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WOMEN’S HEALTH

A newsletter from El Camino Women’s Medical Group

It’s already Spring!   I wish you lots of time in the outdoors and enjoying the beauty of California.

We are excited to finally run with full staffing and room in our schedule for patients who need to be seen urgently.  This has been helped by the addition of Angel Wong. You can learn more about physician’s assistants and the role they play in healthcare here.  For those seeking therapy or counseling with Faradebah Waziri, LCSW, reach out soon, as her schedule is almost full.  Those of you who have been waiting for Dr. Balassiano’s return, her fall schedule will be open for booking by May. Please email the office if you want to be placed on her waitlist so you get a call when the schedule is open.

In this second issue 2025, we explore a wide range of topics to help you care for your body, mind, and relationships—from managing varicose veins and understanding tonsil stones to improving your snacking habits and communication skills. We also dive into women’s health, the importance of annual checkups, and the impact of estrogen deficiency. Whether you’re navigating medical basics or major life changes, there’s something here for everyone. We hope all of you find something to inspire you to better health in 2025.

Please read the Practice Updates section regarding the growing team of physicians, a nutritionist, and a physician’s assistant, the expansion of our mental health program with the addition of Fardebah Waziri, LCSW, and the incorporation of Lovu into our pregnancy care.

I wish you all a wonderful Spring,

Sarah Azad, MD

In this issue:

Practice Updates

Online Prenatal Classes

Getting a leg up on varicose veins and leg swelling

Tonsil Stones: What The Heck is My Tonsil?

Snack Like You Love Yourself: A Realistic Guide to Eating Between Meals 

Annual Physicals: What’s Included and Why You Need One?

Back to Basics: The Importance of Clinical Breast Exam

He Proposed! And I Said Yes! Now, What?

 Relationships and Communication!

The Unequal Toll Of Estrogen Deficiency: Why Some Women Suffer More Severely

Everyone Has Some Risk for Breast Cancer – The WISDOM Study Can Help You Learn Yours

El Camino Hospital Visitor Policy Updates

Highlights from our Women’s Health Blog

Practice Updates

Finally, nothing new!

We are happy to be at our new baseline until the fall.  This gives us time to focus on improving our current workflow and adapting on how to provide the best care for the modern day issues our patients face in a rapidly changing world.

Everyone is up and running with full schedules.

We are so grateful for how quickly both Dr. Dorismond (fluent in French and Spanish) and Dr. Wan (speaks French, Spanish, and Mandarin) have fit into our team, though busy, both are still accepting new patients.  You can call, email, or book online.   Angel Wong, PA-C is also fully available to our patients for both urgent visits and routine care.   A Physician Assistant, Angel is trained to care for patients for a variety of health issues and wellness evaluations.  Faradebah Waziri, LCSW, joined our team in February is also available to patients seeking counseling or support for mental health conditions.  If you are interested in an initial appointment, call, email, or message (through healow) the front desk.

Dr. Balassiano is on sabbatical and will be coming back in 2025

Dr. Balassiano began her sabbatical on June 28th, and while she is away, we are fully committed to providing excellent care for her patients. We’re thrilled to share that she will return in September 2025. For those on her waitlist, we are working on her schedule and will reach out in early summer. If you’d like to join her waitlist, please contact our office.

Our nutritionist is available for appointments

Mariam, our nutritionist, is seeing patients for dietary evaluation and counseling.  Her experience is vast, supporting women dealing with prediabetes and hyperlipidemia to those struggling with PCOS or perimenopause/menopause.  She has a masters in Human Nutrition from the University of Aberdeen (Scotland), and has over eight years of experience working in nutrition at the individual and communal levels.   She is ready to help all of you with your health goals.  If you are interested in an initial appointment, call, email, or message the front desk (through healow).   She sees patients by televisit on Tuesdays, Wednesdays, and Thursdays, and appointments are in-network with your insurance.

Continuing with Lōvu

We’re almost a year into our launch with Lōvu. Lōvu is a digital maternal health platform that combines best-in-class technology-enabled care for mother and baby from pre-pregnancy through two years post-pregnancy.  Co-founded by Dr. Santosh Pandipati, who we’ve worked with for years in his role as a Maternal-Fetal Medicine expert, we remain impressed by the extent of what Lōvu has to offer our pregnant and postpartum patients, from a personal, human navigator to quickly answer questions to virtual resources for breastfeeding and pelvic floor support, they are constantly adding resources and ways to augment our care!  For all of our pregnant patients, please remember to register here.

Coming in the fall…

We are slowly working on adding some space in the suite next door to our office, stay tuned…

Online Prenatal and Women’s Health Classes

Prenatal Classes

We are now offering four virtual prenatal classes a month online. These classes cover preparing for childbirth, breastfeeding, and newborn care.   These classes have been very popular, and we plan to have them every month.  They are also available for women interested in signing up, though we prioritize our patients.

Virtual Breastfeeding Class

This is a 2-hour class presented by Nadia, RN, our lactation educator.  The class is a virtual, in-depth review of breastfeeding.  Learn how to get the best start, avoid pain, make sure your baby is getting enough, and when to ask for help!

 Virtual Newborn Care & Safety Class

2.5-hour class presented by Nadia, RN

Practical tips for caring for a newborn

• Appearance of newborn
• Normal skin conditions
• bathing & diaper changing
• safe sleeping
• Newborn safety:
  • Car seat safety
  • Choking hazards
  • Poison control
  • Childproofing your home

Childbirth Preparation Part One

2.5-hour class presented by Nadia, RN:

• The last month of pregnancy
• Preparing for the hospital
• Laboring at home, when to call and when to come in
• Admission to the hospital
• Active labor
• Pain management

Childbirth Preparation Part Two

2.5-hour class presented by Nadia, RN:

• The last stage of labor: pushing
• Vaginal delivery
• Cesarean delivery
• Initial recovery in the hospital
• The postpartum period

You can learn more about these classes or register here.

Getting a leg up on varicose veins and leg swelling

By: Joyce Lu, MD, RPVI, FSVS, FACS
Vascular Surgeon
El Camino Health: Mountain View, Los Gatos, and Morgan Hill.
https://www.getcare.elcaminohealth.org/providers/joyce-lu-md-1154772515-1

Leg swelling has a variety of causes, some of which are quite medically serious and originate from heart or kidney issues.  Once your doctor has ruled those out, a typical workup can be a referral to a vascular surgeon to see if there are any issues with the veins of the leg contributing to these symptoms.  

Veins are the soft and floppy blood vessels of the body that bring deoxygenated blood that the muscles and organs have utilized back to the heart so it can be reoxygenated in the lungs for redistribution.  This transit can be challenging for blood that was used in the legs because it has to fight the downward pull of gravity to get all the way back up into the chest.  These veins use a series of one-way valves to incrementally allow the blood to return, step-by-step likes rungs of a ladder.  Some people are at higher risk of developing vein disease, which makes these valves faulty due to factors such as genetics, occupations that involve a lot of standing/sitting in one place, pregnancy, or obesity.

With these different risk factors, veins are more likely to stretch out to the point that those valves cannot function correctly anymore, and we cause this “venous insufficiency.”  Varicose veins are an outward sign of venous insufficiency.  This causes the blood to linger longer than typical in the legs (but don’t worry, it eventually makes its way back up!).  Blood vessels are not fully waterproof like plastic pipes, and so when there is a lot of pressure due to venous insufficiency, the plasma (fluid portion) of the blood will “leak” out into the soft tissues of the leg, resulting in swelling, discomfort, and heaviness.  

Varicose veins, in and of themselves, can be painful as well.  Because the blood within them is deoxygenated, they are slightly acidic in pH, causing sensations of itching, burning, and tenderness.  

Elevating the legs as much as possible (ideally above the level of the heart) can help to immediately alleviate some of these symptoms.  But for the times when one cannot sit comfortably at home with their legs way up in the air, compression stockings can allow control of symptoms by slowly emptying out the legs of lingering blood/fluid.  Medical compression stockings are very different from “support stockings,” which are generically sold in pharmacies or online (often very cheaply).  Medical compression stockings assure a durable quality and accuracy of compression strength, which is more effective.  

Compression stockings for patients with venous insufficiency should be 20-30 mmHg in strength and fit the measurements of a patient’s own legs.  Typically for calf-height compression, there are 3 standard measurement locations: 1) the ankle, 2) the widest part of the calf, and 3) the length from the knee to the floor (sock length).  If a stocking says it is sized to your “shoe size,” this is NOT likely to be a good/reputable product.  Your shoe size has nothing to do with the size of your leg and cannot reliably ensure the size will be correct.  Stockings can also come in thigh-high or pantyhose lengths.

Some complaints from patients are that the stockings are too tight or too hard to put on.  While this is understandable, compression stockings ARE supposed to be tight because otherwise they wouldn’t be effective.  Many patients with venous insufficiency find that after getting them on, it is worth the effort because it really helps their symptoms.  

When daily elevation and compression are not enough to solve the problems of venous insufficiency, it may be time to discuss procedural options with your vascular surgeon.  Even though venous insufficiency is not a life-threatening condition, it is a quality-of-life-affecting disease process that deserves a careful workup and discussion to improve how you can feel doing what you love.

Joyce Lu, MD, RPVI, FSVS, FACS
Vascular Surgeon
El Camino Health

Accepting new patients in Mountain View, Los Gatos, and Morgan Hill.

Tonsil Stones: What The Heck Is In My Tonsil?

By Katrina Chaung, M.D.
Board-certified Otolaryngology-Head and Neck Surgery
Camino Ear, Nose & Throat
(408) 227-6300
https://www.caminoent.com

Many people are plagued with a tonsil stone at some point.  For some, it may be a rarity.  However, for others, it can be a recurrent issue that can significantly impact quality of life.

Tonsil stones, also known as tonsilloliths, are not harmful but are essentially debris. Our tonsils have many crevices called crypts, which are prime places to develop small, hard deposits made up of a mix of bacteria, dead cells, mucus, and food particles that get trapped in the tonsils. Over time, these substances can harden into stone-like formations.

Tonsil stones can be readily visible, appearing as small white or yellow spots on or within the tonsil that can range from the size of a grain of rice to larger, pebble-sized stones.  Sometimes, they look hard and chalky.  They can also, but not always, cause symptoms including the sensation of something being stuck in the back of the throat, sore throat, difficulty swallowing, bad breath (halitosis), and even ear pain (since some nerves in the back of the throat are also linked to the ear).

In the majority of cases, conservative measures such as maintaining good oral hygiene, gargling with saltwater, especially after meals, and gently (very gently) using a cotton swab to physically remove the tonsil stones are enough to prevent and manage tonsil stones.  However, in some cases, they can cause issues beyond being an annoyance.  Some patients report that they are limited in social and dating interactions or even job interactions due to the associated bad breath.  Others might describe very frequent pain and irritation of their throats.  In cases that are refractory to conservative measures or if symptoms are severe, tonsil removal (tonsillectomy) may be discussed as an option.  While this procedure obviously has associated risks and a recovery process, for some, the potential benefit greatly outweighs those concerns.

By Katrina Chaung, M.D.
Board-certified Otolaryngology-Head and Neck Surgery
Camino Ear, Nose & Throat
(408) 227-6300
https://www.caminoent.com

Snack Like You Love Yourself: A Realistic Guide to Eating Between Meals

By Mariam AlAgha
Master’s in Human Nutrition 
ElCamino Women’s Medical Group 

Snacking isn’t the enemy. Most of us do it—between meetings, while working from home, after a workout, or just because we’re feeling a little off and need a boost.

The truth is, snacking can either fuel your energy and focus, or leave you feeling sluggish and snacky again an hour later. It all comes down to making intentional choices that serve your body, not just your cravings.

This isn’t about restriction or guilt. It’s about being real with yourself. Here’s how to make snacking something that actually works for you.

Focus on What Actually Fuels You

Snacks with protein, fiber, or healthy fats are your best bet. They help keep you full, support blood sugar balance, and give you steady energy.

On the flip side, snacks that are all sugar or salt (think chips, candy, or soda) give you a quick hit, but don’t actually satisfy your body or hunger.

Snack at the Right Times

Mid-morning or mid-afternoon snacks are your sweet spot. That’s when your body genuinely needs a little something to stay steady.

Late-night snacking, especially after 9 PM, is usually driven by habit, emotion, or boredom, not true hunger. It’s worth checking in with how you feel before grabbing something.

Don’t Snack While Scrolling

Eating while watching, working, or scrolling often leads to eating more without realizing it. You’re not tasting your food, and your brain doesn’t register it the same way.

Even just taking a 5-minute pause to be present with your snack can make it more satisfying.

Keep a Few To-Go Options Ready

When hunger hits, we go for convenience. Having a few solid, ready-to-go snack options makes it easier to stay on track, without relying on willpower alone.

Smart Snack Ideas to Support Your Goals

To Stay Full and Curb Cravings: Choose snacks rich in protein, fiber, and healthy fats to promote satiety and reduce overeating later.

• Greek yogurt with pre-soaked chia seeds and berries
• Apple slices with almond butter, peanut butter, or tahini
• Seasoned chickpeas or beans (baked or sautéed with spices)
• Hummus with cucumber, carrot, or celery sticks
• Guacamole with bell pepper strips and boiled egg
• Labneh with assorted vegetable sticks and boiled egg

For an Energy Boost: Opt for snacks that provide complex carbohydrates, protein, and healthy fats to fuel your body and mind.

• Quinoa salad cups (with vegetables and olive oil)
• Whole grain crackers topped with hummus or avocado
• Smoothie with banana, spinach, a pinch of cinnamon, and flaxseeds

For Something Light and Refreshing: Hydrating, low-calorie snacks help satisfy without heaviness.

• Fresh carrot or bell pepper sticks with labneh or hummus
• Frozen grapes (a naturally sweet, cooling option)
• Cucumber slices with lemon juice and a pinch of sea salt

Add This to Your Rotation: Pickled Lupin Beans

If you haven’t tried lupin beans, you’re seriously missing out. They’re a staple in Mediterranean and Middle Eastern homes—and they’re quietly becoming a wellness favorite.

3 Reasons I’m Obsessed with Lupin Beans

1. They actually keep me full
   Packed with protein and fiber—exactly what your snack needs to be satisfying.
2. They’re salty, crunchy, and guilt-free
   Give them a rinse to mellow the brine, toss with lemon or chili flakes, and they’re honestly better than chips.
3. They secretly support my gut + heart
   They’re fermented, antioxidant-rich, and may help lower cholesterol and improve blood sugar control.

They’re the kind of snack that feels indulgent and nourishing. If you’ve been looking for a new go-to, give them a try.

Bottom Line: Choose Snacks Like You Choose Your People

The best snacks aren’t the ones labeled “guilt-free.” They’re the ones that leave you feeling full, clear-headed, and taken care of.

Snacking isn’t something to fix. It’s something to get intentional about—because how you feed yourself between meals matters too. Snack like you love yourself. Your body will thank you.

Mariam AlAgha
Master’s in Human Nutrition 
ElCamino Women’s Medical Group

Annual Physicals: What’s Included and Why You Need One?

An annual exam is a preventive exam performed by your primary care physician. It is essential for your long-term health and provides an opportunity to detect potential health issues early on and obtain necessary preventive screenings, depending on your age, lifestyle, and gender.

Many people only see their doctor when they feel sick, but preventive care is the key to long-term health. The majority of chronic medical conditions I have diagnosed were caught during annual physical examinations.

During your annual physical, the doctor will assess your overall health, including lifestyle and risk factors. This typically includes a review of medical history, family history, medications, and lifestyle habits. Your vital signs, such as blood pressure, heart rate, temperature, weight, and height, are checked. Depending on your age and risk factors, the doctor may order lab work to monitor your health. Some examples include checking cholesterol, blood sugar, thyroid function, complete blood count, and kidney and liver function.

Many serious conditions, such as hypertension, diabetes, and high cholesterol, develop silently without symptoms, making annual physical exams crucial for detecting these conditions before they become severe. These visits are also a chance to discuss health goals with your physician, such as maintaining a healthy weight, quitting smoking, or managing stress more effectively.

Most insurance plans fully cover one annual physical per year, though it’s always best to confirm coverage with your provider and insurance plan.

Back to basics: The Importance of Clinical Breast Exam 

By: Elaine Lee, MD, FACS
Breast Surgery
Bay Area Gynecology Oncology
910 Campisi Dr. Ste 2A
Campbell, CA 95008
408-827-4275

www.bayareago.com

He proposed! And I said Yes! Now, what?

My niece’s voice was excited, happy, nervous, and overwhelmed all at once.

What follows is what I would say to her, and to other young people in her life stage of 18 to 30. I am speaking to her openly, honestly, with a certain freedom in advising her, both as her Chitti (now almost all of us know this term, thanks to Ms. Kamala Harris) and as a therapist. Chitti in Tamil is a shortened form of ‘smaller mother’ an affectionate term for aunts and definitely has a maternal permission built into it.

Keeping my position as auntie/therapist in mind, please reach out with any topics you would like to see addressed here. I have a plan for about a dozen topics and am open to hearing from my readers about subjects they would like to read about. Of course, all this must be taken in context and is not meant to be a one-size-fits-all, but a jumping off point for more understanding.

This is some of what I said to her, here goes:

“As you prepare for your transition to adulthood, some things become clear, some things get prioritized, and some things take a lot more time. You might have already learned how to do your laundry, how to study, how to make some money, and how to make friendships. Whether you are ready for an intimate relationship or not, some life skills take a little more work.

In my website (www.calmtherapy.com), there’s a link to an article (quarterly focus) speaking to the how-tos of entering an intimate partnership. This article has a level-headed approach to thinking about marriage. It addresses topics like 

• Will you be happier married?
• Do you know what you want from a marriage or relationship?
• Should you make an educated decision or a romantic decision?
• Are you feeling social pressure to be married by a certain age?
• This is a big, expensive decision in terms of money, time, and health – is this a good choice for you?

Check it out from my website or here: https://waitbutwhy.com/2014/02/pick-life-partner.html

As you are getting ready to figure out the next steps, remember this is a marathon, not a sprint. Don’t get so focused on the event of the wedding itself that you lose focus on the larger picture of your marriage – they are not the same thing even though many Indian languages have just one word to describe both – the event of the union, and the much longer-term institution or partnership you are entering.

Ask yourself if you know your partner well enough. The well-known article in the New York Times from 2015 is one stepping off point. You can read it here at https://www.nytimes.com/2015/02/13/style/the-36-questions-on-the-way-to-love.html

There are many ways to get to know someone well, and all of them include being honest with yourself. Are you shrinking from some topics that are important? Are you avoiding topics that stir up anxiety in you? Do you know how to patch up after a disagreement? Are you asking each other for some changes in behavior, or are changes coming from crisis management types of interactions? Do you know how to be assertive – this means being able to say no to some things without escalation of tension and without bottling feelings up so they rush out in a torrent that is unpredictable?

I know this is a lot to think about. Don’t worry if this is all overwhelming! Consider the feeling you have as you hear all this – do you have a sinking feeling of heaviness or a rising feeling of possibility? This by itself will tell you a lot about the relationship you are in and about yourself. If it feels heavy, it could mean that you feel unsure if all this information will be well received. Or it could mean that you have been conditioned to believe this kind of work has to be the feminine part of the relationship. Either way, I hope it has provided food for thought!”

I know I stirred up a lot in my niece as I watched many emotions pass over her face – curiosity, frustration, thoughtfulness, among others. I have much more for her in upcoming chats – things like expectations of family relationships, division of labor, vacation planning, dealbreakers, and of course, child rearing.

Relationships and Communication!

By Dr. Shereen Mohsen, Clinical Psychologist
Founder/CEO of Relucent Psychology Group

Book your appointment from here: Relucent Booking Page

“I can’t believe you just forgot to… ” You probably know, without hearing the rest of the sentence, that you wouldn’t enjoy being on the receiving end of this communication. The way we communicate strongly influences the quality of our relationships, and the quality of our relationships is deeply tied to our mental health. When our mental health deteriorates, our relationships inevitably suffer, and when our relationships cannot provide a safe haven where we feel loved and supported, our mental health takes a hit. People who have the best mental, emotional, and physical health almost invariably report having strong, healthy relationships.  

Typically, we learn to communicate by imitating our family’s communication patterns, and as we mature, we may learn new strategies, but we are likely to fall back on old patterns during moments of stress or strain. If you were one of the fortunate few who grew up with parents who modeled healthy communication, you were set up for success in your future  

relationships. Otherwise, if you grew up in a family that either didn’t communicate much about feelings or communicated ineffectively, you may have difficulty forming intimate connections where you feel an ongoing sense of safety and closeness.  

Some signs that you might benefit from better communication:  

You frequently feel lonely or misunderstood:  

Communication is a way of bridging the gap between our own experience and the experience of others. If our communication fails to foster connection, we will feel increasingly isolated and lonely. As children, we cannot survive without other humans to nurture and care for us, and as adults, our lives quickly become drained of meaning when we don’t feel a sense of belonging. Chronic loneliness is physically, emotionally, and mentally devastating. Maybe you don’t express your feelings with those closest to you, or maybe you do, but no one really seems to get it. 

You struggle to know what you’re feeling or to share your feelings:  

One study found that people typically rely on three words to express the full range of their daily experience: sad, mad, and happy. You might be feeling embarrassed, vulnerable, angry, and hopeful at the same time, but it might be hard for you to tease all that apart and say it. By learning to communicate about your experience with more nuance and precision, you open the door for others to relate to your experience and to you, which fosters a greater capacity for connection.

You feel confused about why others are reacting so strongly to something you said or did:  Maybe your way of expressing yourself is accusatory so the person listening to you has a sense of being blamed and gets defensive. If you emphasize the other person’s actions instead of your own reaction (for example, “when you said x, I obviously felt y”), this can imply a sense of blame even if you don’t intend to. Another possibility is that you are communicating with people who are not emotionally safe. In that case, you might need to seek out people who are more emotionally attuned to share vulnerably with. 

You are reluctant to share your emotions or experience because of others’ reactions:  Perhaps you anticipate that others will react with hostility, or you worry the other person won’t stay in the connection to hear you out. Underneath these fears, there could be several things at play. Oftentimes, underlying our decisions about what and how we communicate, there are beliefs related to our attachment style or past traumas. It can be extremely challenging to express disagreement, for instance, if you have a fear of abandonment that makes it overwhelmingly frightening to express something that might lead to rejection or to the loss of the connection.  

You struggle with conflict:  

You either avoid conflict entirely or you express yourself in a way that leaves you or the other person feeling dissatisfied, disconnected, or upset. Maybe you learned to communicate passively, struggling to say “no” and allowing others to call the shots; maybe you learned to communicate aggressively, dominating or edging out the competition; or maybe you learned to communicate passive-aggressively, bottling up your unowned anger until it seeps out onto others. 

Some tips for enhancing your relationship health:  

Foster a deep sense of self-worth. Self-worth makes it possible to weather the anxiety and discomfort that are an inherent part of being in connection. By self-worth, I mean a deep and abiding belief that you deserve love and are therefore willing to give it to yourself and to receive it from others. If you are overly critical of your appearance or you feel that you should be more [fill in the blank] before you really deserve love, look lovingly at what is underneath those beliefs, as it is likely standing in the way of you fully opening to the love and care around you. You can make small, incremental gains in self-worth by practicing being present with yourself when you need support. 

Know yourself.  If you don’t know what you value or what you’re feeling or needing in a given moment, you cannot communicate that with others. If you haven’t sat with yourself in uncomfortable feelings, you won’t be able to connect with others when they are feeling discomfort, and your capacity for connection will be limited. This sounds simple on one level, but we are all an endless mystery, filled with complexity and contradictions, and it takes a continual investment of time and care to deeply know yourself. Knowing yourself in your complexity makes it possible to provide more nuanced communications and to have a clear sense of what you are and are not willing to accept from those close to you.

Separate guilt from shame and love yourself through your shame. Guilt is what we feel when we have made a mistake, and shame is what we feel when we believe our very existence is a mistake. Oftentimes, people have the two tangled up and quickly go from feeling they made a mistake to feeling that they are a mistake. If I’m terrified to admit I was wrong because then I will feel like I am wrong (read: fundamentally flawed, broken, unlovable), then I can’t recognize when I’ve made a mistake, and I will very likely end up frustrating and hurting the people around me as I do everything I can to avoid my shame.  

Validate other people’s experience. To validate another person means to deeply honor their right to feel whatever it is they are feeling. If my loved one feels devastated because I forgot to call on their birthday, I may not understand why they feel so hurt, but I can seek to understand by assuming they have a reason to feel sad and asking to hear more about what it meant to them. This makes it possible to know them better and to provide love and understanding even when their way of experiencing the world is different from mine.

Express your needs vulnerably. If I don’t enjoy the way my partner is touching me, I might criticize him or her: “that’s too much pressure,” or I might request what I want: “could you please touch my shoulder softly?” If you have practiced shifting your communication from a criticism to a request, you will know how vulnerable it can feel to ask for something. The discomfort tends to pay off, though, as asking vulnerably usually gets better results and leads to a feeling of greater connection.  

Learn to communicate complex feelings. We often experience several emotions at the same time. Particularly in moments that are overwhelming or conflictual, it can be tremendously helpful to slow down and name all of the feelings present. For example,  instead of naming only our anger during a conflict, we can share with another that while we are angry, we also feel ashamed, anxious about hurting their feelings, and remorseful. This  complexity opens the door to restoring the connection. 

However you learned to communicate, it is always possible to learn new ways of expressing yourself to allow for deeper understanding of yourself and others and to foster deeper connections and healthier relationships. Practicing identifying and communicating your feelings makes it far more likely you will be able to meet your needs. If you’re lonely, you can seek connection. If you’re afraid, you can find a way to lean into your fear with the support of others. This will help regulate your emotions, which will allow you to show up as a steady, loving presence for yourself and those around you.  

If you find that you are struggling to apply some of these strategies or if you would like support from a mental health professional for your relationships or any area related to your mental health, please feel free to reach out to us at (408) 680-4114. Our team at Relucent Psychology Group would be happy to help. You can also directly book with us here or reach us by email at moc.g1787934890ptnec1787934890uler@1787934890ofni1787934890.  

Dr. Shereen Mohsen, Clinical Psychologist
Founder/CEO of Relucent Psychology Group

Book your appointment from here: Relucent Booking Page

The Unequal Toll of Estrogen Deficiency: Why Some Women Suffer More Severely

By: Renee Allen, MD
a Board-Certified OBGYN and Medical Media Expert

The Unequal Toll of Estrogen Deficiency: Why Some Women Suffer More Severely

Estrogen isn’t just a hormone—it’s a master regulator that touches nearly every system in the body, and its loss during menopause doesn’t affect all women equally. For some, the absence of estrogen creates mild disruptions. For others, it can lead to a cascade of severe and even life-threatening conditions. Understanding why this happens is key to recognizing the importance of hormone replacement therapy (HRT) in preventing long-term health complications.

Why Do Some Women Experience Worse Outcomes?

1. Genetic Susceptibilities: Certain genes can make women more prone to the adverse effects of estrogen deficiency. For example, genetic variants associated with bone density, cardiovascular health, and inflammatory markers can amplify risks.
2. Pre-existing Conditions: Women with underlying health issues like hypertension, autoimmune disorders, or metabolic syndrome may find their symptoms exacerbated by estrogen loss.
3. Lifestyle Factors: Smoking, poor diet, sedentary behavior, and chronic stress can worsen the effects of estrogen deficiency by accelerating inflammation and metabolic dysfunction.
4. Timing of Menopause: Women who experience early or sudden menopause, such as from surgery or chemotherapy, lose estrogen sooner and are at a higher risk for severe conditions like osteoporosis and cardiovascular disease due to a longer exposure to deficiency.

The Severe Health Consequences of Estrogen Deficiency

1. Hypertension and Heart Failure

• Mechanism: Estrogen plays a critical role in maintaining cardiovascular health. It directly influences mitochondrial function within heart cells, ensuring they have sufficient energy for optimal contraction and relaxation. When estrogen declines, mitochondria become less efficient, leading to reduced energy production, increased oxidative stress, and impaired heart muscle relaxation. This can contribute to heart failure with preserved ejection fraction (HFpEF), a condition characterized by stiff, poorly relaxing heart muscles despite normal pumping function. Additionally, estrogen helps maintain arterial elasticity and reduces inflammation. Without it, arterial stiffness increases, exacerbating hypertension and accelerating atherosclerosis.
• Impact: The loss of estrogen creates a cascade of cardiovascular challenges:
• Heart Muscle Dysfunction: Mitochondrial dysfunction in the heart leads to reduced energy availability and stiffened heart muscles, making it harder for the heart to relax between beats. This can result in HFpEF, a condition particularly common in postmenopausal women and more common among women than men, in general.
• Increased Arterial Stiffness: Estrogen helps keep arteries supple. Its absence leads to stiffer vessels, increased vascular resistance, and higher blood pressure.
• Atherosclerosis and Cholesterol Imbalance: Estrogen deficiency accelerates LDL cholesterol buildup while reducing HDL cholesterol, promoting plaque formation and increasing the risk of heart attacks and strokes.
• Prevention with HRT: Estrogen replacement therapy restores mitochondrial efficiency in heart cells, improving both energy production and heart muscle relaxation. It also reduces arterial stiffness and inflammation, which can mitigate the risks of hypertension, HFpEF, and atherosclerosis. Studies show that initiating HRT within the “critical window” after menopause can significantly lower the risk of cardiovascular complications.

2. Dementia and Cognitive Decline

• Mechanism: Estrogen supports synaptic plasticity and reduces amyloid-beta accumulation, which are crucial for memory and cognition.
• Impact: Estrogen deficiency is linked to an increased risk of Alzheimer’s disease and other dementias, especially in women with early menopause or severe sleep disturbances.
• Prevention with HRT: Studies show that initiating HRT within the “critical window” (within 10 years of menopause onset) can significantly reduce the risk of dementia.

3. Osteoporosis and Fractures

• Mechanism: Estrogen suppresses bone resorption. Without it, bone breakdown outpaces bone formation, leading to weakened bones.
• Impact: Women with estrogen deficiency are at a higher risk of fractures, especially in the hip and spine. Osteoporotic fractures are associated with significant disability and even mortality.
• Prevention with HRT: Estrogen replacement restores bone density and reduces the risk of fractures, often more effectively than bisphosphonates.

4. Colon and Breast Cancer

• Mechanism: Estrogen modulates immune function and inflammation, both of which play roles in cancer development. Its absence creates a chronic pro-inflammatory state.
• Impact: Postmenopausal women have an increased risk of colon cancer due to slowed gut motility and immune dysfunction. Chronic inflammation may also contribute to aggressive forms of breast cancer in the absence of estrogen.
• HRT Consideration: Balanced HRT can potentially reduce colon cancer risk, though it must be carefully managed to avoid exacerbating hormone-sensitive cancers.

5. Rheumatoid Arthritis and Autoimmune Conditions

• Mechanism: Estrogen helps regulate inflammatory cytokines. Its decline can tip the immune system into overdrive, triggering or worsening autoimmune diseases.
• Impact: Women often develop or experience flare-ups of rheumatoid arthritis and other autoimmune conditions post-menopause.
• Prevention with HRT: Estrogen therapy has been shown to decrease the severity of rheumatoid arthritis and improve quality of life for women with autoimmune diseases.

6. Pulmonary Embolism (PE) and Deep Vein Thrombosis (DVT)

• Mechanism: Estrogen plays a role in maintaining blood flow and reducing clotting risk. Its loss can increase coagulability and venous stasis.
• Impact: Postmenopausal women, especially those with risk factors like obesity or immobility, are at higher risk of PE and DVT.
• HRT Consideration: While some HRT formulations (oral estrogens) may increase clot risk, transdermal estrogens are generally considered safer for women at risk.

 The impacts of estrogen deficiency are profound and far-reaching, touching every system in the body. What’s most heartbreaking is how many women are left to endure these challenges without answers, often feeling dismissed or misdiagnosed. Hormone replacement therapy (HRT) has the power to address these root causes, preventing so much unnecessary suffering. Yet, too often, it’s not even discussed as an option.

 We deserve better. Women deserve better. This phase of life isn’t about just surviving—it’s about thriving, aging vibrantly, and protecting our long-term health.

I’d love to hear from you:

• Have you experienced any of these symptoms that felt like they were dismissed or misdiagnosed?
• What’s been your journey with finding answers or relief?

Let’s share our stories and insights—it’s these conversations that empower us all. 💕

Imagine healthcare that connects all the dots instead of treating each symptom as a separate problem. That’s what happens when a doctor actually takes time to understand your complete picture.

If you’re feeling unheard or struggling with symptoms that impact your quality of life, know that there are answers. Proper hormone optimization isn’t just about managing symptoms – it’s about protecting your long-term health and embracing every stage of life with vitality and confidence.

At Eterna Vitality & Wellness, we look at the complete picture—your hormones, metabolism, nutrition, and lifestyle—to create personalized solutions that work WITH your changing body, not against it.

Our approach combines bioidentical hormone replacement therapy (when appropriate) with targeted nutrition strategies and, for some patients, carefully managed GLP-1 medications that address both hormonal and metabolic factors.

We are accepting new patients and proudly serve patients in 12 states: Colorado, Connecticut, Florida, Georgia, Illinois, Maryland, New Jersey, Ohio, Pennsylvania, Texas, Washington, and Wisconsin.

Are you ready to stop fighting your body and start understanding it? 

 Book your initial consultation at www.reneeallenmd.com and let’s create a plan that actually works for your midlife body.

Everyone Has Some Risk for Breast Cancer – The WISDOM Study Can Help You Learn Yours

Breast cancer can happen to anyone with breast tissue, which includes most people, regardless of sex or gender identity. Everyone has some level of risk, but that risk varies based on factors like age, environment, genetics, family history, hormones, and lifestyle (diet, exercise, alcohol, smoking, and more). Since we all age and live with environmental exposures, it’s important to understand your individual risk and take steps to protect your breast health.

How can you learn about your risk? That’s where the WISDOM Study comes in.

The WISDOM Study (Women Informed to Screen Depending On Measures of risk) is a national research effort led by UC San Francisco and partners across the U.S. Since 2016, over 80,000 women have joined the study, which offers participants a no-cost, comprehensive breast cancer risk assessment — including at-home genetic testing — and personalized screening recommendations (when to start, how often, and whether to use mammogram and/or MRI).

If you’re identified as high risk, you’ll also be offered a one-on-one consultation with a breast health specialist to review your risk and explore strategies to reduce it.

What is a breast cancer risk assessment?

Risk assessment tools (also called risk models) use your personal and family medical history to estimate your chances of developing breast cancer over time. These tools help you and your doctor make informed choices about screening and prevention.

Depending on your results, you might decide to:

• Start screening earlier or more often,
• Consider medications like Tamoxifen to reduce risk,
• Or take other proactive steps.

There are many well-established models, including the Gail model (BCRAT), the Tyrer-Cuzick model (IBIS), and the Breast Cancer Surveillance Consortium (BCSC) model, which is the primary tool used in the WISDOM Study.

The BCSC model was recently updated (Version 3) to include factors like:

• Body Mass Index (BMI)
• Extended family history
• Age at first live birth

These updates allow for even more accurate risk estimates. The WISDOM Study also incorporates breast density, BI-RADS scores, and genetic information into its assessments. Plus, new AI models to predict late-stage breast cancer risk are coming soon.

How to Join the WISDOM Study

You can participate if you:

• Are age 30–74
• Live in the U.S.
• Have never had breast cancer

The study is mostly online and takes less than an hour per year. There’s no cost to join, and no insurance is needed.

Here’s how it works:

1. Visit www.thewisdomstudy.org and click Join Now
2. Choose your study group, complete consent forms, and answer a short health questionnaire
3. If you opt into the Personalized Group, you’ll receive a genetic test kit to assess 29 hereditary cancer genes and millions of small gene variants (SNPs)
4. You’ll receive your genetic test results and a personal screening plan
5. Each year, you’ll complete a follow-up questionnaire and get updated screening recommendations

To learn more or enroll, visit:

👉 www.thewisdomstudy.org

Want to dive deeper into breast cancer risk models?

🎥 Watch our educational webinar on risk assessment tools.

Still have questions?

📧 Email us at gro.y1787934890dutsm1787934890odsiw1787934890@ofni1787934890

El Camino Hospital Visitor Policy Updates

General information on visitors’ policy

Last updated visitor guidelines from April 1, 2024

All visitors to the hospital must be healthy and without symptoms of infection.  Please read more here.

Since April 1st, 2024, masking is no longer required of staff, patients, or visitors anywhere in the hospital.

As we all know, this pandemic has been through several phases with changing recommendations, so these visitor policies may change.  At no point during the pandemic has El Camino Hospital prevented laboring or postpartum women from having at least one visitor with them who met requirements.

Highlights from our Women’s Health Blog

General Office Information