Health

Richmond, Va.: I’m having a hysterectomy because of fibroids, and I want to leave my ovaries in. What are the pros and cons?

Celeste Robb-Nicholson, M.D.: If your ovaries are normal, there is no need to remove them during a hysterectomy for uterine fibroids–or any other time, for that matter. If you’re premenopausal, there are good reasons to keep your ovaries. They will continue to make estrogen until they naturally stop at menopause. If you have your ovaries removed before that, you’ll quickly begin to feel the symptoms of menopause. Postmenopausal women who undergo hysterectomy for fibroids often elect to have their ovaries removed because they’re no longer making estrogen anyway. One other factor some experts take into consideration: the ovaries do make some testosterone. No one is sure how important that is for the health of the pre- or postmenopausal woman. Fair Oaks, Va.: Is there a limit to the length of time one should continue to take fertility drugs, Clomid in particular? I’m on my third cycle, so far without success.

For women who ovulate irregularly, infrequently or not at all, fertility drugs such as Clomid (clomiphene) can certainly help them achieve pregnancy. Clomid works by stimulating the pituitary gland (a small gland in the brain) to produce the hormones that cause an egg to ripen and be released by the ovary. Experts agree that for most couples, three to six cycles is a reasonable trial for Clomid. After that it may be time to explore other options. There has been concern that long-term use of ovulation-inducing drugs might increase a woman’s risk for ovarian cancer. Studies on this issue suggest that there may be a connection between infertility and ovarian cancer. But experts think it’s more likely that what’s behind the increased ovarian-cancer risk is the underlying cause of infertility–not the drugs used to treat infertility.

Kalamazoo, Mich.: I’m 52, and my periods have all but stopped. I’m interested in hormone replacement with estrogen and progesterone creams. What are your thoughts about these natural hormone creams?

Many women have become more interested in hormone creams since researchers determined that the risks of the hormone-replacement therapy Prempro–namely, breast cancer and cardiovascular disease–outweigh its benefits. But I have some concerns about these compounded-hormone creams. Taking estrogen and progesterone in any form after menopause is not “natural,” because at that stage of reproductive life, a woman’s ovaries don’t normally pump out these hormones. And any compounded-hormone product is a drug, just like one made by a pharmaceutical company. It may be that all forms of estrogen and progesterone carry the same risks as Prempro, which is the only one that’s been tested. The FDA has ruled that they must all carry warning labels. Furthermore, with individually compounded drugs, we don’t know precisely how much of each hormone is absorbed into the body. Quality control is also a concern. Drug makers are required to show that each pill, patch or cream is of uniform quality. Compounding pharmacies are not required to demonstrate such uniformity or consistency. The decision to use a compounded cream, like so many of our health choices, is a matter of weighing risks and benefits. When a treatment has not been tested in large groups of women, you’ll need to decide how much undocumented risk you’re willing to take for the benefit you hope to get. If you use such a cream, be sure to tell your clinician, so that she or he can determine how best to monitor you.

Woodinville, Wash.: As a woman in her mid-50s, I’ve been through every fitness craze since the early ’70s. Now I want to stay fit without running my joints into the ground. What do you recommend?

Fortunately, things have changed since the “no pain, no gain” days. Researchers have found that 30 minutes of moderately intense aerobic activity on most days of the week can achieve functional fitness and reduce the risk of disease. If you want to spare your joints, swimming, yoga, Pilates, tai chi and weight training are also good ways to get moderate exercise. For optimal benefits, especially weight control, you need to exercise longer–60 minutes on most days each week. That sounds daunting to many busy women. However, you don’t need to fit all your exercise into one session or limit yourself to one activity. For example, take a brisk 15-minute walk during your coffee break and another after dinner. Bicycle for 20 to 30 minutes one day, rake leaves or do yard work the next, and dance or follow a Pilates tape the next. It all adds up.

Columbus, Oh.: I’m only 52 years old and have been diagnosed with degenerative arthritis in my lower back. What exactly does this mean? I take ibuprofen daily, which helps some. What else can I do for my condition?

It sounds as though you have osteoarthritis (also called degenerative arthritis) of the joints of the vertebrae that form the spine. This condition is very common. In fact, almost 90 percent of women over the age of 50 have evidence of it on their x-rays. Not everyone with degenerative arthritis of the low back has symptoms, but the condition can cause intermittent and chronic back pain and stiffness as well as pain that travels down the legs. Osteoarthritis advances at different rates and it can range in severity, so it’s hard to say what this means for you. But there are definitely things you can do to reduce your discomfort and disability.

You can take a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen or naproxen sodium to reduce pain and inflammation. Be sure to take it with a meal, however, because it can irritate your stomach and even result in ulcers, especially if you’re taking it daily. Heating pads or hot packs can relax your back muscles and reduce stiffness. It’s important to get regular exercise to maintain flexibility and muscle strength. You might consult a physical therapist or personal trainer to teach you stretching exercises to keep your back limber, and exercises to strengthen your stomach and low back muscles. Any way you can shore up those muscles will reduce the load on the joints of your spine. Try to time your exercise sessions for when you have the least pain and stiffness–for example, after a hot shower, or when your medicine is at its peak effect. It’s important to keep up your general fitness as well. Aim for four 30-minute sessions of low-impact aerobic exercise each week. Walking and swimming are particularly good.

Maintaining a healthy weight goes a long way toward minimizing wear and tear on the joints. If you’re overweight, weight loss is likely to reduce your symptoms. Some studies have shown that supplements containing glucosamine and chondroitin offer modest benefits, although other studies have not. Most doctors agree that more research is needed, but glucosamine and chondroitin don’t appear harmful or to interact negatively with other medications. However, do talk to your doctor if you decide to try these (or any other) alternative therapies.

Learn to pay attention to your body’s signals. There will be times to rest your back, especially during an episode of acute pain. In many respects, women who live with osteoarthritis most successfully become their own doctors, developing the mix of rest, exercise and medication that works best for them.

Hatteras, N.C.: Every time my husband and I have sex, I get a urinary tract infection, despite washing before and after sex. Is this normal? What can I do about it?

A urinary tract infection (UTI) occurs when bacteria enter the body by way of the urethra, the tube that carries urine from the bladder to the outside of the body when you urinate. UTIs are much more common in women than in men because the opening of a woman’s urethra is closer to the bacteria-rich area around the anus. It’s also shorter, which allows bacteria quicker access to the bladder.

UTIs are a common consequence of sexual activity. Intercourse can move bacteria from the genital area to the urethra. Rubbing during intercourse can inflame the urethra and predispose it to infection. Using a diaphragm increases the risk for a UTI because it can prevent the bladder from emptying completely. This allows bacteria to remain in the bladder and multiply. The creams and gels used with the diaphragm may also irritate the urethra. The physical act of inserting and removing the diaphragm is another source of irritation and possible infection.

There are several things you can do to prevent UTIs. Drinking ten ounces of cranberry juice per day has been shown to reduce the risk of getting a bladder infection. In addition to washing after sex, be sure to urinate. Urine flushes away bacteria that creep up the urethra during intercourse. Drink plenty of water. Avoid using products that contain the spermicide nonoxynol-9, as well as feminine sprays and douches, which can irritate the urethra and leave it vulnerable to infection. If you’re postmenopausal, ask your doctor about using a vaginal estrogen.

Roughly 33 percent of women who’ve had one UTI will have another. Talk to your clinician about preventive antibiotic treatment. You may be able to reduce your risk of recurrent UTIs with a low daily dose of antibiotics for six months or so, or a single dose after sexual intercourse.

Texas: I’m 55 years old and past menopause. But in the past few months, my face has broken out. I feel like I’m going through puberty again! My doctor says I have rosacea and has given me an antibiotic to clear it up. How did I get this? Is there anything else I can do for it?

There are few skin problems as frustrating as rosacea (rose-AY-shah), a chronic condition that affects some 14 million people in the United States. Rosacea usually appears after age 30 and is more common in women than in men. Because it develops gradually, people often mistake its early symptoms–occasional flushing and redness on the central portion of the face-for a temporary condition, such as mild sunburn or a reaction to cosmetics. With repeated cycles of flushing, however, tiny spidery blood vessels called telangiectases may become visible all over the face. Some women break out in red bumps or pimples and think they’re having a delayed case of acne, much as you did. In advanced cases of rosacea, acne-like cysts develop on the face, scalp, neck and upper chest. More than half of rosacea sufferers get a related eye condition (ocular rosacea) that reddens and irritates the eye and may inflame the eyelids.

We don’t know what causes rosacea. It may be a combination of highly reactive blood vessels and low-grade inflammation or infection. Heredity may also figure in. A microscopic mite, Dermodex folliculorum, is associated with rosacea, but we don’t know if its presence on the skin of people who have rosacea is a cause or a product of the condition.

There’s no cure for rosacea, but it often responds well to early treatment. Physicians usually recommend a daily application of an antibiotic cream or gel such as metronidazole. They may also prescribe an oral antibiotic, such as tetracycline or erythromycin. For rosacea affecting the eyes, cleansing and tearing agents should be used along with oral antibiotics. It’s possible to eliminate spider veins or improve their appearance with laser.

Since rosacea is a chronic condition, you may need to take a low dose of an antibiotic long-term. In addition, avoid things that can trigger facial flushing, such as sun exposure, temperature extremes, alcohol, hot drinks, spicy foods, hot baths, stress, and intense exercise. Always wear a sunscreen with SPF 15 or higher when you go outdoors. Exercise in a cool setting rather than in the heat. Drink your tea or coffee at room temperature. On hot, humid days, try to stay in an air-conditioned environment. In the winter, be careful about exposing your face to the cold and wind. Finally, avoid skin products containing alcohol, perfumes, or other irritants.

Orangeburg, N.Y.: Why don’t we hear much about bladder cancer in women? Is it just too uncommon?

Bladder cancer is three times more common in men than in women, and it lags behind lung, colorectal, breast, and some other cancers in terms of the number of women it affects. That’s why it’s not discussed as much. Nevertheless, it’s important to be aware of it, because it’s typically diagnosed later in women–on average nine months after symptoms first appear, compared to three to six months for men–and often at a more advanced stage. Also, women’s survival rates lag behind men’s.

The chief symptom of bladder cancer is blood in the urine (hematuria) that’s visible to the naked eye. Less often, it’s visible only under a microscope and found during a routine urine test. Hematuria caused by bladder cancer may show up once and not again right away–and usually is present throughout urination. Most visible blood in the urine is caused by benign conditions such as urinary tract infection, kidney stones, and interstitial cystitis. These conditions also cause urinary urgency, frequency, and a feeling of incomplete bladder emptying–symptoms that show up in only about one-third of bladder cancers. So cancer is not–and should not be–the first thing we think of when a woman sees blood in her urine or has other urinary symptoms.

A few things help distinguish bladder cancer from common urinary tract problems. Bladder cancer seldom causes pain at first, and it rarely causes fever. Also, certain factors increase a woman’s risk. About half of all bladder cancers occur in people who have smoked cigarettes at some time in their lives. The carcinogens in cigarette smoke concentrate in urine, which comes into contact with the bladder lining. Chronic bladder irritation from frequent infections, stones, and other sources can increase the risk of bladder cancer. Also, women who have undergone pelvic radiation for cervical or ovarian cancer are at higher risk.

Most bladder cancer can be effectively treated if detected early. Unfortunately there is no good screening test. Checking routinely for blood in the urine isn’t appropriate, because most urinary blood is unrelated to bladder cancer. Testing the urine for cancer cells catches some cancers, but also misses a fair number. The best thing a woman can do is to be aware of the possibility of a bladder cancer. If she sees blood in her urine that cannot be explained by an infection, kidney stone, or interstitial cystitis, she should raise the question of bladder cancer with her clinician and be checked out.

Town not identified: I’ve had hemorrhoids since I gave birth last year. They’re neither painful nor itchy, but they make me self-conscious. What can I do about them?

A hemorrhoid is a distended vein in the lower rectum, either inside the anal canal (internal hemorrhoids) or just under the skin outside the anus (external hemorrhoids). The most common symptoms are pain, itching, bleeding, and the protrusion of an internal hemorrhoid through the anus. Hemorrhoids are very common. They’re related to factors such as chronic constipation and straining to pass stools, recurrent diarrhea, prolonged sitting, pregnancy and childbirth, advancing age, and rarely, pelvic tumors.

Although hemorrhoids are unpleasant, most don’t require surgery. Warm baths, witch hazel compresses, and over-the-counter creams containing a local anesthetic can soothe hemorrhoid pain. Creams and suppositories containing hydrocortisone reduce inflammation and swelling, but should be used for a limited time because they can cause the skin to atrophy. The most effective way to relieve hemorrhoids is to increase the amount of fiber you eat, either by adding high fiber foods to your diet or by taking a fiber supplement. Fiber, when taken with adequate fluid, helps stools pass more easily, which reduces pressure on hemorrhoidal veins.

If conservative measures don’t work, small to medium internal hemorrhoids can be treated in the doctor’s office, using a number of techniques. One is a procedure called rubber band ligation. A small elastic ring is placed around the neck of the hemorrhoid, cutting off its blood supply. In about a week, the hemorrhoid shrinks and the rubber band drops off. It may take two to three treatments to completely eliminate the hemorrhoid. Other in-office approaches include laser, infrared light, electrocautery, and sclerotherapy (injecting a chemical solution into the hemorrhoid). Of these minimally invasive procedures, rubber band ligation appears to be the most effective.

Large hemorrhoids and those that have not responded to conservative measures are best treated with hemorrhoidectomy–day surgery performed under general anesthesia to remove affected tissue. Hemorrhoidectomy has a cure rate of 95 percent and very few complications. A newer operation, called stapled hemorrhoidopexy, removes tissue above the hemorrhoids to pull them back up inside the rectum and reduce symptoms. Serious complications are rare after hemorrhoid surgery, although there’s always the risk of infection, bleeding, and drug or anesthesia reactions.

It doesn’t sound like you’re quite ready for a surgical approach. I’d recommend you work on the conservative methods. Also, keep in mind that hemorrhoids can return (especially with another pregnancy).

Midlothian, Va.: I have a vitamin B12 deficiency. What is this and what causes it? I feel tired and my joints ache.

Vitamin B12 is an essential vitamin that helps to maintain healthy red blood cells and nerve cells. It is also needed to make DNA, the genetic material in all cells. Animal products (meat and dairy products) are the only natural dietary sources of vitamin B12, although fortified breakfast cereals are also a good source. During digestion, stomach acid releases B12 from food and the vitamin combines with a substance called intrinsic factor before it is absorbed into the bloodstream.

The Recommended Dietary Allowance (RDA) for vitamin B12 for adults is 2.4 mcg per day (pregnant and breast-feeding women need 2.6-2.8 mcg per day). Most of us get enough B12, but deficiency can occur if a person can’t absorb B12, either because she or he is lacking intrinsic factor, or due to a stomach or intestinal disorder. B12 deficiency most often causes a type of anemia. It also causes symptoms such as fatigue, nausea, constipation, loss of appetite and weight loss. Other symptoms include numbness and tingling in the feet and hands, balance problems, depression, poor memory, and a sore mouth and tongue.

Vegetarians who don’t eat animal products or B12 fortified foods are at high risk of developing B12 deficiency. In vegetarian adults, deficiency symptoms may be slow to appear because it can take years to deplete the normal body stores of B12. But deficiency symptoms, especially poor neurological development, can show up quickly in children and breast-fed infants of women who follow a strict vegetarian diet. People who chronically take proton pump inhibitors for gastritis or ulcers can also develop mild B12 deficiency.

Vitamin B12 deficiency is typically detected during a routine test for anemia and is treated with a supplement. Those who cannot absorb oral B12 need regular intramuscular injections of the vitamin. Elderly adults and strict vegetarians–especially pregnant women–should eat B12 fortified foods, such as breakfast cereals, or take a supplement containing B12.

One note of caution: Low folic acid levels can cause an anemia similar to that of B12 deficiency. Sometimes the two go hand in hand. Taking folic acid (also a B vitamin) can correct the anemia. However, folic acid will not correct the underlying B12 deficiency, which, if not detected, can place people at risk for nerve damage.

title: “Health” ShowToc: true date: “2023-01-18” author: “Georgene Burton”