Women’s Health with Dr. Huh

Black women in Alabama are three times more likely to die from pregnancy-related causes than white women.Audra Williams, M.D., and prenatal nurse navigator Jasmine Maye discuss the clinical and socioeconomic hurdles to improving Black maternal health, as well as the programs making a positive difference.

Occasional exhaustion is normal during and after pregnancy, but it's important to watch for signs of emerging mental health conditions. In Part 2 of their discussion on perinatal mental health, Dr. Huh, Rachel Fargason, M.D., and Katie Orr, M.D., explain key warning signs, available treatments, and how loved ones can provide meaningful support. They emphasize that the best approach is often a combination of medical and non-medical therapies.Resources:UAB Community Psychiatry Program: 205-934-4108UAB Comprehensive Addiction in Pregnancy Program (CAPP): 205-934-5795UAB Beacon Recovery Program: beacon@uabmc.edu; 205-917-3733Postpartum Support International: www.postpartum.net; Helpline: 1-800-944-4773National Maternal Mental Health Hotline: 1-833-852-6262

Up to 85% of women experience postpartum mood disorders. Rachel Fargason, M.D., and Katy Ashley Orr, CRNP, join Dr. Huh to discuss perinatal mental health and explain the differences between temporary “baby blues” and more serious mental health conditions. Learn how to recognize the signs of postpartum depression and anxiety, key risk factors, and when to seek support. Stay tuned for part 2, when the panel will discuss perinatal mental health treatment options and resources.

Hormone replacement therapy (HRT) is generally a safe and effective way to relieve numerous symptoms and risks related to life after menopause. Gretchen Wells, M.D., a cardiologist with expertise in women's heart health, joins Dr. Huh to give context to a study that created some reluctance among doctors and patients to utilize HRT. Learn what the Women's Health Initiative study actually concluded about HRT; how women can generally lower their risk of cardiovascular disease; and which individual factors determine if HRT is right for you.

Almost every drug and treatment advancement available to you had to be proved safe and effective by way of clinical trials — studies on human participants. Learn the fundamentals of clinical trials from Rebecca Arend, M.D., medical director of the Clinical Trials Office at the O'Neil Comprehensive Cancer Center. She discusses the the stages of clinical trials, important research concepts, and the safeguards for participants. Dr. Arend explains why she believes many patients should seek out clinical trials for their condition.

Do you know the difference between bacterial vaginosis (BV) and a yeast infection? What about trichomoniasis, which has similar symptoms of vaginal inflammation and discomfort? These are the most common causes of vaginitis, and they each have different treatment regimens. Learn more about the common conditions from the physicians who lead the UAB Vaginitis Clinic, Christina Munzy, M.D., and Olivia Van Gerwen, M.D. They discuss the widespread prevalence of vaginitis; different causes and treatments; and how their clinic manages recurrent and severe cases with the latest diagnostic tools.

Menopause is a natural physiological process that can diminish quality of life for some women, usually occurring after age 40. Hormone replacement therapy (HRT) can address many of the symptoms of menopause. However, a series of large studies in the early 2000s pointed to increased risks for breast cancer and heart disease, and many providers and women shied away from HRT. William Hurd, M.D., an expert in reproductive endocrinology and infertility, explains the current – revised – state of knowledge about relative risks and benefits of HRT; how the HRT medications themselves have changed since those studies; and how the needle is moving back in favor of HRT for many women seeking to maintain quality of life.

Clinicians have the ability to eliminate cervical cancer thanks to improved screening and the HPV vaccine. At the same time, mortality rates in our mostly-rural state are roughly the same as they were in 1999. Isabel Scarinci, vice chair of global and rural health, introduces Operation Wipeout, a UAB-led plan that mobilizes civil society groups to encourage screening and vaccination across Alabama. Dr. Huh and Scarinci also discuss the hope that self-sampling for HPV screening could offer for women in rural areas who may not be able to travel to a clinic.

Clinicians have the ability to eliminate cervical cancer thanks to improved screening and the HPV vaccine. At the same time, mortality rates in our mostly-rural state are roughly the same as they were in 1999. Isabel Scarinci, vice chair of global and rural health, introduces Operation Wipeout, a UAB-led plan that mobilizes civil society groups to encourage screening and vaccination across Alabama. Dr. Huh and Scarinci also discuss the hope that self-sampling for HPV screening could offer for women in rural areas who may not be able to travel to a clinic.

Girls and young women (0-18) may have unique gynecological issues, yet there are few pediatric and adolescent gynecologists. Blair Lacy, M.D., one of just four such subspecialists in Alabama, explains her training and the complex considerations of working with young women. She also conveys the importance of her clinic being a safe place for parents to seek specialty care and advice about sensitive issues facing their children.

The pelvic floor is an important muscle structure at the base of the pelvis, and when it is not functioning properly it can cause issues such as painful intercourse, incontinence, and prolapse. Jennifer Fagen, a physical therapist who specializes in pelvic floor physical therapy, discusses how she helps patients address pelvic floor dysfunction through internal exams, education and feedback, and specific tailored exercises. Most of her patients improve their pelvic floor function over time, whether their muscles had been chronically tense or lax.

As many as 85% of gynecologic cancer survivors face sexual health challenges. Learn from Christina Wilson, CNP, Ph.D., about the dimensions of sexual health and how UAB providers approach each case uniquely with an expanding array of treatment options for survivors. She emphasizes that this common and sensitive aspect of survivorship is important to address with your doctor. Wilson encourages patients to think about whether or when to include their partner in planning for the sexual health effects of cancer.

Obstetrical injuries, or those that occur during labor and delivery are more common than patients may realize. Six to seven percent of women undergoing vaginal deliveries will have damage to the anal sphincter muscles, or obstetric anal sphincter injuries (OASIS). Holly Richter, M.D., and Clark Powell, M.D. discuss the complex care required for these injuries and describe their research-backed OASIS care bundle that offers a comprehensive approach bridging obstetrics and gynecology. Learn more about the importance of talking about and addressing OASIS, preferably at an institution that actively assesses quality of care.

More women are choosing to delay childbirth until their late 30s and early 40s. Diedre Gunn, M.D., joins Dr. Huh to discuss the relationship between age and infertility. She describes both the challenges and opportunities for women seeking to conceive beyond the optimal age range. Learn about the circumstances under which you and your OBGYN might consider options such as IVF, use of donor eggs, or freezing eggs and embryos.

First trimester pregnancy losses, more commonly referred to as miscarriages, occur in around 10% of all pregnancies. Dr. Huh is joined by Shweta Patel, M.D., an obstetrician, to share little-known facts about early pregnancy loss that can help patients understand this emotional experience: Why does it happen? What are the risk factors you can and can't control? How can a pregnancy loss be managed according to your wishes? The doctors also discuss how they help patients through feelings of grief and loss amid further family planning.

Women's health providers often deliver unexpected or difficult news to patients who may face an emotional rollercoaster. Dr. Huh discusses this important interpersonal aspect of care with Brian Brocato, M.D., a lead physician of the UAB Comprehensive Addiction in Pregnancy Program (CAPP). The doctors discuss the art of listening and connecting patients with counseling when appropriate; encouraging open communication; helping patients look toward their future realistically; and including other loved ones and family in conversations about grief or family planning after a difficulty. Learn more about the special connection effective women's health providers share with their patients through ups and downs.

Modern obstetrics depends on information gathered by way of ultrasound imaging (also called sonography). Most women will have 2-3 ultrasounds at specific points in their pregnancies as part of normal care. Sheri Jenkins, MD, and Niki Marsh, a sonographer, join Dr. Huh to discuss the ultrasound process and how the scans are used to provide individualized care throughout a pregnancy. Learn more about the rigorous national ultrasound accreditation held by UAB Maternal-Fetal Medicine.

Certified nurse-midwives (CNM) are advanced practice nurses who offer women continuity of care throughout adulthood, including during labor and delivery. Shelia Lopez and Anna Floyd, CNMs, join Dr. Huh to discuss the relaunch of the nurse-midwifery pathway at the UAB School of Nursing, and what it could mean for women's health in our state. Learn more about the broad scope of care CNMs offer and how they work with other OB/GYN providers as the “gatekeepers of normal physiologic birth.”

Obstetricians often refer to the immediate months after you have your baby as the “fourth trimester” because it is an important time to watch for common health issues. Sima Baalbaki, MD, joins Dr. Huh to discuss postpartum depression, healthy breastfeeding, and hypothyroidism, among other topics. Learn why is it important to share all symptoms with your obstetrician even if they don't seem serious. Dr. Baalbaki says that obstetricians help you find your best new normal after delivery, emotionally and physically.

Fourteen thousand women are diagnosed with cervical cancer each year despite the effectiveness of vaccination and screening at preventing the disease. Dr. Huh is joined by Haller Smith, MD, a specialist in gynecologic oncology, to discuss strides in screening that have already reduced cervical cancer by 75%, as well as the obstacles to improving prevention even more. Dr. Smith discusses the latest screening and prevention guidelines, which emphasize the effectiveness of HPV vaccines and testing. The doctors discuss the promise of HPV self-sampling as one screening solution for those with limited access to health care.

Endometriosis affects one in 10 reproductive-age women, but it is a complex and painful disease that often takes its sufferers years to get diagnosed. Richard Burney, MD, division director for Reproductive Endocrinology and Infertility, discusses the causes and progression of endometriosis; methods of diagnosis and treatment; and the related concern of infertility – which can be related to the disease itself and certain treatment options. Learn more about the benefits of working with an interdisciplinary team for endometriosis diagnosis and management.

Minimally invasive surgery has become the preferred approach for many gynecologic procedures, often offering precision and better recovery for patients. Dr. Huh is joined by Todd Jenkins, MD, to discuss the benefits of minimally invasive surgery (i.e., laparoscopic) versus traditional, open surgery. As they cover a range of advancements related to the surgery itself and recovery, they place special emphasis on the precise control that robotic surgery gives a surgeon. The doctors delve into the factors that sometimes still make traditional surgery the better choice for a patient.

The COVID-19 pandemic disrupted many women's preventative care schedules, and you may wonder what recommendations have changed since your last regular visit to the OB/GYN. Dr. Huh is joined by Ashely Wright, MD, who leads the ultrasound service at UAB Medicine. She discusses the current guidelines by age range for the Well Woman Alabama initiative and clears up misconceptions about how often to have pelvic exams, pap smears, and other services that are part of good preventative care for women.Submitted By: Kate Hiden

Around 50 percent of women will experience pelvic organ prolapse in their lifetimes, which occurs when the bladder, uterus, or rectum slips down into the vagina. Gena Dunivan, MD, director of the Division of Urogynecology and Pelvic Reconstructive Surgery, joins Dr. Huh to discuss the many effective treatment options for pelvic organ prolapse, which so many women experience but do not talk about. She emphasizes that a level of treatment should correspond with how much the condition is affecting the woman's life—which could mean lifestyle changes, physical therapy, non-surgical devices, or surgery. The doctors encourage patients to seek only treatments covered by insurance.

Did you know that leftover blood from a clamped-and-cut umbilical cord—which is often discarded—can be used to help treat devastating diseases? Dr. Huh is joined by Brain Casey, MD, and Luis Hernandez, director of cellular therapies at LifeSouth Cord Blood Bank—UAB's partner in collection and storage—to understand the impact of cord blood donation. Publicly registered cord blood, they explain, is full of valuable stem cells that may be used to treat blood and immune system diseases, such as leukemia and lymphoma; these stem cells may also be used in research and clinical trials to help find cures for life-threatening diseases. Learn more about the collection and storage process and how a simple consent form can turn medical waste into life for someone else.

Substance abuse contributes to around half of all maternal deaths in Alabama. Dr. Huh is joined by Suzanne Muir, associate director of the UAB Department of Psychiatry and Neurobiology, and Carolyn Webster, MD, a physician within the UAB Division of Maternal-Fetal Medicine, who are part of the leadership team for the Comprehensive Addiction in Pregnancy Program (CAPP). This program, which treated its first patient in 2018, offers pregnant women and new moms a unique web of support, ranging from standard prenatal care and education to peer support, counseling, and recovery services. Webster and Muir discuss the combination of challenges to addressing addiction in pregnancy and how their program is creating a sense of community and safety for these vulnerable families.

5-10% of pregnant women will develop “gestational diabetes,” meaning they did not already have diabetes. Whether pre-existing or gestational, diabetes in pregnancy requires careful management for the health of mother and child. Ashley Battarbee, MD, whose research expertise is diabetes in pregnancy, joins Dr. Huh to discuss the major concerns and methods for controlling the disease. Diet and lifestyle interventions, insulin shots, and oral medications, along with continuous glucose monitoring, may lower the risk of complications—C-section and birth trauma for the mother, and jaundice and low blood sugar for the child. Find out which pregnant women might need to be referred to a diabetes-in-pregnancy clinic.

Informed by two full years of data, medical researchers have more definitive answers on how COVID-19 affects pregnant women—and vaccination is still the best way to safely avoid related health risks. Dr. Huh updates COVID-19 recommendations for pregnant women with guest-host Akila Subramaniam, MD, the only doctor who is board-certified in both maternal-fetal medicine and genetics in Alabama. Learn more about concerning outcomes that are more likely for pregnant women with COVID-19: mortality, pre-term labor, and still birth. Dr. Subramaniam addresses common misunderstandings about how vaccines work on pregnant women and affect their babies. The doctors also review effective treatments for COVID-19.

Women should look for ways to initiate or continue exercising throughout pregnancy,' says Chase Cawyer, MD. Dr. Huh is joined by both Dr. Cawyer and Sara Gould, MD, to discuss general benefits and guidelines for exercising during pregnancy. They also address specific questions about safe maximum exercise intensity that still need further research. Learn more from them about the ways that UAB's new Exercise in Pregnancy Clinic uses innovative techniques to measure fetal well-being during exercise to personalize plans, especially for women with risk factors, who may benefit most of all.

The most common cause of bankruptcy in the United States is healthcare costs. The financial consequences of receiving cancer treatments can be as harmful as some of the physical side effects of treatment. Simply having insurance coverage is often not enough. “Financial toxicity” as a point of consideration for patient research and care is just recently making it into the medical literature. Margaret Liang, MD, who authored some of the first studies on the primary causes and effects of financial hardships on patients, joins Dr. Huh to discuss the key questions patients can ask their care team to lessen the impact of financial toxicity.Resourceshttps://www.patientadvocate.org/explore-our-resources/education-resource-library/https://www.cancer.net/sites/cancer.net/files/cost_of_care_booklet.pdfhttps://www.cancer.org/treatment/finding-and-paying-for-treatment/understanding-financial-and-legal-matters/managing-costs.htmlhttps://www.emot-econ.orgEvery gift makes a difference in the O'Neal Comprehensive Cancer Center's mission to eliminate cancer as a public health concern. There are many ways you can support this work at www.uab.edu/onealcancercenter/giving.

Dr. Agnes Oberko and Dr. Jodie Dionne-Odom lead an interactive discussion on Syphilis in Pregnancy.

Brief overview of various contraceptive methods, including efficacy and dosing, but with focus on the beneficial "side effects" of each method, whether menstrual suppression, acne management, or relief of pelvic pain.

Dr. Isuzu Meyer explains the different types of urinary incontinence, symptoms, and treatment options.

Dr. Theresa Caridi discusses  UAE, who a good candidate for UAE would be, and common misperceptions about UAE for fibroid disease.

Paige Porrett MD provides an update on the UAB uterine transplant program, including indications, current state, and future challenges. Listen as the specialists from UAB Medicine share and advocate for this innovative therapy.

Dr. Michael Straughn, Jr. and Dr. Teresa Boitano discuss how to reduce opioid use and other pain treatment options for gynecologic surgery.

In this panel discussion, Dr. Arbuckle, and Dr. Sukhkamal Campbell discuss oncofertility.

Welcome to our introductory podcast with Dr. Huh. He'll talk about how the podcast came to be, his background and women's health care at UAB.

Dr. Rachel Sinkey and Dr. Audra Williams share their insight on the COVID vaccination and the effects on pregnancy and lactation.