Author: The Group For Women

The Marriage of Mental Health and Medicine: Practice Success

by Barbara L. Kersey, Ph.D. 

The year was 1986. I had earned a Ph.D. in Marriage and Family Therapy in 1984 and was in my first post-graduate position, “in the trenches” of a local mental health agency. I was ready for a change, having become rundown and somewhat disheartened about the difficulties of agency work. I received a call from Jon Crockford, an OB/GYN physician, asking if I would be interested in coming to work in a medical setting.  I was more than interested and couldn’t wait to talk with him.

We chatted for a few minutes and made an appointment to speak face to face in Dr. Crockford’s office.  After that meeting, he arranged for me to meet with all the physicians (at that time, six males) at one of their 7am Thursday meetings. We discussed the possibilities; I knew it made intuitive sense. Women who are seen by their OB/GYN and are in need of mental health care for depression, postpartum issues, marital problems, premenstrual distress, infertility, or hormonal challenges would be much more likely to follow up with a referral to an in-house therapist than to seek help in a psychiatric practice elsewhere. And a practice that specializes in addressing the needs of women would be well served to address their mental health needs as well.

We started off with a series of free seminars informing the public and our patients about our new counseling services. On four separate occasions, one of the physicians and I offered loss, women and relationships, and depression.

One of the groups of patients we wanted to reach was those who experience pregnancy loss. In addition to our free seminar, I drafted a letter of condolence that went out to patients who experience loss, expressing our concern and letting them know that the practice had expanded its services to include counseling. In addition, I sent a booklet on grief that let patients and their husbands and families know what to expect emotionally in the weeks and months following loss. These booklets have now become routine and a part of the medical protocol.

Our counseling services were well received. Within six months of coming on board, I was busy fulltime.  Now, 18 years later the practice includes nine physicians (with four females). The counseling services have been expanded to include a sub-specialty in work with infertile couples and a consulting relationship with both the Jones Institute for Reproductive Medicine and the New Hope Center for Reproductive Medicine. My caseload remains full and now is only open to physician referral. The marriage of mental health care in this medical setting has been a practice success. I feel fortunate to have had the opportunity to do this exciting work.

ACOG Pause Magazine

Menopause – The Group for Women can help you face these natural changes with grace and strength. When you consult with any of our doctors, we will provide thorough information on hormone replacement therapies available to you, and determine the best course of action for your continued health. Hormone replacement treatments are designed to help you overcome issues associated with aging and menopause, recovery from illness, and problems with sexual drive.

Please visit http://menopause.acog.org/ to access the latest issue of pause magazine for information on mid-life women’s health.

Please contact The Group for Women today at 757-466-6350 to learn more about menopause and hormone replacement therapies for women and to schedule your appointment.

A Push for HPV Vaccinations

GARDASIL-e1337115273727 (1)The Group For Women recommends getting vaccinated against HPV.  See this article for more info.

Gardasil is the only human papillomavirus (HPV) vaccine that helps protect against 4 types of HPV. In girls and young women ages 9 to 26, GARDASIL helps protect against 2 types of HPV that cause about 75% of cervical cancer cases, and 2 more types that cause 90% of genital warts cases. In boys and young men ages 9 to 26, GARDASIL helps protect against 90% of genital warts cases.

GARDASIL also helps protect girls and young women ages 9 to 26 against 70% of vaginal cancer cases and up to 50% of vulvar cancer cases.

Important Safety Information: Only a doctor or health care professional can decide if GARDASIL is right for you or your child. Before having GARDASIL, please read the Patient Product Information.

Contact The Group for Women today at 757-466-5751 to schedule your appointment.

Affordable Care Act Rules on Expanding Access to Preventive Services for Women

Before health reform, too many Americans didn’t get the preventive care they need to stay healthy, avoid or delay the onset of disease, lead productive lives, and reduce health care costs. Often because of cost, Americans used preventive services at about half the recommended rate.

Yet chronic diseases – which are responsible for 7 of 10 deaths among Americans each year and account for 75% of the nation’s health spending – often are preventable. Cost sharing (including copayments, co-insurance, and deductibles) reduces the likelihood that preventive services will be used. Especially concerning for women are studies showing that even moderate copays for preventive services such as mammograms or Pap smears result in fewer women obtaining this care.

The Affordable Care Act, the health insurance reform legislation passed by Congress and signed into law by President Obama on March 23, 2010, helps make prevention affordable and accessible for all Americans by requiring health plans to cover recommended preventive services without cost sharing.

Under the Affordable Care Act, women’s preventive health care services – such as mammograms, screenings for cervical cancer, and other services – are already covered with no cost sharing under some health plans. The Affordable Care Act also made recommended preventive services free for people on Medicare.

In 2011, 54 million Americans with private health insurance gained access to preventive services with no cost sharing because of the law. However, the law recognizes and the Department of Health and Human Services (HHS) understands the need to take into account the unique health needs of women throughout their lifespan.

On August 1, 2011, HHS adopted additional Guidelines for Women’s Preventive Services – including well-woman visits, support for breastfeeding equipment, contraception, and domestic violence screening and counseling – that will be covered without cost sharing in new health plans starting in August 2012. The guidelines were recommended by the independent Institute of Medicine (IOM) and based on scientific evidence.

Beginning on Aug. 1, about 47 million women will now have guaranteed access to additional preventive services without paying more at the doctor’s office for policies renewing on or after August 1, 2012.

Under the law, many private plans also must cover regular well-baby and well-child visits without cost sharing. With the addition of these new benefits, the Affordable Care Act continues to make wellness and prevention services affordable and accessible for more and more Americans.

Women and Preventive Health

When it comes to health, women are often the primary decision-maker for their families and the trusted source in circles of friends. They are also key consumers of health care. Women have unique needs and have high rates of chronic disease, including diabetes, heart disease, and stroke.

While women are more likely to need preventive health care services, they often have less ability to pay. On average they have lower incomes than men and a greater share of their income is consumed by out-of-pocket health costs. A report by the Commonwealth Fund found that in 2009 more than half of women delayed or avoided necessary care because of cost. Removing cost-sharing requirements lets women decide which preventive services they’ll use and when. In fact, one study found that the rate of women getting a mammogram went up as much as 9% when cost sharing was removed. In addition to saving lives by catching cancer early, mammograms can also protect families from skyrocketing medical bills that result from treating the advanced stages of the disease.

New Comprehensive Coverage for Women’s Preventive Care

The Affordable Care Act helps make prevention affordable and accessible for all Americans by requiring new health plans to cover and eliminate cost sharing for preventive services recommended by the U.S. Preventive Services Task Force, the Advisory Committee on Immunization Practices, and the Bright Futures Guidelines recommended by the Academy of Pediatrics.

The law also requires insurance companies to cover additional preventive health benefits for women. For the first time, HHS is adopting new guidelines for women’s preventive services to fill the gaps in current preventive services guidelines for women’s health, ensuring a comprehensive set of preventive services for women.

Previously, preventive services for women had been recommended one-by-one or as part of guidelines targeted at men as well. HHS directed the IIOM, for the first time ever, to conduct a scientific review and provide recommendations on specific preventive measures that meet women’s unique health needs and help keep them healthy. HHS based its Guidelines for Women’s Preventive Services on the IOM report issued July 19, 2011.

The eight new additional women’s preventive services that will be covered without cost-sharing requirements include:

  • Well-woman visits: This would include an annual well-woman preventive care visit for adult women to obtain the recommended preventive services, and additional visits if women and their health care providers determine they are necessary. These visits will help women and their health care providers determine what preventive services are appropriate, and set up a plan to help women get the care they need to be healthy.
  • Gestational diabetes screening: This screening is for women 24 to 28 weeks pregnant, and those at high risk of developing gestational diabetes. It will help improve the health of mothers and babies because women who have gestational diabetes have an increased risk of developing type 2 diabetes in the future. In addition, the children of women with gestational diabetes are at significantly increased risk of being overweight and insulin-resistant throughout childhood.
  • HPV DNA testing: Women who are 30 or older will have access to high-risk human papillomavirus (HPV) DNA testing every three years, regardless of Pap smear results. Early screening, detection, and treatment have been shown to help reduce the prevalence of cervical cancer.
  • STI counseling: Sexually-active women will have access to annual counseling on sexually transmitted infections (STIs). These sessions have been shown to reduce risky behavior in patients, yet only 28 percent of women aged 18-44 years reported that they had discussed STIs with a doctor or nurse.
  • HIV screening and counseling: Sexually-active women will have access to annual counseling on HIV. Women are at increased risk of contracting HIV/AIDS. From 1999 to 2003, the Centers for Disease Control and Prevention reported a 15% increase in AIDS cases among women, and a 1% increase among men.
  • Contraception and contraceptive counseling: Women will have access to all Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling. These recommendations do not include abortifacient drugs. Most workers in employer-sponsored plans are currently covered for contraceptives. Contraception has additional health benefits like reduced risk of cancer and protection against osteoporosis.
  • Breastfeeding support, supplies, and counseling: Pregnant and postpartum women will have access to comprehensive lactation support and counseling from trained providers, as well as breastfeeding equipment. Breastfeeding is one of the most effective preventive measures mothers can take to protect their health and that of their children. One of the barriers for breastfeeding is the cost of purchasing or renting breast pumps and nursing related supplies.
  • Interpersonal and domestic violence screening and counseling: Screening and counseling for interpersonal and domestic violence should be provided for all adolescent and adult women. An estimated 25% of women in the United States report being targets of intimate partner violence during their lifetimes. Screening is effective in the early detection and effectiveness of interventions to increase the safety of abused women.

The coverage of these preventive services gives Americans access to many of the services already offered to Members of Congress. In addition, not only are these services similar to a list of preventive services recommended by the National Business Group on Health, but many private employers already cover these services.

New private health plans must cover the guidelines on women’s preventive services with no cost sharing in plan years starting on or after August 1, 2012.

In order to increase access to proven preventive care while protecting religious liberty, the guidelines exempt the health plans of certain religious employers from the requirement to cover contraceptive services. The Administration intends to establish accommodations for additional religious organizations so they will not have to contract or pay for contraceptive services; women who work for these organizations will have alternative access to contraceptive coverage without cost sharing. In the meantime, nonprofit organizations that have consistently not been providing some subset or all of the required contraceptive coverage because of their religious beliefs consistent with any applicable state law are not subject to enforcement by the federal government for one year.

In addition, the rules governing coverage of preventive services, which allow plans to use reasonable medical management to help define the nature of the covered service, also apply to women’s preventive services. Plans will retain the flexibility to control costs and promote efficient delivery of care by, for example, continuing to charge cost sharing for branded drugs if a generic version is available and just as effective and safe.

See Final Rule and fact sheet on Women’s Preventive Services and Religious Institutions.

The Law Means Better Health and Fewer Health Disparities for Women

Not all Americans have equal access to health care. Low-income and racial and ethnic minorities often have higher rates of disease, fewer treatment options, and reduced access to care. By eliminating cost sharing requirements, the Affordable Care Act helps improve access to comprehensive quality health care for all women. Secure, affordable coverage is quickly become a reality for millions of American women and families.

For more information on women’s preventive services, use the resources below:

Menopause—Hormone Therapy

The Experts Do Agree About Hormone Therapy

Ten years have passed since publication of the first results of the Women’s Health Initiative (WHI) hormone therapy trials. The debate that followed gave women and their providers the impression that the experts don’t agree on the topic of hormone therapy.

Top women’s health organizations have now issued a solidarity statement to demonstrate the experts do agree on the key points.

The medical societies listed below take the position that most healthy, recently menopausal women can use hormone therapy for relief of their symptoms of hot flashes and vaginal dryness if they so choose.

These medical organizations also agree that women should know the facts about hormone therapy.

Below are the major points of agreement among these societies.

Hormone therapy reduces menopausal symptoms

Hormone therapy is the most effective treatment for menopausal symptoms such as hot flashes and vaginal dryness. If women have only vaginal dryness or discomfort with intercourse, the preferred treatments are low doses of vaginal estrogen.

Hot flashes generally require a higher dose of estrogen therapy that will have an effect on the entire body. Women who still have a uterus need to take a progestogen (progesterone or a similar product) along with the estrogen to prevent cancer of the uterus. Five years or less is usually the recommended duration of use for this combined treatment, but the length of time can be individualized for each woman.

Women who have had their uterus removed can take estrogen alone. Because of the apparent greater safety of estrogen alone, there may be more flexibility in how long women can safely use estrogen therapy.

Hormone therapy risks

Both estrogen therapy and estrogen with progestogen therapy increase the risk of blood clots in the legs and lungs, similar to birth control pills, patches, and rings. Although the risks of blood clots and strokes increase with either type of hormone therapy, the risk is rare in women ages 50-59.

An increased risk in breast cancer is seen with 5 or more years of continuous estrogen with progestogen therapy, possibly earlier. The risk decreases after hormone therapy is stopped. Use of estrogen alone for an average of 7 years in the WHI did not increase the risk of breast cancer.

Additional information

In large population studies, estrogen therapy applied to the skin (transdermal patches, gels, and sprays) and low-dose estrogen pills approved by the United States Food and Drug Administration (FDA) (the US government group that monitors drug safety) have been associated with lower risks of blood clots and strokes than standard doses of estrogen pills, but studies directly comparing oral and transdermal hormone therapy have not been done.

Many options for FDA-approved hormone therapy (estradiol and progesterone) that is biochemically identical to the body’s own hormones are available for those who want it. We don’t have scientific proof that custom-compounded bioidentical hormone therapy is any safer or more effective than FDA-approved hormone therapies. Many medical organizations and societies agree in recommending against the use of custom-compounded hormone therapy for menopause management, particularly given concerns regarding content, purity, and safety labeling of these formulations.

There is a lack of safety data supporting the use of hormone therapy in women who have had breast cancer. Nonhormonal therapies should be the first approach in managing menopausal symptoms in breast cancer survivors.

The Bottom Line

Hormone therapy is an acceptable option for the relatively young (up to age 59 or within 10 years of menopause) and healthy women who are bothered by moderate to severe menopausal symptoms.

Individualization is key in the decision to use hormone therapy. Consideration should be given to the woman´s quality of life priorities as well as her personal risk factors such as age, time since menopause, and her risk of blood clots, heart disease, stroke, and breast cancer.

Medical organizations devoted to the care of menopausal women agree that there is no question that hormone therapy has an important role in managing symptoms for healthy women during the menopause transition and in early menopause. Ongoing research will continue to provide more information as we move forward.

The North American Menopause Society● American Society for Reproductive Medicine ● The Endocrine Society

Click here for link to this article.

Understanding Breast Density

Frequently Asked Questions

What is breast density?

The term “breast density” describes the composition of a woman’s breasts.
High breast density means that there is a greater amount of milk producing, milk transporting, and connecting tissues, as compared to fatty tissue.

What are some factors that affect breast density?

  • Genetics: high breast density tends to run in families
  • Pregnancy: breast density decreases with each pregnancy
  • Age: younger women typically have denser breasts

How do I know if I have dense breasts?

A radiologist (the physician who interprets your screening mammogram) makes an assessment of breast density after your mammogram has been completed.
If your breasts are dense then the radiologist will share that information with the physician who referred you for your mammogram and will also notify you.

What does it mean if I have dense breasts?

Your breast tissue may hide cancer or other abnormalities from the radiologist interpreting your screening mammogram.
You may be at an increased risk of breast cancer, but, at this time, the amount of this risk is not understood and is controversial.

I’ve been told I have dense breasts. Now what?

There are currently no specific recommendations on how to lower breast cancer risk for women with dense breasts.
It’s important that you continue getting regular mammograms and any further screening tests as recommended by your healthcare provider.

Regardless of your breast density, there are steps you can take to lower your overall breast cancer risk such as not smoking, limiting alcohol use, exercising regularly, eating a healthy diet, and maintaining a normal weight.

References:

  1. National Cancer Institute. Mammograms.http://www.cancer.gov/cancertopics/factsheet/detection/mammograms
  2. American College of Radiology and the Radiological Society of North America. Mammography.http://www.radiologyinfo.org/en/info.cfm?pg=mammo#part_ten
  3. Susan G. Komen for the Cure. The ABCs of Breast Density.http://ww5.komen.org/Content.aspx?id=19327353285&terms=density
  4. American College of Radiology. American College of Radiology Statement on Reporting Breast Density in Mammography Reports and Patient Summaries. http://www.acr.org/About-Us/Media-Center/Position-Statements/Position-Statements-Folder/Statement-on-Reporting-Breast-Density-in-Mammography-Reports-and-Patient-Summaries

Vitamin D & Pregnancy

Vitamin D and Pregnancy
By Jeffrey M Wentworth, MD

Appropriate nutrition in pregnancy is vital and vitamin D plays one of these crucial roles within our body. We now realize how important normal vitamin D levels are for good health. Most people are aware of vitamin D’s association with absorption of Calcium for strong bones, but appropriate vitamin D levels can also help prevent both breast and colorectal cancer, type 2 diabetes, some autoimmune diseases and even depression.

Many women have low vitamin D levels because of inadequate exposure to sunlight, increased use of sunscreen and low intake of vitamin D containing foods. Women who are pregnant require even more! A typical prenatal vitamin has only 400 IU of D, this probably is not enough.

The benefits of adequate vitamin D levels in pregnancy are numerous. Mom’s vitamin D status reflects babies vitamin D status, meaning if mom is low…. baby is low. Low vitamin D in pregnancy has been associated with low bone mass for baby (this can lead to rickets which is when a baby has soft and weak bones), increased risk of gestational diabetes, high blood pressure during pregnancy, preeclampsia and an increase risk of childhood asthma.

First-time mothers-to-be with vitamin D deficiency may be up to 4 times more likely to need a Cesarean section! This risk alone is normally enough motivation for most women to “take their D seriously”.

It is difficult for most women to get enough vitamin D from diet alone because only wild-caught fatty fish (salmon, sardines and mackerel) are a good source. I constantly hear “well I drink milk”. That’s great, but milk is fortified with only about 100 IU per cup.

There is no consensus on how much vitamin D a pregnant women requires each day and ultimately it depends on several factors to include initial level, time of year, diet and how far south one lives. The National Institutes of Health recently funded a study that looked at 4000 IU per day in pregnant women and showed this was safe and effective in achieving normal vitamin D levels as well as resulting in fewer pregnancy complications.

Within our practice, we routinely check vitamin D levels at the initial prenatal visit and again at 28 weeks. Replacement recommendations are individualized for each patient depending on the factors above as well as dose and form of vitamin D required.

Add Tdap to Your Mom-to-Be To-Do List

By Dr. Holly Puritz

All pregnant women have to-do lists – find a pediatrician, register for classes, sign up for a hospital tour… Let’s add Tdap to every expectant parents list of things to do before the baby arrives.

Tdap (Tetanus, Diphtheria and Acellular Pertussis) is a safe vaccine that will protect you and pass that protection on to your baby during your pregnancy. Newborns cannot receive many vaccines until 2 -6 months of age but will be protected if you are vaccinated while you are pregnant.

Whooping cough or pertussis (the “P” in Tdap) is a communicable illness that’s on the rise and it can be fatal to newborns. The disease can occur at any age but infants are at highest risk for severe disease and death. That’s the scary news.

The good news? It’s easily preventable with a vaccine that’s safe for pregnant moms after 20 weeks of pregnancy. All moms to be should be sure to ask their OBs or family doctors about the vaccine – many obstetricians now offer it in their offices.

The next step after you are vaccinated is to make sure close family members also receive the vaccine. Dads, grandparents, caregivers who will be in close contact with your baby after birth need to be vaccinated. It’s easy and safe – a onetime vaccine is protective.

Local health departments are also offering the vaccine to family members (often at reduced fees) or they can go to their own physicians. Family members and moms need to receive the vaccine at least two weeks before having contact with your baby. This creates a safety cocoon of vaccinated caregivers around your baby.

According to ACOG (American College of Obstetricians and Gynecologists): “The vaccine is safe and effective and has not been shown to cause autism or other adverse effects. All family members who will be in contact with your newborn or ANY infant younger than 12 months of age should be vaccinated. This helps provide protection for your baby because he or she cannot get this vaccination until 2 months of age.”

So spread the word – the best gift we can give our newborns is a safe and healthy first year and Tdap is one way to do this. Want more information? Here are some websites that will give you accurate information you can trust:

www.immunizationforwomen.org
www.cdc.gov

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