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Voices of MCMS:

The Modern Mujer

A conversation with Erica Montes, MD, FACOG, of The Modern Mujer, and Deborah Wilson, MD, and Associates.

MCMS: You are the Modern Mujer. Why did you create a bilingual women’s health blog?

Dr. Montes: Thank you so much for having me today. It all started in 2018 when I had my third son. I was up at night, postpartum, and thinking of wild ideas. I told myself, you know, I had been in private practice six years, and now it’s 11. I said I feel like I know so much. I'm a mom. I'm an OB/GYN. There's so much information that I can offer to people in English and Spanish. Why not come up with an online presence to reach people. I started thinking of a name that’s catchy and came up with the Modern Mujer because it’s bilingual. I wanted modern women or mujeres to come to my blog and that’s how it started.

 

MCMS: It's catchy. Were you seeing questions coming in from your patients and that's what you wanted to respond to?

Dr. Montes: I think so. For whatever reason I was getting a lot of misinformation from patients saying, “Hey, I saw this about vaginal infections, or I saw this about endometriosis.” Nine times out of 10, it was false information and I said, you know, if I can get that information, the expert of evidence-based information out there to these women, that's going to be better for them in the long run. Billions of people are on social media every day, day in and day out. More people are going to social media, which could be a good or bad thing, for their health information. They will Google or search hashtags for endometriosis or uterine fibroids. There are, unfortunately, a lot of accounts out there that are just trying to make money trying to give false information, especially about birth control. I said let me just find a little place in this realm of social media to help my community, to help women around the world. I now do second opinion Telemed consults with women from everywhere because they find me. They like my message. It's just grown into an amazing thing for me.

MCMS: That's cool. What has the response been so far with local patients and the branding outside of Arizona?

Dr. Montes: I think a lot of physicians can be skeptical or think that if you're on social media that maybe you’re unprofessional. For me, it’s a mix of professional and personal blog, where I do post some things about my family, like things that are happening with the boys. My patients know that I have three boys and we do things. I think it could be harmful if you don't do it correctly. You have to make sure you are complying with HIPAA, and make sure that you're giving accurate information. I like to include a link where they can find more information on our society websites and things like that so people know it’s more accurate. I think they really have a good response to it. Patients feel like they’re able to see me, feel like it makes me more personable, more approachable. They kind of know me sometimes, even before they see me. They find me and want to see me as their OB/GYN. They know what to expect from me, what I'm going to talk about, what things I focus on in patient visits. I think it gives them some ease, especially with this type of specialty and this type of visit as something that's really personal and intimate.

 

MCMS: You don’t shy away from topics. Has that always been your personality and approach?

Dr. Montes: Yeah, for sure. This is how I am, with a direct approach. Let's get it figured out. Let's do this, this, and this. At most visits, I’ll write a little plan that we're going to do because I feel like patients sometimes hear what we're saying but they can't put it all together. If they can hear it and visualize it, I think they focus on what’s going to happen next. It’s in English and Spanish, because Spanish-speaking patients don’t have a lot of information that they can go to. It really helps.

 

MCMS: Part of the process is scripting your message and then creating videos. Do you have a background in public speaking or acting?

Dr. Montes: Haha, no. Everyone asks me how I came up with topics. If someone tells me something like a misinformation statement that day, then I'm going to talk about that because I know it’s trending or people are thinking about it. I file it way. Whenever I have a little break or on my day off, I’ll talk about it, and I may focus on something for a week or two weeks. That way, it's hitting my community hard about fibroids or sexually transmitted infections and so on. If they know what to expect, then patients want to go back for more. There's more engagement.

 

MCMS: Production and editing can be a steep learning curve. What’s your advice to other physicians about whether they should wade into this at all or just test it out?

Dr. Montes: I guess it does depend on your specialty, but patients are always looking for guidance and answers to their condition. No matter what specialty you're in, people are going to be looking for it online. Now I know a big community of docs across the country who are on social media and kind of do similar things to what I do. We have attended conferences where we help each other out and give each other ideas about our brand.

MCMS: It’s a bunch of physician social media creators or influencers?

Dr. Montes: Yeah, exactly. It kind of started out as women empowerment and docs in private practice. I would say even if you don't want to do videos like I do or reels, try putting out quality information with apps like Canva that make it visually pleasing. When you give good information, people are going to find it and are going to share it. Your community of physicians online who are in your same specialty will share it, too. I've learned so much from those physicians who have a niche for cases I see every day but they take it from a different perspective. It’s like CME for me and CME for everyone. I would say do it. It's good for your practice to keep the new patient flow going. It is time-consuming and the first year to two years take up a lot of your time. After you have a presence and that foundation of your brand and blog or page, it continues to evolve on its own because people find your posts and they like them, and you can repost. Now, it works on its own. I do new things, but it's not as much work as the beginning, so it's easier.

MCMS: Talk about the bottom line. Is there also sponsorship money that you take?

Dr. Montes: I do have some companies and brands that I work with like Figs scrubs. I'm an ambassador for them.

MCMS: Which you're wearing right now, as we’re talking.

Dr. Montes: Yes, yes. Essentially, they find docs or any medical professional on social media, and if they like your vibe, your branding, what you're doing for the community, then they'll ask you if you want to be an ambassador for them. It's just whatever you want to do. If they come out with a new set of scrub colors, they'll send them to you. If you want to wear them on your next video, wear them. If you don't, it's okay. There’s no requirement. For me, it’s always nice to have an extra revenue of income. It is patient care and giving the community evidence-based information and then, at the same time, it gives me an outlet or stress relief. It’s my hobby in a way. It's good from a financial standpoint, but it's also good from a mental health standpoint because it gives me a release from the OB/GYN world.

MCMS: Let's talk about uterine fibroid. What are they?

Dr. Montes: Uterine fibroids are a very common medical condition in reproductive age women. The studies are showing up to 80% of women can have them, but they're three times more likely to occur in African American women. There's a lot of research being done to figure out what's driving these statistics. The fibroids are abnormal growths that are benign in the muscle layer of the uterus. There could be one or multiple.

 

MCMS: What are typical signs and symptoms?

Dr. Montes: There are four categories of symptoms. The first, which is the most common that patients are going to present with are abnormal uterine bleeding or heavy menstrual bleeding. The second one is pain. The third one is what we call bulk symptoms, which would be urinary symptoms or GI symptoms. Sometimes, you think someone has a GI illness and it’s actually fibroids. Then, the fourth is infertility, problem conceiving in general or multiple recurrent miscarriages. Things like that.

MCMS: Okay. What are the options for treatment?

Dr. Montes: In these last five years, there has been an explosion of options. The first one is just expectant management. I have a video that really did well. I show different fibroids based on sizes of fruit because it gives you that visual perspective. That's the perfect way to describe it to a patient. Because if I tell someone, “Your fibroid is 6 centimeters,” they don't know what that means. I can't visualize what that means. But if I say, “Your fibroid is the size of a Mandarin orange,” now I understand.

MCMS: Yeah, that's why everyone uses the app for pregnancy to find out what size food they're kid is.

Dr. Montes: Exactly. I kind of took that as an idea. So, when I say, “A normal sized uterus is the size of a pair, but then if you add a Mandarin orange on top of that or a couple of strawberries, this thing starts getting bigger and bulkier.” There is only so much space. It’s going to press on your bladder or colon. For some women, it’s makes them look pregnant. So, initial treatment is expectation management, which means monitoring it. We may happen to do an ultrasound for a different reason and incidentally find a fibroid. Then, medical management is the second tier of treatment, which would be things like hormonal therapy or newer meds called GnRH antagonists. They help to reduce the bulk of the fibroid and decrease bleeding. And then there's an injection called Lupron, which we use preoperatively to decrease the bulk of the fibroid, so we have a better ability to do it through minimally invasive. After medical treatment, treatment may progress to surgery, but not as definitive as a hysterectomy. These treatments are new as well and I was able to perform the first one here in Arizona for radiofrequency ablation of uterine fibroids. We’re getting really good results with that. You can do it laparoscopically or you can do it vaginally.

 

MCMS: That takes care of it forever, or do the fibroids return?

Dr. Montes: The ones you treat are pretty much dead. Their blood supply is gone. The shell of the fibroid is still going to be there, but it's not going to grow again. It will shrink and soften from a baseball to a marshmallow. It's great because the myomectomy, which is the next tier of surgery, is where you make an incision into the uterus and remove it. You would think maybe that's better but not necessarily because there's a higher risk of blood loss and more risk to pregnancy because you're making an incision on the uterus. There's also one other treatment before hysterectomy that you can consider for patients who aren't really good surgical candidates called uterine artery embolization. Interventional radiologists do it. They essentially block the blood supply to the fibroids directly, similar to radio frequency ablation, but in a different way. It’s necrosis of the cells, so it is a lot more painful than the ablation. It still works well for my patients who are older or not good surgical candidates.

MCMS: What would you say are some of the more complicated cases that you have to work through? I would imagine that it's probably a woman who wants to become pregnant and is wondering about the risks versus the rewards.

Dr. Montes: That usually tends to be the most complicated, or if it's a woman who has a fibroid that's in a very risky location. I’ve seen a patient who had a cervical fibroid which, if it's big, puts you at risk for getting closer to the ureter during surgery. Sometimes, we have to do combo cases with the urologist and put stents in the ureter. Once they get to be that big, it can be a lot more challenging because the anatomy changes so much. It becomes challenging when the patient is doing treatment for fibroids because they desire future fertility. For the radiofrequency ablation options, we still don't have enough data to say it's safe before pregnancy or that they wouldn't need a C-section. But the retrospective data are showing that it's fine. Patients are doing well. Pregnancy outcomes are good. It's been around for more than 10 to 15 years, but now more patients are seeking it out. Social media has really helped to let patients know about it.

 

MCMS: You mentioned that it could be as high as 80% of women with fibroids and three times as many African American versus Caucasian women. What does that percentage look like in the Latino or Latinx community?

Dr. Montes: It's a little higher than white women but it's not as high as African American. I would say it's probably like I would say between 1 1/2 to 2 times more frequent.

MCMS: Are there any ways to prevent this? There might be a genetic component or environmental issues.

Dr. Montes: For whatever reason, a lot of times I hear patients tell me, “I told this physician that I'm having heavy bleeding, or I told them I'm having pelvic pain.” It’s a repeated answer that I'm getting where physicians say that heavy periods are normal and pain during your periods are normal. The point I want to make is that, yes, to an extent these things can be expected, but it's easy to order a pelvic ultrasound that’s not super expensive. It's well tolerated. Patients can get it done everywhere. Ultrasound could save a patient from so many problems in the future. As long as we're listening to our patients and saying, “I heard what you’re saying. Let's just make sure you don't have fibroids and see if there's anything going on.” Early detection is key versus more prevention in a way.

 

MCMS: Is that procedure covered by insurance?

Dr. Montes: For sure. Insurance will cover it. If you go to a radiology place, it’s probably $100-150. Maybe not affordable for some, but there are imaging places in our community that do income-based scans. It’s reasonable to do that as screening. For prevention, we’re talking to patients about healthy lifestyle. Obesity can increase your risk because you have more estrogen in your system and estrogen is what drives these fibroids. For diet, we're trying to focus more on a plant-based diet versus meat that has hormones. There are some studies showing a link between low vitamin D levels and increased risk of growth for fibroids. They're still studying that, and I think there's been some link between alcohol and fibroids, as well. I think it really comes down to a lot of lifestyle changes. It's one of those conditions that should be lumped into our chronic medical conditions because it can cause a lot of issues with a woman’s reproductive health, and then there's a lot of healthcare dollars going into treating this because they need all these medications and surgeries when we get to that point.

 

MCMS: Is there a final message that you want to relay to primary care physicians about how to approach a conversation about women’s health?

Dr. Montes: As a gynecologist, I am in essence of a primary care physician, too, because sometimes I'm the only physician that a woman will see, especially in their reproductive years. But it is important to always remember that their last menstrual period, or the LMP, is technically a vital sign. Their last menstrual period gives us so much information just by knowing that date. You can tell, based on her age, has this patient been menstruating regularly? Is she perimenopausal? Is she menopausal? Because all that affects how we treat their other medical conditions, and it affects whether we want to screen them for these certain conditions. Early detection is key for fibroids, because we can offer them so many more treatments. In this day and age, a lot of women are looking for uterine preserving treatments or uterine sparing treatments. And women are getting pregnant later in life and, by the time we find fibroids, sometimes we don't have many options.

MCMS: As a bilingual physician, what’s your advice to other physicians about learning medical Spanish and how far should they go?

Dr. Montes: I had pre-med student shadowing me and she was asking me about medical Spanish and she's of Hispanic descent. She knew how to converse in Spanish, but she doesn’t know much medical Spanish. She said, “I wish our med school curriculum would at least give us some medical terminology.” At my med school in San Antonio, where more than half of the people living there speak Spanish, we didn't have any of that. It was just a learn as you go approach. I grew up speaking Spanish, but medical terminology was still a hard at first to pick up because we didn't have that exposure when we were growing up. Because the Latino population is going to be a third of the population by 2050, I think primary care docs should have some knowledge of at least being able to understand, just the bare minimum of certain words that we use day-to-day. I haven't really thought enough of how that can happen, aside from having an MA who speaks Spanish or a translator by phone, but that can be cumbersome and complicated. We need to be able to serve these communities better and sometimes they don't have a daughter or a son who can come with them to their appointments. That's a different topic, but I think a lot of that is why these people arrive late or seek care later because they're embarrassed that they can't speak English, or they think no one's going to be able to understand them.

 

MCMS: Dr. Erica Montes, the Modern Mujer, muchas gracias, thank you.

Dr. Montes: Gracias por tu tiempo. I really enjoyed it.

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