Women's Health Under the Hood
Frank talk about reproductive health
Thanks to the innovations in modern medicine, women have more options than ever to help overcome gynaecological health issues.
Dr. Ebru Alper, based in Istanbul's American Hospital is a prominent OBGYN who focuses on in-vitro fertilisation (IVF), pregnancy and delivery, menopause, sexual dysfunction, painful intercourse, genital aesthetics, incontinence, vaginal rejuvenation and gynaecological laser therapy.
She talked to us about her practice and some common gynaecologic health issues that women visit her to discuss and treat.
YOUR BODY AFTER MENOPAUSE
As resilient as our bodies are, there are inevitable changes with age and other life events. A key area of focus for Dr. Ebru is menopause. "A woman is considered in menopause when she has not menstruated in over a year. With this change comes a decrease in oestrogen and progesterone levels in the ovaries which results in hot flashes, vaginal dryness, vaginal atrophy and a lowered libido," Dr. Ebru explained.
The lower one-third of the urethra is sensitive to oestrogen and when there is a drop in levels, women will dry out, which causes irritation and discomfort, even itching. This may also result in labial thinning and tears.
Of course, many of these menopausal symptoms occur around the age of 50, but you will also see women in their mid-30s coming in with symptoms of perimenopause.
TREATMENTS & RELIEF FOR MENOPAUSE
The good news is that current treatment does not focus exclusively on hormone therapy. In Turkey, there is local oestrogen that can be used as well as non-hormonal treatments like hyaluronic acid supplements.
For dryness, local androgen hormones are a common treatment option, but since they are not available in Turkey, laser therapy is suitable for atrophic symptoms. This is a better option for patients with breast cancer as they can’t even use localised hormone therapy.
Vaginal laser therapy allows tissue to heal and regenerate. What’s great about the therapy is that there’s no anaesthesia required, there’s no downtime and the results last one to one-one and a half years after the procedure has been done.
Laser therapy is also an effective treatment for incontinence. Pelvic floor muscle exercises such as kegels, or inserts are very helpful to repair and restore the muscles in the pelvic region, however there are certain activities and exercises that produce a lot of downward pressure which could make any type of urinary incontinence worse. "It is quite common for young women after having two natural deliveries to have leakage when she sneezes or coughs or laughs, so laser therapy would be the best option in her case," advises Dr. Ebru.
"The procedure involves three laser treatments and the results last anywhere from one to one-and-a-half years. If necessary, and based on an individual's anatomy, patients can get additional yearly treatments," she explained.
Another treatment that has been more commonly used in orthopaedics and dermatology is Platelet-Rich Plasma (PRP) Therapy, which can be used for vaginal tears. PRP uses injections of a concentration of a patient's own platelets to accelerate the healing of injured body parts or for regrowth in others. Women are especially vulnerable after menopause and PRP is used for skin rejuvenation to promote cellular growth and regeneration, Even though the results are not proven it is still used in many fields such as for the uterus, in IVF and for the ovaries.
LOSING THAT LOVING FEELING
Dr. Ebru said that during menopause, women who are sexually active may have issues with intercourse—the major problem being that women don’t want it and they try to avoid it. "The result is that their partners may complain and through that discussion and through examination it’s revealed they may have some larger issues such as a urinary tract infection, cystitis, or challenges due to physical issues with their urethra."
Another common issue is sexual dysfunction or a lack of sexual desire or enjoyment. "First off we discuss what other reasons may be leading to these issues. Sometimes it’s a misunderstanding between a couple, or it could be an organic issue like a tear, a loose vagina, dryness, or infection." This means that Dr. Ebru also has to be a good listener and factor emotional or psychological factors that could have an impact on physical symptoms.
FROM IVF TO EGG FREEZING
IVF has been a blessing to many people who are ready to start a family. Nowadays egg freezing has become a viable option for women who are considering a family down the road. Egg freezing is permissible in Turkey under certain circumstances. You do have to get proof from a university physician that you have poor ovarian reserves, that there is potential for risky conception, or there’s a family history of premature menopause. After that time you can start the procedure. Otherwise, if there is any other type of issue such as a malignancy or chemotherapy where it could potentially harm the egg count or the quality of the egg, then some women will be given permission to freeze their eggs before hand.
These are just some of the health issues for which Dr. Ebru treats patients. Luckily, there are more options now that allow women to get help. feel better and not suffer in silence.
Ebru Alper M.D., has patients travelling from all corners of the world to seek her expertise on obstetrics, gynaecological and reproductive health issues. She is fluent in Turkish, English and German.