Women’s Health

Can anything be done to control heavy menstrual bleeding?

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.

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What can I do to prevent my daughter from getting another urinary tract infection?

DEAR DOCTOR K: I think my 4-year-old daughter may have a urinary tract infection. How will it be treated? And what can I do to make sure she doesn't get another one?

DEAR READER: A urinary tract infection (UTI) occurs when bacteria infect urine in the kidneys, bladder or urethra, a small tube that connects the bladder to the outside.

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What is a rectocele?

DEAR DOCTOR K: I'm a woman in my 60s. I saw my doctor because of rectal pain and constipation. She told me I have a "rectocele." What does this mean?

DEAR READER: The vagina is separated from the rectum by a wall of tough, fibrous tissue called fascia. Sometimes, an area of this wall gets weak, and part of the rectum bulges into the vagina. This bulge is called a rectocele.

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Why have I suddenly lost my sexual desire?

DEAR DOCTOR K: I'm a woman in my mid-50s. Lately I haven't been able to become sexually aroused. What could be wrong?

DEAR READER: Sex is complicated, but you probably already know that. Sexual desire surely resides in the head, but other parts of the body can affect desire as well. In particular, the genital organs communicate with the brain. Likewise, the brain communicates with the genital organs. Desire in the brain causes changes in the pelvic organs. Perceiving these changes can, in turn, enhance sexual desire.

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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.

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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.

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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.

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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."

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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.

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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.

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