December 3, 2025 • 33 mins
What if birth control could be your most reliable tool for better cycles, clearer skin, steadier moods, and a smoother perimenopause—whether or not you need pregnancy prevention?
Speaking of Women's Health Podcast Host Dr. Holly Thacker sits down with Certified Nurse Practitioner Dana Leslie to map out a smarter, personalized path through contraception, hormone balance, and sexual health that actually fits real life.
They also break down the latest in at‑home STI testing.
If you found this useful, follow the show, share it with a friend, and leave a quick review so more listeners can find credible, practical women’s health guidance.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Holly Thacker (00:04):
Welcome to the Speaking of Women's Health
podcast.
I'm your host, Dr.
Holly Thacker, and I am back inour Sunflower House season
three to interview one of myfavorite ladies of all time,
Dana Lynn Leslie.
She is our top nursepractitioner in our Center for
(00:26):
Specialized Women's Health.
And I've often said, I wish shewas my daughter or my
daughter-in-law.
She's just so fabulous.
And I've talked about you somuch, Dana, on our podcast,
including on urinary tractinfections, right before I saw
you for my annual.
And I was scrubbing too hard.
I gave myself a UTI.
So we are going to talk aboutall things contraceptives, how
(00:49):
you individualize things foryour women patients.
And I just want to say welcomeback.
Thank you.
And congratulations on your newhome purchase.
Dana Leslie (01:01):
Yes, it's been such an adventure.
It's so fun.
Who would have thought?
Dr. Holly Thacker (01:05):
Yeah, I mean, I can't believe how handy you
are, and you're, you know, a newhomeowner.
You know how to redesignthings, and you're also a
gardener and a farmer and alandscaper.
Dana Leslie (01:17):
Trying my best.
I don't know.
Those are adjectives todescribe myself, but we're
working on it.
Dr. Holly Thacker (01:22):
Well, anyway, it's so great to welcome you
back.
We had you on season one, whichwas when to see a nurse
practitioner.
And we talked about when it's agood time to maybe see an APP
as opposed to your physician.
We also talked about all thedifferent types of IUDs.
So for any of our listeners, ifyou didn't hear that one,
that's a good one to go back to.
(01:44):
Um so Dana is back to discusshow and why individualizing
contraceptive options isimportant, especially in younger
women as well as women inperimenopause.
And we're also going to talkabout a somewhat newer topic,
which is um all about in-homesexually transmitted infection
(02:08):
testing.
Just as a reminder, Dana is acertified nurse practitioner at
the Cleveland Clinic Center forSpecialized Women's Health.
She had her undergraduatedegree at Youngstown State
University.
She was a D1 volleyballathlete, worked her way all the
way through school, and then shegot her graduate degree at the
(02:29):
University of Cincinnati.
And she sees patients at themain campus.
Um, she previously was seeingpatients uh in Lakewood, but now
that it's November, uh she'smoved to her practice Fridays.
She sees women at ourStrongsville facility, which is
where we're expanding on thewest side, and we'll be
(02:50):
expanding on the east side withanother uh nurse practitioner
physician combo that we'll letour listeners know about.
So, anyway, welcome back, Dana.
Dana Leslie (03:00):
Thank you so much.
I'm happy to be back.
Dr. Holly Thacker (03:03):
So let's just start off talking about um if
if a woman is gonna go on somesort of contraception for the
very first time or decides tomake a switch, uh, what should
be their first step or what aresome of the things that you talk
to ladies about?
Dana Leslie (03:19):
Absolutely.
When it comes to contraception,it really depends on the
purpose as to why someone'sgetting on contraception.
There's a lot of differentreasons to start contraception
outside of just preventing frompregnancy.
There's reasons for, you know,you for everywhere from cystic
acne to heavy menstrual flow topainful periods to
perimenopause.
(03:40):
So it's really just figuringout exactly what the person is
coming in for, the reasoningthat they're getting on the
birth control, and then movingfrom there, like going through
their medical history andexactly what would be a good fit
for them.
Dr. Holly Thacker (03:53):
Absolutely.
You know, one of theconversations I have so much
with my patients that are inlate perimenopause, about to be
in menopause, who don't needcontraception uh for a variety
of reasons, tubal ligations,vasectomies, not sexually
active, uh, etc.
Um, they're like, but I don'tneed birth control, but it's
(04:14):
hormonal control.
And I it just amazes me thatthere's a lot of women who come
in.
I don't know if it's because ofeverything on social media, but
they just want, oh, I want thepatch, or I want that
bioidentical hormones.
And why do you tell them thatthat that's not the right option
for them based on theirhormonal status?
(04:34):
Exactly.
Dana Leslie (04:35):
Yeah, we have a lot of patients that are like,
well, I don't need birthcontrol.
I'm not here for birth control.
I need hormonal support, or Iwant something to help
anti-aging as I'm going throughthis transition and things.
Um, and uh, the way I describeit the best is for women that
are still having periods orhaven't gone through that full
365 days of not having bleeding,their ovaries are still
(04:55):
functioning.
So you need a different dose ofhormonal level to help control
that ovarian function so thatyou're able to successfully get
over the symptoms that you'reexperiencing while also reducing
your risk of breakthroughbleeding and spotting.
Dr. Holly Thacker (05:10):
Yeah, that is so true.
And what I also tell women isthat even low-dose hormonal
contraceptive options, whichcontrol the ovaries, which your
ovaries are still young enough,they're not functioning right,
but they're too still too strongthat if you use menopausal
hormones, you're probably goingto have abnormal bleeding,
unless you have an IUD in oryou're at that very, very tail,
(05:33):
tail end where you know it'sjust a matter of a few weeks
before you you go intomenopause, that they're actually
getting more hormone.
And a lot of times it'sactually cheaper.
They may not have a copay.
So sometimes I think when womenhear that, they're a little bit
more accepting.
Um, but of course, not allwomen are options for higher
dose hormonal contraceptives ifthey smoke, if they have blood
(05:55):
clots, um, if they have other,you know, medical conditions.
But a lot of healthyperimenopausal women, whether
they need contraception or not,do very well.
And I think that those womenwho are done with childbearing,
they've already had their tubalare dismayed because they
thought they were just gonnasail right through that process,
which doesn't always happen.
(06:17):
Correct for sure.
So the other day we weretalking about some hormonal
contraceptive pills that havelittle twists on them, like
being chewable or dissolvable.
Dana Leslie (06:26):
Absolutely.
Yeah, there's a coupledifferent kinds out there on the
market now.
So the chewable tablet cameout, I believe the first one was
um FDA approved in 2014.
That original pill isn't evenon the market anymore because
there wasn't such a high demandfor it, but it recently has made
a retick in, you know,production.
Um, there's chewable anddissolvable.
(06:47):
They do have flavors with themso that they can taste like
spearmint for those people thathave a hard time swallowing
tablets or swallowing pills.
You can chew it.
The recommendation is that youdrink a whole glass of water
after taking the medication toget the absorption.
It was interesting, you know,for the chewable tablets, you
can chew the tablet or you canswallow it whole.
Whereas that dissolvable pettablet that just came out, that
(07:10):
one's the newest one that cameout last year in 2024.
The manufacturer doesn't listswallowing that tablet whole as
an available option that hasn'tbeen studied yet for taking.
So it's hesitant to use becauseif someone accidentally
swallows it whole, they say thatyou should be fine, but it's
kind of a murky area.
There isn't a lot of researchon if you actually take the
tablet without letting itdissolve.
Dr. Holly Thacker (07:31):
I have not had anyone in my practice
specifically say that.
Now, I know there's lots ofpeople who don't like to swallow
big pills.
There's people who forget totake pills every day.
Um, the only thing thatconcerns me about the one that
dissolves in the mouth is thatthey think it's a breath mint.
Like I'll pop it in before I'mgonna be intimate.
But it's not like that.
It's not an as-needed thing.
Dana Leslie (07:51):
Right.
Yeah, you still have to take itat the same time every day,
just like your other birthcontrol pills.
Dr. Holly Thacker (07:56):
Yeah, and that is so important, especially
with some of the lower dosepills that have a lot more
breakthrough bleeding.
Do you want to talk about whyyou might pick certain brands
that are better for acne or moodissues versus heavier bleeding
versus women that might have beon seizure medicine or have
recurrent ovarian cyst orpolycystic ovaries that need
(08:17):
like high, even higher doses?
Dana Leslie (08:20):
Absolutely.
Yeah.
So there's a lot of differentreasonings as to why we pick
specific pills.
If someone's coming in and theywant something for their cystic
acne, or if they have acondition called PCOS, or if
they have elevated androgenlevels in their lab work, I like
to use a birth control pillthat leads with drosperinone,
which is a progestin that's inthe combination pill.
(08:40):
So all of the combination pillshave estrogen and progestin in
them.
There's estrogen and progestinpills, or there's progestin-only
pills.
There are no estrogen-onlybirth control pills.
There's estrogen-only hormone,hormonal replacement pills, but
not for contraception.
For contraception, you need theprogestin to protect that
uterine lining because all thesepatients have a uterus.
(09:01):
So I use typically I reallylike the yas and the yasmins or
the gerosperinone-basedprogestins in the any type of
pill because those seems to doit, seem to do a lot better job
with controlling the ovarianfunction, decreasing the
bleeding, and decreasing thoseother symptoms that women have
experienced other than justthose heavy menstrual cycles.
Dr. Holly Thacker (09:22):
Yes, absolutely.
But the Yas and BAS and saffronand yasmin, they have
ethenolesterdiol, which issynthetic estrogen.
One of the newer options thatI've been using in some of my
perimenopausal patients isNextelus.
It has the same threemilligrams of drosperinone,
which is about equivalent to 12and a half of spironolactone for
(09:44):
those that are onspironolactone for acne or
abnormal hair growth.
I see a lot of dermatologistsand primary care doctors put
women on spiron lactone for acneor hair thinning, androgenic
hair thinning.
However, if they'repre-menopausal and they're not
on something to control theircycle, it can actually cause
some cycle abnormalities.
(10:05):
So I always like to use theboth together, and it's usually
not too much as long as there'snormal kidney function.
But this next stellus hasestetrol, which is E4, which is
a natural estrogen.
And so for women who might nothave tolerated other birth
control pills, I think that's agood option, particularly if
they have skin or hair or moodissues, or they're closer to
(10:29):
menopause and want not quite asstrong of a synthetic estrogen.
Dana Leslie (10:34):
Absolutely.
Yeah.
And now, luckily, thosemedications are becoming more
affordable, which makes it a lotbetter, too.
Dr. Holly Thacker (10:39):
Yes, because when they first came out, they
weren't.
And the other one that I'vetalked to your colleague, uh,
another nurse practitioner inour center, a new mom, Kelsey
Kennedy, about abnormal bleedingwas all about Nitasia, which
was the first birth control pillwith natural estradiol in it,
formulated.
Each pill is slightlydifferent, pretty much almost
(11:01):
through the whole pill pack,except for the last two pills,
uh, which are dummy pills,formulated to treat abnormal
bleeding.
And for the longest time, wedidn't have very good insurance
coverage, but it's it'scertainly getting better.
And what's interesting aboutthose two pills, especially
Natasia, but but evenpotentially Nextelis, is you can
still many times see thatincrease in the FSH level and
(11:24):
measure the estrogen level whereyou cannot in other birth
control pills.
And I see so many people orderhormones in women on birth
control pills, and they're theysay, you know, they're not
they're not valid at all.
And women get confused.
Correct.
And you were telling me theother day that women ask you a
lot for progesterone testing andtell me about that.
Dana Leslie (11:45):
There is a lot of um buzzword with progesterone
testing, and that's notsomething that we necessarily do
in our center.
I can personally have neverordered any type of progesterone
testing.
That's something that we reallyfocus on when people are trying
to get pregnant or if they'redoing like um intrauterine
pregnancy or if they're goingthrough infertility treatments
and things like that.
(12:05):
But that is not something thatwe focus on in a perimenopausal
or post-menopausal stage oflife.
Dr. Holly Thacker (12:11):
Right.
How I tell my patients is ifwe're worried that you're not on
enough progesterone, we want toget a tissue level of
progesterone.
And the way we do that is anendometrial sampling, which is a
little bit more than a papsmear, where we go in and get a
sample of that lining of theuterus to look under the
microscope.
Because if it's proliferativeor disordered proliferative or
(12:32):
even hyperplasia or cancer,well, then the cat's out of the
bag and clearly you haven't hadenough progesterone.
If it's secretory, it meansthat you're making enough or
taking enough progesterone, orif it's just benign or inactive.
So for anyone who's concernedthey're not on enough
progesterone and they're not inthe phase of trying to get
(12:53):
pregnant or maintain apregnancy.
I think that's just a lot ofhype by some people who really
aren't menopause specialists.
You know, people like yourselfand so many of the people that
we have in our center.
And I just think that for solong there's been no attention
on perimenopause.
And now there is, and noweverybody is thinking that
(13:16):
whatever issue they have, ifthey're over 30, if they're
between 30 and 50, they thinkit's perimenopause.
So, how do you differentiatesome of some of that in your
practice?
Dana Leslie (13:27):
Absolutely.
There's a lot of it has to bemy hormones, which is fair and
understood because hormonesfluctuate everything, but
there's a lot of differenthormones outside of just
perimenopausal hormones thatcould be affecting things.
So we get a really good medicalhistory.
We make sure we see what thefamily history was like.
We I ask about mothers andsisters or siblings that have
gone or if they have gonethrough perimenopause yet.
(13:48):
And then we do some labtesting.
As long as, like you said,they're not on hormones and
they're not on biotin oranything like that, that we can
check and get an accuratehormone level.
And then I really focus ontheir bleeding patterns and what
those symptoms look like.
Because if you're havingmonthly periods, you're the the
question of am I in menopause isout of the window, you know,
(14:09):
and then we have to figure outexactly what's going on behind
the scenes.
And we make sure we're checkingthe thyroid, make sure we're
checking all other aspects tosee what exactly is going on
instead of it just being solelyperimenopause or menopause.
Dr. Holly Thacker (14:22):
Yeah, I do see a lot of women who have
perfectly monthly cycles, theyknow when they ovulate,
sometimes they even havepremenstrual symptoms.
And I'm like, you can't havemenopause and PMS.
Now, it is possible tosometimes ovulate and have
premenstrual symptoms and thennot ovulate and have hot flashes
and perimenopause.
And so that can happen.
(14:45):
But people who just arecompletely perfectly normal,
nothing has changed about theircycle, and they're complaining
about things.
It makes me wonder (14:53):
do they have a vitamin deficiency, a
sleep disturbance, somepsychosocial stress, do they
have sleep apnea, do they havesome other undiagnosed medical
problem?
Because I've seen women withfibromyalgia, lung cancer, all
sorts of different seriousconditions who had regular
cycles who went to some outsidepractitioner and they gave them
(15:14):
a pellet and superdoses ofhormones.
So, so tell me how you dealwith the women that are coming
in with these pellets.
Dana Leslie (15:22):
So, you know, there is a population of people out
there that swear by theirpellets, and that's awesome for
them.
Pellets aren't FDA approved.
We do not do them in ourcenter, we do not promote them.
They give you a huge burst ofhormones, specifically,
typically it's testosterone, andthen you can have a huge
androgen excess.
So people can come in withfacial hair growth, changes in
(15:44):
their voice, changes in bodystructure.
There's a lot of differentnegative side effects that we
see often.
So we stay away from pellets.
You inject something, you'restuck with it for three months,
you have no control over whathappens after that, and they're
not FDA approved or regulated.
So we really don't use those atall.
Dr. Holly Thacker (16:02):
Yes, that is for sure.
And I think that anytime youboost hormones, just like when
sometimes people take prednisoneor steroids for some rheumatic
condition, oh, there's a boostof energy.
Yes.
I had to take uh some systemicsteroids a few years ago, and
I'm like, I feel like I'm 20.
I have all this energy, I don'tfeel anything in my joints.
But long term, you that's justnot sustainable.
(16:25):
And um having a higher level oftestosterone than is
appropriate for a female canreally cause long-term
irreversible effects.
And what women need if they aretruly low in estrogen is
estrogen.
They don't, they may or may notneed testosterone, and we
certainly prescribe lower dosesof either oral or transdermal
(16:45):
topical uh testosterone in thosewomen that need it.
But um I think it's definitelyabuse.
And I think a lot of women gettired of paying the money and
having abnormal bleeding andthen they show up in our office.
And there is like an addictiontachyphylaxis.
If you get used to these reallyhigh burst of hormones, um it
takes like more and more to kindof reach that peak, and then
(17:07):
that causes havoc on yourbreast, your uterus.
Um, it's just it's notsustainable.
And we have so many otheroptions that people don't have
to suffer that it's really ashame that um so much of the
care that's cash-based uh bypeople who really are not
certified menopausepractitioners, what they're what
(17:27):
they're doing.
Yeah.
So you have been listening tothe Speaking and Women's Health
podcast.
I'm your host, Dr.
Holly Thacker, the executivedirector of speaking and women's
health, and I am with nursepractitioner uh Dana Leslie.
We've been talking about uhcontraception, and we're gonna
move into STDs, but before weleave, um contraceptives, do you
(17:49):
want to make any comments aboutintrauterine systems, implants,
diaphragms, condoms?
Dana Leslie (17:56):
Absolutely.
Yeah, so the biggest thing thatum, you know, the Marina IUD
came out with some new researchthat now it is good for eight
years from a contraceptivestandpoint.
And I think the biggestmisconception, especially in our
practice, is that that IUD canstay in for eight years for
endometrial protection.
And that's not true.
We could only use it for fiveyears for endometrial
(18:17):
protection.
So even though it's good foreight years for birth control,
then you but you still needsomething after that five-year
mark to help protect you ifyou're on an estrogen to help
with perimenopausal symptoms.
Dr. Holly Thacker (18:28):
Yeah, I really like to get people at the
five-year mark, have itswitched out as as they're
getting older, especially ifthey've got any risk for uterine
cancer or abnormal bleeding,and it's only FDA approved to
manage abnormal bleeding as wellfor five years, whether or not
you're adding the the estrogenpatch or not.
(18:48):
Um, and I've seen some decidualtissue in people up to eight
years.
So personally, I, if I wasusing it for contraception,
would want it out at sevenyears, but um yeah, they have
kept pushing it back.
And tell us about there's anover-the-counter
progesterone-only contraceptive.
(19:08):
Tell us about that.
Dana Leslie (19:10):
Yeah, so the over-the-counter progesterone
only, those are your northendrones.
We prescribe them often in theoffice, but now they're giving
people the options to get themwithout going to the doctor's
office for people with lessinsurance, or for whatever
reason, if they don't feelcomfortable talking to their
provider about contraception.
The North Indrones do a reallygood job of preventing pregnancy
as long as you're taking themat the same time every day.
(19:32):
Northindrones do have anincreased risk of breakthrough
bleeding and spotting, and theyhave a very narrow window of how
far off you can divert fromthat hourly mark when you're
taking it before they start tohave where you can you still
ovulate with the north endrones.
They don't manipulate theovarian function.
They work more on the mucus andthe lining to help prevent
(19:53):
pregnancy.
And they're typically prettyexpensive.
So if you have insurance, it'snot a if you feel comfortable,
it's not a bad idea to talk toyour provider or your
practitioner because those inthe um over-the-counters, they I
think they're about $50 a monthfrom last I checked.
But um, they they do work wellif that's what you have and
that's your option, that'sgreat.
(20:13):
But they can be a little priceyand they're not always the best
option.
Dr. Holly Thacker (20:17):
Yes, certainly.
And they they probably wouldn'thelp skin and hair, although
the newest progestant onlythat's by prescription, SLInd,
is one of my favorite.
It's four milligrams ofdrosperinone, which doesn't
raise blood pressure, and itseems a lot stronger.
I do see FSH suppression, so Ithink it's a better
contraceptive.
(20:38):
And uh sometimes it's notreally a progestant, it's
similar to spironolactone, andso it's not really a C19 um
derivative.
So I think there's a lot ofwomen who tolerate that that
better.
Dana Leslie (20:53):
Yeah, absolutely.
And just like those other umbirth controls we talked about,
since it's becoming morepopular, the price of it has
gotten a lot more reasonable,which is nice because it's a
great product.
Dr. Holly Thacker (21:01):
Yes, yes.
So um any any comments aboutimplants, about who might want a
copper IUD as opposed to aprogesterone IUD?
Dana Leslie (21:12):
Yeah, absolutely.
Some people um feel like theyhave a very strong sensitivity
to any type of hormonalfluctuation.
So a lot of times then then wecan recommend the copper IUD.
The copper IUD is good for 10years, it's strictly pregnancy
prevention.
It doesn't have a positiveeffect on the the cycles.
Typically, your periods getheavier, at least for the first
(21:34):
six months with the copper IUD,because of a fore body being in
the uterus.
Um, but other than that, it'sstrictly just for pregnancy
prevention, and that's good for10 years.
The next planon is good forthree years.
It's goes, it's a small rodthat goes into the arm.
It's about the size of amatchstick.
Um, that's they those are allvery efficacious for pregnancy
prevention.
My biggest side effect that Isee with my patients with the
(21:55):
Nexplanon, it's very hit ormiss.
So some people love it, havehad a year through every three
years, get it exchanged and theydo perfect.
Other people have a lot ofabnormal bleeding, so they like
it out and they want a differentoption.
Dr. Holly Thacker (22:06):
I think for people who want an option but
they don't want something put intheir uterus, um, one option
that I use, and I actuallyprefer it over the moraine, even
if they don't have an objectionto an IUD.
But if they need ovariansuppression to reduce their risk
of ovarian cancer, like we haveBRCA patients who are not quite
old enough to have theirovaries out and they don't want
(22:29):
two surgeries.
Some people go get the tubesout to reduce ovarian cancer,
but keep their ovaries untiltheir late 30s or depending on
if it's BRCA1 or two, theirfamily history by age 40 or done
with childbearing, then theytake the ovaries out and
hopefully the uterus.
But while they may needcontraception, which a morena
would give, it doesn't reduceovarian cancer like hormonal
(22:50):
estrogen progestins do.
So I like the annovera ringthat has enough hormones to last
the whole year.
So someone who's busy, shiftworker, doesn't, you know, want
something implanted in theirskin, wants the suppression to
reduce ovarian cancer, uh, theycan just slip that ring in.
(23:10):
And even though it's packagedto come out for a week, like the
Nuva ring, rinsed off and thesame ring put back in, it really
can stay in the whole time andum last a whole year.
So um that's a little nichethat I I I don't see.
I don't know how many if wwomen just don't know about that
option.
But anyone who's been along-term Nuva ring option,
(23:33):
those rings only last for threeweeks, and then you have to
throw it away and get a new one.
Absolutely, yes.
So switching gears a bit, uhlet's talk about in-home S STI
testing.
What is an STI test?
Dana Leslie (23:47):
Absolutely.
STI tests are swabs that we doto check for gonnery and
chlamydia primarily.
When you're in the office, wedo the swabs that we do are a
little bit more involved and alittle bit more detailed, but
the home kits currently aretesting for gonneria and
chlamydia.
They're a great option forpeople that are don't have a lot
of access or um are nervous toask for the FCD screening when
(24:09):
they're in the office orwhatever reason, personal or
whatever, that they don't wantto get it done in a private in a
um uh office setting.
They are efficacious, they dojust as well as detecting
gonorrhea and chlamydia.
The issue in the hiccup comeswith transportation and
packaging and making sure thatonce the swab's completed,
you're putting it back in thattest tube and getting it off
(24:31):
into the mail as fast as you'reable to to make sure that it
gets sent in a timely fashion sothat there's no false positives
or false negatives that aredetected with the lab work once
it gets ran.
Dr. Holly Thacker (24:43):
And so then do they notify the patient who's
purchased this over-the-counterdevice directly if if if it's
abnormal or if it's it'snegative, and then they're told
to contact a healthcareclinician to actually order the
appropriate prescriptions?
Dana Leslie (24:57):
Absolutely.
And I believe a lot of theprograms now or a lot of the
systems that are doing this evenhave like their virtual their
virtual practitioners that theycan make an appointment with to
get these prescriptions and goover that with them.
Dr. Holly Thacker (25:09):
Now, there's it depends on, I'm sure, state
law, and you know, we'repracticing in the state of Ohio,
but uh not too long ago, one ofour fellows uh prescribed uh S
STI treatment for her patientand a male partner, and the
pharmacist had called for somequestion about it, and one of
(25:29):
our nurses was upset.
Why why is one of our women'shealth doctors who only sees
women prescribing for a man?
This doesn't make sense.
Did she just not get it right?
But it was very specific aboutapplying something to the penis,
so clearly it was instructionsfor a man.
And um, I told her, Well, youcan do that, you're allowed by
(25:50):
state law to prescribe forsomeone you haven't seen if
that's a sexual partner.
Dana Leslie (25:55):
Absolutely.
Yeah, it's called expeditedpatient treatment, so or
expedited partner treatment,excuse me.
In the state of Ohio, we'relegally allowed to prescribe for
the patient's uh partner ifthey aren't able to get in or if
it's easier just to get them aquicker treatment and then they
can get tested uh afterwards,after about three months after
treatment to make sure that it'scleared up.
Dr. Holly Thacker (26:15):
And I think it's important for people to
know about antibiotic allergies.
And I think ideally it's betterto see a healthcare clinician
in person.
Um, and it's possible that thepartner could have other things
too that might need to betreated and be instructed on,
you know, risk reduction,perhaps even HIV testing, which
(26:36):
is of course one of the moreserious uh sexually transmitted
infections.
Um but um any other commentsabout about treating women, why
you want to treat young womenwho have sexually transmitted
infections and not just let thatfester?
Dana Leslie (26:51):
Absolutely.
So the CDC recommends thatwomen that are sexually active
under age 25 get screened everyyear.
And then after that, at leastevery three years, for sure, uh
depending on, you know, riskbehaviors and things like that.
Um, we I like to go, I askevery single patient when they
come in if they want STDscreening because you never
know.
And some people just like toknow and to make sure in the
(27:11):
back of their head that they areokay in that department.
Most of the symptoms of STDsare silent, which is why we
really want to get thosescreenings done because the
long-term effects can scarfallopian tubes, which can cause
issues with infertility in thefuture.
Also, it can cause issues withthe cervix, causing different um
pelvic inflammatory diseasesymptoms, and can in the long
(27:34):
run become very painful and veryproblematic for patients if
they don't get them treated.
Dr. Holly Thacker (27:39):
And it can certainly affect fertility, you
know, scarring the tubes,causing ectopic uh pregnancies,
um, which can be deadlyactually.
Uh, talking aboutself-screening, um, talk a
little bit about HPV humanpapillomavirus uh home testing
(27:59):
and where you might recommendthat.
Dana Leslie (28:02):
Yeah, so back in 2024, I believe in July of 2024,
the FDA approved the firstself-suab pap smear or HPV
detection.
So it's still in the UnitedStates, it's still only approved
to do in an office.
They don't recommend it afterthere's no like home kit yet.
Um, but the patient comes intothe office.
These are, I use thisspecifically for people that
(28:23):
aren't currently sexuallyactive, have maybe never been
sexually active, are nervous,have uh traumatic experiences
with pelvic exams or whatevertheir medical history will be,
and they just do not toleratespeculum exams.
There are swabs that you putinto the vagina, you insert it
about two inches into thevagina, and then you turn it or
move it around for 20 to 30seconds, and then you put it
(28:45):
into the test, the tubes, andsend it off to the lab.
It specifically is testing forHPV, which is the virus that
leads to most cervical cancers,and it can reflex the cytology.
However, their cytology thecytology isn't as accurate as
what your typical PAP smear is,but it at least can detect those
high-risk HPVs, and we can geta lot of people that have CIN2
(29:07):
and lesser have a good idea ofexactly what we're dealing with,
so we can get them the adequatetreatment that they need.
Dr. Holly Thacker (29:13):
Now, one thing I've been seeing a lot of,
uh I mean, I think that theco-testing, if you're over 30,
with both the PAP smear to lookat the cells, which is a scrape
of the cervix with a brush and aspatula, spatula first, then
the brush, um, is and and HPVtesting is better than just HPV
testing for sure, but you know,something is better than
(29:34):
nothing.
And I've seen a lot of womenwho, you know, follow
instruction, they haveinsurance, they don't have any
problem with coming in andgetting, you know, a pelvic
exam.
But they're so far arrears intheir PAP.
And um, you know, a lot of themsay, well, I was told I don't
need it or I can do it everyfive years.
(29:55):
Do you want to talk about howwhat our practice is like?
Dana Leslie (29:58):
Yeah, yeah, absolutely.
You know, a lot of people alsodon't know.
So they think that just becausewhatever clinic that they went
to in the past, or whoever theysaw didn't contact them, or they
didn't read it out, or theynever saw anything, that they
have to be absolutely normal andeverything was negative,
everything was fine.
A lot of people don't realizethat they have had a positive
HPV in the past, or they didhave some atypical cells on
(30:20):
their PAP smear.
So everyone's guidelines are alittle different.
You know, most insurances coveryour PAP to be done every
single year.
Um the guidelines currentlystill are at every five years.
However, I personally practice,and in our practice, we do
every three years.
I see a lot happen betweenthree and five that I don't like
waiting, and I've had enoughexperiences where we've caught
things because we've done it inthree years that it doesn't seem
(30:41):
logical to do it in five years,in my perspective.
I do have some patients that donot want it in three years, and
that's absolutely right, 100%.
But I do recommend getting itdone at least every three years.
If you've ever had anabnormality, I like to do a PAP
every year for at least threenormal consecutive years in a
row.
If they're normal negative forthose three years, then we can
(31:02):
go back to that every three-yearscreening.
Someone that says, Oh, I had aleap 10 years ago, I don't need
it anymore.
Depending on what that cytologylooked like prior to that leap,
you still probably need a PAPevery year until 65, if not
older.
So there's a lot ofmiscommunication and
misinterpretation between, well,it happened in my 20s.
(31:22):
It doesn't matter anymore.
And that's absolutely not thecase, especially with PAP
SNEARS.
Dr. Holly Thacker (31:26):
And the immune status, too, you know,
for patients that are on uhimmunosuppressant medicines are
transplant patients, uh patientsthat might be daughters of uh
women who took DES duringpregnancy, they may need yearly
PAPS indefinitely.
And so one size doesn't fitall, and um it just annoys me
when someone goes and gets apelvic exam and it's been four
(31:50):
uh years and a few months sincetheir last PAP and they don't
get it, and the patient thinksbecause a speculum was put in
and they had a bimanual examthat oh, that was their PAP,
which is very different thanjust getting a pelvic exam.
So I think a yearly checkup,whether you're examined or not,
whether you get a PAP or not, isreally important overall
(32:10):
because there's so many changinguh guidelines.
So tell us how can people seeyou who want to see you at main
campus or uh at your newStrongsville location.
Dana Leslie (32:21):
Absolutely.
So there's a couple differentavenues.
You know, we have Sarah whotook the place of Ronda when
Miss Ronda retired.
Um and we can contact her.
She I know there's a new numberout for them now, but I always
give everybody the 216-444-6601to get a scheduling appointment.
And then, you know, if you'veseen me in the past ever, you
can always schedule through mychart as well.
(32:41):
And it typically about a weekor a couple weeks or so
typically to get in, dependingon what that schedule looks
like.
I always tell my patients too,if they're having a hard time,
try to really call oursecretaries or schedulers
because it seems like patientsfall off a lot or cancel, and
there's a lot of same-dayopenings.
If they're able to make it inthat day, they could get in a
lot sooner.
Dr. Holly Thacker (32:59):
And you're the best, you know.
If I ask you, oh, can you seethis patient?
They're from, you know, anotherstate.
You're just so terrific.
Dana Leslie (33:05):
Well, you're awesome and you make it easy.
So it's easy to do.
Dr. Holly Thacker (33:09):
Well, thank you so much for joining us on
this episode of Speaking ofWomen's Health.
If you've enjoyed it, give us afive-star rating.
Uh, send it to your friends.
And if you don't already followor subscribe or collect this
free podcast, please do that.
And remember, be strong, behealthy, and be in charge.
(33:30):
And we'll see you next time.
Welcome to the Speaking of Women's Health
podcast.
I'm your host, Dr.
Holly Thacker, and I am back inour Sunflower House season
three to interview one of myfavorite ladies of all time,
Dana Lynn Leslie.
She is our top nursepractitioner in our Center for
(00:26):
Specialized Women's Health.
And I've often said, I wish shewas my daughter or my
daughter-in-law.
She's just so fabulous.
And I've talked about you somuch, Dana, on our podcast,
including on urinary tractinfections, right before I saw
you for my annual.
And I was scrubbing too hard.
I gave myself a UTI.
So we are going to talk aboutall things contraceptives, how
(00:49):
you individualize things foryour women patients.
And I just want to say welcomeback.
Thank you.
And congratulations on your newhome purchase.
Dana Leslie (01:01):
Yes, it's been such an adventure.
It's so fun.
Who would have thought?
Dr. Holly Thacker (01:05):
Yeah, I mean, I can't believe how handy you
are, and you're, you know, a newhomeowner.
You know how to redesignthings, and you're also a
gardener and a farmer and alandscaper.
Dana Leslie (01:17):
Trying my best.
I don't know.
Those are adjectives todescribe myself, but we're
working on it.
Dr. Holly Thacker (01:22):
Well, anyway, it's so great to welcome you
back.
We had you on season one, whichwas when to see a nurse
practitioner.
And we talked about when it's agood time to maybe see an APP
as opposed to your physician.
We also talked about all thedifferent types of IUDs.
So for any of our listeners, ifyou didn't hear that one,
that's a good one to go back to.
(01:44):
Um so Dana is back to discusshow and why individualizing
contraceptive options isimportant, especially in younger
women as well as women inperimenopause.
And we're also going to talkabout a somewhat newer topic,
which is um all about in-homesexually transmitted infection
(02:08):
testing.
Just as a reminder, Dana is acertified nurse practitioner at
the Cleveland Clinic Center forSpecialized Women's Health.
She had her undergraduatedegree at Youngstown State
University.
She was a D1 volleyballathlete, worked her way all the
way through school, and then shegot her graduate degree at the
(02:29):
University of Cincinnati.
And she sees patients at themain campus.
Um, she previously was seeingpatients uh in Lakewood, but now
that it's November, uh she'smoved to her practice Fridays.
She sees women at ourStrongsville facility, which is
where we're expanding on thewest side, and we'll be
(02:50):
expanding on the east side withanother uh nurse practitioner
physician combo that we'll letour listeners know about.
So, anyway, welcome back, Dana.
Dana Leslie (03:00):
Thank you so much.
I'm happy to be back.
Dr. Holly Thacker (03:03):
So let's just start off talking about um if
if a woman is gonna go on somesort of contraception for the
very first time or decides tomake a switch, uh, what should
be their first step or what aresome of the things that you talk
to ladies about?
Dana Leslie (03:19):
Absolutely.
When it comes to contraception,it really depends on the
purpose as to why someone'sgetting on contraception.
There's a lot of differentreasons to start contraception
outside of just preventing frompregnancy.
There's reasons for, you know,you for everywhere from cystic
acne to heavy menstrual flow topainful periods to
perimenopause.
(03:40):
So it's really just figuringout exactly what the person is
coming in for, the reasoningthat they're getting on the
birth control, and then movingfrom there, like going through
their medical history andexactly what would be a good fit
for them.
Dr. Holly Thacker (03:53):
Absolutely.
You know, one of theconversations I have so much
with my patients that are inlate perimenopause, about to be
in menopause, who don't needcontraception uh for a variety
of reasons, tubal ligations,vasectomies, not sexually
active, uh, etc.
Um, they're like, but I don'tneed birth control, but it's
(04:14):
hormonal control.
And I it just amazes me thatthere's a lot of women who come
in.
I don't know if it's because ofeverything on social media, but
they just want, oh, I want thepatch, or I want that
bioidentical hormones.
And why do you tell them thatthat that's not the right option
for them based on theirhormonal status?
(04:34):
Exactly.
Dana Leslie (04:35):
Yeah, we have a lot of patients that are like,
well, I don't need birthcontrol.
I'm not here for birth control.
I need hormonal support, or Iwant something to help
anti-aging as I'm going throughthis transition and things.
Um, and uh, the way I describeit the best is for women that
are still having periods orhaven't gone through that full
365 days of not having bleeding,their ovaries are still
(04:55):
functioning.
So you need a different dose ofhormonal level to help control
that ovarian function so thatyou're able to successfully get
over the symptoms that you'reexperiencing while also reducing
your risk of breakthroughbleeding and spotting.
Dr. Holly Thacker (05:10):
Yeah, that is so true.
And what I also tell women isthat even low-dose hormonal
contraceptive options, whichcontrol the ovaries, which your
ovaries are still young enough,they're not functioning right,
but they're too still too strongthat if you use menopausal
hormones, you're probably goingto have abnormal bleeding,
unless you have an IUD in oryou're at that very, very tail,
(05:33):
tail end where you know it'sjust a matter of a few weeks
before you you go intomenopause, that they're actually
getting more hormone.
And a lot of times it'sactually cheaper.
They may not have a copay.
So sometimes I think when womenhear that, they're a little bit
more accepting.
Um, but of course, not allwomen are options for higher
dose hormonal contraceptives ifthey smoke, if they have blood
(05:55):
clots, um, if they have other,you know, medical conditions.
But a lot of healthyperimenopausal women, whether
they need contraception or not,do very well.
And I think that those womenwho are done with childbearing,
they've already had their tubalare dismayed because they
thought they were just gonnasail right through that process,
which doesn't always happen.
(06:17):
Correct for sure.
So the other day we weretalking about some hormonal
contraceptive pills that havelittle twists on them, like
being chewable or dissolvable.
Dana Leslie (06:26):
Absolutely.
Yeah, there's a coupledifferent kinds out there on the
market now.
So the chewable tablet cameout, I believe the first one was
um FDA approved in 2014.
That original pill isn't evenon the market anymore because
there wasn't such a high demandfor it, but it recently has made
a retick in, you know,production.
Um, there's chewable anddissolvable.
(06:47):
They do have flavors with themso that they can taste like
spearmint for those people thathave a hard time swallowing
tablets or swallowing pills.
You can chew it.
The recommendation is that youdrink a whole glass of water
after taking the medication toget the absorption.
It was interesting, you know,for the chewable tablets, you
can chew the tablet or you canswallow it whole.
Whereas that dissolvable pettablet that just came out, that
(07:10):
one's the newest one that cameout last year in 2024.
The manufacturer doesn't listswallowing that tablet whole as
an available option that hasn'tbeen studied yet for taking.
So it's hesitant to use becauseif someone accidentally
swallows it whole, they say thatyou should be fine, but it's
kind of a murky area.
There isn't a lot of researchon if you actually take the
tablet without letting itdissolve.
Dr. Holly Thacker (07:31):
I have not had anyone in my practice
specifically say that.
Now, I know there's lots ofpeople who don't like to swallow
big pills.
There's people who forget totake pills every day.
Um, the only thing thatconcerns me about the one that
dissolves in the mouth is thatthey think it's a breath mint.
Like I'll pop it in before I'mgonna be intimate.
But it's not like that.
It's not an as-needed thing.
Dana Leslie (07:51):
Right.
Yeah, you still have to take itat the same time every day,
just like your other birthcontrol pills.
Dr. Holly Thacker (07:56):
Yeah, and that is so important, especially
with some of the lower dosepills that have a lot more
breakthrough bleeding.
Do you want to talk about whyyou might pick certain brands
that are better for acne or moodissues versus heavier bleeding
versus women that might have beon seizure medicine or have
recurrent ovarian cyst orpolycystic ovaries that need
(08:17):
like high, even higher doses?
Dana Leslie (08:20):
Absolutely.
Yeah.
So there's a lot of differentreasonings as to why we pick
specific pills.
If someone's coming in and theywant something for their cystic
acne, or if they have acondition called PCOS, or if
they have elevated androgenlevels in their lab work, I like
to use a birth control pillthat leads with drosperinone,
which is a progestin that's inthe combination pill.
(08:40):
So all of the combination pillshave estrogen and progestin in
them.
There's estrogen and progestinpills, or there's progestin-only
pills.
There are no estrogen-onlybirth control pills.
There's estrogen-only hormone,hormonal replacement pills, but
not for contraception.
For contraception, you need theprogestin to protect that
uterine lining because all thesepatients have a uterus.
(09:01):
So I use typically I reallylike the yas and the yasmins or
the gerosperinone-basedprogestins in the any type of
pill because those seems to doit, seem to do a lot better job
with controlling the ovarianfunction, decreasing the
bleeding, and decreasing thoseother symptoms that women have
experienced other than justthose heavy menstrual cycles.
Dr. Holly Thacker (09:22):
Yes, absolutely.
But the Yas and BAS and saffronand yasmin, they have
ethenolesterdiol, which issynthetic estrogen.
One of the newer options thatI've been using in some of my
perimenopausal patients isNextelus.
It has the same threemilligrams of drosperinone,
which is about equivalent to 12and a half of spironolactone for
(09:44):
those that are onspironolactone for acne or
abnormal hair growth.
I see a lot of dermatologistsand primary care doctors put
women on spiron lactone for acneor hair thinning, androgenic
hair thinning.
However, if they'repre-menopausal and they're not
on something to control theircycle, it can actually cause
some cycle abnormalities.
(10:05):
So I always like to use theboth together, and it's usually
not too much as long as there'snormal kidney function.
But this next stellus hasestetrol, which is E4, which is
a natural estrogen.
And so for women who might nothave tolerated other birth
control pills, I think that's agood option, particularly if
they have skin or hair or moodissues, or they're closer to
(10:29):
menopause and want not quite asstrong of a synthetic estrogen.
Dana Leslie (10:34):
Absolutely.
Yeah.
And now, luckily, thosemedications are becoming more
affordable, which makes it a lotbetter, too.
Dr. Holly Thacker (10:39):
Yes, because when they first came out, they
weren't.
And the other one that I'vetalked to your colleague, uh,
another nurse practitioner inour center, a new mom, Kelsey
Kennedy, about abnormal bleedingwas all about Nitasia, which
was the first birth control pillwith natural estradiol in it,
formulated.
Each pill is slightlydifferent, pretty much almost
(11:01):
through the whole pill pack,except for the last two pills,
uh, which are dummy pills,formulated to treat abnormal
bleeding.
And for the longest time, wedidn't have very good insurance
coverage, but it's it'scertainly getting better.
And what's interesting aboutthose two pills, especially
Natasia, but but evenpotentially Nextelis, is you can
still many times see thatincrease in the FSH level and
(11:24):
measure the estrogen level whereyou cannot in other birth
control pills.
And I see so many people orderhormones in women on birth
control pills, and they're theysay, you know, they're not
they're not valid at all.
And women get confused.
Correct.
And you were telling me theother day that women ask you a
lot for progesterone testing andtell me about that.
Dana Leslie (11:45):
There is a lot of um buzzword with progesterone
testing, and that's notsomething that we necessarily do
in our center.
I can personally have neverordered any type of progesterone
testing.
That's something that we reallyfocus on when people are trying
to get pregnant or if they'redoing like um intrauterine
pregnancy or if they're goingthrough infertility treatments
and things like that.
(12:05):
But that is not something thatwe focus on in a perimenopausal
or post-menopausal stage oflife.
Dr. Holly Thacker (12:11):
Right.
How I tell my patients is ifwe're worried that you're not on
enough progesterone, we want toget a tissue level of
progesterone.
And the way we do that is anendometrial sampling, which is a
little bit more than a papsmear, where we go in and get a
sample of that lining of theuterus to look under the
microscope.
Because if it's proliferativeor disordered proliferative or
(12:32):
even hyperplasia or cancer,well, then the cat's out of the
bag and clearly you haven't hadenough progesterone.
If it's secretory, it meansthat you're making enough or
taking enough progesterone, orif it's just benign or inactive.
So for anyone who's concernedthey're not on enough
progesterone and they're not inthe phase of trying to get
(12:53):
pregnant or maintain apregnancy.
I think that's just a lot ofhype by some people who really
aren't menopause specialists.
You know, people like yourselfand so many of the people that
we have in our center.
And I just think that for solong there's been no attention
on perimenopause.
And now there is, and noweverybody is thinking that
(13:16):
whatever issue they have, ifthey're over 30, if they're
between 30 and 50, they thinkit's perimenopause.
So, how do you differentiatesome of some of that in your
practice?
Dana Leslie (13:27):
Absolutely.
There's a lot of it has to bemy hormones, which is fair and
understood because hormonesfluctuate everything, but
there's a lot of differenthormones outside of just
perimenopausal hormones thatcould be affecting things.
So we get a really good medicalhistory.
We make sure we see what thefamily history was like.
We I ask about mothers andsisters or siblings that have
gone or if they have gonethrough perimenopause yet.
(13:48):
And then we do some labtesting.
As long as, like you said,they're not on hormones and
they're not on biotin oranything like that, that we can
check and get an accuratehormone level.
And then I really focus ontheir bleeding patterns and what
those symptoms look like.
Because if you're havingmonthly periods, you're the the
question of am I in menopause isout of the window, you know,
(14:09):
and then we have to figure outexactly what's going on behind
the scenes.
And we make sure we're checkingthe thyroid, make sure we're
checking all other aspects tosee what exactly is going on
instead of it just being solelyperimenopause or menopause.
Dr. Holly Thacker (14:22):
Yeah, I do see a lot of women who have
perfectly monthly cycles, theyknow when they ovulate,
sometimes they even havepremenstrual symptoms.
And I'm like, you can't havemenopause and PMS.
Now, it is possible tosometimes ovulate and have
premenstrual symptoms and thennot ovulate and have hot flashes
and perimenopause.
And so that can happen.
(14:45):
But people who just arecompletely perfectly normal,
nothing has changed about theircycle, and they're complaining
about things.
It makes me wonder (14:53):
do they have a vitamin deficiency, a
sleep disturbance, somepsychosocial stress, do they
have sleep apnea, do they havesome other undiagnosed medical
problem?
Because I've seen women withfibromyalgia, lung cancer, all
sorts of different seriousconditions who had regular
cycles who went to some outsidepractitioner and they gave them
(15:14):
a pellet and superdoses ofhormones.
So, so tell me how you dealwith the women that are coming
in with these pellets.
Dana Leslie (15:22):
So, you know, there is a population of people out
there that swear by theirpellets, and that's awesome for
them.
Pellets aren't FDA approved.
We do not do them in ourcenter, we do not promote them.
They give you a huge burst ofhormones, specifically,
typically it's testosterone, andthen you can have a huge
androgen excess.
So people can come in withfacial hair growth, changes in
(15:44):
their voice, changes in bodystructure.
There's a lot of differentnegative side effects that we
see often.
So we stay away from pellets.
You inject something, you'restuck with it for three months,
you have no control over whathappens after that, and they're
not FDA approved or regulated.
So we really don't use those atall.
Dr. Holly Thacker (16:02):
Yes, that is for sure.
And I think that anytime youboost hormones, just like when
sometimes people take prednisoneor steroids for some rheumatic
condition, oh, there's a boostof energy.
Yes.
I had to take uh some systemicsteroids a few years ago, and
I'm like, I feel like I'm 20.
I have all this energy, I don'tfeel anything in my joints.
But long term, you that's justnot sustainable.
(16:25):
And um having a higher level oftestosterone than is
appropriate for a female canreally cause long-term
irreversible effects.
And what women need if they aretruly low in estrogen is
estrogen.
They don't, they may or may notneed testosterone, and we
certainly prescribe lower dosesof either oral or transdermal
(16:45):
topical uh testosterone in thosewomen that need it.
But um I think it's definitelyabuse.
And I think a lot of women gettired of paying the money and
having abnormal bleeding andthen they show up in our office.
And there is like an addictiontachyphylaxis.
If you get used to these reallyhigh burst of hormones, um it
takes like more and more to kindof reach that peak, and then
(17:07):
that causes havoc on yourbreast, your uterus.
Um, it's just it's notsustainable.
And we have so many otheroptions that people don't have
to suffer that it's really ashame that um so much of the
care that's cash-based uh bypeople who really are not
certified menopausepractitioners, what they're what
(17:27):
they're doing.
Yeah.
So you have been listening tothe Speaking and Women's Health
podcast.
I'm your host, Dr.
Holly Thacker, the executivedirector of speaking and women's
health, and I am with nursepractitioner uh Dana Leslie.
We've been talking about uhcontraception, and we're gonna
move into STDs, but before weleave, um contraceptives, do you
(17:49):
want to make any comments aboutintrauterine systems, implants,
diaphragms, condoms?
Dana Leslie (17:56):
Absolutely.
Yeah, so the biggest thing thatum, you know, the Marina IUD
came out with some new researchthat now it is good for eight
years from a contraceptivestandpoint.
And I think the biggestmisconception, especially in our
practice, is that that IUD canstay in for eight years for
endometrial protection.
And that's not true.
We could only use it for fiveyears for endometrial
(18:17):
protection.
So even though it's good foreight years for birth control,
then you but you still needsomething after that five-year
mark to help protect you ifyou're on an estrogen to help
with perimenopausal symptoms.
Dr. Holly Thacker (18:28):
Yeah, I really like to get people at the
five-year mark, have itswitched out as as they're
getting older, especially ifthey've got any risk for uterine
cancer or abnormal bleeding,and it's only FDA approved to
manage abnormal bleeding as wellfor five years, whether or not
you're adding the the estrogenpatch or not.
(18:48):
Um, and I've seen some decidualtissue in people up to eight
years.
So personally, I, if I wasusing it for contraception,
would want it out at sevenyears, but um yeah, they have
kept pushing it back.
And tell us about there's anover-the-counter
progesterone-only contraceptive.
(19:08):
Tell us about that.
Dana Leslie (19:10):
Yeah, so the over-the-counter progesterone
only, those are your northendrones.
We prescribe them often in theoffice, but now they're giving
people the options to get themwithout going to the doctor's
office for people with lessinsurance, or for whatever
reason, if they don't feelcomfortable talking to their
provider about contraception.
The North Indrones do a reallygood job of preventing pregnancy
as long as you're taking themat the same time every day.
(19:32):
Northindrones do have anincreased risk of breakthrough
bleeding and spotting, and theyhave a very narrow window of how
far off you can divert fromthat hourly mark when you're
taking it before they start tohave where you can you still
ovulate with the north endrones.
They don't manipulate theovarian function.
They work more on the mucus andthe lining to help prevent
(19:53):
pregnancy.
And they're typically prettyexpensive.
So if you have insurance, it'snot a if you feel comfortable,
it's not a bad idea to talk toyour provider or your
practitioner because those inthe um over-the-counters, they I
think they're about $50 a monthfrom last I checked.
But um, they they do work wellif that's what you have and
that's your option, that'sgreat.
(20:13):
But they can be a little priceyand they're not always the best
option.
Dr. Holly Thacker (20:17):
Yes, certainly.
And they they probably wouldn'thelp skin and hair, although
the newest progestant onlythat's by prescription, SLInd,
is one of my favorite.
It's four milligrams ofdrosperinone, which doesn't
raise blood pressure, and itseems a lot stronger.
I do see FSH suppression, so Ithink it's a better
contraceptive.
(20:38):
And uh sometimes it's notreally a progestant, it's
similar to spironolactone, andso it's not really a C19 um
derivative.
So I think there's a lot ofwomen who tolerate that that
better.
Dana Leslie (20:53):
Yeah, absolutely.
And just like those other umbirth controls we talked about,
since it's becoming morepopular, the price of it has
gotten a lot more reasonable,which is nice because it's a
great product.
Dr. Holly Thacker (21:01):
Yes, yes.
So um any any comments aboutimplants, about who might want a
copper IUD as opposed to aprogesterone IUD?
Dana Leslie (21:12):
Yeah, absolutely.
Some people um feel like theyhave a very strong sensitivity
to any type of hormonalfluctuation.
So a lot of times then then wecan recommend the copper IUD.
The copper IUD is good for 10years, it's strictly pregnancy
prevention.
It doesn't have a positiveeffect on the the cycles.
Typically, your periods getheavier, at least for the first
(21:34):
six months with the copper IUD,because of a fore body being in
the uterus.
Um, but other than that, it'sstrictly just for pregnancy
prevention, and that's good for10 years.
The next planon is good forthree years.
It's goes, it's a small rodthat goes into the arm.
It's about the size of amatchstick.
Um, that's they those are allvery efficacious for pregnancy
prevention.
My biggest side effect that Isee with my patients with the
(21:55):
Nexplanon, it's very hit ormiss.
So some people love it, havehad a year through every three
years, get it exchanged and theydo perfect.
Other people have a lot ofabnormal bleeding, so they like
it out and they want a differentoption.
Dr. Holly Thacker (22:06):
I think for people who want an option but
they don't want something put intheir uterus, um, one option
that I use, and I actuallyprefer it over the moraine, even
if they don't have an objectionto an IUD.
But if they need ovariansuppression to reduce their risk
of ovarian cancer, like we haveBRCA patients who are not quite
old enough to have theirovaries out and they don't want
(22:29):
two surgeries.
Some people go get the tubesout to reduce ovarian cancer,
but keep their ovaries untiltheir late 30s or depending on
if it's BRCA1 or two, theirfamily history by age 40 or done
with childbearing, then theytake the ovaries out and
hopefully the uterus.
But while they may needcontraception, which a morena
would give, it doesn't reduceovarian cancer like hormonal
(22:50):
estrogen progestins do.
So I like the annovera ringthat has enough hormones to last
the whole year.
So someone who's busy, shiftworker, doesn't, you know, want
something implanted in theirskin, wants the suppression to
reduce ovarian cancer, uh, theycan just slip that ring in.
(23:10):
And even though it's packagedto come out for a week, like the
Nuva ring, rinsed off and thesame ring put back in, it really
can stay in the whole time andum last a whole year.
So um that's a little nichethat I I I don't see.
I don't know how many if wwomen just don't know about that
option.
But anyone who's been along-term Nuva ring option,
(23:33):
those rings only last for threeweeks, and then you have to
throw it away and get a new one.
Absolutely, yes.
So switching gears a bit, uhlet's talk about in-home S STI
testing.
What is an STI test?
Dana Leslie (23:47):
Absolutely.
STI tests are swabs that we doto check for gonnery and
chlamydia primarily.
When you're in the office, wedo the swabs that we do are a
little bit more involved and alittle bit more detailed, but
the home kits currently aretesting for gonneria and
chlamydia.
They're a great option forpeople that are don't have a lot
of access or um are nervous toask for the FCD screening when
(24:09):
they're in the office orwhatever reason, personal or
whatever, that they don't wantto get it done in a private in a
um uh office setting.
They are efficacious, they dojust as well as detecting
gonorrhea and chlamydia.
The issue in the hiccup comeswith transportation and
packaging and making sure thatonce the swab's completed,
you're putting it back in thattest tube and getting it off
(24:31):
into the mail as fast as you'reable to to make sure that it
gets sent in a timely fashion sothat there's no false positives
or false negatives that aredetected with the lab work once
it gets ran.
Dr. Holly Thacker (24:43):
And so then do they notify the patient who's
purchased this over-the-counterdevice directly if if if it's
abnormal or if it's it'snegative, and then they're told
to contact a healthcareclinician to actually order the
appropriate prescriptions?
Dana Leslie (24:57):
Absolutely.
And I believe a lot of theprograms now or a lot of the
systems that are doing this evenhave like their virtual their
virtual practitioners that theycan make an appointment with to
get these prescriptions and goover that with them.
Dr. Holly Thacker (25:09):
Now, there's it depends on, I'm sure, state
law, and you know, we'repracticing in the state of Ohio,
but uh not too long ago, one ofour fellows uh prescribed uh S
STI treatment for her patientand a male partner, and the
pharmacist had called for somequestion about it, and one of
(25:29):
our nurses was upset.
Why why is one of our women'shealth doctors who only sees
women prescribing for a man?
This doesn't make sense.
Did she just not get it right?
But it was very specific aboutapplying something to the penis,
so clearly it was instructionsfor a man.
And um, I told her, Well, youcan do that, you're allowed by
(25:50):
state law to prescribe forsomeone you haven't seen if
that's a sexual partner.
Dana Leslie (25:55):
Absolutely.
Yeah, it's called expeditedpatient treatment, so or
expedited partner treatment,excuse me.
In the state of Ohio, we'relegally allowed to prescribe for
the patient's uh partner ifthey aren't able to get in or if
it's easier just to get them aquicker treatment and then they
can get tested uh afterwards,after about three months after
treatment to make sure that it'scleared up.
Dr. Holly Thacker (26:15):
And I think it's important for people to
know about antibiotic allergies.
And I think ideally it's betterto see a healthcare clinician
in person.
Um, and it's possible that thepartner could have other things
too that might need to betreated and be instructed on,
you know, risk reduction,perhaps even HIV testing, which
(26:36):
is of course one of the moreserious uh sexually transmitted
infections.
Um but um any other commentsabout about treating women, why
you want to treat young womenwho have sexually transmitted
infections and not just let thatfester?
Dana Leslie (26:51):
Absolutely.
So the CDC recommends thatwomen that are sexually active
under age 25 get screened everyyear.
And then after that, at leastevery three years, for sure, uh
depending on, you know, riskbehaviors and things like that.
Um, we I like to go, I askevery single patient when they
come in if they want STDscreening because you never
know.
And some people just like toknow and to make sure in the
(27:11):
back of their head that they areokay in that department.
Most of the symptoms of STDsare silent, which is why we
really want to get thosescreenings done because the
long-term effects can scarfallopian tubes, which can cause
issues with infertility in thefuture.
Also, it can cause issues withthe cervix, causing different um
pelvic inflammatory diseasesymptoms, and can in the long
(27:34):
run become very painful and veryproblematic for patients if
they don't get them treated.
Dr. Holly Thacker (27:39):
And it can certainly affect fertility, you
know, scarring the tubes,causing ectopic uh pregnancies,
um, which can be deadlyactually.
Uh, talking aboutself-screening, um, talk a
little bit about HPV humanpapillomavirus uh home testing
(27:59):
and where you might recommendthat.
Dana Leslie (28:02):
Yeah, so back in 2024, I believe in July of 2024,
the FDA approved the firstself-suab pap smear or HPV
detection.
So it's still in the UnitedStates, it's still only approved
to do in an office.
They don't recommend it afterthere's no like home kit yet.
Um, but the patient comes intothe office.
These are, I use thisspecifically for people that
(28:23):
aren't currently sexuallyactive, have maybe never been
sexually active, are nervous,have uh traumatic experiences
with pelvic exams or whatevertheir medical history will be,
and they just do not toleratespeculum exams.
There are swabs that you putinto the vagina, you insert it
about two inches into thevagina, and then you turn it or
move it around for 20 to 30seconds, and then you put it
(28:45):
into the test, the tubes, andsend it off to the lab.
It specifically is testing forHPV, which is the virus that
leads to most cervical cancers,and it can reflex the cytology.
However, their cytology thecytology isn't as accurate as
what your typical PAP smear is,but it at least can detect those
high-risk HPVs, and we can geta lot of people that have CIN2
(29:07):
and lesser have a good idea ofexactly what we're dealing with,
so we can get them the adequatetreatment that they need.
Dr. Holly Thacker (29:13):
Now, one thing I've been seeing a lot of,
uh I mean, I think that theco-testing, if you're over 30,
with both the PAP smear to lookat the cells, which is a scrape
of the cervix with a brush and aspatula, spatula first, then
the brush, um, is and and HPVtesting is better than just HPV
testing for sure, but you know,something is better than
(29:34):
nothing.
And I've seen a lot of womenwho, you know, follow
instruction, they haveinsurance, they don't have any
problem with coming in andgetting, you know, a pelvic
exam.
But they're so far arrears intheir PAP.
And um, you know, a lot of themsay, well, I was told I don't
need it or I can do it everyfive years.
(29:55):
Do you want to talk about howwhat our practice is like?
Dana Leslie (29:58):
Yeah, yeah, absolutely.
You know, a lot of people alsodon't know.
So they think that just becausewhatever clinic that they went
to in the past, or whoever theysaw didn't contact them, or they
didn't read it out, or theynever saw anything, that they
have to be absolutely normal andeverything was negative,
everything was fine.
A lot of people don't realizethat they have had a positive
HPV in the past, or they didhave some atypical cells on
(30:20):
their PAP smear.
So everyone's guidelines are alittle different.
You know, most insurances coveryour PAP to be done every
single year.
Um the guidelines currentlystill are at every five years.
However, I personally practice,and in our practice, we do
every three years.
I see a lot happen betweenthree and five that I don't like
waiting, and I've had enoughexperiences where we've caught
things because we've done it inthree years that it doesn't seem
(30:41):
logical to do it in five years,in my perspective.
I do have some patients that donot want it in three years, and
that's absolutely right, 100%.
But I do recommend getting itdone at least every three years.
If you've ever had anabnormality, I like to do a PAP
every year for at least threenormal consecutive years in a
row.
If they're normal negative forthose three years, then we can
(31:02):
go back to that every three-yearscreening.
Someone that says, Oh, I had aleap 10 years ago, I don't need
it anymore.
Depending on what that cytologylooked like prior to that leap,
you still probably need a PAPevery year until 65, if not
older.
So there's a lot ofmiscommunication and
misinterpretation between, well,it happened in my 20s.
(31:22):
It doesn't matter anymore.
And that's absolutely not thecase, especially with PAP
SNEARS.
Dr. Holly Thacker (31:26):
And the immune status, too, you know,
for patients that are on uhimmunosuppressant medicines are
transplant patients, uh patientsthat might be daughters of uh
women who took DES duringpregnancy, they may need yearly
PAPS indefinitely.
And so one size doesn't fitall, and um it just annoys me
when someone goes and gets apelvic exam and it's been four
(31:50):
uh years and a few months sincetheir last PAP and they don't
get it, and the patient thinksbecause a speculum was put in
and they had a bimanual examthat oh, that was their PAP,
which is very different thanjust getting a pelvic exam.
So I think a yearly checkup,whether you're examined or not,
whether you get a PAP or not, isreally important overall
(32:10):
because there's so many changinguh guidelines.
So tell us how can people seeyou who want to see you at main
campus or uh at your newStrongsville location.
Dana Leslie (32:21):
Absolutely.
So there's a couple differentavenues.
You know, we have Sarah whotook the place of Ronda when
Miss Ronda retired.
Um and we can contact her.
She I know there's a new numberout for them now, but I always
give everybody the 216-444-6601to get a scheduling appointment.
And then, you know, if you'veseen me in the past ever, you
can always schedule through mychart as well.
(32:41):
And it typically about a weekor a couple weeks or so
typically to get in, dependingon what that schedule looks
like.
I always tell my patients too,if they're having a hard time,
try to really call oursecretaries or schedulers
because it seems like patientsfall off a lot or cancel, and
there's a lot of same-dayopenings.
If they're able to make it inthat day, they could get in a
lot sooner.
Dr. Holly Thacker (32:59):
And you're the best, you know.
If I ask you, oh, can you seethis patient?
They're from, you know, anotherstate.
You're just so terrific.
Dana Leslie (33:05):
Well, you're awesome and you make it easy.
So it's easy to do.
Dr. Holly Thacker (33:09):
Well, thank you so much for joining us on
this episode of Speaking ofWomen's Health.
If you've enjoyed it, give us afive-star rating.
Uh, send it to your friends.
And if you don't already followor subscribe or collect this
free podcast, please do that.
And remember, be strong, behealthy, and be in charge.
(33:30):
And we'll see you next time.
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