BackTable Women's Health

How can we educate women about vaginal estrogen for genitourinary syndrome of menopause, especially given the black box warning? In this Brief, Dr. Rachel Rubin and host Dr. Suzette Sutherland discuss misconceptions around the use of estrogen creams and suppositories, particularly focusing on dosage and application for safe, effective treatment.

They address common factors leading to inadequate results and the safety of low-dose vaginal estrogen. The doctors emphasize the importance of patience with treatment, correct understanding of hormone products, and education of patients to combat misinformation. Dr. Rubin and Dr. Sutherland also challenge misleading black box warnings associated with vaginal estrogen and stress the necessity for advocacy to update these labels and educate patients.

TIMESTAMPS

00:00 - Introduction

00:20 - Debunking Myths About Estrogen Cream Usage

04:10 - Safety and Proper Usage/Dosage of Estrogen Products

05:48 - Patient Education and Compliance

08:23 - Addressing the Black Box Warning on Vaginal Estrogen

10:48 - Conclusion

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OBGYN Ep. 33 - Genitourinary Syndrome of Menopause (GSM): Improving a DRY Topic

https://www.backtable.com/shows/obgyn/podcasts/33/genitourinary-syndrome-of-menopause-gsm-improving-a-dry-topic

Everyone knows about the dangers of opioids, but how can physicians provide quality postoperative pain control without opioids? This episode of the BackTable OBGYN podcast, hosted by Dr. Amy Park, features a discussion with experts Dr. Steven McCarus and Dr. Paula Bilica on non-opioid pain control in obstetric and gynecologic surgery.

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This podcast is supported by:

Pacira

https://www.pacira.com/

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SYNPOSIS

Highlighting the use of Exparel, a liposomal bupivacaine formulation, the discussion addresses how it has transformed post-operative pain management by reducing opioid exposure. The episode covers techniques for Exparel application in surgeries such as hysterectomies and C-sections, with positive patient outcomes noted. The conversation also emphasizes the importance of collaboration among healthcare professionals to advocate for better pain management protocols and patient satisfaction, spotlighting upcoming initiatives like the No Pain Act.

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TIMESTAMPS

00:00 - Introduction

04:47 - Introduction to Liposomal Bupivacaine (Exparel)

07:10 - Techniques and Applications of Exparel

20:13 - The No Pain Act

25:07 - Patient Success Stories with Exparel

26:30 - Administrative Hurdles and Solutions

30:24 - Safety and Efficacy of Exparel

32:42 - Educating Staff and Implementing Protocols

38:05 - Final Thoughts

OBGYN Briefs - Managing Genitourinary Syndrome of Menopause

Frequent UTIs and vaginal atrophy/dryness are common signs of genitourinary syndrome of menopause (GSM). In this Brief, Dr. Rachel Rubin discusses the management of GSM and why estrogen is so vital to these tissues.

They address the lack of information and awareness about GSM among urologists and gynecologists while emphasizing its impact on the urinary and genital symptoms experienced by menopausal women. Dr. Rubin details how GSM is not just a matter of vaginal atrophy but involves broader symptoms like urinary tract infections and bladder issues. The doctors also discuss a range of treatment options available, including local vaginal supplementation products like estradiol creams and DHEA suppositories, and their benefits for urinary health.

TIMESTAMPS

00:00 - Introduction

00:20 - Understanding Genitourinary Syndrome of Menopause (GSM)

01:42 - Symptoms and Implications of GSM

03:00 - Vaginal Supplementation Products

05:09 - DHEA and SERM Therapy

08:44 - Estrogen and Vaginal Health

CHECK OUT THE FULL EPISODE

OBGYN Ep. 33 - Genitourinary Syndrome of Menopause (GSM): Improving a DRY Topic

https://www.backtable.com/shows/obgyn/podcasts/33/genitourinary-syndrome-of-menopause-gsm-improving-a-dry-topic 

Pregnancy and childbirth have a significant impact on the pelvic floor, often more than patients realize and even more still than most of our current postpartum care models are designed to address. In this episode of the BackTable OBGYN podcast, hosts Dr. Mark Hoffman and Dr. Amy Park welcome Dr. Lisa Hickman, a urogynecologist and pelvic reconstructive surgeon from The Ohio State University, to discuss peripartum pelvic floor disorders and her dedicated clinic for women with advanced obstetric lacerations.

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This podcast is supported by:

PearsonRavitz

https://pearsonravitz.com/backtable

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SYNPOSIS

The conversation touches on key aspects of pelvic floor health, the impact of pregnancy and childbirth, and effective strategies for preventing and managing pelvic floor disorders. The episode emphasizes the importance of patient education, tailored postpartum care, and multidisciplinary collaboration with pelvic floor physical therapists and other healthcare personnel. Dr. Hickman shares insights on building a sustainable clinical model for peripartum pelvic floor disorders, securing stakeholder support, and implementing standardized processes to enhance patient outcomes.

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TIMESTAMPS

00:00 - Introduction

04:21 - Understanding the Pelvic Floor

05:36 - Impact of Pregnancy and Childbirth

07:48 - Preventing and Managing Tears

22:56 - Postpartum Care and Challenges

28:54 - Starting a Peripartum Clinic: A Roadmap

33:54 - Pelvic Floor PT and Patient Education

40:03 - Impact of Repair Techniques on Long-term Outcomes

50:56 - Sustaining and Expanding the Program

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RESOURCES

Hickman LC, Propst K, Swenson CW, Lewicky-Gaupp C. Subspecialty care for peripartum pelvic floor disorders. Am J Obstet Gynecol. 2020 Nov;223(5):709-714. doi: 10.1016/j.ajog.2020.08.015. Epub 2020 Sep 2. PMID: 32888923; PMCID: PMC7720615.

Thoracic endometriosis occurs in about 12% of patients with advanced endometriosis. Due in part to its lower incidence and inherent diagnostic challenges, many providers are not well-versed in the workup and management of this advanced disease. In this episode of The BackTable OBGYN Podcast, host Dr. Mark Hoffman interviews Dr. Shanti Mohling, a gynecologic surgeon at Northwest Endometriosis and Pelvic Surgery, regarding her approach to thoracic endometriosis.

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CHECK OUT OUR SPONSOR

PearsonRavitz

https://pearsonravitz.com/backtable

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SYNPOSIS

The physicians discuss the embryological and congenital theories of endometriosis etiology, the impacts of retrograde menstruation, and epigenetic factors. Dr. Mohling shares insights into her advanced surgical techniques for treating endometriosis, including diaphragmatic and thoracic disease, and the importance of a comprehensive history, exam, and diagnostic imaging. Her practice patterns, patient care strategies, and interdisciplinary collaborations for optimal outcomes are also highlighted.

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TIMESTAMPS

00:00 - Introduction

06:40 - Pelvic Pain Workup

08:09 - Thoracic Endometriosis

14:12 - Medical Management Post-Surgery

18:48 - In-Office Ultrasound Techniques

23:33 - Collaboration in Surgery

24:59 - Preparing for Thoracic Endometriosis Surgery

36:44 - Managing Postoperative Care

41:13 - Theories on Endometriosis Etiology

46:31 - Concluding Thoughts

Can cranberry juice prevent UTIs? In this BackTable OBGYN Brief, Dr. Suzette Sutherland and Dr. Anne Cameron discuss various strategies for preventing recurrent UTIs, including which supplements are effective. They cover the efficacy of cranberry supplements, emphasizing the importance of quality and proper compound concentration in products like Ellura. The discussion also addresses the limitations of cranberry juice and the resurgence of methenamine hippurate as a non-antibiotic preventive measure, supported by recent studies. Additionally, they outline comprehensive approaches, including lifestyle modifications, hydration, vaginal estrogen, and hygiene practices, while aiming to destigmatize the condition.

TIMESTAMPS

00:00 - Introduction

00:28 - Cranberry Supplements for UTI Prevention

01:22 - Choosing the Right Cranberry Product

03:05 - Effectiveness and Dosage

05:27 - Cranberry Juice vs. Supplements

06:45 - Exploring Hiprex and Vitamin C

07:08 - Methenamine Hippurate: An Old Medication Revisited

08:59 - Overall Strategy for Managing Recurrent UTIs

11:09 - Vaginal Estrogen

11:48 - Final Thoughts

CHECK OUT THE FULL EPISODE

BackTable OBGYN Ep. 42 - Recurrent UTIs: Controlling Those Nasty Little Bladder Infections

https://www.backtable.com/shows/obgyn/podcasts/42/recurrent-utis-controlling-those-nasty-little-bladder-infections

Vulvovaginal disorders can be very complex to manage, and many OBGYNs struggle with diagnosis and treatment, especially if topical steroids don’t improve symptoms. In this episode of the BackTable OBGYN Podcast, guest host Dr. Jessica Ritch welcomes Dr. Hope Haefner, a leading expert in women’s health, to discuss diagnosis and management of several vulvovaginal diseases.

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CHECK OUT OUR SPONSOR

PearsonRavitz

https://pearsonravitz.com/backtable

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SYNPOSIS

The discussion covers the importance of accurate diagnosis through physical exams and intake surveys, approaches to pain and symptom management, the significance of vestibulectomy, and the implementation of different treatments for conditions such as vulvodynia, lichen sclerosus, and hidradenitis suppurativa. Dr. Haefner emphasizes the importance of early treatment, the multidisciplinary approach in their clinic, the use of different types of steroids for lichen sclerosus, and innovative treatments and diagnostics. She discusses next-step treatments if common treatments aren’t working, such as the “lichen sclerosus cocktail.” Finally, the episode highlights the need for ongoing professional education and provides resources for further learning.

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TIMESTAMPS

00:00 - Introduction

04:21 - Common Symptoms and Initial Diagnosis

07:19 - Examination and Workup

13:44 - Treatment Approaches for Vulvodynia

20:27 - Managing Lichen Sclerosus

32:27 - Products to Avoid

36:29 - Anoscopy for HPV

40:34 - Addressing Hidradenitis Suppurativa

44:39 - Final Thoughts and Resources

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RESOURCES

Resources for Everything Vulvovaginal Disorder (by Dr. Haefner):

https://www.dropbox.com/sh/r8nhr1j8c19tn9n/AACRLvxGGSgEtZCi6Zzh-yBQa?e=2&dl=0

OBGYN Brief - Definition and Diagnosis of a Clinical UTI

Cultures are key when it comes to managing UTIs. In this brief, Dr. Anne Cameron discusses the definitions, symptoms, prevalence, and management of urinary tract infections (UTIs). They delve into the differences between bladder infections and kidney infections, the importance of symptomatology along with bacterial evidence for proper diagnosis, and the higher susceptibility of women to UTIs compared to men. The brief emphasizes the complexities of recurrent UTIs, including the challenges in treatment due to improper antibiotic use, persistence of infection, and anatomical or physiological risk factors. Dr. Cameron also explains the necessity of urine cultures in ensuring effective treatment and the various factors that contribute to recurrent UTIs.

TIMESTAMPS

00:00 - Introduction

00:15 - Definitions and Symptoms of UTIs

01:49 - Prevalence of UTIs in Women and Men

02:44 - Recurrent UTIs: Definitions and Challenges

04:48 - Investigating and Treating Persistent UTIs

CHECK OUT THE FULL EPISODE

BackTable OBGYN Ep. 42 - Recurrent UTIs: Controlling Those Nasty Little Bladder Infections

https://www.backtable.com/shows/obgyn/podcasts/42/recurrent-utis-controlling-those-nasty-little-bladder-infections

Women’s health has a history of being underfunded in the United States, leading many women to receive suboptimal care. In this episode of the BackTable OBGYN podcast, hosts Dr. Mark Hoffman and Dr. Amy Park engage in a detailed discussion with Dr. Louise P. King, a minimally invasive gynecologic surgeon, and Christopher Robertson, a law professor at Boston University, regarding the inequitable reimbursement structures that persist within the field of OBGYN.

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SYNPOSIS

The guests emphasize the systemic discrepancies between gynecologic and other surgical disciplines. The conversation delves into the origins of these disparities, the complexities of revising current codes and creating new codes, and potential legislative and legal remedies to address gender-based inequities. The guests also stress the importance of patient care outcomes and the role of proper reimbursement in enhancing healthcare delivery.

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TIMESTAMPS

00:00 - Introduction

06:28 - Background on RVUs and Disparities in OBGYN

12:39 - Gender Disparities in Medical Billing

18:00 - Efforts to Address Inequities

31:22 - RUC Structure and Surgical Specialties

32:42 - Billing and Reimbursement Inequities

35:15 - Diagnosis Related Groups

36:42 - Turnover Times and Gender Disparities

40:21 - Advocacy and Legislative Solutions

48:23 - Legal Approaches for Change

52:44 - Conclusion

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RESOURCES

Watson KL, King LP. Double Discrimination, the Pay Gap in Gynecologic Surgery, and Its Association With Quality of Care. Obstet Gynecol. 2021 Apr 1;137(4):657-661. doi: 10.1097/AOG.0000000000004309. PMID: 33706362.

Robertson, Christopher T. and Kupke, Annabel and King, Louise P., Structural Sex Discrimination: Why Gynecology Patients Suffer Avoidable Injuries and What the Law Can Do About It (May 9, 2024). Emory Law Journal, Forthcoming, Boston Univ. School of Law Research Paper Forthcoming, Available at SSRN: https://ssrn.com/abstract=4800783 or http://dx.doi.org/10.2139/ssrn.4800783