At the recent bi-annual Women’s Health Forum hosted by the Mass Health Council, I was asked to review the top five health issues that women bring to me as their primary care physician. I couldn’t narrow it down to only five, so I came up with six – here they are!
#6 What Supplements Should I Take?
Vitamins: If you have a generally healthy diet that includes fruits and vegetables, then you probably don’t need to take any supplements, except for one, and that’s vitamin D. It’s best to get your vitamins and minerals through your diet rather than through a supplement. Vitamin D can be absorbed through the skin with exposure to the sun, but as we encourage people to wear sunscreen to prevent skin cancer, it becomes more difficult to get this vitamin the “natural” way.
Aspirin: Many women ask about taking a daily aspirin to help with heart health. For many years aspirin was recommended for post-menopausal women. More recent studies have shown that aspirin may still be helpful for men over 50, but that it is less helpful for women over 50. The use of aspirin for women has more to do with your risk factors for heart disease and is something women should discuss with their doctor as they near age 60 – 65.
Protein: If you have a medical condition that requires a very restrictive diet or have malnutrition due to an underlying disease, then protein supplements are something to discuss with your doctor. Otherwise, you can get the protein you need by eating protein-rich foods such as lean meats, fish, cheese, beans, yogurt and nuts.
#5 Why Am I Gaining Weight? Is It My Thyroid?
An underactive thyroid is a common problem in women, but hypothyroidism isn’t the only thing tied to weight gain. The most helpful test for determining any potential issue with your thyroid is the Thyroid Stimulating Test (TSH). Your doctor can determine whether a TSH test should be ordered based on your symptoms. Although hormones are a factor as we age and lose lean muscle mass, your weight gain is more likely related to your choices in food, portions that are too large, lack of exercise, not managing your stress, not getting enough sleep and/or not drinking enough water. The sad truth is there is no magic pill and as you age, you need to exercise more and eat less. I do not recommend that my patients take any weight loss supplements as they typically are not safe. If you are concerned about your weight, talk to your doctor so he or she can rule out any other health-related causes as well work with you to help you lose weight smartly and feel healthier.
#4 Do I Have Cancer or Heart Disease?
I hear this question a lot. Patients have symptoms that they look up on the internet and everything seems to point to cancer. Regular health screenings for women such as mammograms, pap smears and colonoscopies are very important because if we can catch diseases early, then we can treat them more effectively. You may not realize it, but your primary care physician screens for a lot of diseases when asking about your family history, checking your blood pressure, taking your pulse and ordering bloodwork to measure things like your cholesterol and glucose levels. Our questions and these tests are used to help us check for indications of heart disease, diabetes, cancer and other diseases.
Another type of screening your primary care physician should be doing during your visit is a screening for depression and anxiety. One of the most highly prescribed types of medications across the nation, aside from sleeping pills, are those for depression and anxiety. It is important for you to be honest with your doctor about anything going on in your life including the use of excess alcohol, illegal drug and tobacco use. Your physician can help you get the help you need if any of these substances are having a negative impact on your health and your life.
And it’s not only your health, but your safety that needs screening. You may wonder why your doctor asks if you wear your seatbelt when driving or if you have a smoke detector. The reason we ask these questions is because the #1 cause of death in younger adults is not heart disease or cancer, it is accidents. We try to remind patients about the importance of wearing a bike helmet and seatbelt and having properly working smoke and carbon monoxide detectors in their homes.
#3 What Is the Best Way To Not Get (or Get) Pregnant?
First, let’s discuss the ways NOT to get pregnant. When talking about birth control, there are several options such as birth control pills and IUDs, but the real breakthrough in birth control is long acting reversible contraception (LARC) that was discussed in this blog post.
Birth control pills are not only used to prevent pregnancy, but they are also used to treat other medical conditions such as polycystic ovarian disease, difficult periods and acne. Women in perimenopause can have symptoms like hot flashes, night sweats, mood swings and very heavy periods. Being on a birth control pill can help even things out and make the transition a little smoother.
When my young female patients decide to go off birth control to start a family, many of them express concerns about getting pregnant. The good news is that, even if you’ve been on birth control for years, your fertility usually returns to normal soon after you stop taking birth control. The news that causes a bit more concern is that it takes an average of one year to get pregnant. Sometimes it happens quickly, but sometimes it doesn’t. Anxiety and stress have a negative impact on fertility, so it is important for women to be patient when trying to conceive. We don’t usually think about referring a patient for fertility treatment until there has been at least 6-12 months of really trying to get pregnant. The closer a woman is to the age of 35, generally the shorter the time we’d wait before referring. It is very important than anyone thinking about getting pregnant take a minimum of 400 -800 mcg per day of folic acid. Folic acid helps prevent birth defects such as spina bifida. It is most effective if taken before getting pregnant so I recommend any woman who is even thinking about getting pregnant take either folic acid alone or a multivitamin for women which has Vitamin D and folic acid.
I also encourage women who are thinking of having children to plan ahead. And by that I mean that women over the age of 35 are classified as “high risk” when they are pregnant. This is not to say that women over 35 can’t have children, there are just more medical risks and testing required as women age.
#2 I Can’t Sleep. Can I Just Have Some Ambien?
“Sleep hygiene” sounds like a funny term, but you need to think about the health of your sleep. Are you going to bed and getting up at the same time every day? Are you sleeping with the lights on? Do you fall asleep with your iPad clutched to your chest? It’s important to practice good sleep hygiene as outlined in the blog post Sleepless Nights: How to Help with Insomnia.
Getting regular exercise, reducing stress and eating a healthy diet are all important factors when it comes to sleep. There are many free smartphone apps, such as Relax Lite – Stress and Anxiety Relief, which walk you through guided imagery to help you fall asleep. I also recommend my patients try natural sleep aid options such as melatonin or valerian, neither of which affects your Rapid Eye Movement (REM) sleep. Always check with your doctor before starting any over-the-counter medication to ensure it won’t interact with any prescription medications you are taking. Antidepressants, Ambien, Valium and alcohol all negatively affect your REM sleep, so again, it’s important to talk to your doctor about any medications you’re taking.
#1 Can You PLEASE Fix My Hormones?
Fluctuating hormones are part of menopause and can cause PMS as well as libido changes. We can “fix” your hormones with medication, but medication isn’t the only or the best way to deal with these issues. Similar to insomnia and other health concerns, lifestyle changes can have a big impact. We do sometimes recommend birth control pills to help with menstrual irregularity, PMS or even heavy periods. Depending on the symptoms, sometimes antidepressants are helpful even for a short time. If the symptoms are only about heavy periods, using a progesterone IUD can make a big difference in your quality of life when you feel trapped at home due to heavy and/or unpredictable periods.
The bottom line: Exercise, healthy eating, developing a hobby, doing meaningful work (paid or unpaid) and nurturing healthy, positive relationships can all have a positive impact on your health. Whether during times of transition or just the stress of day to day responsibilities, prioritizing a healthy lifestyle is always a great investment in your future. I encourage everyone to work closely with their primary care clinician and their clinical care team to achieve their health goals.