BackTable OBGYN

Vaginal rejuvenation is often misunderstood, misrepresented, and overdue for honest conversations in medicine. In this crossover episode between BackTable Urology and BackTable OBGYN, Dr. Nirit Rosenblum, a urology and OBGYN professor at NYU Langone Medical Center, is joined by Dr. Karyn Eilber, Chair of the Cedars-Sinai Medical Group Department of Surgery, and Dr. Ariana Smith, Chief of Urology at Pennsylvania Hospital. Together, they bring a multidisciplinary lens to one of the most misunderstood areas of women’s health. --- SYNPOSIS The discussion revolves around the broad definition of vaginal rejuvenation, distinguishing between medical and cosmetic interventions. They address common misconceptions, the roles of different health professionals, and emphasize the importance of pelvic floor physical therapy and the appropriate use of systemic and vaginal estrogen therapy. The conversation also highlights critical gaps in research surrounding laser and radiofrequency interventions, underscoring the need for stronger evidence, clearer patient education, and continued advocacy around menopause care and sexual function. --- TIMESTAMPS 00:00 - Introduction02:11 - Defining Vaginal Rejuvenation04:35 - Common Procedures and Misconceptions10:04 - Insurance and Coverage of Procedures12:04 - Laser and Radiofrequency Therapies18:10 - Vaginal Estrogen and Lift of Black Box Warning19:59 - The Role of Systemic Hormone Therapy26:56 - Vaginal Rejuvenation Misconceptions32:21 - Pelvic Floor Physical Therapy and Timing of Procedures34:24 - Regional Variations in Therapeutic Availability38:40 - Gender Inequity in Healthcare40:16 - Final Thoughts --- RESOURCES Joint Report on Terminology for Cosmetic Gynecology https://journals.lww.com/fpmrs/abstract/2022/06000/joint_report_on_terminology_for_cosmetic.2.aspx

Who should consider fertility preservation, when is the right time, and what are the risks? In this episode of BackTable OBGYN, Dr. Amy Park interviews Dr. Mindy Christianson, the section head of Reproductive Endocrinology and Infertility at the Cleveland Clinic, who shares how fertility preservation is evolving for patients planning families and those facing fertility-impacting treatments. --- SYNPOSIS Dr. Christianson discusses her journey into the field of fertility preservation, inspired by an early encounter with a breast cancer patient. The conversation covers various aspects of fertility preservation, including the preservation of eggs, embryos, ovarian and testicular tissue, and planned fertility preservation. Dr. Christianson elaborates on the protocols, patient demographics, and the evolving collaboration between oncology and reproductive endocrinology. The discussion also highlights technologies like ovarian tissue transplantation and in vitro maturation, as well as practical tips for healthcare providers on improving patient access to fertility preservation services. --- TIMESTAMPS 00:00 - Introduction03:34 - Understanding Fertility Preservation07:56 - Consultation Process for Fertility Preservation17:36 - Advancements in Egg Freezing Technology25:55 - Egg Freezing Recommendations26:34 - Collaboration Between Oncology and REI26:52 - Pediatric Oncology and Fertility Preservation28:58 - Ovarian Tissue Transplantation33:17 - Uterine Transposition Surgery40:05 - Gene Editing and Fertility Preservation43:01 - Financial and Emotional Aspects of Fertility Preservation48:02 - Practical Advice for OBGYNs51:12 - Resources and Final Thoughts --- RESOURCES Livestrong Fertilityhttps://livestrong.org/how-we-help/livestrong-fertility/ Resolve: The National Infertility Associationhttps://resolve.org/ Society for Assisted Reproductive Technologyhttps://www.sart.org/ American Society for Reproductive Medicinehttps://www.asrm.org/

A physician’s expertise can extend beyond the exam room and into the courtroom. In this episode of BackTable OBGYN, Dr. Elizabeth Moore, a general OBGYN and founder of MooreExperts, joins host Dr. Mark Hoffman to share her expertise on the intricacies of medical-legal work. --- SYNPOSIS They cover Dr. Moore's journey into expert witness work, including how the pandemic shifted her career focus and ultimately led to the creation of a platform to assist OBGYNs in navigating legal cases. They discuss the challenges of managing extensive medical records, the importance of adhering to the standard of care, and the unique nature of obstetrics cases. They also emphasize the need for precise, evidence-based report writing to avoid unnecessary trials and address the emotional and financial toll legal processes can take on physicians. Finally, the episode explores the need for better systems to protect both patients and healthcare providers while offering insight into future challenges, including AI and private equity involvement in legal cases. --- TIMESTAMPS 00:00 - Introduction05:08 - First Experiences in Medical-Legal Work08:57 - The Role of Education in Legal Cases11:37 - Challenges and Rewards of Medical-Legal Work13:58 - Understanding Standard of Care and Malpractice15:59 - The Importance of Detailed Reports and Depositions20:02 - The Jury System and Its Challenges25:45 - Balancing Professional and Personal Life29:43 - Getting Started in Medical-Legal Work32:07 - Recognizing Patterns in Medical Litigation33:51 - Educating Attorneys for Fair Trials36:33 - Concerns and Improvement of Medical Expert Testimonies45:54 - The Role of Systems in Reducing Medical Errors51:52 - Future Challenges and Opportunities in Medical Legal Work56:07 - Final Thoughts --- RESOURCES ACOG Technical Bulletin 365: Seeking and Giving Consultationhttps://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2007/05/seeking-and-giving-consultation MooreExperts OBGYN Consulting Medical Legal Expert Witness Masterclasshttps://www.mooreexperts.com/ Bless This Mess: A Picture Story of Healthcare by Dr. Stephen Klaskohttps://www.amazon.ae/Bless-This-Mess-Picture-Healthcare/dp/1483479625

What if the key to improving obstetrical surgery outcomes isn’t a new technology, but rethinking who’s in the operating room? In this episode of BackTable OBGYN, host Dr. Mark Hoffman and co-host Dr. Amy Park welcome Dr. Sony Singh, a prominent figure in the field of minimally invasive gynecologic surgery (MIGS) and obstetrics, to share perspectives on the emerging role of MIG surgeons in obstetrical surgery. --- SYNPOSIS Dr. Singh shares his extensive career journey, from his education in Canada and Australia to his current role as department chair of OBGYN at the Ottawa Hospital. The conversation delves into the integration of MIGS into obstetric surgery, including procedures like laparoscopic cerclages, placenta accreta management, and cesarean scar pregnancies. The hosts and guest discuss the challenges and importance of building a robust team, regionalization of care, maintaining work-life balance, and the eventual transition of leadership roles to sustain the high standards of care. This episode highlights the crucial role of minimally invasive specialists in advancing OBGYN practices while promoting a sustainable work culture. --- TIMESTAMPS 00:00 - Introduction 02:08 - Dr. Singh’s Journey07:37 - The Role of MIG Surgeons in Obstetrical Surgery16:06 - Building a Collaborative Team18:38 - Challenges and Best Practices25:26 - Expanding the Scope of MIG Surgeons30:19 - The Evolution of Urogynecology and MIGS31:31 - Leadership and Building Programs37:54 - Scaling Up and Regionalization of Care42:53 - Balancing Work and Personal Life54:37 - Concluding Thoughts --- RESOURCES Canadian Society for Advancement of Gynecologic Excellencehttps://cansage.org/about/ From Strength to Strength, by Arthur Brookshttps://www.arthurbrooks.com/books

How economically viable is gynecologic surgery today, and what happens if the system keeps pushing the limits? In this episode of BackTable OBGYN, Dr. Marisa Dahlman from Virginia Mason in Seattle sits down with hosts Mark Hoffman and Dr. Amy Park to discuss the evolving landscape of this field and the pressures surrounding reimbursement. --- SYNPOSIS Dr. Dahlman begins by sharing her career path and fellowship experience before the conversation expands to explore the shift from MIGS (Minimally Invasive Gynecologic Surgery) to CBG (Complex Benign Gynecology), current reimbursement challenges, the difficulty of balancing obstetric and gynecological practice, and how these forces influence training and clinical life. They also discuss the stressors new graduates face while building viable practices, broader healthcare system challenges, resource allocation, and potential solutions to improve practice sustainability and patient care. --- TIMESTAMPS 00:00 - Introduction 03:06 - Fellowship Training and Career Pathways11:43 - Impact of Reimbursement on Fellowship Applications15:20 - Workforce Issues and Future of GYN Surgery28:02 - Advocacy and Leadership in Healthcare29:27 - Understanding Hospital Revenue and Efficiency31:54 - The Role of Physician Leadership in Healthcare35:35 - Navigating Healthcare System Mergers36:47 - The Future of Healthcare Amidst Financial Cuts41:40 - Addressing Healthcare Costs and Reimbursement45:11 - The Importance of Women's Health Services47:37 - Strategies for Improving Healthcare Systems53:48 - Concluding Thoughts --- RESOURCES Trends in gynecologic surgery reimbursement and physician payhttps://pubmed.ncbi.nlm.nih.gov/40305043/

Everything you need to know about tubo-ovarian abscesses (TOAs): breaking the stigma, safer treatment, fertility preservation, and better outcomes. This episode of BackTable OBGYN features Dr. Katherine Smith, an assistant professor and MIGS Fellowship Program director at UT Southwestern. With hosts Dr. Amy Park and Dr. Mark Hoffman, Dr. Smith provides an extensive overview of contemporary TOA management, emphasizing the significance of early intervention and the evolving understanding of TOAs beyond traditional STI etiologies. --- SYNPOSIS The conversation delves into the management of TOAs, both non-ruptured and ruptured, and the underexplored connection to the female reproductive tract microbiome. They also touch on the integration of AI in clinical practice, particularly in streamlining administrative tasks. The episode underscores the need for updated guidelines and more research into the microbiological aspects of TOAs to improve patient outcomes. --- TIMESTAMPS 00:00 - Introduction 02:20 - Understanding TOAs: Early Interventions and Challenges04:43 - Clinical Management of TOAs08:06 - Surgical Approaches and Considerations22:25 - Microbiome and Infection Insights32:10 - Discussing Patient Reactions and Education32:47 - Teaching Practices and Medical Education34:18 - Clinical Observations and Data36:55 - Surgical Management of Ruptured TOAs40:50 - Challenges in Treating Infected Endometriomas50:13 - Exploring the Role of AI in Medical Practice54:23 - Concluding Remarks --- RESOURCES ACOG Recommends Concurrent Sexual Partner Treatment for Recurrent Bacterial Vaginosis for the First Timehttps://www.acog.org/news/news-releases/2025/10/acog-recommends-concurrent-sexual-partner-treatment-recurrent-bacterial-vaginosis-first-time Strange Bedfellows, Ina Park MD, MS https://www.inapark.net/the-book

Endometriosis and fibroids don't have to block your patient’s path to pregnancy. In this episode of BackTable OBGYN, host Dr. Mark Hoffman welcomes Dr. Jim Robinson, Director of Reproductive Surgery at Shady Grove Fertility in Maryland, to share his guidance on reproductive surgery applications and reproductive health. --- SYNPOSIS The conversation explores the management of endometriosis and fibroids, the use of office hysteroscopy, and the intricacies of hysteroscopic and laparoscopic procedures. Dr. Robinson covers the importance of individualized patient care, the latest advancements in reproductive technology, and insights from his unique career blending academic medicine with a focus on enhancing fertility outcomes. Listeners will gain a comprehensive understanding of the critical role surgical interventions play in reproductive endocrinology and the nuanced approach required to optimize patient outcomes. --- TIMESTAMPS 00:00 - Introduction 05:17 - Understanding Reproductive Surgery08:51 - Hysteroscopy in Reproductive Surgery16:28 - Endometriosis and Infertility23:50 - Diagnosing and Treating Adenomyosis28:10 - Surgical Interventions for Reproductive Health33:52 - Balancing Endometrioma Removal and Fertility35:49 - Surgical Approaches and Patient Goals36:46 - Complexities of Fertility Consultations42:48 - Impact of Fibroids on Reproductive Health45:33 - Adhesion Prevention in Myomectomy48:33 - Innovations in Fibroid Ablation52:10 - Understanding Isthmoceles and Their Impact58:11 - Concluding Thoughts --- RESOURCES ReceptivaDx: What does it mean to test positive for high levels of bcl6https://receptivadx.com/what-does-it-mean-to-test-positive-for-high-levels-of-bcl6/ Impact of hysteroscopic surgery for isthmocele associated with cesarean scar syndrome: https://pubmed.ncbi.nlm.nih.gov/28892298/

Ever wondered what it’s like to train and practice obstetrics and gynecology across New Zealand and Australia? In this episode of BackTable OBGYN, Dr. Amy Park sits down with Dr. Michael Wynn-Williams, a renowned gynecologist and endometriosis specialist. Dr. Wynn-Williams discusses his extensive training across New Zealand, Australia, the UK, and Scotland, emphasizing his role in minimally invasive gynecology.---SYNPOSISThe conversation covers the nuances of gynecology and obstetrics training in Australia and New Zealand, the balance between public and private healthcare systems, and the cultural differences in medical practice. Dr. Wynn-Williams also sheds light on issues like medical-legal environments, insurance, the impact of geography on healthcare delivery, and the integration of advanced ultrasound practices in endometriosis care. The episode provides valuable insights for those considering a career in gynecology in these regions.---TIMESTAMPS00:00 - Introduction07:35 - Training in Australia and New Zealand15:05 - Public and Private Healthcare Systems20:25 - Challenges and Equity in Healthcare24:39 - Balancing Public and Private Practice28:48 - Inpatient Services and Day Case Hysterectomy29:46 - City vs. Rural Practices and Equity Issues31:55 - Staffing Challenges in New Zealand33:57 - Living and Working in New Zealand and Australia35:25 - Navigating Medical Practice Transfers40:10 - Medical-Legal Environment in Australia and New Zealand43:31 - Gender-Based Reimbursement and Training Challenges51:41 - Endometriosis Ultrasound Scanning and Collaboration52:27 - Final Thoughts---RESOURCESThe Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), the professional body responsible for training, accreditation, and standards in obstetrics and gynecology in both countrieshttps://ranzcog.edu.au/

Not all pain is visible and not all solutions are obvious, especially in chronic pelvic pain. In this episode of BackTable OBGYN, host Dr. Mark Hoffman welcomes Dr. Aakriti Carrubba, an expert in minimally invasive gynecological surgery and pelvic pain from the Mayo Clinic, to talk through the evaluation and treatment of chronic pelvic pain.---SYNPOSISDr. Carrubba shares her journey from Kentucky to Florida, detailing her extensive training and interest in managing pelvic pain. The discussion covers the evaluation of pelvic pain, the significance of a thorough patient history and systematic pelvic exams, and the role of interdisciplinary approaches, including physical therapy and pain management. Dr. Carrubba emphasizes the importance of addressing central sensitization and chronic pain syndromes, explaining that not all pain can be attributed solely to structural abnormalities. The episode also touches on the integration of advanced AI tools in medical practice to enhance patient documentation and overall care.---TIMESTAMPS00:00 - Introduction01:09 - Dr. Carrubba’s Background and Journey03:54 - Fellowship Experience and Pelvic Pain Focus06:44 - Approach to Chronic Pelvic Pain14:04 - Detailed Pelvic Pain Exam Techniques17:14 - Trigger Point Injections and Their Role21:33 - Challenges in Pain Management and Education26:34 - Role of Central Sensitization in Chronic Pelvic Pain29:35 - Approach to Central Sensitization and Screening33:13 - Approaches to Excision Surgery36:04 - Post-Surgery Management and Hormonal Suppression38:19 - Teaching and Training in Pelvic Pain Management41:35 - Pain Rehabilitation Clinic for Central Sensitization44:59 - Teaching Pelvic Pain Anatomy to Trainees48:24 - Advancements in AI for Medical Documentation52:26 - Reflections on Pelvic Pain Training and Education56:00 - Final Thoughts

No money, no mission. Understanding coding is the key to funding care and making your practice sustainable. In this episode of BackTable OBGYN, host, Dr. Mark Hoffman, chats with Dr. Jon Hathaway, associate professor at IU School of Medicine and coding specialist. They discuss the intricacies of medical billing, the impact of coding knowledge on revenue, and the systemic gaps in residency training regarding financial literacy. ---SYNPOSISDr. Hathaway shares his journey from mastering coding to becoming a national expert, providing a crash course on CPT, RVU, and ICD codes, and emphasizing the importance of accurate billing for the sustainability of healthcare practices. The episode offers valuable insights into the challenges and opportunities in medical coding and the broader financial aspects of healthcare.---TIMESTAMPS00:00 - Introduction 02:03 - Dr. Hathaway's Journey into Coding04:11 - Understanding the Financial Side of Healthcare07:10 - The Disconnect in Healthcare Payments11:26 - The Complexity of Medical Billing18:11 - The Role of CPT, RVU, and ICD Codes24:03 - The Process of Approving New Procedures32:38 - Understanding the Value Update Process33:47 - Case Study: Cystoscopy in Hysterectomy Codes35:26 - Survey Participation and Its Impact36:12 - Roles and Responsibilities in ACOG38:12 - Challenges of RVU-Based Compensation42:08 - Specialty-Specific RVU Valuation48:42 - Comparing OB and GYN Reimbursements50:02 - Envisioning an Ideal Healthcare System55:10 - Maximizing Billing Efficiency59:46 - Final Thoughts

The future of gynecologic surgery is less invasive, more precise, and closer than you think. In this episode of the BackTable OBGYN podcast, host Dr. Mark Hoffman welcomes Dr. Noam Smorgick, Director of Minimally Invasive Gynecologic Surgery at Shamir Hospital in Israel. They discuss Dr. Smorgick’s journey into the field of OBGYN and her innovative approaches to intrauterine adhesion management and hysteroscopic surgery for complex pathologies.---SYNPOSISTopics include the advantages of hysteroscopic management over traditional methods, the importance of maintaining fertility, the nuances of the Israeli healthcare system, and the development of new surgical instruments and procedures. The episode also highlights shared decision-making in patient care and looks ahead to the future direction of gynecologic surgery. Dr. Smorgick shares insights from recent studies and her experiences, making it a valuable listen for practitioners and anyone interested in gynecologic surgery advancements.---TIMESTAMPS00:00 - Introduction02:05 - Dr. Smorgick’s Journey to Medicine05:01 - Insights into Israeli Healthcare System10:20 - Intrauterine Adhesions and Hysteroscopic Management11:28 - Research on Retained Products of Conception15:07 - Comparing Management of Pregnancy Loss22:02 - Future Directions in Hysteroscopic Surgery23:46 - Infertility Treatments in Israel25:50 - Managing Uterine Septums and Adhesions28:03 - Shared Decision Making in Surgery32:03 - Techniques and Tools for Metroplasty33:08 - Adhesion Prevention Strategies35:35 - Postoperative Care and Follow-Up36:59 - Office Hysteroscopy Procedures38:05 - Reusable vs. Disposable Instruments45:51 - Future of Hysteroscopy---RESOURCESNetherlands Publication: Prevalence of intrauterine adhesions after the application of hyaluronic acid gel after dilatation and curettage in women with at least one previous curettage: short-term outcomes of a multicenter, prospective randomized controlled trial: https://pubmed.ncbi.nlm.nih.gov/28390688/ Dr. Smorgick’s Publications: A comparison of reproductive outcomes following hysteroscopic management versus dilatation and curettage of retained products of conception: https://pubmed.ncbi.nlm.nih.gov/24997472/ Hysteroscopy-assisted suction curettage for early pregnancy loss: does it reduce retained products of conception and postoperative intrauterine adhesions?: https://pubmed.ncbi.nlm.nih.gov/37782418/

When radiology meets surgery, endometriosis care becomes more precise, personalized, and proactive. In this BackTable OBGYN Brief, host Dr. Mark Hoffman is joined by Dr. Wendaline VanBuren, an associate professor of radiology at Mayo Clinic, and Dr. Tatnai Burnett, a minimally invasive GYN surgeon at Mayo Clinic, to discuss the complexities of diagnosing and managing endometriosis. The discussion covers the roles of advanced imaging techniques like MRI and ultrasound, the importance of pre-surgical planning, and the need for multidisciplinary collaboration. They share their approach to managing symptomatic and asymptomatic patients, the use of hormonal treatments, and the significance of monitoring potential malignant transformations in endometrioma cases. The episode underscores the critical role of imaging in planning effective surgical interventions for patients while highlighting the progression of endometriosis management protocols. TIMESTAMPS 00:00 - Introduction  01:07 - Discussing Endometriosis Management 02:18 - Imaging Techniques and Their Importance 04:24 - Interdisciplinary Collaboration 05:40 - Advanced Imaging Protocols 08:12 - Monitoring and Follow-Up Strategies 08:50 - Concerns About Malignancy 11:04 - Future Directions CHECK OUT THE FULL EPISODE OBGYN Ep. 69 https://www.backtable.com/shows/obgyn/podcasts/69/imaging-protocols-to-guide-endometriosis-treatment

Blind biopsies leave questions unanswered. In this episode of BackTable OBGYN, host Dr. Mark Hoffman welcomes back Dr. Linda Bradley, an expert in obstetrics, gynecology, and hysteroscopy from the Cleveland Clinic, to discuss the benefits and advancements of direct visualized endometrial sampling over traditional blind biopsy techniques. ---This podcast is supported by:Medtronichttps://www.medtronic.com/en-us/healthcare-professionals/specialties/gynecology/product-portfolio.html---SYNPOSISDr. Bradley emphasizes the importance of hysteroscopy for accurate diagnosis and treatment of various gynecological issues, including abnormal uterine bleeding. They explore the limitations of blind biopsies and the advantages of hysteroscopy in detecting focal lesions, avoiding unnecessary hysterectomies, and ensuring patient safety. The discussion also touches on the economic and procedural challenges in adopting hysteroscopy more widely in clinical practice.---TIMESTAMPS00:00 - Introduction 03:30 - The Evolution of Hysteroscopy at Cleveland Clinic04:49 - Challenges and Innovations in Hysteroscopy06:30 - Clinical Insights: Direct Visualized Endometrial Sampling12:03 - Case Studies and Practical Applications15:46 - The Importance of Visual Examination in Gynecology20:03 - Advocating for Hysteroscopy in Medical Practice31:07 - Patient History and Trauma Considerations31:34 - Cancer Detection and Missed Diagnoses32:14 - Challenges with Unscheduled Bleeding32:56 - Case Study: Blood Transfusions and Hysterectomy33:38 - Importance of Hysteroscopy34:43 - Hysteroscopy Techniques and Best Practices37:41 - Ultrasound and SIS (Saline Infusion Sonohysterography) for Imaging38:45 - Post-Operative Care and Follow-Up47:41 - Environmental and Economic Considerations in Healthcare52:51 - Final Thoughts and Patient Advocacy

When radiology meets surgery, endometriosis care becomes more precise, personalized, and proactive. In this BackTable OBGYN Brief, host Dr. Mark Hoffman is joined by Dr. Wendaline VanBuren, an associate professor of radiology at Mayo Clinic, and Dr. Tatnai Burnett, a minimally invasive GYN surgeon at Mayo Clinic, to discuss the complexities of diagnosing and managing endometriosis. The discussion covers the roles of advanced imaging techniques like MRI and ultrasound, the importance of pre-surgical planning, and the need for multidisciplinary collaboration. They share their approach to managing symptomatic and asymptomatic patients, the use of hormonal treatments, and the significance of monitoring potential malignant transformations in endometrioma cases. The episode underscores the critical role of imaging in planning effective surgical interventions for patients while highlighting the progression of endometriosis management protocols. TIMESTAMPS 00:00 - Introduction  01:07 - Discussing Endometriosis Management 02:18 - Imaging Techniques and Their Importance 04:24 - Interdisciplinary Collaboration 05:40 - Advanced Imaging Protocols 08:12 - Monitoring and Follow-Up Strategies 08:50 - Concerns About Malignancy 11:04 - Future Directions CHECK OUT THE FULL EPISODE OBGYN Ep. 69 https://www.backtable.com/shows/obgyn/podcasts/69/imaging-protocols-to-guide-endometriosis-treatment

When it comes to menopause care, the facts are better than the fears. In this Urology/OBGYN crossover episode of the BackTable Podcast, host Dr. Suzette Sutherland welcomes renowned urologist Dr. Rachel Rubin to explore various aspects of sexual health and hormone replacement therapy (HRT), particularly for menopausal women. --- SYNPOSIS Dr. Rachel Rubin shares her career journey, expertise in sexual health, and the critical role of hormone replacement therapy (HRT) in managing menopause. She addresses common challenges and misconceptions, particularly around estrogen use, by demystifying the Women’s Health Initiative studies and emphasizing the proven safety and benefits of systemic and vaginal HRT. Dr. Rubin offers practical guidance on prescribing estrogen, progesterone, testosterone, and DHEA, while highlighting her advocacy to remove outdated FDA black box warnings on vaginal estrogen. Through personal anecdotes and professional insights, she empowers practitioners with evidence-based strategies and underscores the importance of education and research in advancing women’s health. --- TIMESTAMPS 00:00 - Introduction03:41 - Challenges in Menopause Medicine07:21 - Misconceptions and Risks of HRT15:35 - Understanding Bioidentical Hormones18:48 - WHI Studies and Their Impact23:21 - Practical Guide to Prescribing HRT33:47 - Understanding Estrogen Levels and Risks36:04 - Debating Gels vs. Patches37:51 - Concerns with Compounded Products and Pellets38:50 - Patient Education and Meeting Them Where They Are42:12 - Progesterone Benefits and Sensitivities46:38 - Testosterone Therapy for Women51:36 - The Importance of Lab Tests55:39 - DHEA and Vaginal Health57:14 - Advocacy for Accurate Hormone Therapy Information01:00:05 - Conclusion and Final Thoughts --- RESOURCES The Peter Attia Drive episode with Dr. Rachel Rubin:https://peterattiamd.com/rachelrubin/ FDA Expert Panel on Menopause and Hormone Replacement Therapy for Women:https://www.youtube.com/live/_2ZRlOivC5M?si=-Xynb_BmWz2sWf4mDr. Rachel Rubin’s Hormone Therapy for Early Adopters Course:https://rachelrubinmd.thinkific.com/courses/MHTCME

The guidelines are in and the myths are out. In this episode of the BackTable Podcast, Dr. Suzette Sutherland hosts Dr. Melissa Kaufman and Dr. Giulia Ippolito to discuss the new 2025 AUA/SUFU guidelines on genitourinary syndrome of menopause (GSM). ---SYNPOSISThe doctors delve into what GSM is, its symptoms, and the new evidence-based clinical guidelines for screening, diagnosing, and treating this condition. The episode emphasizes shared decision-making, safe use of local low-dose vaginal estrogen, and addresses concerns related to hormone therapy and cancer risks. Additionally, the doctors cover non-hormonal interventions, the role of vaginal moisturizers and lubricants, and the use of vaginal lasers. The importance of follow-up and ongoing patient education is also highlighted. The conversation aims to equip clinicians with the knowledge to better manage GSM and improve patient outcomes.---TIMESTAMPS00:00 - Introduction 01:35 - Overview of the 2025 AUA/SUFU Guidelines02:27 - Guideline Development Process05:48 - Categories of Guidelines07:03 - Understanding GSM: Symptoms and Diagnosis10:28 - Patient Education and Shared Decision Making15:22 - Hormonal Interventions and Safety Concerns17:17 - Local Vaginal Estrogen: Recommendations and Usage23:12 - Compounded Estrogens and Alternative Therapies25:48 - Understanding Estrogen Dosage Forms26:11 - Introduction to DHEA and Its Benefits27:15 - Exploring Ospemifene as an Alternative28:05 - Guidelines for Treating GSM Symptoms30:11 - The Role of Vaginal Estrogen in UTI Prevention33:01 - Non-Hormonal Interventions for GSM35:39 - Laser Treatments for GSM39:59 - Addressing Cancer Risks with Vaginal Estrogen44:48 - Endometrial Surveillance and Follow-Up49:14 - Advocating for Vaginal Estrogen Use51:13 - Conclusion and Final Thoughts

Where you perform a procedure could cost your patient thousands or save them just as much. In this Backtable OBGYN Brief, Dr. Mark Hoffman and Dr. Amy Park sit down with Dr. Barbara Levy to discuss the economic challenges and implications of performing medical procedures in various settings such as hospitals, ambulatory surgery centers (ASCs), and office environments.  They explore how hospitals have leveraged billing structures for financial gain, often driving up patient costs, and highlight how procedures like hysteroscopies and endometrial ablations can be performed more efficiently and cost-effectively in office settings. The conversation also touches on how insurance companies and healthcare policy shape both patient expenses and physician practice. Dr. Levy emphasizes the importance of understanding the broader healthcare system to effectively advocate for positive changes in patient care and outcomes. TIMESTAMPS 00:00 - Introduction 00:48 - Hospital Lobbying and Facility Fees 02:43 - Impact on Patients and Physicians 04:06 - Insurance Companies and Healthcare Economics 08:34 - Office vs. ASC vs. Hospital Procedures 12:59 - Cryoablation and Patient Experience 14:53 - Conclusion and Final Thoughts CHECK OUT THE FULL EPISODE OBGYN Ep. 55 https://www.backtable.com/shows/obgyn/podcasts/55/insights-on-obgyn-coding-reimbursements

OBGYN Briefs - Understanding Medical Facility Fees in Practice The way you code and calculate costs might be affecting your practice more than you realize. In this episode of BackTable OBGYN, hosts Dr. Mark Hoffman and Dr. Amy Park welcome back Dr. Barbara Levy, a clinical professor at George Washington University and UCSD. They discuss the complexities of practice expenses and coding in medical specialties, emphasizing the differences between direct and indirect expenses which vary by geography and specialty.  The conversation covers the challenges in surveying costs, the importance of accurate representation in surveys, and the strategic implications of coding. They also touch on the complications arising from procedure revaluation and the impact of site-of-service on reimbursements. TIMESTAMPS 00:00 - Introduction  00:48 - Understanding Practice Expenses 02:28 - Survey Challenges and Fraud Concerns 03:19 - Valuation of Medical Procedures 07:39 - Impact of Code Changes on Payments 11:01 - The Complexity of Medical Coding 15:18 - Site of Service and Facility Fees CHECK OUT THE FULL EPISODE OBGYN Ep. 55 https://www.backtable.com/shows/obgyn/podcasts/55/insights-on-obgyn-coding-reimbursements

OBGYN Briefs - Understanding the RUC's Role in Healthcare Costs Every procedure has a price, but how is it set? In this BackTable OBGYN Brief, Dr. Mark Hoffman and Dr. Amy Park welcome back Dr. Barbara Levy, a clinical professor at George Washington University and UCSD, to discuss her work with the key organizations influencing medical billing and reimbursement. They explore Dr. Levy's extensive involvement with ACOG, AMA's CPT Editorial Panel, and the RBRVS Update Committee (RUC), offering an overview of the complex systems governing coding and reimbursement in medicine. From how new procedures receive codes to the financial impact on physicians, this brief offers valuable insights for OBGYN practitioners navigating the world of medical billing and coding. TIMESTAMPS 00:00 - Introduction  00:48 - Personal Anecdotes and Career Beginnings 02:01 - Understanding Medical Reimbursement 03:17 - Roles and Responsibilities in Medical Committees 05:34 - The Coding Process Explained 09:16 - The Role of the RUC and CPT Editorial Panel 15:16 - RVUs and Practice Expenses 17:48 - Final Thoughts CHECK OUT THE FULL EPISODE OBGYN Ep. 55 https://www.backtable.com/shows/obgyn/podcasts/55/insights-on-obgyn-coding-reimbursements

Menopause isn’t just a diagnosis—it’s a transition, and the way we treat it needs to change. Dr. Kelly Casperson joins Dr. Suzette Sutherland in this urogynecology crossover episode of BackTable to challenge outdated beliefs about menopause and hormone replacement therapy (HRT). They revisit the impact of the 1990s Women’s Health Initiative (WHI) study and explain how its findings—especially around synthetic hormones—were widely misinterpreted and continue to adversely influence patient and provider decisions today. --- SYNPOSIS Dr. Casperson breaks down the differences between the hormones used in WHI and the safer, more targeted options available today. The conversation explores the broad benefits of modern HRT, including reduced risks of cardiovascular disease, osteoporosis-related fractures, and even dementia. Beyond the science, the episode also addresses the urgent need for better medical education and updated guidelines around menopause care.Dr. Casperson and Dr. Sutherland make the case for empowering patients through informed consent and better clinician training. They also discuss Dr. Casperson’s upcoming book, The Menopause Moment, which aims to equip women with the tools and knowledge to navigate this life stage with confidence. --- TIMESTAMPS 00:00 - Introduction02:50 - Focus on Menopause and Hormone Replacement Therapy04:20 - The Women's Health Initiative (WHI) Study05:39 - Understanding Risks and Misconceptions12:43 - Reevaluation of the Women’s Health Initiative Study18:31 - Impact of Media and Physician Education19:58 - Current State of Hormone Therapy22:17 - Broader Implications and Future Directions27:17 - Evaluating FDA Warnings and Gender Bias in Hormone Treatments29:49 - The Impact of Hormone Therapy on Women's Health32:11 - Risks of Not Using Hormones35:44 - Hormones and Brain Health: Debunking Myths40:41 - The Timing Hypothesis and Long-Term Hormone Use46:32 - Advocacy and Education for Menopause Awareness48:04 - Conclusion and Upcoming Resources --- RESOURCES PBS: The M Factor: Shredding the Silence on Menopause:https://www.pbs.org/show/the-m-factor-shredding-the-silence-on-menopause/ The Menopause Moment by Dr. Kelly Casperson: https://kellycaspersonmd.com/the-menopause-moment-book/ Systematic review and meta-analysis of the effects of menopause hormone therapy on risk of Alzheimer's disease and dementia:https://pmc.ncbi.nlm.nih.gov/articles/PMC10625913/