Ovarian Cancer Risk

Ovarian cancer is the deadliest gynecological cancer and affects up to 1 in 70 women in the US. Accordingly, many women are worried about what their risks are of having this kind of cancer. Currently, there are no screening tests for ovarian cancer, but women at high-risk should discuss with their health care providers what options are available to them to reduce their risk.
One of the main problems in diagnosing ovarian cancer are that so many of it’s symptoms are things that we all suffer from occasionally anyway. These include bloating, pelvic or abdominal pain, feeling full quickly, and urinary symptoms like urgency and frequency. The difference is that is normal to feel these symptoms for a day or two here or there, but if they persist almost daily for two to three weeks, you should certainly see your doctor.
The ways we can diagnose ovarian cancer may include a physical exam with a pelvic exam, a vaginal ultrasound, and sometimes a blood test for CA125. CA125 is not useful in all women and often has false positives in women who have not yet gone through menopause. This test is most useful when there is an abnormality on the exam or pelvic ultrasound, if a woman is post-menopausal, or if she is at very high risk of ovarian cancer based on other factors.
While ovarian cancer can affect any woman, there are four categories of risk.

• Average risk: the lifetime risk of developing ovarian cancer is 1 in 70. Women in this category do not have a family history of breast or ovarian cancers, never had problems getting pregnant, and have never taken hormone replacement therapy. For these women, the recommended screening for ovarian cancer is an annual gyn exam with pelvic exam.
• Slightly increased risk: the lifetime risk in this group is 1 in 20. Women in this category may have had problems getting pregnant or taken medications to help get pregnant, have a history of endometriosis, may have taken hormone replacement in menopause, or had breast cancer after age 40. The recommended screening in this group includes an annual gyn exam with pelvic exam. You may also want to discuss with your doctor ways to reduce your risks (see below).
• Moderately increased risk: a lifetime risk of 1 in 10. These women may have had a mother or sister with ovarian cancer, had breast cancer before age 40 or had breast cancer themselves with other members of their family with breast cancer as well, have a strong family history of breast cancer under age 50, have Ashkenazi Jewish heritage, or a close family relative with uterine or colon cancer under age 50. The recommendations for these women include genetic counseling and screening, and possibly testing for the BrCa mutation (a genetic predisposition to breast, ovarian, colon, or uterine cancers). These women should also have an annual gynecological exam with pelvic exam with close follow-up for any problems noted on the exam.
• Very increased risk: lifetime risk of up to 1 in 2. These women may be BrCa1 or BrCa2 positive (gene mutations that increase the risk of breast, ovarian, colon, and uterine cancer), or MLH1, MSH2, or MSH6 positive (gene mutations which increase the risk of colon, uterine, ovarian, and kidney cancers).

Women with the BrCa mutations should have a pelvic exam with a gynecologist 1-2 times a year. Some women will opt to have their ovaries and uterus removed (hysterectomy and bilateral salpingoophorectomy) once they have completed childbearing. Women who wish to avoid surgery should have a vaginal ultrasound and CA125 testing twice a year starting at age 30-35. They should also have an annual mammogram and breast MRI to check for breast cancer, starting at age 25-30.
Women with the MLH or MSH mutations should see their gynecologist 1-2 times a year, as well as have a vaginal ultrasound and CA125 test twice a year. They should also have an endometrial biopsy every year to check for endometrial or uterine cancer. Additionally, they should have colonoscopy every 1-2 years to screen for colon cancer, starting at age 20-25. Some women will also elect to have their uterus and ovaries removed when they have completed childbearing.
Reducing the risk of ovarian cancer can be discussed with your doctor. Birth control pills (and presumably the ring and patch) have been shown to reduce the risk of ovarian cancer by 50% in women who use it for more than 5 years. The longer this form of contraception is used, the more benefits. This is one of the simplest, most effective ways to reduce your risk of ovarian cancer.
For women at very high risk of developing ovarian cancer, removal of the ovaries is an option. Surprisingly, this does not completely eliminate the risk of ovarian cancer, but dose reduce it bu 85-90%. This can also reduce the risk of breast cancer by 40-70% in women who have the surgery before they go through menopause. Surgery is usually only recommended in women who have undergone genetic counseling and testing and have been shown to carry a genetic risk for cancers.
To learn more about ovarian cancer, check out the Women’s Cancer Network at http://www.wcn.org/ or the Gynecologic Cancer Foundation at http://www.thegcf.org/. To learn more about genetic counseling and testing, click on http://www.cancer.gov/cancer-topics/Genetic-Testingfor-Breast-and-Ovarian-Cancer-Risk.

Eating for Two

Eating right can be one of the best things you can do for yourself and your baby before and during your pregnancy. The foods you eat are the main source of nutrients for your growing baby.

If you are planning a pregnancy, see your doctor. She or he will discuss with you your diet, any vitamin supplements you might need (folic acid, for instance) as well as your overall health and how that might affect or be affected by a pregnancy.
A healthy diet is important even before you become pregnant. This helps you and your baby start out with the nutrients you will both need. There’s no magical formula for pregnancy nutrition. The basics of a well-balanced diet with plenty of whole-grains, fresh fruits and vegetables, and lean sources of protein remain the same. Of course, you also want to drink plenty of water – two to three liters a day!
You do need to eat more calories in pregnancy, but it may be less than you think. The number of calories recommended for a non-pregnant woman in 2000 a day. There is no recommended increase in the first trimester (up to about 12 weeks) and only about 300-350 calories more in the second trimester (12-26 weeks). This is equivalent to about a cup of yogurt and a small apple. In the third trimester (after about 26 weeks), the recommendation is about 400 extra calories a day.
Pregnant women also require more folic acid and iron. Folic acid helps prevent birth defects, preterm birth, and growth problems in the baby and iron prevents anemia in the mother. Fortified cereals are a great source of folic acid. Leafy green vegetables, citrus fruits, and dried beans and peas are also all good sources of folic acid. The recommended amount of folic acid in pregnancy is 800-1000mcg. A woman trying for pregnancy should start taking a prenatal vitamin or extra folic acid 3-6 months before she is ready to get pregnant. Some women with certain medical problems or a history of a baby with a birth defect may need more folic acid, so ask your provider if you are unsure.
Another important mineral is calcium, with a goal of 1200-1500mg a day. This is important to help build healthy bones in your growing baby as well to keep your bones strong during pregnancy and breastfeeding. Some studies suggest it might also help reduce the risk of other medical problems in pregnancy, like pre-eclampsia.
Prenatal vitamins are usually good sources of folic acid, iron, calcium, and other important vitamins and minerals, but check the labels and check with your doctor. Also, it’s best to avoid prenatal vitamins or formulations that include things like herbs or extracts since there is little evidence of the safety of these compounds and some have even been shown to cause cramping or problems in pregnancy (even ones that are “pregnancy” herbs!) Of course, the best place to get your vitamins and minerals is in your food.
DHA is an important supplement to help with healthy brain and eye development both in pregnancy and while nursing. DHA is one of the Omega 3 fatty acids and the best way to get enough is with a DHA supplement specifically designed for pregnancy. It’s best to avoid flaxseed oil (due to rare, but documented pregnancy complications) or fish sources (due to concerns about mercury levels).
Weight gain is to be expected in pregnancy, but how much you should gain depends on how much you weigh before you get pregnant. Women of a healthy weight should gain 25-35 pounds while women who are overweight should gain 15-25 pounds. Underweight women usually gain about 25-40 pounds in pregnancy. This increase in weight is needed for many components of your changing body and growing baby. As an example:

• Baby 7 ½ pounds
• Breast growth 2 pounds
• Maternal nutrition stores 7 pounds
• Placenta 1 ½ pounds
• Uterus growth 2 pounds
• Amniotic fluid 2 pounds
• Increase in blood volume 4 pounds
• Increase in body fluids 4 pounds

A few special concerns:

• Vegetarianism
  o If you are a vegetarian, it is safe to continue your diet in pregnancy. Some women choose to add lean meats or fish to help get enough protein and iron, but this is not strictly necessary if you can get enough of these in your diet or with the help of vitamins. Sometimes vegetarians need to take extra iron, vitamin B12, and vitamin D.
• Drinks
  o You should avoid alcohol in pregnancy because frequent use can cause birth defects and mental retardation. A few drinks before you knew you were pregnant rarely cause any problems.
  o Moderate caffeine intake is probably OK (1-2 cups of coffee, sodas, or teas). More than that has been shown to increase the risk of miscarriage. Caffeine also crosses the placenta.
  o Diet drinks and other foods with NutraSweet or Splenda is OK 1-2 servings a day. There is little data about the safety of these, and so it is probably best to reduce your exposure.
  o Avoid unpasteurized juices.
  o Read the labels on herbal teas. Many of the herbs used for teas, when taken in large or medicinal amounts, can potentially stimulate the uterus and induce miscarriage. These include anise, catnip, chamomile, comfrey, ephedra (or ma huang), European mistletoe, hibiscus, horehound, Labrador, lemongrass, licorice root, mugwort, pennyroyal, raspberry leaf, rosemary, sage, sassafras, stinging nettle leaf, vetiver, and yarrow. Also avoid Coca (or mate de coca), kava root, skullcap, valerian, woodruff, and lobelia. Mate tea can contain as much caffeine as coffee.
• Meats
  o Do not eat any raw meats. This includes sushi! The nori (seaweed) that sushi is wrapped in can also contain high levels of mercury, so avoid even vegetarian or cooked sushi.
  o Deli meats are probably OK as long as they are fresh. If they’ve been in the refrigerator for more than a few days, either throw them out or reheat them to steaming.
• Cheese
  o Do not eat unpasteurized or “raw” cheeses (this may include some imported, soft cheeses) – check the labels! Pasteurized soft cheeses are OK.
• Fish
  o Fish (including shellfish) is OK 1-2 servings a week. Avoid shark, swordfish, king mackerel, and tilefish. This is again due to the concern for mercury which is a neurotoxin in developing babies.
  

Morning Sickness

Early pregnancy can be affected by nausea and vomiting, or “morning sickness”. Some women’s “morning sickness” is in the evening and some women are lucky enough not to have it at all. Regardless, if you are feeling sick, one good tip is to never have your stomach too empty and never have your stomach too full. Try to eat a variety of foods, but if one in particular turns you off, it’s fine to wait until this phase of pregnancy passes. Many women have good luck with light or bland foods like crackers, cooked fruit, broiled meats, carrots, apples, popcorn, cereal, dry toast, or flavored gelatin.
Some women find relief from ginger (either real ginger in foods like cookies, ginger ale, etc. or ginger capsules), vitamin B6 (25mg three times a day), or SeaBands (acupressure wrist bands designed for motion sickness). Other women find relief by nibbling on a few saltines before getting out of bed in the morning. Sometimes peppermint can help, too, either as aromatherapy or in candies or gum. Again, real peppermint is better than an artificial flavoring.
If natural therapies aren’t helping, there are also some medications that can help. Nestrex and Emetrol are over-the-counter and safe in pregnancy. There are also prescription medications available that your doctor or midwife should be able to offer you.
Often, prenatal vitamins can aggravate the nausea or even prevent women from taking their vitamins at all. One way to manage this is to take your vitamins at night before bed or with food. If that still doesn’t work, taking just folic acid may be better tolerated. Those pills are often much smaller than the regular prenatal vitamins. A goal should be 800-1000mcg of folic acid a day. Some women can’t even tolerate that, and so skipping a few days or weeks of prenatal vitamins might be the only answer to keep from throwing up.
The good news is that this usually passes after the first trimester. If it doesn’t or it is so severe that you are losing weight, you should talk to your doctor.

Birth Control Implant -- Implanon

Implanon is the latest in implantable contraception. It is a flexible plastic rod about the size of a matchstick that is put under the skin of your arm in an in-office procedure. This is a fantastic option for women who want to avoid having to remember their birth control every day, every week, or every month since it lasts for three years.
Implanon has been used over 4.5 million times worldwide and is more than 99% effective. This is a great solution for women who have problems remembering to take pills, have hectic schedules that prevent them from getting to the pharmacy or taking a birth control method regularly, or who want to avoid having to find that condom or diaphragm when the time is right.
Implanon is a very low-dose hormonal method that contains only progestin, so can be used by women who cannot take or who are sensitive to estrogen. This may include women with histories of clotting disorders, high blood pressure, or migraines. It is also safe for women who are breastfeeding.
The implant is made of a medical material that is safe to leave in the arm for up to three years. At the end of three years, it should be removed. If continued contraception is desired, another one can be placed at the same time as removal. If during the three years, a woman decides the time is right to start trying for a pregnancy, the Implanon can be removed at any time and fertility rapidly returns.
The implant is placed with local anesthesia (like Novacaine) in the doctor’s office. The visit will take about 15 minutes and actually placing it takes about 3 minutes. The best time to have it put in is during your period, but can be placed at any time if it’s more convenient.
The most common side effect that women notice with the Implanon is that their periods change. Usually, this is a reduction in bleeding, but it can also cause periods to be irregular. The number of bleeding or spotting days is similar to that experienced by a woman who is not on contraception. This effect is completely normal and is a sign that Implanon is working the way it should. Less common side effects include acne, change in appetitive, , change in sex drive, ovarian cysts, depression, scarring of the skin over the implant, dizziness, hair loss, headache, nausea, nervousness, pain at the site of the implant, and sore breasts. These side effects are much more rare, and most women adjust to the Implanon quickly and easily.
For more information, discuss with your health care provider, make an appointment with Dr. Swartz, or contact your local Planned Parenthood.

The Doctor's Visit BEFORE You Get Pregnant

We recommend a visit with your doctor when you and your partner have decided to start a family. This visit should include a full physical examination including a Pap smear and cervical cultures, as well as blood tests if these have not recently been done. These blood tests will test you for your immunity to rubella and chicken pox and your blood type. If you are not immune to one or both of these viral infections, you may need to be vaccinated. In this case, it is best to wait a month before trying to conceive.
Optimizing the health of the mother before conception is important for improving pregnancy outcome. This is particularly true for certain women, such as those with medical disorders or who regularly take medications. Preconception care is more important than prenatal care for prevention of birth defects.
This visit may also include a discussion of your medical history, your partner's medical history, your family's genetic history, and optimization of your health. We also will usually discuss healthy lifestyle issues and nutrition. I recommend starting prenatal vitamins with a prenatal DHA supplement (Expecta Lipil for instance) at least 3 months before you start trying for pregnancy.
Many women think that they need to stop their birth control method several months in advance before starting to try to conceive. This is true only for DepoProvera (the shot) and maybe for the Mirena IUD. It is not necessary to stop pills, the ring, the patch, etc. until you are ready for a pregnancy.
As always, if you have questions, talk to your doctor or make an appointment to see me.

Vaccine for Cervical Cancer, Abnormal Pap Smears, and Genital Warts

The Human Papilloma Virus (HPV) vaccine is an exciting development in the fight against cervical cancer and precancerous dysplasia, and is currently FDA-approved for young women between 9 and 26 years old. We have found it is covered by most insurance plans, but for more information, call your insurance company.
The Gardasil vaccine is effective against four of the most common types of HPV (there are about 120 different strains!) that cause abnormal pap smears, cervical cancer, and genital warts. It is a series of three shots over a six month period given in your doctor's office.
The vaccine works best in young women who have not yet become sexually active, but is also recommended in women who are sexually active and even with known HPV disease.
For more information, check out the Gardasil website or call the office for an appointment with Dr. Swartz (303-938-4710).

Disclaimer

We reserve the right to change these terms and conditions at any time, and you agree to abide by the most recent version of this Terms of Use Agreement each time you view and use the Web site and/or blog. You are accordingly advised to consult the Terms of Use Agreement each time you view and use the Web site and/or blog. Do not use the Web site and/or blog if you do not agree to all of the following terms and conditions.
The information on this Web site and/or blog is provided for general information, is not intended to provide medical advice and should not be relied upon as a substitute for professional medical advice, diagnosis or treatment.
We may provide links on the Web site and/or blog to other Web sites or blogs that are not under our control. These links are provided for convenience or reference only and are not intended as an endorsement by us of the organization or individual operating the Web site and/or blog or a warranty of any type regarding the Web site and/or blog or the information on the Web site.
In consideration for your use of and access to our Web site and/or blog, you agree that in no event will this practice, its affiliated or related entities, its content providers or any other party involved in creating, producing or delivering this Web site and/or blog or any site linked to this Web site and/or blog, be responsible or liable to you or entity in any manner whatsoever (including, but not limited to, persons who may use or rely on such data or materials or to whom such data and materials are furnished) for any loss, damage (whether actual, consequential or punitive), injury, claim, liability or other cause of any kind or character whatsoever based upon or resulting from any information provided in this Web site and/or blog or arising from any decision made or action or non-action taken by you or any other person in reliance upon the information provided through our Web site and/or blog, even if you advise us of the possibility of any claims or damages.
This practice has made and will continue to make efforts to include accurate and current information on this Web site and/or blog. However, the materials in our Web site and/or blog are provided "as is" and to the fullest extent permissible pursuant to applicable law, this practice disclaims all warranties, express or implied, including, without limitation, implied warranties of merchantability and fitness for a particular purpose. This practice does not assume any responsibility or risk for your use of the Web site and/or blog. This practice does not warrant that the functions contained in the materials will be uninterrupted or error-free, that defects will be corrected or that our Web site and/or blog or server that makes such sites available are free of viruses or other harmful components. This practice does not warrant or make any representations regarding the use or the results of the use of any of the materials on our Web site and/or blog in terms of their correctness, accuracy, reliability, completeness, timeliness or otherwise. None of the information contained in this Web site and/or blog shall be construed as an indication of this practice's views, opinions or recommendation or endorsement thereof. Except as specifically stated otherwise, this practice does not endorse, operate, control or assume responsibility for any product, brand, method, treatment, information or services on the Web site and/or blog, in any way.
All Contents Copyright ©2009 All Rights Reserved. The images and materials found in the Web site and/or blog are copyrighted or otherwise proprietary and may be downloaded and/or reprinted for personal use only. Permission to reprint or electronically reproduce any document, stills, audio, video footage or any other materials in whole or in part for any reason is expressly prohibited, unless prior written consent is obtained from the respective copyright holder(s).