The Top Reasons You Might Want to See a Primary Care Women's Health Physician with Dr. Laura Lipold

Podcast Transcript

Nada Youssef: Hi, thank you for joining us. I'm your host, Nada Youssef. Our featured expert for this topic today is director of Primary Care Women's Health Dr. Laura Lipold, and before we get started, please remember, this is for informational purposes only and not intended to replace your own physician's advice. Thank you so much for being here today.

Dr. Laura Lipold: Thank you for having me.

Nada Youssef: Sure, if you want to just introduce yourself to our viewers.

Dr. Laura Lipold: Sure. I'm Dr. Laura Lipold. I'm a family medicine-trained physician and I completed a fellowship in women's health, and I'm director of a program here at the Cleveland Clinic called Primary Care Women's Health. We're a network of primary care physicians who really have a special interest in competency in providing health care for women across the ages.

Nada Youssef: Great. Excellent. Okay. I want to talk about, first, the difference in risk factors and symptoms in women and men, and how that plays a role in a woman seeing a primary care physician or a women's health specialist, the difference in the two and why we should be a seeing a women's health primary care physician.

Dr. Laura Lipold: Okay. To start off with question A, we know that women are biologically different than men for a lot of different reasons. They have different hormones. They have different body makeup. They have different fat composition. They have different enzyme levels. For all these differences, there can be some differences in terms of how diseases impact women versus men, how they present with symptoms they may have, what their prognosis may be, and what treatments may be more specific or better tailored for them.

Nada Youssef: Sure.

Dr. Laura Lipold: Then, part B, I think talking a little bit more about when it's appropriate to see a primary care women's health physician.

Nada Youssef: Right.

Dr. Laura Lipold: We can take care of, really, a broad spectrum of women's health needs. We also can provide gynecological care, typically, than non-specialized, non-obstetrical care for women.

Dr. Laura Lipold: For example, if a female has some type of GYN malignancy, meaning like cancer or if they're having complicated gynecological issues, they may need to see a specialist in GYN or if they're pregnant, that would not be appropriate or within our scope of care that we do provide. For example, we can care for a lot of things like osteoporosis, managing menopause, contraception, screening, taking care of their diabetes, addressing their depression, addressing their sleep concerns.

Nada Youssef: Wow. Okay, a wide array of things. To me, as a patient, what are the benefits of having a primary care women's health physician?

Dr. Laura Lipold: The real benefit is going to be one-stop shopping. For women who really like to receive their care in one place with one provider, that's really going to be the real benefit of that altogether.

Nada Youssef:   Sure. It could be a family thing too if you have daughters, correct?

Dr. Laura Lipold: Absolutely. Absolutely. For those of us, especially family medicine physicians who do provide primary care women's health scope and services, we have the benefit of seeing multiple generations of women in the same family.

Nada Youssef: Now, do you get to collaborate with other women's health specialists with your patients as well?

Dr. Laura Lipold: Sure, and especially here at the Cleveland Clinic, we have the benefit of having a lot of specialists and sub-specialists in women's health. For example, if we identified a patient virus who could maybe benefit from preventive women's health cardiology, we can make that referral. If we have a patient who can maybe benefit from seeing somebody in the endocrinology who has specialized women's health care need, we can do that. We certainly collaborate very closely with our OB-GYN colleagues as well.

Nada Youssef:   Excellent. Now, do you offer yearly Pap exams as well?

Dr. Laura Lipold: We do annual preventive care for women.

Dr. Laura Lipold: Certainly, with our guidelines, it may not necessarily require an annual Pap test, but that is one important service that we can provide. I think another benefit of seeing a primary care women's health provider is that you're really going to minimize overlapping visits or preventive care. Instead of seeing both your OB-GYN and your primary care doctor for preventive care needs, you can see just one doctor once a year.

Nada Youssef: Oh, excellent.

Dr. Laura Lipold: It would be really pretty beneficial.

Nada Youssef: Now, can you talk about those important vaccines and screenings that women need and maybe may not be aware of?

Dr. Laura Lipold: Sure. Okay. When we think about some important screenings, we do obviously think about things like cervical cancer screening. Often, we see some, at times, confusing changes as our understanding of risk for cervical cancer evolves. Those guidelines can change. Sometimes, it can be difficult to keep up with that. Again, touching base with a primary care physician and seeing them annually to see if you need to have that Pap or you need to have that HPV test that year or not. Breast cancer screening is also a very important thing. Again, our guidelines have been evolving with that one too as well. It's also very important to keep up to date with your other screenings, so screening for cardiovascular risk factors, screening for diabetes is also really important.

Nada Youssef: Great.

Dr. Laura Lipold: I think I didn't touch on the vaccines.

Nada Youssef: Yeah. Go ahead.

Dr. Laura Lipold: In terms of vaccines, important to remember that, clearly, vaccines are important for children as they are for adults. There are not too many gender differences as far as our vaccine recommendation, just a subtle difference with the upper age of limit with the HPV vaccine, but outside of that, really, no significant gender differences as far as the recommendations, but still important to keep up on them.

Nada Youssef: Okay. Speaking of children, how young are you seeing those patients?

Dr. Laura Lipold: As a family medicine provider, I have the benefit of seeing my patients as young as newborns.

Nada Youssef: Wow.

Dr. Laura Lipold: Yeah, we call it womb-to-tomb scope of services that we do provide. That's wonderful. Then internal medicine primary care physicians, they may be able to see women as young as about 16 years of age.

Nada Youssef: Okay. That's excellent. As a female patient, how do I know a primary care women's health specialist is right for me, and when do you think it's appropriate to go to a specialized physician.

Dr. Laura Lipold: Yeah, that's a really good question. The way I like to think about this is, ultimately, we want women to see the right provider at the right time in their life. If they are of child-bearing age and they are trying to become pregnant or maybe in between pregnancies, thinking of having another child, that might be the time that they're going to be following with their obstetrician, or if they have any specialized GYN needs, they're going to be following with their gynecologist. If they're beyond child-bearing and they do not have any specialized GYN needs, so maybe at the age of 45 and older, that might be a good time to really stick with your primary care women's health provider for your annual preventive care and addressing all of your other medical needs too as well.

Nada Youssef: Okay. Now, are there any female patients that you just could not see, you would not see in your practice?

Dr. Laura Lipold: No, we're primary care providers, so we see everybody.

Nada Youssef: Everybody.

Dr. Laura Lipold: We don't turn anybody away.

Nada Youssef: Great. Excellent. Okay, so I have a list of issues, and I'm a female patient, so I want you to clarify to me and the audience and see if I should be seen by you or go to a different specialist, and then feel free to elaborate.

Dr. Laura Lipold: Okay. Sure.

Nada Youssef: Let's talk about menopause because I know there's premenopause, there's postmenopause, and so do we see you for that?

Dr. Laura Lipold: Sure. That will be appropriate for a primary care women's health provider.

Nada Youssef: Okay.

Dr. Laura Lipold: I will say that not all primary care physicians may feel as comfortable addressing some of these women's health issues, and so there may be times that a primary care physician may refer onto a women's health specialist.

Dr. Laura Lipold: For those of us who do feel more comfortable who are primary care women's health providers, menopause is a very common thing that we can help women, help guide them through and help them manage that.

Nada Youssef: Excellent. How about vaginal pain or bleeding?

Dr. Laura Lipold: Often, we can do the initial evaluation and often can do the initial workup for maybe some abnormal bleeding or pain, but then, quite often too as well, we may need to rely on our GYN specialist for further evaluation and treatment.

Nada Youssef: You'd be able to see them, do the initial screenings, and then be able to [crosstalk 00:08:46]-

Dr. Laura Lipold: To refer them on, correct.

Nada Youssef: Excellent. Osteoporosis?

Dr. Laura Lipold: Osteoporosis is another medical condition in women that we very comfortably can treat as well, primary care women's health providers that is. Sometimes, there may be more medically complex patients with osteoporosis where we may need to refer them onto our bone specialist.

Nada Youssef: Great. What about yeast infections?

Dr. Laura Lipold: That's a very common condition that we can treat.

Nada Youssef: Okay, so you can take care of that one. Excellent.

Dr. Laura Lipold: Absolutely, by all means, and other commonly vaginal infections as well.

Nada Youssef: What about STDs or anything like that?

Dr. Laura Lipold: That's something that we can appropriately treat as well. Correct.

Nada Youssef: Excellent. How about cancer, like ovarian cancer?

Dr. Laura Lipold: Yeah, that would need to be in the hands of the GYN oncologist.

Nada Youssef: Okay. That would be with the oncologist.

Dr. Laura Lipold: Unfortunately, here at the ... Right. Here at the Cleveland Clinic, we've got, really, a great team of GYN oncologist that we collaborate with.

Nada Youssef: Excellent. Then with sleep, because I know that we do sleep studies and there's all kinds of extensive stuff that we do, but would you see, initially, for someone that's having sleep issues, sleep apnea?

Dr. Laura Lipold: Sure. I think primary care physicians are well-positioned to identify sleep disorders and to really manage the complexities around that too as well.

Nada Youssef:   That's excellent. Great. Then I have hypertension.

Dr. Laura Lipold: Hypertension is our bread and butter, so by all means, we think hypertension is a really important condition that we can monitor and that we can treat. Often, some of the primary care women's health providers may also be following women who are thinking about getting pregnant so they provide pre-conceptual care for women who are on medications for certain chronic conditions like hypertension, and so they can maybe assess, well, maybe this is a medication that would not be appropriate if you're trying to get pregnant, so let's make that switch before you do try to get pregnant. Then once they do become pregnant, they will be in the hands of an obstetrician, likely a high-risk obstetrician. Then during the postpartum period, they're going to come right back to us too as well.

Nada Youssef: Okay.

Dr. Laura Lipold: We're going to follow them during that spectrum.

Nada Youssef: Excellent. Speaking of following your patients, adolescent care, transitioning a girl to adulthood, is this something that you would be seeing for?

Dr. Laura Lipold: Absolutely, and that's what I really see as a really gratifying part of my care when we do see younger women as they're starting to become more independent and starting to take more responsibility for their health care and they're transitioning from adolescence to adulthood. It's really a great opportunity to help guide them through that.

Nada Youssef: Great.

Dr. Laura Lipold: We often, as family medicine physicians, we help them transition to that. Now, if it's a pediatrician that they're following with, adolescence is a very common time where they're going to start to talk to them about transitioning to an adult care provider. We often do see that they are making that transition to adult care provider, whether it be a family medicine provider or an internal medicine provider.

Nada Youssef: Excellent. Now, let's say I drop my PCP, my primary care physician, and I'm coming to a women's health's primary care, what's different? What is the biggest difference? What's going to be my initial appointments that's, maybe, different than internal medicine physician?

Dr. Laura Lipold: When I think about the service that I provide women, I do provide a very comprehensive preventive care visit.

Nada Youssef: Okay.

Dr. Laura Lipold: In addition to approaching the general prevention screenings, looking at blood pressure, looking at lipids, looking at glucose. I will do a bone health assessment. I will assess their breast cancer risk. I will be able to very carefully look at their history of cervical cancer screening and really develop an appropriate tailored plan based on that. I've often provided a lot of education around the natural transition from premenopause through perimenopause to postmenopausal time period. I can provide a lot of counseling around that too as well. I can provide contraceptive services if needed to as well

Nada Youssef: Oh, great, and then you mentioned counseling as well.

Dr. Laura Lipold: Mm-hmm (affirmative).

Nada Youssef: Oh, so there's counseling also in the service.

Dr. Laura Lipold: Sure. Absolutely.

Nada Youssef: That's excellent.

Dr. Laura Lipold: Because we're primary care providers.

Nada Youssef: I'm thinking adolescent care and all that definitely need some counseling as well. Great. Well, I'm getting some live questions so I'm going to switch off here. I have Randi, Pap smear, how often for women over 60 should have it?

Dr. Laura Lipold: Okay. The current recommendations are for women who have not had any precancer conditions of the cervix of cancer of the cervix.

Nada Youssef: Okay.

Dr. Laura Lipold: If they're between the age of 30 and 65, our preferred screening is co-testing. That's a Pap with HPV, and that's to be done every five years as long as things are normal. You do have the option for doing a Pap by itself without the HPV every three years.

Nada Youssef:   Okay.

Dr. Laura Lipold: Now, women after the age of 65 can safely exit from screening, again, as long as they've had routine normal screens before then and they haven't been treated for any cervical precancer or cancer.

Nada Youssef: Okay. When you say co-testing, you're saying that's a Pap with HPV.

Dr. Laura Lipold: HPV, correct. Correct.

Nada Youssef: I see. Okay. Let's talk about HPV screening because I feel like ... I'm hearing a lot about it. I'm seeing a lot of commercials. Can we talk a little bit about that? Are there misconceptions? Should every woman go for her HPV screening, and how young should a woman get her HPV testing?

Dr. Laura Lipold: As I mentioned, HPV, as part of a cervical cancer screening strategy, should not be initiated before the age of 30 as it stands with our current recommendations.

Nada Youssef: Sure.

Dr. Laura Lipold: I think that's a great point because it's not that uncommon when we're doing the screening where HPV testing may turn up positive. I always counsel my patients, remind them that HPV, human papillomavirus of the cervix is actually very common. We know that eight out of 10 women have been exposed to HPV. The natural history of it, we learned a lot about that over the past couple of decades, is that when they're exposed, it does take your body's immune system probably about one or two years to actually put that virus in check, and so it really puts it into remission. While it's there, we're just being very careful that it's not really causing any problems with the cells of the cervix as we can detect with a Pap test.

Nada Youssef: Okay. Now, if I'm 30 and over and I'm getting my Pap exam, should I mention it to my physician, or is this something that's just like a part of screening?

Dr. Laura Lipold: Yeah. It is really accepted as a national standard to incorporate that with the Pap, again, as I said, every five years, but you certainly, again, want to be probably fully informed and know what tests are being done. Insurance companies, we haven't really had much pushback at all. Usually, insurance companies are pretty onboard with that altogether. Government payers may have, maybe, a little bit more stringent sometimes, but for the most part, we're not getting too much pushback.

Nada Youssef: Okay. Great. All right, on to the next question. Kimberly, is osteoporosis more common in women?

Dr. Laura Lipold: Yes, osteoporosis is much more common in women. It does occur in men and they have different respecters.

Nada Youssef: Okay.

Dr. Laura Lipold: For women, the strongest respecter is going to be being postmenopausal, and that's because we have lower estrogen levels when we're done with our periods, and the estrogen naturally helps to support the bones. Clearly, men don't have that. However, men can have low testosterone conditions, which can cause osteoporosis too as well. Clearly, because every female ultimately goes through menopause, we clearly see a lot more osteoporosis.

Nada Youssef: Now, menopause, I want to touch on that.

Dr. Laura Lipold: Sure.

Nada Youssef: Because every woman is different with the symptoms when it comes to menopause, what should women look for? What kind of symptoms should we be on the lookout for to be like, "I should see someone for this," versus "I'm just going through age."?

Dr. Laura Lipold: Sure. That's a really great question. I think a lot of women do understand and know that hot flashes are a very common part of the menopausal transition and being postmenopausal. They can be very severe at times, and they can really impact quality of life. I think women sometimes feel like, "Well, this is just a natural process. I just need to live through it." I think a lot of women may not realize that very effective treatment, i.e., hormone therapy, that most women are going to be a candidate for that if they are five to 10 years in menopause. We see at that point that usually the benefits significantly outweigh the risk.

Nada Youssef: Okay.

Dr. Laura Lipold: There are effective treatment options that are available for women who are experiencing really moderate to severe hot flashes.

Nada Youssef: Flashes is the answer.

Dr. Laura Lipold: Yeah.

Nada Youssef: Got it. Thank you. I have Stephanie. What menopause concerns should women be aware of as they get older?

Dr. Laura Lipold: Sure. We mentioned osteoporosis, so thinking about bone health. That's a very important thing too as well.

Nada Youssef: Sure.

Dr. Laura Lipold: The other interesting thing we've seen is that when women are postmenopausal and we, again, believe it's because of lower estrogen levels, that actually does, at that point, significantly increase their risk for cardiovascular disease.

Nada Youssef: Wow.

Dr. Laura Lipold: Being aware of that and being aware of your cardiovascular risk factors is a really important thing, especially when you're postmenopausal.

Nada Youssef: Sure. Great. Thank you. Melissa, everybody is always tired. How can I know what is normal, and how do I know if it's a sleep disorder?

Dr. Laura Lipold: Right. That's a really good question.

Nada Youssef: Yeah, it could be fatigue. It could be thyroid. I mean, there are so many things, right?

Dr. Laura Lipold: Absolutely. I'm going to probably put this in the context of perimenopause and postmenopause.

Nada Youssef: Okay.

Dr. Laura Lipold: I mentioned hot flashes, so that's the most common symptom that most women do experience during that time period. I also want to acknowledge that a lot of women also experience a lot of sleep disturbance during the perimenopausal and postmenopausal time period, and subsequently, some fatigue associated with that, and some weight changes. Hormone therapy actually can be very helpful to improve sleep quality. There's often less fragmented sleep when they go on hormone therapy. That can sometimes help with the fatigue and the quality of life with the hot flashes. Then we also do know that in terms of the weight gain, I often acknowledge that with patients who are going through menopause, it's a very common reported symptom.

Nada Youssef: Sure.

Dr. Laura Lipold: Unfortunately, hormone therapy doesn't necessarily treat the weight gain issue, but at least, you can bring it up to your primary care physician, your primary care women's health physician, and then develop a little bit more of a strategy to approach the weight altogether. Those are common, very common symptoms that are reported. However, it's also very important for the physician to make sure that we're not missing something else.

Nada Youssef: Right.

Dr. Laura Lipold: Back to the point of our viewer, we do want to make sure that we're not missing something, a thyroid disorder, or anemia, or maybe depression, or something else.

Nada Youssef: Okay. Great.

Dr. Laura Lipold: With the sleep disorders, that can get pretty complex too as well. We'd want to investigate that further, make sure we're not missing something like restless legs syndrome or OSS, obstructive sleep apnea.

Nada Youssef: Excellent. Thank you. Lynn, as I've gotten older, I don't seem to sleep as much as I used to. Is that normal?

Dr. Laura Lipold: Great question, so we actually do see that there are normal changes in our sleep cycle that are age-related. As we get older, we do see often that we require less sleep. The bottom line is if you are ... You feel like you're getting less sleep, but as long as you're feeling rested and you're getting through your day and it's not impacting your activities during the day, that's really okay.

Nada Youssef: Sure. I want to actually ask you about thyroid because I know thyroids brings on the symptoms of being really tired and thyroid disorder. Can you talk a little bit about the symptoms of that, what you should check for, and it's something that we can check ourselves, or how does that work?

Dr. Laura Lipold: Absolutely. Common symptoms of an underactive thyroid, and there are two that the thyroid can be off, it can be underactive or, it can be overactive. Common symptoms of an underactive thyroid could be fatigue, could be constipation, could be noticing that you're losing more hair, could be brittle nails, could be dry skin, could be problems with cold intolerance. In women who are still getting periods, it could menstrual irregularities too as well. You were pointing to your neck, and yes, sometimes, not often, but sometimes, women may actually notice too as well that there might be a chance in the actual thyroid gland which sets right here at the base of the neck.

Nada Youssef: Okay.

Dr. Laura Lipold: Some women might actually start to see that that's getting a little bit puffier or swollen or might feel something may be pressing a little bit or maybe some difficulty with swallowing. Sometimes, those could be symptoms or notable changes with an enlarged thyroid. If you're experiencing any of these symptoms or constellation of these symptoms, you may want to talk to your doctor about that.

Nada Youssef: Now, you said those are the underactive, what is overactive?

Dr. Laura Lipold: Overactive can be a different one too as well, but sometimes, it can be overlapped.

Nada Youssef: Sure.

Dr. Laura Lipold: Generally speaking, overactive thyroid symptoms could be feeling more heat intolerant or sweating more easily, feeling often more hot with normal activities, it could be, maybe, some weight loss. I forgot to mention with underactive thyroid, we see weight gain. Sometimes, it can be the opposite with an overactive thyroid.

Nada Youssef: Sure.

Dr. Laura Lipold: Sometimes, I've actually seen women gain weight.

Nada Youssef: Yeah.

Dr. Laura Lipold: Usually, we think about weight loss, sometimes, tremulousness, feeling a little bit more shaky, again, menstrual irregularities can be a common issue with that too as well, maybe more diarrhea, so those are more common symptoms.

Nada Youssef: Okay. Great. Then Nancy has a question. Hello, I'm a patient with osteoarthritis who is also dealing with neurosarcoidosis and pulmonary sarcoidosis who went through menopause at 35 and have been on Prednisone since 2005. How often should I get a bone scan?

Dr. Laura Lipold: That is a really good question. This would be an example of somebody that we may need to be thinking about seeing a bone specialist. You've got two major risk factors there, premature, so pretty early menopause, and that's another area that we'd have to confirm that that's truly the reason why you're not getting periods.

Nada Youssef: Sure.

Dr. Laura Lipold: Then being on chronic steroid therapy. I definitely think about you maybe being in the hands of a bone specialist with those two significant risk factors.

Nada Youssef: Great. Jennifer, hello, can diabetes levels or blood sugar change after surgery?

Dr. Laura Lipold: Yes, it can. Absolutely.

Nada Youssef: Let's see here. Shirin, can you test for menopause while on birth control pills?

Dr. Laura Lipold: That's a really good question. A very common treatment for perimenopause, and I'll step back, so when I say postmenopausal, what I mean is that you're 12 months without a period.

Nada Youssef: Okay.

Dr. Laura Lipold: We might see some changes.

Nada Youssef: A year into it.

Dr. Laura Lipold: Right. Some of those natural changes that lead up to that, we can see that period start to space out. Often, during the time that period start to space out is when hot flashes are typically kicking in altogether.

Nada Youssef: Sure.

Dr. Laura Lipold: To help women ease that transition, we may put them on a low-dose birth control pill. We might put them on a low-dose birth control pill as long as they don't have contraindication in their later 40s even through their early 50s to get them through what would be the typical age of menopause, which is around the age of 52.

Nada Youssef: Sure.

Dr. Laura Lipold: How do we know if they're on a low-dose birth control pill that they're done with periods?

Nada Youssef: Yeah.

Dr. Laura Lipold: Sometimes, we can use clinical symptoms to help us out. When they say, "Well, I'm no longer getting a period when I'm supposed to during that placebo time period. I'm starting to get hot flashes during those sugar pills," so that could be a helpful indicator. If we really need to know for certain, we're going to typically have you seven days off of your active pills, maybe check a blood test, and that could be helpful too as well. We might be able to do it clinically. We might need a blood test once you're about seven days off of your birth control pill.

Nada Youssef: Okay, and then a follow-up to Shirin's question, is there a test for menopause?

Dr. Laura Lipold: It most often is a clinical diagnosis. As I said, the true definition is really 12 months without a period. You typically have symptoms hot flashes that are part of that too as well, and then we'd feel pretty comfortable making that diagnosis.

Nada Youssef: Okay.

Dr. Laura Lipold: For example, if somebody no longer has uterus, we can't use the periods to tell us where they might be with that, and we, maybe, really need to know, then we could do a blood test.

Nada Youssef: Because I know with IUD birth control, some people, some people don't get anything, maybe even spotting, but some people don't get anything at all, so that's also a certain one.

Dr. Laura Lipold: Perfect.

Nada Youssef: Speaking of birth control, how do you know what is good for you without trying all of them?

Dr. Laura Lipold: Right.

Nada Youssef: Because I know there's one that you insert in your arm that my friends have, there is the IUD, there is the pills. What do you recommend to patients, and how do you recommend to patients?

Dr. Laura Lipold: It is a very individualized approach.

Nada Youssef: Yeah.

Dr. Laura Lipold: That's really an advantage that we have so many different options nowadays. The clear advantage is that for women who maybe have medical conditions that may limit what they can use, I mean, it's nice nowadays, we often do have some options that we can even find something for them that'll be a best fit.

Nada Youssef: If one doesn't work out, the effects, you can always switch to a different birth control.

Dr. Laura Lipold: Absolutely. Right.

Nada Youssef: Okay.

Dr. Laura Lipold: I think, traditionally, most people think about a birth control pill is really being an option. In the United States, it's probably the most relied on method of contraception when there are some, really, some great options that are out there not birth control pills and, frankly, more effective too as well.

Nada Youssef: Excellent. Then I have Patty. Is there anything you can do during premenopause to help prevent osteoporosis?

Dr. Laura Lipold: We do know that getting adequate calcium intake is really important for bone health. Nowadays, I think our thought is, is that the best way to get enough calcium is through your diet because your body absorbs it best that way. Some women may not be able to and may have to take a supplement up to what they need.

Nada Youssef: Okay.

Dr. Laura Lipold: We think also getting adequate amounts of vitamin D is important too as well. Your doctor may recommend a supplementation. Getting weight-bearing exercise is really important too as well. Some women who may have menstrual irregularities or maybe on medications that can be associated with bone loss may have to talk to their doctor about how to minimize those risks too as well.

Nada Youssef: Excellent. Then Diane wants to know, can you explain what fibromyalgia is?

Dr. Laura Lipold: Fibromyalgia is a type of condition that we cannot make a diagnosis with a blood test. It is a pain condition. We understand that individuals who are affected with fibromyalgia probably have often sleep issues or part of it. Addressing sleep issues when you have fibromyalgia is a very important thing too as well. It's probably a complex interplay with the neurological system and the musculoskeletal system as well. When we're talking about managing some of the pain with fibromyalgia, sometimes we do use medications, sometimes we use the neurology world as well.

Nada Youssef: Sure. Does something like an inflammatory diet, anti-inflammatory diet would work with that kind of conditions?

Dr. Laura Lipold: I have had patients who have had a good response with anti-inflammatory diets for a lot of painful conditions including fibromyalgia, yes.

Nada Youssef: Great. Then I have Marcia, with a history DVT, are hormones allowed?

Dr. Laura Lipold: With a history of DVT, which is a blood cloth, often, we are avoiding a specific hormone combination. It's a combination of estrogen and progesterone. That could be thrombogenic, meaning that is something that could promote blood clot formation. For some women, using progesterone alone without the estrogen may be an alternative, but you would have to talk to your doctor about that.

Nada Youssef: Excellent. Morgan, my daughter is 12. At what age can I transition her to a primary care women's health specialist?

Dr. Laura Lipold: That is really going to be, I think, based on the comfort level of your daughter, comfort level of you, yourself, discussion with her current health care provider.

Nada Youssef: Okay.

Dr. Laura Lipold: I think everyone is a little bit different in terms of when they make that transition. If it's an internal medicine primary care women's health provider, they may say, "Well, I might be more comfortable taking them around the age of 16 or 17." As a family medicine physician, again, we see individuals of all ages. We'd be happy to see that transition anytime that they're ready.

Nada Youssef: When they're ready.

Dr. Laura Lipold: Exactly.

Nada Youssef: When you're ready, Morgan.

Dr. Laura Lipold: Exactly. Right.

Nada Youssef: Excellent. Then Steph, can you be on birth control for too long? I've been on it for over 10 years.

Dr. Laura Lipold: That's a really good question. One thing that individuals may not hear enough about are some of the non-contraceptive benefits of birth control pills.

Nada Youssef: Okay.

Dr. Laura Lipold: We do know that birth control pills can decrease risk of ovarian cancer and probably endometrial cancer. There is not too long the time period that you really need to be on a birth control pill.

Nada Youssef: Sure.

Dr. Laura Lipold: As I said, often, women who are using them at older ages, through 40s and early 50s, compared to when we did a couple of decades ago to really help women ease that transition through menopause, so we're often using them longer too as well.

Nada Youssef: Now, is birth control used for endometriosis, to keep it at bay? Is that correct?

Dr. Laura Lipold: It is one of the first sign treatments for endometriosis.

Nada Youssef: There is no cure for endometriosis, or is there?

Dr. Laura Lipold: Endometriosis, so we do think about birth control pills. We do think about using other pain medications, per se, and sometimes, there are some surgical treatment options are available.

Nada Youssef: Okay. Then I'm going to ask you one more question here. Now, I hear a lot of people that say, "I've been on birth control for 15, 16 years. I'm going to have a hard time getting pregnant." Is that true?

Dr. Laura Lipold: Oh, good question, no, it's not true.

Nada Youssef: It's not true?

Dr. Laura Lipold: No. No, it's no.

Nada Youssef: Very good to know.

Dr. Laura Lipold: Yeah. Usually, you've been on a birth control pill, when you come off of it, your ovaries wake up. The question is when they wake up. Usually, they wake up within about a week or two. I hardly see it take too much longer. Maybe it'll take a little bit longer, but it's really not going to prevent your ovaries from waking up.

Nada Youssef: Okay. Now, I'm just throwing out what I'm hearing from my friends, but is it bad to skip periods with birth control?

Dr. Laura Lipold: Oh, another really good question, so I actually see more advantages with doing the extended cycle regimens. Number one, because you're taking away some sugar pill intervals, there's less opportunity for there to be an "Uh-oh, wake up the ovary and ovulation." We do a little bit of a longer extended cycle regimen. We're really more successfully suppressing the ovulation. I think it might be a little bit more effective when it comes to contraception. For women who are headache-sufferers, especially if they get headaches around the time of their periods, doing the extended cycle regimens could be a really great strategy to really minimize some of those headaches too as well.

Nada Youssef: Okay.

Dr. Laura Lipold: Keeping in mind the way that a birth control pill works, it keeps the lining of the uterus really thin, so you don't need to worry about how often you're getting a period. It's not harming the uterus.

Nada Youssef: Okay. Excellent. I have one more question for you before I let you go. [Garza 00:31:59] wants to know why do some women go through menopause early? I was 32.

Dr. Laura Lipold: That's a really good question. There are probably a lot of us as primary care physician, if you go through it at that pretty young age, meaning under the age of 40, we may need to refer you to a specialist to try to figure that out.

Nada Youssef: Okay.

Dr. Laura Lipold: Sometimes, there can be autoimmune or genetic reasons why that's happening.

Nada Youssef: Okay.

Dr. Laura Lipold: It is actually an important thing to not only recognize but then also to figure out why that did happen.

Nada Youssef: Sure.

Dr. Laura Lipold: The other important thing too as well, we do know that individuals who do go through menopause at a really young age, as we've mentioned about estrogen supporting bones, are at a significant increased risk for osteoporosis and fragility fracture, and so we actually really do look, if appropriate, to try to keep them on some type of hormone, whether it be a low-dose birth control pill, through the average age of menopause, typically about the age of 52, protect bones, and to protect the heart too as well.

Nada Youssef: Great. Well, that's all the time that we have for today.

Dr. Laura Lipold: Okay.

Nada Youssef: Before I let you go, anything else you want to share with our audience that maybe we haven't touched on? We talked about a lot.

Dr. Laura Lipold: I think we did talk about quite a bit, so I think there are a lot of benefits to seeing a primary care women's health provider, and we can actually help direct you in terms of your care, and if there are times where you need a specialist, whether it be a women's health specialist, a GYN specialist, or an obstetrician, or any other women's health subspecialist who can help guide you through that.

Nada Youssef: Excellent. Thank you so much for being here.

Dr. Laura Lipold: Thank you very much.

Nada Youssef: Thank you. For more health tips and information, please follow us on Facebook, Twitter, Instagram, and Snapchat @ClevelandClinic, one word. Thank you. This concludes this Cleveland Clinic Health Essentials podcast. Thank you for listening. Join us again soon.