The month of May is Women’s Health Month, and we are excited to partner with Children’s Memorial Hermann Hospital in Houston, providing a full range of women’s and children’s services, to answer some of your personal health questions.

With so much information available at our fingertips, it can be very difficult to sift through articles and to identify credible sources. We’ve probably all been told at some point to not Google our medical symptoms! While the internet is not our best medical resource, it can be intimidating and difficult to find a doctor who you can confide in, so we gathered your questions via Instagram stories and directed them anonymously to Dr. Hector del Castillo Jr., MD, an Ob/Gyn with Memorial Hermann Medical Group. Dr. del Castillo has practiced medicine for over 30 years in the Texas Medical Center. Read on below for his insight on a variety of topics ranging from pregnancy to women’s heart health. We hope you find this article to be a helpful resource and tool as you navigate your own personal health and wellness journey!

Heart + General Health

It seems like heart health studies typically center around men more than women. Are all women at risk of heart disease? What can we do to prevent it?

In a sense, all women are at risk of heart disease because of potential effects of genetics, aging, or other factors like poor diet, lack of exercise, diabetes, and hypertension.  Knowing your personal risk factors will allow you to address specific ill effects, especially over the long run.

Does taking blood pressure medicine guarantee heart health?

If you have high blood pressure, proper medication and diet should prolong good heart health.

At what age should you have your first colonoscopy?

Most people are encouraged to start colonoscopies at age 50 unless you have abnormal bleeding, bowel irregularities or family history of colon cancer.

How often should you have blood work done?

If you don’t have any specific risk factors, screening blood work should be done at least every two years until menopause. After menopause, women should consider annual screening.

What are the best ways to prevent bone disease?

Bone loss can be slowed in most women beyond age 40 by ensuring adequate calcium in diet or supplements and daily Vitamin D intake of 2000 units.  After menopause, hormone replacement or specific bone building meds may be considered.

Nutrition & Fitness

How important are dietary supplements to overall health? Are there any vitamins that most women should be taking daily?

Most women can maintain good health with a well-balanced diet and exercise.  For those with dietary issues, supplements are often recommended for heart, bone and digestive support. A family or personal history of kidney stones may cause a woman to reassess her personal calcium intake. A few vitamin recommendations include:

For Heart Health:  Magnesium, mega 3, CoQ10, Garlic

For Bone Health:  Vitamin D3, Calcium, Phosphorus

For Digestive Health: Probiotics, Fiber, B Vitamins, Vitamin C

Diet is also important for receiving nutrients. For example, if you are lactose intolerant, you can receive calcium through leafy greens and fortified breads or calcium tablets.  

How often should women be working out each week?

Ideally, women should “work out” three times per week but I recommend at least 30-45 minutes of brisk walking or exercise daily.

Women’s Health

What is perimenopause, and at what age does a woman experience it?

The national average for menopause is considered 50-52.  This varies by genetics and by what age you started your period.  Some women hardly experience any complaints while others may begin to feel hot flashes, night sweats and concentration issues as early as their mid-40’s, even while still having menstrual cycles.  This is called perimenopause and symptoms vary from person to person.

Changes in hormones, as well as perimenopause and menopause, cause mood swings, anxiety and depression. Other than medication, what are other ways to relieve those symptoms?

Aside from hormone replacement, antidepressants and sleep aids, many women find some degree of relief with acupuncture, diet changes, soy/black cohosh compound and exercise.

There has been a bit of controversy lately over the potential side effects of birth control. Do you think the birth control pill is safe for everyone? Are there any particular side effects people taking birth control should be mindful of?

Birth control pills have been made safer over the decades since their inception and FDA approval in 1960.  The lower dose pills are at least 1/5 the strength of the originals, and consequently, the risk of unforseen effects has lessened.  They are not ideal for everyone, especially if the woman has a history of deep vein thrombosis, smoking or certain cancers. If you’re using birth control, you should monitor circulation issues, skin changes, worsening headaches, etc.

Does being on birth control make it more difficult to have babies once you’re off of it?

Being on birth control pills does not appear to make it more difficult to conceive but Depo therapy – a birth control injection – may delay the return of regular cycles.  Some studies have shown that by using birth control pills for at least 5 years, the risk of ovarian and endometrial cancer is cut by 50% and many ladies see improvement in headaches, acne, menstrual cramping and bleeding.

At what age should you start mammogram screenings?

Different national societies differ on what age to start mammogram screening but most physicians encourage annual mammograms from age 40 onward. Family history and a physical exam could prompt the use of a baseline mammogram at age 30 or 35.

If you have a relative who has had breast cancer, ovarian cancer, or uterine cancer, how does that affect how often you should have screenings? How close does the relation need to be to impact your screenings?

If you have a family history of any cancer, you should have a conversation with your doctor to determine when screenings should start.

What qualifies someone to have the BRCA gene test?

If one person in your family had ovarian cancer, at any age, it’s a trigger for genetic testing. If you have a family member who had breast cancer before the age of 45 then you should also consider genetic testing. Second and third degree relatives count. Tell your physician about any family members with these cancers and they will be able to determine if you should opt for BRCA testing.

Pregnancy & Fertility

What are the major foods to avoid from during pregnancy?

Pregnancy is not an unreasonably delicate state and for the most part, most women should eat their normal diet. However, we urge patients to limit consumption of tuna and similar saltwater fish to one dose per week due to mercury content.  I also advise patients to avoid raw meat and fish, unpasteurized cheese and milk as well as cold deli meats. I also advise patients to stop all alcohol consumption and limit caffeine to two doses daily.

What are the health benefits to breastfeeding?

Breastfeeding greatly improves the baby’s immune protection, digestive development and is credited with intellectual benefit. Also, the mother gains from bonding with the infant, weight control, and if done before age 30, a decrease in Breast Cancer risk.

How does exercising during pregnancy affect a woman’s overall health and delivery?

Exercising during pregnancy should be the same as preconception in variety and intensity, as long as you are not high-risk and your physician approves it. Exercise can help circulation, endurance and the ability to be limber at delivery.

Do you ever work alongside a doula?

We frequently utilize doulas, especially for people who have the goal of an unmedicated vaginal birth and don’t feel comfortable giving birth at a birthing center. I encourage people to have someone who is going to help them during their pregnancy and support them through their labor. Sometimes the father is enough support, but doulas can be wonderful. Not all are created equal though. It’s important that they know their limitations and work as a team with the doctor. A great doula can provide a wonderful experience for both physicians and patients.

Should you advise family members to get a Tdap shot before they are around your baby?

Yes, I would advise that all family members, babysitters and caregivers should get a Tdap shot prior to the baby being born.

What key pieces of advice do you give new moms when they go home with a newborn?

There is so much excitement around a newborn and everyone wants to see baby after 48 hours. Then, everyone disappears and you’re left with responsibility of getting your newborn baby adjusted, while also trying to build your own strength back and get a good night’s sleep. This is a good time to be dependent. If you have access to a mom or other family members and friends who can help you that first week or two, take advantage of it. While fathers have good intentions, sometimes they are ill-equipped. Extra help will be beneficial to both you and the baby too as you will be less stressed, produce better quality and develop a good latch pattern, if you choose to breastfeed. Planning ahead before the birth will also set you up for success once the newborn is home.

Night nurses seem to be a trend right now — what are your thoughts?

I rarely recommend a night nurse as it’s expensive. However, if you are recovering from a cesarean and can afford the extra support, it can be helpful.

If someone is thinking about waiting until later in life before trying to get pregnant, are there any tests that can be done to measure fertility?

The best indicator of fertility is that you have regular cycles that are not significantly painful. In terms of testing, an AMH blood test can check your ovarian reserve. With infertility, there are three components that can all be checked in advance — if you are releasing eggs (regular cycles), normal anatomy, and a fertile partner. If you are waiting until 34 – 35 to have kids, you might want to get these different factors tested and also consider freezing your eggs. While most children conceived in your late 30s are healthy, waiting does increase chances of genetic complications.

How long should you try to get pregnant before consulting a doctor about infertility treatment?

Infertility is defined as a failure to conceive after one year of unprotected intercourse. Most physicians act after 6 months.

Other than medical procedures, what are other ways that women can try to combat infertility?

To combat infertility on their own, women should eat a balanced diet, decrease caffeine intake, take a daily prenatal vitamin, avoid STD exposure and consult a physician for unusual pain or cycles which may represent endometriosis.

Mental Health

How big of a role does stress play in a woman’s health?

Stress affects every aspect of a woman’s life and health.  Her ability to participate in life’s activities with her loved ones as well as the level of joy one experiences can be affected. Stress is increased by over working, over managing situations and by setting unreasonable priorities.  Women tend to stress about family, health and relationships as well as finances or security. This can lead to heart disease, hypertension, delayed fertility and depression.

How can women decrease stress?

It’s always good to fall back on your support system and be willing to let people divide up the responsibilities, especially after childbirth, or a surgery. Take advantage of family and friends and be comfortable with asking for help. The cliché is that it takes a village, but really it just takes family and friends. Taking care of yourself is something moms sometimes feel guilty about doing, but it’s important to listen to what your body needs, whether that’s sleep, eating right, etc. If you’re dealing with stress and don’t have kids, try to reorient your priorities at work. A job will take whatever it can from you, so you need to set limits with yourself. At lunchtime, consider a quiet meditation or take a short nap instead of plugging through your day. You will be a much better employee, mother, and person if you take care of yourself.

What are symptoms of anxiety and depression that needs treatment rather than situational or temporary anxiety and depression?

Treatment and counseling should be sought if someone appears disconnected or oblivious to activities or persons which used to give them pleasure and if a person has episodes of crying, agitation or aggression.