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Article Category: Highlights

Take the Mystery Out of Menopause with Wellstar

Published on November 19, 2024

Last updated 12:18 PM November 19, 2024

Women walking

From sleepless nights to hot flashes and brain fog to vaginal symptoms, many women feel isolated or embarrassed about discussing what they go through during menopause. At Wellstar, our compassionate women’s health team provides individualized care to help women navigate this stage of life, demystify menopause and give women back their confidence during this stage of life. 

Menopause means no more periods. Period.

Menopause is defined as the permanent absence of a period for 12 consecutive months. The average age of menopause in the U.S is 52, but generally, women will experience menopause between ages 45 to 55. 

Perimenopause is the four- to seven-year period prior to menopause when women are having menopausal symptoms.  

“During perimenopause, cycle lengths will vary. Many women experience their periods coming closer together. Hot flashes and night sweats are also common during this transition,” said Wellstar Women’s Health Nurse Practitioner Karin Hulon.  

Women may also experience brain fog, mood swings, fatigue, trouble sleeping, skin and hair changes, vaginal dryness, decreased libido, painful sex, joint pain or inability to lose weight. Every woman is unique and may not experience the same severity of symptoms. The menopause experience may be influenced by genetics, race or environmental factors. 

Many symptoms can be explained by a decrease in estrogen. 

The ovaries are the main producers of estrogen. As women age, ovarian follicular function decreases, leading to decreasing levels of estrogen. These levels can also radically decrease due to surgery, infection, medications or radiation.  

“Estrogen receptors are found all over our bodies. A decrease in estrogen can affect the part of the brain involved in thermoregulation, resulting in hot flashes and night sweats,” said Wellstar Chief of Women’s Health Dr. Paula Greaves. “Research suggests that women who have hot flashes may be at higher risk for developing heart disease. Additionally, research shows that African American women experience more intense and more frequent hot flashes for a longer duration.” 

Estrogen receptors are located in the vagina, vulva, bladder and urethra, helping to maintain blood flow, tissue turgor and microbial balance. Therefore, a decrease in estrogen can lead to vaginal dryness and atrophy, making intercourse painful. The pH of the vagina also changes with decreased estrogen, increasing the risk of infections or urinary leakage.  

These are only some examples of how menopause can impact women’s health and quality of life, and it’s important to treat menopausal symptoms as soon as possible.

Hormonal and non-hormonal treatments are available and can be beneficial—regardless of symptoms. 

Your care team will discuss your concerns and health history to tailor a safe, personalized plan that fits your needs. The choice should be guided by symptoms, medical history, contraindications and shared decision making. There are FDA-approved hormonal as well as non-hormonal options for treatment of hot flashes, vaginal dryness, painful intercourse and even decreased libido.  

“We must promote lifestyle changes such as smoking cessation, weight loss and cognitive behavioral therapy, which can help decrease symptoms,” said Dr. Greaves. 

Even if you no longer have periods, you should still see your OB/GYN.  

“Women: You need your mammograms and your health and cancer screenings, including Pap smears until age 65. Women who have had abnormal Pap smears in the past may need to continue Pap smears beyond age 65,” Hulon said. “Even if you’ve had a hysterectomy and you no longer have a uterus, you still need to ensure pelvic floor health.”

If you experience vaginal bleeding after menopause, schedule an appointment with your women’s health care team.

“The cause of bleeding could be something as simple as vaginal tearing due to dryness or as serious as endometrial cancer,” Hulon said.

Whatever your health concerns may be, Wellstar will partner with you to help you stay healthy. Other diseases can masquerade as menopause, so if something is worrying you or stopping you from feeling your best, mention it to your clinician.

“For example, if you start having joint pain, that may not be menopause. That may be arthritis. Fatigue, weight gain or night sweats may be a sign of thyroid disease, not menopause,” Dr. Greaves said. “Trust and open communication have been instrumental in aiding gynecologists to uncover other diseases affecting our patients who assumed they were menopausal.” 

Wellstar OB/GYN clinicians specialize in addressing the health needs of women and are experienced in caring for people going through menopause.

“It is important when you’re looking for a clinician to find someone who specializes in women’s health and who has a passion for treating women entering the menopause transition,” Hulon said. “Find someone who will listen to you, not dismiss you, will make you feel comfortable and treat you as an individual.” 

While troubling symptoms of menopause may be common, you don’t have to go through it alone. 

“With increasing life expectancy, women will spend more than 40% of their life in this life stage. Therefore, we need to focus our efforts in providing a smooth transition for every woman into menopause so she can enjoy her best years yet,” Dr. Greaves stated.  

Wellstar Women’s Health offers compassionate care through menopause, answering your questions and helping to manage your symptoms. Many of our clinicians are certified menopause practitioners. Find a Wellstar OB/GYN location near you.  

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Karinthian Elaine Hulon Paula Cecilia Greaves Womens Health
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Q&A: Breast Cancer Specialist Answers Mammograms and Self Breast Exams Questions

According to the American Cancer Society, 1 in 8 women will get breast cancer in their lifetime. Breast cancer is the second leading cause of cancer death for women. However, when found in its earliest stages, breast cancer can be stopped from spreading, is more treatable and nearly 100% curable. Screening is the best way to find breast cancer early. Let’s talk about mammograms as well as the right way to perform a self breast exam.

Mammograms

When should I start getting mammograms?

Unless you have a new breast problem or need to start screenings earlier because of risk, most guidelines recommend starting screening mammography at age 40.
How often should I get a mammogram?

Guidelines differ somewhat but are consistent that if you are of average risk, you should have them at least every other year.  If you are at increased risk, including having dense breast tissue or a family history of breast cancer,  it is recommended that you get an annual mammography screening and possibly enhanced screenings with MRI, ultrasound or contrast enhanced mammography.

Is getting a mammogram dangerous to my health?

While there is a small radiation exposure with every mammogram, the benefit of early detection of small, curable cancers almost always outweighs that risk of exposure.

Does it hurt to get a mammogram?

Some women do find mammograms uncomfortable.  This is more common when having imaging just before your menstrual period when breast tissue can be swollen and more sensitive.  If you do have extra sensitivity, scheduling the exam after your cycle starts or taking an over-the-counter NSAID pain reliever* a few hours before the exam may minimize the discomfort.  Because positioning of the breast and taking each mammogram image is typically less than 30 seconds, the extent of discomfort during the exam is short-lived.

*NSAIDs are nonsteroidal anti-inflammatory drugs, like ibuprofen (Advil, Motrin), naproxen sodium (Aleve) and aspirin.

Breast self-exam options

What is the correct technique for a breast self-exam?

Any pattern for feeling all of your breast tissue is acceptable. The goal is to make sure you are feeling with varying pressure from your collar bone to cleavage, to the bottom of the breast out to past where your breast meets your chest wall, including your armpit.

How often should I do a breast self-exam?

Self-exams should not be done too often because it can make it difficult to tell if a lump is evolving over time. Think of how hard it is to tell if your appearance changes gradually as you get older because you see yourself every day, compared to more easily seeing changes in someone’s appearance after not seeing them for a long time. Typically, once a month is enough.

Is there a best time to do a breast self-exam?

 It is important to do your breast self-exam in approximately the same time in your cycle rather than a specific interval—especially since not all menstrual cycles are exactly 28 days apart.  Doing the exam at the same place in your cycle will give you consistency in how the tissue should feel in terms of lumpiness, texture and density. 
I encourage my patients to do their exam the day after their cycle starts as a consistent point in their hormonal cycle fluctuations.

What am I actually looking for during a breast self-exam?

Your breast self-exam should be a tool to familiarize yourself with the general “normal texture” of the tissue in each of your breasts so if you detect something that is different, you will be able to identify it as new or changed. 

Can a breast self-exam replace a mammogram?

Self-breast exams cannot replace mammograms because mammograms can detect subtle changes like densities or calcifications that are too small to feel. The goal with screening mammograms is to detect breast cancer before you can feel it because early detection leads to better overall outcomes.
Learn more about breast cancer screening and treatment at Wellstar. 

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Find Comprehensive Breast Care with Wellstar

Breast health is an important part of every woman’s overall wellness. Routine breast cancer screening and timely evaluation of breast concerns can lead to earlier detection, more treatment options and improved outcomes. At Wellstar, we are committed to helping women feel informed and empowered throughout every stage of their breast health journey.

Catch cancer early

Regular screening mammograms remain one of the most effective tools for detecting breast cancer early, often before symptoms develop. If you’re at average risk of developing breast cancer, you should start annual mammograms at age 40. However, if you have a family history of breast cancer or other risk factors, your care team may recommend starting earlier and will help you create a screening plan.

In addition to annual screening, our team helps women understand their individual breast cancer risk and personal screening recommendations. Whether you are coming in for a routine screening, evaluation of a breast symptom or guidance regarding elevated cancer risk, our goal is to provide compassionate, expert care.

Care for benign conditions and cancer

Our breast health specialists provide evaluation and treatment for a range of breast conditions, from common benign concerns to newly diagnosed breast cancer. We understand that any breast abnormality can create anxiety, and we work closely with you to provide clear communication and individualized care plans.

We treat many benign breast conditions, including:

  • Breast cysts 
  • Fibroadenomas 
  • Breast pain 
  • Dense breasts
  • Nipple discharge 
  • Breast infections and abscesses 
  • High-risk and atypical breast lesions 

If you’ve been diagnosed with breast cancer, we provide comprehensive, multidisciplinary care and guide you through each step of diagnosis, treatment and beyond. We also care for women who are considered high-risk for breast cancer, including those with significant family histories, prior high-risk breast lesions or inherited genetic mutations such as BRCA and other hereditary cancer syndromes. Our team works closely with you to develop personalized surveillance and risk-reduction strategies tailored to your individual needs.

Advanced breast surgical care

At Wellstar, women have access to advanced breast surgical care delivered with a focus on precision, safety and cosmetic outcomes whenever possible. We offer procedures to diagnose and treat breast conditions using evidence-based surgical techniques.

Our surgical services include:

  • In-office ultrasound-guided breast biopsies 
  • Excisional breast biopsies 
  • Duct excisions 
  • Partial mastectomies (lumpectomies)
  • Sentinel lymph node biopsies and targeted axillary dissections 
  • Mastectomies with flat aesthetic closures
  • Skin-sparing and nipple-sparing mastectomies 
  • Breast reconstruction in collaboration with plastic surgery specialists

We aim to streamline care and reduce delays in diagnosis and treatment. If you require breast cancer surgery, our surgeons utilize best-in-class techniques designed to achieve excellent oncologic outcomes while also preserving appearance and quality of life.

Patient-centered approach to breast care

We believe exceptional breast care goes beyond medical treatment alone. Everyone deserves compassionate, personalized care in a supportive environment where questions are encouraged and concerns are heard.

From the first consultation through follow-up care, our team is dedicated to helping you feel comfortable, informed and confident in your care plan. We recognize that navigating breast concerns or a cancer diagnosis can feel overwhelming. We strive to make the process as seamless as possible through coordinated care, patient education and ongoing support.

Learn more about breast surgery at Wellstar.

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How Bariatric Surgery Can Improve Type 2 Diabetes—Even Before Significant Weight Loss

The Weekly Check-up Atlanta


People who seek medical help for weight management are used to hearing that results take time. Imagine the surprise of some patients with type 2 diabetes when their blood sugar improves meaningfully within days or weeks of bariatric surgery.

It happens—and it’s a dramatic sign of the benefits bariatric surgery holds for many patients, said Dr. Fritz Jean-Pierre, a board-certified bariatric surgeon and national leader in minimally invasive and robotic techniques for the treatment of obesity and metabolic disorders.

When changes in blood sugar following bariatric and metabolic surgery were first observed in the 1990s, the reason was a mystery. But today, medical experts know more about the hormones that regulate hunger and insulin production. They also know more about how bariatric surgery affects the same hormones.

Understanding type 2 diabetes: It starts with insulin resistance

Insulin is a hormone that regulates blood sugar. Insulin resistance happens when muscle, fat and liver cells fail to respond to insulin, causing the pancreas to overproduce the hormone. Eventually, blood sugar rises. Patients may develop prediabetes or type 2 diabetes.

Another hormone that affects weight is GLP-1. It’s naturally produced in the gut after eating. GLP-1 helps regulate blood sugar by:

  • Stimulating insulin
  • Suppressing glucagon, a hormone the pancreas produces that raises blood glucose levels
  • Slowing digestion

Many recognize GLP-1 today because of the class of weight-management drugs such as Ozempic, Zepbound and Wegovy. These medications mimic and amplify the effects of the GLP-1 hormone.

How bariatric surgery affects hunger hormones and improves health

Several types of bariatric surgery are performed at Wellstar. While each procedure alters the digestive system differently, all appear to influence the hormones that regulate hunger and blood sugar.

Hormones, such as GLP-1, that promote fullness and insulin sensitivity increase after surgery. The liver produces less excess glucose, and the body becomes more sensitive to insulin. Other hormones—like ghrelin, which signals the brain that the stomach is empty—decrease after surgery.

“We've known since the early 2000s that after bariatric surgery, you have a boost in GLP-1 hormone production,” said Dr. Jean-Pierre. “Patients notice improvements in their blood sugars and that feeling of fullness.”

As a result of hormonal changes triggered by surgery, patients who are not yet on insulin replacement therapy may enter diabetes remission relatively soon, according to Dr. Jean-Pierre.

“The patient may have lost only 5 or 10 pounds yet their blood sugars have become normalized,” he said. “Their diabetes is completely controlled without medication after surgery. That’s the best-case scenario.”

For other patients, improved blood sugar may take longer. Still, clinical trials show that bariatric surgery leads to diabetes remission in 33% to 90% of individuals at one year after bariatric and metabolic surgery.1

“These surgeries are not just changing or shrinking the patient’s stomach,” Dr. Jean-Pierre said. “We're changing their metabolisms in a way that will help improve a lot of related health conditions like high blood pressure, abnormal cholesterol and fatty liver disease.”

Long-term health benefits of bariatric surgery

There are many health risks of type 2 diabetes and obesity. Those include high blood pressure, high cholesterol, sleep apnea and joint pain. Unmanaged diabetes can lead to damage to nerves, kidneys, eyes and heart. Stroke risk is also higher in people with diabetes.

Physicians have more treatment options for obesity than ever, including surgery, medications and lifestyle changes. Wellstar Center of Best Health is a comprehensive weight management clinic with clinicians, dietitians, psychologists and exercise physiologists who work collaboratively with surgeons.

Together, they learn about each patient’s situation and develop a personalized treatment plan with the best chance of success. Some patients may benefit from both surgery and medication.

“Obesity is a chronic, relapsing, multi-variable disease process that we have to approach from different angles in order to best treat it,” said Dr. Jean-Pierre. “You must approach it comprehensively, including nutrition and exercise. Medication itself is not a magic bullet. Surgery is not a magic bullet.”

Wellstar’s weight loss teams support patients throughout their healthcare journey. The goal is to see patients reach their goals and return for follow-up care in even better health.

“It’s amazing when all of these treatment options fire in the right direction and we see the health improvements that come along with surgery,” such as:

  • Better diabetes control
  • Lower blood pressure
  • Less joint inflammation and pain
  • End of the need to use a CPAP for sleep apnea

“Most surgeons fix something, then you don't see your patient again. With bariatric surgery, it's a very different relationship,” Dr. Jean-Pierre said. “We see our patients for a long period of time afterward. We get to share in their successes and see their accomplishments as they lose that weight.”

Learn more about obesity medicine at Wellstar and make an appointment to see an obesity specialist at one of our locations.

1 Affinati, Alison H et al. “Bariatric Surgery in the Treatment of Type 2 Diabetes.” Current diabetes reports vol. 19,12 156. 4 Dec. 2019, doi:10.1007/s11892-019-1269-4

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