Dr. Nadini Verma’s Services
Menopause
Menopause is a natural stage in the life of every woman, typically occurring after a woman has missed her period for 12 consecutive months. It’s not unusual for menopause to start as early as the mid-40s, although in the US the average age is 51 years.
What is menopause?
Menopause is a natural stage in the life of every woman. Typically it occurs after a woman has missed her period for 12 consecutive months. It’s not unusual for menopause to start as early as the mid-40s, although in the US the average age is 51 years. Menopause results in reduced levels of estrogen and other hormones and marks the end of fertility. Menopausal symptoms develop gradually or rapidly depending on the balance of various hormones in the body. Some women have symptoms that appear over time, whereas others have symptoms that appear to develop overnight. Fluctuations in your menstrual cycle are just one of the manifestations of menopause, and a comprehensive evaluation will determine whether a woman is in perimenopause or full blown menopause.
What changes are expected in menopause?
Every woman experiences menopause differently. Some have minimal symptoms outside of irregular periods, while other women experience hot flashes, night sweats, sleep problems, mood disturbances, vaginal dryness, weight gain, slow metabolism, dry skin and thinning hair. These changes are not always related to a lack of estrogen and some (like night sweats and hot flashes) tend to ease up after a period of time. Maintaining a healthy lifestyle during the transition time is essential and can prevent or lessen the effect of some of these changes.
Do all women require hormone replacement therapy?
Not all women require hormone replacement therapy. For many women, maintaining a healthy lifestyle involving exercise and modified diet, along with acupuncture and non-hormonal therapy, can alleviate symptoms and make the transition to menopause easier. However, hormone replacement therapy can be very effective in relieving menopausal symptoms if they are having a negative effect on your quality of life. Often women ask whether they should seek hormonal therapy or tough it out. Studies have shown that if a woman is going to be treated with hormones, an early start can have long term benefits. Early hormone replacement in and around menopause not only gives relief from severe symptoms but reduces risk of heart disease and protects from bone loss and future fractures. Hormone therapy earlier on for a limited duration also minimizes the breast cancer risk.
After a comprehensive evaluation, Dr. Verma can determine if hormone replacement therapy is the right choice for you.
MonaLisa Touch
MonaLisa Touch is a new treatment embraced by menopausal women around the world looking for non-hormonal treatments for vaginal dryness, irritation, discomfort and painful intercourse.
What is MonaLisa Touch?
MonaLisa Touch is a new treatment for vaginal and urinary disorders that was designed and perfected in Italy in 2008. Originally designed for treatment of vaginal atrophy in breast cancer survivors who could not use estrogen, it was embraced by menopausal women around the world looking for non-hormonal treatments for vaginal dryness, irritation, discomfort and painful intercourse. The treatment has since been proven to help women suffering from urgency and getting up frequently at night to empty their bladder. By rejuvenating the tissues in a non-invasive way and restoring collagen, it can relieve the above symptoms faced by many menopausal women and thereby dramatically enhance the quality of their life.
What benefits does MonaLisa Touch offer?
The vaginal dryness and irritation associated with lack of estrogen can make sexual intercourse extremely uncomfortable and painful and sometimes impossible. MonaLisa Touch has the ability to revitalize the tissues and restore vaginal and thinned vulvar tissue to allow intimacy without pain as well as provide relief from debilitating urge incontinence, frequent urination, and recurrent vaginal and urinary tract infections.
Is MonaLisa Touch safe?
This is an in-office painless treatment that requires no anesthesia, no incisions, and lasts less than ten minutes per session.
There is minimal discomfort if any and can be compared to having a vaginal ultrasound. The full course of treatment requires three sessions that are six weeks apart. Women can resume their day to day activities immediately after each visit. Typically there are no side effects; occasionally women experience increased vaginal discharge and minimal spotting. Most women start to see results within one to two weeks of the initial treatment. However for optimal results, the complete course of three treatments is recommended. After completion of the course, a once a year follow-up treatment may be required.
Check out what patients are saying:
“Longtime patient with a lot of trust and confidence in Dr. Verma. First Mona Lisa treatment today, highly anxious. Dr Verma explained the procedure in the detail I needed – and it went exactly as she described. Easy peasy. As I left her office I met a woman bringing a few dozen pink roses to Dr V in gratitude for her Mona Lisa procedure. Made me feel very confident! Less than 5 hrs later I began to feel a benefit from the procedure. Really! So far so great!”
Video: MonaLisa Touch Fractional CO2 Laser Therapy
PMS
Premenstrual syndrome, or PMS, occurs in the days prior to a woman’s menstrual cycle when her hormones begin to fluctuate. For most women, symptoms are mild and tolerable, but for some, they can be debilitating.
What are the symptoms of PMS?
Premenstrual syndrome, or PMS, is an enigma. It occurs in the days prior to a woman’s menstrual cycle when her hormones begin to fluctuate. For most women, symptoms are mild and tolerable, but for some, they can be debilitating. The severity of symptoms depends on the individual’s hormonal imbalance. PMS involves a combination of physical, emotional, and psychological changes which usually lessen within a day or two of the onset of the period. Physical symptoms of PMS include bloating, breast tenderness, increased acne, cramps, food cravings, and headaches.
What is Premenstrual Dysphoric Disorder (PMDD)?
Premenstrual dysphoric disorder (PMDD) is a severe presentation of premenstrual syndrome (PMS) and can occur in up to 8% of menstruating women. Symptoms include but are not limited to anger, irritability, depression, over-sensitivity, and mood fluctuations. PMDD can interfere with daily activities, as well as social activities and relationships. The depressive symptoms of PMDD may be associated with suicidal thoughts and behavior. Researchers believe that PMDD may occur because of an unusual sensitivity to normal cyclical hormonal changes. These fluctuations can cause changes in the level of serotonin a chemical in the brain that helps to transmit nerve signals which may be responsible for behavioral change.
Is PMS related to hormonal deficiency?
Most women who have PMS have a progesterone deficiency that may be present since puberty. Typical progesterone deficiency complaints are extreme irritability, marked anger, anxiety, excessive mood fluctuations that occur in particular in the premenstrual phase. Long term progesterone deficiency can cause breast cysts, breast tenderness before menstruation, abdominal bloating, ovarian cyst, excessive menstruation, and cramps.
Women who have estrogen deficiency are more likely to complain of premenstrual headaches/migraines, short-lived but immense fatigue, depression, feeling of hopelessness, hot flashes, and sweating, especially at night.
How is PMS treated?
Premenstrual Syndrome is treated in many different ways. Beneficial lifestyle modifications include marked reduction in the consumption of caffeine, sugar and sodium (salt), a decrease in alcohol and nicotine use, and ensuring adequate sleep. These in combination with nutraceutical supplements can be used to treat most of the symptoms. In severe cases, medication and correction of hormone balance can bring immediate relief. Dr. Verma will individually assess all presenting symptoms and offer the most holistic approach to addressing your specific PMS issues.
Hormone Balancing Therapy
Hormonal balance within the body is extremely delicate and needs to be monitored closely – it can be the key to improving physical and mental well-being. Dr. Verma believes hormone balance is the key to health and vitality, and she works with her patients to optimize it.
What are hormones?
Hormones are natural chemical substances produced by the body that are essential for all life processes, they act like messengers in the body. Hormones are made in highly specialized tissues called endocrine glands, and are then released in tiny quantities into the bloodstream. Each gland produces specific hormones to carry out certain functions in the body such as ovaries for reproduction. These hormones are stored in the glands until they receive a message from the pituitary gland (the master gland) in the brain to say how much of each hormone is needed at various times of the day at each location in the body. This message triggers the release of hormones into the bloodstream and they are transported to a specific organ or tissue to perform a specific function. Once they reach their destination, hormones pass through the walls of blood vessels and go on the surface of target cells to bind themselves to hormone receptors. As they complete the binding, hormones trigger a chain of reactions that result in beneficial “hormone” effects such as metabolism, growth, reproduction, mood balance, stress resistance, digestion, inflammation reduction, and more. Estrogen, cortisol, insulin, oxytocin, progesterone, and testosterone are all examples of hormones.
What happens when hormones are out of balance?
Most commonly, women experience hormonal fluctuations every month during the menstrual cycle on a regular and predictable manner. However, when hormones are out of balance, several functions in the body can suffer. It is a wide belief that women’s hormonal imbalance takes place before or during menopause, but women can actually experience symptoms much earlier in life. Women as young as their late 30’s can suffer from hormone imbalances as can the women in their 40’s. Fatigue, lack of concentration, unexplained sudden weight gain, and disrupted sleeping patterns are just a few signs that hormones are not optimally balanced. Many women also report suffering from significant fluctuations in mood such as depression, a sense of being overwhelmed, and anxiety. Hormones trigger chemical reactions throughout the body. They also control the amount of glucose in the bloodstream, the stress-induced adrenaline release that impacts energy levels, and weight fluctuations. Hormonal balance within the body is extremely delicate and needs to be monitored closely – it can be the key to improving physical and mental well-being. Dr. Verma believes hormone balance is the key to health and vitality, and she works with her patients to optimize it.
Is hormone replacement therapy the only answer to imbalance issues?
Lifestyle modifications such as exercise, diet, meditation, yoga, and nutritional supplements can all have a positive impact on hormone imbalance. Hormone replacement therapy may be used with (or without) some of these lifestyle modifications. Dr. Verma works closely with each patient to design a treatment plan that is tailored to each patient’s individual needs.
Bioidentical Hormones and Pellets
In young postmenopausal women, Hormone replacement therapy (HRT) is a safe and an effective tool to alleviate moderate to severe menopausal symptoms and to prevent long-term degenerative diseases such as osteoporotic fractures, cardiovascular disease, diabetes mellitus and, possibly cognitive impairment.
What are bioidentical hormones?
Bioidentical hormones are identical to the hormones your body produces. They mimic your own hormones and function in your body the exact same way your hormones do. These hormones are plant-based, but because of the similarity with natural hormones, your body perceives them the same way. This allows for a natural integration into your body’s physiology. Bioidentical hormones are available commercially as well as from compounding pharmacies. These hormones are used to replace what your body no longer makes as you go through menopause. The most popular method of administration of these hormones is by use of a cream, gel, or patch on the skin (i.e. transdermally). If estrogen is taken as a pill, it is first processed through the liver. This stimulates protein associated with clotting factors, which increase the risk of heart disease, stroke and blood clots. When delivered by transdermal routes such as creams or gels, estrogen is not processed first by the liver and does not have these effects. Although estrogen is the main component of Hormone Replacement Therapy and relieves most symptoms, natural progesterone is also added to alleviate anxiety and promote better sleep. Estrogen can be dispensed as Estradiol, Estriol, or Bi-Est. Besides Estrogen and Progesterone, women may need other hormones like DHEA, Pregnenolone, and Testosterone.
What are hormone pellets?
The use of subcutaneous (under the skin) pellets of biodentical hormones offer a uniform, continued release of the hormones. By placing the pellets under the skin, the hormones can be dispensed in a steady amount over a period of time. Pellets obviate the need for daily application of hormone creams and other types of hormone replacement therapy. While other types of HRT may fluctuate in potency, pellets always provide the same, consistent dosage. A single treatment can last three to four months. Pellets are ideal for patients with busy active lifestyles, patients who may forget to use their creams or simply for the sake of convenience.
Dr Verma specializes in pellet therapy and if necessary can discuss this option at your appointment.
Is hormone replacement safe?
In young postmenopausal women, Hormone replacement therapy (HRT) is a safe and an effective tool to alleviate moderate to severe menopausal symptoms and to prevent long-term degenerative diseases such as osteoporotic fractures, cardiovascular disease, diabetes mellitus and, possibly cognitive impairment. Dr. Verma is very conscious of common patient concerns, such as the increased possibility of breast cancer linked with Hormone Replacement therapy as well as controversies regarding compounded hormones. All of your concerns regarding these issues can be addressed at your appointment.
What is the protocol for hormone therapy?
Dr. Verma will carefully consider your medical and family history, genetic factors, and review your baseline lab tests to select the hormones for your specific needs. Hormone replacement therapy typically takes 1-3 weeks to optimize and restore your hormonal balance to regular levels.. An effective and safe hormone replacement program will always involve ongoing monitoring to ensure that dosage levels remain appropriate. To that end, you will have lab testing and follow-up visits with Dr. Verma every 3-6 months.
PCOS
Polycystic Ovary Syndrome (PCOS) is a common hormone disorder with symptoms that can include enlarged ovaries with multiple small cysts containing eggs (polycystic), infrequent or absent menstruation, and a high level of the male hormones (androgens) like Testosterone.
What is PCOS?
Polycystic Ovary Syndrome (PCOS) is a common hormone disorder that affects 5%-10% of women in the reproductive age. It is a collection of symptoms that are found together. Not all women with PCOS have all the symptoms. The exact cause of PCOS is unknown. To be diagnosed with PCOS, a woman must have 2 of 3 possible issues: enlarged ovaries with multiple small cysts containing eggs (polycystic), infrequent or absent menstruation, and a high level of the male hormones (androgens) like Testosterone.
What are the symptoms of PCOS?
PCOS symptoms can vary in different individuals. Women with PCOS usually have irregular or missed menstrual periods. This is the most common symptom and women presents with menstrual intervals longer than 35 days, fewer than eight menstrual cycles a year, or failure to menstruate for four or more months. Some experience increased hair growth facial and body (hirsutism) and significant adolescent acne. Many gain weight or may have difficulty becoming pregnant. The severity of the condition will determine the intensity of the symptoms. Women who have PCOS may also have a higher risk of type 2 diabetes.
How is PCOS diagnosed?
There is no specific test to diagnose PCOS. We use a combination of patient history, physical examination, ultrasounds (sonogram), and blood tests in evaluating PCOS. Early diagnosis and treatment is the best way to prevent future risk of type 2 diabetes and heart disease.
How is PCOS treated?
Dr. Verma treats each woman on an individual basis, as every patient has a unique genetic and physical makeup that may contribute to her diagnosis. Each treatment plan will be geared towards restoring normal menstrual cycles, weight loss and treatments for acne and excessive hair. We will also recommend strategies to reduce health risks of pre-diabetes and help address fertility issues if needed.
Infertility
Fertility problems affect nearly 11% of the US population. A fifth of these are due to unexplained causes. Conception is dependent on a host of factors, and when any one of these factors is impaired, fertility problems can ensue.
What is infertility?
An inability to get pregnant within a specified period of time can be daunting. According to the CDC, Fertility problems affect nearly 11% of the US population. A fifth of these are due to unexplained causes. About a third of the remaining cases are attributed to women, a third of men, and a third to a combination of both partners with reproductive issues.
Conception is dependent on a host of factors: the production of healthy eggs by the woman and healthy sperm by the man, open/unblocked fallopian tubes that allow sperm to reach the egg, sperm’s ability to fertilize the egg when the two meet, the ability of the embryo, or fertilized egg to implant or “stick” to the uterine wall and sufficient embryo quality. When any one of these factors is impaired, fertility problems can ensue.
How is fertility evaluated?
Initial fertility testing involves checking for a woman’s age-appropriate reproductive health, ovulation, and unblocked/open fallopian tubes. We do this through a combination of blood tests, ultrasounds, and a procedure called a hysterosalpingogram. These are done at specific times of a woman’s menstrual cycle. Initial testing for men involves a semen analysis performed in special laboratories.
What does initial fertility treatment involve?
For couples who wish to defer invasive and advanced procedures like IVF and ICSI, chances of pregnancy can be optimized by helping patients better understand their ovulation and menstrual cycles through analyses of ultrasounds and other lab tests to determine the optimal time for conceiving. For certain couples, clomid, an oral medication (used for five days in a cycle) may be administered in conjunction with a timed insemination.
What is assisted reproduction?
In vitro fertilization (IVF): This involves harvesting a woman’s egg, fertilizing it with the partner’s sperm in a test-tube and, once a fertilization of the egg is confirmed, re-introducing the embryo into the uterus.
Intracytoplasmic Sperm Injection (ICSI): This is a process used when there is not a high enough number of normal functioning sperm for IVF. Fertilization is achieved by injecting a single live sperm into each egg. The resulting fertilized egg, like in IVF is reintroduced into the uterus.
Adrenal Fatigue
Adrenal fatigue often refers to the inadequate production of one or more of the adrenal gland hormones. These hormones are essential to life and can get depleted due to adrenal gland overwork (often caused by chronic stress, demanding workloads,) and cause a feeling of being “burnt out.”.
What is adrenal fatigue?
Adrenal fatigue is a controversial term and is usually a diagnosis of exclusion. It often refers to the inadequate production of one or more of the adrenal gland hormones. These hormones are essential to life and can get depleted due to adrenal gland overwork (often caused by chronic stress, demanding workloads,) and cause a feeling of being “burnt out.”.
Our adrenal glands, small organs that are located above the kidney, usually deal with stress by producing adrenal hormones mainly cortisol. A commonly held belief of adrenal fatigue is that when you are facing long-term stress your adrenal glands struggle, and are ultimately unable to keep pace with the body’s fight or flight response. The effects of stress are not limited to the adrenals; it is now known that they also affect the central nervous system. Cortisol is the most crucial stress hormone, and can be overproduced in response to persistent stress. Daily monitoring of cortisol can provide valuable information that will help form a treatment plan.
What are the symptoms of adrenal fatigue?
The impact of stress is unique to each patient. Women who have adrenal fatigue are often exhausted and unable to maintain the level of activity that they have been accustomed to in the past. Difficulty getting up in the morning even after adequate sleep, foggy brain, exhaustion after exercise are all common symptoms. Women with adrenal fatigue may feel tired throughout much of the day and have trouble concentrating. A lack of enthusiasm, feelings of apathy and disinterest, anxiety, nervousness, depression and insomnia may also occur. Many women with this condition go undiagnosed for long periods of time and feel there may be no relief. Comprehensive analysis is necessary to identify early or late stage fatigue and support each patient’s unique needs. Dr. Verma specializes in diagnosing and treating women who suffer from this condition.
How is adrenal fatigue treated?
There are a number of body stressors that may trigger adrenal fatigue. Dr Verma recommends good sleeping habits, practicing relaxation activities like meditation and yoga, moderate (not intense) exercise, eliminating or reducing alcohol and sugar, and checking for food or environmental allergies and chemical sensitivities. Along with Cortisol testing, we will test for all of these factors to determine if they affect you. In addition to helping patient’s manage stress, we will also design a customized treatment plan for each patient that may include diet adjustments, botanicals and vitamin supplements.
Contact Dr. Nadini Verma
Serving the greater Los Angeles, California area as well as the Santa Monica community, Dr. Verma specializes in various types of hormone replacement therapy and other problems many women face including adrenal fatigue, menopause, infertility, PCOS, and menstrual irregularities.
Call Dr. Verma today to book an appointment!