Electronic medical records (EMRs) are patient records of health-related information that can be created, gathered, and managed by authorized clinicians and staff within one health care organization. EMRs were designed to streamline the daily workflow of a busy medical office and could have potential to provide substantial benefits to physicians, clinic practices, and health care organizations. The word could is used here because the technology that is currently in use, is good, but not great, just yet.

EMRs vs EHRs
EMRs differ slightly from electronic health records (EHRs) which can move with the patient to various medical practices but these terms are usually used interchangeably. The upside is that these types of records cut way down on the glut of paperwork, filling in medical offices, and lessens the chance that a record could get lost, among other benefits.

Patient Privacy to Consider
Although there are benefits to moving to a paperless system, the concern that we have at our practice is patient privacy and cyber security. A recent wave of cyberattacks that have shut down hospitals highlights the weaknesses that are still problematic in some of these software programs and online systems currently in existence. Our patients rest assured of the utmost compassion and privacy when discussing the most intimate details of their sexual health with us. Patients deserve not only the highest level of care, but also the most stringent form of privacy.

We Love Technology, But…
We are thrilled with some existing technologies, such as email, our website, and social media avenues of communication, that enable us to continue the conversation about patient health, while educating and continuing to encourage patients outside of the examination room and our offices. So, until cybersecurity improves a lot, we will keep our “UN-hackable” paper health records. We hope other practices and hospitals that use electronic health records are following the recommendations provided by the Health Care Industry Cybersecurity Task Force.

Six Action Items for Practices (They are also good rules for your home computer systems, too.)

1. Ensure that computer operating systems and antivirus software are updated with available upgrades and patches.

2. Establish policies against opening emails and attachments from unknown sources and from accessing websites with suspicious content.

3) Continuously educate staff (your kids, grandchildren and parents) about those policies in number 2 above.

4. Hire a cybersecurity firm to conduct penetration tests, a common practice in other industries, where security professionals test their clients’ computer systems and staff to find vulnerabilities that attackers could exploit.

5. Consider implementing technologies that allow staff (or family members) to open suspicious emails and attachments in a contained environment segregated from other systems and computers.

6. Prohibit unauthorized access to patient data; enforce passcodes, and automatic logoffs.

7. Never share password. Period!

If you’re in the New York City area on April 7-9, 2017 join me and colleagues at the The Westin NY at Times Square for our annual Survival Skills for Today’s Gynecologist program. It’s a great time to catch up with friends and hear discussions about the latest in gynecologic patient care. Each day starts with breakfast and includes time for Q&A to deepen the knowledge-share among us.

Along with Steven R. Goldstein, MD who serves with me as Program Co-Director, we have a terrific faculty who will present on leading-edge therapies and topical issues. You might be interested in the most recent recommendations about cervical cancer screening or are wanting more information about HPV education, VVA treatment, hysterectomy procedures, urogynecology, and much more.

On Friday, I will discuss the following topics:

  • Menopausal Hormone Therapy: Primary Prevention of Disease or Not?
  • Office Management of Female Sexual Dysfunction: You CAN do this.
  • Flashes, Flushes, and Night Sweats: New and Non-Hormonal Approaches

My topic for Saturday is Pelvic Floor Biofeedback/Physical Therapy: Should I Offer This in My Office?

The treatment of our patient population is ever-changing, as new treatments and options become available. The business of medicine is changing too. Don’t miss this great CME opportunity, learn some Survival Skills, and thrive in the years to come.

View the entire course or to Register at www.WorldClassCME.com or by phone at (888) 207-9105, M-F 8:30 am – 5 pm EST

Hope to see you there!

Sexual empowerment not only applies to equality in the boardroom of the work place, but in the bedroom as well. Equality in comfort and sexual satisfaction, and equality in the types and numbers of treatments available. Women who have had their last menses sometimes say good-bye to their enjoyable sex lives because of pain during sexual activity, due to vulvar or vaginal changes, lack of lubrication, all of which can affect one’s libido. Societal cues, shame, or embarrassment about this lack of sexual equality are not being addressed enough and there are solutions. These physical symptoms are brought on by menopause, whether medically-induced menopause or natural menopause, but because the symptoms may “sneak up” on a woman, the connection to menopause is often lost, and women commonly assume this is just another symptom of getting older, like arthritis. There is certainly nothing natural about a sudden halt in one’s sexual life when pain and dryness interfere. We have answers.

Why the Disconnect?
Many postmenopausal women are relatively unaware of how the symptoms of menopause affect them sexually, and what treatments are available, according to findings presented at the Annual Meeting of the North American Menopause Society.

Results of the Women’s EMPOWER survey reveal that women generally didn’t recognize vulvar and vaginal atrophy symptoms, and were reluctant to discuss them with their healthcare professionals. This second part is most concerning to me. I’m available to discuss, mitigate, and resolve sexual issues. Participants in the survey also reported that they lacked knowledge about therapeutic options to alleviate these bothersome symptoms. When compared with six previously conducted surveys — REVEAL, VIVA US, Healthy Women #1, REVIVE, CLOSER North America and Healthy Women #2 — evaluating knowledge, behaviors and attitudes related to vulvar and vaginal atrophy, EMPOWER demonstrated yet again that women failed to recognize vulvar and vaginal atrophy symptoms, and were reluctant to discuss them. Further, participants reported that they lacked knowledge about therapeutic options to alleviate the symptoms. But, there is no reason to suffer in silence. Speak up!

Experts such as myself, a reproductive endocrinologist, sexual medicine and menopause specialist, and Clinical Professor at George Washington University in Washington, DC, and my colleagues seek to address these issues and have released a study on a new treatment that will enable women to reclaim their sexual vitality.

TX-004HR is as soft gel capsule containing low-dose, solubilized, natural, bioidentical 17 B-estradiol.  Our team team conducted a phase 3, randomized, double-blind, placebo-controlled, multicenter REJOICE trial that demonstrated this treatment to be safe and effective for treating moderate to severe dyspareunia (painful intercourse) in postmenopausal women with vulvar and vaginal atrophy (VVA). In total, 764 women were eligible to participate in the study, of which 704 (92%) completed the study.

The study used the Female Sexual Function Index (FSFI) as a measurement of the impact of this treatment on sexual function. The FSFI is a self-reporting tool to assess sexual function during the past 4 weeks. It consists of 19 questions categorized into six domains of sexual function (desire, arousal, lubrication, orgasm, satisfaction, and pain).

VVA affects more than 30 million women who go untreated, in part, because of the perceived risks of estrogen, which I have explained in an earlier post,  Estrogen and Breast Cancer Risk: Separating Fact from Fiction.  But this new treatment  aims to alleviate the symptoms without adding any risk by providing a treatment that goes to the source of the issue, the vagina and vulva, with little or no systemic absorption of estrogen. The REJOICE study compared the effects of 12-weeks of treatment with TX-004HR at varied doses with placebo in postmenopausal women (40 to 75 years old) with VVA and moderate to severe dyspareunia (i.e., difficult or painful intercourse).

The Good News
The research team found that TX-004HR improved sexual function in postmenopausal women with moderate to severe VVA and dyspareunia. After 12 weeks, all three TX-004HR doses increased the average total FSFI score.

This treatment shows promise for women who  experience these symptoms and they should talk with their partners and their medical team to address issues as they arise. If these symptoms are affecting your sex life, I encourage you to give our office a call to help develop a plan for a healthy and happier sexual life going forward.


A tiny butterfly-shaped gland at the base of your neck has an important role in overall well-being; it helps regulate body temperature as well as metabolism (how fast you burn calories). When the thyroid is under-performing or over-performing, issues start to crop up and women, who this mostly affects, begin to feel off, gaining weight, feeling more tired or listless than usual.

An interesting study on subclinical hypothyroidism alerts us to issues such as weight gain and hair loss that may be symptoms of the thyroid being overactive or underactive. However, before jumping to a self-diagnosis, you should consider your family’s genes and inherited traits related to weight and hair, because these also show up at middle age, just simply as a factor of getting older. If you have eliminated those as family traits as possibilities, it may be time to consider some blood tests to see what is going on.

The confounding factor about the thyroid is that the range of normal levels of most hormones is very wide. Because of this, a person may have thyroid hormone levels on the threshold for needing treatment, but still in the “official” normal range. Getting too much thyroid medication to optimize one’s blood results, can lead to other serious medical complications such as heart attacks and cardia arrhythmias (irregular beats), as well as bone loss, osteoporosis, and fractures. So, it is imperative to get the dosage just right. An expert in medical endocrinology or reproductive endocrinology (like me), understands these issues and can make slight adjustments to optimize thyroid replacement or supplementation, which often results in the patient feeling much better, with less fatigue, while minimizing the risk of side effects such as cardiovascular and skeletal disorders.

I always try and look at the whole patient, not just their symptoms or their laboratory values. I take into account the other medications that patients may be taking, which could have an impact on well-being. For example, if a patient is taking an oral hormone therapy to mitigate menopause symptoms, this can upset the normal thyroid balance, so it is vital to find the right balance of both these hormones. Similarly, younger women on birth control pills may experience excessive weight gain because their contraception has thrown off their thyroid. Once the optimal thyroid treatment is determined, the patient can stay on that dosage for a long time. Like butterflies, each patient is unique and a personalized approach works best.

Key Points

  • There is no “one size fits all” thyroid treatment.
  • Most women should be screened around the onset of menopause, if there they are considering going on hormone treatment, to find the thyroid’s baseline levels.
  • Women with rapid and excessive weight gain should be tested.
  • If there is a family history, patients should be screened at age 35 or if other signs of hyper or hypothyroidism are present.
  • Heart attacks, cardiac arrhythmias, and bone loss – occur later in life and are asymptomatic until they occur. Over-treatment with thyroid medication can causes these disorders down the road.
  • To learn more please call the office at (202)293-1000 or email the practice at info@intimmedicine.com.


Hot Flashes

For women going through the menopausal transition, there’s no better discovery than a safe, natural, nonhormonal treatment for hot flashes that really works.

So a study just presented at the annual scientific meeting of the American College of Obstetricians and Gynecologists caught our eye. It focused on an over-the-counter botanical extract derived from pollen. Could such a simple remedy really improve symptoms and quality of life?

To learn more, we spoke with the study’s author, James A. Simon, MD, an ob-gyn in private practice in Washington, DC, and professor at The George Washington University School of Medicine and former president of the North American Menopause Society.

Relizen, the brand name in the US of the botanical extract, was developed after an accidental discovery—a Swedish beekeeper noticed that when bees feasted on the pollen of a particular flower, they seemed more energetic. So he wondered if giving that pollen to men and women would make them more energetic, too.

“It didn’t work,” said Dr. Simon. “But menopausal women who took it said that their hot flashes were better.” So the extract was developed using just the cytoplasm (material inside the cell) of the pollen—according to the manufacturer, that removes the pollen allergens. It’s actually been available in Europe under different names for about 15 years, and it is backed up by peer-reviewed research. In a 2005 double-blind placebo-controlled study of 64 menopausal women, 65% of those who took it had fewer hot flashes—compared with 38% of those who took a placebo. It’s been used by more than a million women in Europe.

In the new study, 324 women going through the menopausal transition took Relizen daily for three months. To get into the study, the women had to be having hot flashes—and be bothered by them.

Results: 86% had fewer hot flashes, and for 91%, their hot flashes were less severe. What the new study adds is an emphasis on self-assessed quality of life—fatigue, irritability, sleep quality. These all got better, says Dr. Simon, who has no financial stake in the company that makes Relizen. “Their sense of well-being improved,” he said. The mechanism—how this extract works—isn’t well understood. Side effects, such as stomach upset, were rare and tended to go away after a week or two.


Because research has confirmed that it doesn’t affect hormones, Relizen may have a particular role to play for women who have survived breast cancer who have been told that hormonal treatments aren’t safe for them. Currently, the only nonhormonal FDA-approved prescription for relief of menopausal symptoms such as hot flashes is the antidepressant paroxetine (Brisdelle, which has the same active ingredient as the antidepressant Paxil). But this antidepressant not only has side effects such as headaches, nausea, weight changes, reduced sex drive and interference with the ability to have an orgasm—it may also interfere with the action of Tamoxifen, the drug that is often prescribed after breast cancer treatment to prevent recurrence. Relizen, according to a recent study in Menopause, doesn’t affect the action of Tamoxifen.


If you want relief from hot flashes and night sweats, Relizen is one of many options, said Dr. Simon. Hormone therapy, such as estrogen, is certainly the most effective for symptomatic relief, but many women want to avoid taking systemic hormones based on safety concerns. (We’ll revisit this controversial issue in an upcoming article.)

Plant-based supplements that have estrogenic effects can help, and Dr. Simon occasionally recommends Remifemin, an over-the-counter product that contains the estrogenic herb black cohosh. “I double the dose on the package insert to achieve the best results,” he said. Purified soy phytoestrogens also work for some patients, he notes. If you decide to pursue either option, he recommends that you work with a health-care professional, as there are safety questions for some women in taking estrogenic compounds, especially women with or at high risk of developing breast cancer.

Among nondrug approaches, he’s seen success with hypnosis. Even acupuncture, which hasn’t been shown in studies to be effective for hot flashes, appears to work for some people, said Dr. Simon.

What he likes about Relizen is that it’s so safe—for any woman, including those with a history of hormone-sensitive breast cancer—that it’s fine to try on your own. “A patient can acquire it by herself and see if it’s beneficial—before seeing her practitioner,” said Dr. Simon. “If it doesn’t work after two or three months, she can see her health-care professional for other options.” (Note: Relizen is currently available through the manufacturer’s website.)

Sources: Study titled “Nonhormonal Treatment of Perimenopausal and Menopausal Climacteric Symptoms” by James A. Simon, MD, CCD, NCMP, clinical professor of obstetrics and gynecology, The George Washington University School of Medicine, and René Druckman, MD, presented at the American College of Obstetricians and Gynecologists Annual Scientific and Clinical Meeting 2016. Dr. Simon is a Washington, DC–based physician who provides patient-focused care for women across the reproductive life cycle, from adolescence to childbirth, and through the menopausal transition.


Non-Hormonal Prescription Option for Hot Flashes

Hot-Flashes1Hot flashes and its nocturnal cousin, night sweats, the highly descriptive street names for the vasomotor symptoms (VMS) experienced by as many as 80% of menopausal women, are the most common of all menopausal symptoms.

No consensus exists on the pathophysiology of menopausal VMS, although many hypotheses have been proposed. Hot flashes (HFs) are hypothesized to result from a dysregulation of the hypothalamic temperature-regulating mechanisms, triggered by a decline in estrogen levels.

Alterations in neurotransmitters such as serotonin and norepinephrine (NE) are thus likely to play a crucial role in menopausal VMS. Core body temperature (CBT) is regulated between an upper threshold for sweating and a lower threshold for shivering. Between these thresholds is a “thermoneutral” zone, within which major thermoregulatory responses (sweating and shivering) do not occur. Fine thermoregulatory adjustments within the thermoneutral zone are affected by variations in peripheral blood flow. According to this theory, heat dissipation responses of HFs (sweating and peripheral vasodilation) would be triggered if CBT were elevated such that the upper threshold was crossed.

Hormone therapy (HT) has been known to be efficacious for most women with VMS due to menopause. Current clinical guidelines for HT recommend using the lowest dose for the shortest duration to relieve symptoms and reach treatment goals. Dose, route of administration, and duration of use should be tailored to the needs of each woman, and periodic reassessment of symptoms is required to evaluate whether a change of treatment is necessary. However, VMS recur in approximately half of women after discontinuation of HT. Certain health risks may preclude the use of HT in some patients, and some menopausal women with VMS who would otherwise be suitable candidates for HT prefer not to initiate or continue such treatments for a variety of reasons, including concerns about potential side effects.

When hormone therapy is not suitable or if there is an unwillingness to take HT, or if a woman simply prefers a non-hormonal therapy, the prescription medication, BRISDELLE, offers women and practitioners an FDA-approved, non-hormonal pharmacologic treatment option for moderate to severe VMS due to menopause. BRISDELLE® (paroxetine) 7.5 mg is a low-dose selective serotonin reuptake inhibitor (SSRI) shown to be efficacious in treating moderate to severe VMS associated with menopause. This dose is lower than those used in treating psychiatric disorders. BRISDELLE is not indicated for depression or any other psychiatric condition. BRISDELLE’s efficacy, safety and tolerability were demonstrated in rigorous clinical trials specifically designed to treat moderate to severe hot flashes due to menopause

The median age of natural menopause is 51.3 years. Women of this age are no longer old and could expect to live an additional active 20 – 30 – 40 years with good health habits and proper medical care. There is no need to debilitate yourself by neglecting any condition for which there are suitable therapies available.

Talk to your doctor or health care professional about your options!


Interested in women’s sexual health? Contact us for an appointment.

180412764 copyGetting a good night’s sleep may just be a dream for many menopausal women. Studies indicate that, along with hot flashes, mood swings, migraine headaches, trouble sleeping is another, unpleasant side effect of menopause. Approximately 61 percent of perimenopausal and postmenopausal women frequently suffer from insomnia, according to the National Sleep Foundation.

I don’t need to tell you that not getting enough sleep can impact your quality of life. Repeated nights of tossing and turning can make you feel irritable, affect concentration and memory, and can even be related to weight gain.

It’s not all bad news, though. There are things you can do to help get a good night’s sleep. Here are a few of my favorite tips to help patients get a little more shut eye:

Keep the room cool.

Tell your partner to bundle up as you crank up the AC, turn the ceiling fan on high and wear loose, lightweight clothing. Often it’s the hot flashes that can wake you up. Keeping the room cool may help.


Exercise can do wonders for many things, not to mention make you tired, relaxed, and ready for bedtime when it rolls around. But, no exercise within 2-3 hours or going to sleep, which can make hot flashes worse.

Decompress, and not just 10 minutes before getting into bed.

Read a book or magazine. Talk about the day with your partner. Watch a TV show. Do anything to help decompress and help get your mind off stressors that can keep you awake with worry. Start this process two hours before going to sleep.

Eat right.

Be sure to eat plenty of fruits and vegetables, and avoid caffeine and a heavy meal right before bedtime.

Those are just a few of my tips that may help you get a little more sleep. Don’t hesitate to talk to your doctor if you continue to suffer from insomnia. Together, you can work out an approach that will help you sleep better.


Interested in women’s sexual health? Contact us for an appointment.

177382140 V2For years, my patients going through menopause have complained of migraine headaches. But for some reason, research has never been able to back up what I’ve known for years, and what women have been experiencing for ages: Migraines are, indeed, a symptom of menopause. That is, until recently.

A new study, part of the American Migraine Prevalence and Prevention Study, reviewed data from 120,000 U.S. households. Researchers found that frequent headaches (10 or more a month) were 50-60 percent more common for perimenopausal and menopausal women.

What Causes Menopausal Migraines?

Migraines in menopausal and perimenopausal can be traced back to the same villain as the hot flashes, weight gain, mood swings and other menopausal symptoms: hormones. Lowered estrogen levels and other fluctuating hormones can trigger headaches and migraines.

 Treating the Person, Not the Headache

Women suffering from menopausal migraines can breathe a sigh of relief that there are treatment options to help ease migraines. But like everything else, the effective approach depends on each individual person and her medical history. Some may respond to exercise, healthy diet, acupuncture or relaxation methods. Hormone replacement may be a good option for some.

If you are suffering from menopausal migraines, please let me know. Together, we can work toward an effective treatment plan for you.

Interested in women’s sexual health? Contact us for an appointment.

Vibrators are often the punch line of the joke; the gag gift at the bridal shower or the cause of an embarrassing situation in a sitcom. But, the reality is, personal massagers are no joke. Vibrators can be an important part of a healthy sex life. Used alone or with a partner, they enable many women to have a happy, enjoyable sex life. And that’s nothing anyone should be embarrassed about.

Personal massagers are believed to play such an important role in women’s sex life that doctors and researchers have conducted studies to identify how women use them, and what men and women think about them. The results were enlightening:

  • Think no one uses a vibrator? Think again. Research found that over 52 percent of women have used a vibrator at least once.
  • Male partner worried you won’t be interested in sex with him if you use a vibrator? He couldn’t be more wrong. Heterosexual women who used vibrators experience an increased desire for sex.
  • Most women (49 percent) started using a personal massager for fun or curiosity.

The bottom line is that vibrators shouldn’t be relegated to the back of the nightstand drawer, and you shouldn’t be too embarrassed to buy or use a vibrator – alone or with a partner. It’s something to consider if you’re curious or want to get your sex life buzzing again. Doctors think vibrators may even help treat common symptoms of menopause. We do sell a variety of vibrators to our patients. Special expertise and training may be required to match the proper personal massager to a patient’s unique needs. We can help.


Interested in women’s sexual health? Contact us for an appointment.

It may not seem like the stuff of sitcoms when it’s happening to you, but my sister pointed out to me the other day that menopause was the theme of a recent CBS show called Mom – and it’s a great reminder that a solid sense of humor can be a terrific asset.

The show is built around the evolving relationships between a mom, her daughter and her mother – three generations of women and the changing nature of their interaction.  In a recent episode, the matriarch of the family started experiencing some textbook symptoms, and her daughter recognized what was at play while her mother went to sitcom-level extremes to deny what was happening.

My sister pointed it out to me, saying the episode has value “even if you don’t watch the show or know the characters”. In her words, “If we can’t laugh about it, we’ll just melt away in a pool of our night sweats.”

Truth is, trying to manage the mood swings, the sleeplessness, the realization of changing sexuality – all a natural part of the aging process – is challenging, maddening…and yes, if you allow it, funny.  When a woman is deep in the middle of trying to manage the symptoms and her reaction to them, the idea of laughing about it all may not be the most top-of-mind approach to consider.  But once things are put into perspective, maybe with the help of some hormone therapy, it does make sense to consider that a strong sense of humor may be at least as valuable as other medically based ways to help manage the process.  And that’s something I strongly recommend in conjunction with the most helpful of clinical approaches.


Interested in women’s sexual health? Contact us for an appointment.

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