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 infertility–not the drugs used to treat it.
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. Drugmakers 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 yardwork the next, and dance or follow a Pilates tape the next. It all adds up.
