By Jackie Moore DNP, WHNP-BC Menopause affects women differently with regards to hot flashes and night sweats. For some it is more of a nuisance, but for others it can be very intense and prolonged affecting quality of life. The hot flashes many women may experience will improve over time; however vaginal dryness usually gets worse. Low estrogen levels associated with menopause causes thinning of the vaginal walls resulting in dryness, painful intercourse, tearing of the delicate vaginal tissue during sex and irritation. Low estrogen levels can also cause urinary complaints such as frequency and bladder infections.  There is no reason menopausal women should suffer through this. There are numerous options that are available such as moisturizers, vaginal estrogen creams, tablets, and rings; non estrogen ovule, oral SERM’s and even low dose SSRI’s. The options are numerous and can be individualized to each woman’s needs.

One in Eight women in America will be diagnosed with breast cancer in her lifetime. Unfortunately, breast cancer does not exclude anybody or discriminate by age. Some women are higher risk based on their own medical history or family history, but anybody can have breast cancer. The Self Breast Exam (SBE) is a simple way to help monitor the breast tissue from month to month. Your healthcare provider can show you the best way to do your self breast exam. We as women, play a pivotal role in our own health care and should monitor our breasts with a monthly exam at home, alerting a health care provider with any new changes. After palpation of the breast, a self visual inspection is also important to look for changes to the skin. You should call your healthcare provider with any notation of changes in skin texture, retraction or indentation of the nipples, discharge or bleeding from the nipples or any puckering of the skin on the breasts. Mammograms typically start at age 40 and should be ordered yearly after, or as needed when any concerns are noted sooner. Some women who are higher risk due to family history may need to start mammogram screening sooner. Your healthcare provider can help you determine when the right time for regular screening mammograms would be best for you. There are things that all women can do to help reduce the risk of breast cancer. Learn your family history and report any breast or other cancers to your health care provider. Maintain a healthy weight, exercise regularly, limit alcohol use and breast feed when possible.  Remember, early detection can save lives!

Hi there! It’s Martha Green, PA-C! I am the “new kid on the block” if you will here at WHP. However, I am neither new to women’s health nor am a “kid” by any means. I joined WHP almost a month ago but I come with 24 years of experience in Ob/Gyn. I am also a mother of 2 sons, Garrett (22) and Gage (17). I graduated from MUSC in 1997 and have been working in Women’s Health since. I am loving it! Everyone here has been so welcoming and friendly. I could not be more thrilled to do what I love with such a great group of ladies (and Dr. Parry of course, the lone male amongst 30+ women). I want to thank each and everyone for the friendly smiles and cheerful personalities who are always willing to help in any way necessary to make me, and ultimately, the awesome patients at WHP feel important! Thank you! I look forward to a long journey with WHP!

Vajacials are a newer concept in the world of esthetic care that is offered in a spa atmosphere, which focuses on the skin of the hair bearing areas of the vulva. Simply stated a “facial for the vulva”. This treatment may include steaming with or without essential oils, extractions of ingrown hairs, exfoliation, application of chemical peel, masks, and serums. Reported benefits are to detoxify, smooth the skin, lighten darker discoloration, unclog pores, reduction of blemishes, with the goal of leaving the skin “youthful and bright”. Generally, a vajacial is safe in the hands of a trained esthetician that specializes in the delicate skin of the vulva. However, there are risks such as allergic reactions and infections. Some of the products used may not be tested for the delicate skin of the vulva and cause the area to become irritated and inflamed allowing viruses and bacteria to penetrate. Chronic irritation of the skin can cause lichen simplex chronicus (LSC) which is caused by exposure to irritants resulting in itching. The itching from LSC can cause increasing irritation, leading to more scratching, then more itching, and more scratching and it becomes a cycle. Another common vulvar skin concern is hidradenitis suppurativa. This is a chronic inflammatory skin condition that causes recurrent bumps and boils to the vulva and underarms. This condition should be treated by a dermatologist as it can progress to significant scarring. There is no medical indication for a vajacial and if you are having no complications, go ahead and enjoy. However, if you notice the skin is becoming irritated and itchy, stop all products and seek medical evaluation.

Many new mothers have questions regarding the effects of birth control on breastfeeding. Women have hormonal and non-hormonal options when it comes to preventing pregnancy while breastfeeding their infant. Non-hormonal include the Lactation Amenorrhea Method (LAM), barrier methods such as condoms, and a non-hormonal IUD called Paraguard. LAM works by suppressing ovulation and can be just as effective as a hormonal birth control when 3 conditions are met: Baby is under 6 months old AND You have not had a monthly period return AND You are exclusively breastfeeding; meaning no formula feeding supplementation For moms who desire an alternative birth control method, or perhaps going back on a hormonal contraception they have previously used and loved, some kinds are avoided because of their potential effect on milk supply. Combination contraceptives contain both estrogen and progesterone and come in the form of pills, transdermal patch, and vaginal ring. Estrogen-containing birth control methods can contribute to lowering a mother’s milk supply which can inhibit breastfeeding all together. Breastfeeding mothers seeking an effective hormonal contraceptive should be counseled about progesterone-only preferred options including progesterone-only-pills(POPs), injection, implant, and hormonal IUD. Evidence reveals the majority of mothers see no changes in milk supply when a progesterone only birth control is initiated at 6-8 wks postpartum. There are so many benefits to breastfeeding that choosing the most appropriate contraception course after birth is beneficial to both mom and her hungry baby. Moms should be reassured that there is a very minimal amount of hormones in birth control that is transferred to an infant through breast milk. Moms and Dads have a lot to think about in the postpartum period, we encourage you to discuss your breastfeeding and postpartum family planning goals with your OB provider prior to delivery

Women go through various stages in their reproductive life cycle; however, it is important to define these transitions so a woman can have a better understanding of what to expect. Premenopause begins with the onset of your menstrual cycles until perimenopause. Perimenopause is considered the transition between premenopausal and menopause. This time usually begins in your 40’s and into 50’s and can last 3-10 years. You may experience irregular cycles, heavy or lighter periods, irritability, hot flashes, night sweats, breast tenderness, headaches, and vaginal dryness. Menopause is defined as your last menstrual cycle and add 12 consecutive months. Once you have achieved no menstrual cycles for 12 months, then a woman is considered menopausal. The average age in the Unites States for menopause is about 51 years old. Not all women will have severe symptoms, however if you do, there are hormonal and non-hormonal options available to address quality of life.

The recommended intervals for pap smears have evolved considerably over the past 15 years. It is based on a better understanding of human papilloma virus (HPV) infection and the length of time it takes for cervical cancer to develop. It was previously thought that HPV infection was a lifelong infection, however it is now understood that upwards of 80-90% of the time your immune system will clear the virus. However, some HPV strains are considered higher risk for a quicker progression and are evaluated differently. So, why do some women get pap smears more often than others? It is based on risk of severe disease and now, very much personalized to YOU. Rather than viewing a single pap result in isolation, numerous other factors are included to provide a recommendation. Factors include your age, current results, previous abnormal pap smears and treatments received, HPV subtype, and whether you have had sufficient pap surveillance. There are exceptions to less frequent screenings. If you have a history of cervical cancer, are HIV positive, have a weakened immune system, or were exposed to DES in utero (1940-1971) you will need a yearly pap smear.  Providing the best care to our patients means balancing cervical cancer prevention strategies and reducing over testing and overtreatment.

A very common question that comes up during a yearly exam is “why don’t I need a pap anymore?”. This answer to this is more complicated than you might think, and some women do need vaginal pap surveillance. If you had a hysterectomy, to include removal of the cervix, and have no history of moderate to severe dysplasia in the past 25 years, routine vaginal pap smears are not recommended. If you had a hysterectomy, to include removal of the cervix, for treatment of moderate or higher cervical abnormalities, yearly pap and or HPV testing is recommended for 3 years, then every 3 years for 25 years. The rationale for continued surveillance is the risk of moderate to severe vaginal dysplasia remains elevated in this population. If you had a supracervical hysterectomy, where the uterus was removed but the cervix remains, routine pap smear guidelines still apply to you.  If there is any uncertainty on pap smear history, obtaining records from can be helpful to clarity surveillance strategy.

Breastfeeding encourages you and your baby to feel more connected. There is a spike in hormones in your body, specifically oxytocin and prolactin, while breastfeeding resulting in feelings of increased attachment and nurturing. The first-produced milk is called colostrum. It comes in smaller amounts before your milk supply increases a few days after delivery. Colostrum is loaded with immune-supporting properties, offering your baby an increased defense system against germs. Evidence also shows that colostrum coats the infant’s intestines with good bacteria aiding in digestion. Mature milk is produced within the first two weeks of breastfeeding and is rich in nutrients that support an infant’s ongoing organ, bone, and GI tract growth and development. Breastfeeding is a plus for moms, too! When breastfeeding is initiated soon after birth, it stimulates the uterus to contract and slow bleeding. Breastfeeding can also suppress your monthly menstrual cycle that most likely won’t return for at least 6 months postpartum. Your chances of becoming pregnant are much lower while exclusively breastfeeding. Breastfeeding even helps to burn more calories and can facilitate postpartum weight loss. Breastfeeding is a unique experience and journey for every mother. We are here to support you with tools, resources, and trained specialists, who are available to you in and out of the hospital setting, to support you on your infant breastfeeding journey.