Women's Health

Polycystic Ovary Syndrome (aka Polycystic Ovarian Syndrome): PCOS Made Simple

PCOS is a group of findings that can explain irregular periods (and subsequent infertility), excess male hormone production, and pre-diabetes.  The exact mechanism behind PCOS is not well understood.  The good news is that our understanding of optimal treatments for PCOS patients is better understood.  Additionally, the diagnosis is one that may come and go throughout the reproductive years.  A teenager diagnosed with PCOS may no longer meet criteria in her late 20’s. Several questions must be explored with each patient including: whether or not excess male hormone production is problematic, whether or not pre-diabetes is a factor, and when or if a patient wants to conceive a pregnancy.  For most patients, the goals are to normalize the frequency and flow of menstrual flow and to decrease acne or unwanted hair growth.  Help with conception and fertility should be individualized between the provider and patient, but is typically one of the easiest causes of infertility to treat.

Long-term treatment goals should include regular cardiovascular exercise, maintaining a goal body weight or body mass index, and a healthy low-glycemic index diet.


Vaginal birth after cesarean (VBAC) describes vaginal delivery by a woman who has undergone a cesarean delivery in a prior pregnancy. Trial of labor after cesarean (TOLAC) describes the process of attempting a vaginal delivery after having had a cesarean delivery. Patients often ask: How safe is it? Who should try it? Will I be successful? The overall success rate for having a vaginal birth after one cesarean delivery has remained constant at approximately 74%. This success rate is dependent on the reason for the first c-section (breech baby versus fetal heart rate decelerations during labor versus the 'head didn't come down and an infection set in during labor'). For example, if the reason for a csection is the mother pushed for 3 hours and the head didn't come down, the success rate is a little less than if the mother had a csection for a breech baby. VBAC's are also more successful and safer when labor occurs naturally versus inducing labor.

The risk of attempting a TOLAC is there is a small chance for uterine rupture. This occurs because the prior scar on the uterus is not as strong as the surrounding uterine wall and can break open. The rate of this occurring after one prior csection at term (in the vast majority of cases) is less than 1%, or 0.5-0.7%. Given this small, but serious risk to the mother and baby, VBAC should not be attempted unless anesthesia is readily available and there is an open, experienced operating room team available to assist in the case of an emergency cesarean section.

For patients who are undecided whether or not they want to try for a VBAC in a subsequent pregnancy, I encourage them to be patient and see what happens. As a pregnancy reaches term, if the cervix is softening, the head is low in the pelvis, etc., there is a very good chance that a TOLAC will be successful and safe. Additionally, if the mother is planning on having more than 2-3 pregnancies, it is much safer for her to have vaginal births as compared to several csections.

At the beginning of a pregnancy, it is very important to talk to your doctor about your prior OB history and about your expectations, fears, and hopes for Your current pregnancy. Your doctor should listen and also explain their preferences and experiences. This kind of open communication starting at the beginning of your doctor-patient relationship will help achieve a happy experience!

Free Doctor Advice: www.healthtap.com

Social media is all around us and the medical community has FINALLY figured out how to utilize it for the betterment of patient education and care!  Most all physicians in the United States have a social media presence, but few are using it as effectively as the folks at HealthTap. I am happy to report I have signed up early with the founders of www.healthtap.com.  In my own words, it is Facebook and Twitter meet WebMD...BUT you can have faith in the content that is posted on HealthTap because it is all written by trusted, leading physicians.  Unlike most other health advice websites, there are no advertisements that skew search results or answers to your questions.

It is free and easy for patients to sign up and start asking their medical questions--go to www.healthtap.com today and sign up!  Find me, Dr. David Finke, and read some of my answers/advice.   Then start asking your own questions!

Bacteria and Your Body: It's a Good Thing!

Our bodies should have natural bacteria.  "Normal bacterial flora" is comprised of organisms that live in and on us.  They promote digestion and metabolism, fight away other disease-causing bacteria, and maintain a normal pH in many parts of our bodies.   In fact, there are more bacteria in and on our bodies than we have cells in our body! While frequent washing with anti-bacterial soaps, body washes, lotions and hand gels may help us stay healthy, they frequently rid the body of this natural bacterial flora.  Likewise, antibiotics used for bronchitis, urinary tract infections, and strep throat can also kill the normal bacteria that should be part of our bodies.

When the normal bacteria counts in the vagina get low, the pH changes.  That pH change can be a perfect environment for yeast infections and annoying bacterial overgrowths--namely bacterial vaginosis.

Probiotics are a great way to keep your body healthy and functioning in tip-top shape!  Probiotics come in all forms and brands; the most important thing to remember is not to consume out-dated or expired probiotics.  The longer they are on the store shelf and if the preparation should be refrigerated, but isn't, the less effective they will be.

One probiotic supplement that has really worked wonders for my patients is Natren's Gy-Na-Tren (available at Whole Foods in Los Angeles).  This supplement includes both an oral component and a vaginal suppository (which helps maintain a normal pH for the vagina).  I recommend occasional courses (5-7 days) of this probiotic to help prevent yeast and bacterial overgrowth infections.

Ask your healthcare provider today about probiotics that promote vaginal and gastrointestinal health!

Disclaimer: I do not have a vested interest in, nor do I own any Natren company stock.

Seafood in Pregnancy: Benefiting You and Your Baby!

You are what you eat.  Choosing the right foods now can make a huge difference for your baby's growth and health!  Nutrient-rich foods like seafood are very beneficial to expectant moms and babies.  Not consuming atleast 2-3 servings of fish per week has even been associated with a higher risk of post-partum depression. Seafood is one of the only foods bursting with Omega-3 DHA fatty acids.  Consumption of this healthy fat has been linked with lower rates of preterm birth and may even boost a child's cognitive development!  Many moms-to-be worry about high levels of mercury in the fish they eat.  The following types of seafood are among the most popular and are SAFE!  These seafoods in 3 ounce servings have levels of mercury well-below the strict FDA safety guidelines:  Salmon, White (Albacore) Tuna, Pollock, Crab, Canned or Pouched Light Tuna, Scallops, Cod, Clams, Shrimp, Tilapia, and Catfish.

Official guidelines from the American College of Obstetricians and Gynecologist (ACOG) and experts around the world agree:  (1) Eat seafood 2-3 times per week; (2) eat a variety of fish; (3) as much as half (six ounces) of fish each week can be from White (Albacore) tuna; (4) The only fish to avoid are shark, swordfish, king mackerel, and tilefish.  (As a general rule, the bigger the fish, the higher it's content of mercury.)

So fear not, you seafood loving moms-to-be and enjoy!!! 

Special thanks to:  www.hmhb.org and www.aboutseafood.com.

Ovaries and Eggs: To Freeze or Not to Freeze?

Let's face it--more and more men and women are delaying child-bearing.  One of my closest friends spent the last 12 years focused on her education and career and is now asking, "Where is Mr. Right?"  Like most professional young Americans (women AND men), that sense of accomplishment and stability trumps a desire to start a family.  Then we turn 30, 35, or even 40...and we start to worry.  Unfortunately, age does matter for fertility.  Additionally, treatments for cancer and auto-immune diseases can potentially render a patient infertile

The good news is that the science of egg freezing or fertility preservation is now a reality!!  After many years of research and trials, the process has been perfected so that it now provides a very good option for preserving fertility. 

The next obvious question remains...how long do I wait before I should freeze my eggs?  The answer isn't as straightforward and varies from patient to patient.  One important thing to remember is that our ability to stimulate the ovaries for egg-retrieval does have limits.  Fertility depends on overall health, family history and prior surgeries--just to name a few!

Talk to your doctor today if you are worried about preserving your fertility!  If you find more questions than answers about this new technology, I encourage you to keep looking, reading and asking the right people until you are educated.  This approach to fertility should be as individualized as you are!

Heavy Periods: What to do?

Heavy periods, or "menorrhagia," affect 10-15% of women.  Of these women, up to 70% report that their heavy periods negatively impact life.  Causes range from fibroids of the uterus, polyps of the uterus, hormonal imbalances, and even cancer of the uterus to name a few.  For decades, the mainstay of treatment has revolved around surgery or hormonal contraception to better regulate and decrease menstrual blood flow.  While these still remain good choices for some patients, women should know there is now a safe, non-hormonal FDA-approved medication to treat heavy periods.  The medication is called Lysteda, or tranexamic acid.  While new to the U.S. for the treatment of heavy periods, the medication has been used for decades to treat hemophiliacs (people with bleeding disorders) when they go to the dentist to minimize blood loss with dental procedures.  Additionally, the medication has been widely used in Europe.  In Europe, it's safety and efficacy is widely accepted and the medication is similar to our over-the-counter products like Advil, Aleve, or Midol. 

Lysteda is not for everyone (namely anyone who has a history of blood clot or clotting disorder), but it is definitely worth the conversation with your gynecologist.  It is important to determine possible causes of heavy bleeding first before starting treatment.  Many of my patients have experienced amazing results with Lysteda and the cool thing is that you only have to take the medication when you are bleeding!  Call your doctor today to find out more!

Disclaimer:  I am working with Ferring Pharmaceuticals to teach other physicians and health care providers about this new treatment for heavy menstrual bleeding.

Got HPV??

...Don't worry, so does most of the U.S. It is estimated that AT LEAST 87% of sexually active adults in the U.S. are exposed to HPV at some point in their lives. Most women will clear an HPV infection without any problems. What you need to know about HPV is that it can change the cells of the cervix, and over years may lead to cervical cancer. This is why it is recommended that women get regular pap smears. Your doctor can identify subtle changes to cells of the cervix and if they get severe enough, can perform a curative, minimally invasive procedure. These procedures, commonly referred to as a 'LEEP' or 'CONE' are why cervical cancer rates have been dramatically reduced in the developed world. They can save your life!

So if you or a friend has had an abnormal pap smear, or if you haven't had a pap smear in awhile, contact your physician and get regular follow up!! Also, don't smoke...this can decrease your body's ability to fight HPV and the damage it can do!

Beyaz: Increased clot risk??

There has been a lot of buzz in the media about Beyaz or Yaz birth control pills and whether or not the compound drosperinone (in the pill) increases a woman's risk of getting a blood clot more than any other pill on the market.  Background:  All birth control pills and hormones increase a woman's risk of blood clots...BUT, here are the facts.

A woman's risk of blood clot who is not on any medication is 5 per 10,000 per year.  For a woman taking birth control, the risk is 9 per 10,000.  For a woman who is PREGNANT, that risk increases to 20 per 10,000.  You've never heard of a woman avoiding pregnancy because it could increase her risk of getting a blood clot, RIGHT? 

So why risk an unwanted pregnancy by refusing to look into birth control pills because they slightly increase the risk of developing a blood clot?

Bayer pharmaceuticals continues to maintain that their birth control pills, Beyaz and Yaz, do not pose any significantly higher risk of blood clot versus any other pill on the market.  And I agree that they have been the subject of a lot of unwarranted media hype regarding blood clots and birth control. 

The truth remains to be seen, but the FDA announced this week they will once again re-examine the studies to see if Beyaz or Yaz have a higher risk of causing blood clots.  Whatever they find, I still think pregnancy carries with it the highest risk of causing a blood clot. 

If you are taking any form of birth control and develop leg pain/swelling or chest discomfort/difficulty breathy, call your doctor immediately. 

Bayer pharmaceuticals did not have any input into this blog or my opinions.

Hypnobirthing: What is it?!?

Hypnobirthing is becoming a popular way to cope with the pain and discomfort of child birth.  I have been a part of some AMAZING hypnobirthing experiences, but admit the technique may not be for everybody.  Recently popularized by Jessica Alba, the experience can help a woman mentally transcend above the pain of contractions (often called "surges").  When it works, it works well; however, I never support pressuring a woman into natural childbirth.   It has to be a decision made by the patient and she must understand that she can change her mind at any point along the way.

There are many hypnobirthing centers, doulas, books, and videos you can use to take you through the process.  Ask your healthcare provider for a referral in your area!