Top 10 Questions Women Ask Their Primary Care Doctor, Part 2

| Posted On Apr 17, 2013 | By:

Top 10 Qs part 2About two weeks ago, I published the first 4 of the top 10 questions women ask their primary care doctor.  Here is part 2, which contains the next 3 questions – #6 – 4, as I’m counting down to the top 3.

I stressed this in the first post but do not want the message to get lost: whatever questions you may have for your doctor or any of your primary care providers about your body or your health, ask them!  It is so important to talk with your doctor as openly, honestly, and frequently as you can.  Only then can you and your doctor make the best choices for you about lifestyle changes, treatments and options.

#6.  Could my weight be a thyroid problem?

I’m sorry to say it, but for about 99% of all women, the answer is “No.”  This often comes up when women start a diet regimen of some kind – and it’s more marked when they do it with their husband.  He’s shedding weight left and right, and she’s not – what is up with that?

Your thyroid (whether it’s functioning correctly or not) does set your metabolic rate, but there are other factors at play as well.  Things as basic as getting a good night’s sleep and eating a good breakfast do kick-start it in the right direction.

Although it does get harder as you get older, it all comes down to what you put into your body and what you burn off.  There are 3 tenets I offer all of my patients to follow for successful weight loss.  They are:

  1. Portion control – you may have heard of “portion distortion” and it’s true: our sense of what’s the right amount is greatly over-shooting the mark.  Here’s a helpful visual from the Mayo Clinic
  2. Fruits and veggies – we’ve moved away from the old Food Pyramid and are now focused on MyPlate, which recommends that half our plate should be filled with fruits and vegetables.  They’re not only highly nutritious but highly filling, and they crowd out a lot of the other (maybe not so good) stuff.
  3. Exercise – a mix of both cardio (burning calories like walking, aerobics, biking, zumba) and muscle strengthening (like weight lifting) is absolutely essential to boost your metabolism.  This is why the husband might be shedding more pounds than you: men have more muscle mass than women, and more muscle mass = higher metabolism = more weight loss.  I always recommend women focus on their quads (your thigh muscles) and their upper back for muscle strengthening.  These give you “the most bang for your buck” just due to their size along with lots of health benefits.  And if you can, mix up your exercise routine, as your brain gets trained what to expect and doesn’t alter your metabolism for your exercise.  You’ll get more benefit when you keep your brain and those muscles on their proverbial toes.

#5.  What is happening to my hair?

Around the menopausal or perimenopausal time frame, women may look in their sinks and freak out a bit.  Hair loss is normal at this time in your life and is usually not “bad” – although it may seem like it to some.  Hair loss is actually more common for women than we think, especially if it is genetic.  If it is genetic, there’s not as much to do.  If hair loss is caused by menopause, hormone replacement therapy is an option, but obviously all of the benefits and risks should be weighed carefully.

For some women, additional screening may be warranted to check for deficiencies in vitamin D or iron as well as normal thyroid function.  These conditions can also cause a hair loss problem and should be ruled out.

Thyroid problems, if left untreated, can cause a host of other medical problems.  Vitamin D is important for bone health and reduces the incidences of falls in older people.

Iron deficiency, although possible, is not common for US women at this stage in their lives.  Usually, iron deficiency in the US comes from blood loss, typically from a heavy menstrual cycle, and a woman close to or in menopause does not usually have heavy periods.  If a woman is post-menopausal and iron deficient, I would check for other possible medical conditions, especially colon cancer since a woman can hide blood loss in her stools.

#4.  Could I have low T?

Popular media in our society leaves us with two related impressions: that we must want sex all of the time, and men’s problem with sex drive or low libido is fixed with a pill, usually blue.

I tell my patients to ignore what “other people” say you should want – it doesn’t matter how often as long as what you want is matched with what your partner wants.  If it’s not, that is distressful for women.  The reality is a woman’s libido can indeed drop or change over time.  Work stress, children or family obligations (their own kind of stress), hormonal changes – all of these and more can change your drive for sex.

I counsel my patients to recognize that intimacy can be great, but it’s a good idea to set expectations if desires do not match–one partner’s cuddling may not be meant to signal something more!  And I often hear that affection often suffers due to the desire not to set false expectations. I edited – but not sure I’m still saying it right.   It’s important to be up front about exactly what you want and set some clear expectations.

If you want to increase your sex drive, please talk to your doctor.  Certain medications you are taking may be depressing your libido.  I also discuss many changing aspects of my patients’ lives to understand what may be going on: How is your overall relationship? Are you still attracted to your partner?  Are you exhausted from kids, work, menopause, or other demands?  Does it hurt to have sex?

Recommendations will vary depending on what’s going on.  Date nights, books on erotica, or sex counseling can help rekindle interest.  Testosterone can be helpful for post-menopausal women only (not good for women before menopause) but it should not be given lightly as there are important side effects.  Sex therapy can also play an important role.


Stay tuned for my Top 3, coming to this blog soon!

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About Dr. Karen DaSilva

Dr. Karen DaSilva joined Harvard Vanguard’s Chelmsford practice in 1994 as a staff physician in both internal medicine and hematology. In 1999, Dr. DaSilva was named Chief of Internal Medicine for the Chelmsford practice. She also serves as Harvard Vanguard’s Director of Internal Medicine. Dr. DaSilva is currently the Deputy Chief Medical Officer and Senior Medical Director for Healthcare Delivery. Dr. DaSilva received her medical degree from Albany Medical College and is board certified in internal medicine and hematology.

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