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September 27, 2017

You think you may have an ovarian cyst. Or, could it be a uterine fibroid?

Ovarian cysts and fibroids have many of the same symptoms and can be difficult to self-diagnose. You may experience pelvic pain during certain activities, dull or sharp pain in your abdomen, or no symptoms at all.

Unless you’re a trained professional, you probably don’t know the differences between the two. In fact, many women often don’t know they’ve got either until their OB-GYN does a routine pelvic exam.

Ovarian cysts are very common and typically go away on their own. While uterine fibroids are not an issue for some women, others experience problems such as changes in their menstrual cycle and even infertility.

In this article, we’ll discuss the most obvious ways to tell which of the two you have. We’ll also cover several treatment options to consider for both.

Overview: Ovarian Cysts

An ovarian cyst is a sac or pouch filled with fluid or other tissue and is caused by your menstrual cycle. As you’ve probably guessed it forms directly on your ovary.

Each month your body grow normal follicles (a cyst-like structure). These follicles produce hormones such as estrogen and regulate the timing of releasing an egg during ovulation. Cysts occur when a normal follicle continues to grow.

Because of this, ovarian cysts are most common for women who are at the childbearing age or going through menopause. You are also at a higher risk of getting ovarian cysts if:

  • You’re taking fertility drugs
  • During pregnancy
  • You’ve had a severe pelvic infection
  • You’ve had ovarian cysts in the past

Most ovarian cysts go away on their own within 1-2 menstrual cycles.

You may experience little to no symptoms when you have an ovarian cyst. However, they can also cause dull or sharp pain in your abdomen during certain activities.

Treating an Ovarian Cyst

When your doctor diagnoses you with an ovarian cyst they will typically suggest treatment if your cyst becomes large, is causing problems such as pain, or if cancer is suspected.

There are two types of treatments for ovarian cysts.

  • Watchful Waiting. This is a process of monitoring your cyst for changes in size or appearance through scheduled ultrasounds.
  • Minimal Invasive Surgery. Typically, your OB-GYN won’t suggest surgery unless the cyst continues to grow or doesn’t go away on its own.

Uterine fibroids can cause discomfort and impact a woman's fertility.Overview: Uterine Fibroids

A uterine fibroid is a growth from muscle tissue. Fibroids can appear as single growths or clusters. They vary in size, shape, and location. Some grow rapidly, while others take years to form.

Unlike ovarian cysts, fibroids can form anywhere throughout the uterus. Fibroids can be found within the uterine walls, on the outer surface, or even attached to the stem-like structure.

Doctors still aren’t exactly sure what the cause of uterine fibroids is. However, research has led to several factors being involved such as genetic changes and hormonal changes.

Women of childbearing age are most affected by uterine fibroids. Often, fibroids will decrease in size after menopause due to reduced hormone production.

Although most women have had at least one uterine fibroid throughout their life, many aren’t aware because often symptoms don’t occur. Other women aren’t as lucky. Fibroids can have numerous adverse health effects including:

  • Abdominal pain or cramps
  • Difficult or frequent urination
  • Bleeding between periods
  • Pelvic Pain
  • Infertility

You may experience one, all, or none of the above symptoms if you have a uterine fibroid. It’s important to have regular visits to your doctor including routine pelvic exams.

Treatment for Uterine Fibroids

Your healthcare provider will suggest seeking treatment for your fibroid if you’re noticing symptoms. Rarely are uterine fibroids found to be cancerous.

There are a few treatment options available to you. Talk to your doctor about which of the following is the best approach.

  • Drug Therapy. Often your doctor will suggest birth control pills or other hormone altering drugs.
  • Myomectomy. This is the surgical removal of the fibroid. During this procedure, your uterus is left in place.

More abrasive approaches include:

  • Hysteroscopy. This is an outpatient procedure that destroys fibroids within the uterine walls through electricity or a laser.
  • Endometrial Ablation. This procedure is intended to destroy the lining of the uterus and in turn, the fibroids.
  • Hysterectomy. This is the surgical removal of the uterus. Sometimes doctors will leave ovaries in place for hormonal reasons. Speak to your doctor about this possibility.

Final Thoughts

Women experiencing pain or other symptoms from either ovarian cysts or uterine fibroids should seek medical advice. Once you get an official diagnosis, your healthcare provider can help you decide on a plan for treatment.

Still have questions? Don’t hesitate to contact us with questions regarding your symptoms or to schedule an appointment. A member of our trained staff will be happy to help you in any way possible.

September 26, 2017

Can post pregnancy exercise help a woman get back to her post-pregnancy weight.If you’re like many new moms, you’re ready to shed that extra baby weight… and now! It’s a perfectly natural feeling but if you’re not careful it can lead to a never-ending cycle of harmful weight loss that doesn’t last.

There is hope, however.

A healthy combination of nutrition and exercise can get you back to pre-baby weight in a matter of mere months. Be sure not to rush it though. Remember, it took 9-months to get to where you are now. Don’t expect lasting weight loss to happen overnight.

Incorporate Exercise into Your Daily Routine

Exercise can be a wonderful tool for new moms for many reasons. Physical activity can help reduce stress and help you sleep while keeping your muscles and bones strong.

Before starting a new routine, take care to get proper guidance on what to you can expect from your post-baby body. Heading to the gym for a workout right away can be harmful to your body, especially if you’ve had a c-section.

So what can you do?

  • Start slow. Having a newborn doesn’t leave you much time for anything, much less exercise. Try incorporating 30 minutes of walking into your daily routine broken into short 10 minute breaks as you can.
  • Incorporate strength training into your routine. Strength training with medium to light weights can help increase bone density as well as building muscle.
  • Don’t go it alone. You’re more likely to stick to an exercise program if you’ve got support from friends, family, or other new moms. Try joining a gym that has classes dedicated to new mothers.
  • Avoid jumping into old routines. Instead of worrying about what you could do before your pregnancy, focus on what your body can handle now. While you’re pregnant your body releases hormones that loosen your ligaments, making giving birth easier. It can take time for them to get back to normal.

Remember, don’t start any exercise until you feel ready. Women that have had c-sections or complicated births should consult a medical professional before starting any exercise programs.

Create A Healthy Diet Plan

Although exercise plays a strong role in meeting your weight loss goals, healthy nutrition is a primary factor for lasting weight loss. No matter how much you workout, exercise does not counteract an unhealthy diet.

It’s often hard to eat right when balancing life with a newborn. But it doesn’t have to be.

Try some of the following tips to get on the right track for reclaiming your body through healthy eating.

  • Eat at least 1,800 calories a day, especially if breastfeeding. Avoid crash diets. Pushing yourself to the max can leave you stressed which actually promotes weight gain.
  • Stock up on healthy snacks. Noshing on foods like sliced fruits, veggies or wheat crackers throughout the day is a healthy way to keep cravings at bay.
  • Choose a well-balanced variety of foods. Stick to foods high in the nutrients you need while low in calories and fats. Try a variety of lean meat, chicken, and fish as your primary source of protein to keep your energy levels up.
  • Drink lots of water. Not only does water keep you feeling full but some studies have shown that water can also aid in speeding up your metabolism.

When you were pregnant you likely changed your eating habits to support your baby’s growth and development. Making the change back to your old routine can seem daunting. Seek support from friends, family, or other new moms when necessary.

Final Thoughts

Don’t be afraid to ask for help with your post-baby weight loss. Every woman and every situation are unique. Here at Cherokee Women’s Health, we have a medically supervised weight loss program designed especially for women.

We can help nursing moms like you find a sustainable diet plan. Feel free to give us a call to learn more about our weight loss programs tailored just for you.

September 20, 2017

“When I started the program at Cherokee Women’s Health I had already lost 16 pounds but it had taken me over 5 months and then I plateaued in my weight loss journey.”

This part of Wendy’s story is not uncommon. Many people begin diet and weight loss programs and see early successes but have a difficult time reaching their goal. At Cherokee Women’s Health Specialists our doctors have formulated a plan specifically for women and their unique needs. The program includes personalized meal plans and nutritional education.

“One big thing that I learned from the program is the relation of calories in food to how many calories my body actually burns and that every calorie counts. I used to let food control me but now I control the food.  It really puts calories into perspective and this program has given me the tools I need to not only lose the weight but to keep it off!”

Each patient gets a personalized plan that can include supplements along with the nutritional counseling, and regular check-ins giving women the skills they need for long term success.

 Goal for the Bridesmaid: Pounds and Dress Size… Going Down!

“In the last 4 ½ months I have lost an additional 38 pounds with Cherokee Women’s Health Specialists. When I began the program, I was shopping for and being fitted for a dress for my sister’s wedding and initially I was going to be in a size 18-20 dress. By the time the wedding came around I had a size 14-16 and still had to have the dress taken in some before the wedding.

The program gave me a huge boost in my weight loss journey. I now have more confidence, I’m happier, I feel better, and best of all I have more energy to run around and play with my kids without feeling so tired.”

Our medical weight loss program is designed to be an effective life style change that puts the power in our patients’ hands. With nutrition counseling, exercise plans and accountability, the medical weight loss plan gets results for women.

Call 770-720-7733 to schedule your free consultation today.

September 6, 2017

by James Haley, MD, FACOG, FPMRS

Dr. Haley photo

Dr. Haley

As many as 86 million people in the United States have prediabetes, yet 90% of them don’t even know it. Prediabetes is the condition that exists when you have higher than normal blood sugar levels, but not high enough to classify as diabetes. Someone with prediabetes has a higher risk of developing Type 2 diabetes and other serious health issues, including stroke and heart disease.

Since this condition has no symptoms, it can easily go undiagnosed. However, there are risk factors to look for, and certainly ways you can decrease your risk of becoming a Type 2 diabetic. Type 2 diabetes is a major public health issue, and more people need to know they are at risk.

Know the Risk Factors for Prediabetes

The American Diabetes Association (ADA) has guidelines that list a total of 11 specific risk factors that determine if you should be screened for prediabetes. They include:

  • High Blood Pressure
  • High Cholesterol
  • Body Mass Index (BMI) over 25
  • History of Heart Disease
  • Physical Inactivity
  • 1st Degree Relative with Diabetes
  • Over 45 years old
  • Had Diabetes in Pregnancy (gestational diabetes)
  • African-American race
  • Latino ethnicity
  • Asian-American race

bmi-photo

If you’re over 45 and have any of the other risk factors, you should see your doctor. A simple blood test can let you know if you are prediabetic. Unfortunately, most Americans these days have a body mass index (BMI) over 25, not realizing the risks associated with it. If you have a calculator, you can easily figure your BMI. Below is the standard formula. If you are in good shape and have extra muscle, it may be a little off. Nevertheless, it is still a good method and will give you a close estimate.

How to Calculate Your BMI

  1. Figure out how many inches tall you are. (Example: if you are 5’4″ you are 64 inches).
  2. Multiply the number by itself. (Example: 64 x 64 = 4096)
  3. Write the total down and clear your calculator.
  4. Now, punch in your weight in pounds and divide by that saved 4-digit number (For a 125 woman, 125 divided by 4096 = .03051758)
  5. Multiply your result by 703. (.03051758 x 703=21.4538)
  6. Here, 21.45 is the BMI

If the result you get is less than 18.5, you are considered underweight. If your BMI is between 18.5-24.9, you are normal weight. But if your BMI is 25-29 you are considered overweight, and over 29 is considered obese.

No matter how undesirable you find your calculations, don’t despair. Make today the first day of positive changes. It’s never too late to start a sensible diet and exercise plan. Change begins with that first step. Get committed!! Get going!

For guidelines on nutrition and weight loss, discuss your concerns with your doctor at your next annual exam.

by James Haley, MD FACOG, FPMRS

Dr. Haley photo

Dr. Haley

As a physician and fitness enthusiast, I’ve read a plethora of articles, books, and journals on weight loss. My patients continually tell me their struggles with dieting, lamenting that the weight always returns, usually along with a few extra pounds. Personally, I can relate. It’s not a dilemma exclusive to women. Men struggle, too. As you age, you just can’t eat like you used to – even if you exercise regularly.

After reading numerous books and trying different diets myself, I finally discovered an author who not only pinpoints the problem of obesity, but also the answer to those last ten pounds.

In his book, ‘The Obesity Code’, Dr. Jason Fung, a nephrologist, states that the real culprit of weight gain isn’t overeating. It’s excessive insulin. He is emphatic that many of his patients would need less medical intervention if they lost weight. Since most of his patients are Type 2 Diabetics, a disease associated with too much insulin, he has been able to determine the common link – SNACKING.

In the past few decades, the number of times we eat daily has increased. People have gone from eating three meals a day to about six, counting snacks. Go on, admit it. It’s what you do – what I’ve done. it’s a cycle, and it makes sense once you understand the reason why. Every time you eat, you stimulate insulin, keeping it at a constant high level. This fools the body into thinking it’s always hungry. Your body is constantly thinking you are hungry because your insulin stays in a high range.

woman weighing on scaleObesity is a hormonal disease. Insulin, a hormone, tells you how much to eat and how much to burn. The body behaves as if the weight is set on a thermostat. So, obesity is not about caloric imbalance. Thus, it makes sense that the idea of cutting calories is totally wrong.

You may not be obese. Maybe you have a few obstinate pounds that won’t melt – a jiggle around the middle resistant to diet and exercise. ‘Fat’, ‘plump’, ‘chubby’ – whatever you call it, a surplus of insulin is causing it. The longer you have higher amounts of it, the more resistant your body becomes, which produces even more and causes that crazy, never-ending cycle.

So what’s the solution?

  • Avoid insulin-stimulating foods like sugar and refined grains. These are the enemy.
  • Eliminate between-meal snacks.
  • Designate mealtimes.

Meal timing and insulin levels work together to regulate our weight. We need periods of time when we aren’t eating, so insulin can go down, leaving our bodies in energy burning mode. If we leave more time between meals…. we burn energy.

And when we burn energy, we lose weight.

To learn more about the other secret to regulating insulin for weight loss, read here.

 

September 5, 2017
Dr. Haley photo

Dr. Haley

by James Haley, MD, FACOG, FPMRS

I have always had a personal interest in nutrition and fitness, and more so after I became a doctor and needed that knowledge to benefit my patients. After reading volumes of research on these subjects and hearing my patients’ struggles with weight gain, I came across nephrologist Dr. Jason Fung’s book, ‘The Obesity Code’.

Most of Dr. Fung’s patients are Type 2 diabetics, and he explains clearly how obesity is a problem due not to caloric intake, but to constant high levels of insulin in the body retained through frequent eating.

In short, Dr. Fung states that the more often you eat, refueling with snacks between meals, the longer your insulin levels remain elevated. Since insulin is a hormone that tells your body how much to eat and how much to burn, high insulin levels fool the body into thinking you are always hungry. Those messages cause you to eat more, and of course, gain weight.

How do you overcome this vicious circle?

1. Stop Snacking

This is the first step. Avoid especially the sugary and refined, processed foods which make your insulin levels spike and fall all day, perpetuating the cycle of hunger and sluggishness, making you think you’re hungry.

2. Stay Hydrated and Eat Well  

Drink plenty of water and eat healthy foods like vegetables, nuts, salads, fruit and protein-rich chicken and fish, which keep your insulin levels steady.

woman fasting fruit photo3. Fast

Fasting! The word may make you shudder. I’m not talking about a three-week, Gandhi-type fast. Dr. Fung suggests a “mini- fast”: going without breakfast. And yes, this goes against everything you’ve ever been told, that breakfast is the most important meal of the day. You don’t need to do it daily, but skipping breakfast gives your body about 14 hours of fasting from the night before. We need periods of time when we aren’t eating, when insulin can go down, leaving our bodies in energy burning mode. This one step will dramatically lower your insulin, which in turn acts to lower the body’s set weight. You’ll start to feel better, have more energy – and you may just get rid of that last, lingering ten pounds.

4. Consult Your Doctor

Fasting is never recommended for pregnant women, breastfeeding mothers, or people with certain diseases.

If you simply need a jump start to weight loss, try the mini-fasting route and let your body’s insulin levels drop to burn energy. You will be surprised at how much better you feel. Once you change your mindset about food, regulate your insulin, and time your meals, you will see many positive results. Whether you need to lose weight or not, you will definitely have more energy, and hopefully live a longer, healthier life.

To learn more about the other secret to regulating insulin for weight loss, read here.

Sherene Harati after the Teal Trot.If you go to our Canton office, there is a good chance you have met Sherene. Her bright smile and helpful attitude keeps her teammates and patients in high spirits.

What you may not know about Sherene is that she is an Ovarian Cancer Survivor. She was diagnosed in 2014 after getting a second opinion for her PCOS. She felt the doctor she was seeing at the time didn’t take her concerns about her symptoms seriously. When she saw a new doctor she mentioned her symptoms again. This time the doctor recommended an ultrasound.

During the ultrasound they identified a mass. Sherene had just graduated from college and didn’t fit the demographics of the women who usually develop Ovarian cancer, so her doctor wanted to keep an eye on the mass. It would have been easy for her to sweep it under the rug, but her doctor followed up, and Sherene kept all of her appointments.

Sherene lost one of her ovaries, but they caught the cancer early. After completing her treatment, including chemotherapy, Sherene is cancer free. It’s been almost three years and Sherene sticks to her follow-up appointments every few months to make sure she is still healthy.

Sherene’s Take Home Message

Sherene’s biggest message? Listen to your body! If you think something isn’t right, talk to your doctor. It’s okay to get a second opinion, especially if you think you aren’t being heard.

Now Sherene is dedicated to spreading the message about Ovarian cancer. Every year she participates in the Teal Trot 5k in Atlanta. She raises money and awareness and has fun in the park with her friends and family. Sounds like a great day!

 

Sherene kept a positive attitude during treatment.

Sherene kept a positive attitude during treatment.

Still smiling! Sherene participates in her first Teal Trot.

Still smiling! Sherene participates in her first Teal Trot.

Sherene gets the word out about Ovarian Cancer Awareness with teal hair.

Sherene gets the word out about Ovarian Cancer Awareness with teal hair.

August 9, 2017

It often takes longer for women to lose weight.While losing weight can be a challenging feat for both sexes, women have a few additional physiological hurdles from the start that men simply don’t. For women, it may take more of an initial lifestyle change to accomplish weight loss than it would for men.

Don’t worry though. All hope is not lost.

Staying focused on hitting your first health related goals can be empowering and keep you on the right track to shedding unwanted pounds down the line.

You may not come out of the gate dropping pounds left and right like your male counterparts, but in most cases weight loss will even out over time.

Physiological Reasons Initial Weight Loss is Harder for Women

Initially, it can be discouraging for women who decide to lose weight with male friends, family, or partners. It may seem as if you’re male weight loss partner is losing weight with little or no effort while you’re struggling to drop that first couple pounds.

Well, it turns out there’s a reason.

Let’s take a look at some of the biological reasons women have a tougher time getting rid of excess weight and looking slimmer at first.

  • Men have a height and weight advantage over women. Performing even simple tasks requires the body to burn more energy the larger the person is.
  • Men typically have a faster metabolism than women due to testosterone levels. Lean muscle tissue can burn more calories than fat even when resting.
  • Women’s fat stores are often spread throughout the body. It’s more difficult to lose weight when fat stores are spread over the entire body rather than held in one place such as the belly like it often is in men.
  • Women have larger fat stores to help during pregnancy. A perfectly fit woman will hold and extra 6-11% more body fat than a perfectly fit man simply due to biology.
  • Post-workout cravings. After a workout women’s ghrelin levels (the hormone that tells us we’re hungry) increase. Meanwhile, our leptin (the hormone that tells us we’re full) drop significantly. This hormonal fluctuation isn’t as prominent in men after exercise.

Don’t despair. Women have some advantages over men too. For example, women tend to burn more body fat when they exercise than men do.

Pushing Through Physiological Obstacles

Whether you want to commit to dropping a significant amount of weight, restore your optimal body weight after a pregnancy, or just live a healthier lifestyle overall, there are several things you can do to expedite the process.

  • Incorporate strength training exercises into your workout and benefit from more muscle mass too.
  • Focus on healthier post-workout snacks to tame cravings.
  • Banish negative thoughts and focus on the positive to nix emotional eating.
  • Have a balanced workout that includes plenty of cardio (at least 20 minutes a day).

Getting your mind in the right place can be helpful during your weight loss journey as well. One thing you can do immediately is to stop thinking of it as a competition. Celebrate and encourage both parties weight loss achievements equally.

Final Thoughts

Don’t be discouraged if you don’t lose weight as quickly as the men around you. Remember, weight loss isn’t a race. It’s a slow and steady process to regaining your optimal well-being and taking control of your life.

Although guys may have an initial head start, your partner’s weight loss will eventually plateau and you should be on the same page over time.

Losing weight doesn’t need to be daunting. Talk to your health care provider for guidance on how to accomplish weight loss and other health-related goals. Feel free to give us a call regarding any questions you may have through your weight loss journey. We’d be happy to schedule an appointment with your doctor for a consultation.

You’ll soon be on the road to feeling great!

Insecurities, Relationship Issues, and Pelvic Health

If you’re considering vaginoplasty, labiaplasty, or other pelvic surgeries, you probably have a lot of questions – and you should! Dr. Litrel has been performing these types of procedures for twenty years and even has a board certification in Female Pelvic Medicine and Reproductive Surgery in addition to his OB-GYN certification. He believes that the best patients are well informed, and does his best to answer all the questions that come his way.

Here are 10 recent questions he answered on an online forum.

1. I am very insecure about my vagina and the color of it. Is it normal? I’m afraid to have sex.

Your appearance is perfectly normal and does not have any issues that require intervention from a cosmetic surgeon. Your insecurity is normal as well to some degree.  Everyone has some fear about social rejection, the feeling that others will not like or love us. This is really a spiritual issue, learning to love ourselves and love others, growing daily in our abilities in this arena. This is what makes life meaningful and fulfills our purpose in life: love.

When it comes to sexuality –  the sharing of our bodies with another in a pleasurable and intimate manner – the insecurity that one feels can prevent us from extending ourselves in this way.  This is painful because sex and intimacy and pleasure are so important to enjoy life.

But as a doctor who specializes solely in the care of woman, the common problem that women experience is not that they can’t find sexual partners, but rather that they choose the wrong sexual partner. Or too many. For men, in many and most cases sex is the end. Sex and orgasm itself is the goal.

Women like sex and orgasm, too. But for women, sex is really the beginning – the beginning of a powerful and important relationship – and the beginning of New Life (pregnancy). This is why so often women are broken hearted by the way they are treated by men. Men get sex – and eventually leave for someone else.

Thus it’s important for women to choose a partner who is committed to not just his own orgasm and his own pleasure – but one who is committed to you and the future of the relationship that God willing may someday include children.

Bottom line is this: if insecurity about the appearance of your genitals is holding you back from “sex” – when you find the partner who is not just attractive physically but spiritually as well – one who will be committed to you and the future, that person will love you so you will not be so afraid.

So it’s okay to wait to have sex and indeed it’s usually better. It builds a better long term relationship. When a woman waits to have sex not only does the guy think that she’s special, he also thinks that he’s special. And thus the relationship becomes special.

2. Is there any way to make my vagina look new again?

Women sacrifice a lot. Pregnancy and delivery is difficult enough as is raising children.  But the changes that women experience to their bodies are just another painful thing that women must confront. There are office procedures and surgeries that can help you with both sexual function and appearance of your genitalia. As far as specifics are concerned that is something that is tailored to each patients desires and anatomy.

3. Suffering from some mild incontinence and loss of muscle tone in my vagina. Does the Apex M pelvic floor exerciser work?

There are three good things about the apex devices. One is that they can help improve the muscle tone on your pelvic floor and can help with incontinence. Two is that they are done in the privacy of your own home. Three they are safe and won’t hurt you. It’s reasonable to try this before surgery. It’s reasonable to use this afterwards as well.

4. Can any board certified surgeon do a labiaplasty?

I would strongly advise you to wait until you find a specialist surgeon who focuses on labiaplasty. This can be a cosmetic gynecologist or a plastic surgeon. But don’t see someone who does not do a lot of these surgeries. Board certification is about education and passing examinations. But the key is experience and skill rather than diplomas on the walls and initials after your name.

5. Vaginoplasty: Can this surgery be personalized based on size of husband? Do all “holes” end up the same after this surgery regardless of requests?

Your surgery should be tailored to the size of your husband. Sexual issues are usually top-of-mind for women considering vaginoplasty. Thus your experience with your sexual partner is an essential part of the interview, the examination and the performance of the surgery.

6. I recently had vaginal tightening surgery. Is it normal to have a lot of pain afterward?

Everyone responds to the pain of surgery in a different way. Our bodies are different. It’s important to get an examination by your surgeon to make sure that there are not issues. But assuming a normal exam, be assured that everyone will have a different response. Typically by seven to fourteen days patients feel alright. If the pain continues, pelvic floor physical therapy can help. Muscle relaxers can also help if the examination demonstrates tenderness on your pelvic muscles.

7. Would a perineoplasty help with some feelings during sex?

The quick answer is that it will help – some.  Your question shows a sophisticated knowledge of your body and the problems you are having.  Pelvic reconstruction is likely required along with vaginoplasty to give you the tightness you desire. and to correct the anatomic deformities and changes your eloquently describe. There are non-surgical modalities such as ThermiVa that can help. But that may be a waste – it will depend upon your anatomy and the findings on physical examination. Good luck!

8. Can I enjoy sex after my clitoris is removed?

This should not be done for any reason other than the rare presence of cancer.  In some parts of the world there is “female circumcision” where young girls suffer genital mutilation. This is cultural and often the clitoris is not injured in the process. If you are considering a procedure make sure you understand what is being done and why.

9. Is a partial labiaplasty possible?

This is a good question. The truth is that every labiaplasty has to be tailored to a patient’s anatomy and also her desire. So really, you should just receive what it is that you desire rather than a “one size fits all.” Likely you have excess skin adjacent to your clitoral hood or the hood itself is more pronounced than you desire. This is a common problem that can be handled during an office procedure.

10. What are the adverse effects from an overly aggressive labiaplasty?

The Labia Minora come in all sizes and shapes. Our bodies differ. Consider how noses and ears are different sizes and shapes. The main thing that troubles patients with a “botched labiaplasty” is emotional upset with appearance. This can cause issues with sex because if we are not comfortable with how we look then it is more difficult to be intimate with another. There are less common instances when an over-aggressive labiaplasty can cause pain with sex but I would not worry about this. The most important things for sexuality to go well is to be in a loving relationship. This is a loving relationship with another – and also with yourself.

Were you questions among the ones Dr. Litrel answered here? If not, let us know! Ask during your next appointment, or call the office. And you can always check Dr. Litrel’s RealSelf profile where he answers questions about several types of vaginal reconstructive surgery and female pelvic health.

July 28, 2017

by James Haley, MD, FACOG, FPMRS

Dr. Haley photo

Dr. Haley

Below are the 7 FAQ’s about Hormone Replacement Therapy I’ve encountered in twenty-five years being an OB-GYN specializing in women’s health. The truth is, the real facts about Hormone Replacement Therapy (HRT) are hard to find! They are submerged in an ocean of misinformation surrounding women’s hormones, available hormone types, and ideas about what is “healthy” and “unhealthy” for women as they experience the sometimes confusing, uncomfortable and even painful symptoms of menopause.

Hormone Replacement Therapy (HRT) can help! Here’s what you need to know, summed up in 7 FAQs:

7 FAQ’s About Hormone Replacement Therapy (HRT)

What types of HRT are there?                                    

HRT is most often spoken of, and divided into, two categories:

Traditional

Sometimes referred to as “synthetic,” these FDA approved medications have in the past been the ones most commonly used for hormone replacement. A few of these could be classified as more “natural” rather than synthetic, as discussed below. Names brands can be very expensive, generics can be very inexpensive.

Bioidentical (sometimes referred to by people as “natural”)

These are compounded at special compounding pharmacies. There are some who claim that, because they are more “natural”, they mimic more of what ovaries produce on their own, and the body responds better, with less potential side effects, then with synthetic HRT. Is that true? See note below. Average cost of bioidentical HRT (BHRT) is approximately $30-$45, although it can cost a whole lot more at certain pharmacies. (Your doctor should help you stay away from those.) BHRT is often cheaper, however, then name brand traditional HRT.

Are Bioidentical hormones (BHRT) better?

I believe there are enough good studies that have now been done to be able to say, “Yes, it would appear BHRT is probably better than traditional HRT.”

This has been hard to prove with absolute certainty, and early on some of those involved with BHRT tried to make these claims without any supporting literature. Now there is much supportive literature out there to suggest it probably is the better way to go for hormone replacement. BHRT definitely allows for the greatest ability to create custom therapy best suited for you as an individual. It is very easy, and obviously better, to be able to add/subtract hormones or tweak doses according to individual needs, rather than having just a few doses of certain hormones to choose from in the traditional hormone route.

How do I know what hormones, and in what amounts, are right for me?

That is where the expertise of your Gynecologist comes in. Based on age, history, symptoms, whether you’ve had a hysterectomy, and other factors, one or more hormones will be suggested. On occasion, hormone levels (blood levels typically being the most accurate) will need to be checked, especially early on or after dose changes are made, but the MOST important factor is – how do you feel? Patient feedback is often a very reliable indication of how we are doing with the hormones chosen and the amounts of each.

If I have the following history, does that mean I can’t take hormone therapy?

  • Family history of Breast Cancer
  • Personal history of fibrocystic changes of the breasts
  • Prior breast cysts drained or benign lump removed
  • Smoker

NO, your history does NOT rule out hormone therapy. These are not contraindications.

Will hormone therapy help me with any of the above problems or symptoms?

HRT can certainly help with any of these, but be aware there are other health factors that can be, and often are, creating problems as well. These include underlying thyroid issues, adrenal gland stress or fatigue, food sensitivity/intolerance, gut immunity or imbalance issues, inflammatory issues, or autoimmune disorders.

What is the best way to receive HRT?

Usually through the skin (such as a roll-on gel), or else under the skin. For most women, oral hormone therapy tends to get broken down in the stomach so that less hormone absorbed, and in a less predictable amount. (On an individual basis, someone may find the oral route works better for them, and that is fine.)

How long should I stay on HRT?

Indefinitely! We know menopause starts an accelerated aging process, with all the potential day-to-day problems, as well as long term problems, that were described earlier. Knowing that, would it make sense to use HRT for just a short period of time? No, not at all.  All the benefits a woman gets from HRT will be lost over time once she quits. So, when you make the decision to start HRT, make it for life (unless your doctor gives you a specific reason you need to stop).

One final note, since a woman’s time in menopause and hormone therapy use are very important matters, it is critical that your gynecologist is current on HRT and it is of interest to them. At Cherokee Women’s Health Specialists, all of our physicians are all up-to-date on the most recent information on menopause, as well as all health matters.

Your quality of life is critical, and I urge you to take care of yourself to enjoy your menopausal years and make them the best you possibly can.

Have you read Part One of this series? Here it is: Menopause Part One: 6 Things Every Woman Should Know

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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.”
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