Pelvic Organ prolapse is a condition where the uterus (womb), bladder or rectum sag or slips out of its normal position. In the U.S. pelvic support defects are relatively common and increase with age. One study of 16,000 patients found the rate of prolapse to be 14.2%. The average age of women who choose to undergo surgery for prolapse is 54.6 years.

Causes of prolapse are varied and may include:

• Vaginal delivery with a large baby
• Difficult labor and delivery
• Reduced muscle tone from aging
• Lower circulating estrogen after menopause
• Family history of prolapse
• Any activity that increases intra-abdominal pressure (frequent heavy lifting, chronic cough, straining to have bowel movements)

Four stages of prolapse are usually defined:

• Stage I:  Descent within the vagina (MILD and asymptomatic)
• Stage II:  Descent to the opening of the vagina
• Stage III: Descent beyond the hymen BUT not completely out of the vagina
• Stage IV: Descent completely out of the vagina

Women with mild prolapse have no obvious symptoms and generally do not seek treatment. However, as prolapse worsens it may cause a variety of symptoms which may include:

• Pelvic pressure (described as heaviness or pressure in the pelvis)
• Pelvic pain discomfort in the pelvis/abdomen/lower back
• Pain with sexual relations
• Protrusion of tissue from the opening of the vagina
• Constipation
• Difficulty with urination

Symptoms may be worsened by prolonged standing or walking due to the pressure placed on the pelvic muscles by gravity.

Currently there are no proven ways to reverse prolapse. The condition is managed either non-surgically, surgically or a combination of the two.

If you would like to discuss management and/or treatment of prolapse, please make an appointment with Dr. Audrey Romero, our on staff board-certified urogynecologist, for a detailed discussion on your best options.

In our last few issues of our newsletter, we asked for your feedback on common and uncommon menopause symptoms from real women. Below is a summary of the most popular responses we received, followed by an article on hot flashes during menopause:

Menopause symptoms by "real women":

• Night sweats

• Hot flashes (also heightened due to blood pressure medication)

• Insomnia

• Forgetfulness

• Pain & dryness during intercourse (one reader experienced remarkable results and an alleviation of pain and dryness after taking Osphena). 

• Acne for the first time

• Painful pap smears after menopause due to dryness

We thank the women who provided feedback on this topic. We hope it's helpful to know that some symptoms are common and many women are having similar experiences.

Menopause symptoms: hot flashes

The average age to start menopause is 51 and hot flashes affect 50 to 75 percent of women. Woman can start to experience symptoms 3-10 years before a complete loss of menstruation.

According to a new study published in JAMA International Medicine, in some cases, hot flashes may last up to 14 years.

In the largest study of its kind, researchers looked into the symptoms of a racially, geographically and ethnically diverse group of 1,449 women reporting frequent hot flashes. Half of the study subjects experienced hot flashes for up to 14 years, and those who started hot flashes earlier in life had them for a longer time - which was the vast majority of women.

For 80% of those who experienced hot flashes before they lost their periods entirely, the duration of symptoms was roughly 11.8 years.

Hot flashes are a result of ovaries starting to slow down and a change in hormones as estrogen levels are reduced.

Some ways to alleviate hot flashes:

• Dress in layers

• Use cooling clothes

• Lower room temperatures

• Avoid spicy foods

• True to manage stress

• Doctor prescribed medications

• Hormone replacement therapy

• Try homeopathic remedies such as acupuncture or soy

The good news is hot flashes tend to slowly decrease in intensity over time after your final menstrual period.

Aetna  announced a few weeks ago that they were unable to reach a new agreement with St. Barnabas regarding insurance participation and therefore patients with Aetna insurance would be considered "Out Of Network" at St. Barnabas, effective March 1.  Aetna began to send letters of notification to their subscribers. This has since changed.

Following this original announcement, Aetna and St. Barnabas have come to an agreement that St. Barnabas will remain in -network with Aetna.  Patients who have Aetna and were planning on using St. Barnabas for a delivery or surgery, can be alleviated of any concerns regarding "Out of Network" treatment.

Read below for the formal announcement:
 

PARSIPPANY and WEST ORANGE, NJ, February 26, 2015 - Aetna (NYSE: AET) and Barnabas Health, New Jersey's largest not-for-profit integrated healthcare delivery system, today announced a new multi-year contract agreement that will be effective on March 1.  Aetna members who receive care at any of the Barnabas Health hospitals and facilities, or from physicians of the Barnabas Health Medical Group will continue to be covered at the in-network level of benefits.  As a result of this agreement, there will be no disruption in coverage.

"This agreement means that Aetna members will continue to have uninterrupted access to care at all previously participating Barnabas Health facilities and physicians," said Michael Costa, Aetna vice president, New Jersey Network. "We look forward to continuing to work with Barnabas Health and building on our solid relationship and shared goals of excellent quality and affordable health care." 

The agreement also includes covered outpatient services provided by Barnabas Health facilities including the System's highly advanced Barnabas Health Ambulatory Care Center in Livingston, N.J.; and state-wide services of Barnabas Health Behavioral Health Network, as well as hospice, home care, and infusion services.  www.barnabashealth.org

Pinot's Palette, an upscale entertainment art studio recently opened in downtown Summit, is a pioneer of the paint and sip experience - a revolutionary way to enjoy art and wine, meet new people and bond with friends.

Mayor Ellen Dickson and Dr. Rubino, Council President, participated in the ribbon cutting ceremony and first class during the soft opening last Friday. Dr. Rubino shares, "What an original way to spend an evening. I thoroughly enjoyed escaping for 2 hours pretending I was an artist."

Guests enjoy a no-experience-required art class-all supplies included-directed by trained, local artists, who guide guests step-by-step through a featured painting. By bringing fun, modern and creative ideas to their events, Pinot's Palette curates a unique, rewarding experience while providing a worthwhile contribution to the community. For more information, visit www.PinotsPalette.com/Summit

Following is an excerpt from an article in a summary journal from Yahoo Health:    

Eating an over-abundance of sugar is easy. Sugar, on its own, can be quite functional in foods, adding sweetness and acting as a natural preservative in foods like jam or aiding in the brown color in bread crusts.  

The root of the problem is this: We just eat too much of it. Americans have a sweet tooth, and it's likely contributing to our expanding waistline simply because of the extra calories it provides. There's also evidence that this overconsumption of sugar is contributing to other problems, such as diabetes and cardiovascular disease. 

The average American consumes about 20 teaspoons of sugar a day, which equates to 320 calories. It's recommended that the average woman consume no more than 100 calories a day from added sugar (about 6 teaspoons), while men consume no more than 150 calories a day from added sugar (about 9 teaspoons).

Here are three steps to start to put sugar back into its proper place in your diet:

Step 1: Learn to visualize sugar content in teaspoons.

Sugar is listed in grams on food labels, which is not very useful for most Americans - it's a measurement we don't have visual cues for, because we cook using standard measurements such as cups and teaspoons. It can be very helpful, not to mention eye-opening, to do a quick math equation using this formula: 4 grams of sugar = 1 teaspoon of sugar

When you remember this equation, it suddenly becomes very easy to visualize how many teaspoons of sugar you might be consuming. Here are some examples of commonly consumed foods or beverages:

• One packet of sugar: 4 grams = 1 teaspoon
• One tablespoon of flavored coffee creamer: 5 grams = 1 ¼ teaspoons
• One bottle of Starbucks Vanilla Frappucino: 31 grams = 7 ¾ teaspoons
• One can of Cola: 33 grams = 8 ¼ teaspoons
• 32-ounce fountain soda with ice: 91 grams = 22 ¾ teaspoons
• One cup of cookie-dough ice cream: 50 grams = 12 ½ teaspoons

Step 2: Shave off sugar where you can.

Despite some popular fad diet warnings, it's not necessary to rid your diet of sugar entirely. However, most of us do need to reign it in a bit, and use our recommended sugar allowance more strategically. Simple swaps are helpful  - choosing water over a can of regular soda, for example, shaves off about 140 calories. Choosing lower sugar breakfast cereals, using less flavored creamer in your coffee and snacking on unsalted almonds instead of an energy bar are all painless ways to trim away the sugar grams without feeling deprived. 

Step 3: Put your taste buds in training.

Our taste preferences are adjustable and trainable, to a point. While all humans are born with an innate preference for a sweet taste, we develop a threshold of preference for sweetness based on what we typically eat. We can also develop a fondness for less sweet foods, with patience - very few people like the taste of black coffee or unsweetened tea on the first try, but they develop a preference for the unsweetened version over time. 

You might need to consciously put your taste buds into a training program if you don't like the taste of less-sweet foods initially. For example, say you typically squeeze a generous dollop of honey into your morning smoothie. Experiment with adding half your usual amount for a few mornings, giving yourself time to adjust to the level of sweetness. Adding spices instead of sugar can also help train your taste buds to enjoy different, no calorie tastes.

Part of this training program is also consciously trying to develop your palate's appreciation of the other types of taste - that is, consuming foods that are savory, bitter or sour. If you like flavored yogurt, for example, try buying unsweetened yogurt and adding a small amount of fruit and honey to begin appreciating the natural sour taste of plain yogurt. 

 The Rubino OB/GYN Group On LinkedIn

Pay Your Bill Online

You can pay your Rubino OB/GYN Group bills online right from the homepage of our website. Simply click on the button at the top of the page that says "New! Pay Your Bill Online!".

Options include paying by credit card or  echeck. It is an easy one-time registration to create a password.

For easy reference, the direct link is: Pay My Bill. 

We hope you enjoy seeing the practice on a more personal level and welcome your feedback! Simply reply to this newsletter.