Women’s Health

I have dense breasts. Does that increase my risk of breast cancer?

DEAR DOCTOR K: My doctor says I have dense breasts, and a friend says that means I have an increased risk of breast cancer. I'm hoping you'll tell me that's not so.

DEAR READER: I wish I could fully reassure you, but I can't. A woman who has dense breasts does have a slightly increased risk of breast cancer, although not clearly an increased risk of fatal breast cancer.

What is pelvic organ prolapse and what can be done to treat it?

DEAR DOCTOR K: My doctor checked me out because I was leaking urine. She said I have pelvic organ prolapse. Can you tell me what it is, and what can be done about it?

DEAR READER: Pelvic organ prolapse is a condition in which tissue from the uterus, bladder, urethra or rectum drops down into the vagina. As many as 1 in 3 middle-aged women have some degree of pelvic organ prolapse.

Am I in perimenopause?

DEAR DOCTOR K: I am in my early 40s. Over the past several months, my periods have become less regular. Sometimes my flow is lighter than normal; other times it's heavier. Is this perimenopause?

DEAR READER: It could be, though you're a bit young. As a woman approaches menopause, periods often become irregular. A woman is said to be in menopause after she has gone for one full year without periods. The transition into menopause is called perimenopause. This phase begins when a woman notices changes in her cycle, usually in her mid-40s. It ends with menopause. Perimenopause usually lasts three to five years -- but it can take as few as two years or as many as eight years for some women.

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.