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November 21, 2018

PMS photo of woman in pain

PMS (premenstrual syndrome) affects most women at one time or another. In fact, it’s estimated that three out of four women suffer from PMS regularly.

What is PMS?

Premenstrual syndrome refers to a cluster of physical and emotional changes a woman undergoes during the two weeks before bleeding actually occurs. This time frame is referred to as the ‘luteal cycle’. At the onset of her period, symptoms usually disappear.

What Are the Symptoms of PMS?

Symptoms of PMS are numerous and may include any or all of the following:

  • Erratic mood swings
  • Abdominal pain, pressure and cramping
  • Moderate to severe depression
  • Uncontrolled aggression and hostility
  • Uncharacteristic outbursts of anger
  • Brian fog or lowered concentration
  • Social isolation or withdrawal
  • Brain fog or mental confusion
  • Anxiety
  • Fatigue
  • Irritability
  • Difficulty sleeping, insomnia
  • Decreased or heightened sexual desire
  • Headaches, migraines
  • Tenderness in breasts
  • Weight gain
  • Joint pain
  • Swelling in feet and hands
  • Mental confusion
  • Unusual cravings, changes in appetite and thirst
  • Bloating
  • Fluid retention
  • Skin problems
  • Hair loss
  • Gas (flatulence)
  • Indigestion
  • Obsessive/compulsive behavior such as an overwhelming need to clean, organize, etc.
  • Suicidal thoughts or attempts
  • Dizziness or light-headedness

What Causes PMS?

The exact cause has not been pinpointed, but lowering levels of the sex hormones, estrogen and progesterone are believed to be key factors. Serotonin, a neurotransmitter responsible for feelings of well-being and happiness, also drops. Though this is a natural process, and necessary to prepare the body for reproduction, the monthly depletion can cause a hormonal imbalance, wreaking havoc on women physically and emotionally. If you are experiencing extreme discomfort and PMS is negatively affecting you physically and psychologically, do not hesitate to see your doctor.

What is Dysphoric Menstrual Syndrome?

Most women have mild to moderate cases of PMS which can be annoying, or at most, uncomfortable. These symptoms cause little or no disruption in their daily routines, and usually does not warrant medical help. However, about 5% of women with PMS suffer from what is categorised as dysphoric menstrual syndrome (PMDD), which is a far more severe and negatively impacts their lives. These women require more aggressive psychological or medicinal intervention.

The criteria to meet the diagnosis of PMDD is that the patient has at least five of the emotional symptoms mentioned above during their luteal cycle. The presence of these symptoms is usually more exaggerated. These are a few that we look for:

  • Suicidal tendencies
  • Anxiety or full-blown anxiety attacks
  • Extreme social isolation
  • Impairment or total collapse of relationships
  • Depression
  • Radical mood swings
  • Highly pronounced or non-existent libido
  • Inability to focus on or perform normal daily activities and tasks

Approximately another 20% meet the definition of ‘subthreshold’ PMDD, meaning that they may be monitored diligently to avoid full-blown PMDD. This particular disorder is classified as ‘menstrually related mood disorder’ (MRMD) and may also need some medicinal or psychological treatment. Like PMS, hormone dissipation during the menstrual cycle may be the underlying cause.

Are There Any Tests That Accurately Diagnose PMS?

There are no specific lab tests to diagnose premenstrual syndrome. Instead, we’ll need to study your medical history to establish if you are suffering from it. It is very important to be completely truthful so that we can help you. We know that some of these symptoms may be frightening to you, and perhaps, at times, embarrassing to discuss, but getting the full picture allows us to give you the best and most effective advice and care. Keeping a diary of your symptoms for a few months helps.

Three of the main things we look for are:

  • Have your symptoms been consistently bothering you several days before your period, and recurred for at lease three consecutive cycles?
  • Do they usually end on or within a few days of bleeding onset?
  • Have they negatively impacted your day to day routine and social life?

Even jotting down specific odd thoughts and ideas, levels of fatigue, etc., can be helpful. This allows us to properly determine which hormonal imbalance is affecting you more and enable us to deal with the more troublesome symptoms accordingly. Remember to list the dates as these symptoms occurred, and exactly when menstruation itself began and ended.

Can PMS be Treated?

Mild to moderate PMS can be fairly easily managed with a few lifestyle changes and over-the-counter pain relievers. Heating pads or warm baths may help with pain, and ice packs with headaches. Topical rubs and ointments can reduce inflammation and joint pain. You may be advised to limit or completely eliminate salt, alcohol, caffeine, sugar and any artificial sweeteners as they contribute to many sleep and anxiety issues.

Other recommendations to help alleviate PMS symptoms are:

  • Exercise regularly, throughout the month, not just when your problems appear. Try to get at least 30 minutes of brisk walking, jogging, dancing, etc. three times a week to elevate endorphins that counteract stress, pain and depression. Endorphins like serotonin, dopamine and oxytocin, are the body’s natural feel-good narcotics and pain killers.
  • Acupuncture or massage: Who doesn’t feel good after a spa day and a little pampering? And acupuncture is a time- honored holistic process that has been proven to be advantageous in treating many emotional and physical menopause symptoms.
  • Relaxation therapy: Yoga, meditation, breathing exercises, biofeedback, etc. go a long way to ameliorating PMS-related depression and anxiety.
  • Support groups and cognitive therapy: Discussing your symptoms and emotions with other women who can relate to them can actually lower numerous PMS issues.
  • Proper diet: A diet rich in vegetables, fruits, grains and protein can ward off various PMS problems. Avoid carbohydrates during this time.
  • Getting enough sleep: Disruptive or insufficient sleep can cause additional hormonal imbalances that can augment those already affected by PMS.
  • Eating smaller meals a day instead of three large ones can reduce gastrointestinal discomfort.

Some herbs and supplements may counteract PMS symptoms, although some have not been studied fully so it’s always best to get these from a healthy diet instead. Before taking them, it is recommended that you speak to your physician. Though they may help, the medications you already take may interact with them and cause adverse, sometimes dangerous interactions. Here is a list of the vitamins, herbs and supplements and the symptoms they may alleviate:

  • Calcium for calcium deficiency that many experts believe contribute to PMS and might stave off changes in appetite, fatigue, erratic emotions, physical discomfort, and depression
  • B6 vitamins for metabolism and immune response
  • Folic acid for lethargy and fatigue
  • Omega-3 for cramps, nausea, headache and fatigue
  • Chaste berry for breast pain, anxiety, depression, food cravings, headaches, cramps, water retention, and swelling
  • Magnesium for headaches, low blood sugar, dizziness, sugar cravings, and mood swings
  • Evening primrose for breast discomfort.
  • Gingko biloba for mood swings, flagging memory, low concentration, and breast tenderness
  • Dandelion leaf for bloating
  • Vitamin E for breast discomfort and swelling

For more severe PMS, your doctor may prescribe one or more of the following:

  • Diuretics
  • Antidepressants
  • Contraceptives
  • Hormone therapy
  • Prescription pain relief
  • Anti-anxiety medication
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)

How Can Cherokee Women’s Health Specialists Help Me?

Because we deal with women’s health issues daily, we are aware of the debilitating effects of PMS. We would never minimize the detrimental influence it can have on you and yours.

We are here to offer counsel, diagnosis, empathy, and treatment, using all our expertise and knowledge of the most up-to-date information medical science has to offer. Our staff includes three doubly accredited urogynecologists with the outstanding certification in OB/GYN and Female Pelvic Medicine and Reconstructive Surgery (FPMRS). This qualifies us to diagnose and treat all your female-related problems. Additionally, our staff includes specialists in other fields related to a women’s unique needs.

To book an appointment to further discuss your PMS symptoms, call 770.720.7733.






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.


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.

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 4, 2018

thinning hairYou always knew menopause would happen. You may have even looked forward to getting rid of those bulky pads, contraceptive devices, and tampons you’ve been using. You expected some hot flashes and maybe a few cranky days, but assumed those probably wouldn’t be much worse than getting through a long summer heat wave and then it would be all over. What you possibly didn’t know is that there are countless other symptoms that science is constantly learning about regarding the menopausal process.

If you’re between the ages of 40 and 65 — and in some cases even a bit younger — you may be suffering with those very symptoms right now. Your body begins to change several years before menopause actually takes place, during the period known as perimenopause. This is the time when periods start to become irregular, along with some other unwelcome physical and emotional developments that you never anticipated.

What are Some of the Lesser Known Symptoms of Menopause?

Menopause comes with many minor and major changes. Some women manage to get through the process with only a little discomfort. Others may be slammed with multiple symptoms, many of which occur gradually over time so that they may not even notice that they’re happening, or that one may be linked to the other.

Most menopausal changes are caused by the decline of three hormones; estrogen, progesterone, and testosterone. Progesterone and estrogen, produced by the ovaries, not only prepare a woman for reproduction during her childbearing years, but they impact the rest of her body’s health, both physically and emotionally. During menopause, the adrenal glands continue to produce testosterone, but those levels also decrease with age.

Some of the most common symptoms of menopause are:

  • Hot flashes and night sweats: Periods of intense heat course throughout the body, raising skin temperature. During sleep, excess perspiration may require the need to get up and change clothing or even bedding.
  • Mood swings: Depleting estrogen affects the production of the mood-regulating neurotransmitters of dopamine, and Mood swings can include euphoria, deep depression, panic disorder, and anxiety attacks.
  • Vaginal dryness and vaginal atrophy: As estrogen decreases, so does the body’s natural lubrication. The vagina can become drier, thinner, less elastic, irritated, and itchy. Sex and stimulation may become painful, lowering arousal and libido.
  • Complete menstrual cessation: After a full year of missed periods, ovaries reduce in size, terminating fertility, egg production, and pregnancy possibilities.

The following menopausal symptoms are not as common, but are also usually caused by the same hormonal shifts:

  • Forgetfulness, confusion, loss of focus, and difficulty concentrating: Decrease of estrogen and progesterone can provoke cortisol levels into becoming erratic, resulting in ‘brain fog’ and slower cognitive skill function.
  • Bloating: During perimenopause and early menopause, flagging hormones can create bloating. This often disappears when levels permanently stabilize.
  • Sleep problems: Dwindling hormones can trigger sleep disturbances such as interrupted rest, insomnia, waking up too early, or sleeping too long.
  • Burning tongue: This condition, simulates a fiery sensation in the mouth and tongue in about 40% of menopausal women. It can create a metallic taste, dryness, soreness, and tingling and is believed to be activated by a drop in estrogen.
  • Urinary and fecal incontinence or frequent urination: Significant changes to pelvic muscles damaged or weakened during childbirth, or waning estrogen can prompt more bathroom visits.
  • Thinning or loss of hair and brittle nails: Increase in androgens (male hormones) spur shrinkage in hair follicles. Bald patches, thinning, and undesirable ‘peach fuzz’ may develop, along with dry, brittle cracked nails.
  • Digestive problems: Constipation, indigestion, and gas can be attributed to cortisol levels affected by hormone reduction.
  • Headaches or migraines: If women experienced headaches before and during menstruation, this may continue throughout perimenopause and menopause. These often decrease or completely disappear after menopause.
  • Weight gain: Estrogen loss prompts fat redistribution to the abdomen, buttocks, thighs, and hips, resulting in that dreaded ‘middle age spread’.
  • Dizziness: Hormone fluctuations can disrupt efficient body and organ function, including the inner ear’s ability to provide balance, accounting for menopausal dizzy spells.
  • Increase in allergies: Ebbing hormones during menopause can accelerate histamine production, introducing new allergies or magnifying old ones.
  • Itchy skin, rash: Lubrication lost through lowered estrogen can spread throughout the body, contributing to dry skin, chafing from fabrics, and unpleasant reactions to soap and perfumes.
  • Breast sensitivity and pain (mastalgia): Hormonal spikes cause fluid buildup in the breasts, resulting in tenderness, swelling, and
  • Arthritis, joint, bone, and muscle aches: Estrogen minimizes inflammation. Loss of it intensifies aches, pains, stiffness, and
  • Irregular heartbeat and palpitations: Precipitated by hot flashes, these frightening sensations cause many women concern that they may be getting heart disease. Usually, this is not the case
  • Electric shocks: Often, these precursors to hot flashes radiate from areas on the head or extremities. It is theorized that these mild to severe jolts of pain can be ascribed to hormonal imbalances affecting the hypothalamus, or to neurons misfiring in the nervous system. Medical intervention is often necessary.
  • Change in body odor: Urinary or fecal odors arising from incontinence, pungent perspiration scents from hot flashes and night sweats, hormonal fluctuations affecting the thyroid’s impact on vaginal PH, producing a ‘fishy’ odor which can cause noticeable, unpleasant smells.
  • Tingling sensation throughout the body (paresthesia): Sensations like prickling, stinging, ‘pins and needles’, ‘crawling’ feelings, or numbness are experienced and are linked to the lubrication lost through estrogen drop.
  • Voice changes: As estrogen and progesterone diminish and testosterone rises, hoarseness, lowered pitch, and vocal fatigue after speaking too long are often overlooked menopausal symptoms.

Hormonal changes during menopause can contribute to several serious conditions in women, including:

  • Diabetes: Uncontrolled diabetes can be life-threatening. Estrogen and progesterone dictate your cells’ insulin behavior. Disrupted hormonal balances weaken that message, leading to blood sugar level chaos, and then diabetes. Complications such as heart attack and stroke may follow.
  • High cholesterol: Waning estrogen boosts harmful LDL cholesterol and decreases good HDL cholesterol, inviting a fatty buildup in the arteries. This can lead to stroke and heart attack.
  • High blood pressure (hypertension): Plummeting hormones weaken the body’s resistance to several dangerous health risks, including those of salt and the rapid rise of a woman’s body mass index (BMI).
  • Irregular heartbeat (arterial fibrillation): Moderate symptoms include fatigue, dizziness, weakness, and shortness of breath. More severe cases can develop into blockages which can trigger stroke, heart disease, and even death.
  • Osteoporosis: Bones become thinner, fragile, and more brittle from lack of estrogen and can lead to fractures and breakage.

How Can Cherokee Women’s Health Specialists Help?

Many menopausal symptoms are of little concern and often correct themselves given time. Others can be easily remedied through diet, exercise, hormone therapy, and/or other medications. However, all unusual symptoms that arise should always be assessed by a physician to rule out other causes.

Our broad-based practice consists of three board-certified, doubly-accredited urogynecologists who hold certification in OB-GYN and Female Pelvic Medicine and Reconstructive Surgery (FPMRS). Our staff also includes obstetricians, gynecologists, nutritionists, nurses, surgeons, medical assistants, experts in holistic medicine and diet, and other specialists who, combined, have decades of accumulated expertise in the unique field of women’s health care.

To schedule an appointment regarding your menopausal symptoms, call 770.720.7733.

August 23, 2018

It’s estimated that 20% of women suffer from depression during the time leading up to menopause (perimenopause) and throughout menopause itself. That means for every five women aged approximately 40 to 65, one may be suffering from menopausal depression.

What are the Signs of Menopausal Depression?

Everyone goes through extended periods of stress, which can often lead to temporary mild depression. When those emotions continue past a reasonable time frame, however, intervention may be necessary.

If you find some of the following signs have remained for prolonged periods during menopause, they may indicate depression. These are:

  • Absence of motivation
  • Fatigue
  • Low energy
  • Memory lapses
  • Excessive sadness
  • Aggressive behavior
  • Restlessness
  • Irritability over minor occurrences
  • Frustration
  • Sudden outbursts of anger
  • Irrational paranoia
  • Anxiety
  • Difficulty focusing or concentrating on everyday tasks
  • Unpredictable mood swings
  • Feelings of low self-esteem
  • Unwarranted feelings of guilt
  • Constant tension
  • Agitation
  • Apathy towards previously enjoyed activities
  • Difficulty making decisions
  • Crying jags or exaggerated emotional reactions
  • Difficulty sleeping or sleeping too much
  • Appetite changes (over-eating or not eating enough – possibly leading to eating disorders)
  • Experiencing unusual pain without medical basis
  • Feelings of deep despair

Sometimes I Feel Like I’m Going Insane! Why is This Happening?

Rest assured that you’re not alone. Menopausal depression is only partially, but not completely linked to hormonal changes within the body. As your ovaries age, they get tired and stop producing estrogen and progesterone, which are responsible for enabling fertility, menstruation and good reproductive health. Other parts of the body go into overdrive to try and make up for the loss. Fat cells, adrenal glands, and the hypothalamus struggle to make up the difference, but aren’t very efficient, causing internal balance disruptions.

The situation is similar to a substitute teacher taking over a class for a week while the regular one is off sick. She does her best but lacks familiarity with both the students and their curriculum. Though the class survives the temporary disruption, it does not function at an optimal level.

In your body’s case, the hypothalamus and pituitary glands produce more luteinizing hormone (LH) and follicle stimulating hormone (FSH) than normal to nudge additional estrogen production, but can’t quite pump out enough to maintain normal levels. Thus, serotonin and norepinephrine, which affect mood don’t get their regular dose of estrogen. Additionally, plummeting progesterone can cause sleep disturbances and erratic mood swings.

Most women can get through menopause with minimal discomfort, but for others whose side effects are much more dramatic, menopausal depression can have a psychological ripple effect when combined with the following occurrences:

  • Empty nest syndrome
  • Fear of aging and facing one’s mortality
  • Death of family members or friends
  • Hot flashes, palpitations, headaches and night sweats causing interrupted rest, full-blown insomnia, exhaustion, irritability and/or loss of focus and memory
  • Declining physical health
  • Negative body changes from aging, resulting in lowered self-esteem
  • Lowered libido resulting from vaginal dryness and sexual pain
  • Caretaking responsibilities of elderly relatives
  • Lack of emotional support from friends and family leading to feelings of isolation and aloneness
  • Divorce or job loss
  • Exposure to environmental pollutants, or sensitivity to chemicals or synthetic hormones found in foods

Who is More Likely to Suffer From Menopausal Depression

Any woman can experience depression during menopause, but some are more predisposed. Extreme menopausal depression can lead to social isolation, relationship breakdowns, and even thoughts or attempts of suicide, especially for women who:

  • Have a family history, or they themselves suffered from depression, Premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), or postpartum depression
  • Have undergone surgical menopause (oophorectomy) or a hysterectomy
  • Feel devalued or non-essential due to their age
  • Regret never having children, whether by choice or circumstance
  • Resent impending infertility and losing their childbearing abilities
  • Are alone, or lack moral and emotional support from family and friends
  • Are unemployed, are of low income, or are experiencing financial stresses
  • Dread aging, menopause, or have low self-confidence
  • Have poor overall health, or have family members suffering from poor health, especially if they are caretakers of the latter
  • Have received minimal education
  • Have multiple regrets regarding past life choices
  • Smoke
  • Do little or no exercise
  • Are unhappy in their relationships
  • Have a sexual abuse history
  • Have extremely stressful lifestyles
  • Have taken antidepressants in the past
  • Suffer from significantly more hot flashes than average

What Can I do to Feel Better?

There are many lifestyle changes you can make to find relief. Some are:

  • Get at least a half hour of regular exercise five days a week
  • Try to get at least 8 hours of sleep.
  • Try relaxation methods such as Tai Chi, massage, yoga, meditation, etc.
  • If you smoke, quit
  • Join or create a support group for women with similar menopausal complaints
  • Avoid alcohol, tranquilizers, recreational drugs, and caffeine-especially near bedtime
  • Find a calming hobby such as painting, gardening, coloring, etc.
  • Find short-term projects that can give you a sense of satisfaction and achievement
  • Avoid isolation. Reach out regularly to family, community, and friends
  • Volunteer to help those less fortunate than yourself
  • Don’t sweat the small stuff: Prioritize and concentrate on what needs your attention now. Break up chores into smaller manageable time frames and declutter your environment
  • While you’re feeling this way, don’t make any life-changing decisions, you may regret later

Are There Any Natural Remedies That Can Help?

Eastern cultures rely heavily on diet and herbal and holistic medicine for many ailments, including menopausal depression. In China, for instance, only 10% of women suffer from different menopausal discomforts compared to 85% of American women. Western medicine recognizes the value of many of these time-honored and effective remedies. Today, many doctors work in tandem with these ideas, incorporating them into their modern day treatments, and recommending different formula combinations which may contain the following:

  • Ginseng
  • Dang kui
  • Sichuan lovage (chuan xiong)
  • Cordyceps (dong chong xia cao)
  • Red sage root (dan shen)
  • Angelica Sinensis (dang gui)
  • San-Qi ginseng (shen-san-qi)
  • Safflower flower (hong hua)
  • Trifoliate orange (zhi-ke)
  • Achyranthes (huai-niu-xi)

A healthy diet rich in protein, vegetables, fiber, and whole carbohydrates is also essential in warding off depression during menopause.

Other natural herbs and supplements include:

  • St. John’s wort (Hypericum perforatum)
  • B complex vitamins
  • Chromium
  • Omega 3 containing EPA and DHA
  • Magnesium
  • Vitamin D
  • Herbal teas containing hops
  • 5 HTP

What if Nothing I Do Helps?

If your depression continues despite all your attempts, you may need medical intervention in the form of short or long-term antidepressants, estrogen replacement therapy, or the additional help of a therapist to discuss your problems.

How Can Cherokee Women’s Health Specialists Help Me?

Cherokee Women’s Health Specialists is a broad-based OB practice consisting first and foremost of three doubly accredited urogynecologists holding certification in OB-GYN and Female Pelvic Medicine and Reconstructive Surgery (FPMRS), a highly coveted credential approved only under the most stringent criteria set forth by the American Board of Medicine (ABM).

Along with these specialists, additional gynecologists, urogynecologists, obstetricians, nutritionists, and experts in holistic medicine and diet, are available for any and all female health-related disorders, concerns, and problems, providing you with the best possible care.

Your depression could be menopause-related, but there can also be other reasons for your symptom. As stated earlier, menopause itself does not cause depression, but it can contribute to it hormonally. You should always discuss your issues with your doctor to rule out any other physical or psychiatric disorders.

Depression is treatable. It is also encouraging to note that, though many women suffer from depression before and during menopause, once the transition is complete, with proper care, the depressive symptoms decrease and often disappear.

For a consult with one of our gynecologists to discuss depression during menopause, call 770-720-7733.

July 25, 2018

Vaginal dryness is a common problem that affects millions of women. Thankfully, lubricants are available to help provide relief from painful sex and irritation. To help you make an informed decision on which lubricant is right for you, it’s first important to learn why you’re experiencing vaginal dryness.

What Causes Vaginal Dryness?

Woman with lubricantsThe most common reason for vaginal dryness is perimenopause, menopause, and post-menopause. Hormones, such as progesterone, estrogen, DHEA (dehydroepiandrosterone) and testosterone begin to plummet with age and can result in dryness.

Several other causes include:

  • Medications that have an overall dehydrating effect
  • Minimal moisture due to inadequate foreplay
  • Certain autoimmune diseases
  • Allergies
  • Stress and prolonged periods of anxiety
  • Alcohol
  • Smoking
  • Cancer treatments
  • Breastfeeding
  • Childbirth
  • Ovarian surgery
  • Hysterectomy
  • Beauty products such as soaps, bath products, scented hygiene products and douches
  • Foods that contain hormones

What Other Conditions Can Accompany Vaginal Dryness?

Lack of vaginal lubrication can affect you in many different ways, resulting in:

  • Pain: When genitals lack sufficient moisture, penetration and other everyday activities can become unbearable.
  • Weakened vaginal elasticity and tissue lining: As vital hormones deplete, skin and tissue thin, sag and lose their ability to stretch. This is why we become reliant on oils, creams, moisturizers, hormonal therapy and lubricants.
  • Psychological issues: Vaginal dryness and the many conditions that cause or accompany it can lead to depression, anxiety and even relationship deterioration.
  • Skin and internal problems: Without vital lubrication, irritation, itching, foul odor, urinary tract infections, and many other pelvic problems can occur. You can even suffer from prolapse, bladder deficiencies, leakage, pressure, chronic pain (vulvodynia) and inflammation (vestibulitis).

Choosing the Right Lubricant for You

Now let’s look at how to select the correct lubricant. There are many types and they range from pleasure-enhancing, non-staining, odorless, perfumed, and even flavored options. And many contain a myriad of unpronounceable ingredients so choosing the right one can be a challenge. Before deciding on the best one for you, you should consider the following:

  •  Safety: You want something that’s natural and safe as certain ingredients contained in over-the-counter lubricants can be unnecessary or harmful. As such, you’ll want to avoid the following:
  1. Chlorhexidine gluconate
  2. Parabens
  3. Benzocaine
  4. Petroleum-based
  5. Propylene glycol
  6. Glycerin
  7. Nonoxynol-9
  8. Phenoxyethanol
  9. Aspartame
  • Multi-purpose usage: Consider buying a lubricant that addresses additional problems such as thinning, skin sensitivity, urine leakage, etc.
  • Compatibility: Will you be using the product in combination with adult pleasure items or condoms?
  • Sensory enhancers: Are taste, smell and texture important? You may prefer something more neutral. Today’s lubricants may also contain menthol or capsaicin, a compound of chili peppers, which tout additional stimulation. While they might enhance your sexual experience, they can also cause uncomfortable stinging or burning to more sensitive skin and tissue.
  • Can any of the ingredients clash with medications you are presently using or any disorder you might currently have?
  • Do you plan to use the lubricant on a daily basis for general dryness, or only when considering intercourse?

Once you have established all safety factors and your personal needs, deciding if you actually need a lubricant, moisturizer, or more aggressive therapies is your next step. Knowing their function and the results they provide will enable you to make the right selection.

What is a Lubricant and What Does it Do?

Most lubricants are designed for mild to moderate dryness and immediate use. They alleviate uncomfortable friction during intercourse and provide short-term relief.

They come in gel or liquid form and the following types are available:

  • Water-based lubricants: These are topical and are not absorbed by the skin. They can be used safely for self-gratification, foreplay stimulation and intercourse. Easy to wash off, they pose no damaging danger to condoms. If you are currently suffering from a yeast infection, make sure your product does not contain glycerin, as it may further aggravate the situation. Water-based lubricants are applied immediately before sex. They do not provide long-term relief for dryness, require no prescription, and are available over the counter.
  • Oil-based lubricants: These may contain petroleum jelly and other harmful additives, so read the labels carefully. Vaginal tissue is highly absorbent, and these lubricants can disrupt your already delicate hormonal balance. Their greasy texture makes them difficult to wash off, exposing you to infectious bacteria and skin disorders. Oil-based lubricants can disintegrate latex condoms that protect you from pregnancy or sexually transmitted diseases (STDs). Polyurethane condoms are recommended. Oil-based lubricants are not intended for long-term relief and available over the counter.
  • Silicone-based lubricants: Silicone lubricants consist of safe, non-toxic ingredients and fall somewhere between the oil- and water- based lubricants. They cannot be absorbed through skin, can be used in water, and pose no danger to latex condoms. Their downside is their disagreeable taste and difficulty to rinse off. Residue can invite bacteria. They should never be used with silicone adult toys because they can stick and cause discomfort. Not everyone feels comfortable with their unusual slipperiness. They are available over the counter and are usually hypoallergenic.
  • Moisturizers: Vaginal moisturizers have been found to be beneficial for women’s menopausal dryness issues. They don’t only soothe friction discomfort, but can be used regularly to minimize daily dryness. Moisturizers continue to work up to four days by adhering to the vaginal walls in the same manner as your natural secretions do. They often come with an applicator for internal use. You may still have to rely on a lubricant for additional help. Moisturizers can be bought without a prescription.
  • Natural, homemade lubricants: Many women make chemical-free lubricants from home ingredients with their own preferred scent and flavor. Some safe ingredients include organic coconut oil, sea buckthorn oil, ghee (purified butter), olive oil or aloe vera. Herbal extracts and essential oils may also be added. Always research if these can be used in tandem with your partner’s condom type to avoid breakage.

Symptoms That May Not be Helped by Lubricants

Store-bought lubricants or other dryness aids may not help some of your symptoms. In that case, you may need to talk to your gynecologist about trying something more effective, such as:

  • Estrogen therapy: Low-dose estrogen therapy requires a prescription. It comes in cream form, tablets with applicators to insert them, or as vaginal rings that must be replaced every three months. The cream should never be used immediately before sex, as hormonal transference is possible. Vaginal estrogen therapy is never recommended for women with breast cancer.
  • Androgen therapy: If you are also experiencing low libido, prolapse, vaginal thinning, or incontinence issues, androgen therapy may be right for you. Available over the counter, this topical vulvar cream contains the hormones testosterone and DHEA (dehydroepiandrosterone). This combination has proven to work wonders for dryness, vaginal irritation, sexual disinterest, urinary leakage, incontinence, thinning and failure to achieve orgasm.

We’re Here to Help You

Dr. Litrel addresses menopause in this informative video as he explains the effects of hormones in various areas of a woman’s life. If you have any questions about vaginal lubricants, moisturizers, or related therapies, our experts at Cherokee Women’s Health Specialists are here to help you. Their skill and training in the most up-to-date technology enable them to diagnose and treat all of your unique feminine issues.

To book an appointment, call 770.720.7733.

February 28, 2018

Hormone replacement therapy (HRT) has been used for decades to correct age-related hormonal imbalances in women. HRT treatments are comprised of both estrogen and progesterone. Depending on your individual needs, hormone replacement therapy can be administered in many ways including; oral, patch, topical, or vaginal treatments.

Hormone replacement therapy is commonly used to treat side effects associated with menopause such as hot flashes, irritability, and even vaginal dryness. Although more research needs to be done, HRT has been shown to be safe and effective when used for short periods of time.

The long-term benefits of hormone replacement therapy are not yet fully known but can include the prevention of bone loss leading to osteoporosis and lower cholesterol levels. However, the risks may outweigh the benefits for many women. There is still much to learn about the different variations of hormone replacement.

HRT Risks Heart health is important for women

It was previously thought that HRT could actually reduce the risk of heart disease but, it may not be as good for our heart health as was once thought. Long-term use of HRT can cause potentially deadly blood clots which can lead to stroke or heart attacks.

After mixed clinical trials, the American Heart Association has recommended that cardiovascular hormone replacement therapy not be given to women solely with the intent to prevent heart disease. Women who have previously had a stroke or a heart attack should not begin taking hormone replacement therapy.

Other Risks associated with hormone replacement therapy may include (but not limited to);

  • Certain Types of Cancers
  • Gallbladder Issues
  • Negative Effects on Mood

Continued research is necessary to fully understand the relationship between hormone replacement therapy and the possible benefits and risks.

Who Should Not Take HRT

Even when used short-term HRT can have an adverse effect on some women. Women with any of the following conditions should seek medical advice before starting hormone replacement therapy to ensure their overall well-being:

  • A history of breast cancer
  • A history of cancer of the uterus
  • Liver disease
  • Blood clots in the veins or legs, or in the lungs (Including blood clots during pregnancy or when taking birth control pills)
  • Cardiovascular disease

Alternative Treatments

Nobody should have to live with painful menopause symptoms. If you’re having bothersome menopausal symptoms but are worried about hormone replacement therapy, talk to your healthcare provider about your options.

Hormone replacement therapy is a widely available option for women seeking to get relief from menopausal-related symptoms but there are alternatives. Here are some of our favorites.

Bioidentical Hormone Replacement

Bioidentical hormones are chemically identical to those found within the human body. They are often used as an alternative to traditional hormone replacement therapy to correct hormonal imbalances. Bioidentical hormone therapy is said to treat such menopausal symptoms as fatigue, bloating, and low sex drive.

Natural Alternatives

Fruits and vegetables with high levels of phytoestrogen (yep, that’s plant-based estrogen), such as soy, red clover, and flaxseed can be used to treat mild to moderate menopausal symptoms.

Additionally, there are many herbal remedies that can help treat side effects associated with hormone deficiencies. One herb, in particular, black cohosh, has shown promising results when it comes to treating hot flashes, insomnia, and vaginal dryness.

Healthy Lifestyle

Maintaining a healthy lifestyle through proper diet and exercise is one of the best ways to manage many menopausal symptoms. Energy levels, mood, mild pain can all be managed through exercise. And, it’s good for your bone and heart health too!

Of course, diet and exercise may not be enough for everyone. You’re encouraged to talk to your doctor about additional treatment options are right for you.

Schedule an appointment with one of our physicians to determine what may be right for you. A friendly member of our staff will be more than happy to answer any questions or address any concerns you have about hormone replacement therapy and your heart.

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.

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“I truly love Cherokee Women’s Health. The staff is very patient and understanding. The providers are wonderful and very thorough! I couldn’t ask for a better group of caring people.”
– Emily E.
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