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It is 4:50 on a Friday, and an ultrasound report lands in your inbox: six centimeter complex right ovarian mass, neoplasm cannot be excluded. What happens next? On this episode of BackTable Women’s Health, Dr. Mona Guo and Dr. Marcia Ciccone team up to discuss how general obstetrician gynecologists should evaluate, follow, and operate on adnexal masses and when to refer to gynecologic oncology. They walk through reading the imaging yourself, understanding what “complex” means on a report, ultrasound features and O-RADS, tumor marker selection, and when an MRI adds value beyond ultrasound. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction02:57 - Incidental Ultrasound Report on a Friday Afternoon05:57 - Ultrasound Features, ACOG Bulletins and O-RADS08:44 - Red Flag Findings and Urgent Evaluation10:58 - Tumor Marker Selection and the Limits of CA 12514:31 - Markers by Age, Tumor Type and New Assays in Development19:38 - When MRI Adds Value23:15 - Surveillance Versus Surgery27:05 - Cystectomy, Oophorectomy and the Consent Conversation31:10 - Preventing Rupture and Containing the Specimen35:42 - Closing Remarks --- More about this episode The conversation separates true emergencies like torsion, hemorrhage, and abscess from imaging findings that require faster evaluation, then breaks down the tumor marker panel, including the limits of CA 125, the value of hormonal and GI markers, and how thresholds shift by age and presentation. They review evidence supporting surveillance of simple cysts under ten centimeters, surgical choices between cystectomy and oophorectomy, and the consent and extraction plans that prevent upstaging from a cyst rupture. The episode closes with practical pearls for preventing spill, managing tubo-ovarian abscess, and the value of a quick call to a colleague when the next step is unclear. --- Resources ACOG Practice Bulletin No. 174: Evaluation and Management of Adnexal Masses. Obstet Gynecol. 2016https://doi.org/10.1097/AOG.0000000000001768 Andreotti RF, et al. O-RADS US Risk Stratification and Management System: A Consensus Guideline from the ACR Ovarian-Adnexal Reporting and Data System Committee. Radiology. 2020https://doi.org/10.1148/radiol.2019191150 ACR Ovarian-Adnexal Reporting and Data System (O-RADS)https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Reporting-and-Data-Systems/O-Rads Modesitt SC, et al. Risk of malignancy in unilocular ovarian cystic tumors less than 10 centimeters in diameter. Obstet Gynecol. 2003https://doi.org/10.1016/s0029-7844(03)00670-7 Im SS, et al. Validation of referral guidelines for women with pelvic masses. Obstet Gynecol. 2005https://doi.org/10.1097/01.AOG.0000149159.69560.ef Society of Gynecologic Oncologyhttps://www.sgo.org Moore RG, et al. Assessing the risk of ovarian malignancy algorithm for the conservative management of women with a pelvic mass. Gynecol Oncol. 2015https://doi.org/10.1016/j.ygyno.2015.09.010 Widschwendter M, Salhia B, et al. OvaPrint, A Cell-free DNA Methylation Liquid Biopsy for the Risk Assessment of High-grade Serous Ovarian Cancer. Clin Cancer Res. 2023https://doi.org/10.1158/1078-0432.CCR-23-1197 Dr. Bodour Salhia, Keck School of Medicine of USChttps://keck.usc.edu/faculty-search/bodour-salhia/ Dr. Mona Guo, Keck Medicine of USChttps://keck.usc.edu/faculty-search/xiaoyue-mona-guo Dr. Mona Guo, BackTable contributor pagehttps://www.backtable.com/shows/obgyn/contributors/dr-mona-guo Dr. Marcia Ciccone, Keck Medicine of USChttps://keck.usc.edu/faculty-search/marcia-ciccone/ Dr. Marcia Ciccone, BackTable contributor pagehttps://www.backtable.com/shows/obgyn/contributors/dr-marcia-ciccone --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

What does it take to design a career in medicine that truly fits your values, your life, and your goals? On this episode of BackTable Women’s Health, Dr. Nicole Faulkner welcomes Dr. Chitra Akileswaran, board-certified OBGYN and founder of Avaiyar Private Care, for a candid discussion on building a career that breaks the mold. Dr. Akileswaran traces her path from global public health and a joint MD-MBA to leadership in county health systems, digital health startups, and now direct pay practice, sharing how each chapter reflected her changing priorities. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction06:19 - Public Health and Global Work10:33 - Residency and Early Career Choices15:04 - Founding a Digital Health Company19:48 - Ambulatory Operations Leadership24:36 - Leading a County Medical Group29:32 - Physician Needs and Retention34:25 - Physician Compensation Overhaul41:47 - Physician Unionization and Employment46:25 - Pregnancy Loss and Perspective49:09 - Launching a Direct Pay Practice57:10 - Mentorship in Private Practice01:03:28 - Closing Remarks --- More about this episode The conversation explores lessons learned leading hundreds of physicians, overhauling compensation and benefits, and navigating unionization and administrative change. Dr. Akileswaran speaks openly about personal milestones, including pregnancy loss, and how it drove her to redesign her life and practice. Topics include mentorship, apprenticeship, work-life integration, and the practical steps and mindset shifts needed to carve out a fulfilling, sustainable career in medicine. --- Resources Avaiyar Private Care, Dr. Akileswaran's direct pay OBGYN practicehttps://avaiyarprivatecare.com/Cleo, the digital health company she co-foundedhttps://hicleo.com/ ACOG Well-Being and Physician Support Resourceshttps://www.acog.org/career-support/well-being AMA Physician Practice Benchmark Survey: Smaller Share of Doctors in Private Practice Than Ever Beforehttps://www.ama-assn.org/practice-management/private-practices/smaller-share-doctors-private-practice-ever MGMA Provider Compensation Data Reports, the benchmarking source referenced on airhttps://www.mgma.com/mgma-data-reports Dr. Chitra Akileswaran, UCSF OBGYN Residency Alumni Profilehttps://obgyn.ucsf.edu/residency-program/chitra-akileswaran-md-mba --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Can shared decision-making and patient support change the treatment journey for overactive bladder? On this episode of BackTable Urology, host Dr. Suzette Sutherland and OAB expert Dr. Jannah Thompson discuss how patient education, clear counseling, and ongoing follow-up improve care for patients with overactive bladder and urge incontinence. They cover practical strategies for building an effective OAB care pathway, staff training for better patient navigation, and proactive approaches that increase adherence and access to advanced therapies. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Medtronic Pelvic Healthhttps://urgencyisreal.com/ --- Timestamps 00:00 - Introduction04:00 - Shared Decision-Making06:51 - Clinic Efficiency10:38 - Expanding OAB Therapy Options12:27 - Long-Term OAB Care17:41 - Building an OAB Program18:18 - Staff Training and Follow-Up25:32 - OAB Navigator Implementation27:14 - Navigation Outcomes28:39 - Scaling with Staff and Epic30:35 - Algorithm Resources34:08 - Neuromodulation Advances38:37 - New Tibial and Battery-Free Devices40:56 - Quality of Life in OAB Care46:11 - Access and Adoption51:22 - Streamlining Therapy Discussions52:47 - Closing Remarks --- More about this episode The conversation explores the diverse landscape of OAB treatment options, the evolving role of neuromodulation, and how new technologies are enabling more personalized care. Dr. Thompson shares insights on empowering staff as part of the clinical team, leveraging patient navigators to boost follow-up and advanced therapy uptake, and the importance of integrating patient preferences and lifestyle factors into every decision. They emphasize that quality of life, not just symptom control, should be central to OAB management, and discuss how to engage patients as partners throughout their treatment journey. --- Resources Patient navigation for overactive bladder improves access to carehttps://link.springer.com/article/10.1007/s00192-019-04085-7 --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Advances in endometriosis research are reshaping how clinicians diagnose, understand, and treat this complex multisystem condition. On this episode of BackTable Women’s Health, Dr. Nicole Faulkner welcomes Dr. Hugh Taylor for an in-depth discussion of the systemic nature of endometriosis, including its metabolic, psychological, and cardiovascular effects, as well as central pain sensitization and bowel and bladder symptoms. They also explore how animal models and biomarkers like microRNAs are deepening our understanding of these connections. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction03:26 - Endometriosis Beyond the Pelvis05:17 - Understanding Systemic Symptoms10:35 - Why Diagnosis Takes Years12:54 - Key Clues to Endometriosis14:35 - Emerging Noninvasive Diagnostics18:13 - Pain Versus Disease Stage19:33 - Precision Medicine Approaches24:04 - Treatment Strategies and Follow-Up27:17 - GnRH Antagonists and Add-Back Therapy29:45 - Danazol and Surgical Options34:26 - Future of Immune-Based Therapies37:49 - Fertility Counseling and Egg Freezing40:17 - Wrap-Up and Key Takeaways --- More about this episode Given that many patients wait years for a diagnosis, Dr. Taylor emphasizes the importance of presumptive clinical diagnosis and selective imaging to expedite treatment. He highlights emerging biomarkers that may offer more noninvasive diagnostic options and help clarify pain mechanisms. The conversation reviews current management strategies, including continuous oral contraceptives, the challenge of progestin resistance, and the promise of blood-based tests to predict treatment response. They also discuss GnRH antagonists, Danazol, surgery for refractory cases, and future directions such as immune-based therapies targeting the inflammation and immune dysfunction at the root of endometriosis. --- ResourcesClinical evaluation of the oral gonadotropin-releasing hormone-antagonist elagolix for the management of endometriosis-associated pain: https://pubmed.ncbi.nlm.nih.gov/31434540/ Circulating microRNAs as potential biomarkers for endometriosis: https://pubmed.ncbi.nlm.nih.gov/25772772/ ---BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Does catching cancer earlier with surveillance always translate to better outcomes for gynecologic cancer patients? On this episode of BackTable Women’s Health, hosts Dr. Mona Guo and Dr. Marcia Ciccone interview Dr. Ritu Salani, Professor of OBGYN at UCLA and lead author of the updated SGO surveillance clinical practice statements. They discuss how post–curative-intent surveillance has evolved amid limited prospective evidence, review the latest guidelines, and highlight the real-world challenges of balancing early detection, patient safety, and cost. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction03:05 - Evolving Guidelines and Consensus10:02 - Lead-Time Bias and Cost Considerations12:05 - Maintenance Therapy and Surveillance Nuances14:44 - Ovarian and Endometrial Cancer: Imaging vs Exam20:24 - Key Takeaways from the TOTEM Trial24:04 - Future Tools, Lifestyle Counseling, and Shared Care27:21 - Cytology, HPV Testing, and Post-Radiation Surveillance31:13 - Hormone Therapy Considerations34:37 - ctDNA and MRD Testing37:39 - Emerging Technologies and Limitations43:22 - Rapid Fire Takeaways45:33 - Closing Thoughts --- More about this episode The conversation explores practice variability, the lack of clear survival benefits from routine imaging and tumor markers, and the risks of cascade testing and lead-time bias. Dr. Salani reviews the TOTEM trial data for endometrial cancer, the importance of symptom review and pelvic exams (especially for lower genital tract cancers), and the reduced role of cytology, even in cervical cancer after radiation. They also discuss shared-care models, lifestyle counseling, hormone therapy considerations, and the promise and limitations of emerging technologies like ctDNA and MRD testing during maintenance therapy. --- Resources TOTEM Trialhttps://ascopubs.org/doi/abs/10.1200/jco.22.00471 2010 Ovarian Cancer CA-125 Trialhttps://pubmed.ncbi.nlm.nih.gov/20888993/ Society of Gynecologic Oncology Clinical Practice Statement on Surveillancehttps://pubmed.ncbi.nlm.nih.gov/41308226/ --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Are we addressing sexual health in clinical practice? On this episode of BackTable Women’s Health, host Dr. Nicole Faulkner is joined by Dr. Christine Vaccaro, a double board-certified urogynecologist and sexual medicine specialist, to discuss the evaluation and care of women’s sexual health concerns. They highlight the importance of open conversations, patient empowerment, and a multidisciplinary approach to support well-being and improve quality of life. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction04:01 - What Is Sexual Medicine07:58 - Understanding Libido, Arousal, and GSM15:54 - Clinic Visit Structure and Patient Counseling19:17 - Clitoral Exam, Adhesions, and Anatomy Education28:17 - Addressing Stigma, Patient Education, and Myths32:03 - Tools for Patient Empowerment: Apps and Self-Examination39:55 - In-Office Procedures, Pain Mapping, and Hormonal Considerations46:37 - Managing Complex Cases and Multidisciplinary Collaboration53:47 - Closing Remarks --- More about this episode The conversation explores practical strategies for evaluating and managing issues such as libido, arousal, orgasm, and sexual pain, with a focus on genitourinary syndrome of menopause (GSM) and clitoral anatomy. Dr. Vaccaro shares her approach to assessing clitoral adhesions, pelvic pain, and hormonal changes, as well as effective ways to educate patients about anatomy and self-examination. They discuss the importance of reducing stigma, addressing misconceptions, and using a multidisciplinary approach to improve patient outcomes. The episode also highlights the role of clinician training, patient-centered counseling, and collaborative care in supporting women’s sexual health across the lifespan. --- Resources International Society for the Study of Women’s Sexual Health: https://www.isswsh.org/ Female Orgasmic Disorder: Current Understanding and Clinical Management: https://pubmed.ncbi.nlm.nih.gov/42314165/ OMGyes: https://www.omgyes.com/join You Are Not Broken by Dr. Kelly Casperson: https://kellycaspersonmd.com/you-are-not-broken-book/ Retrospective Study of the Prevalence and Risk Factors of Clitoral Adhesions: Women's Health Providers Should Routinely Examine the Glans Clitoris - https://academic.oup.com/smoa/article/6/2/115/6956478?login=false Clitoral Adhesiolysis: Technique and Patient Selection - https://www.vjsm.info/videos/all/clitoral-adhesiolysis-technique-and-patient-selection Female Orgasmic Disorder: Current Understanding and Clinical Management - https://pubmed.ncbi.nlm.nih.gov/42314165/ --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

What should you do differently when a UTI becomes a recurring problem? In this episode of the Backtable Podcast, host Dr. Anjali Kapur is joined by physician-scientist Dr. Glenn Werneburg to discuss the latest approaches to recurrent urinary tract infections, including key updates from the 2025 AUA, CUA, and SUFU guidelines. They use real clinical cases to explore diagnosis, prevention, antibiotic selection, and the management of complex patients. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction04:05 - Case One: Recurrent UTIs05:19 - Workup Basics08:50 - Non-Antibiotic Prevention11:42 - Antibiotic Prophylaxis Options15:16 - Case Two: Asymptomatic Bacteriuria 19:14 - Case Three: Complex Patients19:58 - Male vs. Female UTIs21:22 - Neurogenic Bladder Workup22:52 - Elderly Patients and ID Consults25:01 - Case Four: Transplant ESBL25:23 - Machine Learning for Antibiotics 29:49 - Catheter Biofilms31:55 - Embedded Bladder Reservoirs35:23 - Recurrent UTI Vaccine36:23 - Future of Recurrent UTIs39:04 - Wrap Up --- More about this episode The doctors define recurrent UTI and outline the standard workup, including history, physical and pelvic exam, urinalysis, urine culture, and antibiotic sensitivities. They also review occasions where additional testing may be warranted. The discussion covers interpretation of urinalysis, non-antibiotic prevention options, and antibiotic prophylaxis strategies, with consideration of antibiotic resistance and microbiome disruption. They address asymptomatic bacteriuria and when treatment is indicated, along with management considerations for men, patients with neurogenic bladder or CIC, and elderly patients. Dr. Werneburg also discusses his work with machine learning tools to predict antibiotic susceptibility earlier, catheter biofilms, the concept of embedded bladder bacteria reservoirs, and his multidisciplinary complex UTI clinic. --- Resources Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2025)https://www.auanet.org/guidelines-and-quality/guidelines/recurrent-uti --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Have you ever wondered what role the mind could play in treating women’s health conditions? On this episode of BackTable Women’s Health, host Dr. Nicole Faulkner interviews Dr. Sonia Gupte, a family medicine physician and board-certified clinical hypnotherapist, about how clinical hypnotherapy can help patients access the subconscious, resolve emotional barriers, and rewire patterns that affect both body and mind. Dr. Gupte discusses the use of hypnotherapy for a range of women’s health concerns including PMS, postpartum depression, hot flashes, infertility, and chronic pelvic pain, highlighting the potential for more holistic care. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction 04:40 - Discovering Hypnotherapy08:59 - What a Session Looks Like13:02 - Remote Sessions and Results17:27 - Follow-Up and Maintenance20:13 - Women's Health Examples28:05 - Talking to Patients30:47 - Hypnosis vs. Therapy33:07 - Pap Smear Trauma Case37:28 - Breathwork Reset Tool42:42 - Uncovering Repressed Trauma46:17 - Burnout and Stress49:12 - Barriers to Success53:21 - Call To Action54:58 - Live Demo Plans55:50 - Closing Remarks --- More about this episode Dr. Gupte shares how her mother’s experience with cancer, depression, and a suicide attempt inspired her to explore hypnotherapy and ultimately bring it into her medical practice. She describes what a typical hypnotherapy session involves, including relaxation, guided visualization, identifying emotional roots, and using protocols to help patients “reboot” their mental patterns. The discussion also covers practical aspects of integrating hypnotherapy into women’s health care, such as determining treatment frequency, offering remote sessions, setting patient expectations, and addressing common barriers to success. --- Resources Within: Finding Yourself, Fixing What's Broken, & Finally Reclaiming True Health https://enso-nia.com/about-sonia/ --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Every OBGYN, whether in the hospital or community, may face a high-acuity obstetric emergency. On this episode of BackTable Women’s Health, Dr. Nicole Faulkner interviews OB hospitalist Dr. Katie Fung-Yip to explore the evolving role of OB hospitalists and the obstetric emergency department (OB ED) in managing critical situations. They discuss how in-hospital coverage, multidisciplinary teamwork, and dedicated triage protocols can improve emergency response and patient outcomes. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps00:00 - Introduction02:42 - Breaking Down OB Roles06:01 - MFM and Hospitalist Collaboration07:35 - Inside the OB ED12:31 - High Stakes Emergencies Overview18:02 - Amniotic Fluid Embolism21:33 - Cardiac Arrest Pearls and Drills24:44 - Team Leadership Under Pressure29:19 - Emotions Debrief and Bonding37:48 - Simulation Practice and Mentorship 40:18 - Early Career Fit and Support 43:10 - Wrap Up --- More about this episodeDr. Fung-Yip explains how the hospitalist role differs from community OBGYNs, emphasizing the value of continuous in-hospital coverage for urgent and high-risk cases. She describes the spectrum of care, from routine pregnancies to complex emergencies requiring collaboration among hospitalists, maternal-fetal medicine specialists, and multidisciplinary teams. The discussion covers OB ED operations, the Maternal Fetal Triage Index, hospital design for rapid response, and review of critical emergencies such as postpartum hemorrhage and amniotic fluid embolism. Dr. Fung-Yip highlights how these events can escalate to maternal cardiac arrest, requiring immediate ACLS, team coordination, and sometimes resuscitative hysterotomy. She stresses that preparedness depends on ongoing education, simulation, mentorship, debriefing, and strong teamwork. --- ResourcesMaternal Fetal Triage Index (MFTI)https://www.awhonn.org/education/hospital-products/maternal-fetal-triage-index-mfti/ --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.► https://www.backtable.com/app

Hormones aren't the problem. Misunderstanding them is. On this episode of BackTable Women’s Health, Dr. Karen Toubi sits down with Dr. James Simon to discuss menopause, sexual medicine, and his career journey from early IVF research to treating aging women. They also unpack his Green Journal paper with Dr. Barbara Levy, challenging common misconceptions about hormone therapy and explaining why treatment should be individualized because not all estrogens and progestogens are the same. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction03:11 - Why Menopause Medicine07:51 - Hormone Therapy Paper11:48 - Counseling Perimenopause16:14 - Unopposed Estrogen Strategy23:01 - IUDs And Progesterone26:54 - Estrogen Types Explained34:59 - Thrombosis Risk Approach43:11 - Oral Estrogen Use Cases44:48 - Breast Cancer Risk Counseling46:49 - Estrogen Risk Myth48:11 - Pregnancy and Breast Cancer50:09 - Counseling BRCA Patients53:26 - Duavee: Who Benefits?55:32 - Bazedoxifene Access Limits57:47 - Ospemifene for Genitourinary Syndrome of Menopause (GSM)01:00:37 - Dryness Explained01:02:41 - Thrombosis Risk Screening01:05:01 - UTIs and Vaginal Estrogen01:07:18 - Starting HRT After 6001:12:47 - Window of Opportunity01:14:46 - Staying on HRT01:16:43 - Blood Levels and Absorption01:20:13 - Clinician Takeaways --- More about this episode The conversation explores strategies for managing perimenopause, including when hormonal contraception is the best option and when symptom-focused hormone therapy may be more appropriate. They cover practical guidance on using transdermal estradiol, Mirena and Liletta for contraception and endometrial protection, and how thrombosis risk differs depending on the type and route of hormone therapy. The episode wraps up with a discussion on newer treatments for genitourinary syndrome of menopause, when to consider hormone therapy, and why clinical experience is so important in menopause care. --- Resources A Contemporary View of Menopausal Hormone Therapy https://journals.lww.com/greenjournal/abstract/10.1097/aog.0000000000005553~a-contemporary-view-of-menopausal-hormone-therapy?redirectionsource=fulltextview --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

The standard infertility timeline does not apply to every patient. When should infertility counseling begin, and when is it risky to wait? OBGYN Dr. Nicole Faulkner and REI specialist Dr. Jennifer Kulp Makarov discuss how age, irregular cycles, endometriosis, recurrent pregnancy loss, and male factor infertility should shape counseling and referral decisions on this week’s episode of the BackTable Women’s Health. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction02:37 - Launching a New Practice04:23 - When to Refer Patients06:23 - Basic Infertility Workup08:39 - Counseling Patients Over 4014:05 - Personalized IVF Protocols17:59 - Embryology and PGT-A23:54 - Egg Preservation Timing28:20 - Using Frozen Embryos Later31:36 - Components of Personalized IVF33:30 - Patient Experience and Education37:25 - Alternative Fertility Options40:46 - Approaching Recurrent Miscarriage42:28 - Key Takeaways --- More about this episode Dr. Kulp Makarov reviews when patients should be referred to an REI based on age, while emphasizing that earlier referral is appropriate for patients with irregular cycles, endometriosis, recurrent pregnancy loss, or known male factor infertility. Although anti-Müllerian hormone (AMH) testing can be a useful initial assessment, it should not delay specialist evaluation. The discussion also explores how advances in reproductive medicine have expanded fertility treatment options. Dr. Kulp Makarov highlights personalized IVF protocols, embryo banking, and preimplantation genetic testing, while emphasizing both the benefits and limitations of these approaches. She also shares practical guidance on egg freezing, pregnancy in the mid-40s, and when donor eggs, gestational carriers, or other fertility treatment options may be appropriate. Finally, she explains how REIs approach the evaluation and management of recurrent pregnancy loss. --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

How can OBGYNs navigate the complexities of modern prenatal carrier screening? In this episode of BackTable Women’s Health, host Dr. Nicole Faulkner interviews Dr. Mary Kate LoPiccolo, a pediatrician and medical geneticist at Mount Sinai, to break down the essentials of prenatal carrier screening in OBGYN practice. They discuss what carrier screening is, when to order it, and how to manage and interpret results in real-world clinical settings. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction 03:03 - Understanding Carrier Screening04:40 - Partner Testing: When and Why06:22 - Selecting the Right Panel Size08:27 - Managing Time Constraints and Making Referrals 10:52 - Pretest Counseling Essentials16:44 - Decoding Results and Effective Reporting 20:52 - Limits of OB Counseling26:19 - Navigating Common X-Linked Pitfalls 30:11 - Equity, Costs, and Over-Testing36:11 - Tele-Genetics and Lab Resources43:43 - Final Takeaways --- More about this episode Dr. LoPiccolo reviews the evolution from Tay-Sachs screening in Ashkenazi Jewish populations to today’s pan-ethnic expanded panels, emphasizing carrier screening as a blood-based screening test for recessive and X-linked conditions ideally performed preconception and for both partners. The conversation covers panel size selection, best practices for pre-test counseling, common pitfalls with X-linked results, documentation and report interpretation, cost and equity barriers, and the value of referrals, telegenetics, lab genetic counselors, and resources like GeneReviews to optimize care. --- Resources GeneReviews - https://www.ncbi.nlm.nih.gov/books/NBK1116/ Open Evidence - https://www.openevidence.com/ --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

As over-the-counter continuous glucose monitors (CGMs) become more common, clinician guidance matters more than ever. In this episode of BackTable Women’s Health, Dr. Nicole Faulkner welcomes Dr. Nicholas Canelo, a family medicine physician and founder of the Perlman Wellness CGM program, to discuss how to effectively guide CGM use in OBGYN practice, from preconception and PCOS to pregnancy and perimenopause. They highlight the importance of interpreting data trends, setting realistic glucose targets, and supporting patients through the practical and emotional challenges of CGM use. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction04:58 - CGMs in Women’s Health07:33 - OTC Data Sharing Issues09:52 - Pregnancy Glucose Targets16:20 - Accuracy and Variability20:10 - Anxiety and Eating Disorders24:41 - Counseling and Follow-Up28:29 - Prescription and OTC CGM Picks37:24 - False Lows and Sensor Errors41:23 - Alarm Settings and Logging44:06 - Interpreting Metrics and Limits46:44 - Provider Dashboards 48:42 - Final Thoughts --- More about this episode Given the lack of well-established blood glucose targets outside of type 1 diabetes, Dr. Canelo reviews commonly used ranges for individuals without diabetes, those with prediabetes, and pregnant patients with type 1 or 2 diabetes. He explains how to interpret CGM data, including the time in tight range, coefficient of variation, and the importance of focusing on overall trends rather than isolated glucose spikes. They also discuss the potential drawbacks associated with CGM use, including anxiety and eating-disorder risks. Practical considerations include sensor inaccuracies, false lows readings, and optimizing alarm settings. Dr. Canelo emphasizes the importance of having patients log meals and other events while wearing the sensor and scheduling follow-up after the initial 15-day wear period to ensure accurate interpretation and effective counseling. Finally, they compare OTC and prescription CGM options, including costs, clinician access to patient data, and insertion tips. --- Resources Stelo - Over the Counter CGM Optionhttps://www.stelo.com/en-us --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Are you building a business that can thrive without you, or just creating a job you can never leave? In this episode of BackTable Women’s Health, host Dr. Karen Toubi sits down with Dr. Nneka Una (Unachukwu), a board-certified pediatrician, founder of Ivy League Pediatrics, and creator of EntreMD, to discuss the mindset and skills needed to build a truly sustainable medical practice. The conversation explores why physician entrepreneurship is essential in today’s evolving healthcare landscape, the difference between building yourself a job and building a resilient business, and practical strategies for long-term growth. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction04:47 - From Employee to Owner05:53 - Skills That Changed Everything07:35 - The Wake Up Call10:44 - Why Doctors Resist Business15:06 - Profit as Patient Care18:20 - Job vs. Business Entity21:13 - CEO Hat and Team Systems25:14 - Exit Value and Sellability29:00 - More Profit: More Time Off30:24 - Fear Before Breakthrough35:32 - Choose Service Over Perfection39:11 - Invest in Your Potential46:26 - MEAT Week Priorities48:40 - Three-Part Daily Rhythm55:02 - Advice for Burned-Out Docs59:29 - Wrap Up --- More about this episode Dr. Una shares how doctors can overcome resistance to “business,” why every practice needs a strong business engine, and how to balance profitability with ethical, people-centered care. She explains how to shift from employee to physician-CEO, tackle imposter syndrome, and develop systems that give your practice true staying power. The discussion provides actionable advice on hiring, team management, building exit value, and creating the freedom to take more time off without sacrificing patient care or financial stability. --- Resources EntreMD https://entremd.com/about-us/ The Profitable Private Practice Playbook https://entremd.com/method-book/ --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Lower C-section rates, faster deliveries, and less physician burnout: could the OB hospitalist model deliver all three? In this episode of BackTable Women’s Health, host Dr. Nicole Faulkner interviews Dr. Maliha Sayla, a board-certified OBGYN and medical director of labor and delivery at Northwestern Medicine Delnor Hospital, to explore how the OB hospitalist model is reshaping care for physicians, patients, and healthcare systems. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction 03:27 - Why Hospitalists Matter05:33 - How Their Model Works07:15 - Managing Pushback10:18 - Measuring Better Outcomes15:58 - Drills and Emergencies19:50 - Staffing and Transition24:33 - ROI and OB-ED26:33 - Residents and Teaching30:52 - Future Flexible OB Careers34:14 - Patient Acceptance of Model36:47 - Collaboration and Lifestyle Balance40:00 - Conclusion --- More about this episode Dr. Sayla shares her journey from traditional private practice to full-time OB hospitalist work, explaining how this model reduces physician burnout by making labor and delivery a dedicated role rather than one juggled alongside clinic visits, surgeries, and administrative responsibilities. She details her institution’s staffing structure, where hospitalists provide continuous labor and delivery coverage, allowing generalist OBGYNs to focus on outpatient care. Dr. Sayla highlights the benefits of having dedicated physicians available for bedside counseling, fetal monitoring, and real-time decision-making. The episode explores improvements in communication, collaboration, and patient outcomes, including lower NTSV (Nulliparous, Term, Singleton, Vertex) cesarean rates and shorter induction-to-delivery times after adopting the hospitalist model. Additionally, she discusses the hospitalist role in obstetric emergency preparedness and interdisciplinary collaboration, patient perspectives, and the potential of hospitalist programs to address OBGYN workforce shortages. --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app