Yuliya Mikhael

Yuliya Mikhael OB-GYN Consultant/ Pregnancy&Delivery/Aesthetic Gynecology/Fetal Medicine/Laser

The short answer is YES. What actually happens ? * In young women with consistently good estrogen production vaginal mu...
13/08/2026

The short answer is YES.
What actually happens ?

* In young women with consistently good estrogen production vaginal mucosa cells contain good amount of glycogen .

* Glycogen is stored form of glucose that is used as fuel for growth of Lactobacilli - the « good » bacteria that should inhabit vaginal cavity.

* Good number of Lactobacilli helps to maintain « healthy » low, acidic pH.

* Low pH is protective to vaginal mucosa as it does not let « bad » bacteria develop.


WHAT HAPPENS IN PERIMENOPAUSE?

* estrogen production becomes unstable - causing serious fluctuations throughout the cycle. In menopause it becomes even worse - very low.
* as a result - Glycogen stores in vaginal mucosa cells rapidly drop
* Since glycogen is the source of « food » for Lactobacilli - their growth is decreased
* pH is not anymore low and acidic- it raises , «inviting » bad bacteria to grow
* Vaginal mucosa becomes thin and vulnerable - causing recurrent vaginal and urinary infection

‼️In this situation treatment of infection by antibiotics /antifungals is NOT ENOUGH. If we want to stop infections coming back, vaginal hormonal preparations are the best way to go.

Some of my patients who use Mounjaro or Ozempic for treatment of insulin resistance or weight loss noticed that their ha...
11/08/2026

Some of my patients who use Mounjaro or Ozempic for treatment of insulin resistance or weight loss noticed that their hair is thinning out.

Indeed, according to the recent study in >500000 patients- use of GLP-1 agonist injections is linked to hair loss:

* Risk of telogen effluvium - 76% higher
* Risk of androgenic alopecia - 64% higher

WHAT IS MOST LIKELY REASON BEHIND IT?

Actually, few of them:

- decreased absorption of iron and vit B12 due to delayed movements of gastro intestinal tract
- insulin/IGF-1 signaling
- androgen changes
- direct follicle effect

WHAT TO DO TO AVOID IT?

- take nutrients dense diet rich in essential amino-acids, vitamins and minerals needed for approriate hair growth
- monitor the level of Ferritin and vit B12 every 6 months- maintain Ferritin above 60 ng/mL, vit B12 > 600 pg/mL
- Monitor level of DHT (most potent androgen hormone) that can provoke androgenic alopecia and hair thinning -> work with knowledgeable doctor who can reduce this effect
- Local follicle growth stimulation: topical scalp serums, regular brushing, scalp massaging, PRP injections, exosomes injections - if indicated .

# hairloss

WHAT ARE THE MOST COMMON CAUSES OF HAIR LOSS IN WOMEN? * iron deficiency- often seen in women with heavy periods or vege...
25/06/2026

WHAT ARE THE MOST COMMON CAUSES OF HAIR LOSS IN WOMEN?

* iron deficiency- often seen in women with heavy periods or vegetarians
* Hypothyroidism- low thyroid hormones level, sometimes as a part of autoimmune thyroiditis Hashimoto
* Nutritional deficiencies (iron, group B vitamins, vit D, biotin, selenium)- mainly in those with poor diet or poor gut absorption
* insulin resistance /pre-diabetes
* Conditions with increased “male” hormones (androgens) levels, like PCOS (PMOS)
* Low level of estrogen in Menopause and perimenopause
* Stress
* Fibrosis (scalp scarring) that decreases blood supply to hair follicles.
* Mitochondrial decline in hair follicle- vital energy for normal hair growth process

WHAT ARE THE BLOOD TEST TO RUN IF YOU SEE EXCESSIVE HAIR LOSS:

* ferritin / full anemia panel
* Thyroid function test
* Vit B12, vit D, biotin, selenium
* Hormonal panel including E2, FSH, free and total testosterone, DHEA, DHT, 17-OH -progesterone
* HOMA index (insulin test)
* Total protein
* Gut microbiome test (if malabsorption is suspected)
* Cortisol saliva test (in case of stress exposure)

WHAT TO DO IF ALL BLOOD TESTS CAME BACK NORMAL?

‼️sometimes scalp biopsy is required when the diagnosis is difficult to reach - very useful to confirm androgenetic alopecia( AGA)- in this case the hair loss is primarily caused by hair follicles’ genetic sensitivity to androgens (like DHT) rather than elevated hormone levels in your blood or nutrients deficiency.

WORRIED ABOUT HAIR LOSS ? READ THIS Hair in women is a well recognised symbol of feminity, vitality and beauty. Having b...
24/06/2026

WORRIED ABOUT HAIR LOSS ? READ THIS

Hair in women is a well recognised symbol of feminity, vitality and beauty.

Having beautiful, voluminous, shiny locks is an ultimate sign of good health too.

Thats why women are very concerned when they notice excessive hair loss or thinning.
But what is considered excessive?

WHAT IS NORMAL HAIR LOSS:

* losing between 50 and 100 strands of hair per day is considered normal- its a part of the natural hair growth cycle, each hair is replaced by a new one.
* If you do not brush your hair for 4 days, shedded hair will accumulate- so you will loose ~350 hairs at once when you finally wash or brush - it s normal.
* Short hair loss is less noticeable than a long one - If your hair is long or thick, 350 hair strands can look like a large amount, but it is usually just the accumulated “normal” shed.

WHEN YOU SHOULD BE CONCERNED :

* Sudden, excessive thinning of hair, obvious widening of the part, visible recessions on the temples.
* Appearance of the bald spots or patches.
* Obvious shedding that is visibly more than before, shedding that continues to be high even with regular daily brushing.

There is a “new kid on the block” for treatment of PMOS (formerly known as PCOS) : it is Resveratrol -natural polyphenol...
10/06/2026

There is a “new kid on the block” for treatment of PMOS (formerly known as PCOS) : it is Resveratrol -natural polyphenol found in grapes, red wine and berries.
Available in form of a supplement.

It was found to lower circulating androgens and combat insulin resistance
- the key features of PMOS.

WHY IS IT SO IMPORTANT?

- women suffering from PMOS(PCOS), often have overproduction of androgens - causing nasty symptoms like oily skin, acne, excessive facial hair and scalp hair thinning.
- Not too many natural options exist to mitigate these symptoms. Resveratrol does it.
- PMOS(PCOS) is a chronic condition, so, avoiding longterm “standart”medications, like birth control pills, in favour of more natural supplement without side effects sounds like a great alternative.

HOW ABOUT THE DOSE?

- randomized study on resveratrol and PCOS [PMID: 37333786] found that 1,500 mg /day of resveratrol significantly improves hormonal imbalances and metabolic function.
- ‼️that is much higher than usual dose of Resveratrol used for longevity protocols - 170-300 mg.

IS IT POSSIBLE TO SOURCE OT FROM FOOD?

- No, it is not possible to get the required resveratrol amount from diet:

* Red wine contains only 0.05 -1 mg per glass
* 1-cup (150g) of red grapes contains only 0.24 to 1.25 milligrams (mg) of resveratrol
* Only 0.03-0.1 mg per 100 grams (1/2 cup) of fresh blueberries.

As you may know many HRT preparations for hormone optimisation are made for transdermal ( via skin) application. Transde...
04/06/2026

As you may know many HRT preparations for hormone optimisation are made for transdermal ( via skin) application.

Transdermal forma are usually much safer and help to reduce the risk of abnormal blood clotting.
But what are the best ways to use them?

‼️first of all - make sure to read carefully the label and understand what is your dosage - how many pumps or clicks you need to use to receive the correct dose.

BEST AREAS TO APPLY HORMONAL CREAM:

- Inner surface of the forearms
- Inner surgace of the thighs
- Lower abdomen
- Lateral sides of the abdomen (Flanks)
- Behind the knee
- inner surface if the arms
- Vaginal (see below about testosterone!)
🔹Rotate sites for better absorption.
🔹Women with who worry about medication transfer to the partner or kids:
- apply the cream behind the knees, on inner thigh, and lower abdomen
- avoid direct skin-to-skin contact after the application until 4-6 hrs later.

WHICH AREAS TO AVOID WHILE APPLYING HRT CREAM?

- Face and neck (unless you are using estriol creams for specific indications)
- Breasts
- Skin that is broken or irritated
- Do not apply right before workouts, sauna, or swimming - allow 1-2 hours for proper absorption.

‼️Important for testosterone cream:

🔹applying topical testosterone too close to cl****al tissue can increase the risk of cl****al enlargement - avoid this route unless there is specific instruction.
🔹Just because a hormone is applied vaginally does NOT mean it stays local. Vaginal hormones can still make systemic effect.

You have heard about DEXA scan as an option to asses your bone density so to understand - whether or not you have osteop...
25/05/2026

You have heard about DEXA scan as an option to asses your bone density so to understand - whether or not you have osteoporosis /osteopenia.

IS DEXA SCAN ENOUGH TO STUDY OSTEOPOROSIS?

🦴Actually, no, there is much more to that. To decide about good strategy for your bones health optimization we need to dig more.
There are special blood markers that help us understand what is actually going on in our bones tissue:

* P1NP measures bone-building activity (by the cells called « osteoblasts »).
* CTX measures bone resorption or breakdown (by the cells called « osteoclasts »).

🦴To understand which process is currently dominating in your bones we need to know P1NP / CTX ratio.

🦴The P1NP/CTX ratio can evaluate bone health by comparing bone formation to bone breakdown.

WHAT IS THE IDEAL RATIO?

🦴 P1NP/CTX ratio >150 indicates a healthy dominance of bone building over breakdown. This value is recommended by functional medicine practitioners and bone health specialists as a target.

🦴If you have been diagnosed with with osteoporosis or osteopenia - it is highly recommended recommended to measure your P1NP/CTX ratio to figure out best treatment option.

🦴If you are taking bone-building medications (like Forteo or Tymlos) or anti-resorptive drugs (like Fosamax or Prolia), your markers will change dramatically - it may be required to test them from time to time.

For accurate measurements, these blood tests must be dine in the morning on fasting state - as bone turnover markers are highly sensitive to food and time of day .


📌« Whooping cough » (or, coqueluch, or, pertussis) is potentially serious disease that can affect newborn baby during fi...
04/05/2026

📌« Whooping cough » (or, coqueluch, or, pertussis) is potentially serious disease that can affect newborn baby during first few months of life.

IS WHOOPING COUGH COMMON?

📌the incidence of whooping cough cough in UAE is low (only 9 cases reported in 2019), however the disease can be severe, sometimes causing severe complications or even death.

WHY TO CONSIDER VACCINE DURING THE PREGNANCY ?

📌Newborn babies are at the highest risk since they cannot receive their own vaccine until they are 2 months old.

📌vaccination during pregnancy is highly recommended as the most effective ways to protect a newborn from a potentially fatal disease.

📌 When pregnant woman receives the vaccine, her body produces antibodies - they cross the placenta and transfer to the baby, offering immune protection immediately after the birth.

📌Vaccinating the mother during pregnancy reduces the risk of pertussis in young children by 80–91%.

WHEN TO GET THE VACCINE?

📌ideal time is between 26 -32 weeks of pregnancy (can be given as early as 16 weeks up until delivery).

IS IT NECESSARY TO VACCINATE IN NEXT PREGNANCY?

📌yes, it s better to receive the vaccine during each pregnancy, even if they are close together, to make sure the baby receives maximum antibodies.

IS IT SAFE?

📌 Pertussis vaccine does not contain live bacteria (contrary to other vaccines, like e.g. chickenpox) and has been proven safe for both - mom and baby.

Many of my patients asked me - does IVF increase breast cancer risk? The short answer is “NO”: 📌Few large studies follo...
14/04/2026

Many of my patients asked me - does IVF increase breast cancer risk?

The short answer is “NO”:

📌Few large studies followed many thousands of women that underwent multiple IVF over 20 years -> they showed NO increased risk of breast cancer, even after six or more IVF cycles.

📌interestingly, some research showed that having >7 IVF stimulation cycles is associated with LOWER cancer risk.

HOW ABOUT OVARIAN CACER?

📌for ovarian cancer, a big study in >40,000 women found no increased risk of ovarian cancer related to IVF.

‼️Borderline (precancerous)ovarian tumors: studies slightly higher risk - with NOT aggressive tumor biology, excellent prognosis, tha usually required surgery only for the treatment.

CONCLUSION?

📌Multiple IVF cycles do NOT increase breast or ovarian cancer risk.
📌Standard screening (annual trans vaginal pelvic ultrasound) is sufficient for most women.

WHAT ARE SPMs? When you get injury or infection, your body responds by sending in “first responders” -your white blood c...
30/03/2026

WHAT ARE SPMs?

When you get injury or infection, your body responds by sending in “first responders” -your white blood cells- to fight the damage.

As we know know, inflammation does not fade away on its own- it is an active process. After finishing initial «attack » the body goes into “cleanup mode”.

Specialized Pro-Resolving Mediators (SPMs)- are compounds produced naturally by our body to put an end to inflammation and start tissue repair. 

SPMs are like a “cleanup team”, the “janitors”, that work with immune system to fight off an infection or injury. 

SPMs tell the «first responders» to stop fighting and leave, and instruct the «cleanup cells» (macrophages) to eat up debris and dead cells. 

HOW ANTI-INFLAMMATORY MEDICATIONS ARE DIFFERENT FROM SPMs?

* Anti-inflammatories (e.g., Ibuprofen, Advil): block inflammation, without helping the repair process.
* Pro-Resolving Mediators ( SPM): actively end the « fight», clear the mess, and initiate tissue repair. 

HOW OUR BODY SOURCES SPMs?

SPMs are made from mainly the Omega-3 fatty acids (EPA and DHA) found in fish oil.

THERE ARE 4 TYPES OF SPMs:

1. Resolvins: made from EPA and DHA (Omega-3).
2. Protectins: made from DHA (Omega-3).
3. Maresins: made from DHA (Omega-3).
4. Lipoxins: made from Arachidonic Acid (Omega-6). 

WHY SPMs ARE SO IMPORTANT ?

When our body doesn’t produce enough SPMs, acute inflammation continues, leading to chronic inflammation.

This is usually the case with conditions such as arthritis, heart disease, Alzheimer’s, and diabetes. 

CAN YOU TAKE THEM AS SUPPLEMENTS?

Yes, although, the good diet should ne the main source of SPMs, taking them as supplements can help to treat chronic inflammation.

Address

Dubai

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Monday 09:00 - 17:00
Tuesday 09:00 - 17:00
Wednesday 09:00 - 17:00
Thursday 09:00 - 17:00
Sunday 09:00 - 17:00

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+97144542640

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