When radiology meets surgery, endometriosis care becomes more precise, personalized, and proactive. In this BackTable OBGYN Brief, host Dr. Mark Hoffman is joined by Dr. Wendaline VanBuren, an associate professor of radiology at Mayo Clinic, and Dr. Tatnai Burnett, a minimally invasive GYN surgeon at Mayo Clinic, to discuss the complexities of diagnosing and managing endometriosis.

The discussion covers the roles of advanced imaging techniques like MRI and ultrasound, the importance of pre-surgical planning, and the need for multidisciplinary collaboration. They share their approach to managing symptomatic and asymptomatic patients, the use of hormonal treatments, and the significance of monitoring potential malignant transformations in endometrioma cases. The episode underscores the critical role of imaging in planning effective surgical interventions for patients while highlighting the progression of endometriosis management protocols.

TIMESTAMPS

00:00 - Introduction 

01:07 - Discussing Endometriosis Management

02:18 - Imaging Techniques and Their Importance

04:24 - Interdisciplinary Collaboration

05:40 - Advanced Imaging Protocols

08:12 - Monitoring and Follow-Up Strategies

08:50 - Concerns About Malignancy

11:04 - Future Directions

CHECK OUT THE FULL EPISODE

OBGYN Ep. 69

https://www.backtable.com/shows/obgyn/podcasts/69/imaging-protocols-to-guide-endometriosis-treatment

When it comes to menopause care, the facts are better than the fears. In this Urology/OBGYN crossover episode of the BackTable Podcast, host Dr. Suzette Sutherland welcomes renowned urologist Dr. Rachel Rubin to explore various aspects of sexual health and hormone replacement therapy (HRT), particularly for menopausal women.

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SYNPOSIS

Dr. Rachel Rubin shares her career journey, expertise in sexual health, and the critical role of hormone replacement therapy (HRT) in managing menopause. She addresses common challenges and misconceptions, particularly around estrogen use, by demystifying the Women’s Health Initiative studies and emphasizing the proven safety and benefits of systemic and vaginal HRT. Dr. Rubin offers practical guidance on prescribing estrogen, progesterone, testosterone, and DHEA, while highlighting her advocacy to remove outdated FDA black box warnings on vaginal estrogen. Through personal anecdotes and professional insights, she empowers practitioners with evidence-based strategies and underscores the importance of education and research in advancing women’s health.

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TIMESTAMPS

00:00 - Introduction
03:41 - Challenges in Menopause Medicine
07:21 - Misconceptions and Risks of HRT
15:35 - Understanding Bioidentical Hormones
18:48 - WHI Studies and Their Impact
23:21 - Practical Guide to Prescribing HRT
33:47 - Understanding Estrogen Levels and Risks
36:04 - Debating Gels vs. Patches
37:51 - Concerns with Compounded Products and Pellets
38:50 - Patient Education and Meeting Them Where They Are
42:12 - Progesterone Benefits and Sensitivities
46:38 - Testosterone Therapy for Women
51:36 - The Importance of Lab Tests
55:39 - DHEA and Vaginal Health
57:14 - Advocacy for Accurate Hormone Therapy Information
01:00:05 - Conclusion and Final Thoughts

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RESOURCES

The Peter Attia Drive episode with Dr. Rachel Rubin:
https://peterattiamd.com/rachelrubin/

FDA Expert Panel on Menopause and Hormone Replacement Therapy for Women:
https://www.youtube.com/live/_2ZRlOivC5M?si=-Xynb_BmWz2sWf4m
Dr. Rachel Rubin’s Hormone Therapy for Early Adopters Course:
https://rachelrubinmd.thinkific.com/courses/MHTCME

The guidelines are in and the myths are out. In this episode of the BackTable Podcast, Dr. Suzette Sutherland hosts Dr. Melissa Kaufman and Dr. Giulia Ippolito to discuss the new 2025 AUA/SUFU guidelines on genitourinary syndrome of menopause (GSM).
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SYNPOSIS
The doctors delve into what GSM is, its symptoms, and the new evidence-based clinical guidelines for screening, diagnosing, and treating this condition. The episode emphasizes shared decision-making, safe use of local low-dose vaginal estrogen, and addresses concerns related to hormone therapy and cancer risks. Additionally, the doctors cover non-hormonal interventions, the role of vaginal moisturizers and lubricants, and the use of vaginal lasers. The importance of follow-up and ongoing patient education is also highlighted. The conversation aims to equip clinicians with the knowledge to better manage GSM and improve patient outcomes.
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TIMESTAMPS
00:00 - Introduction
01:35 - Overview of the 2025 AUA/SUFU Guidelines
02:27 - Guideline Development Process
05:48 - Categories of Guidelines
07:03 - Understanding GSM: Symptoms and Diagnosis
10:28 - Patient Education and Shared Decision Making
15:22 - Hormonal Interventions and Safety Concerns
17:17 - Local Vaginal Estrogen: Recommendations and Usage
23:12 - Compounded Estrogens and Alternative Therapies
25:48 - Understanding Estrogen Dosage Forms
26:11 - Introduction to DHEA and Its Benefits
27:15 - Exploring Ospemifene as an Alternative
28:05 - Guidelines for Treating GSM Symptoms
30:11 - The Role of Vaginal Estrogen in UTI Prevention
33:01 - Non-Hormonal Interventions for GSM
35:39 - Laser Treatments for GSM
39:59 - Addressing Cancer Risks with Vaginal Estrogen
44:48 - Endometrial Surveillance and Follow-Up
49:14 - Advocating for Vaginal Estrogen Use
51:13 - Conclusion and Final Thoughts

Where you perform a procedure could cost your patient thousands or save them just as much. In this Backtable OBGYN Brief, Dr. Mark Hoffman and Dr. Amy Park sit down with Dr. Barbara Levy to discuss the economic challenges and implications of performing medical procedures in various settings such as hospitals, ambulatory surgery centers (ASCs), and office environments. 

They explore how hospitals have leveraged billing structures for financial gain, often driving up patient costs, and highlight how procedures like hysteroscopies and endometrial ablations can be performed more efficiently and cost-effectively in office settings. The conversation also touches on how insurance companies and healthcare policy shape both patient expenses and physician practice. Dr. Levy emphasizes the importance of understanding the broader healthcare system to effectively advocate for positive changes in patient care and outcomes.

TIMESTAMPS

00:00 - Introduction

00:48 - Hospital Lobbying and Facility Fees

02:43 - Impact on Patients and Physicians

04:06 - Insurance Companies and Healthcare Economics

08:34 - Office vs. ASC vs. Hospital Procedures

12:59 - Cryoablation and Patient Experience

14:53 - Conclusion and Final Thoughts

CHECK OUT THE FULL EPISODE

OBGYN Ep. 55

https://www.backtable.com/shows/obgyn/podcasts/55/insights-on-obgyn-coding-reimbursements 

OBGYN Briefs - Understanding Medical Facility Fees in Practice

The way you code and calculate costs might be affecting your practice more than you realize. In this episode of BackTable OBGYN, hosts Dr. Mark Hoffman and Dr. Amy Park welcome back Dr. Barbara Levy, a clinical professor at George Washington University and UCSD. They discuss the complexities of practice expenses and coding in medical specialties, emphasizing the differences between direct and indirect expenses which vary by geography and specialty. 

The conversation covers the challenges in surveying costs, the importance of accurate representation in surveys, and the strategic implications of coding. They also touch on the complications arising from procedure revaluation and the impact of site-of-service on reimbursements.

TIMESTAMPS

00:00 - Introduction 

00:48 - Understanding Practice Expenses

02:28 - Survey Challenges and Fraud Concerns

03:19 - Valuation of Medical Procedures

07:39 - Impact of Code Changes on Payments

11:01 - The Complexity of Medical Coding

15:18 - Site of Service and Facility Fees

CHECK OUT THE FULL EPISODE

OBGYN Ep. 55

https://www.backtable.com/shows/obgyn/podcasts/55/insights-on-obgyn-coding-reimbursements

OBGYN Briefs - Understanding the RUC's Role in Healthcare Costs

Every procedure has a price, but how is it set? In this BackTable OBGYN Brief, Dr. Mark Hoffman and Dr. Amy Park welcome back Dr. Barbara Levy, a clinical professor at George Washington University and UCSD, to discuss her work with the key organizations influencing medical billing and reimbursement.

They explore Dr. Levy's extensive involvement with ACOG, AMA's CPT Editorial Panel, and the RBRVS Update Committee (RUC), offering an overview of the complex systems governing coding and reimbursement in medicine. From how new procedures receive codes to the financial impact on physicians, this brief offers valuable insights for OBGYN practitioners navigating the world of medical billing and coding.

TIMESTAMPS

00:00 - Introduction 

00:48 - Personal Anecdotes and Career Beginnings

02:01 - Understanding Medical Reimbursement

03:17 - Roles and Responsibilities in Medical Committees

05:34 - The Coding Process Explained

09:16 - The Role of the RUC and CPT Editorial Panel

15:16 - RVUs and Practice Expenses

17:48 - Final Thoughts

CHECK OUT THE FULL EPISODE

OBGYN Ep. 55

https://www.backtable.com/shows/obgyn/podcasts/55/insights-on-obgyn-coding-reimbursements

Menopause isn’t just a diagnosis—it’s a transition, and the way we treat it needs to change. Dr. Kelly Casperson joins Dr. Suzette Sutherland in this urogynecology crossover episode of BackTable to challenge outdated beliefs about menopause and hormone replacement therapy (HRT). They revisit the impact of the 1990s Women’s Health Initiative (WHI) study and explain how its findings—especially around synthetic hormones—were widely misinterpreted and continue to adversely influence patient and provider decisions today.

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SYNPOSIS

Dr. Casperson breaks down the differences between the hormones used in WHI and the safer, more targeted options available today. The conversation explores the broad benefits of modern HRT, including reduced risks of cardiovascular disease, osteoporosis-related fractures, and even dementia. Beyond the science, the episode also addresses the urgent need for better medical education and updated guidelines around menopause care.
Dr. Casperson and Dr. Sutherland make the case for empowering patients through informed consent and better clinician training. They also discuss Dr. Casperson’s upcoming book, The Menopause Moment, which aims to equip women with the tools and knowledge to navigate this life stage with confidence.

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TIMESTAMPS

00:00 - Introduction
02:50 - Focus on Menopause and Hormone Replacement Therapy
04:20 - The Women's Health Initiative (WHI) Study
05:39 - Understanding Risks and Misconceptions
12:43 - Reevaluation of the Women’s Health Initiative Study
18:31 - Impact of Media and Physician Education
19:58 - Current State of Hormone Therapy
22:17 - Broader Implications and Future Directions
27:17 - Evaluating FDA Warnings and Gender Bias in Hormone Treatments
29:49 - The Impact of Hormone Therapy on Women's Health
32:11 - Risks of Not Using Hormones
35:44 - Hormones and Brain Health: Debunking Myths
40:41 - The Timing Hypothesis and Long-Term Hormone Use
46:32 - Advocacy and Education for Menopause Awareness
48:04 - Conclusion and Upcoming Resources

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RESOURCES

PBS: The M Factor: Shredding the Silence on Menopause:
https://www.pbs.org/show/the-m-factor-shredding-the-silence-on-menopause/

The Menopause Moment by Dr. Kelly Casperson: https://kellycaspersonmd.com/the-menopause-moment-book/

Systematic review and meta-analysis of the effects of menopause hormone therapy on risk of Alzheimer's disease and dementia:
https://pmc.ncbi.nlm.nih.gov/articles/PMC10625913/

Vaginal estrogen is not the enemy. Outdated data is. In this crossover episode of the BackTable Urology and OBGYN podcasts, Dr. Suzette Sutherland and Dr. Yahir Santiago-Lastra delve into the persistent challenges and ongoing advocacy efforts surrounding the FDA's black box warning on vaginal estrogen.

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SYNPOSIS

They explore the historical context and far-reaching influence of the 1990s Women’s Health Initiative (WHI) study, asserting that its misinterpretation continues to shape misconceptions and hinder effective menopause care. The discussion highlights recent data refuting the risks associated with vaginal estrogen therapies and underscores the urgent need for updated, evidence-based guidelines to support women throughout menopause. Dr. Santiago-Lastra also draws attention to gender-based inequities in hormone treatment, the robust evidence contradicting the current black box warning, and the multi-faceted advocacy required to bring about change. This episode is part of a broader series focused on various aspects of menopause.

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TIMESTAMPS

00:00 - Introduction
02:01 - Menopause Series Overview
03:55 - History of the Black Box Warning on Estrogen
07:26 - Understanding the Black Box Warning
12:11 - The Citizen's Petition and FDA Process
18:11 - Gender Inequity in Medical Treatment
22:45 - Factors Resulting in Gender Inequity
29:02 - Genital Urinary Syndrome of Menopause (GSM)
29:32 - Benefits of Vaginal Estrogen
33:33 - Legislative Advocacy and Medicare
34:43 - Professional and Patient Advocacy
36:35 - Challenges and Progress in Label Change
43:35 - Historical Context and Gender Equity
45:07 - Recap and Future Directions

Step inside the evolving world of fetal therapy where precision, teamwork, and full-spectrum care matter most. In this episode of the BackTable OBGYN Podcast, Dr. Anthony Shanks, Vice Chair of Education in the OB department at Indiana University School of Medicine, interviews Dr. Hiba Mustafa, a distinguished maternal-fetal medicine specialist and fetal interventionalist at Riley Children's Hospital. They discuss Dr. Mustafa's expertise in fetal diagnosis and therapy, her training journey through various fellowships, and her role in directing multiple fetal medicine programs.

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SYNPOSIS

Dr. Mustafa elaborates on the intricacies of fetal interventions, including procedures for complications in monochorionic twins, spina bifida repair, and new emerging therapies. They also touch on research methodologies like the Delphi consensus technique and summarize key findings from recent studies on conditions such as hemolytic disease, gastroschisis, lower urinary tract obstructions, and preterm birth in twin pregnancies. Dr. Mustafa shares insights on how to stay sharp in the field, the importance of teamwork in surgical procedures, and advice for those aspiring to enter the field of fetal therapy.

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TIMESTAMPS

00:00 - Introduction
02:45 - The Role of a Fetal Interventionalist
04:00 - Dr. Mustafa’s Training Journey
07:42 - Fetal Surgery Fellowships
16:43 - Conditions Treated by Fetal Interventionalists
21:17 - Monitoring and Referrals for Monochorionic Twins
30:04 - Understanding Percutaneous Procedures
31:10 - Navigating the Equator in Fetal Surgery
32:31 - Laser Surgery Techniques and Outcomes
33:18 - The Importance of Placenta Delivery
33:47 - In Utero Spina Bifida Repair
36:19 - Minimally Invasive Techniques for Spina Bifida
38:28 - Maintaining Skills in Fetal Interventions
42:11 - Delphi Consensus Technique in Medical Research
46:19 - Key Takeaways from Recent Research
51:55 - Future of Fetal Therapy and Personal Insights

Real innovation? It’s not just the tools and techniques you use, it’s how you think. In this episode of the BackTable OBGYN podcast, hosts Dr. Mark Hoffman and Dr. Amy Park welcome Dr. Kevin Stepp, a MIGS surgeon and urogynecologist in Charlotte, North Carolina, and an OBGYN professor at Wake Forest University School of Medicine. Dr. Stepp shares his journey into the field, including his serendipitous start in single-port laparoscopy and the many surgical innovations that he has pioneered.

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SYNPOSIS

The conversation highlights the importance of anatomical knowledge, thinking beyond conventional surgical approaches, and the significance of teamwork and efficiency in the operating room. A central focus is placed on the development and application of single-port techniques, highlighting the associated learning curves and the evolving role of robotic surgery. The discussion also explores how surgical team dynamics, effective communication, and ongoing innovation collectively contribute to better patient outcomes and advancement in the medical field.

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TIMESTAMPS

00:00 - Introduction
03:50 - Pioneering Single Port Laparoscopy
10:10 - Challenges and Advantages of Single Port Surgery
13:52 - Cosmetic Considerations and Incision Techniques
27:27 - Innovative Approaches and Future Directions
30:40 - Understanding 3D Anatomy in GYN Surgery
32:10 - Sustaining Innovation in Urogynecology
33:53 - Efficiency in Surgical Procedures
39:20 - Advancement of Surgical Educational Materials
42:47 - Single Port and Robotic Procedures
50:50 - Building a Team through Positive Surgical Culture
01:02:13 - Continuous Improvement and Humility in Surgery