The SkinLess Project

May 5, 2012

Birth Control that is not The Pill

As a gynecologist, I discuss birth control options with women a dozen times a day.  This past month brought several women who specifically were looking for non-pill options.  It was in counseling these patients that I realized that a lot of women have only a vague idea of what non-pill options exist out there.  So here is the skinny on birth control that is not The Pill:

NuvaRing: NuvaRing is a small plastic ring that is placed inside of the vagina monthly.  It works the same way as the pill, but the hormones are released from the ring slowly over the course of the month.  It stays in place for 3 weeks and is removed for the last week, which is when a period occurs.
When I first describe NuvaRing to patients, they almost always make a face.  For some women there is an "ick" factor involved with putting the ring into their vagina.  But as I remind folks, tampons are inserted into the vagina too, and no one thinks twice about that!
NuvaRing is great for people who can't remember to take a pill daily.  It stays in place during intercourse and isn't felt by either partner.  Most women who try NuvaRing are pleasantly surprised by how simple and easy it is to use.

Intrauterine device (IUD) :  IUDs are my favorite.  Why?  They are essentially foolproof.  Almost all forms of birth control work really well...if used properly.  Condoms, as a matter of fact, are 98% effective at preventing pregnancy if used consistently and correctly.  The average person, however, does not use birth control consistently and correctly.  People forget to take pills, put in rings, show up for injections or use condoms.
That is the beauty of the IUD.  It is a small device that is placed inside of the uterus by a physician in what amounts to a 5 minute office procedure.  One type of IUD is hormonal and lasts for 5 years.  The other is completely non-hormonal (made of copper) and is good for 10 years.  Viola!  You're covered.  No trips to the pharmacy, no refills on the pill pack, no hassle.  And should you decide to get pregnant, the IUD can be pulled out at any time and fertility returns.
IUDs are safe to use in any woman, and are seeing a renewed popularity these days.  They are long lasting reversible forms of contraception, which is what most people are looking for.  Among my ob/gyn colleagues, IUDs rank highest in personal use!

Implanon: Implanon is the new contraceptive implant that is placed just under the skin of a woman's upper arm.  It is reversible and lasts for up to three years. The procedure to insert it is quick, and a local anesthetic is given to the skin of the arm to minimize discomfort with the insertion.  I don't use Implanon as much as IUDs, because it tends to cause irregular and unpredictable bleeding.

DepoProvera: aka "the shot".  This injection is given every 3 months.  It works well, but has the hassle factor of having to come in to the clinic every 3 months, as well as a prolonged return to fertility once the injections are stopped.  A few years ago, there was concern raised that it causes bone loss which may or may not be reversible.  And it causes weight gain in a majority of patients.  Enough said.

Condoms: The good old condom may be the easiest form of non hormonal contraception out there.  It is relatively inexpensive, does not require a doctor's visit or a prescription, and has a high efficacy rate when used correctly.  It also offers what no other method can: protection against sexually transmitted infections!  Alas, the condom is often misused (or not used), which leads into a common joke among doctors.

Q: What do you call people who use condoms?
A: Parents.

There are a handful of other options that I have not reviewed: patches, diaphragms, cervical caps, sponges, spermicides and the rhythm method (to name a few).  And then there are the surgical options: tubal ligations and vasectomy.  The bottom line is that birth control has to be matched to the individual and the lifestyle, and each person's situation and needs are different.  Talk to your doctor about what will work best for you.  And know that there are lots of great options out there that are not The Pill.

-Dr. Jahedi

April 1, 2012

HPV 101: Why you have a Pap smear and
what it means

I have had the HPV conversation with a lot of women in my office this month-
as pap smear after pap smear has come back abnormal and we move to the
necessary steps of follow up. My patients are mostly young women, and my
discussion of HPV (human papillomavirus) is usually the first time that they are
really learning about this little virus. I am always surprised at how little women
know about why we do Paps and how abnormal results can affect them. So here
is a primer for Pap smears and HPV- with a little history thrown in!

The cervix is the opening to the uterus, and is found at the very top of the
vagina. Back in the day, cervical cancer was the leading cause of death
in women, and no one knew why, or how to test for it. Enter Dr. Georgios
Papanicolau, who in 1923 was doing research on female guinea pigs and
studying vaginal fluid to try to better understand the menstrual cycle. As chance
would have it, one of his guinea pigs had uterine cancer and he realized that
he could plainly see the abnormal cells under the microscope. It was an "a-
ha!" moment for Dr. Papanicolau and a breakthrough in what ultimately became
known as the Pap smear.

Cells are obtained from a woman's cervix with a brush and studied under
the microscope. Abnormal cells signal precancerous changes that can then
be treated, thus preventing cervical cancer. But the cause of these cellular
abnormalities was still a mystery. Then in 1983, German virologist Harald zur
Hausen proved that HPV was the cause of cervical cancer, and went on to win
the Nobel Prize for this important scientific discovery.

So now we know: HPV is the cause of abnormal pap smears.

How does someone get HPV? It is sexually transmitted. As a matter of fact,
HPV is the number one sexually transmitted infection out there. Between 75-
80% of Americans have been exposed to HPV at some point in their lifetime.

Patients ask me all of the time what they can do to prevent getting it, and the
answer gets tricky. HPV is small enough that even condoms don’t protect you
entirely. The key would be not to have intercourse with anyone who has already
been exposed- but how can you tell if someone has been exposed? While men
certainly carry this virus, most never know that they have it, because it does not
cause any symptoms at all. And it is not something that they are ever tested for,
so when someone tells you that they have "been tested for everything", it usually
does not include HPV.

I tell my patients not to stress about an abnormal pap smear, even if it means
that they have been exposed to HPV. So have 8 out of 10 people out there! It is
so common that I hate to give it the stigma of an std. It is something that people
live with, and that their immune systems fight successfully every day. Keep on
top of your pap smears and follow ups, and HPV won't interfere too much with
your life.

For our younger generation of daughters, consider the HPV vaccine. Once HPV
was definitively linked to cervical cancer, the scientific world raced to develop a
vaccine, and Gardasil was introduced in 2006. In 2009, it was approved by the
FDA for young boys as well, since they are carriers of the virus and transmit it to
women. It has been safely given to thousands of young women and men, with
the understanding that it is most effective BEFORE the onset of sexual activity,
and hence before exposure to HPV. This vaccine is the newest tool in our
evolving fight against abnormal pap smears and cervical disease in women.

Dr. Papanicolau would have been proud.

March 1, 2012

Love Your Heart...and Know Your Numbers

I encourage every woman who walks into my office to take a moment to love her own heart.  Yes, I'm talking about the flesh and blood heart that is beating away in your chest.  This heart has faithfully served you since you were a wee embryo, and continues to beat tirelessly day in and day out, asking little in return.

The human heart beats at an average rate of 70 beats every minute.  Think of it...that's 4,200 beats in one hour...and over 100,000 beats a day!  This fantastic organ keeps life's blood flowing through your veins, and deserves a moment of recognition.  There are many things you can do to keep a healthy heart- here are just a few to get you started.

1. Exercise!  The benefits of exercise on heart health have been solidly proven.  I usually counsel my patients to walk.  Its cheap, it works and it has the lowest dropout rate of any exercise regimen.  If you have a gym membership, then walk the treadmill 30 minutes a day at least 3 days/week.  If not, then walk at the mall.  Walk at home.  Take the dog for a walk.  In short, walking works.  www.startwalkingnow.org can help you get started.
2. Eat right.  God only knows that I am as guilty as anyone else of ordering takeout for dinner at the end of a long day (isn't every day a long day?).  Our culture of eating out is making us fat, and in turn, destroying our hearts.  Despite our busy lives, I really do believe that with some effort, healthy meals can be made at home.  It is a mindset.  To help you get started, the American Heart Association has a website www.heart.org , with a Nutrition Center link that can guide you.
3. Have your cholesterol checked.  And get to know your numbers! Cholesterol screening is recommended once every 5 years for everyone over the age of 20.  Have you had your cholesterol checked?  You'll remember having it done, because it is a fasting blood test, which means that you couldn't have anything to eat or drink overnight before your blood was drawn.  There are a lot of numbers in cholesterol screening, but here  are the very basics:
1. LDL is bad cholesterol. You want to have levels under 100.
2. HDL is good cholesterol.  Aim for levels above 60.
3. Your total cholesterol should come out less than 200.
4. Triglycerides, which are another measure of heart health, should measure less than 150.

I have so many patients daily who ask me about their risk for breast cancer.  I have yet to have anyone ask me about their heart- despite the fact that heart disease is the number one killer of women.  More women die of heart disease per year than all types of cancer, including breast cancer.  So make an effort to change your lifestyle a bit, know your cholesterol screening numbers and take good care of your heart!  In turn, it will take good care of you.

February 1, 2012

The Annual Exam and Why You Should Get One

As a physician whose specialty revolves around taking care of only women, I am continually amazed at how much women accomplish on a daily basis. Women are the backbones of their families, and they keep everyone on track. Yet I am not surprised when women ignore their own health needs. After all, there are only so many hours in a day, and most women will address the needs of their family members before their own.

Your annual exam to the doctor should not be one of those things that gets sacrificed for your family. Why? Because the only way that you are going to be around to keep your family running is if you take a moment to address your own health.

What does the annual exam involve? Most exams include a head to toe physical, as well as some conversation about your lifestyle.

• Do you have good nutrition in your busy life? Do you get out and get moving every once in a while?
• When was your last lipid screen? This simple blood test can detect high cholesterol levels that could otherwise negatively impact your future health in a big way (we're talking early heart disease and stroke!).
• Are you up to date on immunizations? Immunization is singlehandedly one of the best prevention techniques out there. Some vaccines, such as the HPV vaccine, can actually help prevent cervical cancer.
• Speaking of cervical cancer, when was your last Pap smear? HPV is a pesky little virus that causes big problems like cervical cancer. The bad news? Over 75% of the population has been exposed to some form of HPV. The good news? A pap smear can detect precancerous changes in your cervix- so get one! Pap smears save lives.
• If you are over the age of 40, mammograms become a part of your prevention arsenal. Newer technologies have made them less uncomfortable than they were previously, and mammograms can detect early breast cancers. Why would you not want to detect breast cancer if you can help it?
• If you are over the age of 50, then colonoscopy becomes a must. The reasons are simple: colonoscopies detect colon cancer, and colon cancer kills people. The bad news? You have to clean out your colon beforehand and have a camera up your butt during the procedure. The good news? They put you under for it and you won't remember a thing. The best news? You only have to have it done once every ten years- and it could very well save your life.

In a nutshell, the annual exam will help keep you well. When you consider the big picture, the complex life that you lead (not to mention all of the lives that revolve around you) will run even more smoothly if you are a happy, healthy captain at the helm.

Best wishes for a healthy and happy year ahead!
-Dr. Jahedi

Please Note: Dr. Jahedi's blog should not be seen as medical advice. It is a blog for general information only. As every patient's needs are different.