Dra. Leila Catherine Onbargi,

A woman's bones undergo changes throughout her lifetime, with constant renewal and regeneration. From age 30 onwards this process starts to function less efficiently and women undergo bone loss. Significant bone loss is known as osteoporosis, and is associated with a risk of fractures. Women are significantly more prone to this condition than men, and the best course is prevention. Many factors determine a patient's individual risk; hereditary and genetic factors, diet, life-style, exercise, etc. In this office we offer screening and medical care for the prevention and treatment of osteoporosis.

According to statistics, 1 in every 3 women will suffer some kind of cardiovascular disease. In Europe, it is the direct cause of the death of 43% of women, many more than with breast or other cancers. In fact women tend to develop cardiovascular disease much later than men (at age 60 as opposed to age 50 for men), but in a woman's case it is more likely to be associated with morbidity and mortality in women. Stress, smoking, cholesterol and high blood pressure are risk factors. It appears that women's hormones play a role in protecting them from heart disease before the onset of menopause.

In our office we provide extensive healthcare and life-style guidelines that are tailored to the needs of each patient according to her personal risk factors.

Many women are reluctant to discuss urinary incontinence, even with their doctors because they are embarrassed by it and feel it is a normal part of the aging process. Many women suffer in silence, and often become limited in their regular activities and lifestyle, rather than seeking help.

In this office we encourage preventive care in stress urinary incontinence, addressing it in its early stages. We do this with pelvic floor rehabilitation and exercises. We have a specialized pelvic floor therapist in our office who provides pelvic training and therapy for pelvic support issues and urinary incontinence.

Often times the incontinence is vastly improved without the need for sugery. Medication can be used for non stress urinary incontinence with good results. When required, we refer patients who do not respond for specialised care, usually surgery.

One in nine women will develop breast cancer at some stage in her life, and increasingly, this becomes a concern in the menopause.

Some women have inherited genes that make their risk for breast cancer very high. These patients can have genetic testing performed, and if positive, preventive measures are available to them, once they are done with child-bearing, to decrease their risk of developing cancer.

With the new treatments available today, the prognoses for breast cancer patients has improved considerably. In fact, the mortality rate of breast cancer is far lower than that of cardiovascular disease in women. The key is early detection. Yearly screening with mammography and ultrasound is recommended. In patients with high risk factors for breast cancer, or for patients who have already been diagnosed and treated for breast cancer, breast magnetic resonance, which is highly sensitive in picking up early cancer, is being used.

Smoking is detrimental to a healthy organism, and the effects are especially harmful for women after menopause. Tobacco robs the body of oxygen, and accelerates cell aging. It helps cause and worsens symptoms of illnesses that are already considered risk factors for menopausal women, such as osteoporosis (it destroys calcium deposits in bones), cardiovascular disease (it narrows arteries), and it is associated with several cancers that can occur at this stage of life.

If you have not managed to give it up earlier, it is especially recommendable to do so now, and in this office we can help with guidelines and treatment to quit smoking for good

The hormonal changes that occur in menopause do not affect all women in the same way. Sometimes these changes can cause depression. The depression sometimes has a more psychological basis; a sense of loss at no longer being able to conceive, feeling less attractive, less useful or needed (Empty Nest Syndrome), weight control problems, etc. In this office we screen for depression during the annual exam and offer our patients a questionnaire developed in the U.S. that helps doctors to detect depression with reasonable precision. Depending on the outcome, we recommend treatment and refer patients to specialized professionals if necessary.

Sex is a normal, healthy part of life. Many women develop problems with sex when they enter the menopause. Hormone levels decrease and may contribute to lack of libido or sexual desire.

Lack of sexual desire can be exacerbated by problems with a relationship, depression, stress or anxiety which are also common during this time of a woman's life. Lack of estrogen also decreases vaginal lubrication during sex which can make intercourse painful, but there are good local therapies to prevent this.

A problem with sex is only a concern if it causes you distress or worry. A sexual problem may not affect your life in any way. However, if it is affecting your well-being and your relationship with your partner, and you are concerned, you may want to seek a solution.

We address these issues in our office, provide counseling and guidelines. Natural treatments can often be helpful, but we can also treat women with low doses of testosterone therapy for short periods of time to help increase libido and sexual response.

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