dr. martin’s contributionsalabamapublichealth.gov/minorityhealth/assets/menopause.pdf ·...

4/3/2012

1

Lifetime Changes To Be Treasured

Presenter: Angela M. Martin, MD, FAAP

The Office of Women’s Health

Steering Committee

February 9, 2012

Property of Dr. Angela M. Martin

Dr. Martin’s Contributions

� Focused on zip code 36201

� Examined patients who live in 36201, or whose immediate relatives have lived in 36201 for 2 generations

� Asked environmental questions and have taken environmental histories

� Offered to test for PCBs at one and four years of age. According to the CDC, one of few doctors who require that all kids be tested for lead prior to entering school

� We are currently observing an emerging entity--Hobson City, AL--a historically black city that is reportedly polluted with PCBs, mercury, lead, arsenic, and selenium

� Organized a Health Fair, August 21, 2004, in historic Hobson City to bring additional caring, competent, and compassionate professionals to the table

� We assisted the National Medical Association in composing a resolution to train physicians, dentists, and lawyers in environmental justice issues. We intend for this resolution to go to all professional health and legal organizations across America

� Was awarded the contract to provide medical services for the Tolbert vs. Monsanto claimants on November 8, 2004

� Received the nation’s third largest EPA health education grant in 2008


The Chatty Cathy of Puberty

Periods Come at the End of a Sentence, and…


What Is Puberty?

• Puberty is the time, between 10 and 12 years of age, when girls develop into women.

• Acne, breasts, pubic hair, and body odor erupt.

• All of this normally gets started when the hypothalamus secrete gonadotropin-releasing hormone (GnRh).

• This hormone signals the base of the brain to release luteinizing hormone (LH) and follicle stimulating hormone (FSH).

• This stimulates the ovaries to produce estrogen.

• This hormonal release leads to odor and the girl’s first menses.


Participation of the Brain at Puberty


Boys Have Pimples, Too


4/3/2012

2

Pubertal Changes


Puberty in Girls


The Monthly Reproductive Cycle


The Reproductive Cycle


Menstruation


Common Menstrual Abnormalities

• Endometriosis

• Uterine Fibroids

• PCOS


4/3/2012

3

Endometriosis

• An abnormal growth of endometrial tissue outside the uterine cavity

• Often an unexpected finding in at least 20% of pelvic surgeries

• Growth is dependent of stimulation by ovarian hormones similar to normal endometrial cells

• The longer these cycles occur without a break, the larger the lesions can become

• Symptoms start around the ages of 25 and 35

• Lesions can occur in the vagina, cervix, episiotomy scars, laparotomy scars, umbilicus, lungs, and nose


Endometriosis Symptoms

• Acquired pain

• Similar to dysmenorrhea

• Abnormal bleeding

• Infertility

• Ruptured ovarian cyst


Endometriosis Diagnosis

• Diagnosed with certainty only by direct

inspection and microscopic examination

• Pelvic infection

• Ovarian cancer

• Benign ovarian masses

• Urinary tract lesions causing hematuria

• Bowel lesions causing rectal tenesmus


Endometriosis Treatment

• Conception

• Hormones like Depo-Provera to cause

amenorrhea

• Surgery


Endometriosis Sites


Uterine Fibroids

• Also called leiomyomas, myomas, fibromyomas

• Benign lesions that develop from smooth-muscle cells of the uterine wall

• Found in at least 1/5 of the uteri of women past 30 years

• Start earlier and are more aggressive in black women

• Appear in nulliparas, as well as highly fertile women

• Exact cause unknown, but appears to be associated with estrogen surges


4/3/2012

4

Fibroid Symptoms

• Symptoms vary with location

• Heavy bleeding with little change in the cycle

• Pressure and pain in the back and legs

• Frequent urination

• Dysmenorrhea

• Infertility


Fibroid Differential Diagnosis

• Can be made by abdominal and bimanual

palpation

• Sonogram

• Cancer of the uterus or cervix

• Pregnancy

• Ovarian cancer


Fibroid Treatments• Observation, unless it continues to grow after menopause

• Surgery

Hysterectomy

Myomectomy

• Exablate with MR-guided focused ultrasound

• Myolysis

• Endometrial ablation

• Uterine artery embolization

• Gonadotropin-releasing hormone agonists—Lupron, Synarel

• Progestin-releasing IUD

• Androgens--Danazol

• Hormones, like Depo-Provera


Uterine Fibroids


Is This a Woman of Mediterranean

Descent or PCOS?


Polycystic Ovarian Syndrome

• First classified in 1935 as including

amenorrhea, infertility, facial hirsutism, and

acne

• May include and be complicated by obesity

• The ovaries may be 2-3 times their normal size

• Multi-factorial causes

• Reflects long, uninterrupted periods of

anovulation


4/3/2012

5

PCOS Hormonal Abnormalities

• FSH levels fall in the low-normal range with absence of the mid-cycle peak

• LH secretion remains high without the mid-cycle surge

• The ovaries produce large amounts of estrogen precursors, androstenedione and testosterone

• Androstenedione undergoes conversion to estrone by fatty tissue which contributes to the circulating estrogen pool

• 30% will become insulin resistant


PCOS


What You Are About to See Is A

Normal Part of Life


The 7 Menopausal Dwarfs


What is Wrong With Me?


I Used to Be Able to Eat Anything


4/3/2012

6

Is This the End of Life?


The Maturing Reproductive System


Metabolic Syndrome


Compare Menaport Fat

With

Metabolic Syndrome


Consistent Signals Are Lacking


Old-school Jeans


4/3/2012

7

Contemporary Jeans


Typical Buffet Meal


No Hamburger Has Ever Looked So Good


The Eyes Are Bigger Than the Belly

Big Extra with Cheese 810 calories

Super Size French Fries 610 calories

Super Size Coca-Cola 410 calories

TOTAL 1830 Calories


Acanthosis Nigrans


Acanthosis Nigrans


4/3/2012

8

Are We There Yet?


There Are At Least 43 Things Changing Within Me—

Some Things All Can See, Some Things Only I Can See


Can I Get Pregnant at This Stage?


The Hormones of Life

• Estrogen

• Progesterone

• Testosterone

• Melatonin

• Thyroid

• Cortisol

• Insulin


The Pathways of Life


Thyroid Hormone

• Low thyroid function is the single most common hormone imbalance today.

• It remains the most under-diagnosed and under-treated endocrine problem.

• Symptoms include: depression, cold hands and feet, thin or dry hair, skin, and nails, trouble concentrating, obesity, and heavy menses.

• Many organs are affected, because thyroid hormone is the master regulatory hormone.

• It sets the metabolic rate for every tissue in the body.


4/3/2012

9

More on Low Thyroid

• Low thyroid function may show up as low or low-normal free T4 and free T3, with a high TSH.

• TSH alone is a poor predictor of thyroid status.

• A person can still be hypothyroid even if the lab tests are normal, because of thyroid hormone resistance.

• The thyroid receptors in each cell fail to respond properly to thyroid hormone.


Ideal Thyroid Testing

• In addition to testing T4, T3, and TSH, it is important to monitor your temperature.

• Most of our enzymes do not function well below 98.2 degrees Fahrenheit.

• Restoring thyroid function requires making sure the body converts T4 into the active form T3.

• Thyroid support with whole foods is important.

• If symptoms persist, a test for gluten allergy or sensitivity should be done.


Female Population in Alabama

• 2.5 million females in Alabama

1.7 million females are white

700,000 females are black or Hispanic

193,000 white females are born each year

100,000 black females are born each year

• Females that will survive to 80 years of age

88,000 white females

22,000 black females


Important Alabama Female Statistics

• Alabama is #2 for both obesity and

hypertension

• 40% of our females did not mind getting

pregnant

• Most females still think HIV is a gay male

disease


Financial Barriers to Health Care

In Alabama, only 2 occupations pay females more than males:

Social Services

Food Services

Nationwide, for every $1 a man makes, the woman will earn

$0.78

In Alabama, for every $1 a man makes, the

woman will earn $0.66

Although more females attend college, we continue to live longer, but earn less money, and therefore less Social Security


Barriers to Maintaining Good Health

• Without Social Security, 61% of Alabama’s

elderly women will finish life in poverty

• Alabama is #3 for America’s highest number of

families living in poverty

• 431,000 females live in poverty in Alabama

• 34% of us will not finish high school

• Only 16% of us will complete high school on

time


4/3/2012

10

The 5 Ways You Will Die

• Genetics

• Environment

• Diet

• Immune

• Accident


DEFINE POLY CHLORINATED BIPHENYLS

(PCBs)

� Polychlorinated biphenyls

are a family of chemicals

formed by attaching one or

more chlorine atoms to a

pair of connected benzene

rings

� Toxicity of PCBs varies from

one congener to another


Exposure Pathways

�Accidental leaks and spills

�Leaks and fires from products containing PCBs

�Poorly maintained toxic waste sites

�Illegal dumping or improper disposal

�1.25 billion pounds were produced 1929-1977

�450 billion pounds were released into the environment, coupling with air, water, and soil during manufacture, use, and disposal

�Environment


Routes of Exposure After Release Into the

Environment

• Adsorb strongly to dirt and sediment

• Cycle through the air and can be inhaled

• Travel long distances and can be found far away from

where they were released

• Contaminated meat, fish, and poultry

• Bioaccumulation up the food chain


Health Effects of PCBs

• Skin damage

• Liver damage

• BRAIN damage

• Lung damage

• Known to cause cancer in animals

• Effects generally depend on:

1. Dose

2. Duration

3. How you are exposed through eating

4. Personal traits and habits

5. Other chemicals present


Animal Studies

• Animal studies show that PCBs in large amounts cause liver cancer in rats/mice

• ADHD like activity in monkeys

• The potential to cause cancer varies with the PCB congener

• PCBs act as co-carcinogens in rats/mice

• PCBs appear to cause impaired learning in rats and monkeys

• PCBs affect immune function in rats in the following ways:

Antibody formation

Killer T cells

Resistance to infection

• Feminized male alligators


4/3/2012

11

HUMAN STUDIES

Endocrine disruptors are exogenous

synthetic or natural chemicals

that can mimic or modify the

action of endogenous hormones:

� Thyroid

� Pancreas

� Adrenal

� Ovaries/Testes


Leading Causes of Death for Females in Alabama

• Heart Disease

• Cancer

• Cerebovascular Disease

• Chronic Lower Airways Disease

• Alzheimer’s


Back to Heart Disease

• The largest disparity we face

• The most common disease of all diseases

• The most common disease among blacks

• The most preventable disease in Alabama,

America, and the world


How We Can Prevent Heart Disease

• Control Your Cholesterol

• Control Your Blood Pressure

• Stop Smoking

• Increase and Maintain Daily Physical Activity

• Achieve Your Ideal Weight

• Maintain a Consistent Blood Glucose


Cover Your Plate With Color


Exercise Has Huge Fringe Benefits

• Aerobic exercise reduces blood pressure in adolescents with hypertension*

• Regular physical activity helps in weight loss

• Regular physical activity reduces insulin resistance**

• Weight reduction causes hepatic enzymes to normalize***

*Hansen HS.BMJ 1991;303:682-685;**American Diabetes Association.Pediatrics 2000;105(3):671-680***Rashid

MJ.Paediatr Gastroenterol Nutr 2000;30:48-53


4/3/2012

12

Cultural Barriers to Our Well-Being• Sedentary lifestyle

• No family values

• Lost of respect for authority

• Name it and claim it, call it

and haul it

• What’s in it for me

• Church is for entertainment

• Racism

• Come to work late, and

leave work early

• Lackadaisical attitude

• Detachment

• Low expectations

• Low self-esteem

• Need for validation by

others

• Feelings of entitlement

• Male chauvinism

• Abuse of our natural

resources

• Sexual pre-occupation

• $ Worship

• Bishop Worship

• People Worship

• No attitude gratitudeProperty of Dr. Angela M. Martin

Healthy Bodies Need Healthy

Communities and Healthy Churches

• Innovation

• Historical Relevance

• Association

• Infiltration

• Participation

• Proclamation

• Diversification

• Education

• Service


Treasure YourselfThink Highly of Yourself and Think for Yourself

Read to Yourself

Equip and Empower Yourself

Affirm and Appreciate Yourself

Sing to Yourself

Unleash the Unlimited Potential in Yourself

React Positively to Yourself

Explore and Enlighten Yourself

Yield Yourself to the Creator

Organize Yourself and Know Your Purpose

Understand and Value Yourself

Recognize and Reward Excellence in Yourself

Smile to Yourself

Educate and Edify Yourself

Love and Adore Yourself

Feel and Experience Peace in Yourself

C. May-Holmes


dr. martin’s contributionsalabamapublichealth.gov/minorityhealth/assets/menopause.pdf ·...

Documents