Premier Care for Women’s Dr. Eva Arkin, a native New Yorker, came to Emory University as an undergraduate, flew through in three years, and proceeded straight into Emory School of Medicine, where she met her husband – and never left.
Her philosophy is to provide thorough gynecological care by being a good listener. As a mother of three, Arkin likes to work out while watching the Food Network.
Here she addresses frequently asked questions.
Jaffe: Are there new guidelines about who gets pap smears?
Arkin: Women who are young, but older than 21, should get annual exams. Low risk patients do not have to get a pap [test] or HPV [human papillomavirus] analysis annually. Women do need to have their ovaries checked, and older women need a rectal exam annually. After 65, paps should be done on all high-risk patients who smoke, have multiple sexual partners or have a history of GYN cancers. The patient and her physician will determine her risk and need for pap follow-up.
Jaffe: Are you seeing progress in bone density conditions?
Arkin: There are many choices for patients now trying to preserve bone mass. Medications work, along with exercise and vitamin D. Weight-bearing exercise is a major key for bone health.
A real help for preserving bones is HRT (Hormone Replacement Therapy) or ERT (Estrogen Replacement Therapy), especially within the first five years of menopause.
The medications that are available are usually very well-tolerated and a huge help for preventing bone loss and osteoporosis. The best is Prolia, which is injected twice a year.
Jaffe: What are some of the newer ideas for treating PMS?
Arkin: PMS [premenstrual syndrome] is an entity from which many women suffer. There are a variety of treatments, from medication, yoga, weight-bearing exercise to nutritional changes, such as cutting out refined sugars and food preservatives/dyes and processed foods. As for medications: cycle control is key.
The new low-dose birth control pills are very well-tolerated and control cycles well with minimal periods. The newer IUDs [intrauterine devices] with progesterone may eliminate periods altogether. Some respond beautifully to a very natural progesterone supplement (by doctor’s prescription).
Jaffe: You routinely test for HPV. How would you treat that in an older patient who had not been vaccinated?
Arkin: Most women have been “exposed” to some form of HPV. The real question: Does the woman harbor the more virulent HPV, and is it active or dormant? Most HPV in women are dormant, but stress and other decreases in the immune system may make it get “expressed” on the pap. Exposure to multiple sexual partners and/or smoking/drinking may also allow for it to be expressed.
The vaccine is definitely recommended for all young women and men from early adolescence to 26.
All women get tested for HPV along with the pap and that will determine if a woman’s cervix has active HPV and if it’s of the “high risk “ variety.
Jaffe: Science vacillated on the use of HRT for the symptoms of menopause as research unfolded.
Arkin: There have been numerous studies on the risks and benefits. HRT is recommended to treat menopause symptoms for those between 50 to 60 years old to improve quality of life. Decreasing the intensity of menopause symptoms is the main reason to take HRT. There are many benefits and some risks. Most women do benefit from HRT; the hot flashes and night sweats are controlled, and sleep is restored. There are contra-indications to HRT such as a history of breast and uterine cancer and history of blood clots, stroke or cardiovascular disease.
Jaffe: Any new innovations?
Arkin: Many years ago, women would have to get a hysterectomy for heavy and uncontrolled bleeding. Now, we have many choices of good IUDs and “endometrial ablation,” a procedure that cauterizes [heats] the uterine lining.
Women who have uncontrolled bleeding don’t have to go to the emergency room, get a blood transfusion or hysterectomy.