Archives of the Vagina: A Journey through Time

by Dr. Margaret Aranda

For my Caring Friends, here's a preview of my newest book, written before the doctor dropped me on the floor in March, 2013. I wrote this book (many of you will understand) because I'm not sure if I'll live long enough to see my daughter live through all the stages of womanhood: the maiden, the mother, and the crone.

                                   Book Cover Photo. Archives of the Vagina: A Journey through Time.

The book starts with my first period, and is very tongue-in-cheek humorous, because we all know where we were when we started our first period. Then I go through history, sociology, anatomy, and the endocrinology of the ovaries.

I discuss what Aristotle thought of menstruation and menopause, how William T. Stead is a hero we never hear about for rescuing children out of prostitution in London's brothels. This book is filled with the sociology of menstruation, including whether women on their periods can fly a plane, and whether women who are camping on their periods attract bear attacks that lead to death.

One of the most surprising statistics that I learned in my research and interviews of women is that in the USA, in women over 45 years old, 40% have had a hysterectomy. Of these, nearly 50% have had normal ovaries removed without proper Informed Consent. I dedicate an entire chapter to "Ovarian Conservation" (i.e., keeping your ovaries), and give you all the risk factors you need to know so you can put yourself on the Chart to see if you are at risk for ovarian cancer, and hence should get them removed. So my next book will be Hysterectomy can be Hell. I hope to get an Army behind me on this one, because it will take a Movement to change our culture. And changing a culture always means that people won't like you. Believe me. I've been there before.

I discuss the HPV vaccination for girls aged 11-12, starting your period, how to put in a tampon, and introduce what most women don't know: the menstrual cup, and the nondisposable pad. I promote a certain program that helps girls in Africa obtain menstrual pads so they don't have to miss school, be drop-outs, get pregnant, contract HIV, attain a lower socioeconomic status, and die earlier than the girls that are more educated. So expect a Movement there, too, ladies and girls.

I go through the Women's Health Initiative and basically tear it to shreds, because it had, in my opinion, no application to women in menopause suffering symptoms of vaginal dryness and hot flashes. I let you skip a very medical chapter if you would like, but I also put it in there for medical personnel to evaluate it for themselves. I dissect menopause and give the man's perspective, too, hopefully leading you to more self-discovery and compassionate understanding. Pretty funny stories there, too, my friend.

The last half of the book is dedicated to such things as Invisible Diseases, the Low Glycemic Diet, Immunonutrition and Fish Oil, Telemeres, Living for not only Health & Wellness but also for Quality of Life, Caregiving (and the effects on women, by ethnicity), Long-Term care, and death and dying. I empower you to ask questions, eat Spoon by Spoon, and Don't Fall when you are elderly. I tired of seeing women come into the Operating Room for hip fractures from a fall. You need to know your bone density, and take your Vitamin D or Calcium. The role of an Endocrinologist in your care can not be underestimated. I also believe that Cenegenics has an excellent program for Concierge Medicine, private pay by cash, that is mostly utilized by Presidents and CEOs of companies. They are mostly men. This needs to change, because there are plenty of millionaire women out there. And women need to stop spending all their time nurturing others, and start spending some time nurturing themselves. So I took all this knowledge in my head and told it to you before my traumatic brain injury and DI occurred; and I thank God that I did it.

There. I said it. My opinion rings throughout this book, and it is backed up by over 200 Stanford-quality references that are NIH-funded. I list them all for you, and many of them are dated in 2012 and 2013. Nothing but the best for you, my friends. Nothing but the best. Be prepared to learn, to grow, and to  ROCK your WORLD. You can PRE-ORDER the book (February launch date perhaps) on The Aranda MD Shoppe. My official site is Coming Soon....and I hope you like it. 

God Bless You in all that you do.

Medi-Baskets(TM)

by Dr. Margaret Aranda

Medi-Baskets(TM): Diagnosis-driven, Individual Care Packages 

are a Novel Method to Prevent Complications and Optimize Quality of Life 

at the Time of a New Diagnosis

When a person is given a new diagnosis, many times there is a lag of time between the day of diagnosis and the time that the patient acquires key ingredients and supplies that are tailored to the diagnosis. For bad arthritis, one may need a grabber to get things off of high shelves. Or, the patient may have a new diagnosis of Heart Disease or Diabetes. It may or may not have taken months or years to get that diagnosis, and that is why we exist. We are here to cater to your individual needs, because every patient is different.

In the former days of medicine, the doctor gives the diagnosis, the patient may or may not receive a Brochure, peruse websites, talks to another doctor, and/or participate in an Educational Clinic or two. These are all great avenues to become educated about a Diagnosis and how important it is to watch the blood glucose levels, but they stop short from bringing practical and useful items into a patient's home and every-day life. These items are chosen for everyday use, to prevent complications or to optimize health and Quality of Life. Either way, we hope you have a little fun with it, and mostly, we hope you use it!

With MediBaskets(TM), we go beyond this continuum. We strive to supply you with key ingredients that are specific for your diagnosis. So, for diabetes, your insurance will pay for your a glucometer to check your blood glucose (sugar) levels, and you take it home with the insulin bottle and syringes. These are  standard items that most people obtain to check their sugar levels. We don't just stop there.

If you are new to a diagnosis of diabetes, perhaps you do not know that a great pair of softening socks may help you keep your feet from cracking. It doesn't matter if you are rich or poor; diabetes will cause amputations in people of all societies. Foot cracking can lead to bleeding, infection, and gangrene. With diabetes, foot and leg sores can develop into severe lesions complete with eaten-away skin. In the worst case scenario, foot lesions can lead to gangrene and the need for emergency amputation. That is a medical fact. I've seen it in the Operating Room too many times. Then people suffer from phantom limb pain. And it all started with what you ate. What you put in your mouth. How much of it was green? How much of it came out of a box? Do you have abdominal obesity, putting you at risk of heart disease, chronic inflammation, metabolic syndrome, and death? What can you do now, today?

Some prevention or delay of kidney failure may be possible. Even if you don't have high blood pressure, studies from 20 years ago show that if you are simultaneously placed on an anti-hypertensive ACE-inhibitor, you will 'spill' less protein into your urine, protecting the kidneys. You're not supposed to spill any protein into your urine. So let's keep your kidney functioning normally for as long as possible, ok? We need you to visit your grandchildren or your children instead of spending 4 hours/day, 3 days/week going to a dialysis center. You'll have to have an iv port in, but you can buy special clothes that have zippers so you can hook your dialysis catheter up to the machine. But we don't think that was in your head as a real idea of a fashion statement. Your blood pressure goes down during dialysis, and the most common complaint after dialysis is a headache. Do you see how your Quality of Life will change? It's not funny. It's serious. And it's pretty much All in Your Hands.

So we try to think ahead for you. Whether you have a new diagnosis of heart disease, menopause, diabetes, dysautonomia, traumatic brain injury, hypertension, or you have a friend, relative, or co-worker who has a list of diagnoses we now serve, we can send them a MediBasket (from you or a group of co-workers, or a group of friends) to fit their needs. We know what it feels like to be suddenly athletic and then to be suddenly bed-ridden and sick, and we think we can make things better. 

So our President and CEO, Dra. Margaret Aranda vowed to make use of what we do know, and to pass it along to you!

Sample Medi-Basket(TM) for Diabetes. Individually made per patient, the Medi-Basket(TM) comes in four ascending sizes. The goal is for Preventive Medicine to rule, providing the patient with needed supplies for the mind, body, and soul. Perhaps a dash of humor here, and some body-soothing products will ease the physical and mental aspects of a new diagnosis. A physician is available to ask questions, but please realize that the answers are not meant to provide a medical diagnosis, treatment, advice, or cure.

But we think you are sure to feel loved by the person(s) that sent it to you, because our CEO knows what it's like to be a patient, having been bed-ridden from dysautonomia for 6 years. She was getting better until she sustained another head injury, giving her DI. But she pushes ahead on the Medi-Basket (TM) because of you. Because Keeping you in the Community and Out of the Hospital?

That's our goal. 

We are doing our part to Keep You in the Community by sharing information and education with you, your loved ones, friends, and/or co-workers. This is only by your request or the request of a Caring Friend that you know. So, how wonderful is it to know that you are not alone. Others are rooting for you, so you keep up the good fight, and persevere!

How wonderful it is that people are helping people? We think that It's About Time! Of course we want to see you well, and we wish you all the Best in your Recovery. If you get bored, tune in to Medibaskets.com for some brainteasers and information, or comment, critique, or just be cranky. Don't let anyone tell you not to be yourself. There's nothing wrong with you; it's your injured body that you are living in that's just a little broken right now.

Medical Disclaimer: Remember that your new diagnosis needs to be managed by your doctor, to keep you In the Community and not in the hospital. Nothing is meant as medical advice, treatment, or cure. A doctor has to see you in person for a thorough examination, if needed.

Aranda MD Enterprises, LLC

26500-102 Agoura Road

Suite 656

Calabasas, CA 91302

www.medibaskets.com for Preventive Medicine Gift Baskets

www.MyPerseverance.com for free Resources

The Ovaries: Reproduction and Endocrine Function

The Ovarian Follicle: Reproductive and Endocrine Organ

The female body is endowed with the uterus and ovaries as reproductive organs.  But having babies is not their only function. Initial breast bud and pubic hair formation occurs because of hormones produced by the ovaries.  Later, a girl will have her first period.

A girl begins to menstruate because her ovaries are producing estrogen and progesterone.  The 28-day menstrual cycle may not begin with the first period.  It may take 2-3 years for a girl to be ‘established’ with monthly periods, as she may have her periods only once or twice in the first year, then more often as time progresses.

Women are born with two ovaries, one on each side of the uterus (See Figure 1).

Figure 1.  The female pelvis.  The uterus is behind the urinary bladder.  1 = Fallopian tube; 2 = urinary bladder; 3 = pubic symphesis; 4 = vagina; 5 = clitoris; 6 = urethral opening; 7 = vagina; 8 = ovary; 9 = fascia; 10 = uterus; 11 = posterior cervix; 12 = cervix; 13 = colon; 14 = rectum.

It is important to understand that the human ovary serves two functions:  reproduction and endocrine.  Both of these functions are tightly coupled, as the release of hormones makes the uterus ready for fertilization of an oocyte that comes from the ovarian follicles (See Figure 2).

Figure 2.  Reproduction:  The Ovarian Follicle and the Cycles of Menstruation.  With the monthly cycle, the ovarian follicle prepares an oocyte for maturation and release to the Fallopian tube, with the possibility of fertilization and reproduction. 

There are three types of cells in the human ovary:  the oocyte or mature egg, the granulosa cells, and the external thecal layers.  The follicle houses the oocyte that is maturing to the time of release.  The granulosa cells are in the follicle, and they surround the oocyte.

Hormone production dictates what happens to the follicle. When testosterone increases, the number of granulosa cells decrease.  When gonadotropins (i.e., protein hormones produced by the anterior pituitary gland) increase, the granulosa cells increase in number, not size.  Pituitary gonadotropins include:  follicle-stimulating hormone (FSH) and lutenizing hormone (LH).  FSH tells the granulosa cells to make LH receptors on the cell surface so that when LH is produced and binds to the receptors, the end of the cycle proliferation occurs.  This makes the period stop (see Figure 3).

Figure 3.  Endocrine:  The Ovarian Follicle and Hormone Production.  The human ovarian follicle produces estrogen and progesterone during the Follicular Phase and Luteal Phase, respectfully.  At the time of the early menstrual period, estrogen dominates.  Once the egg is released and there is no fertilization, progesterone dominates.

Another human gonadotropin is produced by the placenta, and this is known as human chorionic gonadotropin (hCG).  The hCG is the hormone test for pregnancy that is commonly used on pregnancy strips.  If hCG is present, placenta is making it.  As the placenta increases in size during the early stages of pregnancy, the hCG also increases in number.  During pregnancy, the placenta also produces estrogen.

During the nonpregnancy state, the human female ovaries produce estrogen, progesterone, and testosterone.  Granulosa cells in the ovarian follicles and the surrounding corpora lutea make estrogen.  Other organ cells participate in estrogen production, but to a lessor extent:  the fat or adipose, liver, breasts, and the adrenal gland.  Postmenopausal estrogen production can still occurs from these extra-ovarian sources, but a woman's individual blood levels must be measured to know what phase her ovaries are in.  In the nonpregnant female, the highest levels of estrogen occur just prior to ovulation, near the end of the Follicular Phase (see Figure 3). 

Figure 4. The metabolism of cholesterol.  A variety of biochemical reactions exist whereby cholesterol is metabolized to progesterone, then on to dehydroepiandrosterone, testosterone, dihydrotestosterone, or estradiol.  Cholesterol is not all bad, and our bodies must produce cholesterol not just in order to procreate, but to develop neurologically. Cholesterol is important to the structure of cells, as well as being a precursor of oxysterols, bile acids, and steroid hormones.  

Cholesterol is the "Mother Molecule" of androgen and estrogen steroids (See Figure 4). Actually, you may be surprised to learn that the cholesterol molecule is a major part of the human brain, and there is no organ in the human body that contains more cholesterol than the human brain (Orth, 2012).  In fact, about 20% of the body’s cholesterol is contained in the brain.  The brain does not have the same metabolic pathway as other organs, and the brain is responsible for what is called de novo synthesis of cholesterol.  This means that the brain makes it freshly. It was Couerbe who, in 1836, described the cholesterol molecule as being “un element principal”, meaning ‘a key element’ in the central nervous system (Couerbe, 1834).

It is important to note that the ovary is uniquely tied into the hormones that they produce.  The ovaries are an organ, and they synthesize and coordinate the lifecycle of a girl and a woman. In old age, the same ovaries dictate how menopause is approached.  

If a woman undergoes a hysterectomy and the surgeon also removes the ovaries, this is 'surgical menopause'. A woman undergoing a hysterectomy gets a 'crash course' in menopause if the ovaries are removed, and she should be offered a discussion of whether or not she should be placed on hormone replacement therapy (HRT).  Backing up for a moment, wait just one moment.  Actually, we must first question whether the ovaries should be removed at all.  Stay tuned for the next article, which will address this issue.

References:

Couerbe JP. Du cerveau, considere sous le point du vue chimique et physiologique. Annales De Chimie Ed De Physique. 1834;56:160-193.

Orth M., and Bellosta S.  Cholesterol: its regulation and role in central nervous system disorders.  Cholesterol, 2012;2012:292598, doi:10.1155/2012/292598. Epub 2012 Oct 17.  http://www.ncbi.nlm.nih.gov/pubmed/23119149

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Additional Articles by Dr. Margaret Aranda

Menopause and Painful Intercourse

The Cochran Report

What Aristotle Thought of Menstruation

From Menarche through Menopause

The History of Menopause

The Different Types of Hysterectomies
Low Sexual Desire: Is It HSDD?

Surgical Menopause and Testosterone Therapy

Bears Can Smell the Menstruation: Or Can They?

The Ovaries: Reproduction and Endocrine Function

Menopause and Pain on Intercourse

Menopause causes the ovaries to decline in function.  Hormones diminish, and this includes estrogen, progestin, and testosterone.  Since a woman's body is complex, there are a multitude of symptoms that can result.

I have noticed, for example, that a postmenopausal woman can be talking to me at night, and indeed let's make that a ~ cool ~ night with a breeze.  Her upper lip and forehead are covered with sweat.  In fact, her upper eyebrows and neck glisten in the moonlight.  I ask (during our conversation on menopause), "Do you get hot flashes?"

She says, "No, I never get hot flashes."

So I ask, "Do you have pain with intercourse?"  Well, no big response there.  I persist, "Do you enjoy sex?"  She scoffs, "I could take it or leave it.  I just have sex to make my husband happy, but if it was up to me, I wouldn't even have sex.  And I would not miss it."  She smiles ever so gently.  

So I back up again, "Well, why don't you enjoy it?"  She thinks.  She hesitates.  I wait, patiently.  "Well, I guess that it just doesn't feel good."  

Results are in from Menopause, The Blog, which you can Click Here to Read.  While millions of women in the USA may have vaginal atrophy from a decrease of estrogen production after menopause, only about an estimated 7% are getting treatment.  This is simply astounding to me!  

It could be that a woman does not realize that she has vaginal dryness.  The change could have happened so gradually that she does not realize that she actually has pain on intercourse, or dyspareunia.  Other women say without hesitation that "It feels like a knife blade", to have sex with their husbands.  So let's just step back a moment and realize that vaginal dryness, vaginal atrophy, and pain on intercourse ~ all these things can happen.  It's ok.  

We just need to realize, like the perspiring woman who says she does not get hot flashes, that our bodies are changing. We need to continue to be attuned to our bodies, as we can spend fully one-third of our lives in menopause.  So we'd better get 'good' at being IN menopause, yes?  Let's do!

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Other Articles by Dr. Margaret Aranda

Menopause and Painful Intercourse

The Cochran Report

What Aristotle Thought of Menstruation

From Menarche through Menopause

The History of Menopause

The Different Types of Hysterectomies

Low Sexual Desire: Is It HSDD?

Surgical Menopause and Testosterone Therapy

Bears Can Smell the Menstruation: Or Can They?

The Ovaries: Reproduction and Endocrine Function

Surgical Menopause and Testosterone for Women

There is a common misconception that only men need testosterone.  The idea that women naturally produce testosterone, that they need testosterone, and that they can take testosterone supplementation to correct a testosterone hormone deficiency needs to be defended.

In women before menopause, about 300 mcg, or 1040 nmol of testosterone are produced each day.  Half of the testosterone production comes from the ovaries.  The other half comes from the adrenal glands.   If you are having a hysterectomy, this is one huge thing to think about before removing the ovaries, too.  Especially if your ovaries are normal.

Some women undergoing a hysterectomy are still being told:

"You don't need your ovaries any way."

Studies show that if you have not gone through natural menopause, and you have a hysterectomy and the ovaries are taken out, too, you could experience a 50% decrease in testosterone production and an 80% decrease in estrogen production.  The ovaries can continue to produce hormones for up to 10 years after the onset of menopause. 

When checking testosterone hormone levels in the blood, it is important to know that there are three possibilities:  

Free Testosterone (pg/ml) 

Bioavailable Testosterone (ng/dl)

Total Testosterone (ng/dl)

Also, an increased sex-hormone binding globulin level leads to a decrease in free testosterone. Related testosterone-pathway hormones that may also be checked include dihydrotestosterone, dehydroepiandrosterone (DHEA), estrone, and estradiol.  So how much of these does a normal pre-menopausal women have in her body?  Here are the normal levels:

DRUG                                                                  NORMAL VALUE*                UNITS

Free Testosterone                                                       1.3 - 6.8                                 pg/ml

Bioavailable Testosterone                                          1.6 - 12.7                               ng/dl

Total Testosterone                                                       14 - 54                                  ng/dl

Sex-hormone binding globulin                                   36 - 185                                 nmol/l

Dihydrotestosterone                                                  4.4 - 20.4                                ng/dl

Dehydroepiandrosterone (DHEA)                             60 - 255                                 mcg/dl

Estrone                                                                       32 - 159                                 pg/ml

Estradiol                                                                     34 - 225                                 pg/ml

There are many variables that go into deciding whether to remove the ovaries at the time of hysterectomy.  If your ovaries are normal, their estrogen, progesterone, and testosterone production may serve to protect you from heart disease, bad moods, insomnia, vaginal dryness, fatigue, losses in bone density, and hot flashes, to name a few.  

If you are at increased risk of ovarian cancer, most doctors would recommend that you do get your ovaries removed.  How do you know if you are at an increased risk?  Family history of ovarian or breast cancer may put you at risk.  If your ovaries have been popping eggs out every month all your life and you have never had a baby or breastfed, this may put you at increased risk but that also depends on your age.  It's more complicated than that, but those are the basics.  If you are at increased risk and you are getting your ovaries out, you may be considered for estrogen and testosterone replacement; many doctors also check the thyroid gland at this time.

Keep your ovaries unless you are at increased risk of ovarian cancer: 

It may be that this is the general word.

Talk to your doctor about what is right for you.

Every woman is different, and you should get a Second Opinion from a different surgeon on the matter of a hysterectomy.

Oh.  And treatment with higher doses of testosterone in women after hysterectomy and oopherectomy have shown marked improvement in both psychological well-being and sexual function.  So don't enter your operation for a hysterectomy wondering whether or not to get your ovaries removed, as the general sentiment today has to do with "ovarian conservation".   

Your ovaries could be your future quality of life.

Medical Disclaimer:  Nothing in this blog is meant to give an individual specific medical advice, treatment,  or recommendation.  Each medical decision must be made between a women and her doctor.  

* = Endocrine Sciences, Calabasas, CA

Full Disclosure:  Dr. Margaret Ferrante is an Institute Physician with Cenegenics Medical Institute, which practices Age Management Medicine components of diet, exercise, hormones, and a balanced lifestyle. She may be contacted at mferrante@cenegenics.com for a Free Consultation.

References:  

Abraham GE.  Ovarian and adrenal contribution to peripheral androgens during the menstrual cycle.  J Clin Endocrinol Metab 1974;39;340-6.

Davis S., et al.  Testosterone enhances estradiol's effects on postmenopausal bone density and sexuality.  Maturitas 1996;21:227-36.

Shefrin, J.L., et al.  Transdermal testosterone treatment in women with impaired sexual function after oophorectomy.  N Engl J Med; Sept 7, 2000;  Vol. 343 (10); 682-8.

Shefrin, J.L., et al.  Incidence of sexual dysfunction in surgically menopausal women.  Menopause 1988;5:189-90.

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Other Articles by Dr. Margaret Aranda

Menopause and Painful Intercourse

The Cochran Report

What Aristotle Thought of Menstruation

From Menarche through Menopause

The History of Menopause

The Different Types of Hysterectomies

Low Sexual Desire: Is It HSDD?

Surgical Menopause and Testosterone Therapy

Bears Can Smell the Menstruation: Or Can They?

The Ovaries: Reproduction and Endocrine Function