Contemporary Women’s Health | Obstetrics, Gynecology, Aesthetic and Massage

Gynecology Q&A

Menstration

My daughter is 16 years old and her periods are very irregular. Is this normal?

In a normal menstrual cycle there is regular hormone production and thickening of the lining of the uterus. This cycle primes the endometrium (uterine lining) for implantation of a developing embryo. If no implantation occurs, the lining sheds, resulting in a menstrual period. There are two phases in the menstrual cycle: the follicular phase and the luteal phase. The follicular phase occurs prior to ovulation and involves thickening of the lining of the uterus. This phase usually lasts 10 to 14 days. The luteal phase is the period of time from ovulation to the onset of menses when the lining of the uterus undergoes stabilization prior to menses. This phase usually lasts 14 days.

During the first 2 years after the onset of menstruation, cycles are often irregular. These early cycles are often anovulatory-there is no ovulation during the menstrual cycle and therefore the luteal phase does not occur properly. Because of this a woman will experience irregular bleeding. As long as the menstrual cycles are no longer than 40 days, no shorter than 21 days, and the duration of bleeding is no longer than 7 days, this is considered normal in a woman who has recently started menstruating.

If irregular bleeding lasts longer than 2 years or the blood flow is excessive, your physician may suggest further evaluation.

Are there risks or benefits to douching?

Despite all the advertising by manufacturers of feminine hygiene products, there are no practical reasons for women to douche on a regular basis.

I have a headache every month just before or just after my period starts. Please help.

Migraine headaches that occur on a cyclic basis with the menstrual cycle are known as menstrual migraines. To classify as a menstrual migraine, the headache must begin anywhere from 1 day before to 4 days after the onset of menses. Approximately 15% of migraine sufferers are classified as having menstrual migraines.

Treatment of menstrual migraines is similar to that for standard migraine headaches. The one advantage for women with menstrual migraines is that they can start their treatment earlier, since they will be able to anticipate when their migraine will occur. Lifestyle changes such as increased exercise and diet low in salt, fat, and sugar has been shown to help alleviate menstrual migraines. Non-steroidal anti-inflammatory agents such as ibuprofen or naproxen are often a good first-line choice of medication. In women with severe migraines, sumatriptan (Imitrex) has been extremely effective. Women often experience relief within one hour of a subcutaneous injection.

I have a lot of bloating that begins about a week before my period starts. What causes this?

Premenstrual Syndrome (PMS) is a disorder experienced by many women. This syndrome has many associated symptoms. One of these symptoms is bloating. This often begins approximately 1 to 2 weeks prior to menses and is characterized by bloating and weight gain. Often women notice a significant reduction in their weight immediately after menses.

Initial treatment for PMS is lifestyle changes such as exercise and changing your diet to decrease salt, caffeine, and chocolate intake. If you have a significant amount of bloating prior to your menses and it is affecting your daily life, your physician may prescribe a diuretic to be taken during the second half of your menstrual cycle. This is known as a "fluid pill" in lay terms and is often used to treat people with high blood pressure. A common diuretic used for premenstrual bloating is spironolactone. To date, studies on diuretics have been conflicting, and it is not clear if they truly help premenstrual bloating. Although no good studies support their use, many women report improvement in symptoms with the use of birth control pills.

What is the thick substance that I get a couple of days into my period?

What you are describing is a normal pattern of menstruation and a normal menstrual period. A normal menstrual period last about 5 to 7 days, the bleeding is heaviest during the first couple of days and then slows for the remaining 3 or 4 days. As your bleeding slows, the blood clots. This could be what you are seeing. Another possibility is that you are seeing a portion of the uterine lining (endometrium) which is the tissue that is shed during menstruation. In short, you should be reassured that your period is normal. Because you are of reproductive age, you should make certain that your diet is rich in folic acid and that you are getting enough calcium and iron. You might consider supplementing your diet with these vitamins and minerals.

At what age should a girl start going to a gynecologist as opposed to her pediatrician?

Females should have their first gynecological exam by the age of 20, or when they become sexually active. At this point they should begin having yearly pap smears and pelvic exams. Many pediatricians are comfortable taking care of their patients' gynecological problems. If this is the case, your pediatrician may continue to see you for your gynecological exams. If you or your pediatrician feel that it would be more comfortable for you to see a gynecologist, you may be given a referral to one. Should your gynecological issues become more difficult, seeing a gynecologist may be to your benefit.

At what age should my periods start?

Periods are also known as menstrual cycles. The onset of menstrual cycles (menarche) occurs during the teenage years. Menstruation continues until a women is in her 50s and reaches menopause. The average age of menarche in the United States is 9 to 17 years of age, with a median age of 13.

Primary amenorrhea is a condition where a woman fails to start her menstrual cycles. If you have other signs of puberty, such as breast development or pubic hair, but fail to start your menses by the age of 16, you should see a physician. If you have no signs of puberty by age 14, you should see a physician.

Can a woman have a baby at age 49 and everything be okay?

Over the last twenty years the number of women waiting until their 40s to conceive has nearly doubled. One of the main determinates of having a healthy pregnancy is being healthy as you enter pregnancy. However, no matter how healthy you are, there are still risks beyond your control. Medical conditions such as high blood pressure and diabetes are more common when a woman reaches her 40s. Also, the number of chromosomal disorders, such as Down syndrome, increases as your age increases. For example, the risk of Down syndrome at age 25 is one in 250. At age 35 is the risk is about one in 300. At age 45 the risk is one in 30, and at age 49 the risk is one in 11. Your total risk for chromosome abnormalities is a bit higher too. At age 35 it is one in 200, while at age 45 the risk increases to one in 21, and to 1 in 8 at age 49. Women in their 30s and 40s have an increased risk of miscarriage. This is most likely due to the increase in chromosomal disorders. In addition, it appears that older women also have an increased risk of requiring a cesarean section. In summary, yes you can have a healthy pregnancy, but your risks at age 49 are SIGNIFICANTLY HIGHER.

Sexuality

I am 40 years old. I don't really want to have my tubes tied. What are some types of birth control that I can use?

Contraceptive options for women over age 40 are similar to those for a younger woman. Types of contraception include:

Barrier contraception

  • Spermicide - spermicide is a jelly or cream that is toxic to sperm. It is placed into the vagina before each episode of intercourse. The effectiveness rate is 74% to 94%.
  • Condoms - condoms are devices, often made of latex, that are placed over the penis to provide a barrier between the penis and the vagina. This form of birth control is the only method that also provides protection from sexually transmitted diseases. The effectiveness rate is 86% to 97%.
  • Diaphragm - A diaphragm is a round rubber shield that is inserted into the vagina and placed against the cervix. This device is used in conjunction with spermicide. It may be inserted up to 2 hours prior to intercourse and must be left in place for at least 6 hours after intercourse. The effectiveness rate is 80% to 94%.

Barrier methods of contraception are useful for women of all ages, and are as effective for women in their 40s as they are for younger women.

Intrauterine Device An intrauterine device (IUD) is an extremely effective form of contraception. IUDs are inserted into the uterus by a physician. These devices release a small amount of copper or progesterone that cause an inflammatory response within the uterine cavity. This inflammatory response provides the contraceptive benefit. The effectiveness rate is 98% to 99.9%. This form of birth control is a good choice for someone in a monogamous relationship, and is often a good choice for older women.

Methods
  • Oral Contraceptive Pills - Oral contraceptive pills are a common form of contraception. Oral Contraceptives are well tolerated in older women unless they are over 35 and smoke, or have high blood pressure. These factors increase the risk of cardiovascular complications. The effectiveness rate of birth control pills is 97% to 99.9%. There has been no evidence in the literature that contradicts oral contraceptives in general in older women, nor is there associated increased risk of breast cancer. Oral contraceptive use is safe all the way to menopause.
  • DepoProvera - DepoProvera is injected progesterone. Injections are administered every 3 months. Effectiveness rate is 99.7%. The greatest complaint from users of DepoProvera is irregular bleeding.
  • Implanon - Implanon is a small, thin, implantable hormonal contraceptive that is effective for up to three years. It was approved in July, 2006 by the U.S. Food and Drug Administration.

All the hormonal forms of birth control have been shown to be safe for a healthy woman in her 40s. Discuss with your physician which of the above options is best for you.

Can a woman have a negative test for chlamydia but already be infected?

Chlamydia is one of the most commonly reported sexually transmitted diseases in the United States. The CDC estimates approximately 4 million new cases per year. Several methods are often used to test for chlamydial infection. The most common method is the use of the DNA probe–a test similar to a Pap smear. This test has a sensitivity of 65% to 70 % meaning that 65% to 70% of people who test positive truly have the disease. It has a specificity of 95% to 99% meaning the 95% to 99% of people who test negative truly do not have the disease.

If you tested negative for chlamydia by DNA probe, it is unlikely that you had chlamydia at the time of test. If later you had a positive test, it would be most likely that you acquired chlamydia during that time frame. It is possible to harbor chlamydia in the tissues for a long period of time, and therefore it is possible that your sexual partner may have had the infection and just recently passed it on to you. To date, there does not appear to be a significant incubation period for chlamydia. It is a sexually transmitted disease.

I am 28 years old and married. Sexual intercourse is painful for me. What could be causing this and what can I do to make the pain go away?

Painful intercourse is also known as dyspareunia.Causes of painful intercourse range from simple problems that are easy to treat, to more complex problems that may require extensive testing and treatment.

One of the most common causes of painful intercourse is lack of adequate lubrication. This situation can be remedied by longer foreplay prior to intercourse, or by using lubricating agents such as K-Y jelly or Astroglide.

Another common cause of painful intercourse is vaginal infection or irritation. Yeast infections, trichomonas vaginitis, and bacterial vaginosis may all have associated pain with intercourse. Also, certain douches, spermicides, and condoms have agents that are irritating and result in inflammation with associated painful intercourse.

Women who experience pain on deep penetration during intercourse may have a pelvic infection, pelvic mass, endometriosis, or bowel problems. If you have pain with deep penetration you should see your physician for further evaluation.

Finally, some women experience dyspareunia due to psychological factors. Factors leading to the pain may include prior unpleasant sexual experiences and/or prior sexual abuse. Relationship difficulties may also lead to pain with intercourse.

What is the role of testosterone as part of hormone replacement therapy?

Testosterone has been used as a component of hormone replacement therapy in certain circumstances. This component is usually used in women who have decreased sexual drive, also known as decreased libido. Decreased sexual drive in women may be due to decreased testosterone levels. The ovaries normally produce small amounts of testosterone even after menopause. Women who have had their ovaries removed surgically may benefit greatly from replacement of testosterone.

Testosterone can be replaced in two forms, as a pill in conjunction with estrogen, or as an injection. It has been shown that testosterone may cause an adverse effect on cholesterol levels. Therefore, testosterone supplementation should be used only on an individual basis.

Does a form of STD always cause chronic cervicitis and will cryosurgery alone

Cervicitis is very common, affecting more than half of all women at some point during their adult lives. It is most often caused by an infection.

I am a healthy 27-year-old woman who has no desire for sex. Is there anything I should try?

Lack of desire is the sexual problem most frequently reported by women. It manifests as a disinterest in or avoidance of sex, and in many cases is reflected as a discrepancy in the couple's desired frequency of sexual contact. Lack of sexual desire is a problem that presents both partners in a relationship with a confusing dilemma. Couples often question the level of commitment and caring for one another when one or both lack sexual interest. A cycle often develops resulting in their undergoing increasing levels of stress in daily interactions that negatively impact problem-solving skills and communication patterns.

Physiological and/or medical problems may contribute to a decrease in sexual functioning. Medical evaluations often focus on assessing hormone levels, thyroid function, use of medications such as anti-hypertensive medications, vaginal infections, or any other illnesses or conditions that may affect sexuality. In addition, the use of alcohol, drugs and the excessive use of chemicals can drastically decrease sexual interest and may be confused with sexual dysfunction. The lack of sexual desire is a frustrating problem for many couples regardless of the cause.

Once all physiological components have been ruled out, you should focus on communication, sexual expectations, stress levels, and the amount of time set aside for emotional and sexual contact.

If you decide to go in for couples' counseling, treatment is usually structured over a several week period. It begins with individualized touching exercises that the couple does at home. They learn to be together physically and emotionally without the pressure and demand to feel or be sexual. Verbal and nonverbal communication is enhanced as attitudes, behaviors, and relationship dynamics are explored and modified. Each person learns that they are in control of their sexuality and can choose if and when to turn on or turn off their feelings.

Women’s Health

My doctor told me I have a condition called lichen sclerosus. What is lichen sclerosus and what is the treatment?

Lichen sclerosus is a benign inflammatory condition of the skin of the vulva. It can occur in women of any age, but is most common in postmenopausal women. Symptoms include itching and burning with associated pain during intercourse. The surface of the vulvar skin is often extremely thin and may have a paper-like appearance. Because of this, the skin may tear during intercourse and cause pain or bleeding.

Standard initial treatment of lichen sclerosus is application of creams containing high-potency steroids to the affected area. The most common steroid cream is known as clobetasol or Temovate. This cream should be applied to the area twice a day for approximately 2 to 3 weeks, then tapered to once a day, and finally down to occasional use. Most women notice an improvement in symptoms within 1 month of use of the steroid cream. This treatment may be continued on a long-term basis.

Other possible treatments of lichen sclerosus include topical testosterone or progesterone. These treatments, however, are not as effective as steroids. Additionally, your physician may recommend surgically excising the scar tissue often associated with lichen sclerosus. Again, this treatment is not as effective as topical steroids.

Home remedies for lichen sclerosus include keeping the skin over the affected area clean and dry, lubricating the skin with K-Y jelly or vegetable oil, or using sitz baths or warm water soaks.

My mother and sister had breast cancer at the age of 40 and 55 respectively. What test should I have to find out if I am at increased risk of getting breast cancer?

Breast cancer is the second leading cause of death in women. About 5% of breast cancers have a genetic component-a possible mutation in the BRCA1 or BRCA2 gene. These genes are normally involved in suppression of tumor cells. Women who have the BRCA1 mutation have an approximately 80% risk of developing breast cancer. They also have an approximately 40% risk of developing ovarian cancer.

If you have a strong family history of breast cancer with multiple first degree relatives with the disease, get tested for mutations in the BRCA1 or BRCA2 genes. A family member with the disease must be tested first. If that person has the mutant gene, tests will be done on you to look for the same mutation. If you are found to have the mutation, you may want to consider mastectomies (removal of your breasts) or oopherectomy (removal of your ovaries) as a preventative measure.

At this point, BRCA1 and BRCA2 testing is not beneficial as a screening tool unless you have a strong family history of the disease. In addition, negative tests do not rule out the possibility of developing breast or ovarian cancer later.

One important issue to consider is the impact genetic testing may have on your future. It is still unclear how insurance companies will react to a positive screening. You must consider the chance that an insurance company will classify a positive test as a preexisting condition, with the possibility of limited medical coverage in the future.

What can be done about the lumps in my breasts?

Fibrocystic changes of the breasts are very common, especially from the ages of 20 to 50, and are thought to be directly related to estrogen. Fibrocystic breast masses usually occur on a cyclic basis in relation to the menstrual cycle. They can be quite painful and often appear rapidly with the onset of menses, and then disappear afterward.

The most important characteristic of a fibrocystic lesion of the breast is that it resolves on its own. If your masses/cysts do not resolve, especially after a menstrual cycle, you need to see your physician so that the mass can be further evaluated to assure that it is not a cancerous lesion. This evaluation may necessitate cyst aspiration or biopsy of the mass.

Often people with fibrocystic changes of the breasts notice associated breast tenderness. This pain may be alleviated by wearing a tight bra for support. Although there is no good evidence to support its use, many physicians advocate use of vitamin E and reduction of caffeine to alleviate some of the symptoms.

If you have cysts under the skin, rather than in your breast tissue, you may need other treatments. You should see your physician to exclude this possibility.

What causes yeast infections, and can they be prevented?

It is thought that 45% to 75% of women experience yeast infections (also known as vulvovaginal candidiasis) in their lifetime. It is thought that 45% to 75% of women experience yeast infections (also known as vulvovaginal candidiasis) in their lifetime. In over 80% of cases, infection is caused by an orgainism known as Candida albicans. This is a fungus that resides in the vagina of a significant number of women. Several situations allow overgrowth of Candida albicans including recent antibiotic use, pregnancy, and diabetes.

The signs and symptoms of a vaginal yeast infection often include itching, a thick white vaginal discharge often described as being similar to cottage-cheese, and redness of the vulvar and vaginal areas.

Treatment of a yeast infection is variable. The most common treatment involves using a topical antifungal cream in the vaginal area (such as Gyne-Lotrimin or Monistat). An applicator full of cream is placed in the vagina at bedtime from 1 to 7 days. The medication can be obtained over-the-counter, but should only be used by someone who has been diagnosed by a physician or has had similar symptoms in the past where a diagnosis was made. An oral treatment is now available by prescription and is given as a single dose. This is known as Diflucan. After a single treatment with this medication, symptoms often resolve in 3 to 4 days.

If you have chronic yeast infections, your physician may start you on a monthly regimen of treatment, usually for a total of 6 months.

What could be a possible problem when blood is found in the urine? My sister is a 53-year-old woman and blood was detected in her urine.

Blood in the urine is called hematuria and should never be ignored. It is important to determine exactly where the blood is coming from. In women, the blood may appear to be in the urine when it is actually coming from the vagina or rectum. Discoloration from drugs or foods can mimic hematuria. A catheterized urine sample is an important diagnostic test to make sure that the discoloration is really blood and that the bleeding is coming from the bladder. Also, there is a condition called microscopic hematuria, in which the urine has microscopic amounts of blood that cannot be seen with the naked eye. In the majority of cases tests will be negative and no treatment is necessary. However, before you can make this diagnosis, other more serious causes must be eliminated.

The most common cause of hematuria is a bladder infection, which is more common during pregnancy. Other possible causes include:

  • Kidney or bladder stones
  • Tumors in the urinary tract (urethra, bladder, ureter, or kidney)
  • Infection in the kidney (pelonephritis)
  • Infection in the urethra (urethritis)
  • Trauma (Fracture of the pelvis, bruised kidney, etc.)
  • Surgical procedures, including catheterization, circumcision, surgery, and renal biopsy
  • Certain drugs can also cause hematuria
    • anticoagulants
    • cyclophosphamide
    • metyrosine
    • oxyphenbutazone
    • phenylbutazone
    • thiabendazole

Depending on the particular situation, tests that may be used to isolate the cause of the blood include:

  • Blood studies such as a CBC
  • Urinalysis
  • Cystoscopy
  • Kidney biopsy
  • IVP
  • Abdominal ultrasound
  • CT scan of the abdomen

Blood in the urine should never be ignored. It is important to see your physician and have the problem isolated and treated.

What could cause blood in your stool or bloody bowel movements?

Blood in the stool or bloody bowel movements is also known as rectal bleeding. Most of the time rectal bleeding is due to non-serious conditions such as hemorrhoids or anal fissures (anal tears). However, certain serious conditions may present as rectal bleeding. These conditions include rectal cancer, colon cancer, polyps, and inflammatory diseases such as Crohn's disease or ulcerative colitis to name a few.

It is of utmost importance to contact a doctor if you notice blood in your stool. If you are over 40, there is an increased risk of colon cancer. If your physician is concerned about the blood in your stool and there are no obvious causes (such as hemorrhoids), he or she may order several tests for further evaluation. These tests include anoscopy, examination of the anal canal and lower rectum for hemorrhoids and tears. If the results are normal, he may order a sigmoidoscopy or colonoscopy. Both of these tests involve placing a light into the rectum with a camera attached so that the inside of your rectum and colon can be viewed. If any suspicious lesions are present, your physician may biopsy them.

Always contact a physician if you experience rectal bleeding.

What is an acceptable amount of daily sodium intake?

As I looked at my 'Healthy Choice' label today, I realized that though low in fat, the sodium amount seemed high. As I begin to reevaluate the foods I am eating because I am pregnant, I am curious—what is an acceptable amount of daily sodium intake?

Sodium intake is variable in most people. The recommended daily allowance of sodium is 60 to 120 mEq. However, the body rapidly clears sodium from the urine and therefore attempts to keep a constant amount in the body. During pregnancy, sodium levels decrease slightly. This is because of the increased rate of urination that is seen with pregnancy. However, it is not necessary to increase salt intake during pregnancy.

Do tampons and maxi pads contain materials that are actually dangerous to a woman's health?

I recently received an e-mail from a friend that was a little alarming. It stated that Tampons and maxi pads contain materials that are actually dangerous to a woman's health. Specifically, Rayon and Dioxin (some even contain asbestos). Is this true? The article also mentioned that there are only 2 or 3 brands of feminine products that are 100% cotton, but these are hard to find and usually only available in major health food stores. Should we be concerned or is this a clever marketing plot on behalf of these alternative products?

Your friend’s e-mail is correct in that virtually all of the feminine hygiene products contain some amount of synthetic materials. However, there is no evidence that the products are not safe. Nor, is there any evidence that any of the products cause cancer or other conditions. With that said, some patients do experience an allergic type reaction or develop skin irritation from the use of one product or the other. But, these are generally individualized to the patient. There is one article that has appeared in the medical literature about Always brand products. These 'super' absorbent products contain a petroleum-based product in the lining. A number of patients have experienced a contact vulvitis associated with the use of this particular brand. On the other hand, there are many patients who experience no symptoms. I am not aware of any reactions to the all-natural cotton products, although I must admit that I’m not sure how popular these brands are given their somewhat limited availability. If you aren't having any problems, I would suggest that you continue to use the product with which you feel most comfortable.

What is Dysplasia?

Dysplasia is considered a precancerous cell type. However, if the dysplasia is classified as low-grade squamous dysplasia, then about 30% of the time, the abnormal cells will disappear without treatment.

How are hormones related to stress in women?

Stress affects our bodies in ways that we do not yet understand. Scientists know that many types of stress activate the body's endocrine (hormone) system, which in turn can cause changes in the immune system, the body’s defense against infection and disease (including cancer). On the positive side for women, there is some evidence that women who breast-feed their infants produce lower levels of stress response hormones, such as adrenalin and cortisol, than do women who bottle-feed.

I have a small cyst on my right ovary. Should I be concerned?

The question you have asked is a very important one, but its answer is dependent on a couple of factors which you haven’t included. First, it is dependent on your age. Since you are continuing to have periods, I am assuming that these are “natural” periods and that you are not menopausal. If this is true, then having a small cyst on the ovary is not uncommon. In fact, you make a cyst each month as your follicle develops and you ovulate. If the cyst is classified as a simple cyst, meaning that it is fluid filled and doesn’t have any solid tissue included in it, no other treatment or follow-up is needed. If you were menopausal, the treatment would also be based on the size and type of the cyst. If the cyst is simple (no solid component) and less than 4.0 to 5.0 cm in size, the likelihood that the cyst is a cancer is extremely unusual. In some cases it might be helpful to obtain a CA-125 blood test. If this test is in normal range, the cyst is simple and small, and there is probably no reason to seek any additional treatment. You also asked whether you should talk with your gynecologist. Absolutely, you should always feel free to talk with your physician about any concern that you have.

I have been trying to get pregnant for about two years. My doctor told me he thought I had endometriosis. How would I know?

Endometriosis is a condition in which tissue that normally lines the inside of the uterus (the endometrium) spreads and implants in areas outside of the uterus. Often the site of the implantation is somewhere in the abdominal cavity. In patients with endometriosis, these implants of endometrium grow on a cyclic basis just as the normal endometrium does. When the normal endometrium sheds during your menstrual cycle causing your period, so do these endometrial implants. They can cause a small amount of bleeding within your abdominal cavity which results in pain.

Symptoms of endometriosis are often described as menstrual cramping and pain that begins before the onset of menstrual bleeding, and continues through the menstrual cycle. The severity of endometriosis often does not correlate with the degree of pain experienced with endometriosis. Often women with a small amount of endometriosis will have significant cyclic pain, and often women with a large amount of endometriosis will have minimal pain. Endometriosis is often seen in women who previously had pain-free menstrual cycles, and have gradually noticed a worsening in their pain.

The definitive diagnosis of endometriosis can only be made through surgery where the endometriotic lesions can be seen and sometimes biopsied to make the diagnosis.

I have had three bladder infections in the last three months. What should I do about it? Can these be prevented?

Bladder infections or urinary tract infections are also known as cystitis. Women often notice an abrupt onset of symptoms, which include burning with urination, urinating more frequently than usual, and abdominal pain. If a urinary tract infection has spread to the kidneys (also known as pyelonephritis) a woman may experience fever and back pain.

Urinary tract infections are caused by spread of bacteria that normally reside in the rectum into the urethra and bladder. Several situations increase your risk of getting a urinary tract infection, among them, recent intercourse, delayed emptying of your bladder after intercourse, and use of a diaphragm.

Many women with one urinary tract infection will have multiple urinary tract infections. Your physician will grow out your urine before and after treatment to be sure treatment is completely irradicating the bacteria. Additionally, it may be helpful to empty your bladder completely after each episode of intercourse. The ultimate treatment for recurrent urinary tract infections will be up to your doctor. She may recommend staying on a medicine that suppresses bacteria consistently, taking medication after intercourse, or taking medication as soon as you notice symptoms.

I have noticed a discharge from my left breast. That breast is a lot larger than the other. I mean A LOT LARGER. The difference is a C cup on one side and the other is a DD cup. I had a baby 21 months ago and noticed this difference in the last few months. Is this normal?

It is not unusual for one breast to be larger than the other. It is unusual for one breast to be this much larger and for the change to occur rather suddenly. You should have a complete breast exam to make certain that a cyst has not developed.

The fact that you have a discharge from this breast is not normal. I am assuming from your description, and because it is common, that your discharge is breast milk. This condition is known as galactorrhea. If this is the case, it is important that you see your physician and have a thyroid stimulating hormone (TSH) test and your prolactin level checked. These tests will help determine the cause of the discharge. Most likely these tests will be normal and the problem will resolve. However, it is important that you be evaluated.

I seem to experience what I call mild anxiety in anticipation of certain events. Is there a drug I can take?

Anxiety has many causes that range from situational anxiety, to performance anxiety, to panic disorder. Many people experience feelings of anxiety before certain events, especially events that involve stress or large amounts of preparation. Often, once the event is over, the anxiety is completely relieved. People with this type of situational anxiety usually do best with exercises in coping with stress. Medications have not been shown to be helpful in these situations and often lead to excessive sedation.

People with performance anxiety may benefit from certain medications such as beta blockers, which are normally used to decrease the heart rate and decrease blood pressure. These medications are particularly helpful for people who feel anxious before presentations and speeches.

People with true anxiety disorders or panic disorders often need both medications and psychiatric consultation. People with panic disorders have intense physical complaints along with associated feelings of dread or fear. Panic episodes can occur with no warning as often as once a week. If you have these symptoms, contact your physician for treatment.

I am 38 years old. How often should I have a mammogram?

A mammogram is an important screening tool used in the prevention of breast cancer. Breast cancer is the second leading cause of death for women. Appropriate screening for this deadly disease is of utmost importance.

Several guidelines for mammographic screening are recommended. For women with no family history of breast cancer and no prior history of breast cancer, initial screening is recommended at 40 years of age. Although the benefit of breast cancer screening in the 40s is still under debate, the American College of Obstetrics and Gynecology recommends starting to screen patients at the age of 40. Between 40 and 49 years of age screening is recommended every 1 to 2 years. The benefit of breast cancer screening in the 50 to 69 age group has been clearly established. Women in this age group should receive yearly mammograms. Over age 70, the benefit of breast cancer screening has not been clearly established. Due to the increasing risk of breast cancer with age, however, most physicians still advocate yearly screening after 70 years of age.

You should have your first screening mammogram by age 40. Discuss the frequency of subsequent mammograms with your physician.

I am 51 years old and perimenopausal. Is there a type of vitamin that will give me more energy?

I would recommend a multivitamin. You may be noticing a decrease in your energy levels from the decreased calorie intake on your new diet. However, if the diet is continued, many women notice a subsequent increase in energy. I would reevaluate your diet to be certain that you are not leaving out any of the major food groups. Provided your diet is balanced, adding a multivitamin to your regimen should be adequat.

What are the effects of antibiotic use on birth control pills?

Some antibiotics and certain other medications have the potential to reduce the effectiveness of birth control pills. Some antibiotics slightly reduce the amount of hormones absorbed by the system.

Among the suspect antibiotics are those in the penicillin family, including penicillin, amoxicillin, and ampicillin; tetracycline, and related drugs such as doxycycline and erythromycin. Some epilepsy drugs, tranquilizers, barbiturates, anti-inflammatories, and laxatives may also reduce the effectiveness of oral contraceptives. The same effect may also occur if you have an intestinal illness that causes diarrhea or vomiting.

I would like to know the difference between taking oral estrogen/progesterone versus the patch.

The difference between oral hormones and transdermal hormones involves the route of absorption. Oral hormones are absorbed in the gastrointestinal tract and metabolized in the liver. Transdermal hormones, however, are directly absorbed into the blood stream. Therefore the difference between the two routes may account for some difference in gastrointestinal symptoms. Additionally, for people with elevated triglyceride levels, transdermal hormones have been found to be beneficial.

To date, hormone replacement therapy has not been linked to weight loss or weight gain. There is also no evidence to suggest hair loss or acne are related to the low levels of hormones supplied by hormone replacement therapy. The progesterone component of hormone replacement therapy has been associated with bloating. However, it is not safe to take estrogen without progesterone unless you have had a hysterectomy. Sometimes changing the type of progesterone used can be of benefit.

It is unlikely that changing from oral to transdermal hormone replacement therapy will improve all of your symptoms.

Childbirth

Is it possible for a woman diagnosed with Polycystic Ovarian Syndrome to become pregnant?

Polycystic Ovarian Syndrome is a condition associated with anovulation and was first described in 1935 by Drs. Stein and Leventhal. Thus, the condition is also known as Stein Leventhal Syndrome. As originally described, the condition was associated with decreased menstrual flow, hirsutism, and obesity. However, we now know that the condition is much more complex than originally described. The cause or the event that precipitates the problem is unknown. Because you are not ovulating on a regular basis, you are less likely to conceive. As a result, many women with Polycystic Ovarian Syndrome require medication in order to precipitate ovulation. In general, if you have no other problems that would contribute to infertility, the majority of women are pregnant within three to five cycles. As they say, 'individual results may vary' since everyone is a bit different. With this said, you should feel encouraged. Most women with Polycystic Ovarian Syndrome can have a very successful and healthy pregnancy.

How long should I wait for an accurate result from a home pregnancy test?

The first day of my last period was on the 28th. I had unprotected sex on the third. I took a pregnancy test on the 11th. The result was negative. How long should I wait for an accurate result?

If your periods are normally every 28 days, then you will ovulate on Day 14. With that in mind, you would ovulate on the 10th. Again, if your periods occur every 28 days, your next period would be on the 25th. The home pregnancy test will detect pregnancy on or about the time for your next period. I would wait and see if your period starts on time. If it does, then obviously you are not pregnant. If it doesn’t, then repeat the pregnancy test.

I am concerned that I will not be able to have children in the future. Should I stop taking the pill after a certain period of time?

This a very common question asked by many women who are currently taking oral contraceptives. Women who use oral contraceptives have no reduction in their fertility once they stop taking the pill. There are a number of myths or misconceptions about the use of oral contraceptives. For example, you do not have to stop the pill or switch pills after a certain period of time. In fact, there is no reason to stop the pill until you are ready to have children. Furthermore, there is some evidence that using oral contraceptives actually helps to preserve a woman’s future fertility. For example, women taking oral contraceptives have a reduced incidence of endometriosis and have a reduced incidence of ovarian cyst formation. Unless you experience side-effects with the pill or you are ready to become pregnant, you should continue your oral contraceptives without fear of them reducing your future fertility.

Abnormal Periods after Childbirth and Surgery

It is not at all unusual for it to take several months for your body to get back to normal after childbirth.

What is the best time in a woman's cycle to get pregnant?

Most women ovulate approximately 14 days prior to the onset of their menstrual cycle. Therefore, if you have regular 28-day periods, you should be ovulating on approximately Day 14. The best chance of pregnancy is 3 to 4 days before ovulation and approximately 2 days after ovulation. Therefore, intercourse during this time frame would have the highest likelihood of being successful. There are ways to test for ovulation such as measuring your basal body temperature or testing your urine for a luteinizing hormone (LH) surge. This may help a woman determine the time of ovulation if her cycle is irregular.


For more information please visit ACOG.org.

A note about this information. The recommendations and information provided by this Web site are for educational purposes only. This Web site does not contain comprehensive coverage of the topics addressed, and is not a substitute for direct consultation with your health care provider. Always consult a health care provider regarding your specific condition. Trademarks referred to are the property of their respective owners.