Women’s Health

Does hormone replacement therapy increase heart disease risk or not?

DEAR DOCTOR K: I'm in my third year of menopause, and my doctor won't prescribe hormone therapy. He says it increases the risk of heart disease. I think I recall that you told another reader that this is not true. Is my doctor right, or are you?

DEAR READER: You won't be surprised to learn that I think I'm right. But in the previous column you refer to, I didn't say exactly what you remember. I said that the effect of hormone therapy (HT) on heart disease depends on a woman's age and how recently she entered menopause. In younger women, in their first six to 10 years after menopause, HT protects against heart disease. In contrast, in older women, HT increases the risk of heart disease. It's called the "age effect."

Why do women tend to live longer than men?

DEAR DOCTOR K: I've heard that women tend to live longer than men. Why is that?

DEAR READER: On average, women do live about five years longer than men. In the United States, 57 percent of all who are ages 65 and older are female. By age 85, 67 percent are women. You can see this for yourself in most nursing homes or assisted living facilities in the United States: Women usually outnumber men, and the magnitude of the difference is often striking.

What are the treatment options for uterine fibroids?

DEAR DOCTOR K: I have fibroids that cause heavy menstrual bleeding and painful cramping. What are my treatment options?

DEAR READER: As I'll explain shortly, the first question you need to ask yourself is whether you want to have children in the future. That's because some of the most effective treatments for fibroids make becoming pregnant more difficult, or impossible.

Have there been any recent advances in the treatment of polycystic ovary syndrome?

DEAR DOCTOR K: I have polycystic ovary syndrome and treatments are helping only a little. My doctor says there has been recent progress in understanding what causes it, and that I should not give up hope. What is your opinion?

DEAR READER: For readers who don't know about polycystic ovary syndrome (PCOS), I should explain a few things first. PCOS is pretty common: About 10 to 20 percent of women have it to some degree. The key features of this illness are multiple cysts in the ovaries, failure of the ovaries to release eggs (and resulting difficulty getting pregnant), irregular menstrual periods and high levels of androgens.

What can I do about vaginal pain during intercourse?

DEAR DOCTOR K: I'm in my late 50s. Lately, I have vaginal pain every time my husband and I have intercourse. I mentioned this to some friends, and it turns out a few of them also experienced vaginal pain, starting around menopause. What is causing this problem? And what can I do?

DEAR READER: If you're in your late 50s, you probably have gone through menopause. At menopause, levels of the hormone estrogen plummet. This causes the vaginal lining to become thin and produce fewer lubricating secretions, resulting in dryness and irritation. The vagina becomes shorter and less elastic, and the vaginal opening narrows. All of these changes can make intercourse uncomfortable, painful or impossible.

Do I need to get a Pap test every year?

DEAR DOCTOR K: I've had a Pap test every year for 20 years, since I was about 25. It's always normal. Do I still need one every year?

DEAR READER: The answer used to be yes. The reason was that doing the test often would help catch cancer of the cervix at its earliest and most curable stage. However, studies showed that less frequent Pap tests for younger women caught just as many early cancers. The studies also showed that many older women with repeatedly normal Pap smears (like you) had an extremely low risk of ever getting cancer of the cervix.

What could be causing my painful urination?

DEAR DOCTOR K: I'm a woman in my 50s, and every so often it is painful for several days when I urinate. The doctor tests me, says I don't have a urinary tract infection, and that there's nothing to do. It's true that it goes away, but I'd like some relief when it hurts. Is there anything I can do?

DEAR READER: Urinary tract infections are a common cause of painful urination, but there are other causes as well. And those other causes can be treated. Here's what you need to know before you talk again to your doctor.

Are there any natural remedies for hot flashes?

DEAR DOCTOR K: I'm afraid to take hormone therapy for my menopausal hot flashes. Are there any natural remedies that work?

DEAR READER: Natural remedies can help for hot flashes, but hormone therapy is helpful more often. For that reason, I'll come back to the pluses and minuses of hormone therapy after answering your question.

Why can’t women drink as much as men?

DEAR DOCTOR K: Can you explain why "moderate" drinking is defined differently for men and women? Is it because men tend to be heavier? Or is there more to it?

DEAR READER: Women are advised to drink less alcohol than men because they are much more vulnerable to alcohol's harmful effects.