Know Your Options

A Guide to Women’s Health

By Bondi Wood

Although women suffer some of the same health problems as men, women alone experience gender-specific health issues such as ovarian and cervical cancer, menstruation, pregnancy, childbirth and menopause. Because women are often the caregivers in families, they tend to overlook their own health issues. In particular, women will put off seeking treatment for themselves but will insist that their children and spouses receive medical attention.

In this story, three local physicians, who are also women, wives and mothers, speak specifically to women’s health issues and to health and wellness in general. Their unified message is twofold: prevention and individualized attention. The biggest threats to women’s health are mostly preventable, and women must seek out physicians who avoid the one-size-fits-all mentality of health care.

PREVENTION

Dr. Lynn Puckett of Women’s Health Associates Inc. has a favorite inspirational message she often shares with her patients. “Humans are a balance of lifestyles and genetics. We only have control over one of these things: lifestyle. We should therefore maximize it.”

Specifically, Puckett is speaking to the preventive measures of a good diet, regular exercise, tobacco cessation and healthy sleep patterns.

Dr. Laura Grant of the Women’s Wellness Center concurs. Grant says: “Nutrition is key. If you want your body to last a long time and to be in good working order, you must put the right fuel into it.” National research shows that unhealthy eating habits are the leading nongenetic culprits for heart disease, stroke, diabetes and obesity.

Regular exercise goes hand in hand with healthy eating habits. “It seems obvious and preachy, I know, but it has to be mentioned that exercise is so important to overall wellness,” Grant says. Because Missouri weather often offers a ready excuse for not exercising outdoors, Grant recommends an activity that can occur at any time of the day in your own home.

“We are creatures of habit, and this is the key to success with an exercise program,” Grant says. “It’s way too easy to get out of a habit when the activity relies on nice weather.” Grant recommends inexpensive home equipment; something as simple as a set of dumbbells in conjunction with an aerobic routine will suffice, she says. Puckett agrees that both aerobic and weight-bearing exercises are crucial to an effective workout.

Avoiding tobacco, excessive drinking, substance abuse and stress are self-explanatory, but regular preventive exams and procedures are still underutilized by many American women. Dr. Renee Boulicault practices at Women’s Health Associates Inc., and though she enjoys all aspects of obstetrics and gynecology, her specialties are minimally invasive surgeries and obstetrics. Boulicault says her patients range in age from 10 to 99.

“Often I’m asked from a mother when a girl should have her first gynecological exam,” Boulicault says. “That is always a tricky question because it depends on the girl.” Still, all three physicians recommend a range from 10 to 18 years of age, depending on the onset of menstruation, existing health problems or sexual activity. All three also say they typically do not perform pap smears on young girls but meet with them to discuss their reproductive health.

“There are times I do exams at a patient’s first visit, and there are times that I do not,” Boulicault says. “It depends on the clinical circumstances that brought that patient to my office.”

In addition to annual pap smears, there are numerous other prevention testing milestones that women should follow. However, Puckett, Grant and Boulicault all emphasize that these milestones are general, and your personal circumstances might require earlier or additional testing. Below is a combined list from the three physicians:

AGE 10 TO 18

First visit with a gynecologist, might or might not require an exam

AGE 19 TO 40

Annual pap smears; STD testing for high-risk groups; HPV vaccine for those younger than 26; blood test screenings for cholesterol and thyroid abnormalities and diabetes beginning at age 30 and conducted at five-year intervals

AGE 40

First mammogram: Although recent news suggested exams every two years beginning at age 50, most physicians still recommend annual mammograms.

AGE 50

First colonoscopy repeated every five to 10 years; first bone density test

AGE 65+

Annual bone density, thyroid screening and urinanalysis

INDIVIDUALIZED ATTENTION

Fortunately, health care trends during the past decade have reflected this push for prevention, and a welcome side effect is that women’s health issues are being taken more seriously and researched more thoroughly. As a result, new treatments and minimally invasive surgeries have been developed. Grant, who specializes in perimenopause and hormone health, cites a 2002 broad-based national study, “The Women’s Health Initiative,” as a turning point in hormone therapy for menopausal women.

“We have evolved in our understanding of the safety and benefits of hormone therapy,” Grant says. “Physicians are in agreement that whether or not to use hormone therapy is a decision that must be individualized for each woman.”

Still, Grant laments that many physicians will not take the time for the detailed personal interviews required to determine appropriate hormone therapy for individual patients. In fact, Grant says, “Many people, even some doctors, still think of it as a quality-of-life issue rather than a health issue.”

Although Grant originally gave up obstetrics to spend more time with her family, she soon discovered a cohort of nonpregnant patients, women in their 40s and 50s, seeking treatment for the transition through menopause.

“These women were looking for a doctor who would listen to them, educate them about what was happening with their bodies and, above all, make them feel better,” Grant says. Grant feels especially qualified to help them as she admits, “Being perimenopausal myself, it made sense to explore this area in depth.”

In addition to giving real relief via hormone therapy to menopausal and pre-menopausal women, strides in minimally invasive surgery techniques have dramatically decreased the recovery time for many procedures. Of laparoscopic hysterectomies compared to traditional hysterectomies, Boulicault says: “I am able to do a surgery with a few small incisions rather than a large one. This allows the patient to heal faster, have less pain and to return to work earlier.”

According to Puckett, similar strides have been made in endometrial ablation, a procedure to treat women suffering from heavy menstrual bleeding, also known as menorrhagia. “Now with endometrial ablation, patients can get back to work within one to two days with minimal discomfort and dramatically improved success rates,” Puckett says.

KNOWING YOUR OPTIONS

Because personal habits and regular exams/tests are crucial to health and wellness, the responsibility ultimately lies within each of us. We all are largely responsible for our own health. Medical professionals cannot control whether a patient puts down the cupcakes or picks up the phone to schedule a mammogram.

Boulicault, Puckett and Grant have all witnessed a trend in which women are becoming more proactive in their treatment. Most women patients, especially perimenopausal and menopausal women, have conducted some research prior to making an appointment. The three doctors agree that many of their women patients are less reluctant to ask questions and are better educated on treatment options. Still, there are some women who do not understand the extreme benefits of prevention.

According to Puckett, “Many still do not understand the importance of medical prevention and early intervention.”

There are reasons for this, Grant says. “Women have more choices today than ever before, and so it does take time to consider all the options.”

For more info on women’s health issues, visit:

Annie’s Choice: The Ethical Implications of Prevention

A moral dilemma lies at the heart of every plot written by top-selling novelist Jodi Picoult. The author has made a living forcing her readers to peer into their deepest beliefs and re-examine them in the light of new or unusual circumstances. With today’s strides in health care technology and genetic testing, the fiction is becoming reality. Under most circumstances, women would never consider removing perfectly healthy reproductive organs or surgically removing a healthy breast. But, if you knew that doing so might improve your chances of avoiding cancer in the future, would you consider it?

Just days before submitting this article, I went to visit a friend of mine who, after extensive genetic testing, discovered she is gene-positive for breast and ovarian cancer. In other words, she carries the harmful mutation BRCA-1, which increases her risk of getting breast and ovarian cancer by 40 to 50 percent.*

In the wake of the devastating news, my friend Annie (not her real name) was advised by her doctors to undergo a prophylactic double mastectomy and a complete hysterectomy to reduce her chances of getting cancer. Even more worrisome is the doctors’ advice that Annie’s two daughters and one son also be tested for the gene, which ultimately forces them to determine how deep prevention should cut.

I visited Annie as she was recovering from the hysterectomy. Even in recovery, she was emotionally preparing herself for the prospect of a double mastectomy and eventual reconstructive surgery. Because Annie has survived two separate bouts of breast cancer, at ages 31 and 39, she maintained a false sense of security in the fact that she had remained cancer-free for nearly a dozen years.

“I thought every day I survived, my risk of getting cancer was declining,” she says. In reality, her risk level has always remained the same. That is, until now. The hysterectomy reduced Annie’s risk of getting ovarian cancer by 80 to 96 percent. Likewise, having both her breasts removed could improve Annie’s breast-cancer risk rates by 90 percent.**

Annie is determined to beat the cancer at any cost. As she says, “Why would I stop fighting now?” Annie, 50, believes the surgeries are her best opportunities to increase her future health, even though they require invasive, painful procedures that carry their own risks.

For Annie, the thought of removing healthy organs is not as troubling as missing out on being a grandparent. The talk of grandchildren brings conversations of both joy and anguish. The joy all grandchildren bring and the anguish of even darker decisions her children might be forced to make: Should I have children when I know that being gene-positive might shorten my life span? Should I bring children into this world who might be gene positive? Even though we’re sitting in the sun, Annie and I both shiver.

*According to estimates of lifetime risk, about 12 percent of women in the general population will develop breast cancer sometime during their lives compared with about 60 percent of women who have BRCA1 or BRCA2. Lifetime risk estimates for ovarian cancer among women in the general population indicate that 1.4 percent will be diagnosed with ovarian cancer compared with 15 to 40 percent of women who have a harmful BRCA1 or BRCA2 mutation (National Cancer Institute, 2005, 2009).

**Most research suggests that for gene positive women, removing the breasts can reduce the risk of breast cancer by 90 percent. Similarly, removing the ovaries can reduce risk of ovarian cancer by as much as 80 to 96 percent for women who have the BRCA1/BRCA2 cancer-predisposing gene mutation (Rebbeck, 2004, Kauff, 2002, Rutter, 2003).