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Women undergo multiple hormonal changes throughout their lives, leading to different physical and emotional experiences. Dr. Carilyn Hoffman, at Renown Women's Health, explains these confusing life stages and helps decode menopause. Perimenopause: Transitioning Towards Menopause Defined as the time "around menopause," perimenopausal symptoms are caused by hormonal fluctuations that occur as the ovarian function declines. Levels of estrogen and progesterone decrease, and follicle stimulating hormone increases. These hormonal fluctuations may cause a range of symptoms including: Irregular or abnormal periods: Initially cycles intervals vary in length by greater than 7 days, then in later stages the interval increases to greater than 60 days between cycles Hot flashes and night sweats: This is the most common symptom and 50-82% of women will have vasomotor symptoms Mood swings and memory problems Anxiety or insomnia Heart palpitations Decreased libido and vaginal dryness Weight gain and thinning hair Increased risk of urinary tract infections Decreased bone density Menopause Menopause is defined as year without a menstrual cycle and marks the timeframe when the ovaries stop making estrogen. This signifies the end of the reproductive years. The average age of menopause is 51; however, the menopausal transition can last about 8 years. This means that women in their late 30’s and 40’s may start to have symptoms of perimenopause. The worst vasomotor symptoms are typically experienced at the one-year mark since the last period. Unfortunately, some women experience symptoms throughout the entire menopausal transition. Postmenopausal After 12 months without a menstrual cycle, a woman is confirmed to be postmenopausal. This is sometimes difficult to define, as women may have had procedures that cause menstrual suppression such as a uterine ablation or hysterectomy or they may still be on contraception. Sometimes, lab work may be recommended to help determine menopausal status. However, due to the broad time period that the menopausal transition occurs and the variations in normal hormone levels throughout a cycle, lab work is not always helpful. Dr. Hoffman explains the importance of thorough counseling for patients seeking to "check their hormone levels." She emphasizes that menopause is diagnosed clinically, focusing more on the individual's symptoms rather than lab values. This approach ensures that patients understand the implications of the test results and the treatment strategy. Menopause Medical Management Medical management of symptoms should be tailored to the individual’s concerns. Abnormal Bleeding: There are a range of medications, IUDs and procedures available if the main concern is irregular or prolonged menstrual bleeding during perimenopause.  Hot Flashes and Night Sweats: Hormone Replacement Therapy (HRT): HRT is currently the most effective method for relieving vasomotor symptoms. However, it's important to discuss potential risks with a healthcare provider, as HRT can increase your risk of blood clots and breast cancer. If improperly prescribed, it can also increase the risk of uterine cancer. The American College of Obstetricians and Gynecologists recommends the lowest dose for the shortest duration. Low-dose antidepressants: SSRIs/SSNIs may mitigate hot flashes and mood disorders for those who are not candidates or prefer to avoid HRT. Currently, only Paroxetine is FDA-approved for this use.  Fezolinetant: This is a newly FDA-approved non-hormonal medication that works at the brain's level to treat vasomotor symptoms. Gabapentin: This is an anticonvulsant medication that has been shown in several studies to be helpful for vasomotor symptoms, but it is not currently FDA-approved. Genitourinary Symptoms of Menopause:  Vaginal estrogen: Vaginal dryness and pain with intercourse due to thinning vaginal tissue is a common symptom of menopause. Vaginal estrogen is highly effective at decreasing these symptoms and has fewer side effects than systemic HRT. Ospemifene: This is a selective estrogen receptor modulator that is a non-hormonal FDA-approved medication for severe vaginal dryness. Natural Symptom Relief Strategies: Nutrition: Incorporate calcium, vitamin D, and high-quality protein to support bone health and muscle maintenance. There are limited studies on phytoestrogens (found in soy and tofu) and vasomotor symptoms. While the data doesn’t necessarily support that these phytoestrogens relieve symptoms, no detrimental effects were found and these tend to be high quality and healthy proteins. Exercise: Regular physical activity can ease menopausal symptoms and support weight management. Data doesn’t support that this reduces vasomotor symptoms, but it can be helpful in weight management and sleep quality. Beverage choices: Limiting alcohol and caffeine can help decrease the frequency of vasomotor symptoms and may also improve sleep quality. Alternative remedies: One study shows that Chinese herbal medicine and acupuncture are effective at relieving vasomotor symptoms. There is not enough evidence to recommend Black Cohosh, and it is associated with liver toxicity in high doses. Studies don’t show that St. John’s Wart or Gingko Balboa are any better than placebo.  Always mention your alternative medical therapies to your provider as some do interact with other prescribed medications. By understanding and recognizing that the symptoms of menopause are real and treatable, women are empowered to manage this transition better and can maintain their well-being and quality of life. Please schedule an appointment with Renown Women’s Health if you’d like to discuss your menopause symptoms with a provider.

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Obstetrician-gynecologists (OBGYNs) see patients from menses (the monthly menstrual cycle that occurs as a part of the female reproductive system), pregnancy and childbirth through menopause and play a pivotal role in managing reproductive health and overall wellness. Dr. James Alexander with Renown Women's Health explains. "As experts in women's health, we are uniquely positioned to recognize subtle changes or symptoms that might indicate broader health issues. This comprehensive approach allows us to serve as a valuable first touchpoint for various health concerns." Preventive Screenings: A Proactive Approach One key aspect is an OBGYN's ability to recommend preventive screenings based on your symptoms, age, lifestyle and medical history. For instance, lipid screenings are critical for monitoring cholesterol levels, which can be a significant factor in women’s heart disease. An OBGYN keeps up with the current guidelines for routine screening as well as in women with risk factors such as high blood pressure, diabetes, or a family history of heart disease during your visit. By identifying risks and abnormal screening early, they can collaborate with you to implement lifestyle changes or treatments to reduce your risk of heart conditions. Schedule Your Screening Appointment Make an Appointment by Phone: 775-982-5000

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Dr. Carilyn Hoffman with Renown's Women's Health explains the symptoms, causes and treatments of Polycystic Ovary Syndrome (PCOS) (also referred to as Polycystic Ovarian Disease (PCOD)), a prevalent condition among women of reproductive age that influences hormonal balance, metabolism and fertility. Make an appointment with Renown Women's Health Click here to schedule Call to schedule: 775-982-5000 PCOS Defined PCOS is a constellation of symptoms characterized by two of the three criteria: multiple small cysts on the ovaries visible via ultrasound, irregular periods and signs of hyperandrogenism. Other symptoms include infertility, insulin resistance, and increased risk of cardiovascular disease. Symptoms of PCOS The symptoms of PCOS can vary from woman to woman, but some of the most common include: Irregular menstrual cycles: This is often one of the first signs of PCOS. Women may experience fewer than nine periods a year, more than 35 days between periods, frequent spotting, and/or abnormally heavy periods. Excess androgen levels: High levels of male hormones may result in physical signs such as excess facial and body hair (hirsutism), severe acne and male-pattern baldness. Polycystic ovaries: Enlarged ovaries containing numerous small cysts can be detected via ultrasound.     Causes and Risk Factors The exact cause of PCOS is unknown, but several factors may play a role: Genetic predisposition: A family history of PCOS increases the risk. Insulin resistance: High insulin levels might increase androgen production, causing difficulty with ovulation. Obesity: Women with elevated BMI’s are more likely to have PCOS, although 20% of women with PCOS are not obese. Diagnosis and Treatment Dr. Hoffman outlines that diagnosing PCOS requires a medical history review, a physical exam, blood work and an ultrasound to evaluate the ovaries. Treatment options can range from lifestyle modifications, like diet and exercise and weight loss, to medications for menstrual regulation, fertility assistance, and rarely surgery. Lifestyle Changes A healthy lifestyle is a cornerstone of managing PCOS. Regular exercise, a nutritious diet, and weight management can help reduce symptoms and the risk of long-term health issues. In overweight patients, weight loss as little as 5% has been shown to improve symptoms of PCOS. Medication Medications may include hormonal contraceptives to regulate menstrual cycles, anti-androgens to reduce hair growth and acne, and Metformin to address insulin resistance. Fertility Treatment For women with PCOS who are trying to conceive, ovulation induction with clomiphene or letrozole is sometimes necessary. Sometimes a referral to a reproductive endocrinologist and infertility specialist is needed for more advanced technologies like IVF. Health Implications PCOS is not just about cystic ovaries or irregular periods; it can have profound implications on a woman's overall health. Women with PCOS are at an increased risk for several conditions, including type 2 diabetes, high blood pressure, heart disease, and endometrial cancer.

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Vitamin D, often hailed as the sunshine vitamin, plays a crucial role in our health by helping the body absorb calcium and promoting bone and teeth strength. However, despite its importance, Vitamin D deficiency is widespread, contributing to various health issues ranging from osteoporosis to type 2 diabetes. We asked Alexandra Westover, APRN for Renown Health, for more information. Understanding Vitamin D and Sun Exposure How Vitamin D is Synthesized Vitamin D functions like a pro-hormone produced when our skin is exposed to sunlight. It's vital for bone health and immune function and can even reduce the risk of type 2 diabetes by 15%. Challenges in Vitamin D Synthesis Achieving adequate Vitamin D levels is more complex than basking in the sun. The vitamin breaks down quickly; during winter in northern latitudes, UVB rays are often too weak to contribute to its production. Expert Insight Alexandra shares, "Vitamin D deficiency is linked to multiple health concerns, including cancer and depression. Unfortunately, deficiency rates are high in the U.S., partly due to limited dietary sources and the increasing prevalence of obesity." Dietary Sources of Vitamin D Foods High in Vitamin D: Fatty fish like salmon and tuna Fortified milk and orange juices Mushrooms Eggs Cod Liver Oil Alexandra's Advice on Supplements "While foods and over-the-counter supplements can help, they often fail to correct deficiencies. Many individuals need prescription-strength doses of Vitamin D."

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Early detection is a significant piece of the breast cancer puzzle. Susan Cox, Renown Health Director of Cancer Operations, discusses what you need to watch for and how the latest technology can help detect potential cancer sooner. When should women start getting breast exams? It depends on risk factors: Average-risk women: Most medical organizations recommend the first mammogram between 40 and 44. Higher-risk women: Dependent on their high risk, which will dictate when they start screening, but generally around the age of 30 and not before 25 years old.

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Unfortunately, men are less likely to visit their doctor for exams, screenings, and consults than women. So with the help of Bonnie Ferrara, MD of Renown Health, we've put together a list of eight screenings to help men stay on top of their health game. 1. Blood Pressure Tests Ages 20+ Blood Pressure tests measure the pressure in your arteries as your heart pumps. Biennial (every two years) checks are recommended if you have normal blood pressure or more frequently if you have high blood pressure (hypertension) or low blood pressure (hypotension). The United States Preventative Services Taskforce cites normal blood pressure below 120 systolic (top number) and 80 diastolic (bottom number). 2. Cholesterol Screening Ages 20+ High levels of cholesterol increase your risk of stroke and heart disease. A simple blood test will help your healthcare provider determine your numbers and if you're at risk. If you have a family history of diabetes or heart disease, you may need yearly screenings. But, again, your doctor can provide the best course of action.

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While there used to be three basic treatment options for cancer -- surgery, radiation and chemotherapy, or a combination of the three -- there's a fourth option: clinical trials. Here, a Renown patient shares her successful battle with ovarian cancer, aided by a clinical trial. Shari Flamm's battle with ovarian cancer began in 2011. She was experiencing prolonged bleeding, irregular thyroid levels and anemia and was scheduled to undergo a hysterectomy. Before the surgery, her gynecologist ran routine tests to check for cancer as a precautionary measure. All tests were negative for cancer, expect her CA 125 test. A CA 125 test measures the amount of the protein CA 125 (cancer antigen 125) in the blood. In some cases, a CA 125 test may be used to look for early signs of ovarian cancer in women with a very high risk of the disease. In most laboratories, the normal level is 0 to 35 units/ml. Flamm's CA 125 level was 121. As Flamm can attest, early diagnosis played a key role in her battle with ovarian cancer. September is Gynecologic Cancer and Ovarian Cancer Awareness Month – an important time to learn the signs, symptoms and risk factors of this type of cancer so your doctor can diagnosis the disease as early as possible. Ovarian Cancer: Round One Despite the elevated CA 125 results, her doctor recommended they move forward with the hysterectomy. But when surgery began, doctors discovered a mass. She had stage 4 cancer. The procedure was halted, the mass was biopsied and she was immediately seen by Dr. Peter Lim of the The Center of Hope. Following diagnosis, Flamm underwent surgery with Dr. Lim to remove the cancer, which had spread to part of diaphragm, spleen, colon and other organs. Three months after surgery, Flamm had recovered enough to start six rounds of chemotherapy in her hometown of Carson City. She continued working at a doctor's office during her treatment, and was grateful for Dr. Lim’s ability to co-manage her care so she could stay close to work and family. “To me, chemo was the scariest part because I didn’t like feeling sick,” Flamm says. Thankfully, her body responded well to the treatments and she was back to the things she loved. “I stated working out at the gym, even if it was only for 10 minutes,” she says. She also stayed positive by spending time with her grandchildren, attending a San Jose Sharks hockey game, going for walks and enjoying concerts. Ovarian Cancer: Round Two In November 2014, Flamm had a cancer check-up. That’s when doctors discovered three cancerous tumors. For this round, Flamm choose another treatment option -- clinical trials at Renown Institute for Cancer. Clinical trials are the studies that test whether drugs work, and inform doctors' decisions about how to treat their patients. Flamm participated in a clinical trial that featured oral-targeted therapy stronger than IV chemotherapy. The hope was for the drug to shrink her tumors, however the result was stabilization -- meaning the lumps weren’t growing or spreading. The best part of the clinical trial, Flamm says, was the constant monitoring. Between the CT scans every six weeks, a heart scan every three months and monthly doctor visits, she was confident that if the cancer started growing or spreading, her healthcare team would catch it right away. For Flamm, the benefits of the clinical trial included less hair loss, less fatigue and more time to focus on what’s important in her life -- her family. “I decided I wasn’t going to be that sick grandma on the couch with cancer,” Flamm says. After taking the oral medication for one year, Flamm developed a rash and discontinued treatment due to discomfort. Clinical Trials, Setbacks and Survival In June 2016, two of the three tumors began to grow and had to be surgically removed. Despite the setback, Flamm was determined to maintain a positive outlook. "You have to stay positive because cancer feeds off anger, depression and stress," Flamm says. Flamm was released to go home with clear margins, meaning the tumors were removed and are surrounded by a rim of normal tissue that does not have cancerous cells. Flamm says her outlook on life has changed drastically since her first cancer diagnosis. “Your whole mentality changes when cancer disturbs your life," Flann says. "The things that weren’t important, are now ever so important. I’m a lot calmer now,” Flamm says.

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Breast cancer is the leading cause of cancer deaths in women in the U.S. That’s why early detection is so important. Dr. George Krakora, a radiologist with Renown Institute for Cancer, explains what to watch for and how new technology can lead to early detection. Most women know the importance of breast health and staying current with annual breast exams, but may not know that both screening guidelines and technology is evolving. So we asked George Krakora, MD, a radiologist for the Renown Institute for Cancer, what every woman should know about breast cancer detection and which screening method is right for them. First off, when should women start getting breast exams? Generally, women should start getting breast exams using mammography or ultrasound after they turn 40 years old. But we also want women ages 18 to 39 to talk to their primary care provider and ask for what’s called a formal risk assessment to see if screening is needed sooner. And you want to make sure your care provider is giving you a breast exam starting at age 25. It’s also a good idea to be familiar with how your breasts look and feel so you can report any changes to your care provider. What are the risk factors for breast cancer? Are there any preventive steps women can take? There a few risk factors you can’t control, like your age, family history of breast or other cancers, and if you have dense breast tissue. Your risk for breast cancer increases as you get older, and most breast cancers are diagnosed after age 50. Knowing your family history is important because a history of cancer and shared lifestyle can raise your risk. Your breast density can also increase your risk: Women with high breast density are four-to-five times more likely to get breast cancer than women with low breast density. But the good news is there are quite a few things you can do to prevent breast cancer, like not smoking, watching your alcohol intake, and maintaining a healthy weight with good diet and exercise. There are a lot of newer screenings out today. What is the difference between 2-D and 3-D mammography? In a 2-D mammogram, the tech takes X-rays of the breast. These pictures can show the radiologist if there are any lumps or tumors you might not be able to feel. In 3-D mammography, the process is largely the same but more X-rays are taken and it takes a few seconds longer for each image. This kind of exam detects 41 percent more cancers and reduces the number of false-positive results given to patients. This improvement in technology is great for both patients and their care providers. 3-D mammography provides better images of the breast, which allow doctors to more clearly diagnose and avoid false positives, especially in women with dense breast tissue. And what about a whole breast ultrasound. What is that? A whole breast ultrasound uses sound waves to detect cancerous tumors in the breast without using any radiation — it’s an ultrasound just like pregnant women get to check up on their baby. And the exam only takes about 20 minutes. We recommend these exams for patients whose mammograms have shown that they have dense breast tissue. Dense breast tissue can make it harder for doctors to see any abnormalities, lumps or tumors in a mammogram, so this technology ensures better early detection.

Read More About 3D vs Whole Breast Ultrasound Which is Right for You