Author Archives: Medical Associates

Perimenopause: A Transition Worth Talking About

Let’s talk about menopause and abnormal bleeding, a topic often brought up in a Gynecologist’s office. What is it? When does it happen? What the heck is happening to my body, and what do I do about it?

Most women have heard tales of infamous “hot flashes” from mothers and grandmothers by the time they reach their 40s. These are no joke, but they’re not the whole story of menopause. You don’t just wake up one day in a red-hot sweat having concluded your last period and realize, “Hey, I’m in menopause.” The average age of menopause diagnosis is around 51 years old. The full transition into menopause, however, actually occurs over many years. A clinical diagnosis of menopause is only made 12 months after your last menstrual cycle. At this point, we know that the ovaries have slowed hormone production to the point where they can no longer make a follicle – the structure that releases an egg – and thereby trigger a menstrual period. Before that, a woman can experience YEARS of fluctuations in her hormonal milieu. This is called perimenopause.

It is during this transition period when women often visit their gynecologist without a good understanding of how to deal with their symptoms. For example, menstrual periods can become very irregular. This is the first sign of a change and is completely normal. A woman may have typical bleeding one month, no bleeding for three months, and then the heaviest period she’s ever seen might occur seemingly out of nowhere. These irregular cycles, though very frustrating, are usually a helpful clue that the ovaries are doing less for you than they used to. This isn’t something mothers and grandmothers talk about much, and it’s definitely not as public as hot flashes.

So as you undergo perimenopause, how can you decipher what’s normal and what’s not? During this time period, take note if your bleeding can be described by any of the following: if it occurs more often than every 3 weeks, lasts longer than 10 days, is extremely heavy, or occurs after a 6 month lapse in bleeding. Those are all reasons to see your physician. You should also be sure to see your doctor if you are experiencing irregular bleeding and have a family history of uterine cancer.

Even if those situations don’t apply, this is still a really good time for a woman to schedule a visit with her doctor in order to help ease the transition into menopause over the next few years. As the ovaries slowly stop production of estradiol, many aspects of a woman’s overall health are impacted. These include cognitive ability, sleep cycles, and the overall health of bones, heart, and the colon just to name a few. Sexual function, libido, and vaginal health are also strongly tied to the production of estradiol by the ovaries. Symptoms related to any or all of these systems can be a part of your body’s path to menopause.

So if you and your physician determine you’re on your way to the no-more-periods period, what can you do about it? During the perimenopausal years, it is still safe for most women to take oral contraceptive pills. Your physician may even recommend them to provide contraception (yes, you can still get pregnant!), decrease risk of ovarian cancers, increase bone density, and keep menstrual cycles lighter and more regular. All of these benefits can make your years leading up to menopause healthier and happier. I also discuss lifestyle changes with my perimenopausal patients – things YOU can do without a prescription to make menopause a little easier. For example, every woman should take in adequate calcium and vitamin D (1,200 mg of Ca2+ and 600 IU of VitD per day), engage in regular exercise to reach and maintain a BMI under 30, and avoid smoking. For some women, even getting a little extra estrogen from soy products in your diet can be helpful.

Irregular bleeding caused by your ovaries winding down to retirement doesn’t need to be a hushed-up, stressful situation. It can be viewed as a helpful message from your body, clueing you in to what’s next. Take the opportunity to get healthy, see your gynecologist, and prepare for menopause itself… because, as my mother just told me, “That deserves its own article.”


by Kelly McGuire, DO
Medical Associates Clinic




Dr. McGuire practices with the Medical Associates Department of OB-Gyn, in collaboration with Joseph Berger, MD, Tara L. Holste, DO, Lisa A. Kramer, MD, Trupti S. Mehta, MD, Laura Neal, MD, and Erika O’Donnell, MD. They provide a complete range of specialized care for women. Call 563-584-4435 to schedule an appointment.


Heart Health for the Entire Family

As the leading cause of death for men and women in the United States, heart disease is commonly discussed with the older, adult population. However, the conditions that lead to heart disease are happening at younger ages causing heart disease to develop in younger adults increasingly more often. Heart care and prevention is important for everyone. Being aware of what causes heart disease, while also developing heart healthy habits with your family, are both great forms of defense.

What can you do to take control?

Make heart-healthy choices in your diet. Diets high in trans-fat, saturated fat, and added sugar increase the risk for heart disease. Sodium (or salt) increases blood pressure, and most Americans eat too much of it, including children. Pay attention to the nutrition labels on food packaging. A food’s sodium content is something that is clearly listed. By replacing foods high in sodium with fresh fruits and vegetables, you can help lower your blood pressure. In fact, only 1 in 10 adults is getting enough fruits and vegetables each day.

Other helpful ideas to use with children include focusing on the quality of what your child is eating and that they eat until they are full. In other words, no clean-plate club. Quality over quantity. Remember to use kid-sized portions. A good rule to keep in mind is one tablespoon of food per age of the child for each meal option (about two or three foods). It’s also good to serve one meal for your entire family. Plan meals to include at least one thing that everyone likes. Try healthier options for celebrations, and instead of rewarding children with food, give verbal praise or hugs for good behavior. Finally, if you have some particularly picky eaters, get creative to make fruits and vegetables fun. Try using unsweetened raisins or small pieces of fruit to make faces on healthy foods.

Stay active. Physical activity helps keep the heart and blood vessels healthy. Yet, only 1 in 5 adults meets the physical activity guidelines of getting 150 minutes a week of moderate-intensity activity. In fact, more than 1 in 3 American adults – and nearly 1 in 6 under the age of 18 is obese. Carrying around this extra weight puts stress on the heart. It can also contribute to more serious conditions like diabetes. This disease causes sugar to build up in the blood, causing damage to blood vessels and nerves that help control the heart muscle. Simply taking an evening walk as a family or playing an active game together in the back yard each night can help everyone meet their daily cardio goal.

Don’t smoke. Smoking damages blood vessels in our body and can cause heart disease. Despite the decades of health warnings, smoking is the leading cause of preventable death in the United States. More than 37 million U.S. adults currently smoke on a regular basis, and thousands of young people start smoking every day. If you don’t smoke – fabulous! Don’t start and be sure to talk with your older children about the dangers of smoking as well. If you do smoke, learn more about our smoking cessation services. Quitting smoking takes a lot of emotional energy and can be very stressful. Let our qualified staff help develop an individualized quitting plan.

Be consistent in managing any current health conditions. Millions of Americans (of all ages) have high blood pressure, and about half don’t have it under control. Having uncontrolled high blood pressure is one of the biggest risks for heart disease, as well as other harmful conditions including stroke. Work with your healthcare team to manage conditions such as high blood pressure and high cholesterol. Be honest and work together with your provider. Take medications as prescribed.

Heart disease can often be prevented when people make healthy choices and manage their health conditions. By making some simple changes to your family diet and exercise habits, you can help keep your family on the heart-healthy track. Set attainable goals and try to be consistent. Modeling these behaviors will also help your kids form these great habits. When communities, health professionals, and families work together, living heart healthy is possible.


Medical Associates is proud to provide advanced heart care that’s close to home. All of our cardiologists are board certified and bring many years of exceptional cardiac care to the community, making it the most complete and up-to-date cardiology program in the Tri-State area. Medical Associates also offers the only cardiothoracic surgeons in the area, and we have the experience and expertise to perform a full array of complex surgeries and techniques. These departments work closely with Internal Medicine, Gastroenterology, and others to provide comprehensive medical management, diagnosis, and treatment of patients.



Seasonal affective disorder: feeling down when the temperatures drop

Do you start feeling down in the winter months? You aren’t alone. Seasonal affective disorder, or SAD, presents as a variety of depression-like symptoms caused by your body getting out of its biological rhythm. Winter-onset SAD (the most common type) results from your body “losing its bearings” during the period of reduced daylight. Without sunlight to give your hormones a clue about the natural dawn-dusk cycle, your body’s chemical levels become unbalanced.

Especially if your work routine means arriving at and leaving the office when it’s dark outside, your body may be producing too much melatonin or too little serotonin, hormones involved in your body’s sleep-wake cycle. This kind of imbalance produces the slew of possible symptoms:

  • Fatigue and drop in energy levels
  • A tendency to oversleep
  • Change in appetite, like cravings
  • Weight gain
  • Difficulty concentrating
  • Irritability and anxiety
  • Antisocial behavior
  • Heightened sensitivity to social rejection
  • Lack of interest in normal activities
  • Feelings of guilt
  • Feelings of hopelessness
  • Physical problems, like headaches

While 10 to 20 percent of people in the United States suffer some SAD symptoms (called the “winter blues”), only four to six percent of people meet all the criteria of SAD diagnoses. SAD is more common in women than in men and generally shows in people at least 20 years of age. The risk increases for adults with age or for those that live in regions where winters are long and harsh.

Luckily, there are ways to combat SAD. Melatonin supplements and light therapy (intentionally exposing yourself to more sunlight) are ways of treating SAD. Melatonin is the hormone that your body starts producing when it gets dark in order to prepare you for sleep. Ensuring that your melatonin levels rise and fall on the proper timeline can offset SAD. Light therapy involves using daylight-simulating devices for certain periods of time each day to reach the same goal, and exposure to actual sunlight will do this naturally.

Antidepressants may also be used in some cases, as many antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs), work by helping to restore serotonin hormone balance.

If you have concerns about seasonal affective disorder or believe you are experiencing symptoms, be sure to discuss it with your health care provider. Visit our website or call (563) 584-3000 to schedule an appointment with Medical Associates today.

Note: SAD may share many symptoms with major depression or dysthymia. Call a doctor IMMEDIATELY if you are experiencing suicidal thoughts.

24-hour National Suicide Prevention Lifeline: 1 (800) 273-8255
Medical Associates 24-hour HELP Nurse: 1 (800) 325-7442



Source links:
Mayo Clinic
American Academy of Family Physicians
National Institute of Mental Health

Heart Failure and the Importance of Staying Active, even in the Winter Months

Young trainer helping senior woman in aqua aerobics. Senior retired woman staying fit by aqua aerobics in swimming pool. Happy old woman stretching in swimming pool with young trainer.

When thinking of things that are bad for your health, sitting isn’t often the first thing that comes to mind. However, inactivity or sitting for extended periods of time can be harmful to your health. It is especially harmful to those with heart failure. But when many feel cooped up during these winter months, how can you stay as active? Karena A. Sauser, DNP ARNP, from the Cardiology Department at Medical Associates shares more on the importance of staying active and tips to do it safely in the winter months.

For a patient with heart failure, difficulty breathing and fatigue resulting in diminished exercise tolerance are among the main factors that contribute to decreased social and physical functionality and quality of life. Exercise is a safe, non-pharmacological intervention in stable patients with heart failure. Along with medical therapy, exercise has positive effects on both morbidity and quality of life. Remember to speak with your healthcare provider before starting any form of exercise.

Some patients with heart failure may qualify for cardiac rehab. During cardiac rehab, exercise occurs under supervision with monitoring of blood pressure, heart rate, and heart rhythm. The added responsibility of showing up for appointments gives cardiac rehab patients more motivation to exercise. Cardiac Rehab Programs are offered in the following regional locations: Mercy-Dubuque, Maquoketa, Independence, Anamosa, and Manchester in Iowa; Galena in Illinois; and Darlington, Dodgeville, Boscobel, Lancaster, and Prairie Du Chien in Wisconsin.

However, if your provider tells you it is okay, it is also acceptable to exercise on your own. Just remember to start slow and gradually increase the length and intensity of your workout. You can start with 5-10 minutes/day at a slow pace and increase time and speed as you get stronger. An ideal goal for patients with mild to moderate heart failure is to exercise at least 150 minutes per week (30 minutes 5 days/week or 20-25 minutes daily). It is best to pick activities that you enjoy and are low-impact, such as walking, biking, or swimming. It is important to have a five minute warm-up/stretching period and five minute cool-down/stretching period. Avoid abruptly stopping exercise or immediately sitting or laying down after exercise to prevent dizziness or lightheadedness. It is also important to exercise year-round, even during the bitter cold of winter. If fitness centers are not an option or do not fit into your budget, there are many other heated places to exercise as the weather turns cold. You can always walk in churches, shopping malls, bigger “boxy” stores (like Wal-mart), or at the Mystique ice arena on the upper deck.

When in doubt, remember to follow these tips to exercise safely with heart failure:

  • Avoid exercises that require or encourage holding your breath.
  • Wait at least one hour after eating to exercise.
  • Avoid exercises or actions that require short bursts of energy (interval training).
  • Exercise when you have the most energy. For most heart failure patients, this is in the morning.
  • Think about exercising with a friend or family member. This can make it more enjoyable and social. It also keeps you more accountable/committed.
  • You should be able to talk while you exercise. If not, then you are probably exercising too hard and need to slow down.
  • The day after exercise, you may feel more tired. It is important to balance activity and rest.
  • Avoid exercising in extreme weather conditions. Find safe spaces to exercise that are between 40 and 80 degrees Fahrenheit and under 80% humidity.
  • Avoid exercise when you are not feeling well, have a fever, or your heart failure symptoms are not controlled.

One of the most important ways people with heart failure can maintain their sense of well-being is to stay active. The impact of movement, even leisurely movement, can be profound. Remember to speak with your healthcare provider before starting any form of exercise. Window shopping the mall aisles with a friend, roaming your local museum or art gallery, or stretching and doing some light exercises throughout your daily tasks at home are a few great ways to stay active during the cold months. It all helps burn calories, increase your energy, maintain muscle tone, as well as improve your mental well-being, especially as you age.



Karena A. Sauser, DNP ARNP
Department of Cardiology
Medical Associates Clinic