Articles pertaining to women's OBGYN topics, obstetrics, gynecology, birth, breast health, pregnancy, menopause, women's health. The Women’s OB/GYN Medical Group offers a full range of premier obstetrics and gynecology services & expertise to women in the North Bay Area.
We are pleased to announce the arrival of our newest obstetrician and gynecologist, Dr. Erin MacDonald
Erin MacDonald, MD, is now available to see patients at NCMA Women’s OB/GYN Center in Santa Rosa. She is proud to join Northern California Medical Associates’ obstetricians/gynecologists and midwives medical practice. We could not be more thrilled to add a physician of her caliber and passion for women’s health.
Dr. MacDonald’s recent experience says a lot about her: Over the past year, she cared for patients at a specialty women’s health group for high-risk and underserved populations in Memphis, Tenn.
In addition to delivering OB/Gyn care at a Level 1 trauma center serving a diverse patient population, Dr. MacDonald has expertise in routine and high-risk deliveries, vacuum-assisted delivery, obstetric emergencies, maternal trauma, maternal ICU care, open abdominal/pelvic and minimally invasive surgery, annual health care/preventative health maintenance, routine and high-risk prenatal care. Call for an appointment today: 707-579-1102.
Endometriosis is a chronic gynecologic disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus in other parts of the abdomen. As a condition that occurs in 6–10 percent of women of reproductive age, endometriosis represents a significant health problem for millions (maybe as high as 6.5M) of U.S. women.
If you’re still reading, you’re probably one of them, or you may know someone who has had to deal with these common endometriosis symptoms:
Painful periods (dysmenorrhea).
Pain during intercourse.
Pain with bowel movements or urination.
Other symptoms, which may include fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.
Clearly, this is not a fun list. The symptoms or clinical manifestations of endometriosis are variable and unpredictable in both presentation and course. It can vary greatly from woman to woman.
One thing to keep in mind is that the pain associated with endometriosis may not correlate with the stage of the disease. In other words, a woman experiencing significant endometrial pain may not necessarily be in a deep stage of the disease, and the opposite may also be true for someone else. There may be some association with the depth of infiltration of endometrial lesions. Painful defecation during menses and painful sexual intercourse are the most predictable symptoms of deeply infiltrating endometriosis.
According to U.S. Department of Health & Human Services’ Office on Women’s Health, other health problems women experience with endometriosis can include, allergies, asthma, chemical sensitivities, autoimmune diseases (these can include multiple sclerosis, lupus, and some types of hypothyroidism), chronic fatigue syndrome and fibromyalgia.
There is some good news: Endometriosis isn’t a fatal disease. In some cases, endometrial cells create cysts that can rupture and bleed. While this is serious and may sound a bit like cancer, endometriosis isn’t cancer. However, ovarian cancer does occur at higher than expected rates in women with endometriosis. Some studies suggest that endometriosis increases this risk, but it’s still relatively low, according to Mayo Clinic. Although rare, another type of cancer — endometriosis-associated adenocarcinoma — can develop later in life in women who have had endometriosis.
Who is likely to get endometriosis?
Endometriosis usually develops several years after the onset of menstruation (menarche). Signs and symptoms of endometriosis often end temporarily with pregnancy and end permanently with menopause, unless you’re taking estrogen.
Endometriosis is especially common among women in their 30s and 40s, but I’ve also treated patients in their 20s that had the disorder. Statistically, it is racially neutral, meaning there appears to be no racial predisposition to endometriosis. Research suggests a familial association of endometriosis. Patients with an affected first-degree relationship have a seven- to ten-fold increased risk of developing the disorder.
How do we diagnose endometriosis?
A definitive endometriosis diagnosis can only be made by a diagnostic laparoscopy procedure. Your doctor will then order a histology (a study of the microscopic structure of tissues) of the lesions removed during the surgery.
Before recommending a diagnostic laparoscopic procedure, your doctor will talk to you about your symptoms and do or prescribe one or more of the following to find out if you have endometriosis:
Imaging test (ultrasound or MRI).
Prescription medicine. If your doctor does not find signs of an ovarian cyst during an ultrasound, he or she may prescribe:
Hormonal birth control (which may help lessen pelvic pain during your period).
Gonadotropin-releasing hormone (GnRH) agonists, which block the menstrual cycle and lower the amount of estrogen your body makes. GnRH agonists also may help pelvic pain.
If your pain gets better with hormonal medicine, you probably have endometriosis. But, these medicines work only as long as you take them. Once you stop taking them, your pain may come back.
How do you treat endometriosis?
There is currently no cure for endometriosis, but several different treatment options can help manage symptoms and improve your chances of getting pregnant. Talk to your doctor about your treatment options.
It is important to note that the best course of action for you will be greatly informed by whether you are or wish to remain fertile. Other important factors include your age, how severe your symptoms are and how severe the disease is.
Endometriosis treatments will vary depending on whether the focus of your care is for pain or more for fertility concerns. For pain, there are three possible approaches:
Pain medications (NSAIDS, opioids).
Hormone therapy (birth control pills, progesterone, progestin, GnRH agonists).
Surgical treatment (laparoscopy, others).
Endometriosis is different for every woman. My colleagues and I at our practice, NCMA Women’s OB/GYN Center, first seek to treat the whole person, rather than address presenting symptoms only. In many cases, we will recommend laparoscopy to remove growths as a way to also improve fertility in women who have mild or minimal endometriosis.
Although studies show improved pregnancy rates following this type of surgery, the success rate is not clear. For some, we recommend in vitro fertilization (IVF) as the best option to improve fertility.
Even though the use of hormones in IVF is successful in treating infertility related to endometriosis, other forms of hormone therapy are not as successful. The American College of Obstetricians and Gynecologists does not recommend using oral contraceptive pills or GnRH agonists to treat endometriosis-related infertility. The use of these hormonal agents prevents ovulation and delays pregnancy, so this risk means you and your doctor must be on the same page about your risks and health goals.
The hormones used during IVF do not cure endometriosis lesions, which means that pain may recur after pregnancy and that not all women with endometriosis are able to become pregnant with IVF. The relationship between the extent of disease and the degree of symptoms, the effects on fertility, and choosing the best treatment, remains a challenge for many patients.
NCMA’s Suzi Saunders, CNM, on providing care to women in countries where access is challenging, like Haiti and the Philippines
Photo by Suzanne Saunders, CNM
I have been a certified nurse midwife for 21 years. Having worked with NCMA Women’s OB/GYN Center for nearly 18 of those years, I’m very happy to continue my work both in Sonoma County and in sometimes faraway locales where adequate care is scarce.
I truly love women’s health. And let me tell you, there is nothing like holding a brand new baby in your hands!
I have long had an interest in providing care to women in countries where access is challenging. In addition to my master’s in nursing at Emory University, I also completed a master’s in public health, with a focus on international health concerns. My public health program emphasized the need for sustainable programs that had a lasting effect rather than “Band-Aid”-type efforts. Most programs rely heavily on donated supplies, and on volunteer labor to sustain them over time. I knew I wanted to make an impact, but wasn’t sure how to get started.
My first adventure became a family adventure
On the advice of a local colleague, I looked into two programs that had lengthy histories in their host countries, and had made significant impacts on local maternal health. The one I chose in 2011 was with Mercy in Action. It is located in Olongapo, Philippines, which was a nice coincidence, as my brother lived a few hours from there! I wanted my kids to be a part of my efforts. Although they were too young at the time to participate directly, by traveling there with me they could understand why it was important to me. In addition, I wanted them to realize how different life can be outside the U.S. By choosing this project, I could start my adventures as a volunteer, as well as get the kids involved.
I participated in a two-week intensive training on providing care in a low-resource environment, in addition to hiking to remote areas to provide needed prenatal and post-partum care to rural Filipina women. It was an amazing learning experience! My kids stayed with family, and while they were not with me, I did my work. They still had a lengthy trip in a developing nation. They were 5 and 10 at the time, and have never forgotten it.
On the ground in Haiti
Two years later, I went to Hinche, Haiti, with a group called Midwives for Haiti. It is a non-governmental organization (NGO) based in rural Haiti for the last 25 years. A midwife colleague had been there, and highly recommended the work they were doing.
After some vigorous fundraising, two labor nurses and I flew into the unknown. Haiti is the most dangerous country in the Western Hemisphere to have a baby, due to factors such as:
difficult access for rural women,
very few providers per thousand population,
a preference for home delivery due to costs, and
a high rate of risk factors such as preeclampsia and malnutrition.
In the U.S., midwives are often in a position of protecting normal pregnant women from having a disturbed or interventive birth. In Haiti, many, many births are high risk, and many more women need intervention than actually get it.
Midwives for Haiti has three main directives:
To teach as many Haitians as possible the profession of midwifery. The more providers there are in the country, the more women have access to care.
To support the mobile midwife service. These are a group of 5–6 midwives that go to a rural village every day, for a total of about 25 communities a month. This is typically the only way the women in those villages will ever get prenatal care.
To train the “matwons,” which are traditional or “granny” midwives, working in remote areas but typically without much medical knowledge. The mobile midwives work closely with the matwons, to encourage them to give the best care they can, and to refer high risk women back to them.
Suzanne Saunders (L) loves her volunteer work.
The conditions in Haiti cannot be more different than here, and can be quite shocking if you have not traveled to truly desperate, developing nations. I saw and experienced things you might only see once, or never, in an entire career in the U.S. We had a patient die of pre-eclamptic complications the second day of our trip, which would have been fairly easily treated and dealt with here. It’s crushing to know that every woman you treat knows a friend or family member (often several) who has died of childbirth complications. The ambivalence toward newborn babies that might not even survive their first six months is heartbreaking.
Watching what Midwives for Haiti can do on a shoestring budget is a bright light in all of this! They train 20–30 midwives a year, who then go and serve their own communities for years and years. They send midwives out into the villages to give women much-needed prenatal care. And support the home-based Matwons in their quest to provide home birth. All of this has made a significant impact on maternal and infant mortality in their corner of Haiti. I am very satisfied that their program meets many criteria of sustainability in the NGO realm, and have seen with my own eyes the impact they are having.
Going back to Haiti
I went back to Haiti two years later and it was just as powerful. The supplies and medicines we brought were eagerly distributed as needed. Our work felt important, in a way that is hard to describe. It is incredibly hard work, under ridiculous conditions (think, rare running water—in the hospital!, think 90+ degrees with nary a fan, think riding in a rattle-trap jeep over washboard roads for two hours to reach the mobile clinic, think mosquitos that are trying to kill you!). But fulfilling in a way that first world health care isn’t.
Every dollar goes to teaching students, purchasing meds and supplies to bring along, and to the very small staff that keeps it all running. Believe me, they make every dollar work double time! Certain supplies are highly desirable, as are certain medications.
Most needs are simple, like
blood pressure cuffs, and
A basic kit of equipment is put together for each midwife student, to make sure they are prepared for their training and first months of work afterwards.
If any of you have donations of medical supplies, and/or funds to purchase said supplies, they are very warmly and happily accepted.
Menopause care may include hormone therapy treatment
Your body’s hormone levels go through significant changes during the menopause transition, and resulting hormonal imbalances can create uncomfortable physical symptoms and mood swings. Fortunately, hormone therapy (HT) enables menopausal women to substitute for the hormones that are reduced during this transition to relieve symptoms and achieve long-term health advantages. Our physicians will talk with you about the risks and benefits of hormone therapy to help you find the options that best fit your individual body and lifestyle.
In recent years, the media has spotlighted menopause and HT helping to increase general awareness, but it is still important to filter the available information in the context of scientific-based research and peer-reviewed evidence from medical professionals.
The term “hormone therapy” covers both traditional hormone therapy (HRT) and natural (bioidentical) hormone replacement therapy (BHRT), as well as estrogen and combined estrogen/progesterone treatment.
BHRT makes use of hormones that are identical to human hormones, and HRT makes use of synthetic hormones that have a slight physical variation to bioidentical hormones, but serve the similar purpose of replacing hormones lost during menopause.
Nearly all modern hormone medications are derived from the same plant sources.
Your physician at Women’s OB/GYN Medical Group will personalize your HT treatment after accounting for various health benefits and risks based on your symptoms and lifestyle. Not all women will be candidates for HT, and medications and other health factors can affect eligibility.
In this article Dr. Shazah Khawaja MD of the Women’s OB/GYN Medical Group of Santa Rosa focuses on empowering women for Breast Cancer Awareness month by highlighting breast cancer prevention strategies.
During October’s National Breast Cancer Awareness Campaign, The Women’s OB/GYN Medical Group is focusing on empowerment through knowledge leading to healthy choices. “We believe that when a woman understands the facts about breast cancer she becomes empowered to take the necessary steps towards prevention. By working to detect the disease in its early stages, a woman is able to make lifestyle changes to reduce the odds of developing the disease in the first place,” explains Dr. Shazah Khawaja, MD, Obstetrician & Gynecologist.
Despite decades of pursing an all-out cure and national efforts aimed at education and prevention, breast cancer remains the most common cancer among women in the United States, second only to skin cancer. Today millions of women are surviving the disease, thanks in part to early detection, improvements in treatment and by enacting healthy lifestyle choices.
The First Step in Staying Healthy
Experts agree that the key to not only surviving a breast cancer diagnosis, but to thriving for years afterwards is early detection followed by early treatment. Routine breast exams and general awareness of how to maintain breast health are both important elements in staying healthy. Practitioners at the Women’s OB/GYN Medical Group encourage routine screening including regular self-breast exams, breast checks during annual gynecologic exams, and screening mammography – all approaches that help to detect breast problems early-on. “I routinely tell my patients that when we have the opportunity to catch and treat breast problems early, we have a better shot of ensuring the treatment will be successful,” says Dr. Khawaja.
Understanding Breast Cancer Risks for Better Outcomes
Although a having a higher risk for developing the disease may be frightening, it is also true that women who have one or more risk factors for developing breast cancer, never actually develop the disease. With increased awareness about the risk associated with certain factors – particularly those that revolve around lifestyle choices that can be changed – women of all risk levels can become empowered to make better choices.
Some risk factors such as age, genetics or race obviously cannot be changed. Other factors including environment, can also be difficult to modify. While some factors influence risk more than others, a person’s risk for developing breast cancer can change naturally due to aging and by making certain changes in habits and daily practices.
Having children after age 30 (shown to increase the risk of breast cancer in some cases).
Birth Control (oral and injectable contraceptives stand out in studies as contributors to breast cancer).
Alcohol consumption (the more consumed, the higher the risk).
Weight (women who carry extra pounds have a higher risk for developing breast cancer, primarily due to the higher insulin levels that accompany obesity).
Smoking (evidence suggests a link between smoking and breast cancer risk, particularly in premenopausal women).
Known Factors that Lower Risk:
Researchers continue to pursue the link between diet and breast cancer risk and many studies actually indicate that diet does play a role. More and more studies cast a wary eye towards red meat consumption, and there is an increased risk associated with high-fat diets, which perpetuates weight gain and obesity (a known breast cancer risk factor).
There may be sure way to prevent breast cancer as of yet, but there are things women can do to help lower the risk. A short list of actions includes;
Breast Feeding – for women who breast feed for 1.5 to 2 years studies suggest that there may be some benefit in reducing breast cancer risk
Physical Activity – a growing body of evidence indicates that a person’s risk of developing almost any cancer, particularly breast cancer is reduced by adopting a daily routine of physical activity. For example, as little as 1.25 hours of moderate physical activity per week may reduce the risk by up to 18 percent according to some studies.
Limit dose and duration of hormone therapy – Combination hormone therapy for more than five years is known to increase the risk of breast cancer. If you and your healthcare provider decide that the benefits of short-term hormone therapy outweigh the risks, use the lowest dose possible.
How OB/GYN Providers Can Help
Self-check breast exams are easy to perform in the home and should be conducted monthly in addition to annual breast exams with a physician at Women’s OB/GYN Medical Group. Depending on a patient’s age and individual health, we may recommend a more frequent interval of regular check-ups with a health care provider. And of course, if you suspect a breast health problem contact a provider immediately.
About the Women’s OB/GYN Medical Group
Women’s OB/GYN Medical Group’s staff of physicians include; Lela Emad, MD, Shazah Khawaja, MD, Amita Kachru, MD, and Susan Logan, MD along with two new providers; Tara Bartlett, D.O and Melissa A. Seeker, M.D. Together, these doctors share a unique whole-body approach to medicine as they strive to find the underlying causes of a woman’s health problems, rather than simply treating the symptoms. The expanded team of health professionals including Certified Nurse-Midwifes and Nurse Practitioners is committed to both alleviating short-term ailments and maximizing long-term health. The Women’s OB/GYN Medical Group strives to better the lives of all women with a holistic approach to women’s health. To learn more visit our website or to call for an appointment dial (707) 579-1102.