2016 Issue 3, Quarterly Newsletter


2016 Issue 3www.ElCaminoWomen.comJuly 25, 2016


Welcome to the third issue of Women’s Health, a quarterly newsletter focused on relevant health issues to women of all ages. There’s quite a bit going on at the office we want to share as well as a review of several newer technologies that are less invasive than previous options relevant to women’s health.

We have four people in our office out (or about to be out) on maternity leave. Nadia, our Lactation Educator, has already had her beautiful baby boy, Omar, at the end of June. We expect her back teaching our breast feeding classes in September. Dr. Amy Teng and Sandrine, one of our Medical Assistants, are both out and waiting for their boys to join us on the outside! We look forward to welcoming them both back in September. Dr. Rania Awaad has just started her leave and will be returning in November. We wish them all good health, safe deliveries, and lots of rest!

In order to make sure our schedules are open for all of our established patients, we have closed the office to new patients until October. We always appreciate your referrals and will welcome them in a few months, after Dr. Teng is back at work. Barb Dehn, our Nurse Practitioner has also increased her hours during this time to make sure everyone can be seen in a timely manner.

Please continue reading for other updates and information on new, minimally invasive technologies in the field of Women’s Health. It’s a great time to be an OB/GYN, so much innovation and research going on to help make women’s lives better.

Sarah Azad, MD

In this issue:

Office Changes

Updates for patients of Dr. Sutherland and Crystal


Endometrial Ablation

Permanent Contraception

MonaLisa Touch

Highlights from the Women’s Health Blog


In addition to the above temporary staffing changes due to maternity leave, Atefeh, our Office Manager, has moved to Sacramento. She is still on staff and is your point of contact for billing questions or any other issues you may have

As we mentioned in our last newsletter, we regrettably decided to “Opt-out” of our Medicare contracts due to the changes that are supposed to start this year. As of July 1, 2016, we are unable to accept Medicare insurance for payment, but strongly believe you’ll find the self-pay prices for appointments reasonable.

We are also excited to announce that Dr. Rania Awaad, our Psychiatrist who is also on faculty at Stanford’s School of Medicine, is now in network for all the insurances that we accept. She will be accepting new patients in November when she is back from her maternity leave.


We are approaching the 1 year anniversary of the closing of Dr. Sutherland’s and Dr. Crystal’s practices. We have been honoring all refill requests and reviewing all results for patients of both practices and will continue to do so for up to 15 months from your last visit.

Starting January 1, 2017, we will be unable to continue prescription refills for patients who have not yet been seen in our office. We encourage you to establish care before that time. Though we are not accepting new patients until October, we consider all patients of Dr. Sutherland and Dr. Crystal’s our own and would be happy to see you at any time.

If you prefer to establish care with another physician, requests for transferring your medical records can be found on our website.


One of the biggest advances in the care of pregnant women has been the arrival of Non-Invasive Prenatal Testing (NIPT). Current technology allows for the extraction of fetal DNA that is present in the mom’s blood as early at 9 weeks. This very early, non-invasive method of testing a fetus’s DNA allows for many advantages over older technology.

Screening vs Diagnostic Testing

The decision to screen for genetic disorders prenatally is one of great importance to many expectant mothers. Screening tests can assess the baby’s risk of having Down syndrome and other chromosomal problems, as well as neural tube defects. If a screening test shows an increased risk of a birth defect, diagnostic tests may be done to determine if a specific birth defect is present. Screening tests have varying levels of accuracy, the current “First trimester screening” detects 82-87% of fetal chromosomal anomalies. When “First” and “Second trimester screening” are combined, they detect around 90% of fetal chromosomal anomalies. When mother’s screening test comes back “high risk” for an abnormality, we then recommend diagnostic testing. Diagnostic testing has a 100% accuracy level for chromosomal problems, but due the invasive nature of these tests there is also a small risk of losing the pregnancy.

What is NIPT?

NIPT (Non-invasive prenatal testing) uses maternal blood work to detect pieces of the fetus’s DNA in the Mother (cell free DNA, cfDNA) any time after 9 weeks of gestation, and has a 99% Detection rate for Down’s syndrome. Given the direct testing of fetal DNA, sex chromosomes can also be measured and fetal gender can be determined before the end of the first trimester.

What this means for parents

Given the high accuracy of NIPT results and how early the can be done, we order NIPT on all pregnant patients. Expecting parents can learn earlier and with more clarity how their fetus is doing. This often provides a lot of assurance to parents at high risk for a problem. Women of older maternal age, women who carry a sex-linked chromosomal abnormality, etc, can learn earlier on that everything is okay at a chromosomal level, or if they need diagnostic testing. You can learn more about Prenatal Genetic Testing on our website.


As women enter their 40s, irregular bleeding can become more common. After evaluation, many women have no definitive cause for the bleeding and are offered options for managing the symptoms. Options include hormonal management and surgery. For over a decade there have been highly successive endometrial ablation technologies that allow quick, outpatient treatment for this problem.

What is the endometrium, and why does it cause problems?

The endometrium is the inner lining of the uterus, this is usually shed throughout menstruation. Some women suffer from abnormal bleeding and have heavy periods (menorrhagia). There are many different causes throughout the stages of a woman’s life, but abnormal bleeding is primarily seen in those still in their reproductive years. For these women the primary treatment is pharmacologic: hormonal or anti-inflammatories medications. When these medications are either not tolerated, or don’t work, historically, hysterectomy was the next step .

Who should consider Ablation?

Prior to any surgical treatment for heavy bleeding- endometrial malignancy must be ruled out, typically via outpatient biopsy. If no malignancy is found and medical treatment has failed and the bleeding persists- the option to ablate the endometrial lining is the next line of treatment. Ablation may be done via various methods: via thermal injury, microwaves, lasers, or radiofrequency. Some methods are also ok to use in women with certain types of fibroids inside the uterine cavity, but each patients cause for bleeding must be evaluated individually.

What about pregnancy?

It is important to note that ablation is not recommended for women who wish to become pregnant; when the endometrium is removed, it may lead to improper implantation and development of the placenta. A conversation about contraception after the procedure is important as some women may become pregnant.

What are the risks and is it effective?

As with any procedure, it is important to note the risks; complications of ablation include perforation of the uterus (rare, less than 0.3% of cases), excessive bleeding, blood retained inside of the uterus and infection. Ablation has an approximate 90% rate of success- with up to half of women reporting amenorrhea (no period) 6 months after. Repeat ablation occurs in 15% of women. 20% of women will end up with hysterectomies when medical management and ablation have failed. The bottom line is ablation technology has been a huge advancement in women’s health, resulting in a 85% success rate for women struggling with abnormal bleeding, allowing them to avoid hormonal management and major surgery.


The average woman will have almost 40 years of menstrual cycles. In the modern era, most women spend the majority of that time sexually active and trying to avoid pregnancy. Contraception, both reversible and permanent, is an area that is constantly seeing new advances.

What is permanent contraception?

Sterilization (or permanent contraception) involves a surgical procedure to permanently prevent pregnancy. There are various methods of achieving sterilization, from occluding the Fallopian tubes via banding, clipping and cauterization to complete excision of the tubes to hysterectomy. Each of these methods is considered permanent, however all tubal procedures continue to have a slight failure rate of 0.3% to 0.7%. For women who are confident they no longer desire their fertility, permanent contraception is an excellent option.

When can it be performed?

What we now commonly refer to as the BTL (Bilateral tubal ligation) involves surgically occluding or removing both Fallopian tubes to prevent fertilization; this can be done concurrently with Cesarean section, 48 hours after vaginal delivery or a minimum of 6 weeks after delivery.

How is the procedure done?

There are also various approaches to whichever method will be used. The most common procedure in our practice is using laparoscopy (3-4 small incisions on the abdomen that allow us to operate using a camera) to fully remove both Fallopian tubes. This has two advantages: the highest success rate of all methods of tubal surgery for sterilization and also reduces the risk of pelvic cancer in the future. Other common approaches include a small incision below the belly button where the tubes are cut and closed.

Other options: Essure

Essure is a small nickel-coated coil that is placed into the Fallopian tubes using hysteroscopy; it may be done in the office or the hospital. It leads to inflammation in the tube surrounding it, with scar tissue that occludes the tube. It offers the advantage of a less invasive approach, and no need for anesthesia. However, once the procedure is done, an alternate form of contraception is needed for 3 months. In addition, a study to confirm that the device has properly closed the tubes (a hysterosalpingogram) is also needed.



These options all confer the least risk of becoming pregnant and require that you are absolutely sure you no longer wish to bear children.


Many postmenopausal women are experiencing changes that can affect a woman’s quality of life in unexpected ways, leading to many unpleasant symptoms. Vaginal dryness, pain, frequent infections and pain with sex are some of the most common issues that women experience around the time of menopause. The MonaLisa Touch is a new, non-invasive, non-hormonal treatment option that has an over 95% success rate in restoring vaginal health.

What is the MonaLisa Touch?

MonaLisa Touch is a new treatment that uses laser energy to treat the symptoms you may be experiencing. MonaLisa Touch is a medical laser that delivers controlled energy to the vaginal tissue so cells make more collagen. Over the course of 3 treatments, each 6 weeks apart, the vaginal wall is slowly remodeled to a healthier, younger version of itself. There are thousands of women, and several of our own patients, who have gone several years without vaginal intercourse due to the pain who are now resuming regular sexual activity. The MonaLisa Touch is considered “game-changing” technology for the issue of vaginal changes from menopause.

What does the procedure feel like?

The in-office procedure is virtually painless, requires no anesthesia and typically is done under 5 minutes.Most MonaLisa Touch patients feel improvement about 3-4 weks after the very first treatment, although the procedure calls for three treatments to reach full success.

Where to learn more

We welcome questions about this new technology at our office, call our office or contact Shar to make an appointment for consultation. You can also learn more at our website.


Our Women’s Health Blog is a way for us to put out up to date information on various topics. One of our most popular articles ever How Can I Ensure I get Pregnant with a Girl (or Boy) was published in June. Dr. Rania Awaad also wrote an excellent article on Post Partum Depression in May, it’s an excellent article to share with loved ones who are currently pregnant.


Address:2500 Hospital Dr. Bldg 8A
Mountain View, CA 94040

 1685 Westwood Dr. Ste 3
San Jose, CA 95125




Email (billing):moc.n1713462444emowo1713462444nimac1713462444le@ni1713462444mda1713462444

pop up imaging stating that ECWMG is not accepting new patients starting 3/1 and you can ask to be put on a wait list.