Dr. Tia Meechan

So excited for the 2026 OANP Annual Conference this month in Portland!

I'll be speaking on Saturday morning, discussing Cognitive Function in Women's Health: how hormonal fluctuations across the menstrual cycle, perimenopause, and other transitionary periods may influence brain function, cognition, and quality of life as well as discuss how cognitive health is affected by common women's health pathology. We will explore how ADHD and other neurocognitive disorders may present differently in women, how hormonal transitions may alter symptom severity, and practical considerations for optimizing treatment. Attendees will gain evidence-informed clinical pearls for evaluating cognitive disturbance in women and integrating pharmacologic and nonpharmacologic strategies to support brain health across the lifespan.

Hope to see you there!

Skene's glands (AKA paraurethral glands) are a pair of small glands located bilaterally on either side of the urethral opening (where urine leaves the body). These glands secrete mucus that helps lubricate and protect the opening of the urethra, and they contribute to overall lubrication of the va**na during s*xual arousal.

Normally, you can't see or feel the Skene's glands. They usually only become noticeable when the duct that drains one of them gets blocked, causing fluid to build up and form a cyst. Many Skene's gland cysts are small, cause no symptoms, and don't need treatment, but a larger cyst or an infected one can cause symptoms such as a tender lump near the urethra, pain, burning with urination, a change in your urine stream, repeated urinary tract infections, or pain during s*x. Any new lumps or bumps should always be evaluated by a healthcare provider to be safe!

Stress is real and its effects on the body can be significant. High/chronic stress can influence menstrual cycles, digestion, sleep, appetite, energy, mental health, coping capacity, and the ability to consistently meet nutritional needs.

Identifying stress and supporting stress management is a discussion in most of my patient visits, and it can be a very meaningful part of care. But "stress" isn't a diagnosis, and should never be used in place of proper workup and management. When "its just stress" is used as a stopping point, it implies that symptoms would disappear if a patient simply figured out a way to manage their stress. It puts blame on the patient for what they are experiencing without considering the whole picture. It can also delay appropriate testing, follow-up, referrals, or consideration of other contributors.

Good medical care can hold both truths: stress is relevant and stress management tools are an important part of care AND symptoms still deserve curiosity and appropriate evaluation and management.

"The cervix doesn't have nerve endings." Can we put this outdated, harmful myth to rest once and for all?!?

This statement is not true. The human cervix has a rich supply of nerves, including sensory fibers. Cervical sensory fibers carry the very same pain-sensing molecule found in the nerves of other pain-sensitive areas of the body including the skin and, go figure, the p***s and g***s. So when someone says the cervix can't really feel a biopsy, a tenaculum, or an IUD being pushed through it; it is not based in science. It is based in bias.

Where did this myth come from? A large portion of this answer is s*x and race-based bias. Also, the outer surface of the cervix is a bit less sensitive to things like light touch or temperature but "less sensitive on the surface" is NOT the same as "no nerves." Not to mention, once you go a little deeper (where many procedures occur), the nerve supply gets very dense which is exactly why stretching, grasping, or sampling the cervix can be very painful.

This isn't just some harmless old myth; this outdated bias still shows up in medical offices. Patients are told they "won't feel much" during IUD insertions, colposcopies, and other cervical procedures, and are sometimes offered little to no pain relief.

In 2025, the American College of Obstetricians and Gynecologists (ACOG) released formal guidance saying pain-management options should be discussed with and offered to EVERY patient having an in-office uterine or cervical procedure. When choosing a provider for a procedure, it is absolutely okay to ask what pain management options they offer.

Symptoms before me**es have been collectively referred to as "PMS" (or premenstrual syndrome) for years. Let's talk about what else could be going on if you experience luteal phase symptoms.

PMS and PMDD (premenstrual dysphoric disorder) are both cyclical, hormone-sensitive disorders characterized by emotional, cognitive, and physical symptoms during the luteal phase. PMDD symptoms especially improve shortly after me**es begins (a lot of patients report onset of bleeding to be a wave of relief) and are minimal or absent during the postmenstrual follicular phase. Along with this, an important point that differentiates PMS and PMDD is that with PMDD there is a significant distress or impairment from symptoms on work, school, social functioning, and/or relationships.

Another consideration is Premenstrual Exacerbation (PME), which is a premenstrual worsening of a condition that remains present across the menstrual cycle. ADHD, major depressive disorder, generalized anxiety disorder, panic disorder, OCD, chronic pain conditions, and more.

Differentiating between these conditions is important for proper management. If you experience disruptive luteal symptoms, make an appointment with your doctor to discuss options.

October is Breast Cancer Awareness Month. Let's talk about how to get to know your normal with breast awareness (which just means knowing how your breasts usually look and feel, so you can notice with something changes). Here are some breast changes that warrant a visit to your doctor to check-in:

- A new lump, thickening, or swelling in the breast, underarm, or near the collarbone
- A change in breast size, shape, or appearance
- Skin dimpling, puckering, redness, scaling, or irritation
- Skin that looks pitted like an orange peel
- A ni**le that newly turns inward or changes
- New ni**le discharge that isn't breast milk
- Crusting, scaling, or eczema-like changes on the ni**le
- A sore on the breast that won't heal
- Persistent breast or ni**le pain
- Anything that simply feels different for YOU

The majority of breast changes turn out to be benign (not cancer). But it is always best to be safe and get them checked. Know your normal. Check in early. 🩷

Hormone-balancing is a big topic in women's health lately, and a controversial one. While there are conditions that have abnormalities in hormones (elevations, low values, improper ratios), there are also cases where your hormone values themselves are normal but other factors are preventing your body from doing its job effectively.

Trying to optimize hormonal/reproductive health via supplements targeted at estrogen/progesterone while:
- sleeping 5 hours per night
- living on iced coffee and 1 meal daily
- never taking rest, always in "productive" mode

is not sustainable or effective. The stress on your body directly impacts your menstrual cycle and several other areas of your health. It might be why you're feeling burnt out and overwhelmed despite putting so much effort into your health. Layering on adaptogens to manage the stress might work in the short-term, but for sustainable support, foundations are crucial for 1. determining what symptoms are the result of stress on the body vs underlying pathology (i.e. if further treatment is needed) and 2. helping your treatment to be effective. If you're undergoing a plan to optimize reproductive/"hormone" health and it doesn't include prioritizing sleep, regular balanced meals, and rest, it is likely not going to be sustainable long-term.

Sleep, rest, and controlled stress are foundational to health in so many ways. I have so many patients who are doing all the things: eating healthy, exercising, taking medications & supplements... and they are still struggling. Often, when we dig deeper, they are deprioritizing rest. They're working hard, taking care of others, and feel like they need to be constantly productive. I'll tell you what I tell them: Rest is productive. And you don't have to do anything, or meet any goal, to deserve rest.

A well-rested, regulated body and nervous system is foundational. Without that, all of the other changes and supports can only go so far. We don't feel guilty for choosing a healthy breakfast, or going to the gym, so why do we feel guilty for allowing our body & mind to rest when they need? Or think we have to earn that?

Cervical cancer is a highly preventable and highly treatable cancer with appropriate screening protocols. Cervical cancer screening includes cell cytology (aka your pap smear) and HPV testing. HPV is a virus that can lead to cervical cancer. Screening guidelines vary by age:
- Under 21: no screening is recommended
- Ages 21–29: pap (cytology) every 3 years
- Ages 30–65: co-testing with pap cytology & HPV testing every 5 years

Why the change at 30? Cervical cancer risk starts climbing, and an HPV infection that hasn't cleared becomes more meaningful. Before 30, HPV is so common (and often clears on its own) that testing for it can lead to unnecessary intervention and procedures.

Guidelines for those older than 65 depend on history of screening, history of cancer, and other risk factors and is a decision made between you and your provider.

Check in with your provider about when you're due for your next cervical cancer screening and if you've had a history of painful or traumatic paps, talk with a provider about steps to make the experience more comfortable for you.

Bartholin glands (AKA greater vestibular glands) are a pair of 2 pea-sized glands located bilaterally on either side of the va**nal opening. These glands secrete mucus to provide lubrication to the va**nal opening, particularly during s*xual arousal, along with other glands.

Typically, you can't see or feel the Bartholin glands unless one becomes swollen. This usually happens when the duct becomes blocked and fluid builds up (forming a cyst), which can sometimes then become infected.

Bartholin cysts are relatively common and many cysts are small, painless, and go away on their own. See your doctor if the lump becomes painful, red or swollen, if you develop a fever, or if it keeps coming back. An infected cyst (abscess) usually needs to be drained and won't clear up on its own. In some cases, antibiotics are necessary.

Any new lumps or bumps should always be evaluated by a healthcare provider to be safe!