Women’s Health

What could cause irregular bleeding all month long?

DEAR DOCTOR K: My periods used to be pretty regular. But for the past few months, I've been spotting all month long. Why is this happening?

DEAR READER: There are many possible explanations. Fortunately, few of them can turn into serious problems. Before talking about the causes of abnormal bleeding from the uterus, it's worth reviewing the menstrual cycle. Normally, the cycle is triggered by signals from sex hormones. Hormones made in the brain travel to the ovaries, leading to the production of other hormones by the ovaries: estrogen and progesterone.

What is cervicitis and how do you get it?

DEAR DOCTOR K: My doctor diagnosed me with cervicitis. What is this? And how did I get it?

DEAR READER: Cervicitis is an inflammation and irritation of the cervix, the doughnut-shaped opening to the uterus. (I've put an illustration of the area affected by cervicitis, below.)

Cervicitis is usually caused by a sexually transmitted infection (STI). Most common are chlamydia and gonorrhea. Trichomoniasis and genital herpes can also cause the condition. In some cases, cervicitis may result from trauma, frequent douching or exposure to chemical irritants. Cervicitis often causes no symptoms. When they do occur, symptoms can include pain during intercourse.

What are drug-free ways to relieve menstrual pain and cramping?

DEAR DOCTOR K: Can you recommend drug-free ways to relieve menstrual pain and cramping?

DEAR READER: For most women, menstruation is accompanied, at one time or another, by pain and cramping known as dysmenorrhea. For some women, the pain is so severe that it causes them to miss work and social events. Some doctors don't regard menstrual pain as a "serious" problem. But any symptom that interferes with your personal or work life needs to be attended to and not dismissed. The cause of menstrual pain appears to be overproduction of the chemicals known as prostaglandins.

What is toxic shock syndrome?

DEAR DOCTOR K: I saw a warning about toxic shock syndrome on a box of tampons. What is it, and what does it have to do with tampon use?

DEAR READER: Toxic shock syndrome (TSS) is a rare, life-threatening illness triggered by certain bacteria. The two bacteria most often involved are streptococci ("strep") and staphylococci ("staph"). The cases caused by streptococci tend to be the most severe. In TSS, toxins (poisons) produced by these bacteria cause a severe drop in blood pressure that can lead to organ failure.

Does menopause cause weight gain?

DEAR DOCTOR K: Does menopause cause weight gain?

DEAR READER: In the United States, women typically go through menopause between 47 and 59 years of age. And the average woman gains about one pound per year around the time of menopause. Not surprisingly, we tend to assume that menopause causes weight gain.

What are fibroids and how are they treated?

DEAR DOCTOR K: I saw my doctor because of pain in my pelvis and heavy menstrual bleeding. Tests showed that I have fibroids. What are fibroids and how are they treated?

DEAR READER: A fibroid is a lump or growth in the uterus that is not cancerous. Fibroids can be as small as a pea or as large as a basketball. They are usually round and pinkish in color, and they can grow anywhere inside or on the uterus. The number of fibroids, their size and how fast they grow varies from one woman to another.

What are the benefits of breast-feeding?

DEAR DOCTOR K: I'm pregnant and am getting a lot of pressure from family and friends to breast-feed. I'm not ruling that out, but I'd like to know what the research shows about the benefits of breast-feeding.

DEAR READER: Breast-feeding can be a contentious issue. On the one hand, there's no question that breast-feeding is healthy for babies. But some mothers prefer not to breast-feed, and others simply can't for a variety of reasons. So how much difference does breast-feeding make to a baby's health? A series of articles recently published in the journal Pediatrics gives us an idea.

Does estrogen therapy increase the risk for heart problems?

DEAR DOCTOR K: I'm 68 years old and have been on low-dose estrogen therapy since I had a hysterectomy (and started menopause) at age 50. My doctor won't prescribe it anymore because he says it increases my risk of heart problems. Is that true?

DEAR READER: The effect of hormone therapy on the heart is a controversial area. Hormone therapy usually involves "combination therapy," with both estrogens (the main female hormones) and progestins (other important female hormones). Estrogen helps reduce symptoms of menopause, such as hot flashes. Progestin reduces the risk of cancer of the uterus.

Is there evidence the HPV vaccine has real benefits?

DEAR DOCTOR K: My daughter's pediatrician would like her to have the HPV vaccine. I'm not sure. Is there evidence the HPV vaccine has some real benefit?

DEAR READER: Yes, there is evidence -- overwhelming evidence. And with this vaccine, the benefit is not that it will reduce the risk of a short-lived illness, like the flu. This vaccine will reduce your daughter's risk of getting a common and life-threatening cancer. Human papillomavirus (HPV) is the main cause of cervical cancer and genital warts

What can I do about my heavy periods?

DEAR DOCTOR K: I bleed very heavily during my menstrual periods. Is there anything that can be done about this? Or do I just have to put up with the discomfort and inconvenience every month?

DEAR READER: Excessive menstrual bleeding (the medical term is menorrhagia) is a common problem. In my experience, a few primary-care doctors tell their patients just to "live with it." Not surprisingly, obstetrician/gynecologists are more likely to recognize excessive menstrual bleeding as a problem that needs treatment.