It’s been 44 years since Our Bodies, Ourselves was published. The landmark book encouraged women to learn about their bodies and take ownership. Local experts continue the tradition by informing women about key issues that impact them.
[osteoporosis diagnosis]
Brenda Kingen, Kingen Chiropractic Wellness Center chiropractic physician:
Many women are scared into taking osteoporosis medications. The most common ones are Fosamax, which is associated with digestive issues, and Boniva, which may result in low calcium levels. There’s also a once-a-year injection of a medication called Reclast. It reduces the risk of bone fracture but may cause an abnormal heart rhythm. While these medications build bone, it’s not hard bone. It’s more of a chalky or weak version.
There are three areas we focus on after a woman is diagnosed with osteoporosis: nutrition, supplementation and exercise. We find out what’s causing her body to be so acidic that it’s not absorbing calcium. We recommend vitamin D-3 supplementation; the body needs it to absorb calcium. We also recommend an appropriate form of weight-bearing exercise, such as walking or using an elliptical machine. Although it sounds contrary, stress on the bones helps build bone. It also keeps muscles strong and improves stability. Many of our patients with osteoporosis participate in our BStrong4Life training program, a medically supervised exercise program that addresses balance, core strength and bone health.
Dr. John Morley, SLUCare geriatrician:
The first thing a woman identified with osteoporosis should do is make sure her diagnosis is correct. Physicians make mistakes. Ask to see your fracture risk assessment tool (FRAX) results. It indicates fracture risk in postmenopausal women and men, 45 and older. If your physician doesn’t show you your FRAX results, take the test yourself. It’s available online. FRAX results determine treatment. If you have a 30 percent chance of a hip fracture in 10 years, then it’s reasonable to seek treatment. If you have less than a 10 percent chance of a fracture in 10 years, then you can do the basics: taking 1,000 international units of vitamin D daily and taking calcium. You don’t need huge amounts of calcium, a couple of Tums or a large yogurt will do. Take calcium at night because your calcium comes off the bone when you lie down. If you do have a risk for fracture, work with your physician to determine which medications are best for you. At this time, the treatment for almost everybody at risk for fracture is bisphosphonate, and the least expensive one is Fosamax. There’s no advantage to more expensive versions.
[yoga]
Stressed? Tense? Maybe you should take some slow, cleansing breaths—and a dose of yoga. “Yoga postures lengthen muscles and strengthen and stabilize the body,” says Valerie Love, yoga/Pilates Instructor, St. Louis Jewish Community Center. “The goal is to be mentally present to the sensations in the body, and mindfully and honestly move into, hold and move out of the poses.” Studies suggest that yoga lowers blood pressure, increases range of motion and improves general strength, Love notes. “Breath, movement and diet are the three single elements that can be manipulated to improve health,” she says. “The most expensive one of these elements is eating fresh, real whole food. But movement and breath cost absolutely nothing.” Whether in yoga class or not, mindful breathing has an immediate influence on health, Love adds. “Simply by breathing more deeply, one can lower blood pressure and saturate tissues with more oxygen. It’s one of the most important elements of increased vitality. Be patient with yourself on the mat. Yoga is a lifelong process of mental focus and relationship with the body.”
[nighttime urination]
Dr. Cathy Naughton, Metropolitan Urological Specialists:
Frequent urination in women can be part of a complex known as overactive bladder (OAB), which is described as urinary frequency, urgency and nocturia (nighttime urination). OAB can present with or without leakage, but leakage also can result from stress urinary incontinence. OAB is very common. One in three people have it—that includes men. But more women present with symptoms. It’s important to make sure there are no other medical issues, because OAB symptoms can mimic bladder cancer, stones in the bladder and urinary tract infections. There are multiple treatment options. Most people start with behavior modification. They reduce their intake of caffeine, chocolate, alcohol and spicy foods. They try acupuncture or massage to reduce stress. Physical therapy should be added to every treatment program. But it’s not good enough to just give written instructions. Patients need to know how to correctly isolate, relax and control their pelvic muscles. And for that, they need a physical therapist specialist. Almost all women stop taking OAB medications within six to 12 months. The drugs are expensive and may have side effects.
Dr. Jerry Lowder, director of Female Pelvic Medicine & Reconstructive Surgery, Washington University:
A common cause of female urinary frequency that often goes undiagnosed is pelvic myofascial pain, also called pelvic-floor muscle spasms. These spasms give a woman a sensation of urgency and frequency and cause her to void small amounts of urine. Consequently, many patients are treated for an overactive bladder and prescribed anticholinergic medications. These medications block the nerves that control bladder muscle contractions and allow the smooth bladder muscle to relax. But the bladder isn’t the source of the problem with pelvic-floor muscle spasms.
The problem is musculoskeletal. Pelvic-floor physical therapy, not medication, is the cornerstone for treatment. But it’s a different type of physical therapy. The goal is to release the trigger points causing pain that can result in spasms. Trigger points are tender areas in soft tissue that cause radiating pain. With pelvic spasm, trigger points are usually located in the pelvic-floor muscles, which are a group of sling-like muscles supporting the uterus, bladder and rectum. The pain radiates to the bladder and results in spasms that give rise to the sensation of urinary frequency and urgency.
[replacement therapy]
Our hormones rage during adolescence. As we age, they plummet and deprive us of sleep, libido and concentration. Hormone replacement therapy can adjust these imbalances, but often the replacements are synthetic. Dr. Kathy Maupin, Medical Director, BioBalance Health, thinks there’s a better way: bioidentical hormonal pellet therapy. But this obstetrician-gynecologist wants to improve more than diminished estrogen levels in women. She recommends replenishing testosterone, too. “It’s the secret female hormone,” Maupin says. “Testosterone protects us from age-related muscle and bone loss and weight gain, and keeps our minds sharp.” Bioidentical means the hormones are identical in molecular structure to hormones produced naturally by the body. Maupin uses plant-derived hormones and pellets that contain either pure powdered estradiol (an estrogen hormone) or testosterone. “The hormones are packaged into a pre-prescribed pellet size so you get a consistent dose,” she explains. “It’s inserted under the skin, in the fat of the hip where it slowly dissolves, providing a very steady hormone level—much like your ovaries did before they went into a decline with menopause.” Patients are retested for dosage levels before new pellets are inserted.
[iud comeback]
Dr. Kent Snowden, Saint Louis Associates in OB/GYN:
Intrauterine devices fell into disfavor in the 1970’s when the Dalkon Shield—a common IUD at that time— was linked to an increased risk of pelvic inflammatory disease and a high incidence of uterine perforation. Usage fell to almost zero. They’re now making a comeback with about 10 percent of fertile women in the United States using an IUD for contraception. However, this is low when compared to other countries or continents, such as Asia, where about 25 to 30 percent of fertile women use IUDs. The braided strings attached to the IUDs were the culprit years ago. They acted like a wick that allowed bacteria to ascend into the uterus and fallopian tubes. There was also no test to detect asymptomatic chlamydia infections then. Consequently, there was an increased risk of severe pelvic infections, which led to an increase in infertility with blocked tubes and pelvic abscess. All three IUDs available in the U.S. today have monofilament (single strand) strings, which are not associated with an increase in infection. IUDs offer long-lasting contraception—three to 10 years—and are safe and cost-effective. They’re a great option for any age group, and especially for women who might have issues with compliance.
Dr. Teresa Knight, Women’s Health Specialists:
IUDs are making a comeback for a variety of reasons: they’re cost-effective, they have an excellent safety profile, and they have a low risk of side effects. There was a very large study performed in St. Louis by Washington University called the Contraceptive Choice Project, where they offered free birth control to all the women who entered the study. Participants were able to choose their method of birth control, and IUDs had the highest satisfaction rating among participants. The average failure rate for birth control pills is 5 percent. The failure rate for IUDs is equal to that of permanent sterilization, but an IUD is completely reversible. For women who are finished bearing children or think they want to wait four or five years, IUDs are a worry-free means of contraception. It’s also a good form of contraception for nursing moms and for women who cannot take birth control pills because they have a blood clot disorder or some other contraindication.
By Mary Konroy