Tag Archives: Diana Bitner MD

All hormone medications are not the same

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Think any hormone supplement will do? Think again. Get an expert’s opinion. (For Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat

 

A patient I’ll call Bev recently came to see me for her annual physical, and she had just a few complaints: rare hot flashes, occasional night sweats and irregular spotting.

 

So far, so good.

 

At age 54, her last regular period was approximately 16 months ago. Since that time, she had started using hormone creams prescribed by her chiropractor.

 

Bev brought the creams in to show me, boasting that they were all natural. She told me she had been feeling great since starting the hormone cream.

 

Her hot flashes were rare, and her once-thinning hair was now getting thicker. I continued to listen with an open mind as we discussed the rest of Bev’s health.

 

She happily reported that her hypertension was being controlled with low-dose medications from her primary care physician, and she had no other risk factors for heart disease, stroke, blood clots or diabetes. Furthermore, Bev was a healthy weight.

 

For the most part, I liked what I was hearing.

 

Finally, we confirmed that her health screening was up to date, including lab work, mammogram and colonoscopy. As a final step, I performed a breast exam, Pap smear and pelvic exam. Her pelvic and breast exams were normal, and I had no reason to expect any issues with her Pap results.

 

Now that we had all the background information and physical exam taken care of, I could address her concerns of lingering hot flashes. We were able to relate them to days when she was not drinking enough water, had increased stressed or drank an extra glass of wine.

 

I then felt obligated to voice my concerns about the natural hormone creams she was taking and the possible relationship to her irregular spotting.

 

As a result of my concerns, I asked Bev to have a pelvic ultrasound to measure the lining thickness of her uterus. Post-menopause bleeding can be a sign of uterine lining pre-cancer or cancer.

 

When women take FDA-approved estrogen replacement therapy and progesterone, their risk of uterine cancer is lower than women who take nothing. Estrogen stimulates the lining to grow, and progesterone keeps it in check.

 

However, the non-FDA-approved hormones Bev used are not shown to protect the uterine lining and can actually increase the risk of uterine cancer.

 

Bev’s ultrasound of her uterus did show a thick lining, and her endometrial biopsy showed benign thickening. We reversed the thickening first with synthetic progesterone and then switched her to two FDA-approved products: a bio-identical estrogen patch and an oral bio-identical progesterone.

 

Today, Bev feels great—hair and skin included—and I feel good that we are keeping her safe and healthy.

 

Reprinted with permission from Spectrum Health Beat.

Get your groove back

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Don’t allow sexual issues sideline you from the pleasures of life. (For Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat

 

Sexual health is a part of our overall health, and it impacts a woman’s (and a man’s) sense of self and feeling of being healthy.

 

Women who suffer from depression or anxiety are more likely to have sexual health concerns, and women with sexual health concerns are more likely to have depression and anxiety. It’s a vicious cycle—one that can be frustrating and difficult to break.

 

Chronic health issues or chronic health diseases such as heart disease, diabetes, obesity or arthritis can interfere with a woman’s ability, or a couple’s ability, to have a healthy sexual relationship. And common conditions like pain with sex, low desire and relationship issues all play a part.

 

I recently saw a patient who came in for her second visit to our Spectrum Health Cancer, Menopause, and Sexual Health Clinic at the Lemmen-Holton Cancer Pavilion.

 

She shared her excitement about once again being able to have sex after we treated her pain. She told me that cancer had taken so much away from her, but she felt whole again now that she could be intimate with her husband.

 

I love sharing stories like this because it shows how committed we are to helping everyone live better lives—including being as sexually aware and healthy as they wish to be.

 

I recently found the following quote from the World Health Organization:

 

“The purpose of sexual health should be the enhancement of life and personal relationships and not merely counseling and care related to STDs and preventing unwanted pregnancies. Sexual health should involve (1) the capacity to enjoy and control sexual and reproductive behavior in accordance with a social and personal ethic; (2) a freedom from fear, shame, guilt, false benefits and other psychological factors inhibiting sexual response and impairing sexual relationships; and (3) freedom from organic disorders, diseases and deficiencies that interfere with sexual and reproductive functions.”

 

I share this quote with you because, as a physician, I believe in what it says, and I try to keep it in mind when discussing sexual health with my patients.

 

There are many causes of sexual health concerns, and they can be grouped in the following categories: interpersonal issues, physical issues and psychological issues.

 

When discussing interpersonal issues, we think about lack of intimacy, lack of respect and emotional abuse.

 

Physical issues include pain with sex from menopause and dryness, pain from history of pain and/or tight pelvic muscles, and medical conditions such as diabetes or arthritis.

 

Psychological problems include depression or anxiety, history of sexual abuse and poor self image.

 

No matter what your sexual issues include, there are solutions. Reach out to your medical provider for help.

If you have concerns about how to get your groove back, make an appointment to specifically discuss this topic and options with your doctor or a Spectrum Health Midlife and Menopause Clinic expert. Call 616.267.8225 to make an appointment.

 

Reprinted with permission from Spectrum Health Beat.

Manage menopause with a mantra

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Pick and stick to your personal mantra to gain control of your life. (For Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat

 

The other day I had lunch with a friend at Panera. I had been craving my favorite Fuji apple salad and was really hungry when placing my order.

 

I have been avoiding simple carbs for quite some time, so I ordered an apple as a side—not the French baguette I love.

 

My friend ordered the baguette, and it looked so good! It was so fresh and warm, and I could tell it was crunchy on the outside and soft on the inside—exactly the way I like it.

 

I remembered my mantra and grabbed my apple.

 

My mantra is “lean and ease of movement.”

 

It means I can sit with my knees up like I used to when I was younger (and more flexible). It means no extra weight around my middle, and it also means feeling “light” as I move around. My mantra (and everything it represents) is so important to me.

When I am carrying extra weight, I hate the way my clothes feel—tight and restricted. It makes me feel trapped and reminds me of times when I had to sit and practice piano. When I am lean, I feel healthy and in charge of my health, and I don’t have to shop for bigger clothes (an added bonus).

Why do we make the choices we make? Choices imply active decision-making, but sometimes the decision is made by the act of not deciding.

When I was growing up, there was a sign on the wall in the stairwell of my home that read, “Not to decide is to decide.” I think that says it all.

For example, if I choose to not make my lunch or bring a snack to work, I am choosing to be without good choices throughout the day. As a result of not having a plan for lunch or snacks at work, I am choosing to eat fast food or unhealthy snacks, which are not the best for my mind, my mood, or my waistline.

So, what do you care about?

Do you care about your heart and really don’t want to have a heart attack at 50 like your aunt did? Do you want to feel and look great at 60, unlike your sister who smoked and chose not to exercise?

If you dig deep and get at what you really care about and create a mantra to fit, you will claim power over the day-to-day and significant situations that occur in your life.

It could be as mundane as choosing what to eat for lunch (healthy versus unhealthy) or whether or not to exercise when you don’t feel like it, or as important as finding the courage to quit your job to pursue a new career.

Here are a few questions to ask yourself when creating your mantra:

  • What do I really want for my life (or health) in the next six months?
  • When I think about what I really want, what does that mean to me?
  • What feelings do I experience when I look at what I really want for my life?
  • What mantra would capture the feeling of what I want?
  • In what situations would I need/use a mantra?

My mantra helps steer me in the right direction almost daily. Take some time to compose your own mantra and enjoy having more power over the choices you make each day.

To learn more or to schedule an appointment with the Spectrum Health Midlife, Menopause & Sexual Health team, call 616.267.8520.

 

Reprinted with permission from Spectrum Health Beat.