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November 14, 2018

By James P. Haley, MD, FACOG, FPMRS

Overweight woman in pain PCOS photoCan Your Weight Be a Factor?

Polycystic Ovary Syndrome, or PCOS, has recently received a great deal of exposure in the media. 5 to 10% of women in the United States suffer from this condition. It is one of the leading causes of infertility, yet fewer than 50% of those women are diagnosed correctly. That amounts to a staggering 5 million women!

What is PCOS?

Polycystic Ovary Syndrome is a genetic hormonal endocrine disorder that disrupts the menstrual cycle often resulting in anovulation (not ovulating) during a women’s childbearing years. Women suffering from PCOS will have disruption of normal female hormones and produce higher than normal levels of the male hormone, testosterone, (hyperandrogenism). This imbalance can cause a growth of numerous small cysts filled inside the ovaries, (hence the name “polycystic.”) The ovaries are often enlarged. These cysts are follicles that house eggs that have never matured due to the glut of male hormones inhibiting ovulation.

Most PCOS sufferers (possibly all) are also more resistant to insulin. This leads to further problems, including weight gain and susceptibility to developing diabetes.

Dr. Gandhi Discusses Polycystic Ovary Syndrome: “PCOS is often missed as a diagnosis.”

What are the Symptoms?

Because it is a genetic condition, Polycystic Ovary Syndrome can begin in utero, but symptoms only usually begin to occur when a female begins puberty. These include:

  • Obesity or undesirable weight gain
  • Absence of, or irregular periods
  • Heavy, prolonged menstruation
  • Excessive hair growth on face, neck, buttocks, and chest
  • Skin issues such as acne, psoriasis, skin tags, etc.
  • Male pattern baldness
  • Hair loss (alopecia)
  • Mood swings
  • Inflammation which may cause brain fog, joint pain, aches and fatigue.
  • Depression
  • Glucose intolerance
  • Patched, dark skin in creased body areas such as thighs, underarms, nape etc.
  • Difficulty becoming pregnant
  • Abdominal pressure and pain
  • Pregnancy complications- i.e. miscarriage, premature birth etc.

What Causes PCOS?

There are varying theories as to what causes PCOS. Because it is believed to be genetic, daughters of women with a history of it are very likely to suffer from the condition too. This may start as early as in the womb when they are exposed to the same oversupply of androgens as their mothers.

Insulin is produced by the pancreas to extract food sugars for energy. PCOS causes women to produce too much insulin. As a result of insulin resistance which, in turn, stimulates more over-production of androgens. These male hormones interfere with ovulation, impacting fertility. Male hormones then dominate female ones, resulting in some of the masculine characteristics mentioned earlier.

Since other factors can also contribute to surplus androgen development, medical science is still trying to pinpoint the exact cause of PCOS.

How is PCOS Diagnosed?

There is no actual test to diagnose PCOS. It is a matter of eliminating other disorder possibilities until the diagnosis of PCOS is reached.

Two primary symptoms of PCOS:

1) A history of skipping periods

2) Elevated androgen hormone levels (hyperandrogenic effect) alert physicians to suspect that a woman may have PCOS. Being overweight or obese strengthens the possibility, especially in females with more upper body fat. Weight gain in this area is more male-related, thus indicating the existence of higher testosterone levels.

This diagnosis is derived through:

  • Menstrual history
  • Blood tests
  • Gynecologic examination
  • Pelvic ultrasound
  • Evaluation of family medical history
  • Visual and reported confirmation of other common PCOS symptoms.

Does PCOS Cause Weight Gain and Obesity, Or Is It the Other Way Around?

Not every woman diagnosed with Polycystic Ovary Syndrome is overweight, but approximately 80% are. Other female family members tend to be overweight or obese as well. Realize, however, that PCOS causes weight gain for most patients, but being overweight or obese does not “cause” PCOS.

What are the Risks of PCOS?

Overweight and obesity alone can cause severe health problems. Compounded with PCOS, the following risks are elevated:

  • Diabetes or pre-diabetes: It is estimated that more than half of women suffering from PCOS will develop the disease by the age of 40. Diabetes is so serious that it aversely affects health more than almost anything else.
  • Cardiovascular disease and heart attack: Carrying around unhealthy weight can raise anyone’s risk of cardiovascular disease. However, compounded with other PCOS-related problems, women with Polycystic Ovary Syndrome have a 4 to 7 time higher chance of having a heart attack.
  • Endometrial cancer: A natural buildup occurs monthly on the uterus lining (endometrium) which is sloughed off during menstruation. Infrequent periods can result in an accumulation, leaving PCOS sufferers three times more likely to develop endometrial cancer that can occur as a result of this surplus.
  • Abnormal lipids: Insulin resistance, too much body fat, and the production of excessive androgens can wreak havoc on the delicate balance between good and bad cholesterol.
  • Obstructive sleep apnea: This is a dangerous condition of abrupt breathing cessation during sleep, characterized by snoring, gasping, choking or continual awakening. It can lead to serious issues such as hypertension, cardiovascular problems, sleep deprivation, etc. Overweight and additional male hormones contribute to the condition.
  • Hypertension: PCOS-related symptoms like obesity and hormonal imbalance may raise blood pressure.
  • Metabolic syndrome: Women with PCOS are at higher risk for having two or more of the above risks.
  • Breast cancer: Though it is not proven that PCOS causes breast cancer, PCOS sufferers with a family history of it are more susceptible to the disease than those without.

Can PCOS be Controlled?

Though it is a lifelong condition and a leading cause of infertility in women, PCOS can be controlled, especially if treated early.

What are the Treatments?

Once it is established that you have PCOS, your doctor may recommend some or all of the following:

  • Lifestyle changes: You will be encouraged to follow a healthy diet and to exercise regularly if you need to lose weight. Even less than 10% loss can have a tremendously positive impact on ovulation and fertility problems. If you smoke, you will be told to stop. Smoking elevates androgen levels.
  • Medications: Birth control, other hormone-controlling drugs, and diabetes medication may be prescribed.
  • Electrolysis or other hair removal options may be recommended.
  • Surgery when warranted may be considered.
  • In vitro fertilization (IVF): If all other interventions are unsuccessful, your physician may propose IVF, providing you are deemed healthy enough to undergo treatments.

PCOS -prescribed medications may have strong side effects, or become more potent with steady, consistent weight loss. You will have to be monitored and tested regularly to insure proper dosage for your continuing good health.

How Can Cherokee Women’s Health Specialists Help Me?

Our broad-based establishment has specialists at your disposal to deal with all PCOS irregularities. Doubly accredited, board-certified urogynecologists holding enviable degrees in OB/GYN and Female Pelvic Medicine and Reconstructive Surgery (FPMRS), nutritionists, specialists in holistic medicine, and more professionals are available. We are trained to diagnose, treat, and encourage you throughout your struggles with Polycystic Ovary Syndrome until and after a healthy and manageable level is reached.

You are the best judge of any bodily changes that might be of concern. By seeing a physician immediately when you suspect something is wrong, you stand an excellent chance of correcting troublesome symptoms of PCOS before they become detrimental to your reproductive health.

To book an appointment to further discuss PCOS, call 770.720.7333.


November 8, 2018

by James Haley, MD, FACOG, FPMRS


Holiday parties are here. Yes, it’s great to see friends and family – but it can be exhausting and sometimes downright stressful.

Whether you’re getting ready for family photos, the annual work party or a neighborhood get-together, a quick cosmetic treatment with Botox and fillers just might be the best gift you could give yourself this holiday season.

3 Reasons to Consider a Holiday “Pick-Me-Up”:

1. HELP! I know it’s normal, BUT… can I lose these crow’s feet and frown lines for just a little while?
Those pesky lines between your brows, or those little wrinkles at the corners of your eyes, are your badge of honor for living life to the fullest. But sometimes you might want them less…noticeable. Just one treatment of Botox can help smooth those lines away.

Botox is one of the most extensively studied esthetic treatments, used for facial injections to “freeze” muscles so they can no longer form habitual lines and wrinkles. The most amazing benefit of Botox is that facial lines and tell-tale signs of age are wiped away.

2. Finally, I can see my cheekbones! Now how about some baby fat to plump them back up?
As we age, fat may accumulate on the body, but it actually diminishes in certain areas such as the face, neck and shoulders. Dermal fillers help restore plumpness and lost fullness to relieve facial “furrows.” A filler is an injectable FDA-approved substance designed to take the place of lost fat beneath the skin. A single filler treatment will restore plumpness and fullness for a more youthful face.

3. I’ve got the holiday blues – can I have a little mood lift?
One of the most surprising effects of Botox has emerged from several recently published studies: the potential to relieve some depression (and not just because you look better).

Studies performed in Hanover Medical School in Germany in 2012 found that Botox injections in facial muscles involved with emotion eased the symptoms of depression. There appears to be a link between the emotions expressed by the face and the brain, a “feedback” cycle transmitted through the nerves. When Botox is injected into facial muscles, frown lines are not able to physically form. Our brains interpret the feedback from our facial nerves as more positive feelings. Three small subsequent studies from a researcher at Georgetown University appeared to confirm these findings.

Why Choose Cherokee Women’s Health Specialists?

Our double board-certified physicians know and understand a woman’s anatomy from head toe — and Dr. James Haley has been certified and trained in injectables since 2007 — so whether your reasons are 1, 2, or 3, Botox and dermal fillers can help you feel refreshed and renewed for the holidays.

Call today to schedule a free consultation at 770.720.7733.

October 19, 2018

How One Patient Got “the Fireworks” Back in Her Marriage

The O-Shot is a treatment available for women which can have a positive effect on her relationships and desire to be intimate.

In the video, Dr. Litrel explains how the O-Shot works, and shares the stories of patients who have experienced changes in their relationships with the O-shot treatment. “I have one patient in her early 30’s with two children, ages 2 and 5, who experienced such a drop in her sex drive that she said it was affecting her marriage,” Dr. Litrel explains.

Dr. Litrel Shares What He Has Seen In Patients Receiving the O-Shot

“It’s quite common for women to have decreased sexual desire after having children! After meeting with my patient several times and trying different hormone approaches, and noting a normal exam, I recommended she consider the O-Shot. This is a treatment that injects platelet-rich plasma from a woman’s own blood into her genitalia to help with sexual satisfaction. It takes about five minutes for the procedure, performed right in the office, and only about 30 minutes total.

“When she returned five or six months later to my office,  she let me know she was delighted with the changes she had experienced. She had the fireworks back in her marriage. She told me she “felt hope” that her children didn’t destroy her desire to be intimate with her husband.”

Dr. Litrel concludes, “This is technology that was not available a few years ago. With such an easy procedure to perform, it’s very rewarding to be able to provide this now for our patients.”

The O-Shot can also help treat urinary incontinence, as Dr. Litrel discusses in this video.

oshot-graphic free ebook link

To schedule an appointment, call our Canton or Woodstock offices at 770.720.7733.

October 10, 2018

photo of an attractive woman in perimenopausePerimenopausal symptoms can be confusing. Along with the usual hot flashes and night sweats, you may also experience some lesser known symptoms such as extreme fatigue, anxiety, and racing heartbeat, along with a myriad of other symptoms.

Lisa Haley, wife of Cherokee Women’s Dr. James Haley, understands this all too well since she entered menopause at an early age. As she entered perimenopause, she began to experience lesser known symptoms. Even married to an OB-GYN — and familiar with the classic signs — Lisa didn’t recognize her unusual physical and emotional fluctuations as being perimenopause-related.

Lisa Talks About Her Experience

We talked to Lisa about her experience with perimenopause and menopausal symptoms. She didn’t understand what was happening at the time and hopes by sharing her experience that women may better understand the signs of perimenopause.

Q: Hold old were you when you began to experience perimenopausal symptoms and what were those symptoms?

Lisa: I was only 40 when I began to feel different. If I’d had hot flashes, night sweats — any of those universally known symptoms — I would have recognized it as perimenopause right away.

I was always a high-energy, laid back, and easy-going person. I never had any problems keeping up with my kids, aged 11 and 7 at the time. I could throw myself into their extracurricular activities, volunteer for different events, look after my home, attend family functions, play tennis, exercise, and still have enough stamina left over for more. I did it all cheerfully and enjoyed every second.

The Symptoms Overtook Me

Suddenly, though, I found myself moody, snappish and easily upset. I started having frequent heart palpitations, which terrified me. Was I having an anxiety attack — or worse — a heart attack? I was young and in peak physical health and couldn’t understand what was happening to me. At times, I felt like I was losing my mind, but I forced myself to act normally, especially since the anxiety and palpitations would eventually go away.

I began to lose focus and interest in all the things that I loved doing before. I didn’t feel well. It was even difficult for me to get out of bed.

Then, an overwhelming sense of exhaustion overtook me. At times, I could barely stay awake. I had no control over it. No matter how hard I tried, I would doze off, almost without warning.

One day, I was driving when that unusual fatigue came over me. I could feel my eyes closing against my will. I pulled into the first parking lot I saw and turned off the motor. ‘I’ll just rest my eyes for minute and I’ll be okay,’ I convinced myself.

I woke up two hours later to the sound of my phone ringing. It hit me then just how perilous a situation I’d put myself in. Here I was, alone and sound asleep for hours in a strange, empty parking lot. Anything could have happened to me!

Getting Tested

That night, I finally told my husband Jim what was happening to me. He immediately recognized my symptoms as being perimenopausal. He arranged to have me tested to rule out any other conditions. One of those tests checked for levels of estrogen and follicle stimulating hormone (FSH). In perimenopause and menopause, estrogen levels fall and FSH levels rise, determining whether the body is either entering or has entered these life cycles.

Though Jim was certain that I was in perimenopause despite my early age, we were both stunned to discover that my estrogen, progesterone, and FSH levels indicated that I was at the very cusp of full menopause.

Hormone Replacement Therapy

I was immediately placed on hormone replacement therapy (HRT). Women who no longer have ovaries, a uterus — or neither — are usually given estrogen only. Since my uterus and ovaries were still intact, I was given both estrogen and progesterone, the latter to prevent endometrial cancer. I began taking it regularly and within three days, I felt like myself again!

Q: There’s so much negativity and controversy regarding HRT. Weren’t you afraid?

Lisa: Not a bit! It gave me back my quality of life. I was monitored carefully. None of the risks I had prevented me from taking estrogen and progesterone, like a history of breast or ovarian cancer, blood clots, stroke, liver disease, or vaginal bleeding. I don’t smoke either, so I was a good candidate.

Dr. Haley tells you what you need to know in this informative video about bioidentical hormone replacement therapy.

Q: How long were you on HRT and isn’t it dangerous to use for extended periods?

Lisa: I’m still on it, and I’m still doing fine. I took synthetic hormone replacement in pill form for eight years. Three years ago, I switched to bioidentical hormone replacement therapy, which is a natural, plant-based formula made up of hormones that molecularly are nearly identical to the body’s own hormones. This type of therapy can be adapted to each woman’s individual needs. Though synthetic HRT is perfectly safe in the right dosage, and as long as you have no risk factors, bioidenticals are more natural, and therefore considered more compatible to a woman’s needs. In my case, the cream — which I apply to my arm daily — is made up of progesterone, estrogen and a bit of testosterone. Testosterone is necessary to maintain good muscle and bone health and it also helps regulate mood.

HRT For Life

I’ll most likely be on HRT for life. These hormones are necessary and must be replenished regularly. My mother is 76 and will also be taking HRT for life. She has never had any problems or side effects either.

Without HRT, the body would eventually deplete its own resources and the symptoms I experienced would come back — possibly worse than ever — and possibly accompanied by even more dangerous ones. To me, the choice is obvious.

Cherokee Women’s Health Can Help

If you have questions about perimenopause or are experiencing symptoms, please call 770.720.7733 to make an appointment with one of our providers.

October 9, 2018

By James Haley, MD, FACOG, FPMRS

woman with prolapsed bladderLiving with a Prolapsed Bladder

As GYNs, we address bladder issues on a daily basis, so when we discovered that our longtime patient suffered from a prolapsed bladder, we asked her to share her story of life before — and after — bladder surgery.

“I knew every bathroom in town,” recalls Gabrielle, a vibrant woman in her mid-50s, a common age for women to experience bladder problems. “I never leaked – but I had to use the bathroom ALL the time,” she explained. “My husband used to complain, ‘I hate running errands with you because you have to go to the bathroom at every stop.’

“It started in my late 40s, when I began getting this weird feeling that my bladder had ‘fallen’. It got worse and worse, and it just became this constant pressure. It affected everything. When I exercised it was never painful, but I felt this constant sensation of pressure.

“I finally talked to my GYN, and he said it was caused by a prolapsed bladder.”

What is Prolapsed Bladder?

Prolapsed bladder, also known as Fallen Bladder or Cystocele, is a condition where the bladder drops down from lack of support. Pelvic floor muscles and tissues hold the bladder and other organs in place, but they can weaken over time. This causes the bladder to descend from its fixed position and slip downwards into the vagina. In more severe cases, the bladder may dangle completely outside of the vagina.

What Causes Prolapsed Bladder?

There are four main reasons a woman may develop a prolapsed bladder:

  • Childbirth: A difficult delivery, long labor, a large baby or multiple births
  • Strain: Heavy lifting, strained bowel movements, excessive coughing
  • Menopause: Lack of estrogen, which is vital in maintaining the health of vaginal tissue
  • Obesity: Excess weight, which puts undue strain on pelvic muscles and tissues

What are the Symptoms?

  • Sensation of pressure in the bladder or vagina
  • Leakage of urine when coughing, sneezing, laughing, etc.
  • Protrusion of tissue from the vagina
  • A sensation that the bladder is not completely empty right after urinating
  • Difficulty urinating
  • Pelvic pain or discomfort
  • Painful intercourse

Life After Treatment

Gabrielle relates that she was given multiple treatment options but ultimately chose a permanent treatment solution called a surgical bladder lift. “That surgery literally changed my life. It’s been five years, and I’ve never had a problem. AND no more crazy bathroom trips!”

When Should You See Your Doctor?

If you notice that you have any of these symptoms and you suspect a prolapsed bladder, you should see your doctor immediately. This is not a condition that repairs itself. It usually worsens over time. However, it can be fixed, thanks to many modern methods available today.

Why Our FPMRS Specialists are Experts in Bladder Prolapse

Our board-certified OB-GYNs Dr. Michael Litrel, Dr. Peahen Gandhi, and Dr. James Haley have earned board certification in Female Pelvic Medicine and Reconstructive Surgery. FPMRS is a surgical sub-specialty addressing the problems women experience with the changes to their anatomy from having children and pelvic prolapse. FPMRS surgeons are also known as ‘board-certified urogynecologists.’ Cherokee Women’s Health Specialists, PC, has unique surgical expertise in the Southeast United States as an OB-GYN practice with three board-certified urogynecologists.

To schedule an appointment, call our office today at 770-720-7733.

o-shot photoA Real Patient’s O-Shot Experience, by Lauren Barnes.

As I sat in the stirrups waiting for my doctor to come in and give me an O-Shot, in other words, to inject my vagina with a shot of my own blood (PRP), I had to remind myself of why I was there in the first place. I was a bit nervous, but confident that what I was about to endure was the right decision for me.

How it All Started

Last February, I was having one of those days where I just wanted to cuddle up in bed and watch old movies all day. It was rainy, cold, it had been an exhausting week at work, and my kids and husband were getting on my last nerve. I just wanted some “me” time, and quite frankly, I was long overdue for a day to myself.

Cuddling up in my spot in bed, I began flipping the channels. Much to my amazement, I came across one of my all-time faves from the 80s, “When Harry Met Sally.” Classic love stories never get old and I smiled to myself as I started watching, knowing that it was just what I needed.

Even if you haven’t seen the movie, you’ve probably heard of the famous scene where Sally (played by Meg Ryan) graphically acts out a fake orgasm in a restaurant. The room gets deathly quiet as all eyes are on Sally, then another woman promptly tells her waiter, “I’ll have what she’s having!”

The movie came out in the late 80s, and at that time, acting out an orgasm was a bit progressive. Boy have times changed. But after thinking about it for a few minutes, I found myself feeling sad. I realized that I used to have real orgasms just like that. Really. No acting required. What’s happened to me? Why has it changed over the years? This isn’t fair!

Time for a Change

Suddenly my afternoon of movie bingeing became an afternoon of self-reflection. As I’ve gotten older, it’s been rough facing all the shocking truths about my aging body. Health problems here and there, loss of eyesight, aging face, gray hair, menopause, and the ever-increasing weight gain. None of it is easy to face, and aging is not for sissies. It really sucks. But I haven’t really stopped to think about how sex has changed over the years, how it once was, and what it has become for me.

I have a fantastic marriage and husband, so it’s not really about that. It’s more about the feeling during sex — at one time, being practically “earth-shattering,” and then progressing to just being okay or ho-hum. It’s been a slow, gradual decline in pleasure. I can read about it and explain all the medical reasons why, but it’s sad to think that it will most likely continue to get even worse.

I Decided: “I’ll Have what She’s Having!”

The facts are that I’m over 50 and I’ve had three children. I love where I’m at in life and am honestly very grateful. But wouldn’t it be nice if something could bring back that feeling that was once there?

I heard about the O-Shot procedure from a friend who had great results and recommended her doctor to me. I read up on the procedure and scheduled an appointment with Dr. James Haley at Cherokee Women’s Health in Woodstock, GA. Three of the MDs at their office, including Dr. Haley, are double board-certified in OB-GYN and Female Pelvic Medicine and Reconstructive Surgery. I knew if I was going to get a shot in the vagina, I was going to a vagina expert!

In and Out in 35 Minutes

When I first went in the exam room, the nurse drew my blood, and then my doctor placed numbing cream inside my vagina. This cream was left in place for 20-25 minutes, while they spun my blood in a centrifuge. They then injected my platelet-rich plasma into my clitoris and vaginal wall. Although I slightly felt the shot, it was not painful. I was in and out of the office in 35 minutes. It wasn’t a big ordeal at all, and I had no problem driving myself back to work.

Amazing Results

I could hardly wait to test it. The next day, I positively noticed more feeling in my vagina. It was a warm feeling, as if more blood was circulating, a feeling I recognized from ages ago, but had been reduced over time. When we were finally alone, I practically jumped on my husband. I can honestly say that it was incredible. I hadn’t felt that intense of a feeling during sex for a very long time. And the orgasm was much stronger and longer lasting than it had been in decades. I was blown away, literally, and so thankful to get that feeling back.

5 Months Later

Does it stand the test of time? So far so good. It’s been five months, and it’s still doing the trick. It was a bit more intense the first couple of weeks, but it’s still incredibly better than it was before the shot. Dr. Haley has told me that I can expect it to typically last for a year and possibly longer. As soon as it starts to wear off, I will absolutely be getting another one. It is completely worth it to me.

Highly Recommend

Would I recommend the O-Shot to my friends? Definitely. I know some women who have had the procedure and all have reported positive results. A couple of women have told me they have more intense orgasms, and one has told me her urinary incontinence is much improved.

For me, I think I could do my own personal restaurant scene from “When Harry Met Sally” now, but just for my husband — who by the way, is one very happy guy.

O-Shot To Help Treat Sexual Dysfunction and Urinary Incontinence

Dr. Litrel discusses how the O-Shot can help treat both sexual dysfunction and urinary incontinence so you can help get your life back on track.

oshot-graphic free ebook link

For more information or to make an appointment, please call 770.720.7733.

September 26, 2018


12 Tips Change Your Mind and Your Body 

“Exercise. Eat right. Move more. Don’t snack.” Sure, we’ve all heard these things a million times when we’re trying to get healthy, lose weight or feel better. And sure, they make perfect sense. But when you’re feeling bad about yourself, or keep the same negative thoughts keep looping in your brain or you’re surrounded by negative people, getting motivated to actually do these things can be nearly impossible.

Change Starts with Positive Thinking

12 tips will help you get on the path to healthy living today!

  1. Let go of grudges: Resentment serves no purpose other than to absorb happiness. Clear up minor grievances. If resolution is impossible, walk away. When anger bubbles up, invading your thoughts, distract yourself. Write a grocery list or scrub your floors. Vent bitterness constructively.
  2. Toot your own horn: No one likes a braggart, but your accomplishments deserve merit and validation. Be your own cheerleader. Wave your own pom-poms for a while. Success generates incentive to achieve more and better things.
  3. Be grateful: Record at least one good thing in a daily ‘blessings’ journal that happened that day, even if it was just drinking a perfectly brewed coffee. Then, when life seems overwhelming, go back and read your entries.
  4. Laugh: There’s a reason they say laughter is the best medicine. Laughing’s fun but it also releases endorphins so you feel more energized. And that’s just what the doctor ordered to help you get out the door and walk a trail, take a class or just soak up nature.
  5. Avoid Debbie Downers: Surround yourself with positive people. If your social circle includes a whiner who constantly wallows in self-pity or finds something wrong with nearly every situation, step away. You’ll feel emotionally drained and that in no way will motivate you to better health.
  6. Encourage yourself: “You is kind. You is smart. You is important.” There’s a reason this quote from the movie “The Help” resonated with so many people. We all need to feel like we matter but and the best way to feel that is to feel it within. It’s nice to hear it from someone else but nothing means more than actually feeling and believing it ourselves. Leave positive notes on your mirror, in your car, wherever you’ll see it every day. It works!
  7. Volunteer: It’s true what they say, when you volunteer to help someone or some cause, you actually benefit more than the person you’ve helped. It gives us such gratification to know that we’ve helped someone. If you’re feeling down, you may not think you have the strength to help others but if you start with baby steps, you’ll find you’ll want to do more and more. And with each step, you’ll feel better and better.
  8. Expect the best: Don’t create negative, self-fulfilling prophecies. Can you imagine if the Olympic athlete told herself she couldn’t do it just before she stepped on the mat and competed? Make a habit of telling yourself you CAN do and you WILL do it. Because you can!
  9. Relax: Your body and mind need tranquility sometimes. Meditate. Listen to calming music. Cuddle up with your cat and lose yourself in its purr. Quality, quiet downtime will help give you strength and mental preparedness to help you get out there and tackle what needs to be done to achieve better health.
  10. Don’t sweat the small stuff: And it’s all small stuff, right? Standing your ground for important issues is admirable but going ballistic over a smeared glass or a perceived insult not only raises your blood pressure but it puts you in a negative state of mind. If it won’t matter six months from now, let it go.
  11. Stop the negative loop: We all have them. Those same negative thoughts that play over and over in our heads when we’re not feeling great about ourselves. Some of us have even held onto these thoughts since we were kids. Not only are they destructive but they’re usually not true. We’re all worthy of love, health and happiness and it’s crucial to remind ourselves of that, every second of every day. So change the recording in your head and start being kind — and truthful — with yourself and you will start feeling better and more motivated to make good changes in your life!
  12. Be kind: Being kind is infectious and it takes so little to make someone happy, which in turn will make you happy! So do something nice for someone every day. Whether it’s just a compliment or you buy a stranger a cup of coffee. Kindness strengthens self-worth and that’s exactly what we need to obtain better health.

woman with hot flashesHRT, which stands for hormone replacement therapy, is exactly as the name implies — a treatment to replenish flagging hormones within the body, specifically during menopause.

Why and When is HRT Used?

HRT is usually administered for women between the ages of 40 to 65, and sometimes earlier, when menopause begins and whose lives are severely affected by menopause. Still, you should always be made aware any potential health hazards.

If you have entered this midlife stage, you may be experiencing some of the many physical and emotional changes, such as menstrual cessation, mood swings, night sweats, sleep problems, and vaginal dryness, to name only a few of the more common disruptions. These are due to the decline of the hormones, estrogen, progesterone, and testosterone.

Estrogen and progesterone are the hormones that keep your reproductive system in good running order throughout life, especially during your childbearing years.

Testosterone contributes to good bone and muscle maintenance, energy, mood, and sexual interest (libido).

What are the Different Blends and Kinds of HRT?

There are several different formats and types:

  • Estrogen-alone therapy (ET): This is prescribed for women in a medical menopause who are devoid of both their uterus and ovaries after having a complete hysterectomy.
  • Combined estrogen/progesterone therapy (EPT): Both hormones may be needed for women whose uterus and ovaries are still intact, and who are undergoing natural menopause.
  • Local estrogen: To be used topically by women experiencing extreme vaginal dryness and vaginal tract issues.

Depending on a woman’s individual needs, HRT comes in several forms:

  • Pills
  • Transdermal Patches
  • Gels
  • Vaginal rings
  • Creams
  • Sprays
  • Tablets

Dr. Litrel discusses menopause and hormone therapy in this video.

What Are the Risks Associated with HRT?

In the past, HRT was provided to compensate for hormonal dissipation and to ease the transitional effects of menopause. It made medical sense to replenish the diminishing hormones, thus staving off the unpleasant repercussions this waning had on women.

Mother Nature, unfortunately, did not always agree, and, though HRT helped many women, others had adverse effects such as:

  • Cancer of the endometrium: Estrogen alone is given to women in some cases during natural menopause to ward off certain symptoms, leaving them vulnerable to endometrial cancer. This is because menstruation would previously slough off endometrial cells, a process that stops after periods have ceased. This creates a cell buildup along the uterine wall (endometrium) which can lead to cancer.
  • Progesterone is needed in tandem with estrogen to prevent this.
    Women who have had hysterectomies do not need progesterone because, lacking a uterus, they are no longer susceptible to this particular cancer.
  • Breast cancer: Studies show there is a slight increase in women developing breast cancer while using HRT. Women receiving estrogen therapy, especially over a period of many years, are at higher risk.
  • Venous thromboembolism (VTE): HRT can contribute to the formation of blood clots in the deep veins of the groin, legs. or arms which can subsequently detach and travel into the lungs, leading to pulmonary thrombosis. Risk lessens when HRT is administered in non-oral form.
  • Heart Attack: There is a small risk of heart attack associated with use of combined HRT.
  • Gall bladder disease: Oral HRT increases risk.
  • Unpleasant mood changes and lowered energy: Some forms of HRT, especially when taken orally, can lessen androgen production.
  • Stroke.

Dr. Haley discusses bioidentical hormone therapy in this video.

What are the Advantages of HRT?

Hormone replacement therapy can be beneficial for many menopausal symptoms caused by a woman’s natural depletion of estrogen and progesterone. Minor symptoms may be alleviated, such as:

  • Hot flashes
  • Mood swings
  • Night sweats
  • Vaginal dryness
  • Sleep disturbances
  • Dryness leading to painful sex
  • Adult acne and other skin disorders
  • Urinary tract infections.

More severe complications of menopause can also be mitigated with HRT, such as:

  • Osteoporosis
  • Elevated cholesterol counts
  • Heart disease
  • Diabetes
  • Risk of fracture
  • Colon cancer prevention: Combined estrogen and progesterone therapy appears to lower the risk of developing colon cancer.

Am I a Good Candidate for HRT?

As long as you do not have any risk factors, but find that your symptoms are impacting you negatively, you should discuss if HRT is right for you with your doctor. Additionally, if there is a history of osteoporosis in your family, HRT may be advantageous for you.

There are also many lesser known symptoms attributable to menopause, so you should always be forthcoming about any emotional or physical changes that are occurring during midlife to rule out other disorders. Your health care provider is the best judge of whether HRT can help you. They’ll also decide if you need it short -or long-term.

How Long Can I Take HRT?

Doctors are now initially prescribing HRT in the lowest dose possible, making modifications as necessary until effectiveness is achieved.

All potential risks must be taken into consideration based on thorough disclosure of your symptoms, medical history, family history, and lifestyle. This is vital to insure the best outcome for your individual needs, and whether the benefits outweigh the risks. At one time, it was thought that taking HRT for five years or less posed no danger, but recent findings proved that, depending on the individual, there can be problems even during this short time span. Other women may not be negatively affected at all.

Today, women using HRT are being prescribed lower doses than before. There are also different methods available besides the past standard oral prescriptions. Vigilant and regular monitoring can alert us to any issues that may arise so that you can receive immediate intervention.

Who Should Avoid HRT?

Women with a history of the following issues are cautioned against using HRT:

  • Breast cancer
  • Liver disease
  • Uterine cancer
  • Vein, leg, or lung blood clots
  • Cardiovascular disease.

Are There Other Options to HRT?

If you wish to avoid HRT, or are not a good candidate for it, there are several other medical and natural remedies you can try.

These include:

  • Exercise: Regular exercise strengthens bones, elevates mood and keeps your heart and other organs at peak performance.
  • Diet: Many plant-based supplements that contain natural estrogen called phytoestrogen. This can be found in flaxseed, red clover, fenugreek, sesame seeds, beets, lentils, wheat germ, ginseng, carrots, apples, black cohosh, mint, and many other sources. Bioidentical hormone replacement: These plant-derived hormones are molecularly identical to those found in the human body and are often used as alternative for women unable to use HRT.
  • Lubricants: Vaginal lubricants can decrease dryness and pain during sex.
  • Regular check ups: Annual visits to you doctor are essential for your continued good health.
  • Antidepressants: These can lessen mood swings.

To book an appointment to discuss your menopausal issues and obtain information about HRT, call 770.720.7733.

September 18, 2018
Midwife Susan Griggs, APRN, CNM photoWe often receive questions from expectant mothers about the different members and roles of our team throughout the pregnancy and delivery process. If you are wondering what the differences are between a midwife and an OB-GYN, you are not alone. Let’s take a closer look and break down what distinguishes an OB-GYN from a certified nurse midwife.

What Type of Education Does a Midwife and OB-GYN Have?

Both OB-GYNs and certified nurse midwives have extensive training to support you throughout your birthing experience. No matter which option you choose, you’ll be in good hands.
  • OB-GYN: An OB-GYN is a doctor who has studied 4 years of medical school, plus 4 years of residency and 3 more years of specialization.
  • Certified Nurse Midwife: A certified nurse midwife is a Registered nurse with an advanced Master’s degree in nursing and a certification by the American Midwifery Certification Board. Typically they study for 2-4 years (Bachelor’s degree), plus another 2 years (Master’s degree).

What Types of Care do Midwives and OB-GYNs Provide?

The most important thing is that you do what makes you feel the most comfortable and safe. It does not necessarily need to be an either/or decision; it is perfectly acceptable to see both a midwife and an OB-GYN. Ultimately, we encourage you to consider what you feel is best for you and your baby.


  • Can assist with hospital births and any surgical procedures including cesarean sections
  • Able to prescribe medication
  • Able to prescribe contraception

Certified Nurse Midwife

  • Can assist with home births, birth center births, or hospital births
  • Able to prescribe medication
  • Able to prescribe contraception

What is the Focus of a Midwife Versus an OB-GYN?

These two types of care providers are separate but complementary professions. They may also work together on a team to provide effective patient-centered care. When choosing your main care provider, it really boils down to what you feel you need.


  • OB-GYNs work in teams at Cherokee Women’s regardless of if you’re expecting a child or are coming for a routine gynecology check-up.
  • Trained to manage high-risk pregnancies, complications and perform surgery if needed (for example cesarean sections), offer epidurals or use instruments such as forceps and vacuums to facilitate delivery.
  • OB-GYNs are not typically present for the entire labor, as they are attending to more than one patient at a time.
  • Focus on prenatal care, surgical prenatal care, childbirth, surgical childbirth, women’s health, postpartum care, menopause care.

Certified Nurse Midwife

  • Midwives rely on clinical experience to provide expert care in normal pregnancies. They see birth as a normal, natural process, intervening only when necessary and not routinely.
  • Certified nurse midwives are present for labor support, often using more natural approaches such as breathing techniques and hydrotherapy.
  • Focus on prenatal care, childbirth, women’s health, postpartum care, transitional counseling (ex. nutrition and exercise, breastfeeding, emotional changes post-partum)

Things to Consider Before Making Your Decision

You may want to speak with family, friends and other health care professionals. Ask them about their own experiences and recommendations. Next, ask yourself some of the following questions in order to help you decide:
  • Is vaginal birth your priority?
  • Would you like a natural or medicated birth? Do you think there is a good chance you will want an epidural?
  • Do you want your caregiver with you during labor?
  • What are your plans for pain management?
  • What are you hoping will happen at the hospital?
  • Do you wish for more support and advice for your transition to parenthood?
  • Are you considered high-risk or do you have any complications such as diabetes?
  • What does your instinct tell you?

Final Thoughts

At Cherokee Women’s we are pleased to be able to offer flexible labor and delivery options. Our practice has two certified nurse midwives on staff. If you wish to have a midwife as a caregiver we do our very best to work with you to offer this type of care. We cannot guarantee that a certified nurse midwife will be available at the exact time of your delivery, but we will ensure that you and your baby are provided with the most competent, compassionate and safe care possible.
If you have any further questions, please do not hesitate to contact us or make an appointment at 770.720.7733. We are happy to help you to be more informed and feel as comfortable as possible throughout your pregnancy.
September 5, 2018

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!

Learn more or help Sherene on her mission to spread awareness by visiting the Georgia Ovarian Cancer Alliance site. The next Teal Trot will be September 15, 2018; to sponsor Sherene, visit her campaign page!

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.

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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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