TODAY’S DOSE OF HONESTY

3 things THIS doctor would never do.

I get asked questions like this frequently, on my Instagram feed (@drjashton) or when I’m out and about: “As an OB-GYN, what are the things you would never do?” There are quite a few, but here are my top 3:

1

Without a doubt: I would never douche. 

Actually, I find it jaw-dropping that douches are still available on the market. Not only are they totally physiologically unnecessary, but they can also cause harm, in numerous ways. Despite this, an estimated 20-40% of American women between ages 15 and 44 say they use a vaginal douche. Higher rates are seen in teens and African American and Hispanic women.

To begin with, the very idea that the vagina needs “cleaning” is absurd. Your vagina is not a waterpark; it doesn’t need to be flushed, irrigated, or cleansed. Why? Because one of the jobs of the cervix is to secrete mucus that literally does this for a living. In addition to removing suboptimal organisms or substances (like blood), cervical mucus is also responsible for keeping the vaginal microbiome in a state of relative equilibrium, where various organisms (good bacteria, like Lactobacilli species) live in peace with one another. 

Part of how cervical mucus does this is by keeping the pH of the vaginal microbiome stable. While many things can and do disrupt this pH (like menstrual blood, semen, lubricants, saliva, and even diet), one of the fastest and easiest ways to disrupt vaginal pH is douching. Many douches contain ingredients other than water that can really alter this fragile environment. There is also the possibility that forcefully pushing water into the vagina could introduce vaginal bacteria into the uterus and even the fallopian tubes or peritoneal (internal) cavity and cause infection. 

And there’s more. Women who douche more than once a week have more difficulty getting pregnant than those who don't douche. Douching may increase the risk of ectopic pregnancy by as much as 76%. Research has also found that women who douche may have a 73% higher risk of getting pelvic inflammatory disease (PID), an infection of the uterus, fallopian tubes, and/or ovaries. And a 2016 study published in The Journal of Infectious Diseases linked vaginal douching with an increased risk of genital human papillomavirus (HPV) infection, particularly the high-risk types associated with cervical cancer.

Bottom line: Save your money and vagina, and don’t douche.

2

If I had a uterus, which I do, I would never take estrogen without also taking a progestin (progesterone). 

Usually, this comes up with respect to hormone replacement therapy (HRT) for the treatment of menopausal symptoms. Women who take unopposed estrogen (without progestin) face a real and significantly increased risk of developing endometrial hyperplasia, which is a precursor to endometrial cancer.

Here’s why: There are two main hormones that women produce, estrogen and progesterone, and they work very differently but mutually in the uterus. Think of estrogen as the “building blocks” of the lining of the uterus, kind of like bricks. Now think of progesterone as the glue or cement that holds those bricks together. Both hormones have to be in the right balance to stabilize the uterine lining to prevent any irregular bleeding. Too much progesterone will thin out the lining; too much estrogen will fluff it up. Endometrial hyperplasia is basically an abnormal fluffiness of the uterine lining caused by too many bricks and not enough cement. Therefore, any woman taking HRT for menopause symptoms who still has her uterus MUST take progesterone in some form to protect the uterine lining. To clarify: This doesn’t necessarily mean at the exact same time of day, or even the same form (oral/pill, cream, patch, or IUD). It just means that if someone takes estrogen in pill, patch, or transdermal cream form, there must also be some progesterone present if there is still a uterus in the mix.

Note: Vaginal estrogen does not require the administration of a progesterone. Also, a progesterone-releasing IUD is considered acceptable protection against endometrial hyperplasia for women who are taking estrogen in pill, patch, or transdermal cream form.

3

If I cared at about my fertility,
I would never vape or smoke. 

Even if I were not planning or thinking of becoming pregnant for years, vaping or smoking is quite literally the worst thing a woman can inflict on her future fertility. 

Yes, vaping and smoking are bad for the heart, brain, mouth, lungs, and blood vessels too, but these behaviors are a grenade to the ovaries and fallopian tubes for two simple reasons: Vaping/smoking dramatically ages the ovaries and accelerates menopause and ovarian failure. And the chemical ingredients in e-cigarettes or combustible (standard) cigarettes paralyze the tiny hairs (called cilia) that line the fallopian tubes and serve as a conveyer belt to transport a fertilized egg from the tubes to the uterus. Let me restate that: Vaping/smoking stops the movement of cilia dead in their tracks, thereby interfering in a key step in the fertilization/implantation process that results in pregnancy.

That said, 12.7 percent (A LOT) of American women smoke regularly, and nearly 24 million women under the age of 44 use e-cigarettes. Obviously, women who smoke do somehow manage to conceive, but it’s dangerous on many levels. I recently spoke to one of the top infertility doctors in the world who said, and I quote, “We don’t even fully understand the damage to the ovaries from vaping, but we do think that the consequences in 5-15 years on all these young women who vape is going to be horrible, unlike anything we have ever seen.” That means there are actually two risks to vaping/smoking when it comes to fertility: a present risk (paralysis of the cilia) and a future risk (accelerating menopause and decreasing ovarian reserve—how many viable eggs are in the ovaries) that may not reveal itself for years. 

So, protect your fertility and do not vape or smoke, and if you do, make it your priority to quit. Today.

My 6-month Fitness Challenge update!

I am now 6 weeks into my 6-month experiment, and I have a lot to share!

First, my once-chronic back pain is now gone. Completely! My strength work on the asymmetry that was at the root of this pain has been incredibly effective. I will share these exercises that have been helpful for my back in next week's newsletter. 

Also, remember when I shared that my weight actually increased by 5 pounds? Well, my trainer, Korey Rowe, helped reassure me that this was due to a) more muscle mass and b) cellular inflammation and the resulting water retention from the hard and intense training I was doing. Nevertheless, it was a bit of a mental struggle for me to accept this. 

Two days ago, I returned from a week’s vacation in Italy. Yesterday morning, I weighed myself and was shocked to see that I actually LOST 4 pounds during that time. I attribute that to two main factors: 1) Unfortunately, because of my life-threatening nut allergy, I had to avoid all bread and desserts while in Italy. This was not my choice but rather a necessity because of the presence of almonds in many foods on the Amalfi coast. And 2) I exercised 5 out of 7 days while I was away, but these workouts were not as intense as my sessions with Korey. That gave my body the chance to recover from the muscular inflammation and swelling and, therefore, allowed the few pounds of resulting water weight to dissipate.

Today, when I worked out with Korey, I felt rested and stronger than ever. I learned to trust my body again, to enjoy vacation without undue stress and pressure, and also, to trust the expertise of Korey! And for the first time in my life, I enjoyed my vacation time without feeling that I was undoing anything that I had started prior. I ate lots of vegetables, fruit, and fish, had a little fresh pasta and a few Aperol Spritz's, walked and swam a lot, and loved every second. Ciao!

SYMPTOM SOLUTIONS

Traveling? Here’s how to prevent THIS scary thing from happening.

For many of us, plane travel is a necessity—for work, for leisure, for family events both joyful and sad. For me, it seems I’m in the air at least once every week! And while there are a number of things that make people uneasy about flying (tight quarters, middle seats, delays and, of course, accidents), this one is more insidious because it happens inside our bodies, and without warning. It’s a blood clot, which can lead to a medical condition that could be fatal.

Clots can occur in veins or arteries. Here, we’re concerned about veins. These low-pressure vessels carry deoxygenated blood from the body's organs to the heart, where it is enriched again. An abnormal clot in a vein may restrict blood flow back to the heart; blood subsequently gathers behind the clot, which can lead to pain and swelling. Deep vein thrombosis (DVT) is a type of clot that forms in a major leg vein or another large vein in the body.

Here’s the scary part: A DVT may detach from its point of origin and travel through the vein to the heart and then to the lungs where it gets stuck, preventing adequate blood flow. This is called a pulmonary embolism (PE). And it can be extremely dangerous. According to the American Society of Hematology (ASH), DVT/PE affects as many as 900,000 people in the U.S every year and kills up to 100,000. Despite the prevalence of this condition, the public is largely unaware of the risk factors and symptoms of DVT/PE.

So, why am I talking about plane travel and blood clots in the same breath? It’s the SITTING.

Among a long list of risk factors for DVT/PE (which includes age, family history, smoking, diabetes, obesity, heart disease, and certain cancers), immobility, such as happens after a stroke, during extended bedrest following surgery or illness, or with obesity, is a big one. Prolonged inactivity—when you’re stuck in a plane seat for hours, for instance—can trigger DVT/PE too. On flights, bus rides, or car rides of 4-6 hours or more, DVT/PE may be a risk for anyone but in particular for those who have some of the previously mentioned risk factors. In planes, changes in cabin air pressure, immobility due to cramped seating, and dehydration can all contribute, and being obese puts you in more significant danger.

The good news: Clots during travel can be prevented. In fact, according to ASH, they are one of the most preventable types of blood disorders, but it takes action on your part.

• First and foremost, talk to your doctor; if your journey will be more than 4-6 hours, they may recommend wearing compression socks or prescribe an anticoagulant if you have risk factors for DVT/PE.

• Drink plenty of water before and during your flight or ride. While it might prompt a need to use the restroom more, staying hydrated is important to keeping your blood oxygenated and flowing properly.

  

• Similarly: Avoid alcohol and caffeinated beverages, which are diuretics. If you must indulge, bring a large water bottle with you and sip often.

• Choose an aisle seat on the plane so you can stand up and walk around often. If you’re in a car, take regular breaks for stretching and short walks.

• Exercise your calf muscles and stretch your legs while you're sitting. Calf raises, foot flexes, and marching your legs help keep your blood flowing.

• Use overhead bins for storage. Your mobility is even more limited if there is a bunch of stuff near your feet.

• Hormones such as those in HRT and birth control pills are known to increase the risk of clotting. So, women who are on hormones should take extra precautions to minimize the risk of DVT/PE during travel. Talk to your doctor for guidance.

How do you know when you might have a blood clot? It depends on where the clot is located, but some of the most common symptoms include:

• In the heart: Chest heaviness or pain, discomfort in other areas of the upper body, shortness of breath, sweating, nausea, lightheadedness.

• In the brain: Weakness of the face, arms or legs, difficulty speaking, vision problems, sudden and severe headache, dizziness.

• In arms or legs: Sudden or gradual pain, swelling, tenderness, unusual warmth.

• In the lungs: Sharp chest pain, racing heart, shortness of breath, sweating, fever, coughing up blood.

• In the abdomen: Severe abdominal pain, vomiting, diarrhea.

If you experience any of these symptoms after a long flight or vehicle ride, call your doctor immediately. If you are enroute, ring a flight attendant for help; if you are in a vehicle, stop and seek medical assistance.

COMMUNITY

“Do toe spacers work? Or are they just a gimmick?”

Truthfully, I never thought much about toe separators, except the ones nail techs use when I get pedicures! But on my recent summer vacation, my friend shared that her husband is using them to allegedly help with hip realignment. That seemed to be quite a claim, so I did some investigation. Here's what I learned.

What are they?

Like those we wear during toenail painting at the salon, toe separators (also called toe spreaders or toe spacers) do just that—separate the toes. They serve a variety of needs, but I want to focus on their medical uses. From a medical standpoint, toe separators are intended to treat people who suffer from common toe conditions including bunions, hammertoes, and overlapping toes. They may also be recommended for people who suffer from other conditions that affect the toes and feet, such as arthritis, plantar fasciitis (the most common cause of heel pain), and metatarsalgia (inflammation on the ball of the foot).

One search online, and you’ll discover dozens upon dozens of brands, styles, and constructions, all claiming to bring healing relief to painful toes and feet. Toe separators come in various materials, including gel, silicone, foam, and fabric. They range from simple devices that fit between each toe to more elaborate designs that cover the entire foot. The choice of design really depends on the specific needs and preferences of the user.

Do they really work?

The answer is a qualified yes. Contrary to marketing promises, they won’t “cure” bunions or other structural issues with the toes/feet. And they might not be effective at treating issues beyond the lowermost extremities. But they can be helpful to overall foot and toe health.

• Better posture and balance. Promoting natural toe splay, toe separators may improve the overall posture of the foot, which can positively affect balance and gait.

• Improved toe alignment. They temporarily realign toes that have been compressed by wearing tight shoes.

• Pain relief and comfort. They may help alleviate pressure and friction between the toes.

• Reduction of inflammation caused by friction and pressure.

• Improved blood flow. They may enhance blood circulation in the feet, which is beneficial for overall foot health and can help with recovery from injuries.

• Post-surgery and injury recovery. After surgery, they may be used to ensure proper healing and alignment.

• Muscle engagement. They may help strengthen foot and toe muscles by encouraging them to work independently.

• Flexibility. They may help improve foot and toe flexibility, which is beneficial for overall foot function and movement.

What type is best?

Given the plethora of options available, don’t make that decision on your own. If you want to try toe separators to address a specific foot or toe issue, it’s best to work with a foot specialist, who can help you determine the appropriate style for your needs. Start with your primary healthcare provider, who can refer you to a podiatrist or other qualified specialist.

ABOUT DR. JEN

In her roles as chief medical correspondent for ABC News and on-air cohost of “GMA3: What You Need to Know,” Dr. Jennifer Ashton—”Dr. Jen”—has shared the latest health news and information with millions of viewers nationwide. As an OB-GYN, nutritionist, and board-certified obesity medicine specialist, she is passionate about promoting optimal health for “the whole woman.” She has written several books, including the best-selling The Self-Care Solution: A Year of Becoming Happier, Healthier & Fitter—One Month at a Time. And she has gone through menopause…

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