Advancing women’s health and well-being requires that each woman be at the center of her health care. From this foundation, UCSF’s many experts have developed an approach to women’s health based on patient choice, leading-edge research and coordinated care among clinicians, provided in welcoming environments.
Women who receive care from the National Center of Excellence in Women’s Health (CoE) are at the heart of a collaborative process that can begin within a women-focused primary care practice or with an expert in one of more than 20 specialty areas, ranging from infertility and incontinence to heart disease, HIV, and breast and gynecological cancer, among others.
Elena Gates, MD
Supporting patient choice is the hallmark of all these practices, says Elena Gates, MD, chief of the UCSF Division of General Gynecology. “There is no ‘one size fits all’ for any condition in terms of treatment. There are several approaches, and we focus on the best outcomes in partnership with patients.”
This philosophy of personalized medicine is reflected in all the clinical services and, to be effective, requires excellent data. This is captured by Laura Esserman, MD, MBA, in the mission statement of the UCSF Carol Franc Buck Breast Care Center: “Our mission is personalizing treatment by advancing our knowledge of tumor biology, our understanding of women’s preferences and the continuous improvement of our performance.”
UCSF has added to the field of women’s health through research elucidating how hormones and other biological traits make women and men respond differently to medical treatments, diagnostic tests and prevention strategies.
Moving Science to the Patient
“We have made great progress in our understanding of women’s health, but it only becomes meaningful when we translate it into better care for all women,” says Nancy Milliken, MD, vice dean of the UCSF School of Medicine and director of the UCSF CoE. “This is why the CoE is focused on translating new scientific evidence into clinical practice and putting up-to-date information into the hands of women.”
UCSF was among the first academic medical centers in the country to receive the prestigious designation of Center of Excellence in 1996. The UCSF CoE pioneered a new model of advancing women’s health and well-being that promotes gender-based research, innovative clinical care, evidence-based professional education and training, community partnerships, and leadership for women in health care.
Community services of the CoE include a Women’s Health Resource Center that provides information, referrals and resources to the public. The CoE engages in collaborations with schools and with community and governmental organizations to make progress on issues that affect women’s health and women’s lives.
Array of Special Services
The range of special services in women’s health at UCSF includes:
- HIV and women: Now in its 15th year, the Women’s HIV Program provides comprehensive health and social services to women and families living with HIV/AIDS in the San Francisco Bay Area. It was among the first programs in the country dedicated to HIV-positive women and is a national model of care for this vulnerable population.
- Primary care: The Women’s Health Primary Care practice includes internists and nurse practitioners with a special interest and expertise in caring for women. The practice provides comprehensive care with an emphasis on prevention, education and patient participation. When needed, patients are referred to UCSF specialists.
- Mental health: Mental health services include the Pregnancy and Postpartum Mood Assessment Clinic; the Medication Alliance Clinic, providing personalized co-management of antidepressant prescriptions and extensive education on mood disorders and treatment options, along with follow-up; and the Women’s Mood and Hormone Clinic, with services for women when hormone function may influence mood and well-being.
- Fibroids: Fibroids are benign muscle tumors in the uterus, affecting an estimated 20 percent to 50 percent of all women. Nationwide, some 200,000 hysterectomies are performed annually to treat fibroid disorders. Some women avoid care because they are afraid of having a hysterectomy. The UCSF Comprehensive Fibroid Center, which opened in 2001, provides the latest techniques for managing the growths, which includes avoiding a hysterectomy if a woman chooses.
“Our fibroid program has succeeded because we partner with a woman to assist her with decisionmaking about all the different options that are available, including no treatment,” says Alison Jacoby, MD, director of the center.
- Continence: Incontinence is a problem for more than 13 million Americans, 85 percent of whom are women. Despite the prevalence of the disorder, few patients seek help for the sensitive issues of bladder, rectal or pelvic floor problems, which spurred UCSF in 1991 to found the most comprehensive continence program in Northern California.
“We do a combination of clinical work and research in order to bring discoveries to the treatment arena as quickly as possible,” says Jeanette Brown, MD, director of the Women’s Continence Center. “When women come for clinical care, they are benefiting from the latest and greatest research.”
Expectant mother Ohnmar Lin has a check-up with Elena Gates, MD.
- Low- and high-risk pregnancy: In the UCSF obstetrical practices, the patient care team partners with women toward the common goal of a healthy pregnancy. Obstetricians, family practice physicians and certified nurse-midwives deliver 1,800 babies each year at UCSF. “Patients can choose a family-oriented birthing option, but a perinatologist also is on call during birth and always available if needed,” says Mari-Paule Thiet, MD, director of the Division of Maternal-Fetal Medicine. UCSF also opened a CenteringPregnancy® Program in the mid-1990s, a group approach to prenatal care that has been adopted in hospitals nationwide. About eight to 10 women or couples with similar due dates meet regularly with a certified nurse-midwife to learn about pregnancy and connect with other expecting couples. The UCSF Prenatal Diagnostic Center offers the latest tests in evaluating a developing fetus for health complications. For the 6 percent to 8 percent of pregnancies in which high-risk complications occur, a team of pregnancy specialists meets weekly to discuss the best plan of care for each patient. In addition, UCSF is a world leader in fetal intervention: diagnosing life-threatening health problems in the developing fetus and then performing corrective procedures in the fetus while it remains positioned in the mother’s uterus.
- Infertility: For women who would like to get pregnant and for expecting mothers, UCSF provides a range of health care services, including access to physicians who specialize in treating those with previous health issues such as diabetes or cancer, or those who struggle with recurring problems during pregnancy. In 1983, UCSF was first in the Bay Area to launch an in vitro fertilization program, and today the UCSF Center for Reproductive Health, directed by Marcelle I. Cedars, MD, continues to be a pioneer in addressing reproductive issues. The center offers a comprehensive array of infertility evaluation and treatment options in a multidisciplinary environment. The center is distinguished as one of only a few nationwide to involve reproductive care for men and women on the same site with integrated care in genetics, psychology, andrology (male reproductive health) and embryology.
- The UCSF Polycystic Ovarian Syndrome Multidisciplinary Clinic, led by Heather Huddleston, MD, is the only one of its kind nationally to integrate care by reproductive endocrinology, dermatology, genetics, psychology and nutrition specialists. This “whole person” approach is a springboard for research and recognizes the many facets of this diverse clinical condition.
- The Fertility Preservation Center, led by Mitch Rosen, MD, is dedicated to providing information and treatment to female and male cancer patients who face difficult decisions regarding cancer treatments that, while lifesaving, may end an individual’s reproductive future. The program’s multidisciplinary team maintains close interaction with a patient’s oncologist, and provides immediate consultation and options for egg, sperm and embryo preservation. Even if fertility preservation is not pursued, the program offers support and counseling to individuals and integration with a vibrant basic science group searching for ways to protect the ovaries and to offer novel options for the future.
- Cancer care: UCSF experts also are dedicated to addressing a variety of cancers that affect women. Medical teams focusing on abnormal pap smear results and treatment of cancers of the reproductive system help women understand the latest research, and partner with them on their many treatment choices. The UCSF Carol Franc Buck Breast Care Center specializes in providing innovative, comprehensive services that address the needs of the whole person, including diagnosis and evaluation, medical care, psychological support, clinical trial options, and a prevention program for women at increased risk of developing breast cancer.
New Women’s Specialty Hospital at Mission Bay
UCSF labor and delivery medical staff.
UCSF women’s health care will be strengthened in 2014 with the opening of the new UCSF Medical Center at Mission Bay, which will feature a women’s specialty hospital integrated with one of the nation’s premier children’s hospitals and a world-class cancer hospital.
The new complex will mean that women facing high-risk pregnancies, for example, will be treated by expert obstetricians collaborating with leading neonatologists. Women with cancer will receive care from experts who understand their unique needs as women. A teen facing pelvic surgery will have both pediatric and gynecologic experts on her clinical team. New molecular tests will improve diagnosis and help customize treatments. And the latest technologies for minimally invasive surgeries will enable women as soon as possible to return to their families, their communities and their lives, and to regain their full health.
“We have the opportunity to incorporate our expertise, experience, unique model and passion into this new hospital, which has been designed to provide women with a lifetime of quality reproductive health,” says Milliken.