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Penn Health for Women Newsletter

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Tuesday, February 16, 2016

Heart Health Through the Years

What’s the best way to ensure you have a healthy heart when you’re in your 50s and 60s?

“Begin thinking about it when you’re 20,” says Chileshe Nkonde-Price, MD, MRCP, director of the Women’s Cardiovascular Program at the Hospital of the University of Pennsylvania. “Most women don’t realize they begin setting the tone for their heart health well before they are even thinking about things like heart attacks or strokes.”

Fortunately, there are things you can do to improve your heart health at every stage of life:

Heart Health in Your 20s

“This is the time when women should start adopting healthy habits that they maintain for years to come,” says Nkonde-Price. “You can start by having annual physical exams. These help establish baseline information about your body."

Other recommendations include:

  • Don’t smoke
  • Be mindful of how much sitting you do
  • Maintain a healthy diet
  • Limit alcohol intake
  • Get at least 2.5 hours a week of moderate-intensity exercise

Heart Health in Your 30s

The 30's are a busy time in a woman's life. Oftentimes the focus is on others - having children, taking care of a new family, a career or all of the above. It is an important time to take a step back, reevaluate and make sure that you are taking care of yourself, too.

“The child-bearing years are the time to be aware of conditions in pregnancy that can affect long-term heart risk,” says Nkonde-Price. “Women who develop preeclampsia during pregnancy are four times more likely to develop high blood pressure later in life, and preeclampsia doubles the risk of heart attack and stroke 10 to 15 years later.”

Nkonde-Price advises women to avoid excess weight gain during pregnancy, as it also increases future risk of heart attack and stroke.

“I know that it’s difficult to lose baby weight,” Nkonde-Price adds, “but, as the saying goes, it takes 9 months to go up and 9 months to come down.”

Heart Health in Your 40s

In this stage of life, women often struggle to keep up with the demands of their family, work, and personal life, leading many of them to burn the midnight oil or sacrifice sleep altogether.

“Recent studies among women in their mid-40s showed that women who sleep less than six hours per night are twice as likely to develop a heart attack or stroke compared to those who get between six and eight hours a night,” she says. “Instead of squeezing in tasks late at night, I advise that women save them for the morning and go to bed at a reasonable hour.”

Heart Health in Your 50s

By their early 50s, most women are entering menopause, a time when their bodies go through many changes and symptoms of heart disease can begin to appear.

“Many women consider hormone replacement therapy to help manage hot-flashes and other symptoms of menopause,” says Nkonde-Price. “My recommendation for women who are having a tough time with menopause – but worry about how hormone therapy will affect their heart – is to know their personal risk.”

She advises that women see a cardiologist to have their heart risk factors, such as family history, diabetes and blood pressure, evaluated and monitored. This personal risk can help you make a more informed decision about hormone replacement therapy.

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Monday, November 23, 2015

When to See a Fertility Specialist

Couples who have been trying to conceive for months without success may be wondering when to seek professional help from a fertility specialist.

Dr. Samantha Butts

A fertility specialist is a physician specially trained in treating men and women unable to conceive. At Penn Medicine, all fertility specialists are board certified in both obstetrics and gynecology and reproductive endocrinology and infertility.

Infertility is a complex issue. “But the good news is that there are many treatment options available today,” says Samantha Butts, MD, MSCE, a Penn Fertility Care specialist. “For example, common medical conditions such as thyroid disease and polycystic ovary syndrome (PCOS) are some examples of conditions that affect fertility, but can respond to medical treatment.”

Dr. Butts advises that women under age 35 who have not conceived after a year of unprotected sex, or women age 35 and older who have not conceived after six months of unprotected sex talk to their gynecologist or primary care physician. There are things they can recommend before seeking help from a fertility specialist.

“If a woman has uncontrolled medical problems like diabetes, for example, she can work with her primary care physician to control it,” says Dr. Butts. “Pre-existing health conditions may impact her chances of becoming pregnant and maintaining a healthy pregnancy.”

But there are situations when women should not wait to see a fertility specialist.

“If a woman is up to date with her medical and gynecologic screening, it is reasonable to see a fertility specialist straight away. In addition, women with irregular periods or conditions such as fibroids or endometriosis who have not conceived successfully should consult with a specialist. These conditions can be treated with surgery.” says Dr. Butts.

“Penn is at the forefront of emerging fertility treatments through research,” says Dr. Butts.

While 80 to 90 percent of patients know the reasons they cannot conceive, others never get an explanation as to why they experience infertility. If a patient’s tests all come back normal, but they still cannot get pregnant, this is referred to as unexplained infertility (no found cause) and accounts for 10 to 15 percent of all women with infertility.

“The good news is, even with unexplained infertility, there are still viable treatment options for couples, including intrauterine injections and in vitro fertilization,” says Dr. Butts.

Thursday, October 22, 2015

Five Ways to Fight Uterine Prolapse and Stress Incontinence before Menopause

Menopause is no picnic. It’s riddled with hot flashes, depression and vaginal dryness, among other symptoms.

But for some women, the symptoms don’t stop there. Some women experience uterine prolapse – a condition in which the uterus slips down into the vagina – and a weak bladder, also known as stress incontinence.

While menopause is inevitable, uterine prolapse and stress incontinence don’t have to be. Fortunately, you can take steps to reduce your chance of developing these conditions.

Uduak Andy, MD, urogynecologist and assistant professor of obstetrics and gynecology at Penn Medicine, offers these five ways you can fight uterine prolapse and urinary stress incontinence before they start.

1. Maintain a healthy weight.

Your pelvic muscles, also called your pelvic floor, quite literally do a lot of heavy lifting. Think of them as a bowl of muscles that support a number of organs, including your uterus and bladder.

They don’t need any additional stress from excess body weight. Obese women have a 40 to 75 percent increased risk of pelvic organ prolapse, reports the American Urogynecologic Society.

“Obesity or any additional fat around your abdominal area is going to put more pressure on your pelvic floor,” Dr. Andy explains. “Maintaining a healthy weight is important to reduce strain on pelvic muscles.”

2. Stay regular.

Chronic constipation is more of a problem than you’d think. Many women just deal with the discomfort, but addressing this issue can have a wider impact on your health. If you’re constipated too often, the constant pushing and straining to bring on a bowel movement can increase your risk of uterine prolapse.

“Increasing fiber in your diet can help,” Dr. Andy suggests. “Discuss ways to manage your constipation with your doctor.”

3. Avoid heavy lifting.

When it comes to heavy lifting, less is better. When you lift something heavy, you engage the muscles in your abs. That also means you’re using your pelvic muscles.

“If you do a lot of work with heavy lifting, it puts pressure on your pelvic floor, which increases your risk of prolapse,” warns Dr. Andy.

4. Put your Kegels to work.

There is a kind of lifting that is acceptable, however. It’s the lifting of your pelvic floor muscles by doing Kegel exercises. These exercises strengthen the muscles that support your bladder, uterus, and large intestine.

“Doctors should be talking to their patients about pelvic floor exercises, such as Kegels,” says Dr. Andy.

While many know about Kegels, few people do the exercises correctly. Far too often, women are contracting their abdominal muscles, which is incorrect.

Dr. Andy offers a surefire way to help patients identify what muscles they should be working.

“Imagine you’re in an elevator and there are other people in there, and gas is about to come out. You don’t want the gas to come out, so you hold back. Those are the muscles you need to be contracting,” explains Dr. Andy.

“Very often women are contracting the wrong muscles. So they’re not really gaining the benefits,” she says.

5. Get started now.

Although you may not be able to completely avoid uterine prolapse or incontinence, taking measures to prevent it now can’t hurt.

“We don’t have any good data on when it’s best to begin preventive measures for uterine prolapse and incontinence,” says Dr. Andy. “But you can never start too early.”

Thursday, October 15, 2015

Five Myths about Childbirth and Uterine Prolapse

Childbirth awards us with the incredible gift of children, but changes to your body can linger long after your little one has grown up. One of the most important casualties is damage to your pelvic floor muscles.

This group of muscles, ligaments and tissues do the hard work of supporting your uterus, bladder and rectum. But keep in mind that these are muscles. With enough wear and tear, they can get weak.

When these muscles weaken, things start to drop, like your uterus bulging down into your vagina, which is called prolapse.

Pamela Levin, MD, urogynecologist and Assistant Professor of Obstetrics and Gynecology with Penn Medicine, dispels five myths about what role childbirth really plays in how your pelvic floor muscles fare.

Myth 1: Long or difficult labor is usually the culprit.

Although difficult labor that involves breach births, extended pushing, and deliveries that require forceps or vacuum pumps prove stressful for pelvic floor structures, prolapse can start long before delivery with pregnancy itself.

“Simply carrying a pregnancy does put a lot of strain on the support structures of the vagina and the pelvic floor that sets the stage for prolapse in the future,” says Dr. Levin. “And that’s prolapse of any wall of the vagina.”

Your pelvic floor muscles have a bowl shape that cradles your bladder, uterus and rectum. If the prolapse occurs:

  • In the front wall, then the bladder can sag
  • In the wall supporting the top of the vagina, then the uterus sags
  • In the back wall of the vagina, then the rectum can sag

“And the end result is that it creates a bulge in the vagina,” adds Dr. Levin.

Myth 2: C-sections prevent pelvic floor disorders.

Having a C-section doesn’t protect you from prolapse or urinary incontinence. You’re at the mercy of many other factors as well.

“It’s the carrying of the baby, your genetics and bad luck at play,” says Dr. Levin. That’s because genes can determine muscle and tissue strength. Women born with weaker tissues are at greater risk for prolapse, reports the American Urogynecologic Society.

Dr. Levin warns women not to “make any quick judgments about how functional your pelvic floor muscles are until you’ve had plenty of time to recover after pregnancy.”

Myth 3: It will worsen with each birth.

Not so, says Dr. Levin.

“We don’t have a direct correlation that says if you have a certain number of babies, you’re going to have a certain extent of prolapse,” she says.

Studies have shown that women who have never had babies have prolapse alongside women who have had multiple babies with minimal to no prolapse.

“Certainly, have as many babies as makes sense for you, your family and your life, but not so much based on your pelvic floor,” she says. “You may end up with or without it regardless of what you do.”

Myth 4: Prolapse repair surgery is fine between births.

No. This is largely non-negotiable.

“With very few exceptions, we don’t repair prolapse until women are 100% done having children,” says Dr. Levin. “If we repair your prolapse and then you carry another pregnancy, we may be right back where we started.”

Not to mention what could happen later: “Each time we go back and do more surgery, you’re at higher risk for injuries and complications,” she says.

Myth 5: What happens to pelvic floor muscles during pregnancy remains after delivery.

Thankfully, pregnancy is finite. That also rings true for the conditions that can occur during pregnancy.

“The way you are in pregnancy isn’t necessarily indicative of how you’ll be after pregnancy,” says Dr. Levin.

For example, “If you have incontinence during pregnancy, it doesn’t necessarily guarantee that you’ll have it after delivery,” she explains.

Just because pelvic floor muscles are unpredictable doesn’t mean you have to suffer.

“Prolapse may be a fact of life, unfortunately,” adds Dr. Levin. “But there are lots of things we can do to manage it, so it doesn’t have to be a permanent fact of life.”

Thursday, October 8, 2015

The Warning Signs of Preeclampsia, Before and After Pregnancy

Sarah Donza just thought she was tired. Six days earlier, she delivered her second child and was now at home caring for her newborn daughter.

She had blurry vision, was out of breath and had a dull headache that wouldn’t go away. Her husband urged her to call her obstetrician at Pennsylvania Hospital, who ordered her to come back to the hospital immediately. Her obstetrician diagnosed her with preeclampsia, a condition marked by elevated blood pressure and excess protein in the urine.

“I didn’t think it could be anything serious like preeclampsia; I thought only women who were pregnant could get preeclampsia. I already had my baby,” says Sarah.

What is preeclampsia?

Dr. Sindhu Srinivas
While it is true that preeclampsia is most common in pregnant women, in cases like Sarah’s is can happen after a woman has given birth.

“Preeclampsia typically develops after the 20th week of pregnancy. However, it can also develop after a woman delivers and is discharged from the hospital,” says Dr. Sindhu Srinivas, director of Obstetrical Services at the Hospital of the University of Pennsylvania.

“Preeclampsia and related disorders are most often characterized by the presence of a sudden rise in blood pressure. This can lead to seizure, stroke, multiple organ failure and death of the mother and/or baby,” Dr. Srinivas warns.

What are the symptoms of preeclampsia?

Preeclampsia affects five to eight percent of women and is one of the top causes of maternal mortality. Symptoms can include:

  • High blood pressure
  • Blurred vision
  • Headache
  • Swelling of the face, hands and feet
  • Upper abdominal pain
  • Vomiting
  • Shortness of breath

Knowing the symptoms of preeclampsia is vital, especially for women at higher risk for the disorder. Women who have chronic hypertension, have had preeclampsia in previous pregnancies or who have certain medical conditions, such as lupus, are at increased risk for developing preeclampsia.

“Women at risk should consult with a maternal-fetal medicine specialist before conceiving to better understand her risk and how to optimize the pregnancy for the best outcome,” says Dr. Srinivas.

“Even if the condition is mild, it can affect the baby’s growth and the mother,” she says. “If the condition is stable, we may only need to monitor and test during pregnancy. But if a woman’s condition worsens or is severe, the only cure for preeclampsia is to deliver the baby.”

What can be done for preeclampsia?

To support the need for more education and monitoring, Dr. Srinivas is working with the  Center for Healthcare Innovation at Penn Medicine to pilot a program that sends new moms home with wireless blood pressure cuffs.

“This program helps us monitor women without making them come into the clinic for a blood pressure check,” says Dr. Srinivas. “It’s our hope that by monitoring their blood pressure in this way, we can address issues before they become serious.”

Today, Sarah speaks openly about her experience and advocates for women at risk for preeclampsia.

“I am thankful to have had Penn Medicine doctors who are up to date on the latest research and information and could diagnose me quickly,” says Sarah. “After a few days on magnesium sulfate and wearing an oxygen mask, I was on track to recover and get back home to my family.”


Thursday, October 1, 2015

Three Ways to Bond with Your Baby in the NICU

“No parent ever expects or plans to end up in the NICU,” says Michelle Ferrant, MSN, RNC-NIC, CBC, DNP(C).

Michelle is a staff nurse, Clinical Level IV at Penn’s intensive care nursery (ICN), and the staff chair on the ICN Family Advisory Council.

One of the hardest things parents may struggle with is feeling that they can’t form a close relationship with their newborn, especially when they can’t hold him.

But there are ways to form that sense of attachment, Michelle says. Here are three ways to bond with your baby in the NICU.

1. Acknowledge your emotions.

Having a child in the NICU is definitely an emotional experience.

“One of the phrases you’ll hear us use is that it’s a roller coaster. There really is no better way to describe it. There are good days, and there are bad days,” she says.

The American Academy of Pediatrics (AAP) says that parents may feel a number of intense—and perfectly normal—emotions when their baby is in the NICU:

  • Fear
  • Anger
  • Guilt
  • Loss
  • Powerlessness

Michelle says that disappointment is another common emotion that parents of NICU babies express.

She tells parents that, “While this wasn’t your plan, this is now the baby’s plan. And we’re all in this together to make this as positive of an experience as it can be, so that you have some things to look back on and feel good about.”

Remember that these emotions are completely normal. It’s important for you to acknowledge how you are feeling—and seek help if necessary—so that you can be there for your child during this difficult time.

2. Talk to your baby.

Even though they are not able to fully understand what you’re saying, babies can recognize familiar voices, says the National Center for Infants, Toddlers, and Families.

“Your baby knows who you are. He knows your voice,” Michelle says. She recommends talking or reading to your baby.

In fact, speaking in front of your child is part of how he develops language skills of his own.

Preemies who are exposed to normal adult language during their time in the NICU have better developed language skills by the age of three, according to a February 2014 study in Pediatrics.

3. Get involved in your baby’s care.

If your child is stable enough, kangaroo care often comes first. “Also known as skin-to-skin care, the baby is undressed to just a diaper and tucks into mom’s chest and goes right on her skin,” explains Michelle.

“They can hang out there together for up to four hours as long as the baby is maintaining their temperature and heart rate,” she adds. “Babies really do well with that, and moms and dads like it as well.”

Even if you can’t hold your baby, which is rare, there are still ways for you to establish a care routine just like any other parent of a newborn, the AAP says.

Michelle adds that, “Parents are truly partners in care. While we might be providing all of the medical care, they are the parent, and they are also important.”

When you’re ready to get involved, Michelle explains, “We’ll stand at the bedside while you change the diaper—just to help manage the baby, and all of the cords and tubes—to make it a little more comfortable.”

“Then, as the baby progresses, the parents can become more involved by taking the baby’s temperature,” she adds. “As the baby starts taking food orally, mom can breastfeed or dad can offer the baby bottles.”

There really are many ways that parents can be partners in their baby’s care. “There is so much that they are providing their baby that we can’t.”

“We highly encourage parents to be an active partner in their baby’s care,” Michelle says. “Many times, when the babies are very little and sick, parents are too nervous or scared. Check in with the nurse to see how your baby is doing and how you can help.”


Thursday, September 24, 2015

Know the Signs of Heart Disease in Women

When it comes to heart disease, many people think of it as a condition that effects only men. It may surprise you to learn, however, that heart disease is the number one cause of death in the US for women, as well as men.

Heart disease, in all its forms, is responsible for over 400,000 deaths a year among women – more than all forms of cancer combined. And although new research on the importance of heart-healthy diets, exercise and quitting smoking have decreased heart disease rates among men in the past 30 years, the rate for women hasn’t budged, according to a report from the National Institute of Nursing.

Here, we will address the most important questions and issues to help women become more heart smart.

What exactly is “heart” or “cardiovascular disease?”

Heart or cardiovascular disease is a blanket term that actually covers different diseases of the heart and vascular systems of the body. The types of heart disease are:
  • Coronary artery disease (CAD) is the most common form of heart disease. CAD is caused when the coronary arteries that supply the heart with oxygen and nutrients become narrowed or clogged. This can cause chest pain (angina), heart attack (myocardial infarction) and even sudden death.
  • Congestive heart failure occurs when the heart muscle is weakened and is longer able to pump blood effectively. The most common symptoms include shortness of breath, fatigue or swelling of the legs. Congestive heart failure is often the result of damage to the heart muscle caused by a heart attack.
  • Cardiac arrhythmia, or abnormal heart beat, can be health-threatening if it keeps the heart from pumping efficiently. If this is the case, then an arrhythmia can contribute to congestive heart failure or even cause sudden cardiac death.
  • Stroke is caused when blood vessels bringing blood to the brain become narrowed or clogged.
  • Peripheral vascular disease (PVD) is very similar but occurs in the arteries of the legs.
  • Valvular disease referes to damaged or malfunctioning valves of the heart, and an aneurysm, is the abnormal widening, or bulging of an artery due to a weakened arterial wall from severely clogged and hardened arteries.

What is a heart attack?

Coronary arteries bring blood and oxygen to the heart. If blood flow to part of the heart is blocked long enough and the heart is starved of oxygen, heart cells dies and that part of the heart muscle is damaged or dies, resulting in a heart attack – more formally known as myocardial infarction.

How prevalent is heart disease in women in the US?

According to the American Heart Association, more than one in three female adults has some form of cardiovascular disease (CVD). Beginning in 1984, the number of CVD deaths for females began to exceeded those for males. Research shows that women who have heart attacks are more likely to die within a year of the event compared to men, and a whopping 64 percent of women who died of sudden cardiac events had no previous symptoms.

What are the symptoms of a heart attack?

Recognizing the symptoms of heart attack in women may not always be as clear-cut as it is for men. The most prominent symptoms which are sure signs of trouble that women should keep an eye out for are:
  • Pressure, tightness, fullness and discomfort in the center of the chest that lasts more than a few minutes, or it comes and goes in waves
  • Pain or pressure that spreads to the shoulders, between the shoulder blades, neck, upper back, jaw, or arms
  • Jaw or throat pain
  • Crushing chest pain
  • Shortness of breath and difficulty breathing
  • Nausea and/or dizziness
  • Cold sweat, paleness
  • Overwhelming fatigue or weakness
  • Abdominal pain
Women often mistakenly think only severe chest pain is a symptom of a heart attack and delay seeking medical care. You know your body and when you aren’t feeling well. Seek the medical attention you need and deserve.

What should you do if you think you’re having a heart attack?

Is it heart burn? A pulled muscle? Fatigue? Just what is that pain and what does it mean? It’s important for women to be aware of the signs and symptoms of a heart attack, but even more important – don’t wait for the pain to pass. Seek help. Unfortunately though, woman can experience the full gamut of symptoms or only one or two. The only way to know for sure if you’ve had a heart attack is to be examined by a physician and undergo testing, such as an electrocardiogram (ECG).

If you think you’re having heart attack seek help immediately and call 911. Don’t take a chance and try driving yourself to a hospital since you run the risk of losing consciousness. Tell the 911 operator and tell the paramedics that you are experiencing heart attack symptoms. Don’t be afraid to be firm. A 2009 Penn Medicine study  showed that there are definite gender disparities in pre-hospital care and that women with chest pain are less likely than men to receive proper treatment from paramedics. Once at the hospital, make sure you get an ECG and/or blood enzyme test to see if you are having a heart attack.

By knowing the risk factors and symptoms, you can begin living a heart smart life.

Thursday, September 17, 2015

Post-Pregnancy Life: Six Things Mom Never Told You

Having a baby is both exhilarating and overwhelming. Your mom probably told you all about when you were a newborn, but she probably also left out some things about life after baby arrives.

Here are six things your mom never told you about post-pregnancy life.

1. Finding a good sitter is like finding a bag of money.

If a loved one can’t babysit your child, then the hunt begins. You can ask for a referral, but good babysitters are like precious gold. When parents find them, they don’t want other parents hijacking them.

So, where does that leave you? Well, it could leave you paying the equivalent of a second mortgage for quality child care. Or it could make you reconsider your daily schedule to be home with the baby.

You could also consider asking around at your local place of worship, your local school or other community resource.

Either way, be prepared to put in the time and effort to find the right person.

2. Your uterus moves.

You’re fully aware that your uterus holds your baby during pregnancy, but your mom probably never told you to worry about what’s holding your uterus in place.

Pregnancy can weaken your pelvic floor muscles, which support your pelvic organs.

Some women experience a condition known as uterine prolapse well after pregnancy. This occurs when your uterus drops into your vagina because the ligaments in your pelvis were stretched during delivery.

In severe cases, it may require a pessary—a donut-shaped device placed in the vagina to hold the uterus in place—or even surgery.

3. Your bladder control becomes questionable.

Mom never mentioned a pesky problem called stress incontinence, did she? This is also known as a leaky bladder.

This pelvic floor disorder happens when pregnancy strains and weakens the muscles supporting your bladder.

So, when you laugh, cough or sneeze, the weakened muscles around your bladder fail to constrict the flow of urine. Then, you start leaking.

Four ways to treat the condition, according to the National Library of Medicine, include:

  • Changes in behavior, such as drinking less fluids or wearing pads
  • Medication or surgery
  • Pelvic floor exercises, such as Kegels

4. Sleep truly becomes a treasure.

You’ve probably heard how exhausting a new baby can be, but nothing can prepare you for chronic sleep deprivation. Nothing.

But new parents don’t have to settle for feeling like a zombie, says the National Sleep Foundation. They suggest trying the following: 

  • Sleep during the day while the baby sleeps.
  • Set a sleep schedule with an early bedtime for yourself and the baby.
  • Turn off anything with a screen.
  • Ask family members to babysit while you nap.

5. Everyone is an expert on raising your child- except you.

Everyone can be a critic when you’re a new parent. Judgment is rampant from family, friends and even strangers. But you don’t have to be at the mercy of other people’s opinions.

You can choose instead to:

  • Acknowledge their opinions but don’t argue—because you won’t change their mind.
  • Take an informational approach where you state the facts behind your choices.
  • Change the subject, which means you don’t have to justify yourself to that person.
  • Politely tell people your personal decisions are just that—personal.

6. Breastfeeding is natural, but it may not be easy.

Your mom, your obstetrician and everyone else may urge you to breastfeed, which makes sense. Breast milk is loaded with all kinds of nutrients to help your baby thrive, says the National Library of Medicine.

What your mom may have left out is that breastfeeding comes with a whole host of struggles, according to the American Pregnancy Association. These include:

  • Low milk supply
  • Sore nipples
  • Engorgement

Then, there’s the time commitment. If your little one wants to feed every 90 minutes, your daily schedule will have to revolve around feeding time.

If you’re struggling to breastfeed and you’re healthy enough to do it, ask for a referral to a lactation consultant or find your local La Leche League chapter for support.

Like most aspects of being a new mom, it becomes easier with time.


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