When one of her young cancer patients wants to have a baby, gynecologic oncologist Rahel Ghebre, M.D., will send her to colleague Kirk Ramin, M.D., who specializes in high-risk pregnancy.
June LaValleur, M.D., who specializes in mature women’s health, has steered patients with new cancer diagnoses to Ghebre. And cancer specialists with midlife and older patients experiencing sexual function concerns have referred those patients to LaValleur.
These are just a few examples of how faculty members in the Department of Obstetrics, Gynecology, and Women’s Health at the University of Minnesota collaborate to serve patients from young womanhood through maturity. “It’s seamless,” LaValleur says.
In the past, obstetric and gynecologic care was mainly associated with treating women in their childbearing years. Today, the department offers continuity of care—and guidance on a vast array of health issues—throughout the lifespan.
LaValleur says she appreciates “having colleagues that I absolutely trust to deliver the same kind of care that I would want to have delivered to me, or to my family.”
Protecting young women’s health
Starting in puberty, patients can avail themselves of expertise in adolescent gynecology and teenage women’s health. The department has played a major role in promoting the health of young women through its ongoing testing of vaccines to prevent the human papillomavirus (HPV). HPV is a sexually transmitted infection and is the most common cause of cervical cancer. Approved for use in girls and women ages 9 to 26, the vaccine is most effective when given to girls before they become sexually active.
Carolyn Torkelson, M.D., M.S., assistant professor of family medicine and community health, sees many patients in their late teens and early 20s. She says some are under intense pressure, juggling schoolwork, employment, and extracurricular activities—while lacking sleep and good nutrition. “It’s a prescription for disaster,” she says.
“They think they’re handling it. Then it manifests as a physical complaint,” such as gastrointestinal distress, Torkelson says. She uses a holistic approach, drawing upon both Western and complementary and alternative medicine, to help young patients develop good self-care skills.
Torkelson adds that the University’s Deborah E. Powell Center for Women’s Health, a nationally designated Center of Excellence in Women’s Health, has fostered unprecedented collaboration across departments and disciplines, which has made more resources available to female patients of all ages.
The age of motherhood
Some of the department’s work stems from evolving expectations concerning age and aging. According to the National Center for Health Statistics, childbearing by women in their 30s and 40s continues to increase.While older women bring assets such as life experience and greater maturity to parenthood, they’re also more likely to face significant health issues in pregnancy.
“If you go into a pregnancy healthy and fit, even over 40, you can do fine,” Ramin says.
But 40-something moms are more apt to encounter fertility problems and higher rates of multiple births, such as twins or triplets, he says. They also are more likely to confront diabetes, as well as preeclampsia, stroke, and other blood-clotting disorders.
Ramin would like to see family physicians, obstetricians, and gynecologists trained to teach patients to get in shape well in advance of planning a pregnancy. A preconception consultation could help prevent some of the more common complications that make a pregnancy high-risk, Ramin says.
Changing norms
In generations past, women in their 50s might have been gearing up for retirement—if they had held paid employment. Today, they may well be in the prime of their careers, and part of the “sandwich generation” with children at home and aging parents who need care, all while dealing with the challenges of menopause.
“They’re facing that midlife issue of looking at your life: where have you been, where are you, and most importantly, where are you wanting to go,” LaValleur says.
The combination of these factors can make hot flashes, night sweats, and other menopausal symptoms that much more burdensome, LaValleur says. She’s grateful to be able to call upon psychologist Sue Petzel, Ph.D., to help patients struggling with mental and emotional well-being.
For many patients in midlife, osteoporosis is also a real risk. Ghebre says she and her colleagues try to educate patients about important lifestyle choices they can make to prevent or mitigate it.
“Osteoporosis is very diet-dependent,” Ghebre says. “We try to make patients aware of calcium and vitamin D intake, exercise, and nutrition to help them maintain bone density.”
A focus on wellness
Through wellness education and outreach, faculty physicians in the Department of Obstetrics, Gynecology, and Women’s Health are reaching out to the community to help improve the lives of women, whether they’re 18 or 80.
Ghebre says wellness promotion is a major focus of the department. “One of the biggest cancer prevention strategies is helping women quit smoking,” she says. “Most people understand that smoking is directly linked to lung cancer but don’t know that it also increases your risk for other subtypes of cancer such as cervical cancer and bladder cancer.”
People who smoke suffer other morbidities, as well, including cardiovascular disease, premature aging, and premature failure of the ovaries, Ghebre adds.
Torkelson emphasizes the impact of nutrition and fitness, or lack thereof, on issues ranging from headaches to heart disease.
