Your Guide to Women’s Health

By Sue Sveum

With all the demands on our time, women learn pretty quickly to prioritize. Sadly, on our daily to-do lists, sometimes our health takes a backseat to most everything else. But the truth is, good health is what gets us through the day — and beyond. Good health is like an insurance policy. It’s vital, and attaining or maintaining good health helps you be your best self, for you and your loved ones.

Here, four SSM Health providers address some of the most common questions and misconceptions concerning women’s health.

Addressing Overall Wellness with a Midwife

Amber Latch, CNM, is a Certified Nurse Midwife in Obstetrics and Gynecology at SSM Health in Madison.

COULD YOU EXPLAIN THE BREADTH OF WORK A MIDWIFE DOES WITH PATIENTS?

A midwife is a provider specializing in women’s health and the care of healthy women throughout pregnancy, labor and birth. But you may not realize you can see a midwife for other health concerns: irregular periods, trouble getting pregnant, birth control, breast exams and cervical cancer screening. Midwife actually means “with woman,” and we truly try to journey alongside our patients in meeting all their health care goals.

WHY ARE ANNUAL WELLNESS VISITS IMPORTANT FOR ALL AGES?

There’s so much to know about the amazing things our bodies can do, so naturally, a lot of questions arise about what’s “normal” and what may be of concern. We encourage women to visit us from puberty to menopause and beyond. Whether it’s for a routine breast exam, to discuss reproductive plans (family planning, preconception care or fertility) or just to stay up to date on health screenings (like Pap tests or mammograms), we can help.

WHAT’S INCLUDED IN A WELLNESS VISIT?

At wellness visits, we cover topics like mental health and emotional well-being, pelvic health (periods, infection concerns, pain) and sexual health (prevention of STIs, concerns about assault or abuse, or painful sex). We’ll do a breast exam and pelvic exam if needed, being sensitive to your concerns. We understand you may be hesitant to see a provider for pelvic health, because you don’t want an exam or are worried it may be painful or trigger prior traumas. We’ll never perform an exam without your permission. Your comfort — both physical and emotional — is incredibly important to us.

WHY ARE THESE VISITS AN IMPORTANT ASPECT OF PREVENTATIVE CARE?

Women are at the highest risk for breast cancer as well as uniquely at risk for a number of cancers affecting the pelvic organs and skin around the vagina. For many of these, outcomes are drastically better when caught early. That’s why we recommend checkups even when you’re feeling well and don’t have concerns. We’ll also discuss ways to reduce your risk of these cancers.

WHAT QUESTIONS SHOULD WE BE ASKING OUR PROVIDER?

Ask what you can specifically do to stay healthy, and if they identify anything that puts you at increased risk for health problems in the future.

I also strongly encourage you to be open and honest with your provider about things that worry you that sometimes feel awkward to talk about (like sexual concerns, vaginal odor or discharge). I promise you that we welcome these questions. We’re all women’s health nerds, and love the opportunity to talk about these topics in a safe, judgement-free space. Privacy guaranteed.

Understanding Breast Health at All Ages

Michelle Mackay, MD, is a Radiation Oncologist at SSM Health Turville Bay Radiation Oncology Center.

WHAT ARE THREE ASPECTS OF BREAST HEALTH YOU WANT WOMEN TO KNOW?

Know your body. Breast tissue varies in consistency for every person and can normally feel nodular and lumpy. That’s why it’s important that you know what your normal breast tissue looks and feels like, so if something changes, you can better recognize that change and get it evaluated. Watch for changes in breast contour, shape, dimpling or tucking of the skin; redness or swelling; a mass or lump; and nipple discharge or bleeding.

Hormones can cause breast tissue to change throughout your menstrual cycle. Your breasts also change as you age, with mammary glands decreasing in size and ligaments losing elasticity.

Everybody is different. Although women’s breasts vary in overall shape, size and nipple color, your own breasts are generally symmetrical – although it’s not unusual for one to be slightly larger than the other.

WHAT ARE SOME COMMON BREAST HEALTH MISCONCEPTIONS?

If I don’t have breast cancer in my family, I’m not at risk. Although family history of breast cancer is a risk factor, you can still get breast cancer with no family history. If there’s breast cancer in your family, genetic evaluation may be a good option.

Mammography will cause cancer, so I shouldn’t undergo that test.

Although mammograms use X-rays to detect breast cancer, it’s a very low dose. Mammography is considered the gold standard in early breast cancer detection, so the benefits do outweigh the risks.

There’s nothing I can do to prevent breast cancer.

Lifestyle changes such as regular exercise; limiting alcohol intake; and eating a healthy, well-balanced diet low in fats, moderate calorie intake, plenty of vegetables, lean meats or protein and fiber, have been proven to decrease cancer risk.

WHAT CAN WOMEN IN THEIR 20S AND 30S DO TO BETTER THEIR BREAST HEALTH?

Health and wellness are lifelong goals that take practice, so start incorporating healthy habits like the ones above now for your future breast health and overall wellness.

WHAT QUESTIONS SHOULD WE BE ASKING OUR DOCTORS?

  • Ask to be evaluated if you notice any change in your breasts.
  • If you have a breast cancer diagnosis, ask what treatment choices are available and what’s best for your diagnosis and stage. Ask about goals and how to best prepare yourself for treatment.
  • Ask about side effects and what’s normal to experience during treatment. Clear treatment guidance is important to ensure you’re healing appropriately, physically and mentally.

Getting Familiar with Pelvic Health

Temitope Rude, MD, is a urology and urogynecology provider specializing in female pelvic medicine at SSM Health in Madison and Dodgeville.

WHAT ARE THREE ASPECTS OF PELVIC HEALTH YOU WANT WOMEN TO KNOW?

I emphasize three main themes to my patients: Pelvic health symptoms are common, treatments are individualized and you’re in the driver’s seat.

Symptoms related to pelvic health, like incontinence and prolapse (pelvic organs drooping into or out of the vagina), are incredibly common — with an estimated 50% of women having symptoms of bothersome vaginal bulge and incontinence. Historically, more than one in 10 women will have surgery for pelvic health over their lifetime — even younger patients [in their 20s].

With a wide range of treatment options, your care is extremely individualized. But a treatment that was successful for your sister or neighbor with similar symptoms may not be right for you. We’ll work with you to present all the treatment options for your specific needs.

IS THERE ANYTHING WOMEN IN THEIR 20S OR 30S CAN OR SHOULD DO TO BETTER THEIR PELVIC HEALTH?

You may recognize the importance of your core for stability and overall health, but your pelvic floor is an extension of those core muscles, providing support for all your pelvic organs. Infections, pain and childbearing can cause injuries, leading to symptoms over time. It’s good to be aware of pelvic floor muscles, even when young. I’m a huge proponent of pelvic floor physical therapy (PFPT) to help identify and strengthen those critical but hard to identify muscles.

For women without symptoms, PFPT can start with Kegels (tightening and releasing the muscle that controls urine flow), but can also go beyond that to include stretching and lengthening those muscles to avoid spasms.

Managing Perimenopause and Menopause

Sarah Block, DNP, APNP, is a Nurse Practitioner in Obstetrics and Gynecology at SSM Health in Madison.

WHAT ARE THE DIFFERENCES BETWEEN PERIMENOPAUSE AND MENOPAUSE?

Perimenopause is the transition between childbearing and menopause, a process that can take years. Shorter or longer intervals between periods and a heavier flow are common. Other symptoms include hot flashes, night sweats, sleep disturbances, vaginal dryness, mood changes, memory changes, weight gain and difficulty losing weight. No two transitions are the same, but it can be stressful when you don’t feel like yourself, and some symptoms require medical intervention.

WHAT ARE SOME TREATMENTS, AND HOW DO THEY ALLEVIATE SYMPTOMS?

Maintaining a healthy lifestyle is important as this may dull or alleviate some symptoms. And for vaginal dryness, a vaginal estrogen prescription can be very helpful. But hormone replacement therapy is most effective, especially for hot flashes, since symptoms are caused by a decrease in estrogen and progesterone. Mild hot flashes may not require treatment, but if they become bothersome, hormone therapy (in the form of a pill, patch, vaginal ring or cream) is warranted. Some women have told me it gave them their life back!

But there are other options. Nonhormone drugs called selective serotonin-reuptake inhibitors, originally approved to treat depression, have been effective in treating hot flashes in women without depression. And you may find relief from nonmedical treatments including deep breathing, yoga, meditation, homeopathy or acupuncture.

WHAT ARE SOME MISCONCEPTIONS ABOUT PERIMENOPAUSE AND MENOPAUSE?

There are two common misconceptions about perimenopause and menopause. First: You just need to deal with the symptoms because they’re “part of life.” And, second: hormones are unsafe. Years ago the risk of getting breast cancer from hormones loomed large, but we now know that risk doesn’t increase until after five years of use. The rule of thumb with hormone replacement is the appropriate dose for the appropriate amount of time.

So please know that hormone replacement therapy is safe and effective. And if you’re experiencing symptoms that interfere with your daily life, it’s perfectly acceptable to seek treatment.

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