Special Q & A from Women's Health Event!

Special Q & A from Women's Health Event!

On September 17, 160 Female & Fabulous women attended a special Women's Health Event with Drs. Susan Ervine, Laurie Birkholz and myself presenting on breast health, nutrition during midlife and sexual health. Guests had questions for us - here's what we had to say based on our topics!

Susan Ervine, M.D., Answers Questions on Breast Health:

Q: If you’re a cancer patient, is it better to have a breast MRI or the 3D mammogram? And how often?

A: For women who have been treated for breast cancer, it is important to plan a breast cancer screening regimen with your doctor. Your oncologist, surgeon, and/or primary care doctor can help you determine the screening plan that is best for you. If it is determined that you have a 20 percent or greater lifetime risk of another breast cancer, annual screening breast MRI may be right for you. Annual screening mammography is recommended for all women, and it’s important to remember that breast MRI is not a substitute for screening mammograms, but rather performed in addition to an annual mammogram.

Tomosynthesis, also known as 3D-mammography, allows the radiologist to see through breast tissue more clearly because it obtains multiple images through the breast, reducing tissue overlap. For the same reason, tomosynthesis is also helpful for evaluating post-surgical changes in the breast and therefore is a good option for women with a history of breast cancer. Screening tomosynthesis can be performed annually in conjunction with your mammogram.

One common screening regimen for high risk patients is an annual breast MRI and annual mammography with tomosynthesis, alternating every six months so that they are being screened more often and with multiple types of imaging.

Q: I have been told I have dense breasts, how often should I be checked?

A: Breast density is just one of many breast cancer risk factors. For average risk women with dense breasts, annual screening mammography is recommended. Breast cancers may be invisible or harder to detect in dense breast tissue. Women with dense breasts may choose to have additional screening with tomosynthesis (3D mammography).

Q: Does having larger breasts mean you also have an increased risk of dense breasts?

A: No. Breast density is not necessarily higher for women with larger breasts. Dense breasts tend to be more common in younger women with smaller breasts; however anyone can have dense breasts regardless of age or breast size. Breast density is determined by the radiologist when interpreting your mammogram.

Laurie Birkholz, M.D., Answers Questions on Nutrition During Midlife:

Q: What forms of soy? Real, not powders?

A: The type of soy is VERY important! REAL soy, never supplements or soy “isolates." Examples are: miso, soy beans, soy milk, soy nuts, tofu and tempeh.

Q: Reduce sugar – does that mean reduce carbs too or more the white sugar?

A: Carbohydrates in general are not necessarily “bad.” Fruits and vegetables are, in fact, carbohydrates! The more “complex” the carbohydrate the better, so whole wheat flour is preferable to refined white flour, for instance. The real culprit today is SUGAR. Sugar, in any form (agave, honey, table sugar), should be limited.

Q: Black cohosh – is it ok to take if you have bleeding disorder? (VonWillebrands)

A: Black Cohosh should be fine to use in the setting of a bleeding disorder such as von Willebrands disorder. Nonetheless it is always important to review any supplements with your primary care provider.

Q: Can you comment on GMO vs. non-GMO foods?

A: Genetically modified foods or GMO foods, also genetically engineered foods, are foods produced from organisms that have had changes introduced into their DNA using the methods of genetic engineering. Genetic engineering techniques allow for the introduction of new traits as well as greater control over the traits than previous methods, such as selective breeding and mutation breeding.

Despite a general scientific consensus that genetically modified crops are not inherently dangerous to human health, there exists much controversy amongst the public regarding their safety. At this point in time there are no well-controlled, rigorous studies proving harm to humans. However, there continues to be concern regarding the issues of labeling, conflicts of interest in the field of research, and environmental impact; just to name a few.

Q: Do you know anything about the use of Moringa?

A: I don’t know much about Moringa and have not used it in my practice. The following is from a reputable resource, Memorial Sloan Kettering Cancer Center: Moringa oleifera (MO) is an edible plant that is native to Asia and Africa but is cultivated around the world. The leaves and the seed pods are nutritious and widely consumed as food; the bark and the root are thought to have medicinal properties and are used in folk remedies. Products derived from the herb are used to treat a variety of conditions, including asthma, diabetes, ulcers, infections and cancer. Extracts from the plant are used in primitive water filtration systems to remove harmful pollutants and algae (1).

In vitro and animal studies indicate that the leaf, seed, and root extracts of MO have anticancer (3) (4), hepatoprotective (10), hypoglycemic (12), anti-inflammatory (13) (14), antibacterial (18) (19), antifungal (20), antiviral (21), and antisickling (37) effects. It may also protect against Alzheimer’s disease (29) and stomach ulcers (24), help lower cholesterol levels (25), and promote wound healing (30). In addition, MO extract has demonstrated antifertility effects (28). Only a few studies of inadequate design and/or small number have been conducted in humans (36). In one of these studies, MO did exhibit a positive but small effect on lipid profiles (38).

It's important to be aware that MO inhibits CYP450 enzymes and may interact with prescription drugs.

Q: Can garlic and fish oil pills boost the omega-3 and garlic needs? If so, how much per day?

A: In general eating the REAL food source is preferable. So for fish oil, that means eating salmon, or another cold water, fatty fish 2-3 times per week. There is decent literature regarding fish oil supplements and in general if it’s not feasible to eat the real food, then 1000 mg of EPA + DHA are recommended for prevention. The dose can be up to 4000 mg of EPA + DHA if being used as treatment for high triglycerides. The literature around garlic supplements is less robust. In addition, it is important to recognize that supplements are not regulated and you may not be getting what you think you are. On the other hand, garlic is garlic!

Q: How do you know when to decrease or end estrogen supplements?

A: There is no magical answer to the question of when to stop hormone therapy. We will often suggest women trial off their hormones after around five years due to some of the research studies. Some women do fine; others will have their symptoms return. At that time it is important to discuss with your providers the pros/cons of resuming therapy.

Barb DePree, M.D., Answers Questions on Sexual Health:

Q: Do you have any prescription recommendations instead of Osphena?

A: Other prescription options to treat painful intercourse or vulvovaginal atrophy are all “localized estrogen.” They are Estring (a vaginal ring), Vagifem (a vaginal tablet) and Estrace or Premarin - both vaginal creams.

Q: Is there any help for a female who’s had a partial hysterectomy but no longer able to have the same type of uteral (big “O”) orgasm?

A: Unfortunately, this isn’t too uncommon. It’s hard to say if the change is related to the surgery (nerve disruption), hormones or other medications. A physical exam may help determine the cause. If its hormone related, hormone treatment can be helpful. This is the classic time a vibrator can be very helpful too.

Thank you for attending the event and your questions! Hopefully, our answers bring some insight!

Your partner in midlife wellness,
Dr. Barb

  • Barb DePree, MD

    Barb DePree, MD

    Recipient of North American Menopause Society’s 2013 Certified Menopause Practitioner of the Year for her exceptional contributions to menopause care, Barb DePree, MD, specializes in menopausal medicine, hormone replacement therapy and sexual health. With nearly 25 years in women’s health, Dr. Barb has comfortably answered all the uncomfortable questions of sexual health and the changes that occur as we age.

    After completing her Master's in Medical Management, Dr. Barb launched her own website, MiddlesexMD.com, that connects with people across the country and provides additional advice and products for patients. Dr. DePree obtained her Clinical Cancer Genomics Community of Practice Certification through the City of Hope. In addition to being a provider at Lakeshore Health Partners Women's Health, Dr. DePree is also part of the Holland Hospital Comprehensive Breast Services team, seeing patients at the High Risk Breast Clinic. 


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