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Contact : (703) 528-6300
Event Information:
Thursday, June 9th at 6 pm
431 Park Ave., Suite 300 • Falls Church, VA 22046
Healthcare for Women would like to thank you for your support and patience during this pandemic. We have always prioritized the safety and health of our patients and staff. Both our offices are fully open for all types of appointments. Please come see us!
Healthcare For Women COVID Information
Because we care about everyone, we must protect those who are unvaccinated or have compromising health conditions. We want to share the changes in our Covid protocols:
-Everyone is still required to wear a mask inside our office.
-Companions and children (partner/parent/caregiver/interpreter):
– We implemented remote check-in via Otech/UStart: 2-3 days prior to your appointment, a secured link will be texted and emailed to the patient. We ask patients to complete this process at least 24 hours prior to the appointment time to ensure the completion of forms and a fast check-in process.
-Patients and staff are encouraged to stay at home if they feel sick.
We all know that there is a risk of breast cancer that comes with the fact of being born female. And the way to find breast cancer early is this thing called the mammogram. Maybe you just had your first mammogram and received a call that you need to return for further imaging – how concerned should you be? Maybe you have had annual mammograms for 10 years and still wonder what it means that your breasts are apparently “heterogeneously dense.” Let’s review the mammogram technology and what these specialized x-rays mean for you and your breasts.
Mammograms, like all x-rays, use ionizing radiation to create images of your breast tissue. The breast is compressed between 2 paddles and multiple angles of x-rays are applied to create either a 2D or 3D image. Though unpleasant, the compression improves the quality of the image for the interpreting radiologist, helps keep the breasts steady to avoid artifact, and limits the radiation exposure by minimizing the volume of imaged tissue. The x-rays for mammograms are lower energy than that needed for imaging bones. Though excess radiation is something we know to avoid generally, the amount of radiation from a routine mammogram is 0.4milisieverts, roughly equivalent to the amount of background radiation (the amount our body is exposed to by the earth, water, stars, man-made things, etc) we are exposed to over about 8 weeks, so a mammogram is considered quite safe particularly when weighed against the risk of missing an early breast cancer.
There are 2 primary types of mammograms: screening and diagnostic. Screening mammograms are for the annual check of the entire breasts when there is no particular concern. Diagnostic mammograms focus on a specific area of concern and employ additional x-ray views for assessment of the area; they take a little longer and the radiologist is usually reviewing the images while you are still there in case further evaluation is needed.
The risk of breast cancer increases with age. The guidelines of when to have your first screening mammogram have been determined based on weighing the drawbacks of the mammogram with its benefits. The drawbacks include the time and expense of the test, a chance of a false positive results (with its unnecessary anxiety and further testing), and the minimal radiation exposure. The benefit is finding breast cancer and therefore easier or more successful treatment and survival. According to the American Cancer Society and the American College of Obstetricians and Gynecologists, age 40 is when the benefit outweighs the drawbacks for most women. Those with a with a history of breast issues or a family history of breast cancer may be an exception and should discuss breast cancer screening with your healthcare provider individually.
Mammograms are certainly not perfect. As mentioned previously, there are false positive results, meaning an abnormal finding that is actually benign after further imaging or a biopsy. Younger women and women with more dense breasts are more likely to have false positives. If you get a call requiring additional imaging, remember than most women who get a call back for further imaging do not have cancer. Additionally, the false negative rate, meaning that cancer is there and the mammogram misses it, is estimated at about 10%. For woman with dense breasts, 3D imaging with tomosynthesis can be used to increase accuracy. Ultrasound is another modality which may be recommended by the radiologist after the mammogram, particularly when evaluating an area of concern. Ultrasound is also useful for imaging the breasts of younger women.
The birads scoring system is something used by radiologists which helps to standardize results. The following is a summary of what each birads category means:
Birads 0: Need additional imaging or prior imaging records to complete evaluation
Birads 1: Negative — no action other than 12 month follow-up
Birads 2: Benign — breast findings which are stable and/or confidently benign, no action other than 12 month follow-up
Birads 3: Probably benign — short interval follow-up, typically 6 months
Birads 4: Suspicious — requires a tissue diagnosis (biopsy)
Birads 5: Highly suggestive of malignancy — more than 95% likely is cancer, requires a tissue diagnosis (biopsy)
Birads 6: Known malignancy, already biopsy-proven — monitoring progression or treatment response
In the common event of a birads 0, you will be called back usually for additional x-rays or an ultrasound. This is common if it is your first mammogram because there is less certainty about your breasts before there are multiple years worth of images to compare. Sometimes with a birads 0, they will simply need to obtain and review previous mammograms if you have had them. The call back experience may make you nervous, but reassuringly, 9 times out of 10 the final results are benign.
In addition to the birads category, you will usually see a breast density description on your mammogram report. It is determined as 1 of 4 levels: almost entirely fatty, scattered areas of fibroglandular density, heterogeneously dense, or extremely dense. The majority of women will be one of the middle two categories. The breast density can only be determined through mammography (you can’t tell just by feeling or examining your breasts). People with breasts rated as heterogeneously or extremely dense have a higher risk of breast cancer. Part of this is because the dense areas can “hide” an early mass, but even aside from this, it is thought that dense breasts in themselves bear a higher lifetime risk of cancer. If you have other increased risks for breast cancer along with dense breasts, you may be a candidate to have breast MRIs annually in addition to mammograms — a topic for another article, but please discuss with us in the office if you wonder about this for yourself.
Lastly, a word about the time-honored self breast exams: they are a worthwhile detection method, however, they are limited and very non-specific and if any lump or new mass is felt, diagnostic imaging is additionally necessary. And just because you don’t feel a new lump or mass, it doesn’t mean that there aren’t abnormalities which are small, deep in the tissue, or simply non-palpable. This is why mammograms, friends. It is not recommended to rely on self breast exams alone as a cancer screening method.
So mammograms, like humans, are flawed but incredibly valuable things. Thanks for reading and let’s talk about what’s right for your breasts at your next annual visit.
When should I have a bone density scan?
Bone Density Screening – For premenopausal women, a bone density scan is rarely necessary unless there is a relevant chronic disease known to affect bone density. However, the reproductive years (teens-40s) are an important time to build and maintain bone strength to protect again osteoporosis and life-altering hip and spine fractures in the future.
Once in menopause, if a woman is noticing height loss (a sign of potential vertebral fracture), breaks a bone, or develops new back/spine pain, a bone density scan may be recommended. In addition, a bone density scan may be recommended in menopausal women with risk factors for bone loss such as smoking, drinking more than 2 alcoholic drinks daily, using glucocorticoid medications long-term, having rheumatoid arthritis, having a low weight, or if your mother ever broke her hip. For those at high-risk, check with your provider at your annual visit about when it is recommended to have a bone density scan.
Regardless, is recommended that post-menopausal women have a bone density scan by age 65. Osteoporosis does not typically cause pain or other symptoms until there is a broken bone. Spine and hip fractures can be serious. Checking for whether you are at risk before there is an incident is why screening is recommended.
How does a bone density scan work?
A test called dual-energy X-ray absorptiometry, or a DEXA scan, is used to determine bone density. It utilizes low levels of X-rays and takes only a few minutes. The most useful result for post-menopausal people is the “T-score,” which is in terms of standard deviations from the mean bone density of a healthy 30-year-old person (age of peak bone mass). A T-score below -2.5 is consistent with a diagnosis of osteoporosis. Osteoporosis can also be diagnosed if a person experiences a “fragility fracture” or breaks a bone by a low-impact mechanism such as falling from standing.
How can I prevent osteoporosis?
Of course, everyone hopes that their DEXA scan result shows strong healthy bones. A lot of whether a person has osteoporosis or not is simply her age plus her genetics. Various hormones play critical roles in signaling the buildup and breakdown of bone. There is a constant turnover happening in normal healthy bones. Once a woman is past menopause, the low levels of circulating estrogen lead to a gradual net loss of bone. However, as mentioned before, the lifelong habits of a person contribute to the baseline density of bone when she enters the menopause transition. Regular calcium intake, ideally through the foods eaten, or through a supplement, vitamin D supplementation, and consistent weight-bearing exercise such as walking or running, and strength training are centrally important to maintaining bone density and decreasing the rate of decline.
The annual preventive visit with a women’s health provider is when this screening is discussed. For women before menopause, these annual visits are also when discussions are had regarding calcium intake and appropriate types of physical activity to help build and maintain strong bones throughout your life. If you have any questions or concerns, please bring these to your annual physical exam, we would love to see you!
As women approach menopause, there are many changes that can happen in the body including changes in the menstrual cycle. Most women experience several years of changes in the cycle before they completely stop. This transition into the period stopping is called perimenopause. And menopause is retrospectively defined as 12 months without a period. The average age for menopause is 51 years old but this varies for each woman and is influenced by several factors including genetics, smoking, weight, activity level, and previous surgeries. There is no reliable testing that can accurately predict when a woman will become menopausal but on average, perimenopausal changes begin 4 years before the period completely stops.
During perimenopause, because of changes in hormones, periods may become erratic, such as:
Even though these changes can be normal, there are times when medical evaluation is recommended, such as:
Medical evaluation for irregular bleeding can include blood work, a pelvic ultrasound, a biopsy of the tissue inside the uterus (ie: an endometrial biopsy) and/or using a camera to look inside the uterus (ie: a hysteroscopy). All of this can conveniently be performed in our office when deemed necessary.
Depending on the severity of the menstrual changes and the results of the evaluation, treatment may be optional or recommended. Treatment options vary widely but may include: birth control pills, IUDs, non-hormonal medications to slow menstrual bleeding, endometrial ablation, or hysterectomy.
At Healthcare For Women and our Hormone Menopause Resource Center, we have a special interest in promoting hormonal wellness and healthy aging. Perimenopause can be a challenging and confusing time and we want to educate our patients on their bodies – what are normal expectations and when there should be a reason for concern.
Please contact us to learn more, ask questions about Perimenopausal Menstrual Irregularities and work together to make this transition easier.
Written By Dr. Bridgett Casadaban
These medical experts set the record straight for today’s parents and prospective parents. Our Doctors (Doctor Porter and Doctor Winterling) are quoted in the article. Read the full NBC Washington news article here.
Fractional CO2 Laser Therapy May Aid Sexual Function in Breast Cancer Survivors. Click the link below to read the following article published by HealthDay News:
Contact us at Healthcare For Women to learn more.
Do you think, or have you been told, that this is just what happens when you go into menopause and there is nothing that can be done about it?
While, yes, painful sex is quite often a result of declining estrogen levels with menopause, there actually are many treatment options available.
First, some education, because here at the Healthcare For Women Hormone and Menopause Resource Center we believe that it is important to understand the changes that are happening in our bodies, causing the symptoms that we feel, and to be able to make more informed decisions about treatment options.
The genitourinary syndrome of menopause is defined as a collection of signs and symptoms associated with estrogen deficiency that can involve changes to the labia, introitus, vagina, clitoris, bladder, and urethra. The syndrome includes genital symptoms of dryness, irritation, and burning; urinary symptoms of dysuria, urgency, and recurrent urinary tract infections; and sexual symptoms of dryness and pain.
There are receptors for estrogen throughout the vagina, vulva, urethra and even in the bladder. Estrogen maintains blood flow to the vulvovaginal tissue, the collagen within the epithelium and the hyaluronic acid and mucopolysaccharides within the moistened epithelial surfaces. Estrogen also plays a role in supporting the microbiome and protecting the tissue from pathogens. A decrease in estrogen leads to a thinning of the vaginal epithelial tissue, and a subsequent loss in elasticity, leading to a narrowing of the vaginal canal.
All of these changes can lead to painful sex, vaginal dryness and urinary symptoms.
Many treatments are available including non-hormonal over-the-counter lubricants and vaginal moisturizers, local vaginal estrogen therapy, intravaginal DHEA, oral estrogen agonist/antagonist, and the fractional CO2 laser.
Come visit us at the Healthcare For Women Hormone and Menopause Resource Center for an evaluation and discussion about the best treatment for you.
Contact us today and set up your appointment.
Written by Dr. Winterling.
Vaccinating Pregnant and Lactating Patients Against COVID-19
Read the article here: Vaccinating Pregnant and Lactating Patients Against COVID-19
If you have any questions please contact our office to make an appointment to talk with your doctor.
“This Practice Advisory was developed by the American College of Obstetricians and Gynecologists’ Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group in collaboration with Laura E. Riley, MD; Richard Beigi, MD; Denise J. Jamieson, MD, MPH; Brenna L. Hughes, MD, MSc; Geeta Swamy, MD; Linda O’Neal Eckert, MD; Mark Turrentine, MD; and Sarah Carroll, MPH.” – American College of Obstetricians and Gynecologists
Click the Read More button to find more information about the change in Insurance Acceptance with United Healthcare.
FROM HEALTHCARE FOR WOMEN, PC – Insurance Acceptance with United Healthcare
August 31, 2020
Dear Patient:
We know that you have many choices when it comes to health care, and we are honored that you have chosen to partner with us on your journey to health and wellbeing. It is therefore with a heavy heart that we write to inform you that effective October 1, 2020, we will no longer accept United Healthcare insurance.
Please understand that this decision was not made lightly and that we are aware of the inconvenience this will cause you as a United Healthcare insured patient. However, our last contract negotiation with UHC was in 2005, 15 years ago and despite exhaustive efforts on our part to work with them on fair reimbursement, we have been unable to come to an agreement for the care and services we provide. At a time when physicians are on the front lines of a pandemic, their reimbursement remains below the standard of any other insurer, including Medicare. That being said, UHC is having an amazing year with profits in the second quarter of $6.7 billion.
With inadequate reimbursement, we are then forced to see more patients at the same time confines. We have built our practice and reputation by consistently providing the highest quality, personalized care, so when faced with the choice to part company with an insurer or compromise on standards of care, the choice is clear. We simply refuse to provide our patients with anything less than exceptional medical care.
However, should UHC return to the table with an agreement that does not force a compromise to either our values or standards, we will of course be open to resuming our relationship.
If you are upset about this change, please contact UHC and let them know. Our focus on treating our patients and their families with dignity has not changed. Sadly, United Healthcare has put our practice in a very difficult situation, and we refuse to provide our patients with anything less than exceptional medical care.
You may also direct all questions and concerns to your HR Department, Broker, or the UHC Member Service Number on your card. We appreciate your patience during this transition time.
It has been our privilege to serve you, and we thank you for being a Healthcare for Women patient.
Sincerely,
Amy E. Porter, M.D.
Ingrid M. Winterling, M.D.
Ji Eun Paik, M.D.
Nicole A. McClendon, M.D.
Bridgett L. Casadaban, M.D.