Women’s Health

Perimenopause: What’s Normal & Not?

You may have heard older female friends and relatives complain about hot flashes, mood swings, bloating and other strange symptoms, and chalk them up to menopause, the “change of life.”  But the real culprit isn’t menopause – it’s perimenopause.

“Perimenopause is the transition to menopause, Sashi Amara, M.D., an internal medicine specialist at the Palo Alto Medical Foundation, says.  “It can start a few years before a woman’s periods end and continue for 12 months after that.”

Hallmark symptoms of perimenopause include hot flashes, night sweats and irregular periods. But other medical problems can also occur around the same age, the mid-40s, Dr. Amara says. So it’s important to know what’s normal, and what’s not. Read More

Cervical Cancer Screening Guidelines: What You Need to Know


Getting an annual Pap test to screen for cervical cancer used to be a routine part of women’s health care, but leading medical organizations no longer recommend this test yearly for all women. Why this change, and what are the current guidelines?

“The Pap test is an extremely useful and successful tool for detecting cervical cancer, but thanks to ongoing evidence-based studies and research, we now understand much better how cervical cancer develops,” says Amy Kane, M.D., an obstetrician and gynecologist at the Palo Alto Medical Foundation. “The current more nuanced guidelines that take a woman’s age and health history into consideration are based on the most up-to-date knowledge. Following these guidelines ensures that we are not under or overscreening women and providing them with the best and most appropriate care.” Read More

The Truth About Age and Fertility


We’ve all heard a story like this: A 40-something celebrity gets pregnant with twins. But these headlines may be giving false hope to women who wait until later in life to start a family. National Infertility Awareness Week in April, aims to increase knowledge about infertility and clarify some common misconceptions.  Alexis Kim, M.D., a fertility expert from the Palo Alto Medical Foundation (PAMF), helps shed light on common myths about age and fertility.

Myth: A woman can easily get pregnant well into her 40s.

“This is one of the most common misconceptions about fertility: that a woman can easily get pregnant in her 40s,” Dr. Kim says. “The decline in a woman’s fertility starts to become more noticeable in her mid 30s or sometimes even earlier. By the time she is in her 40s, it is significantly harder for her to conceive.” Read More

Hot Flashes: What to Know

Woman cooling off with a hand-held fan.Some women experience “hot flashes” when they begin menopause, which is when their menstrual cycle comes to an end. Hot flashes are sudden onsets of overheating—most commonly on the face, neck and chest. These onsets can cause a red flush to appear on the skin, and in some women they cause perspiration accompanied by a rapid heartbeat or chills. In this blog post, Palo Alto Medical Foundation internist Amy S. Brendel, M.D., answers some of the questions you may have about hot flashes. Read More

Delivering Medical Wonders

Brian and Gwen with twins, Mason and Gavin.

Two years ago, Gwen realized that while her job as director of constituent communications at U.C. Santa Cruz was rewarding, she wanted more in her life: she wanted a family. She’d been dating, but hadn’t found her soul mate.

“When I got to 39, I thought: ‘I want to have kids, so I’m going to do it on my own.’ I thought I should see about my fertility, so I went to the PAMF fertility clinic,” she says.

The verdict? Things looked good, except for the fibroids. Uterine fibroids – benign (noncancerous) growths – are very common, occurring in roughly 40 percent of women. They grow either underneath the uterine lining, inside the uterine wall or outside the uterus. Most fibroids are small and insignificant. They can cause problems if they are large enough to interfere with or prevent pregnancy, as was the case with Gwen. In order to get pregnant, women with large fibroids often need surgery.

According to PAMF obstetrician Howard Salvay, M.D., the only surgical option for removing fibroids used to be through open abdominal surgery called a myomectomy – a major operation requiring up to six weeks for recovery. A myomectomy can cause extensive scarring, as it involves cutting through the abdominal muscles and into the uterus. If the scar tissue lay inside the uterus, it too could interfere with pregnancy. Dr. Salvay performed Gwen’s surgery using the robotic da Vinci® surgical system, which allows for precise, high-definition 3D magnification and minimal scarring both inside and out. Her recovery time was two to three weeks.

In the middle of all this, Gwen met her soul mate, Brian. “I wasn’t expecting anything, since we’d just met. But he said he really wanted to be a dad again (he has a daughter from another marriage). He said let’s give it a try,” she says.

Four months after her surgery, she was pregnant and seemed to be getting very big very fast. Then she found out she was going to have twins. “During the first ultrasound, Dr. Salvay said, ‘It’s a miracle: you just had a myomectomy four months ago, you’re 40 and you’re pregnant!’” Gwen recalls. “Then he said I was having twins. I nearly fainted.”

Mason and Gavin were born weighing 6 pounds, 8 ounces each. With two baby boys and a wedding to plan, Gwen’s life is full. “It’s all happened very fast,” she says. “It’s been amazing.”