Women's Health Questions with Dr. Kenneth Sekine

INTRODUCTION: Welcome to Qualgen's podcast where we talk about all things health and wellness related, including hormones, pharmaceuticals, health trends and ways you can help better your life.  

JENNIFER: Hi everyone! Thank you for taking time out of your day to listen in. Today I am talking with Dr. Kenneth Sekine. Dr. Sekine has practiced in the medical specialty of Obstetrics, Gynecology, and Infertility in the Jacksonville area since 1982. Dr. Sekine – thank you so much for joining me today! 

DR. SEKINE: Well, thank you for having me.  

JENNIFER: Absolutely. What made you decide to be an OBGYN Provider? 

DR. SEKINE: Well, that goes back to medical school and decision residency days and in medical school you tend to rotate through different specialties, and I liked medicine, I liked surgery and I had this real mystique about babies - delivering babies and taking care of women. So, OBGYN really turned out to be the one that covered all those bases and I felt that I would be less bored with the same thing every day in any other specialty.  

JENNIFER: Well, that makes sense then. I'm just going to ask you some random questions about women's health today. So, first I want to ask you about perimenopause and menopause. Can you explain the difference between the two?  

DR. SEKINE: Well, there's a thin line. I think the word peri menopause is kind of a fabricated title of certain symptoms that happen in a woman's life as she's getting older. Menopause by definition is a woman not having her menstrual period for a whole year. The other thing that goes along with the menopause is what we call climacteric, which is the symptoms of menopause. So that would be, what everybody knows is hot flashes, and night sweats, and not being able to sleep well, and just having anxiety, and sexual drive tends to decrease. The perimenopause, some of those symptoms can be there, but a woman is still having her periods and when we actually check the hormone levels in menopause, there's a certain hormone we look at called follicle stimulating hormone or FSH. and if that number is very abnormal, then that kind of objectively defines menopause. If we have a woman that has a relatively normal FSH, but has some of those symptoms and typically, perimenopausal patients will say, “I don't have it all the time. I'll have periodic hot flashes or night sweats, but that happened a few months ago and it's not happening now.” So, I usually encourage them to just kind of keep a watch on it and I assure them that with time those symptoms will come back and stay.  

JENNIFER: So basically, the perimenopause is the start of the hormone imbalance that comes with menopause, is that accurate?  

 DR. SEKINE: Yes, Yeah, I think from an objective standpoint that could be ups and downs and fluctuations of the hormones that would give periodic symptoms of menopause, but they're not consistent. 

JENNIFER: And what treatments do you utilize for your menopausal patients? 

DR. SEKINE: Once we determine that a woman is truly menopausal and the first part of that determination of the symptoms that they come in with and as I mentioned, you get some blood work to look at hormone levels. Then the gold standard to treat menopausal symptoms is replacing those hormones, because as I tell my patients, I think the master plan is flawed that women have outlived their ovaries by about a third of their life. So, when the ovaries quit working, they're not producing the hormones that they need to, we call the sex hormones, to keep them comfortable from those menopausal symptoms. So, the only way to truly treat those symptoms is to get those hormones replaced. 

JENNIFER: And what hormone treatments do you recommend in your practice?  

 DR. SEKINE: Well, I've been doing gynecology, obstetrics, and gynecology, but now just gynecology. But I've been in the specialty for 40 years, and up until about 10 years ago, I was using the traditional conventional hormonal replacement, which was anything from pills to patches. And I learned about bio identical hormones probably 10 years ago. But I had heard about them during residency because where they began was at the University of Georgia and they've been around since 1939. But these are in the form of pellets, and I started using them back probably seven or eight years ago and I have not strayed from using those ever since because the response of patients has been just short of miraculous.  

JENNIFER: Absolutely. So, moving on from menopause, how important are annual checkups and what is the purpose of checkups?  

 DR. SEKINE: Well, annual checkups are truly for preventative reasons. Many women, and men I say more so men, but people wait until they have symptoms of something and then they, in the modern day, google it coming in my office and tell me everything that they think they have. I’d like to have a cup on my desk that says, “please don't confuse your google search with my medical degree.”, but I think it's for preventative reasons over the years I've discovered things that were not symptomatic and we’re able to nip them in the bud whether they be noncancerous or even cancerous that was caught early enough to be able to cure the problem.  

JENNIFER: And what about the pap test? Because even I have no idea what it is or what it tests for. So, can you explain that?  

 DR. SEKINE: Well, the pap test is something that probably started back in the 40s by a Dr. Papanikolaou, that's where the name came. So, pap refers to taking cells from the cervix, which is a painless procedure. Specifically looking for pre cancer and cancer cells. We have discovered probably in the last 10 to 15 years that the human papilloma virus, or HPV, is the absolute cause of cervical cancer. The way to determine pre cancer cells, and even cancer cells, is to do a pap test and we usually start them around 21 years old and then we stop doing them about 65 years old. We pick up many many pre cancer changes of the cervix which we can treat and avoid anything progressing to cancer.  

JENNIFER: Absolutely. And what about mammograms? What is the purpose of a mammogram? And when should a woman start getting those?  

 DR. SEKINE: Well mammograms are basically an X-ray of the breast tissue, and the purpose is again to determine breast cancer. Probably one in eight, or even more than that, women will develop breast cancer. It's recommended to start at 40, unless there's a strong family history, or there has been some physical changes in the breast tissue earlier than 40 and we're concerned then we start doing more diagnostic testing, but the mammogram is something that again if we pick it up early, we can cure the breast cancer. If I've seen women who haven't had mammograms in years that come in with very advanced breast cancer, which could have been avoided if they had their mammograms.  

JENNIFER: And why is the age 40? Is there something that changes up until then that would cause that difference? What why is it 40?  

 SEKINE: Well, we used to think that you know, most women under 40 don't get breast cancer and I think that's still true that most women under 40 don't get breast cancer. But I've seen women in their mid to late thirties who have who have breast cancer, no family history, and no underlying reason why they would have developed it. So, I think just from a statistical standpoint, starting at 40 is where we feel we have the best chance of picking up early stages of breast cancer. We know that breast cancer cells are in the breast for 10 years prior to them being diagnosed. The earliest way to diagnose the breast cancer is not just with self-breast exam, because by the time the tumor is palpable, it's been there for a while. So there have been many breast cancer that's been found just by the mammogram showing some calcification changes of the breast tissue and that biopsy is done, and it turns out to be breast cancer. 

JENNIFER: Interesting. That's a long time for a cell to stay in there.  

DR. SEKINE: Yes.  

JENNIFER: What about cervical cancer? Is there anything that actually causes cervical cancer?  

DR. SEKINE: Well, cervical cancer has been classified as a sexually transmitted disease, because it is it is caused by HPV, human papillomavirus. We know that HPV has infiltrated the population probably 85-90%. So, when we do a pap smear and we see that there's some minimal abnormal changes, then they automatically do an HPV test on that smear, on those cells, and if the cells say they see what they call high risk HPV changes then we keep a close watch on that because there's a possibility that that pap smear the next time in three months - six months - a year, could become pre cancer cells of the cervix, and I'm sure you're aware of the HPV vaccine that has come into existence and we're recommending that kids eight years old to 26 years old get the vaccine. I think they even extended it past 26 years old. I think the 26-year cut off was because that's what the insurance companies would pay up until. But they have now extended it past 26. 

JENNIFER: And how common is it for a woman to have irregular cycles?  

 DR. SEKINE: Well, you know it just depends on what the reason for the irregular cycles are. Quite a few different reasons, you know what we do to evaluate that is to find out when they started, how old they were when they started having periods, was it irregular from the beginning, or were they regular up until a certain age and then they became irregular? So, you know, the reproductive system in the female is extremely sensitive to stress on the body. So, a woman who gains more than 10% of her ideal body weight, or a woman who loses more than 10% of her ideal body weight, or a woman who is, you know, emotionally and psychologically stressed - all these things can have an influence on their menstrual cycle and on their periods. So, of course, there's the number one reason why women stop having periods would be pregnancy, unless they've had their tubes tied, but then you can still possibly get pregnant. But, you know, any stress on the body is going to cause the reproductive system to be affected.  

JENNIFER: Absolutely. This is kind of going towards the fertility with hormones. With using hormone treatments. Does that affect fertility at all?  

 DR. SEKINE: Well, women who are in the fertile years are not usually going to be a hormonal replacement, their ovaries are usually working. Now, you know, if I've been asked if a person has been on birth control pills for years, will it affect their ability to get pregnant? Usually once they're on birth control pills and their cycles are normal, they often forget what their cycles were like before they went on the birth control pills. So many women go on birth control pills or hormones to control and regulate their cycles, because they're not ovulating every month, which would cause them to have normal cycles. Once they stop the birth control pills, their body reverts back to the way it was before they ever went on the birth control pills and if they weren't having normal periods, they're likely not to have normal periods. And just to answer the fertility part of it, one of the things that kind of tip us off to infertility. The first question we ask is that, you know, are your periods normal off the birth control pills, because in order to have a normal period, a woman has to ovulate and if she doesn't ovulate every month, then she's going to miss periods or she's going to have irregular periods and that's the first tip off to us that there might be something not right with their fertility.  

JENNIFER: Absolutely. Well, that makes so much sense. And how important is it to be completely honest and open with your doctor?  

 DR. SEKINE: Well, I think if you want the right answers and you want the right treatment, we have to know about it, you know, I see patients who come in that have a discharge and it's bothersome to them and they're reluctant to tell me they have a new partner, they have more than one partner or you know that their partner told them that they had to go to the doctor because they had some type of infection. So, our hands are tied unless we have all the pieces to the puzzle. 

JENNIFER: Yeah - absolutely. Well, is there anything else you would like to add?  

 DR. SEKINE: I just think, you know, going back to your question about routine physical exams, and mammogram, pap smears, that how important it is. I always tell my young patients that the easiest thing to learn is an uncomfortable examination and the hardest thing to unlearn is an uncomfortable examination. So, if I've seen young women who have had a traumatic experience with their first exam, I have to really work hard to get their confidence and show them that everybody doesn't do the exam the kind of way that they had at the first time. But I think routine, you know, making sure that you pay attention, don't wait until there's a signal that something may be wrong. 

JENNIFER: Absolutely. I couldn't agree more. Well, thank you again for joining me. I really enjoyed this conversation. I feel like it's very educational and things that I learned a lot today. For more information on Dr. Sekine, please visit srbobgyn.com and thank you everyone for listening. Please make sure to subscribe and follow us on social media to stay up to date on Qualgen. Thank you, Dr. Sekine!  

 DR. SEKINE: Thank you. I enjoyed the conversation. 

JENNIFER: Me too - have a good day! 

Disclaimer: The information, including but not limited to, text, graphics, images and other material contained on Qualgen’s website and podcast are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.