BackTable Women's Health

Within six months of starting general OBGYN practice, one gynecologic surgeon says she felt like “a jack of all trades and a master of none,” and a few years later she left her job to become a fellow again. On this episode of BackTable Women’s Health, Dr. Joseph Chen, a complex benign gynecologic surgeon at Kaiser Permanente East Bay, is joined by Dr. Jessica Shields, program director of the Complex Benign Gynecology Fellowship at Lahey Clinic, to discuss what it takes to return to training after years in practice. They cover why some OBGYNs choose subspecialty training over a high-volume gynecology practice, how to apply to fellowship as a practicing physician, and what changes when an attending becomes a fellow again.

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Timestamps
00:00 - Introduction
03:47 - From Generalist to Fellowship Applicant
06:26 - Subspecialty Training Versus a High-Volume Gynecology Practice
09:49 - Applying From Practice and How Program Directors Review Applications
13:57 - Building a Competitive Application While in Practice
16:48 - Returning to Training as a Former Attending
19:41 - Finding a Focus in Endometriosis and Chronic Pelvic Pain
21:59 - Match Competitiveness and Whether Fellowship Is Necessary
25:14 - Resident Readiness for Independent Surgery
28:12 - Should OBGYN Residency Be Longer?
30:13 - Perseverance and Closing Remarks

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More about this episode
Dr. Shields shares the case log lesson from her own interview day, the order in which she now reads applications, and how attendings without protected research time can show commitment through courses, hospital committees, and mentors. The conversation moves through life as a fellow after being an attending, the patient with pelvic pain who steered her toward endometriosis care, why the complex benign gynecology match remains competitive, and whether fellowship is needed for a gynecology-focused practice. Drs. Chen and Shields close on resident readiness for independent surgery, whether OBGYN residency should be longer, why daily repetition sets fellowship apart, and the perseverance that carried her from a missed match to the fellowship she wanted.

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Resources
Guntupalli SR, et al. Preparedness of Obstetrics and Gynecology Residents for Fellowship Training. Obstet Gynecol. 2015
https://doi.org/10.1097/AOG.0000000000000999

Complex Benign Gynecology Fellowship, Lahey Clinic (Dr. Jessica Shields, Program Director)
https://www.lahey.org/education-training/graduate/fellowships/complex-benign-gynecology

Dr. Joseph Chen, BackTable contributor page
https://www.backtable.com/shows/obgyn/contributors/dr-joseph-chen

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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

Heart disease is still the leading cause of death in women, and for many women the OBGYN is the only doctor they see each year, so how can obesity medicine become a natural part of that visit? On this episode of BackTable Women’s Health, Dr. Nicole Faulkner is joined by Dr. Taylor Hahn, an OBGYN board certified in obesity medicine and founder of VIA Women’s Health Collective, to discuss how general OBGYNs can integrate obesity care into everyday practice. They cover how to raise the weight conversation with and without a patient’s cue, which baseline labs to order, how to counsel patients on GLP-1 medications around pregnancy, and how to build a multidisciplinary team.

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Timestamps

00:00 - Introduction
02:52 - Making Time for the Weight Conversation
05:10 - A Cardiometabolic Framework for Discussing Weight
09:14 - Baseline Labs: Lipids, Apolipoprotein B, Lipoprotein(a), and Thyroid
14:48 - Building a Multidisciplinary Care Team
18:35 - Obesity Across Gynecologic Conditions
22:36 - GLP-1 Medications Around Conception, Pregnancy, and Postpartum
27:46 - Opportunities for OBGYNs and Removing Shame
31:37 - Follow-Up, Monitoring, and Barriers to Lifestyle Change
36:39 - Advice for OBGYNs New to Obesity Medicine
40:53 - Adding Weight to the Health History Questionnaire
42:56 - Closing Remarks

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More about this episode

Dr. Hahn explains why she frames the conversation around cardiometabolic health rather than the number on the scale, and why she adds apolipoprotein B, lipoprotein(a), and more complete thyroid testing to her baseline workup. The conversation moves through the ways obesity intersects with abnormal uterine bleeding, polyendocrine metabolic ovarian syndrome (PMOS, formerly PCOS), fertility, and perimenopause; how to counsel patients who conceive while taking a GLP-1 medication, plan a washout before conception, and restart therapy postpartum; and what follow-up looks like during titration and maintenance. The discussion closes on removing shame from the conversation, adding a weight question to the intake form, and the reminder that OBGYNs do not need a second board certification to make a meaningful difference.

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Resources
Guideline on the Management of Dyslipidemia. Circulation. 2026
https://doi.org/10.1161/CIR.0000000000001423

Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process. Lancet. 2026
https://doi.org/10.1016/s0140-6736(26)00717-8

VIA Women’s Health Collective (Dr. Taylor Hahn)
https://www.viawomenshealth.com

Dr. Nicole Faulkner, BackTable contributor page
https://www.backtable.com/shows/obgyn/contributors/dr-nicole-faulkner

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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

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.

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Timestamps

00:00 - Introduction
02:57 - Incidental Ultrasound Report on a Friday Afternoon
05:57 - Ultrasound Features, ACOG Bulletins and O-RADS
08:44 - Red Flag Findings and Urgent Evaluation
10:58 - Tumor Marker Selection and the Limits of CA 125
14:31 - Markers by Age, Tumor Type and New Assays in Development
19:38 - When MRI Adds Value
23:15 - Surveillance Versus Surgery
27:05 - Cystectomy, Oophorectomy and the Consent Conversation
31:10 - Preventing Rupture and Containing the Specimen
35:42 - Closing Remarks

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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.

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Resources

ACOG Practice Bulletin No. 174: Evaluation and Management of Adnexal Masses. Obstet Gynecol. 2016
https://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. 2020
https://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. 2003
https://doi.org/10.1016/s0029-7844(03)00670-7

Im SS, et al. Validation of referral guidelines for women with pelvic masses. Obstet Gynecol. 2005
https://doi.org/10.1097/01.AOG.0000149159.69560.ef

Society of Gynecologic Oncology
https://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. 2015
https://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. 2023
https://doi.org/10.1158/1078-0432.CCR-23-1197

Dr. Bodour Salhia, Keck School of Medicine of USC
https://keck.usc.edu/faculty-search/bodour-salhia/

Dr. Mona Guo, Keck Medicine of USC
https://keck.usc.edu/faculty-search/xiaoyue-mona-guo

Dr. Mona Guo, BackTable contributor page
https://www.backtable.com/shows/obgyn/contributors/dr-mona-guo

Dr. Marcia Ciccone, Keck Medicine of USC
https://keck.usc.edu/faculty-search/marcia-ciccone/

Dr. Marcia Ciccone, BackTable contributor page
https://www.backtable.com/shows/obgyn/contributors/dr-marcia-ciccone

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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.

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Timestamps

00:00 - Introduction
06:19 - Public Health and Global Work
10:33 - Residency and Early Career Choices
15:04 - Founding a Digital Health Company
19:48 - Ambulatory Operations Leadership
24:36 - Leading a County Medical Group
29:32 - Physician Needs and Retention
34:25 - Physician Compensation Overhaul
41:47 - Physician Unionization and Employment
46:25 - Pregnancy Loss and Perspective
49:09 - Launching a Direct Pay Practice
57:10 - Mentorship in Private Practice
01:03:28 - Closing Remarks

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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.

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Resources

Avaiyar Private Care, Dr. Akileswaran's direct pay OBGYN practice
https://avaiyarprivatecare.com/
Cleo, the digital health company she co-founded
https://hicleo.com/

ACOG Well-Being and Physician Support Resources
https://www.acog.org/career-support/well-being

AMA Physician Practice Benchmark Survey: Smaller Share of Doctors in Private Practice Than Ever Before
https://www.ama-assn.org/practice-management/private-practices/smaller-share-doctors-private-practice-ever

MGMA Provider Compensation Data Reports, the benchmarking source referenced on air
https://www.mgma.com/mgma-data-reports

Dr. Chitra Akileswaran, UCSF OBGYN Residency Alumni Profile
https://obgyn.ucsf.edu/residency-program/chitra-akileswaran-md-mba

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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.

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Get the BackTable app
https://www.backtable.com/app

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This podcast is supported by

Medtronic Pelvic Health
https://urgencyisreal.com/

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Timestamps

00:00 - Introduction
04:00 - Shared Decision-Making
06:51 - Clinic Efficiency
10:38 - Expanding OAB Therapy Options
12:27 - Long-Term OAB Care
17:41 - Building an OAB Program
18:18 - Staff Training and Follow-Up
25:32 - OAB Navigator Implementation
27:14 - Navigation Outcomes
28:39 - Scaling with Staff and Epic
30:35 - Algorithm Resources
34:08 - Neuromodulation Advances
38:37 - New Tibial and Battery-Free Devices
40:56 - Quality of Life in OAB Care
46:11 - Access and Adoption
51:22 - Streamlining Therapy Discussions
52:47 - Closing Remarks

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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.

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Resources

Patient navigation for overactive bladder improves access to care
https://link.springer.com/article/10.1007/s00192-019-04085-7

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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.

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Timestamps

00:00 - Introduction
03:26 - Endometriosis Beyond the Pelvis
05:17 - Understanding Systemic Symptoms
10:35 - Why Diagnosis Takes Years
12:54 - Key Clues to Endometriosis
14:35 - Emerging Noninvasive Diagnostics
18:13 - Pain Versus Disease Stage
19:33 - Precision Medicine Approaches
24:04 - Treatment Strategies and Follow-Up
27:17 - GnRH Antagonists and Add-Back Therapy
29:45 - Danazol and Surgical Options
34:26 - Future of Immune-Based Therapies
37:49 - Fertility Counseling and Egg Freezing
40:17 - Wrap-Up and Key Takeaways

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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.

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Resources
Clinical 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.

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Get the BackTable app
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Timestamps

00:00 - Introduction
03:05 - Evolving Guidelines and Consensus
10:02 - Lead-Time Bias and Cost Considerations
12:05 - Maintenance Therapy and Surveillance Nuances
14:44 - Ovarian and Endometrial Cancer: Imaging vs Exam
20:24 - Key Takeaways from the TOTEM Trial
24:04 - Future Tools, Lifestyle Counseling, and Shared Care
27:21 - Cytology, HPV Testing, and Post-Radiation Surveillance
31:13 - Hormone Therapy Considerations
34:37 - ctDNA and MRD Testing
37:39 - Emerging Technologies and Limitations
43:22 - Rapid Fire Takeaways
45:33 - Closing Thoughts

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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.

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Resources

TOTEM Trial
https://ascopubs.org/doi/abs/10.1200/jco.22.00471

2010 Ovarian Cancer CA-125 Trial
https://pubmed.ncbi.nlm.nih.gov/20888993/

Society of Gynecologic Oncology Clinical Practice Statement on Surveillance
https://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.

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Get the BackTable app
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Timestamps

00:00 - Introduction
04:01 - What Is Sexual Medicine
07:58 - Understanding Libido, Arousal, and GSM
15:54 - Clinic Visit Structure and Patient Counseling
19:17 - Clitoral Exam, Adhesions, and Anatomy Education
28:17 - Addressing Stigma, Patient Education, and Myths
32:03 - Tools for Patient Empowerment: Apps and Self-Examination
39:55 - In-Office Procedures, Pain Mapping, and Hormonal Considerations
46:37 - Managing Complex Cases and Multidisciplinary Collaboration
53:47 - Closing Remarks

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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.

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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/

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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.

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Timestamps

00:00 - Introduction
04:05 - Case One: Recurrent UTIs
05:19 - Workup Basics
08:50 - Non-Antibiotic Prevention
11:42 - Antibiotic Prophylaxis Options
15:16 - Case Two: Asymptomatic Bacteriuria
19:14 - Case Three: Complex Patients
19:58 - Male vs. Female UTIs
21:22 - Neurogenic Bladder Workup
22:52 - Elderly Patients and ID Consults
25:01 - Case Four: Transplant ESBL
25:23 - Machine Learning for Antibiotics
29:49 - Catheter Biofilms
31:55 - Embedded Bladder Reservoirs
35:23 - Recurrent UTI Vaccine
36:23 - Future of Recurrent UTIs
39:04 - Wrap Up

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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.

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Resources

Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2025)
https://www.auanet.org/guidelines-and-quality/guidelines/recurrent-uti

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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.

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Get the BackTable app
https://www.backtable.com/app

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Timestamps

00:00 - Introduction
04:40 - Discovering Hypnotherapy
08:59 - What a Session Looks Like
13:02 - Remote Sessions and Results
17:27 - Follow-Up and Maintenance
20:13 - Women's Health Examples
28:05 - Talking to Patients
30:47 - Hypnosis vs. Therapy
33:07 - Pap Smear Trauma Case
37:28 - Breathwork Reset Tool
42:42 - Uncovering Repressed Trauma
46:17 - Burnout and Stress
49:12 - Barriers to Success
53:21 - Call To Action
54:58 - Live Demo Plans
55:50 - Closing Remarks

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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.

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Resources

Within: Finding Yourself, Fixing What's Broken, & Finally Reclaiming True Health https://enso-nia.com/about-sonia/

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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.

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Timestamps
00:00 - Introduction
02:42 - Breaking Down OB Roles
06:01 - MFM and Hospitalist Collaboration
07:35 - Inside the OB ED
12:31 - High Stakes Emergencies Overview
18:02 - Amniotic Fluid Embolism
21:33 - Cardiac Arrest Pearls and Drills
24:44 - Team Leadership Under Pressure
29:19 - Emotions Debrief and Bonding
37:48 - Simulation Practice and Mentorship
40:18 - Early Career Fit and Support
43:10 - Wrap Up

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More about this episode
Dr. 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.

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Resources
Maternal 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.

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Get the BackTable app
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Timestamps

00:00 - Introduction
03:11 - Why Menopause Medicine
07:51 - Hormone Therapy Paper
11:48 - Counseling Perimenopause
16:14 - Unopposed Estrogen Strategy
23:01 - IUDs And Progesterone
26:54 - Estrogen Types Explained
34:59 - Thrombosis Risk Approach
43:11 - Oral Estrogen Use Cases
44:48 - Breast Cancer Risk Counseling
46:49 - Estrogen Risk Myth
48:11 - Pregnancy and Breast Cancer
50:09 - Counseling BRCA Patients
53:26 - Duavee: Who Benefits?
55:32 - Bazedoxifene Access Limits
57:47 - Ospemifene for Genitourinary Syndrome of Menopause (GSM)
01:00:37 - Dryness Explained
01:02:41 - Thrombosis Risk Screening
01:05:01 - UTIs and Vaginal Estrogen
01:07:18 - Starting HRT After 60
01:12:47 - Window of Opportunity
01:14:46 - Staying on HRT
01:16:43 - Blood Levels and Absorption
01:20:13 - Clinician Takeaways

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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.

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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

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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.

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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.

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Timestamps

00:00 - Introduction
02:37 - Launching a New Practice
04:23 - When to Refer Patients
06:23 - Basic Infertility Workup
08:39 - Counseling Patients Over 40
14:05 - Personalized IVF Protocols
17:59 - Embryology and PGT-A
23:54 - Egg Preservation Timing
28:20 - Using Frozen Embryos Later
31:36 - Components of Personalized IVF
33:30 - Patient Experience and Education
37:25 - Alternative Fertility Options
40:46 - Approaching Recurrent Miscarriage
42:28 - Key Takeaways

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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.

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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.

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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.

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Timestamps

00:00 - Introduction
03:03 - Understanding Carrier Screening
04:40 - Partner Testing: When and Why
06:22 - Selecting the Right Panel Size
08:27 - Managing Time Constraints and Making Referrals
10:52 - Pretest Counseling Essentials
16:44 - Decoding Results and Effective Reporting
20:52 - Limits of OB Counseling
26:19 - Navigating Common X-Linked Pitfalls
30:11 - Equity, Costs, and Over-Testing
36:11 - Tele-Genetics and Lab Resources
43:43 - Final Takeaways

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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.

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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.

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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.

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Timestamps

00:00 - Introduction
04:58 - CGMs in Women’s Health
07:33 - OTC Data Sharing Issues
09:52 - Pregnancy Glucose Targets
16:20 - Accuracy and Variability
20:10 - Anxiety and Eating Disorders
24:41 - Counseling and Follow-Up
28:29 - Prescription and OTC CGM Picks
37:24 - False Lows and Sensor Errors
41:23 - Alarm Settings and Logging
44:06 - Interpreting Metrics and Limits
46:44 - Provider Dashboards
48:42 - Final Thoughts

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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.

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Resources

Stelo - Over the Counter CGM Option
https://www.stelo.com/en-us

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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.

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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.

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---

Timestamps

00:00 - Introduction
04:47 - From Employee to Owner
05:53 - Skills That Changed Everything
07:35 - The Wake Up Call
10:44 - Why Doctors Resist Business
15:06 - Profit as Patient Care
18:20 - Job vs. Business Entity
21:13 - CEO Hat and Team Systems
25:14 - Exit Value and Sellability
29:00 - More Profit: More Time Off
30:24 - Fear Before Breakthrough
35:32 - Choose Service Over Perfection
39:11 - Invest in Your Potential
46:26 - MEAT Week Priorities
48:40 - Three-Part Daily Rhythm
55:02 - Advice for Burned-Out Docs
59:29 - Wrap Up

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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.

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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.

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Timestamps

00:00 - Introduction
03:27 - Why Hospitalists Matter
05:33 - How Their Model Works
07:15 - Managing Pushback
10:18 - Measuring Better Outcomes
15:58 - Drills and Emergencies
19:50 - Staffing and Transition
24:33 - ROI and OB-ED
26:33 - Residents and Teaching
30:52 - Future Flexible OB Careers
34:14 - Patient Acceptance of Model
36:47 - Collaboration and Lifestyle Balance
40:00 - Conclusion

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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.

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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.

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Get an inside look at prolapse surgery, from technique to training to team-based care. In this episode of BackTable Women’s Health, Dr. Amy Park talks with Mayo Clinic urogynecologist and pelvic reconstructive surgeon Dr. John Occhino about the art and strategy behind prolapse repair. They explore why Dr. Occhino favors vaginal approaches, when robotics come into play, and how he frames staged treatment strategies, particularly for younger patients at risk of recurrence.

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---

Timestamps
00:00 - Introduction
02:09 - Choosing Vaginal vs. Robotic Approach
10:24 - Why Vaginal Skills Declined
13:20 - OR Setup and Positioning
16:32 - Anterior Entry Technique
20:05 - Ureter Safety and Suspension
28:14 - Robotic Hysteropexy Considerations
31:47 - Collaborative Training Culture
35:41 - Beyond See One Do One
46:13 - Anatomy Keeps You Safe
49:46 - Leadership Authenticity
53:45 - Team Support and Wrap Up

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More about this episode
The conversation covers how to counsel patients about prolapse as a dynamic condition, the trade-offs between durability and mesh aversion, and the importance of prioritizing symptoms and quality of life in decision-making. They share practical tips on vaginal hysterectomy technique and ergonomics, discuss why vaginal surgery skills are declining, and highlight best practices in surgical education, including apprenticeship-style training, promoting psychological safety, setting targeted goals, fostering collaboration among program directors, and grounding surgical judgment in anatomy and authenticity in leadership.

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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.
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Can a “normal” pelvic exam mask life-altering pain? On this episode of BackTable Women’s Health, host Dr. Karen Toubi interviews board-certified OBGYN Dr. Chailee Moss about why common vulvovaginal pain and skin conditions are frequently missed or dismissed as “normal” exams. Dr. Moss explores how gaps between gynecology and dermatology, limited training, and the under-recognition of non-life-threatening but highly morbid pain contribute to these diagnostic challenges, including mental health impact and even suicidality in some cases.

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---

Timestamps

00:00 - Introduction
03:56 - Why Pain Gets Missed
08:58 - Building Trust With Time
10:51 - Vulvodynia Workup Basics
16:02 - Hormonal Vestibulodynia Clues
21:21 - New Treatments On Horizon
23:07 - Lichen Steroid Maintenance
26:25 - Biopsy Decisions And Mimics
30:30 - Multimodal Treatment Planning
33:00 - Pelvic Floor PT Done Right
35:55 - When To Consider Surgery
37:33 - Clinical Trials Ketotifen Botox
40:40 - Conclusion and Resources

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More about this episode

They discuss rebuilding trust through time, attentive listening, and clear communication, along with a detailed evaluation process that includes medication review, targeted symptom questions, Q-tip mapping, vulvoscopy, cultures, and selective biopsy. The approach informs an individualized, multimodal treatment plan. Additional topics include lichen steroid counseling,differentiating mimickers like yeast and irritant dermatitis, and connecting patients to resources such as ISSWSH, ISSVD, and support groups.

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Resources

Experiences of Care and Gaslighting in Patients With Vulvovaginal Disorders https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2833711

ISSWSH

https://www.isswsh.org/

Pudendal Hope

https://www.pudendalhope.info/

Tight Lipped

https://www.tightlipped.org/

The National Vulvodynia Association

https://www.nva.org/

---

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 do you decide which noninvasive prenatal testing option is best for your patient, and when should you reach for single-gene NIPT? In this episode of BackTable Women’s Health, host Dr. Nicole Faulkner interviews maternal-fetal medicine specialist Dr. Andrei Rebarber to break down the evolving world of prenatal genetic testing. They discuss the importance of pan-ethnic carrier screening, the clinical scenarios where single-gene NIPT is most useful, and how to navigate counseling and follow-up for a wide range of patients.

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This podcast is supported by

Natera
https://www.natera.com/info/fetal-focus

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Timestamps

00:00 - Introduction
04:43 - Prenatal Genetic Testing Basics
07:10 - Larger Panel Screening Benefits
10:49 - Defining Single-Gene NIPT
14:51 - Counseling and Invasive Options
18:26 - Accuracy Data and No Call Rate
22:03 - Patient Acceptance of Test
24:18 - When to Test and Screen
26:13 - Counseling Carrier Results
30:12 - In Utero Treatment
32:36 - Workflow for Generalists
35:33 - How to Interpret Literature
40:08 - Closing Remarks

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More about this episode

Dr. Rebarber shares how witnessing in-utero transfusions for severe Rh disease inspired his career in OBGYN and maternal-fetal medicine, highlighting the importance of treating the fetus as a patient and the rapid growth of fetal therapy. The episode reviews ACOG-guided carrier screening for conditions like cystic fibrosis and hemoglobinopathies, the trend toward larger, pan-ethnic screening panels, and why carrier findings are common but true “double-carrier” couples are relatively rare. Dr. Rebarber also discusses the clinical utility of single-gene NIPT—a cell-free placental DNA test for select recessive conditions—especially when partner testing isn’t possible or when patients wish to avoid invasive procedures. The conversation compares screening and diagnostic strategies, including CVS and amniocentesis, and provides practical insight into interpreting test performance and emerging research.

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Resources

EXpanding Prenatal Cell Free DNA Screening Across moNogenic Disorders (EXPAND)
https://clinicaltrials.gov/study/NCT06808880?tab=study

---

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