most dietary calcium is actually much more bioavailable or available to the body so it's important to get you know sources of that whether that be um vegetarian sources or um through Dairy um and then vitamin D is important there was a big focus on vitamin D about 10 years ago where we really got quite aggressive with vitamin D and I think the biggest thing is you know make sure you have a good source of vitamin D and then when we get sun around here expose yourself to Safe Sun on a regular basis sunre um yes and exercise is important um and we should all be exercising throughout our lifetime there's not a time and place during a visit at a certain age where I say now you need to start exercising or now you need to start taking calcium and vitamin D we should assure that those things happen as early as possible good Dr cassine what are common menopause symptoms and what treatment options are there so the the classic symptoms of menopause are hot flashes night sweats sleep disturbances and vaginal dryness there there are many other symptoms that can be related to menopause um but those are generally the the Cardinal symptoms um there are many many treatments and we can go into behavioral modification dietary changes um there are medications both hormonal and non- hormonal that can be used so um it's a big topic right now it's all over Tik Tok and Instagram um and and we're prepared to handle it so um if patients are having menopausal symptoms or think they have symptoms that may be related to menopause come on in and we're happy to talk to you yeah and I think it's it's helpful to talk to us about that because there is sort of some misconceptions about when par menopause starts when menopause starts when it's treatable with or without hormones or what symptoms might be improved with treatment and what symptoms actually may not be improved with treatment additionally it's very individual isn't it we know that now good absolutely what you experience and then uh how you should be treated uh is different for every patient this question is I get a lot of uh patients who come in with a lot of fears about birth control pills can you give your perspective on what control birth control Bill pills do to a person's body Dr Stover that's a good question I mean birth control pills have been out since um well even in the 50s but the 60s they became popular in the in the United States and the there are levels of estrogen that are involved in most birth control pills are progesterone as well in most of them in various balances to that we we pick to match to what a woman's need would be the idea of what they do is they basically sort of take over the hormones that the ovary would normally be doing so the OV kind of goes into vacation mode you know and in that process of being on vacation it doesn't make any eggs and if you're not making any eggs you don't get pregnant so that's how they work there are side effects to everything that we do the side effects to birth control pills are relatively minimal definitely relative to a pregnancy that you're not quite ready to or not planning for at that point in time but the the side effects can sometimes impact headaches or or clotting issues in your body and we screen for that when we work with women to make decisions about their reproductive choices that they have there are other non- hormonal ways that we can also help manage uh U people's choices manage reproduction too anything to add to that no okay Dr vtor what are normal period symptoms and when should I be concerned what what's abnormal in other words I think they're asking and I think that's individual as well so normal period symptoms can you know are mild cramping some mild mood changes before that um some people experience bloating or water retention and then the obvious which is the the bleeding vaginally but what is not normal kind of depends on who you are and how well you tolerate menstrual cycles you should not be vomiting with your menstrual cycle you should not be going through a pad or a tampon every 1 to two hours with heavy bleeding um if you are finding that you you know regularly offend your relatives your spouse other people at work because of your menstrual issues that is not normal but it all depends on sort of you know where you fall on that Spectrum okay great I was I would say that um also it you know women will experience manarchy or their first uh menstrual cycle you know anywhere between in their early teens roughly um it can go several years on either side but you know 13 it can 8 to 18 is still reasonable um but women will will develop a cycle and what is usual for them well it may be heavy it may be painful they experience that well some women have a lighter period um the point is if you have a change in your cycle we know that often times women will have a change in their cycle um when they start the birth control pill uh when they have a baby um as they get older so monitoring a change in your cycle and again similar to the breast uh discussion is just knowing what is normal for you and just because as normal for you doesn't mean you have to tolerate it you know we can usually make symptoms better I'm surprised that the number of my patients that young patients now that monitor themselves on on their phones it's far I feel like it's far more than when I was a young person so yeah and I think it's important to know like in the teen years abnormal is normal for a lot of teens so you know some people will get their period and not get it for four five months when they kind of first start their menstrual cycle some will get regular bleeding right away there can be other kinds of mood moodiness that will settle into a more even keeled pattern that is normal for you so those first couple of years of of of ministration again it's helpful to talk to family members who who you may share a similar pattern with and it's helpful to talk to a physician so that you can um consider what might make it easier through that time period And also the last couple of years yes very very unpredictable and uh difficult to anticipate y okay Dr vorio what is um endometriosis what's the treatment yeah so so endometriosis um is the growth of abnormal endometrial tissue and demetrial tissue is the center lining of the uterus we have an endometrium a myometrium and an external layer um and this layer can deposit itself on abnormal places inside the abdomen and so when women menstrate or get the hormonal signal to have symptoms in their endometrium they can develop that on their bowels they can develop very painful um cycles that involve some GI symptoms they can develop internal bleeding small pockets of that um it can be genetic um so it does run in families um it treatment ranges anywhere from taking control of the hormones with birth control pills to actually going in surgically and removing um spots that appear Andor organs that are damaged by that so wide range of symptoms and treatment good um not good for the women who have it um Dr cassine how often should I be checked with my diagnosis of lyan sclerosis that's a very good question um so lyan sclerosis is a it's a chronic condition um of the external genitalia and the answer to that is if your symptoms are controlled um once a year is is fine um and usually you have to come in for a steroid cream refill or um something like that anyways um the again a similar theme we've had through throughout the show if you have a change in your symptoms or if your treatment that was working isn't working anymore then that would be a sign that you should come in to be seen sooner but but generally once a year especially if you're uh if you're on a stable regimen is is plenty okay um Dr Stover does baby aspirin prevent preeclampsia and is it beneficial to take during pregnancy another a good question uh the preclampsia is where blood pressure can Rise um great than it should during pregnancy and it's actually related to a feedback loop that involves the immune system involves the kidney involves the liver uh and that has been found that aspirin in people who are at risk for developing preclampsia it can help reduce that and I I'll definitely Dr casting and what what else would you add to that yeah no we uh this has been kind of a real development in the last 10 years um and it's almost like who doesn't qualify for aspirin so um if you if your doctor does recommend all your wife a uh a baby aspirin um it's certainly very safe and could be uh helpful for you and is unlikely to be harmful I'm hoping Dr Gan Regal's watching the show because she we do research she does research on this at the University of Minnesota so it's a great question thank you for those great answers and you're a great teacher Dr Stover all right Dr vitorio I'm a postmenopausal woman I was on Depo pra from 30 to 45 years of age I recently heard Deo pra is not meant for long-term use is this true and should I be concerned um there are some concerns about the long-term regular use of Depo um we do know that it does affect bone density but the thing we know is that if you take holidays or if you take breaks from the medication the bone density rebounds okay well um and so Depo Pria is a progesterone it's given in injection form um and it it essentially eliminates the menstrual cycles um in general we still use it and we do generally regard it as safe we just know that long-term long-term use you may want to consider an alternative periodically and and I would say that um breast screening is going to be important in that patient because if there is a a risk of uh of long-term Depo per use other than the bone um mineral density it's breast cancer okay I think we have room for one more question about one minute left can you take talk about Dr ask can you talk about hormone replacement therapy during and after menopause I give you a short one yeah um so hormone replacement therapy is is a lot safer than we used to think um when I was a first year medical student the Women's Health Initiative came out and the vast majority of women were taken off their hormone replacement therapy um hormone replacement therapy in a high number of patients can be very safe and Incredibly effective and when we talk about hormon replacement therapy we mean estrogen uh either by itself or with progesterone and it can be given in multiple forms including vaginal estrogen so um if your symptoms are not controlled um come in we're happy to talk to you um because it can be safe and Incredibly effective so that's the theme of the night go and talk to your doctor you got questions find your doctor right all right so I want to thank our panelist Dr Michael cassine Dr Sandy Stover and Dr Addie vtorial and our medical student volunteers Jessica crosson Danielle Santos and Brook Wilson please join Dr Ray Christensen next week for a program on men's health prostate bladder and kidney problems thank you for watching and good night [Music] [Music] [Music] for