Women’s Health

Do all cases of DCIS breast cancer need aggressive treatment?

DEAR DOCTOR K: I have been diagnosed with ductal carcinoma in situ. My doctor wants me to have surgery. But recently I read about a study that said not all women with this type of breast cancer even need to be treated. Can you help clear this up?

DEAR READER: Ductal carcinoma in situ (DCIS) is a type of breast cancer. In DCIS, the cancerous cells are contained within the breast's ducts (which carry milk to the nipple) but have not invaded surrounding tissue.

I have pelvic organ prolapse. Are there any exercises I should avoid?

DEAR DOCTOR K: I have pelvic organ prolapse. Are there any exercises I should avoid?

DEAR READER: Pelvic organ prolapse is a condition in which the uterus, bladder, urethra or rectum drop down and press against the walls of the vagina. Normally your pelvic floor -- a sling of muscles and ligaments that stretches from your pubic bone to your tailbone -- holds your pelvic organs in place. Pelvic organ prolapse results from a weakened pelvic floor.

How can I prevent recurrent UTIs?

DEAR DOCTOR K: I'm in my 30s and fairly healthy. However, I keep getting urinary tract infections. My husband and I want to know what I can do to prevent them.

DEAR READER: Many women know well the symptoms of a urinary tract infection (UTI). You might feel a frequent urge to urinate, yet pass little urine when you go. It may hurt when you urinate. Your urine might be cloudy, blood-tinged and strong-smelling. Furthermore, many women have a tendency to get repeated UTIs. UTIs are usually caused by bacteria that live in the gut and are present on the skin around the rectum.

Does the new female libido drug really work?

DEAR DOCTOR K: I am a woman in my 30s. I love my husband, but I am just not interested in sex. Will the new female libido drug help?

DEAR READER: You're referring to flibanserin (Addyi). This is the first medicine to be approved by the FDA for low libido (little interest in sex) in women. It is designed to help women who would like to increase their sexual desire, and it has been shown to slightly improve sexual satisfaction in some women. Flibanserin is only approved for pre-menopausal women. So it would be appropriate for you, but not for post-menopausal women.

How much calcium do I really need?

DEAR DOCTOR K: I'm a 65-year-old woman. My doctor says my bones are strong, and he wants to keep them that way. So, for years I've been taking a daily 1,200 milligram calcium supplement. Now I hear that might be too much. How much calcium do I really need?

DEAR READER: I've gotten this question from so many patients. As I assume is true for you, their bones have normal amounts of calcium. That is, they do not have osteoporosis (or "thin bones"). To prevent osteoporosis, they have been taking the recommended amount of calcium -- 1,000 milligrams (mg) a day for women ages 50 and younger and 1,200 mg for women over 50 -- in an effort to preserve their bones.

Is my birth control what’s causing me nausea and severe headaches?

DEAR DOCTOR K: I started taking combined birth control pills a few months ago. Ever since then, I sometimes feel nauseous and get severe headaches. Should I switch to a different pill?

DEAR READER: Nausea and headaches are common side effects of birth control pills, but they usually can be eliminated by adjusting the pills. Combined birth control pills contain the hormones estrogen and progestogen. When taken correctly, they are 98 percent to 99 percent effective in preventing pregnancy. But these hormones can cause side effects.

What can I do to relieve uncomfortable hot flashes?

DEAR DOCTOR K: What can I do to relieve uncomfortable hot flashes?

DEAR READER: Yesterday I discussed new research showing that menopausal hot flashes can last for much longer than the "several years" the textbooks say they are supposed to last. We are beginning to understand why women in menopause (and sometimes for years after) get hot flashes. There is a center in the brain that is constantly measuring the inner temperature of our bodies. For example, body temperature rises on a hot day, or when we exercise. When the brain center thinks the body needs to cool off, it causes little blood vessels near the skin to open wide.

How long can I expect hot flashes to continue?

DEAR DOCTOR K:I just experienced my first, full-blown menopausal hot flash. It was awful. How long can I expect hot flashes to continue?

DEAR READER: Your question reminds me of a patient I saw when I had recently finished my training. (Believe it or not, I was even younger then than I am now.) She said she had come to see me because of hot flashes. Then she said: "I had heard about hot flashes since I was a girl, and I thought I knew what to expect. But you can't really imagine it until you've experienced it."

Can you discuss how menopause might affect my sex life?

DEAR DOCTOR K:

I have recently entered menopause. Can you discuss how menopause might affect my sex life?

DEAR READER: As a woman approaches and enters menopause, her ovaries gradually make less and less of the hormones estrogen and progesterone. The drop in these hormones -- of estrogen in particular -- can affect how a woman experiences sex. Estrogen stimulates the growth of breast tissue. It maintains blood flow to and lubrication of the vagina. The decline and eventual end to estrogen production provokes a host of symptoms. These include hot flashes, fatigue, vaginal dryness and loss of libido. Many of these changes can have unwanted effects on a woman's sex life.

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.