Women’s Health by the Decades

By Megan Willome

Part II: The 30s — The busy years

LThis month the Wacoan continues a series on women’s health, one decade at a time. We consider the 30s, which can encompass a variety of life stages simultaneously. A woman may be having babies while also beginning to notice signs of perimenopause. It’s a decade when women’s bodies are changing and they may seek a doctor’s advice to help improve their health and wellness.

Lacy Coker Kessler, M.D., is a local — born at the old Hillcrest hospital, attended high school at Vanguard College Preparatory School and graduated from Baylor University. From there she went to Houston for medical school at UT Health and then to Amarillo, where she served as administrative chief resident during her OB-GYN residency at Texas Tech University Health Sciences Center. But she came back to Waco as soon as she could, opening a private practice in 2012. Last year she was joined by Dr. Hayley Voige, and together they opened Deerwood Women’s Health & Wellness.

Dr. Kessler says one of the benefits of being an OB-GYN is that she gets to take care of people in one of the best times of their lives.

“There are not many fields where you get to take care of happy people,” Kessler said. “Usually when you go to the doctor, you’re sick. I do have my sick patients, but I get to take care of people during one of their happiest times as well.”

Wacoan writer Megan Willome spoke with Dr. Kessler by phone to learn what to do when you think you’ve had your last baby, how to begin good breast health habits, and what issues a woman should not be shy about with her doctor.

WACOAN: When did you decide to become an OB-GYN? Did you go into med school with that desire?

Kessler: I didn’t really know what an OB-GYN did until medical school. I loved hands-on, surgical-type fields, but most of the opportunities in surgery you don’t get to know people very well. You do surgery and move on.

I love delivering babies. It’s a miracle that never gets old. It’s exciting every day. Then I also get to do surgery and get to know women and help them for long periods of time.

WACOAN: What did you study at Baylor?

Kessler: I was a University Scholar, with an emphasis in organic chemistry.

WACOAN: Did you know then that you wanted to go to medical school?

Kessler: My grandfather’s a physician. I just always liked the idea of becoming a doctor, since I was about 4 years old and never changed my mind.

WACOAN: Had you always planned to come back to Waco after your residency?

Kessler: I hadn’t decided 100% until I finished, but I knew I wanted to come back home. I talked a lot with Dr. [J. Mark] Rister. He helped me get on my feet and get started.

WACOAN: And you opened your practice here in 2012?

Kessler: Originally it was under my own name, but now it’s Deerwood Women’s Health & Wellness. We rebranded to Deerwood in August of [2019]. I hired Dr. Hayley Voige a little over a year ago. She’s a Waco girl too. We grew up on the same street, Deerwood [Drive]. This is where we both decided to become doctors, where it all began, so it was a good name for our practice.

WACOAN: Why does Deerwood offer aesthetic services?

Kessler: Over the years I started to realize that women had many different needs that seemed to come up time and time again. Some [women] started to come to talk about aesthetic concerns. I have done my best to integrate a collection of aesthetic services, all of which offer excellent safety profiles and are designed to achieve optimum results with the least possible downtime. Women often put off doing things for themselves because of the downtime that takes away from their families and careers.

WACOAN: What are some of the basic concerns women in their 30s have who are coming to see you?

Kessler: They’re coming in for pregnancy, to plan for it too. To talk about contraception. For wellness visits. Most of my 30-somethings are wellness- and pregnancy-related.

WACOAN: Are most of the pregnant women in this age group having a second or third child, as opposed to a first?

Kessler: There’s an equal mix. A lot of women are in their early 30s for their first baby, but the majority of my patients are in their late 20s with the first. For a lot of my patients in their 30s it’s their last baby, and they’ve had two or three already. It’s probably ages 26-34 for first-time moms.

WACOAN: What are some of the things you address with a mom when it’s not her first time to give birth?

Kessler: A lot of them come in concerned. It depends on what happened with the first pregnancy. If they experienced a complication, we talk about that, the risks of it coming back.

I do allow patients to have vaginal deliveries after a C-section, if they’re a good candidate. We talk about what the risks and benefits of that are.
We talk about family planning, integrating a new baby into the mix, all the kinds of things that go along with that. Contraception comes up more when it’s not their first baby — planning for what they want to do.

WACOAN: Do women frequently make changes to their method of contraception in their 30s?

Kessler: It depends on their plan, on how many children they want. A lot of women, especially in their later 30s, may be sure they don’t want any more babies. Then we talk about tying tubes. I tell them the greatest risk is regret, so if there’s any hesitancy there, don’t do it.

We also talk about LARCs, Long-Acting Reversible Contraception, like IUDs or implants. Their efficacy is as much as a tubal ligation, but they last three to six years, maybe up to 10. I do a lot more of [LARCs] in that age group. If they’re going to be breastfeeding, I like to avoid things with estrogen, [like birth control pills], while they are breastfeeding.

WACOAN: Is this the age when you begin to talk about breast health?

Kessler: We talk about breast self-awareness. I do recommend an annual clinic breast exam. Even if they don’t systematically do an exam once a month at home, they can pay attention to their breasts, how they’re changing in size, if they notice masses, if there are changes in skin texture or redness and pain that they haven’t had before.

If they have a family history of breast cancer, we explore if there’s a need for mammograms early. As long as there’s not a history of breast cancer in the immediate family, we wait until 40 to start mammograms. The main thing is family history [of breast cancer] in someone that was younger than 50. Also if there is a family history of ovarian cancer because those genes can be linked to breast cancer.

WACOAN: How can women stay healthy between babies?

Kessler: It depends on what other medical conditions they have. I tell women to continue with a good women’s multivitamin for their iron and folic acid. Having a good healthy diet and staying fit is helpful. Little ones can make things complicated. But sometimes you get enough exercise chasing them around.

WACOAN: At what age is a woman’s pregnancy considered high risk?

Kessler: After 35 we consider it to be advanced maternal age, from a risk perspective. The main thing people are concerned about is with chromosomal abnormalities. The risk is 1:200, so there’s still less than a 1% chance.

For women in this age group we offer them additional genetic screening, if they’re interested. That could consist of blood work or targeted ultrasound. We screen to see if they are at more risk for diabetes, hypertension. We screen them as we would anyone, then if something shows up, we move appointments to be more frequent and watch them more closely.

WACOAN: It seems like hormones start shifting in this decade, affecting metabolism and other things.

Kessler: Everyone is so different. Women start to go through a perimenopausal stage up to 10-12 years before menopause. For most women that’s in their early 40s, but for some that can start in their late 30s, having some hot flashes. Women get concerned about weight gain that’s harder to manage, night sweats, irritability, those things. We can visit about it. I tend to treat based on symptoms rather than big panels of labs. We talk about what symptoms they’re having so those can be addressed.

WACOAN: Are there things women are hesitant to bring up to a doctor that they should?

Kessler: The most common things women do not bring up that they should that we can help with is if they have a little leaking urine, especially if they already have had children. They say, ‘Oh, that’s normal,’ but we can help with that.

Also women can have a decreased sex drive and less satisfaction, sexually. They can be anxious to bring that up, wondering whether that’s normal at their age. There’s options to help.

Those are the ones people are most shy about.

WACOAN: I noticed on your website that you have a section about urinary incontinence.

Kessler: Oh, yes. People have a misconception that if I had a C-section this shouldn’t happen. But pregnancy is traumatic on the pelvic floor, just carrying the baby. It can happen to [women who have had] vaginal deliveries, to C-sections. I’ve had it happen to some women who’ve not had children at all.

WACOAN: Do you see menstrual changes in this age group?

Kessler: That can start to happen in the 30s or early 40s. That’s when women tend to make a big change in contraception decisions. Maybe their partner gets a vasectomy. Maybe they’ve been on the birth control pill and noticed big changes in their cycle. For some women periods start spacing out. They frequently have heavier cycles. A lot of women, we’re all busy moms and have a lot going on. They say, ‘It’s normal, it’s normal, it’s normal,’ then they become ill because they’ve lost so much blood.

WACOAN: When should a woman bring up menstrual issues to her doctor?

Kessler: Bring it up if a period lasts longer than 5-7 days, or if they’re needing to change their sanitary products more than every 2 hours.
WACOAN: Are there common misconceptions you see with this age group?

Kessler: I get a lot of women who think once they hit their late 30s or more in their 40s that they can’t get pregnant anymore. Or they think that while they’re breastfeeding they can’t get pregnant. That’s not necessarily true. As long as women are still menstruating, they can get pregnant. I had a 48-year-old with a surprise pregnancy not too long ago. As long as they’re still having cycles, there’s still that potential.

One common misconception, people think birth control can make it harder for them to get pregnant, but that’s only true for Depo-Provera. The shot has a delay in fertility.

WACOAN: Are there any new trends and treatments that apply to women in their 30s?

Kessler: In OB-GYN we do a lot more minimally invasive surgery, laparoscopic, but there are not a lot of women in their 30s who need surgery. It’s a pretty healthy age group. They just had children or are about to have children.

WACOAN: What about infertility? Where do you begin when a woman in this age group is not getting pregnant?

Kessler: The most basic thing is to track a menstrual cycle to determine if there’s ovulation or not. After tracking the cycle we do some labs to evaluate if they’re ovulating, if anything is off that can trigger infertility. We check the thyroid and things like that.

The next step would be to check if the uterus is healthy, if there are any anatomical or structural problems. We have different medications to assist with ovulation, but when the problem is beyond that, I typically send them to an infertility specialist at that point.

WACOAN: What have you enjoyed about practicing in this field of medicine?

Kessler: Even though I’ve only been practicing for eight years, I’ve had families who’ve delivered four babies with me. There are women who have had babies and had hysterectomies.

I love just getting to know people and know their families and be part of special times in their lives but still get to do surgery and hands-on doctor stuff.