Women’s Unique Healthcare Needs with Dr. Laura Lipold

Podcast Transcript

Nada Youssef:    Hi, thank you for joining us. I'm your host Nada Youssef. We are talking about women's primary care. Primary Care Women's Health provides ongoing support and education that our female patients need in order to manage changes that occur throughout their lives and a 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.

Laura Lipold:      Thank you for having me.

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

Laura Lipold:      Sure. I'm Dr. Laura Lipold. I'm a family medicine trained physician and I completed a fellowship in woman's health and I'm director of a program here at the Cleveland clinic called Primary Care Women's Health. And 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, so I want to kind of 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 woman's health specialist. The difference in the two and why we should be seeing a woman's health primary care physician.

Laura Lipold:      To start off with question A, so 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 of these differences, there can be some differences in terms of how diseases impact women versus men, how they present, what symptoms they may have, what their prognosis may be and what treatments may be more specific or better tailored for them.

Then part B, I think talking a little bit more about when it's appropriate to see a primary care women's health physician. We can take care of really a broad spectrum of woman's health needs. We also can provide gynecological care, typically the non-specialized, non-obstetrical care for women. For example, if a female has some type of GYN malignancy, meaning a 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. But 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 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?

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

Nada Youssef:    All together. It could be a family thing too if you have daughters.

Laura Lipold:      Absolutely. Absolutely. And so for those of us, especially family medicine physicians who do provide primary care women's health scope of 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?

Laura Lipold:      Sure. And especially if you're 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 have, if we identify a patient of ours 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 endocrinology who has a specialized women's healthcare need, we can do that. And we certainly collaborate very closely with our OB/GYN colleagues as well.

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

Laura Lipold:      We do offer annual preventive care for women and certainly with our guidelines, it may not necessarily require an annual pap test, but that is one important service that we can provide. And 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.

Laura Lipold:      And that 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?

Laura Lipold:      Sure. Okay. When we think about some important screenings, we do obviously think about things like cervical cancer screening and often we see some, at times, confusing changes as our understanding of risk for cervical cancer evolves. Those guidelines can change and so 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 very important thing. And 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. Screening for cardiovascular risk factors, screening for diabetes is also really important.

Nada Youssef:    Okay, great.

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

Nada Youssef:    Yeah, go ahead.

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 recommendations. 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?

Laura Lipold:      As a family medicine provider I have the benefit of seeing my patients is young as newborns, so we call it womb to tomb scope of services that we do provide. That's wonderful. And 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 primary care women's health specialist is right for me? And when do you think it's appropriate to go to a specialized physician?

Laura Lipold:      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 and, or maybe in between pregnancies thinking about 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. But if they're beyond childbearing 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 preventative care and addressing all of your other medical needs as well.

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

Laura Lipold:      No, we're primary care providers so it's everybody.

Nada Youssef:    Everybody.

Laura Lipold:      We don't turn anybody away.

Nada Youssef:    Okay, great. Excellent. Okay. 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. Let's talk about menopause because there's, I know there's pre-menopause, there is post-menopause and so do we see you for that?

Laura Lipold:      Sure. And so that's, that will be appropriate for a primary care women's health provider. 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 you on to a women's health specialist. But 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. Kind of help guide them through and help them manage that.

Nada Youssef:    Okay, excellent. How about vaginal pain or bleeding?

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:    Okay. You'd be able to see them and do the initial screenings.

Laura Lipold:      Correct.

Nada Youssef:    And then be able to...

Laura Lipold:      To refer them on, correct.

Nada Youssef:    Excellent. Osteoporosis.

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. And sometimes there may be more medically complex patients with osteoporosis where we may need to refer them on to our bone specialist.

Nada Youssef:    Okay, great. And what about yeast infections?

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

Nada Youssef:    Okay. You can take care of that one.

Laura Lipold:      By all means. And other commonly, vaginal infections as well.

Nada Youssef:    What about STDs or anything?

Laura Lipold:      That's something that we can appropriately treat as well, correct.

Nada Youssef:    Excellent. Excellent. How about cancer? Ovarian cancer?

Laura Lipold:      Yeah. That would need to be in the hands of a GYN oncologist.

Nada Youssef:    That would be the Cleveland Clinic.

Laura Lipold:      And here at the Cleveland clinic we've got really a great team of GYN oncologists that we collaborate with.

Nada Youssef:    Excellent. And then with sleep, 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 with apnea?

Laura Lipold:      Sure. And 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. And then I have hypertension.

Laura Lipold:      Hypertension is our bread and butter. By all means, I 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 can provide preconceptual 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 come get pregnant. And then once they do become pregnant, they will be in the hands of an obstetrician, likely a high risk obstetrician, and then during the postpartum period, they're going to come right back to us too as well. We're going to follow them during that spectrum.

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

Laura Lipold:      Absolutely. And that's another, that's what I really see as 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 healthcare and they're transitioning from adolescence to adulthood, it's really great opportunity to help guide them through that. 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 transition 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 primary care. What's different? What is the biggest difference? What's going to be my initial appointments that's maybe different than a internal medicine physician?

Laura Lipold:      I think when I think about the service that I provide women, I do provide a very comprehensive preventive care visit. 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 often provide a lot of education around the natural transition from pre-menopause, through peri-menopause, post-menopausal time period. And I can provide a lot of counseling around that too as well. And I can provide contraceptive services if needed too, as well.

Nada Youssef:    Oh great. And then you mentioned counseling as well. Oh, so there's counseling also in this service.

Laura Lipold:      Sure, absolutely.

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

Laura Lipold:      Okay. The current recommendations are for women who have not had any pre-cancer conditions of the cervix or cancer of the cervix. And if they're between the age of 30 and 65, our preferred screening is co-testing and 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. Now, woman 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 pre-cancer or cancer.

Nada Youssef:    Now when you say co-testing, that's, you're saying that's a pap with HPV.

Laura Lipold:      Correct. Correct.

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

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. 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 think I always counsel my patients, remind them that HPV, human papilloma virus of the cervix is actually very common. We know that eight out of 10 women have been exposed to HPV and the natural history that 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 out 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 to make sure that it's not really causing any problems with the cells of the cervix as we can detect with the 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 a part of screening?

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 probably be fully informed and know what tests are being done. And insurance companies, we haven't really had much pushback at all. Usually insurance companies are pretty on board with that all together. There may be 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, onto the next question. I have Kimberly. Is osteoporosis more common in women?

Laura Lipold:      Yes. Osteoporosis is much more common in women. It does occur in men and they have different risk factors. For women, the strongest risk factor is going to be being post-menopausal. 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 and clearly men don't have that. However, men can have low testosterone conditions, which can cause osteoporosis too as well. But clearly because every female ultimately goes through menopause, we clearly see a lot more osteoporosis.

Nada Youssef:    Now menopause, I want to kind of touch on that. Not knowing 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 it to be like, I should see someone for this. Versus I'm just going through age.

Laura Lipold:      Sure, 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 post-menopausal. They can be very severe at times and they can really impact quality of life. And 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, IE. hormone therapy is a, that most women are going to be a candidate for that if they are within five or 10 years of menopause. And we see at that point that usually the benefits significantly outweigh the risk. There are effective treatment options that are available for women who are experiencing really moderate to severe hot flashes.

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

Laura Lipold:      Sure. We mentioned osteoporosis. Thinking about bone health, that's a very important thing too as well. The other interesting thing we've seen is that when women are post-menopausal and we again believe it's because of lower estrogen levels, that actually does at that point, significantly increases their risk for cardiovascular disease. Being aware of that and being aware of your cardiovascular risk factors is a really important thing, especially at the time and when you're post-menopausal.

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

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

Nada Youssef:    It could be fatigue, could be thyroid. There's so many things.

Laura Lipold:      Absolutely. And I guess I'm going to kind of probably put this in the context of peri-menopause and post-menopause. We 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 peri-menopause and post-menopausal time period and subsequently some fatigue associated with that. And some weight changes. Hormone therapy actually can be very helpful to improve sleep quality and 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.

And 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. 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 all together. 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. Back to the the point of our viewer, we do want to make sure we're not missing something. A thyroid disorder or anemia or maybe depression or something else. And then 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 leg syndrome or obstructive sleep apnea.

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

Laura Lipold:      That, great question. 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. And 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, sure. Okay. I want to actually ask you about thyroid because I know thyroid brings on the symptoms of being really tired and thyroid disorder. Can you talk a little bit about symptoms of that? What you should check for and it's something that we can check ourselves or how does that work?

Laura Lipold:      Sure, absolutely. Common symptoms of an underactive thyroid, and there are two ways that a thyroid can be off. It can be underactive or it can be overactive. In 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. And in women who are still getting periods, it could be menstrual irregularities too as well. And you were pointing to your neck and I yes sometimes, not often, but sometimes women may actually notice too as well that there might be a change in the actual thyroid gland, which sits right here at the base of the neck and some woman might actually start to see that that's getting a little bit puffy or swollen or might feel something, maybe 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:    You said those are the underactive, what is overactive?

Laura Lipold:      Overactive can be a different one too as well. Sometimes there can be overlap, but generally speaking, overactive thyroid symptoms could be feeling more heat intolerance, sweating more easily, feeling often more hot with normal activities. Could be maybe some weight loss. I forgot to mention with underactive thyroid we see weight gain. But sometimes it can be the opposite with an overactive thyroid. Sometimes I've actually seen women gain weight, but 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 feeling maybe more diarrhea. Those are more common symptoms.

Nada Youssef:    And then Nancy has a question. Hello, I'm a patient with osteoarthritis, who's also dealing with neuro sarcoidosis and pulmonary sarcoidosis, who went through menopause at 35 and have been on prednisone since 2005. how often should I get a bone scan?

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 would also, that's another area that we'd have to confirm that that's truly the reason why you're not getting periods and then being on chronic steroid therapy. I definitely think about, you may be 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?

Laura Lipold:      Yes it can. Absolutely.

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

Laura Lipold:      That's a really good question. A very common treatment for peri-menopause, kind of step back. When I say post-menopausal, what I mean is that you're 12 months without a period. We might see some changes. And so some of those natural changes that lead up to that, you can see that periods start to space out and often during the time that periods start to space out is when hot flashes are typically kicking in all together. And to help women ease that transition, we may put them on a low dose birth control pill and we might put them on a low dose birth control pill as long as they don't have contraindications in their later 40s even through their early 50s. To kind of get them through what would be the typical age of menopause, which is around the age of 52. How do we know if they're on a low dose birth control pill that they're done with periods?

Sometimes we can use clinical symptoms to help us out. They may 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." That could be a helpful indicator. If we really need to know for certain, we're going to have you, 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:    And then a follow up to Shereen's question, is there a test for menopause?

Laura Lipold:      It most often is a clinical diagnosis. As I said, the true definition is really 12 months without a period. Typically are the symptoms of hot flashes that are part of that too as well. And then we would feel pretty comfortable making that diagnosis. But for example, if somebody no longer has a uterus, so we can't use the periods to tell us where they might be with that. And we may be really need to know, then we could do a blood test.

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

Laura Lipold:      Perfect.

Nada Youssef:    But speaking of birth control, how do you know what is good for you without trying all of them? Because I know there's one that you insert in your arm that my friends have. There's an IUD, there's the pills. What do you recommend to patients? Or how do you recommend it to patients?

Laura Lipold:      It is a very individualized approach and 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, 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 different birth control.

Laura Lipold:      Absolutely. Right. I think, traditionally most people think about a birth control pill as really being the 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 and not birth control pills and are frankly more effective too as well.

Nada Youssef:    Right. Okay. Great. Excellent. And then I have Patty. Is there anything you can do during pre-menopause to help prevent osteoporosis?

Laura Lipold:      We do know that getting adequate calcium intake is really important for bone health. And 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. We think also getting adequate amounts of vitamin D is important too as well. So your doctor may recommend a supplementation. Getting weight bearing exercise is really important too as well. Some women who may have menstrual irregularities or may be 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:    Okay, excellent. And then Diane wants to know, can you explain what fibromyalgia is?

Laura Lipold:      Fibromyalgia is a type of condition that we do not, 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 are a 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, musculoskeletal system as well. When we're talking about managing some of the pain, fibromyalgia, sometimes we do use medications that sometimes we use in the neurology world as well.

Nada Youssef:    Is this something like an inflammatory diet. Anti-inflammatory diet would work with? With that kind of.

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. And then I have Marsia with a history DVT, are hormones allowed?

Laura Lipold:      With a history of DVT, which is a blood clot, 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:    Okay, excellent. And Morgan, my daughter is 12 at what age can I transition her to a primary care women's health specialist?

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 healthcare provider. I think everyone's 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." If it's a family medicine physician, we see, again, we see individuals of all ages who we'd be happy to see that transition at any time that they're ready.

Nada Youssef:    When they're ready.

Laura Lipold:      Exactly. Exactly right.

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

Laura Lipold:      That's a really good question. And one thing that we may not, the individuals may not hear enough about is are some of the non-contraceptive benefits of birth control pills. We do know that birth control pills can decrease risk of ovarian cancer and probably and probably endometrial cancer. There is not too long the time period that you really need to be on a birth control pill. And as I said, often women, we're 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. 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?

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

Nada Youssef:    And there is no cure for endometriosis.

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

Nada Youssef:    Okay. And 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 like 15, 16 years. I'm going to have a hard time getting pregnant. Is that true?

Laura Lipold:      Good question. No, it's not true.

Nada Youssef:    It's not true.

Laura Lipold:      No, it's not.

Nada Youssef:    Very good to know.

Laura Lipold:      Yeah, so usually, so you've been on a birth control pill. When you come off of it, your ovaries wake up. 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?

Laura Lipold:      Oh, another really good question. Actually seeing 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 of the ovary and ovulation. We do a little bit of a longer extended cycle regimen. We're really more successfully suppressing ovulation so we think it might be a little bit more effective when it comes to contraception. And 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. And 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 the period. It's not harming the uterus.

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

Laura Lipold:      That's a really good question and there are probably a lot of us as primary care physicians, if you do 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. Sometimes there can be autoimmune or genetic reasons why that's happening. It is actually an important thing to not only recognize but then also to figure out why that did happen. And 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 age, the average age of menopause, typically about the age of 50. To protect bones and to protect the heart too as well.

Nada Youssef:    Great. Great. Okay, well that's all the time that we have for today. Before I let you go, anything else you want to share with our audience that maybe we haven't touched on? And we talked about a lot.

Laura Lipold:      I think we did talk about quite a bit. 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 to see a specialist, whether it be a woman's health specialist, a GYN specialist, or an obstetrician or any other women's health sub-specialist, we can help guide you through that.

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

Laura Lipold:      Thank you very much.

Nada Youssef:    Thank you. And for more health tips and information, please follow us on Facebook, Twitter, Instagram, and Snapchat @clevelandclinic, one word. Thank you. We'll see you next time.