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February 20, 2018

As National Heart Health Month comes to a close, we’d like to touch on a disease that affects an estimated 44-million of women every year. Cardiovascular disease is the number-one killer for women across America. You may be surprised to learn 1-in-3 deaths of women is caused by this deadly disease.

Heart disease differs from woman to woman. Warning signs can be hard to spot and even non-existent. That’s why it’s important to take every possible measure to live a heart-healthy lifestyle especially if you have one or more risk factors.

Cardiovascular disease can include diseased blood vessels, structural problems, or blood clots. Over time, heart disease can cause strokes, heart attacks, arrhythmia, and more.

Who’s at Risk? 

The truth is cardiovascular disease can adversely affect anyone. However, there are several factors that can put you at a higher risk. A whopping 90% of women have at least one or more risk factors for heart disease.

Today, we’ll go over several key risk factors women should be on the lookout for. While some factors cannot be controlled such as age, race, or genetics, there are steps you can take to lower your chances of getting heart disease.

Women from all walks of life should get an annual well-woman exam and maintain an open dialog with their physician. If you have a family history of heart disease or any of the following risk factors, your doctor should be aware.


Most women don’t start to think about heart disease until they’re older. And, while it’s true that age can play a major role in your heart health, it doesn’t always have to. Did you know, the combination of birth control and smoking increases young women’s risk for getting cardiovascular disease by 20%?

Family History

Family history plays a key role in your heart health. High blood pressure and cholesterol levels can pass from one generation to the next and can increase your risk.

You may be at a higher risk for getting heart disease if:

  • Your father had a heart attack before the age of 55.
  • Your mother had a heart attack before the age of 65.
  • Your mother, father, sister, brother or grandparent had a stroke.


Yes, heart disease affects all women but your ethnicity can put you at a significantly higher risk. For example, Hispanic women are more likely to develop heart disease 10-years earlier than Caucasian women. Forty-eight percent of African-American women 20-years and older have cardiovascular disease.

High Blood Pressure/Cholesterol

Having high blood pressure for long periods of time puts added strain on your heart. After a while, it scars and damages the arteries leaving you vulnerable to heart attacks, stroke, kidney failure, and more.

High cholesterol levels can potentially harden and line the artery walls over time causing unwanted blockages. These blockages can lead to blood clots, heart attacks, and stroke.


We all know just how bad smoking is for us. It causes cancer, makes us gain weight, and increases irritability but did you know it affects your heart too? Take a look at how smoking puts you at greater risk for cardiovascular disease.

  • Nicotine makes your heart rate and blood pressure levels skyrocket.
  • Carbon monoxide in tobacco rob your heart, brain, and arteries of oxygen.
  • It damages your blood vessels and makes your blood sticky, making blood clots more likely.
  • It lowers your tolerance for physical activity and decreases HDL (good) cholesterol.

Women who smoke are 25% more likely to get heart disease than men who smoke.

Sedentary Lifestyle

Physical inactivity can lead to blood clots, high blood pressure, heart attack, and strokes. People who don’t have regular to moderate physical activity are 30-40% more likely to be at risk for heart disease.


Even if you have no other health conditions, being 20% overweight can put you at a greater risk for cardiovascular problems. Carrying extra weight (especially in the waist area) puts extra strain on your heart. It can also increase your risk for other heart disease causing factors such as increased cholesterol and blood pressure levels, and induced diabetes.


Adults who have diabetes are 2-4 times more likely to have heart disease or a stroke. Over time, high glucose levels can damage blood vessels and the nerves that control the heart. The good news is, diabetes can be controlled through medication, as well as diet and exercise.

Signs You’re Having a Heart Attack

When it comes to actual warning signs, men and women differ a good deal. While men typically have very specific symptoms such as tightness or extreme pain in the chest, women have more subtle symptoms.

Some signs you may be having a heart attack include (but are not limited to);

  • Indigestion
  • Shortness of breath
  • Nausea/vomiting
  • Dizziness/ lightheaded
  • Discomfort in the jaw, upper back, or arms
  • Prolonged excessive fatigue

Listen to your body. If you think you may be having a heart attack, stay calm and seek immediate medical attention.

Steps to Take Towards a Heart-Healthy Lifestyle

Okay, you may not be able to go back in a time machine and lower your age, but there are several steps you can take towards a healthier life.

  • Be more active. For every hour of regular exercise you get, you keep heart disease at bay and gain approximately two hours of additional life.
  • Lose Weight. Losing as few as 10-pounds can decrease your risk for getting heart disease.
  • Avoid Smoking. After only one year of non-smoking, your risk for cardiovascular disease is cut in half.
  • Lower Cholesterol Levels. Lowering your cholesterol by 1 point decreases your risk for heart disease by 2%.
  • Reduce Blood Pressure. About 7 of every 10 people having their first heart attack have high blood pressure.

Implementing a healthier lifestyle through diet and exercise can add years to your life. Consider making small changes to your daily routine and keep heart disease at bay.

Schedule an annual well-woman visit today to learn more about your risk factors for getting heart disease. Together, you and your doctor can create an action plan for preventing and maintaining healthy heart health.

February 19, 2018

Lately, you’ve noticed that the rosy glow to your face is slowly disappearing, and a grayish tinge is replacing it. Your skin seems droopy. People regularly ask if you’re more tired than usual, even though you feel fine.

Upon closer scrutiny in the mirror, under bright, unkind lighting, you are shocked to realize that signs of aging are beginning to make an appearance around your eyes, mouth and a few other places.

Well, you’ll have none of that! You’re still too young, and you’re not about to look older than you feel, so you do some research, ask around and hear about something called Platelet Rich Plasma (PRP) Therapy –otherwise known as a Vampire Facelift. Though it sounds intimidating and, let’s face it, a little creepy, it’s a surprisingly simple, unique procedure with some amazing benefits.

What is a Vampire Facelift?

A vampire facelift is a process where your own blood is drawn, treated, combined with a filler and then reintroduced to targeted areas via injection. This procedure is called Platelet Rich Plasma (PRP) Therapy, and it can, indeed, revert your skin back to its previous, youthful, glowing appearance.

How Does PRP Work?

Collagen, which is the body’s most plentiful protein, replenishes dead skin cells and provides skin elasticity and strength. As you age, you lose collagen, which is why your skin tends to become loose, stretched, and less supple, just like an overused rubber band that needs an extra twirl around your Saturday morning ponytail to keep it from falling into your eyes while you clean.

Blood contains growth factors called platelets. In Platelet Rich Plasma Therapy (PRP), a vial of blood is drawn from your arm and put through a centrifuge for several minutes. This isolates the plasma and platelets together from the rest of the blood so that they are concentrated and no longer diluted by the rest of the blood.

A special additive spurs the plasma to release their growth factors. It is then thickened with a hyaluronic acid filler. (Hyaluronic acid is a natural gel-like molecule found naturally in the body which provides moisture, hydration, and lubrication) Upon injection to the area that will be treated, increased collagen growth is stimulated, replenishing what was lost over time.

What are the Benefits of PRP in a Vampire Facelift?

Platelets play a key role in the body’s healing and clotting process. When a wound occurs, they’re the first to arrive on the scene. They develop a stickiness and latch on the hurt cells, which in this case is the injection site. They then band together, in essence, ‘joining hands’ with each other to fashion a protective web of sorts, both in and over the wound. This forms a weak wedge or plug to stem the flow of blood.  They then emit chemicals to ‘call’ or attract stem cells over help begin stronger clotting—like radioing someone for backup. The body then begins to develop extra collagen to heal the wound.

In PRP therapy, injecting the site with so many plasma rich platelets that the body already recognizes as its own, dupes it into thinking that, since there are so many platelets at the ‘accident site’ the damage must be excessive. It assumes extra collagen is needed and produces it. That additional collagen, along with added filler used in the Vampire Facelift procedure, pushes out the hollows and wrinkles, smooths out the skin, and continues to produce healthy skin for months to come. For women between the ages of 25 to 70, this results in:

  • Almost immediate younger looking, firm skin with renewed elasticity
  • Continuing improvement in appearance over time as growth cells and blood supply continue to be stimulated
  • Diminishment of crow’s feet and other fine lines around the eyes, mouth lips and forehead
  • Healthier looking color and texture
  • Hydrating replenishment of papery looking, sun-damaged and loose skin
  • Fuller, more taut skin around the neck
  • Less visible scarring
  • Improvements to hollowed or darkly circled eyes
  • Overall improvement lasting for up to a year-even more
  • A more radiant, healthy-looking

What’s the Difference Between a Vampire Facelift and a Vampire Facial?

You may not need a full Vampire Facelift if you only have moderately visible lines that you want to correct. In that case, a Vampire Facial, which only uses the platelet-rich plasma without any added soft tissue dermal filler may adequately take care of the problem.

How Can Cherokee Women’s Health Specialists Help?

Any injections into the body require skill, knowledge, focus, concentration, and expertise. Only an accredited professional should be consulted to perform such procedures. At our clinic, Dr. Haley and Litrel are doubly accredited urogynecologists. They hold degrees in OB-GYN and Female Pelvic Medicine and Reconstructive Surgery (FPMRS). Dr. Haley has over a decade of experience in injectables, having obtained his certification in the field in 2007. Our physicians’ intense combined training makes them a superb choice for all your women’s health and cosmetic needs. They are committed to doing their utmost to ensure the health, confidence, well-being, and beauty of their patients, one woman at a time.

For a free consultation or to schedule an appointment for a Vampire Facelift, contact our office.

Lack of sexual desire. The inability to become aroused or orgasm during intercourse. Painful or unpleasant sex. These are all symptoms of sexual dysfunction and if you’re experiencing any of them, you’re not alone. Nearly 43% of women report at least some degree of poor sexual function.

Sexual dysfunction affects women of all ages. However, it can be particularly brutal for women entering menopause thanks to hormonal imbalances. If you’re simply no longer interested in sex or have trouble staying lubricated before or during intercourse, you may want to consider the O-Shot.

Aptly named, the O-Shot or ‘Orgasm Shot’ works to improve overall sexual health so you can take your life back. It’s a simple minimally-invasive procedure that safely and effectively restores your ability to climax by improving lubrication and sensation.

How Does It Work? 

Before your O-Shot treatment, you’ll undergo a simple blood draw. One of our specialists will then spin, clean, and process the blood into platelet-rich plasma (PRP) while you wait in-office.

The PRP is then injected directly into the clitoris and inside the vagina. The process stimulates the growth of new cells and encourages the formation of new collagen, blood vessels, and nerves. In turn, the injection sites become more sensitive.

A topical numbing agent is placed on the injection sites prior to your treatment to minimize discomfort. There is no downtime associated with the O-Shot and patients are free to go about their daily activities immediately following the procedure, including intercourse.

Unlike other similar procedures, the O-Shot uses your own body’s natural healing process. Dermal fillers used for vaginal rejuvenation provide short-term results and are quickly absorbed and expelled from the body. Surgical methods are costly, time-consuming, and have longer recovery times.

What To Expect

Because the O-Shot uses a biologic process, some women may experience improvement almost immediately while it can take several weeks for other women to notice results. Once the O-Shot takes effect, you should experience better sexual function for up to a year or more.

After your Orgasm Shot, you can expect improved sexual desire, better lubrication, and the ability to climax more often. Stronger, longer-lasting orgasms can also be accomplished with O-Shot injections. Most women don’t need more than one O-Shot injection, however, you may want to consider an additional treatment 3-4 months if desired results are not achieved.

No significant side effects have been reported with the O-Shot. Some patients expressed temporary spotting, swelling, and hypersensitivity after their vaginal rejuvenation procedure. Any adverse side effects should dissipate within 1-3 days.

Am I A Good Candidate?

The ideal candidate for the O-Shot include women who are seeking a non-surgical way to improve their sexual health. With a short, in-office appointment women can achieve long-lasting results without the downtime.

You may be a good candidate if you have one or more of the following sexual concerns:

  • Vaginal Dryness
  • Urinary Incontinence
  • Lack of Sexual Desire
  • Inability to Become Aroused or Orgasm
  • Pain During Intercourse

Menopausal and post-menopausal women can especially benefit from the O-Shot. New collagen, blood vessels, and nerves that are formed help restore your sexual health to its previous good health.

Women who go into the procedure with realistic expectations are more likely to be happy with the results of their O-Shot procedure. During your consultation, your doctor will be able to explain the procedure in detail so you can make an informed decision about what’s right for you.

Ready to improve your sexual health with the O-Shot? Schedule a consultation with Cherokee Women’s Health today to inquire about getting the O-Shot for yourself. One of our friendly staff members will be happy to confidently answer any questions you have about how you can treat your sexual dysfunction

With the soaring popularity of fillers, cosmetic surgeons have been inundated with questions, including how long the effects last, and who can safely receive the injections. At Cherokee Women’s Health Specialists, these and other queries come up on a daily basis, and we’re more than happy to take the time to answer them, both here and during your free consultation.

What Causes Skin Volume Loss?

We all have a substance called subcutaneous fat. It is directly under our skin, separating it from muscle. Sometimes, we spend a lifetime trying to get rid of it, because it’s what makes our tummies, buttocks thighs and other places bulge undesirably. However, among other important functions, it serves the purpose of giving our outer layer of skin volume, smoothness and contour.

As we age, this fat diminishes, most noticeably in areas like the face, neck, and shoulders. The backs of hands and feet can be affected too. This decrease brings the muscles visibly closer to the surface. Continued use of the muscles, now without the buffer of fat, causes droopiness and sagging. Combined with the additional loss of collagen, which contributes to the skin’s elasticity, the formation of wrinkles, creases, folds, and hollows begins. This results in a drawn and tired facial appearance.

What are Fillers? 

A cosmetic filler is an injectable, FDA- approved substance consisting of soft tissue. It is designed to take the place of the reduced subcutaneous fat. Skin puckers and grooves normally occur due to natural aging, sun damage, and repetitious facial expressions such as laughing, squinting, concentrating and grimacing.

Fillers restore plumpness and lost fullness to these facial furrows. They smooth out areas around the eyes, nose, mouth, cheeks, and chin where laugh lines, crow’s feet, and other wrinkly or papery looking skin typically form. They can also be used to refine facial flaws and irregularities including scarring from acne or minor injuries.

Fillers can also improve the look of the hands, décolletage, and earlobes where bones might protrude, or where skin may have a deflated appearance. They can even provide cushioning relief to regions of the feet exposed to chafing and discomfort from footwear. The entire procedure is similar to reinflating a softened beach ball to make it firm, contoured, and smooth again.

What are Fillers Made of, and Are They Safe?

Because of strict guidelines set forth by the FDA, and the conscientiousness and surgical skill of qualified, accredited physicians like those at Cherokee Women’s Health Specialtists, fillers today are safer than ever.

In the past, fillers consisted of animal-based collagen. This collagen caused allergic reactions in the recipients. Today, synthetic fillers are made of hyaluronic acid (HA) which is modified and bacterially produced. Hyaluronic acid is found naturally in the body. It is a gelatinous molecule that works to keep your joints and skin lubricated-in essence, oil for the body. As you age, your body produces less of this substance, depriving your skin of moisture and causing it to become dry and wrinkled, the same way lettuce becomes limp if it’s not sprayed regularly in a grocery store. Because hyaluronic acid is not alien to the body, there is less chance of any unpleasant reaction.

How Long do the Results of Fillers Last?

It is impossible to pinpoint exactly how long the aesthetic benefits of any dermal filler can last. Longevity depends entirely on a myriad of factors and cannot be predicted or guaranteed, but the norm is 2 months to one year. Variables that can affect duration include:

  • The area treated: The more actively the muscles are used in the treatment, (i.e. mouth versus cheeks), the shorter the effectiveness of the product
  • The amount and type of filler used: Each brand has different active ingredients which impact the product’s longevity.
  • Serum thickness: Thicker serum usually extends the filler’s
  • Injection technique: Fillers require specific methods of injection, (‘linear threading’, ‘fanning’, ‘serial puncture’, ‘cross hatch’ etc.), all of which our professionals are qualified to perform. Based on the necessary process, each syringe perforation may use a different amount of filler, thus affecting duration.
  • Body metabolism: Today’s fillers, especially those consisting of naturally occurring hyaluronic acid, are absorbed, go through the waste process and are eliminated the same way food is. Therefore, the duration of a filler’s effectiveness is also based on your metabolic rate.
  • Lifestyle: Active lifestyle and excessive exercise can cause the body to break down fillers more quickly due to increased metabolic rate. More frequent treatments may be required to maintain results.
  • Sun exposure: Sun accelerates the aging process which, in turn, necessitates more treatments.
  • Body chemistry: Each individual undergoing the procedure will process the filler differently based on such things as genetics, use of medication, diet, etc.

Who is a Good Candidate for Dermal Fillers?

Cherokee Women’s Health Specialists use fillers made by Juvederm. We rigidly adhere to all maker’s product guidelines. Our clientele falls into their recommended category of women aged 25 to 75. Additionally, the best candidates should be:

  • Non-smokers
  • Women who are diligent in practicing impeccable skin care
  • Women who do not expect their appearance to be so dramatically changed that they become unrecognizable.
  • Women whose general health is good and don’t suffer from any chronic or debilitating illnesses or immune conditions that may be compromised by receiving dermal filler injections.
  • Women who are not pregnant, breastfeeding or planning either while receiving filler treatments. (No conclusive studies exist regarding filler impact on pregnancy or breast milk)
  • Women who have no evident allergies to any filler ingredients.
  • Women without severe scarring or pigmentation
  • Women who have not recently had other facial treatments or plan to do so while using fillers
  • Women who do not regularly take medication that may cause problems when used in conjunction with cosmetic fillers.

Why Should I go to Cherokee Women’s Health Specialists for my Filler Procedure?

In one word–expertise! Fillers replace many of the highly-invasive rejuvenating plastic surgeries women had to undergo in the past to maintain a youthful appearance.

Because treatments are quick, virtually painless and need no convalescence, many inexperienced non-professionals are performing them with limited training in correct dilution, application, or anatomical knowledge. Women have been left with irreversible damage after being lured by the promise of dramatic, unrealistic results that come with a preposterously low price tag. In many cases, women have attempted the process themselves, using rogue, imitation products. The outcomes were disastrous-blindness, scarring, infection,-even permanent disfigurement, just to name a few.

At Cherokee Women’s Health, our practitioners possess the highest qualifications and are abreast of the most up-to-date cosmetic surgery developments available. Drs. Litrel and Haley are both board- certified urogynecologists with double accreditation in OB-GYN and Female Pelvic Medicine and Reconstructive Surgery (FPMRS). The latter degree sanctions us to minister to all of your uniquely feminine requirements. Our proficiency in rejuvenation and reconstructive procedures tops the list of the many broad-based services we provide. Moreover, since 2007, Dr. Haley has been certified in injectables, giving him over a decade of skill, practice, and experience in this field.

The aging process does not have to be a visually undesirable one. Today’s facial cosmetic techniques can easily and safely match your outer appearance to reflect your inner youth. You can trust us to help you attain that goal with the safest and most meticulous precision, expertise, care, and commitment to your safety and well-being.

Call to schedule a free consultation with one of our double-board certified physicians at (770) 721-6060.

February 16, 2018

By James Haley, MD, FACOG, FPMRS 

The fountain of youth may be just around the corner. 

Actually, the truth is that there have been tremendous advancements in non-invasive cosmetic procedures. All-natural dermal fillers have been gaining in popularity the more their incredible benefits have become apparent. These products are made from natural elements already found in the skin, elements which happen to decline with age. Using these products as fillers produces a lasting positive benefit – simulating skin to rejuvenate itself without having to go through the pain and long recovery of plastic surgery. 

The Downfall of Traditional Facelifts 

A traditional facelift requires a substantial investment of money and involves a long recovery period, usually about 6 weeks. There are risks associated with anesthesia and undergoing surgery. We have all seen the pictures of celebrity facelifts gone bad, and you always run the risk of becoming disfigured or scarred in some way. When done properly, a facelift can have great results, but there is considerable pain and recovery time. 

Dermal fillers offer an obvious advantage over surgery in both the pain and recovery aspects, as well as the procedure itself only taking a short time. 

The Benefits of Dermal Fillers 

Natural dermal fillers are an excellent way to achieve rejuvenated youthful appearance – with virtually no pain and no downtime. In the aging process, skin loses elasticity and shape. The face begins to sag. Dermal fillers such as Juvederm are injectable gels made from hyaluronic acid, a hydrating substance that your body produces naturally. Injecting different types of these fillers under the skin immediately adds volume and reduces wrinkles and deep folds. 

Different types of fillers are formulated for each distinct purpose. Juvederm Voluma adds volume and contour to the cheeksreducing lines and giving the face an overall lift.  Juvederm Ultra adds volume to the lips and fills in the lines around the mouth. Juvederm Ultra Plus fills deep lines such as the nasolabial folds or marionette lines (the downturned lines from the corner of your mouth to the jawline). The results are not only instant, but can be quite dramatic 

Your face is the most visible part of you, and dermal fillers can help give you a more youthful and refreshed look.  Schedule a free consultation with experienced double-board certified physicians to achieve the health and beauty you desire – inside and out! (770) 721-6060. 

This article was originally featured in the February 2018 issue of Townelaker Magazine. To view an online version, please click here

January 24, 2018

Polycystic ovarian syndrome, commonly known as PCOS, affects nearly 1-in-10 women of childbearing age. PCOS is a hormonal imbalance where the ovaries or adrenal glands produce an excess of the male hormone, androgen. Fluid-filled can cysts grow on the ovaries due to the imbalance.

PCOS Symptoms

Women with polycystic ovarian syndrome may experience one or more of the following symptoms:

  • Irregular Menstrual Periods
  • Pelvic Pain
  • Cysts on One or Both Ovaries
  • Infertility
  • Weight Gain
  • Acne
  • Excess Facial or Body Hair
  • Patches of Thick Skin

Many of the above symptoms can be signs of something bigger. It’s important to schedule regular check-ups to maintain a overall healthy well-being. Talk to your doctor about any concerns you may be having in regards to your health.

If you experience severe pelvic discomfort or pain, seek medical attention immediately.

Causes of PCOS

While the exact cause of PCOS is still unknown, there are several key factors that are linked to the hormonal disorder.

  • Obesity – Polycystic ovarian syndrome is more common in women who are overweight or obese. Weight loss can have a positive impact on reducing symptoms.
  • Genetics – Women who have a close relative that has PCOS is more likely to be afflicted with the condition. Also some ethnic groups have higher risks of PCOS, including South Asians and Hispanics.
  • Lifestyle Factors – Sedentary Lifestyle, consumption of hypoglycemic index foods

Polycystic ovarian syndrome can be diagnosed through several methods. If you or your doctor thinks you may have PCOS, they will first perform a physical and pelvic exam. The next step would then be a pelvic ultrasound or laboratory tests.

Treatment for PCOS

Once it’s confirmed that PCOS is present, there are several treatment options available. Unfortunately, PCOS is not curable but with medical intervention, symptoms can easily be managed.

Depending on the severity of your symptoms and plans for children, you may be prescribed one or more of the following medications and lifestyle changes:

Exercise can help with PCOS symptoms

  • Exercise and low glycemic diet – Diet, exercise, and lifestyle changes can help control the symptoms associated with PCOS. If you are obese, weight loss is the preferred method of treatment. Talk to your doctor about what treatment options might be right for you.
  • Hormonal Based Birth Control. Birth control that contains both estrogen and progesterone are ideal for treating the majority of PCOS symptoms. Women who are not considering children in the near future can benefit from hormonal based birth control.
  • Anti-Androgen Medication. Although these medicines are not FDA-approved for all PCOS symptoms, they can be prescribed to reduce unwanted hair growth and acne.
  • Metformin. Over time, metformin can help lower insulin and androgen production. After several months, the medicine may help restart ovulation. Metformin has no effect on excess hair growth or acne symptoms.

Complications Associated with PCOS

Women who suffer from polycystic ovarian syndrome are often at a higher risk for other health problems and potential pregnancy complications. Among others, type-2 diabetes, heart disease, high blood pressure, and certain cancers are all potential problems down the line. If you have PCOS, it is important to maintain regular doctors visits for preventative and diagnostic care.

Questions or concerns about your health? Schedule an appointment with one of our skilled healthcare providers today at our Woodstock and Canton locations.



If your doctor looked at your face discoloration that has been worrying you and quickly murmured the word, ‘melasma’, you have nothing to fear. It is not only treatable but oftentimes, it is temporary and in no way a health risk.

What is Melasma?

Melasma is a skin issue that most often affects women, but men can experience it too. Brown or brownish-gray blemishes, or inflamed, red patches (erythrosis pigmetosa faciei) begin to appear in a typically recognizable configuration and hue that physicians can easily identify in areas such as:

  • The jawline (mandibular pattern)
  • The cheek (lateral cheek pattern)
  • Nose, cheeks, upper lips and forehead (centrofacial pattern)
  • Nose and cheeks (malar pattern)
  • Upper arms and shoulders (acquired brachial cutaneous dyschromatosis)
  • The sides of the neck, usually after the age of 50 (poikiloderma of civatte)

What Causes Melasma? Melasma is a common skin condition during pregnancy

The cause is unclear, but there is speculation that hormonal factors, combined with heat, sun, and light exposure, may create an imbalance of cells in the body called melanocytes. These melanocytes normally create the skin pigmentation, melanin, which decides the uniform color and shade of your skin. When melasma occurs, it is thought that the confused melanocytes sense some sort of disruption and command the melanin to generate more pigment. This results in patches of off-color skin.

Who Gets Melasma?

Melasma is completely impartial. Anyone, male or female can get it, but it is more commonly found in:

  • Pregnant women: This form of melasma is known as ‘chloasma’ or ‘the mask of pregnancy’.
  • Women taking contraceptives: Because progestin and/or estrogen found in birth control pills fool the body into believing it is in a state of pregnancy, women taking these medications are also prone to chloasma.
  • Women taking hormonal replacement drugs or steroids
  • Women using intrauterine devices or other implants
  • Women using certain medications for cancer and other problems that may make them more vulnerable to solar rays (photosensitivity)
  • Women using essential oils or certain toiletries, hygiene, and cosmetic products such as soaps, deodorants etc. that may result in skin reactions (phototoxicity) when exposed to the sun’s rays.
  • Darker skin-toned women such as females of Middle Eastern, North African, Latin, Mediterranean, Asian, and Indian descent
  • Women whose backgrounds may include a family history of melasma
  • Women between the ages of 40 to 60 and beyond who have been regularly exposed to the sun.
  • Women suffering from hypothyroidism or other medical issues
  • Women suffering from stress.

How is Melasma Diagnosed?

Melasma is easily identifiable and usually only requires a visual diagnosis, especially if you are obviously pregnant, or if any of the abovementioned criteria apply to you. However, if there is any doubt on the part of your doctor, certain tests can be performed.

One is called a Wood’s lamp examination. This lamp emits a particular light that, when scanning a targeted mottled section, can enable your physician to evaluate the depth of skin affected by the suspected melasma. Treatment would then depend on those findings.

Once the number of skin layers affected by melasma is determined, the Wood lamp results are usually categorized into one of these three classifications:

  • Epidermal melasma which responds very well to treatment
  • Dermal melasma which can be difficult to treat
  • Mixed melasma which can be treated partially.

If the doctor is still not positive that you are presenting with melasma, an additional procedure of removing a small skin sample for further analysis (biopsy) may be required.

Is Melasma Dangerous?

Not at all. Melasma poses no physical health risks whatsoever. It is purely a visual cosmetic issue. Its impact is more emotional and psychological due to the fact that it is predominantly a facial discoloration that is always noticeable. Women with severe melasma often suffer from low self-image, social discomfort and even depression depending on the severity of the condition.

Is There Any Treatment For Melasma?

Absolutely! With pregnancy-related melasma, the condition often disappears by itself after giving birth. Drug modification or complete cessation of medication containing steroids, hormones, or other melasma triggers can eliminate the problem as well.

Minor cases can be addressed through home remedies made with items found in your pantry or spice rack that contain natural bleaching or exfoliating properties. Many recipes are available online and include such ingredients as:

  • Turmeric
  • Papaya
  • Oatmeal
  • Apple cider vinegar
  • Almonds
  • Onion juice
  • Horseradish
  • Lemon juice
  • Sandalwood
  • Aloe Vera gel
  • Mulberry extract

Over the counter preparations can help too. Your doctor may prescribe oral medications or creams containing medicinal ingredients.

For more stubborn or resistant melasma, there are other, more aggressive options that your doctor may discuss with you such as:

  • Dermabrasion
  • Microdermabrasion
  • Topical glycolic or acid peels
  • Fractional lasers
  • Intense pulsed light (IPL)

Does Melasma Always Go Away Completely?

Unfortunately, not all the time. Usually, the gentler interventions mentioned are enough to eliminate the problem altogether or lighten it to a more acceptable level. Some cases of melasma, however, are difficult to correct. They may require several treatments, and even ongoing care to minimize large or extremely dark blemishes. Every case is different and only a specialist can determine your unique needs.

Is There Anything I Can do to Make Sure I Don’t Get Melasma?

There are definitely precautions you can take to lower your risk of getting melasma. You can:

  • Wear SPF 30 or higher sunscreen daily, reapplying it every 2 hours
  • Select make-up that also includes sunscreen
  • Avoid extreme exposure to the sun
  • Wear a wide-brimmed hat, and make sure your neck, shoulders, and arms are covered or protected outdoors
  • Discuss all medications you are taking with your physician to see if any of them may make you more prone to developing melasma. Sometimes a simple adjustment can prevent the condition from occurring.
  • Avoid rough or abrasive cleansers and soaps
  • Apply moisturizer regularly if your skin is dry


If you have already been diagnosed with recurring melasma, or have been unable to eliminate all traces of it, there are now excellent camouflage cosmetics available that greatly reduce the appearance of darker discolorations. As well, if you are experiencing psychological repercussions that often accompany more severe cases. It may be to your benefit to join a support group that can help you share and possibly overcome these issues.

Cherokee Women’s Health Specialists Can Help You if You Have Melasma

At Cherokee Women’s Health Specialists, our doctors can diagnose most cases of melasma. Honest, open, confidential dialogue regarding all your concerns allows us to give you the best possible attention and discuss treatment options you deserve.  We can help you. Melasma can be treated and controlled, and we are available to make that happen.

To book an appointment to discuss melasma with one of our doctors, call (770) 721-6060.

January 15, 2018

If your period pain has ever made you lie to your boss, you’re not alone. Recently, an Australian study found that 77% of women surveyed admitted menstrual difficulties affected their work. Only over a third honestly admitted the reason to their bosses, while 43% fibbed, using some other excuse. Almost a quarter of those surveyed stoically worked through the discomfort which ranged anywhere from mild to excruciating.

Almost every woman has suffered from menstrual cramps or heavy bleeding at least once since her first period. For many, a simple over the counter pain reliever, heat applications, or a soothing hot bath can alleviate the discomfort, but for others this can be a debilitating experience month after month, often interfering with enjoyment of daily living.

Our professionals at Cherokee Women’s Health Specialists encounter this problem on such a frequent, regular basis that our skills are honed to immediately recognize the symptoms and provide help. We know the physical limitations and psychological impact chronic pelvic pain and heavy bleeding have on your life. Our physicians take menstrual pain very seriously and are very aware of the limitations it may put on you if you suffer from its distressing effects.

Menstrual pain is different from premenstrual syndrome (PMS) in that PMS usually occurs within 7 to 14 days before actual menses. Symptoms associated with PMS are bloating, irritability, weight gain, and fatigue, whereas menstrual pain occurs during your period.

Symptoms include cramping and a throbbing dull ache or pressure low in your abdomen. It can radiate to your lower back, hips and inner thighs. Other more extreme symptoms may be nausea, vomiting, or diarrhea. It can be annoying, but tolerable for -or so severe that it limits functionality.

Different Types of Menstrual Pain 

Menstrual pain is called dysmenorrhea, and there are two types –primary and secondary.

Most women suffer from primary dysmenorrhea, which is usually linked directly to menstruation itself without any other underlying conditions. Contractions of the uterus push against neighboring blood vessels, briefly cutting off blood supply to the uterine tissue, thus resulting in menstrual pain. It generally lasts 2 to 4 days.

Secondary dysmenorrhea is caused by a medical disorder of your reproductive system which may require testing to identify the source. It is typically treated with either medication or surgery. Some causes may include conditions such as pelvic inflammatory disease (PID), fibroids, adenomyosis, cervical stenosis, or endometriosis. There can also be diarrhea, nausea, fatigue or vomiting. Accompanying pain lasts longer and begins earlier than primary dysmenorrhea.

Another menstrual disorder that can lessen the quality of life, interfere with regular activities, and is often cause to call into work to take the day off, is heavy bleeding or menorrhagia. It affects a whopping 10 million American women and is one of the complaints gynecologists hear most often. This excessive bleeding can last longer than a full week. Sanitary napkins or tampons need changing every hour or two and, often, throughout the night. There can be leakage, even with precautionary double padding. Some women with severe menorrhagia can pass large, quarter-sized clots. This condition can cause serious anemia if left untreated for too long.

Causes of menorrhagia can include:

  • Hormonal disturbances or imbalances
  • Dysfunction of the ovaries
  • Fibroids
  • Polyps
  • Pelvic inflammatory disease (PID)
  • Bleeding diseases-hereditary or other
  • IUDs
  • Thyroid disorders
  • Ectopic pregnancy
  • Stress
  • Ovarian cancer
  • Endometriosis
  • Cervical stenosis
  • Kidney disease
  • Medications
  • Miscarriage
  • Cancer of the ovaries
  • Adenomyosis
  • Liver disease
  • Cervical cancer
  • Menopause
  • Perimenopause

If you suffer from menstrual pain that is not relieved by over the counter medicine, rest, heat application, or soothing hot baths- or if experience heavier than normal bleeding, you should seek the advice of an accredited practitioner familiar with women’s reproductive wellness, especially if your discomfort interferes drastically with day to day life.

At Cherokee Women’s Health Specialists we are familiar with every aspect regarding a woman’s exclusive health issues. Doubly accredited Drs. Haley, Gandhi and Litrel, our urogynecologists, hold certification in Female Pelvic Medicine and Reconstructive Surgery (FPMRS) and OB-GYN. They were among the first to receive this special recognition by the American Board of Medical Specialties (ABMS) in recognition of their ability, proficiency, and training. This qualifies them to diagnose and treat any and all disorders pertaining to your feminine health. Furthermore, they are three of only a limited number of doubly accredited physicians in private practice in Atlanta.

When you choose our facility for your care, your first consultation will probably consist of in-depth questions in order to determine what your possible complications might be. A pelvic examination may reveal the problem immediately. If not, our state-of-the-art facility and our close affiliation with Northside Hospital Cherokee, with access to all its amenities, enables us to perform all additional testing necessary such as:

Laparoscopy: A tiny fibro-optic telescope can be inserted through a minuscule incision to examine internal reproductive organs, and take a small sample of tissue for biopsy.

Hysteroscopy: A fibro optic telescope is introduced into the womb via the vagina to look for any abnormalities.

Urine and blood tests: These pinpoint and accurately identify any medical disorders or diseases

Pelvic ultrasound study: This detects physical irregularities painlessly via high-frequency sound waves.

Pap smear: A quick swab rules out any cancer, infection, dysplasia or inflammation.

Sonohysterogram: After the uterus is infused with fluid, ultrasound is used to find any anomalies.

Dilation and curettage: Though this is usually a treatment, it can also be used to pinpoint any physical abnormalities.

Normally, invasive intervention is unnecessary. We do our best to avoid any treatment that makes you more uncomfortable. We analyze results carefully, taking in all factors such as your age, general health, weight, etc., and use our combined expertise and decades of accumulated knowledge to decide on the most effective management for your dysmenorrhea or menorrhagia.

Treatment Options for Severe Period Pain and Heavy Bleeding

The first option we look into is oral hormonal or non-hormonal therapy such as contraception, non-steroidal anti-inflammatories (NSAIDs), or other medications that can reduce bleeding and pain. If you suffer from anemia as a result of your condition, folic acid or iron supplements might be prescribed. In some cases, a hormonal intrauterine device (IUD), patch, vaginal ring or injections can be helpful.

Should you require a surgical alternative to alleviate your pain or bleeding, our FPMRS, OB-GYN specialists have the most current medical knowledge to do everything possible to treat your individual problem.

Severe period pain and heavy bleeding do not have to keep you from living the life you want. With the proper help, you can get better and no longer have a reason to lie to your boss.

If period pain or prolonged, heavy bleeding is interfering with your life, call today to schedule an appointment at 770.720.7733.

Disturbing statistics show that, after previous years of decline, premature births are now on the rise in Georgia. Reports state that, in 2016, there was an 11.2% increase. Though this is partly due to lack of funding and, consequently, the shutting down of many medical facilities in Georgia, it is also happening nationwide.

Babies born before 37 full weeks of gestation are considered premature. Many maternal factors can contribute to preterm deliveries, and some of these include:

  • Diabetes
  • High blood pressure (Hypertension)
  • Pregnancies occurring within 6 to 18 months of each other
  • Racial and ethnic factors: Premature births to African American mothers surpass Caucasian ones by 50%
  • Malnutrition
  • Poverty hindering regular prenatal care
  • Drug or alcohol abuse
  • Smoking
  • Limited access to prenatal care for women living in rural areas
  • Reproductive system irregularities such as a malformed uterus, short cervix, or closed cervix (incompetent cervix)
  • Placenta previa
  • Previous or existing infections and STD’s
  • Mothers who are obese or underweight
  • Multiple births, whether natural or through in vitro fertilization
  • Pregnancy before the age of 18 or after 35
  • Fetal abnormalities
  • Overwork, excessive standing
  • Uterine rupture
  • Previous fibroid removal
  • Blood clotting irregularities
  • Injury from domestic violence or abuse
  • Stress or recent traumatic life experience
  • Pollutant or chemical exposure
  • Previous abortion or miscarriage
  • Rapid hormonal changes
  • Prior birth by C-section (Cesarean)
  • Epilepsy
  • Mental illness

Premature babies often suffer from both short and long-term health complications, neurological issues, and developmental delay concerns such as:

  • Hypothermia
  • Infections
  • Underdeveloped lungs and breathing problems
  • Cerebral palsy
  • Hearing and/or vision problems
  • Higher incidence of Sudden Infant Death Syndrome (SIDS)
  • Cardiac irregularities
  • Blood pressure complications
  • Brain hemorrhage and/or brain fluid buildup (Hydrocephalus)
  • Gastrointestinal difficulties
  • Jaundice
  • Anemia
  • Metabolic issues
  • Lowered immune system
  • Dental problems
  • Learning disabilities
  • Reduced cognitive skills
  • Psychological and/or behavioral problems

If you are not yet pregnant but may potentially give birth prematurely, prenatal counseling and testing are usually advised.

Is Your Pregnancy High-Risk?

If your pregnancy classifies as high risk with a danger of premature birth, you should find a fully accredited physician who is both familiar with and can treat complications associated with these pregnancies, as you will probably need extra monitoring throughout gestation.

Any medications, vitamins or supplements you are taking will be evaluated and possibly stopped or modified. Your diet might be adjusted to create a more nutritious and beneficial plan. Additionally, you will be provided with a list of any danger signs that may point towards a premature birth.

Prenatal Care for All Pregnancies 

At Cherokee Women’s Health Specialists, we offer you exceptional prenatal service. All of our professionals possess up-to-the-minute knowledge in their fields of obstetrics, gynecology, surgery, midwifery, cosmetic surgery, nutrition, medical assistance, nursing, holistic medicine, and equipment technology. They are committed to putting your well-being and that of your child first.

Unlike many OB-GYN facilities, we conveniently deliver multiple women’s health services to meet your needs under one roof. Our priority is to prevent as many premature births as possible by providing you with these broad amenities.

Along with being voted “Best OB-GYN in Towne Lake, Woodstock, and Canton, we are affiliated with Northside Hospital Cherokee, the nation’s leader in maternity services. We have unlimited access to their state of the art equipment, test center, and birthing center. Their Neonatal and NICU facilities have the most advanced technology to ensure that your baby is given every possible opportunity to fight against the challenges it might face due to a premature birth.

At Cherokee Women’s Health Specialists, we offer you exceptional prenatal service. Drs. Gandhi, Haley, and Litrel were among the first doubly accredited specialists in America to meet the high standards necessary to achieve certification in Female Pelvic Medicine and Reconstructive Surgery (FPMRS). This enviable distinction is only given to qualified individuals after years of training, education, and experience, and adheres to the stringent criteria demanded by the American Board of Medical Specialties (ABMS). Their expertise enables them to administer superior care throughout your pregnancy. Additionally, Drs. Hale, Crigler and Clay and our certified-nurse midwives, Susan Griggs and Ruth Roser, complete our provider team and help us offer the best obstetrical care in Cherokee County.

Not all premature births can be foreseen or prevented, but at Cherokee Women’s Health Specialists, we try to do everything within our scope of expertise to deliver one healthy baby at a time.

An observational study conducted at the Keck School of Medicine of USC determined that intrauterine devices (IUDs) may have the surprising health benefit of lowering the instances of cervical cancer.

Worldwide, cervical cancer is the third highest cancer among women. Projected statistics by the World Health Organization (WHO) estimate that, by 2035, the numbers in the United States alone will climb to 756,000.

According to the information collected from 16 different epidemiological studies, (i.e. studies of disease in different populations), the results of 12,000 women from around the world who used IUDs were analyzed. Findings revealed that invasive cervical cancer among them was lowered by 30%.

Though this revelation is both hopeful and promising, doctors urge you to remember that the statistics are currently based solely on observation and not clinical trials. A great deal more exhaustive research must be done in controlled settings before these conclusions are found to be of merit. Clinical trials require years of intense scrutiny, but if this correlation is proven, it can offer a beacon of hope for women everywhere. Until that time, it is recommended that you be vigilant, schedule regular cancer screening, and vaccinate against the HPV virus—the latter preferably before sexual activity begins.

How does an IUD Work?

An IUD is a device formed like a letter T and is used as a method of birth control. A gynecologist inserts it into your uterus to prevent pregnancy. It is 99% effective and can last anywhere from 3 to 12 years, but can be removed at any time.

To date, there are two kinds of IUDs: hormonal and non-hormonal IKUDs.  Traditional non-hormonal IUDs prevent pregnancy by releasing copper which causes an inflammatory effect. This reaction inhibits sperm movement, stopping it from reaching the egg to achieve ovulation. More recently manufactured IUDs are hormonal. These devices release synthetic progestin. High progestin levels in the body form thick cervical mucus that is hostile to sperm, preventing it from reaching the egg and succeeding at fertilization.

Since hormonal IUDs are a fairly new concept, it is assumed that the subjects used the copper-releasing types, but this information still needs to be clarified.

Exactly why IUDs can lower cervical cancer rates is still a mystery. Speculation is that when the physician is making sure the device is placed correctly, this adjustment in the area known as the transformation zone results in an immune response, protecting the cervix from the pre-invasive lesions which lead to cervical cancer. It is also thought that IUD’s may assist the body in repelling Human Papilloma Virus (HPV) infections, which carry the most danger of triggering cervical cancer.

For many women, the benefits and convenience of an IUD far outweigh the possible risks. IUDs eliminate the worry of forgetting to take a daily pill or renewing a monthly oral contraceptive prescription. Periods are often lighter-even non-existent, so IUDs can also prevent anemia from excessive monthly blood loss. There is no need to interrupt ’the mood’ to insist on a condom to prevent conception–as long as you are in a trusted monogamous relationship. Last, but not least, the almost 100% effectiveness gives women complete peace of mind, allowing them to enjoy lovemaking without worrying about babies they’re not prepared to have.

Though the recent findings and theories provide an optimistic outlook to both women and cancer research, specialists, including those of us at Cherokee Women’s Health Specialists, caution against pinning your hopes on these yet unproven hypotheses. Insisting on an IUD solely to prevent cervical cancer is both unwise and sometimes dangerous.

IUD’s ensure against pregnancy and can possibly lower your risk of a deadly disease based on this new discovery, but they do not guard against sexually transmitted diseases (STDs) or infections (STIs). It is recommended that a condom and/or spermicide always be used, especially if intimacy is with a new partner.

IUD’s can cause cramping, pain, and spotting between periods. You may also experience irregular periods. IUDs can also slip out of place, causing pregnancy-and possible ectopic pregnancy if you are unaware of your condition.

An unknown allergy to copper, if you are given the non-hormonal IUD, can be life-threatening-possibly fatal. In rare cases, an IUD put in place incorrectly can push through the wall of the uterus, which may necessitate removal through surgery.

Are You a Good Candidate for an IUD? Smiling young woman

Because every woman’s body is unique, an IUD may or may not be right for you.  In order to make the right decision that benefits you the most, we take the time to study your medical history in depth. We evaluate any medications and supplements you may be using, run tests if necessary, establish that all is well with a pelvic examination, take into consideration any food or product sensitivities, inquire about allergies and much more. The smallest detail may be of utmost importance in establishing the proper course of birth control for your individual needs.

Our extensive training and accumulated knowledge give us the tools we need to make sure your pelvic and reproductive health is guarded at all times. Alternative birth control methods to an IUD may be prescribed in your case, along with full disclosure of any risks, possible side effects, and percentage of effectiveness. Some of these additional methods are:

  • Vaginal ring (Nuvaring)
  • Birth control patch
  • Birth control pills
  • Copper non-hormonal IUD
  • Hormonal IUD
  • Female condom
  • Male condom
  • Spermicides
  • Cervical cap
  • Depo-Provera injection
  • Diaphragm
  • Sponge
  • Birth control implant

If you no longer wish to have children, you may opt for tubal ligation, a procedure our surgeons are very capable of performing.

If you prefer not to use any of these methods or are unable to tolerate them, we can, upon request, counsel or instruct you on the Fertility Awareness-Based methods (FAMS) and withdrawal methods.

It remains to be seen if the surprising health benefits of IUDs observed in the above mentioned studies do indeed have potential merit before relying on the findings to prevent cervical cancer. If they do show irrefutable proof of prevention, Cherokee Women’s Health Specialists will most likely be among the first of the OB-GYN facilities in Atlanta to implement those findings in the daily care we provide to our patients.

Why Choose Cherokee Women’s for Your Birth Control Options

All methods of birth control carry risks. This is why it’s important that you choose an accredited physician to determine the best option for you if you are trying to prevent pregnancy.

At Cherokee Women’s Health Specialists, we have three doubly accredited urogynecologists- Drs. Litrel, Haley, and Gandhi. All three hold certification in Obstetrics-Gynecology and in Female Pelvic Medicine and Reconstructive Surgery (FPMRS), the latter being an enviable recognition requiring years of training and experience before receiving approval and acceptance by the American Board of Medical Specialists. Furthermore, all three are only among very small, select group of physicians who hold these degrees and practice privately in Atlanta.

Together, along with an additional stellar staff that makes us a broad-based practice offering multiple services, Cherokee Women’s Health Specialists was voted “Best OB-Gyn in Towne Lake, Canton and Woodstock, making us a wise choice for not only your birth control necessities, but also for all your other feminine health and wellness needs.

Call today to schedule an appointment to discuss what birth control options are safest and most beneficial for you at 770.720.7733.

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“Dr. Litrel was a fantastic doctor. I had my first exam with him, although at first I was skeptical about a male doctor for my GYN. But after I met him I’m glad I kept an open mind, and I couldn’t have dreamed up a better doctor. He cares about you as a person and not just a patient. The front desk ladies and nurses were very friendly and it’s a great office, very clean and not intimidating. I highly recommend Cherokee Women’s Health.”
– Vicki