Women’s health issues

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Just How Important Is Calcium?

Monday, February 24th, 2014

Through every stage of life, calcium is an important component of a woman’s diet. Calcium is involved in many aspects of overall health. It is believed to be important for bone health, prevention of cardiovascular disease, blood pressure regulation, weight management, and prevention of some types of cancer.

How Much Calcium Do You Need?

The recommended daily allowance of calcium for women between 19 and 50 years of age is 1,000 mg. That recommendation does not change when you are pregnant, but meeting it does become even more important, because you are providing nutrition for your baby as well, and his or her bones and teeth need calcium for proper development. In addition, when you don’t get enough calcium for a long period of time, you are at risk for developing osteopenia, which can lead to osteoporosis.  What’s the difference? Osteoporosis is a disease that breaks down the tissue in our bones, making them fragile and more likely to break. Osteopenia is not a disease, but a term that describes low bone density. Both can lead to painful fractures.  While osteopenia is not considered a disease, being diagnosed with osteopenia requires further monitoring. Preventive measures should be taken since osteoporosis may develop if bone density loss increases.

Actually, the real protection against osteoporosis begins when one is a teenager, because porousness of the bones is the end stage of a long process. Continuing to drink milk after childhood through the teenage years is like putting calcium in the bank to be drawn on later. Unfortunately, teenagers favor sodas over milk and not many drink the two glasses of milk a day that would allow them to meet more than half their daily calcium needs.

Which food has more calcium?  A cup of collard greens or a cup of whole milk?  The answer is collard greens!  Eight ounces of skim milk contains almost 300 mg – even more than whole milk, and in a healthier, fat-free package. Yogurt and cheese are good sources of calcium too, but remember that dairy products are just one of many ways to get the calcium you need. Salmon, kale, broccoli, and calcium-fortified orange juice are just a few of the other many places to find calcium.  I don’t believe that my orange juice should be calcium-fortified, but the manufacturers are offering the option.  Just drink milk!

What about calcium supplements? Their safety is often called into question, although for now they appear to be harmless. The real issue is that supplements are not a stand-in for natural foods that contain calcium, because they lack the protein, vitamins, and minerals that you, and your growing baby if you are pregnant, both need. With just a little effort you can get all the calcium you need easily through a healthy diet.

Calcium need during menopause is 1200 milligrams per day. After menopause, it increases to 1500 milligrams per day.  We once thought that calcium and Vitamin D supplementation should be taken to prevent bone fractures in postmenopausal women.  However, the United States Preventive Services Task Force, an independent panel of experts in prevention and primary care, recently issued a draft statement in June, 2012, recommending that healthy postmenopausal women should NOT take low doses of calcium or Vitamin D supplements to prevent fractures.  Why?  Because the supplements were found NOT to prevent fractures and only increased the risk of other problems, such as kidney stones.  So the risks outweighed the benefits and taking these supplements may actually be harming you.


Lactose Intolerance

Lactose intolerance is a common condition in which unpleasant symptoms such as bloating or diarrhea occur after consuming lactose, milk’s natural sugar. This happens when an individual does not produce enough of the enzyme lactase to properly break down the lactose. Lactose intolerance can unsurprisingly make it more of a challenge to consume enough calcium. However, some individuals can consume a small amount of milk without issue. Yogurt is often a good alternative.  However, there are many products today designed for lactose-intolerant individuals. In addition, there are many non-dairy sources of calcium available such as kale, broccoli, collards, and foods fortified with calcium.

Can You Get Too Much Calcium?

Like anything other good thing, too much calcium can present potential problems. Hypercalcemia can cause renal and vascular problems, as well as kidney stones. It can also cause constipation. However, it’s important to realize that you would have to consume more than three times the recommended daily allowance of calcium for problems to begin to occur. Given the average American diet, this is just not a real concern. So drink plenty of skim milk and enjoy lots of other calcium-rich foods as part of your balanced nutritious diet, especially while you are pregnant, lactating or postmenopausal.

For more information about the risk factors associated with postmenopausal osteoporosis, I refer you to my health book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.

Strenuous Exercise Temporarily Decreases Fertility

Thursday, February 13th, 2014

A study from NTNU (Norwegian University of Science and Technology) suggested that the combination of strenuous workouts and achieving pregnancy may be too much for the body to handle. Therefore, female athletes or heavy exercisers may want to ease up a little if they want to become pregnant.

It is well known that women who are involved in elite sports struggle with fertility more than others. Now it appears that women who participate in other types of extreme exercise may encounter more fertility problems as well. In a study that included 3,000 women, researchers at NTNU discovered that frequent and strenuous exercise may reduce fertility – but only temporarily, or while the hard training lasts.

None of the women in the study had experienced a history of problems with fertility, and all of them were of childbearing age and in good health. Two groups of women showed a higher risk of fertility problems: those who trained nearly every day, and the ones who exercised until they were completely exhausted. The ones who fell into both groups experienced the most fertility problems.

In addition, the effects of strenuous exercise on fertility appear to be transient, ending when the hard training slowed down.

The theory is that extremely demanding physical activity requires so much energy that the body can actually experience periods of a deficiency of energy, in which the amount of energy needed to maintain the mechanisms, hormonal and otherwise, to enable fertilization just isn’t there.

It is important to note that women who engaged in low to moderate activity had no fertility impairments, so there is no reason for women to stop exercising altogether while trying to conceive. In fact, exercise can reduce stress, which is good for fertility. Moderate exercise has been previously shown to improve insulin function and promote better fertility as compared to complete inactivity.

It appears that the worst choices for women trying to conceive fall at both ends of the spectrum: extreme physical activity and extreme sedentariness. Pinpointing what constitutes the perfect level of activity, however, can be tricky, because it can be unique to individual women. If your menstrual cycle is particularly long or nonexistent, this could be a sign that you are exercising enough to negatively affect your fertility.

A woman is considered to be infertile after a year of unprotected intercourse without a pregnancy occurring. In women older than 35, it makes sense to see a doctor sooner; perhaps after four to six months of trying unsuccessfully to conceive. There are many factors that can affect fertility in women, including problems with the fallopian tubes, the ovaries, or the uterus, problems with ovulation, and hormonal issues. Sometimes the reason for infertility cannot be pinpointed, and sometimes it may the male partner who has the fertility problem and not the woman. A doctor’s evaluation is the only way to find out for sure.

– Yvonne S. Thornton, M. D., M. P. H.

What You Need to Know about Cervical Cancer

Thursday, February 6th, 2014

Cervical cancer, just as the name implies, forms in the tissues of the cervix, which connects the vagina and the uterus. Generally slow growing, cervical cancer usually does not cause any symptoms. This makes it extremely important to get regular pelvic exams, during which screening tests are done that can find early-stage cervical cancers and even precancerous cells.

Any women can get cervical cancer, but it is typically found in women over 35. There are about 12,000 new cases diagnosed in the United States each year. Almost all cervical cancers are caused by HPV (human papilloma virus), the virus that causes genital warts.

Who Is at Risk?

There are several risk factors that increase a woman’s chances of developing cervical cancer. If you have none of these risk factors, your odds of getting it are very low. These risks include HPV infection (which you may not be aware of, another reason why those pelvic exams are so important); smoking or exposure to secondhand smoke; HIV infection, which can significantly weaken the immune system; certain medications which weaken immune system response; and multiple sexual partners.   

Can Cervical Cancer Be Prevented?

The good news is that cervical cancer is highly preventable. The first step for younger women and girls is to get vaccinated against HPV. Gardasil, a vaccine that prevents HPV infection, protects against the four types of HPV that are responsible for most cervical cancers as well as genital warts (70% and 90% respectively). The vaccine is administered via a series of three simple injections and has very few and mild side effects.

An annual visit to your gynecologist is another excellent way to be sure that, should cervical cancer be present, it is caught in its early and easily treatable stage. It is important for women to realize that even if they haven’t been sexually active recently, they are still at risk for cervical cancer if they have ever had sex. For this reason, continued screening is vital and saves numerous lives every year.

Keep in mind that anyone can lower their risk of various types of cancers by living a healthful lifestyle. Eating plenty of fruits and vegetables, getting enough exercise and enough sleep, and avoiding smoking and other dangerous chemicals are all effective ways to protect yourself and your family.

While cancer cannot always be prevented, it can often be found early and treated. If you haven’t seen your gynecologist recently and it’s closing in on a year (or has been longer than that), make an appointment today. Ignorance is not bliss when it comes to cancer – it’s often a death sentence.

– Yvonne S. Thornton, M. D., M. P. H.

Cancer Deaths Down; More Progress Still Needed

Monday, February 3rd, 2014

Great news: the death rate from cancer is falling. Over the past 20 years, cancer deaths have decreased dramatically and steadily. After peaking in 1991, deaths from cancer have fallen 20%. That’s well over a million deaths prevented over 20 years!

The American Cancer Society’s research shows progress – for example, middle-aged black men are the group with the largest decline in cancer deaths – but also the need for continued research and improvements in care, as cancer deaths are still more common in black men than in white men. Experts estimate that there will be over 1.5 million new cases of cancer in the US in 2014, about 586,000 of which will result in death.

The divide in cancer cases and deaths between races and ethnicities is starkly evident when one considers that even though the rate of deaths has been effectively cut by half in middle-aged black men, their deaths from cancer are still significantly more common than those of white men. The lowest rate of cancer deaths is seen in Asian Americans. Even more deaths could be prevented if the knowledge we now have about fighting cancer were applied across all groups of people – including the poorest subset of the population.

Lung cancer continues to top the list of fatal cancers, along with breast, colon, and prostate cancers. These four cancers alone are responsible for almost half of all cancer deaths in the US, with lung cancer causing more than a quarter of cancer deaths. Researchers estimate that this year, these four cancers will be the most common cancers diagnosed.

Still, the rates of not only deaths but new cases of cancer are also falling. One reason is that more people are having regular colonoscopies, during which pre-cancerous polyps can be removed and full-blown cancer avoided. Lung cancer occurrence has also decreased, thanks in large part to declining numbers of smokers.

Doing Your Part

The number of new cancer cases as well as the number of deaths from cancer can be further reduced by individuals taking a proactive approach to preventing cancer – or catching it early. This is one reason why your annual appointment with your gynecologist is so important; cervical and other cancers can be detected and treated in the early stages, before metastasis complicates your prognosis. Screening for other types of cancers, such as breast cancer and colorectal cancer, is also highly effective at detecting cancer early on. Most cancers are highly treatable when caught early. Free and low-cost cancer screenings are available in many states.

You can further reduce your cancer risk by getting an HPV vaccine and/or a hepatitis B vaccine; ask your doctor if these are right for you. Besides getting regular preventive medical care, avoiding tobacco, limiting sun exposure and avoiding tanning beds, keeping alcohol use to a minimum, getting plenty of exercise, and eating lots of fruits and vegetables can all go a long way toward helping your prevent – and fight – cancer.

– Yvonne S. Thornton, M. D., M. P. H.

Exercise May Spell Relief for Migraine Sufferers

Monday, January 27th, 2014

Some people who suffer from migraines say that exercise can bring on the severe headaches, but a recent study shows the opposite – that exercise may, in fact, help prevent them. In the study, three groups of participants were observed. One group took the drug topiramate, which is commonly prescribed for migraines; one group practiced relaxation exercises; and one group exercised for 40 minutes three times a week.

After three months, no significant difference was observed between the groups in terms of the presence of migraines. All three groups showed a decrease in the number of migraines they got, suggesting that exercise may be just as effective as drugs at preventing migraines.

For people who know all too well the pain and misery of a migraine, it’s worth a try. It’s probably true that there is no one “right” approach that works for everyone; different people will find that different approaches are effective for them and some trial and error is inevitable in most cases. What is true is that as long as you have no physical contraindications, exercise usually won’t hurt and is a safe and healthy activity for most people.

Migraines can be difficult to diagnose, as they have several variants. In general, they are severe and even disabling headaches affecting about 22% of women and about 10% of men. Migraines can affect a person’s ability to go about his or her daily routine for hours or even days at a time and can be difficult to treat, so the information that exercise may help prevent them is good news for those who haven’t had much success with drug treatments or relaxation exercises.

A typical migraine can produce severe, throbbing pain, visual disturbances, nausea, vomiting, and sensitivity to sound and/or light. Many people find that once they have a headache, physical activity can make it worse, so finding ways to prevent migraines is important. Migraines may occur anywhere from once a year to several times a month.

The exact cause of migraines is not well understood. There is no shortage of theories, however, and they range from changes in the trigeminal nerve (a main facial nerve) to serotonin imbalance. Food sensitivity may play a role in some individuals. Another factor, particularly in women, may be hormonal fluctuations. Stress and heredity are also suspects in some cases. Still other possible triggers include sleep disturbances, barometric pressure changes, altitude changes, bright flashing lights, and strong smells such as gasoline or paint.

There are two main types of drug treatment used by migraine patients: those that treat an existing migraine and those that aim to prevent migraines from occurring in the first place. In individuals who have found that they aren’t responsive to drug treatments, regular exercise just may provide a new avenue to explore for the prevention of the debilitating headaches.

– Yvonne S. Thornton, M. D., M. P. H.

Managing Urinary Incontinence

Thursday, December 26th, 2013

Urinary incontinence refers to the loss of bladder control and is a very common problem. Unfortunately, it is also a very embarrassing problem for many women, and so they often just live with it rather than discussing it with their doctors – which is too bad, because there are effective treatments available, and some of them are very simple.

Urinary incontinence can be mild or severe, ranging from the occasional leak upon sneezing or coughing to having such strong, sudden urges to urinate that you can’t make it to the toilet in time. If incontinence is affecting your day to day activities, please don’t hesitate to talk to your doctor about it. He or she has heard it before, and some simple medical treatment or even just lifestyle changes in some cases can make a huge difference. There are several different types of urinary incontinence, for example:

Stress Incontinence: Leaking urine when pressure is exerted on the bladder, such as through laughing, sneezing, coughing, or heavy lifting. Childbirth and menopause often result in stress incontinence. Obesity is a very common culprit.

Urge Incontinence: An intense and sudden need to urinate. Women with this type of incontinence often experience involuntary loss of urine and “not making it” to the toilet in time. The bladder contracts and in some cases the woman has only a matter of seconds to reach a restroom. This type of incontinence can be caused by a variety of health problems such as UTIs (urinary tract infections), stroke, Parkinson’s or Alzheimer’s disease, and multiple sclerosis. 

Overflow Incontinence: Women who have trouble emptying their bladders completely may experience overflow incontinence, or the frequent or constant leaking of urine. A women with this type of incontinence may not be able to empty her bladder and may be able to produce only a weak stream of urine; typically, this is caused by some type of damage to the bladder – for example, nerve damage caused by multiple sclerosis or diabetes.

There are also cases where women experience more than one type of incontinence. To be sure, it can feel embarrassing to tell your doctor you are having a problem with incontinence. But this is a much better option than suffering in silence. For starters, incontinence may be a symptom of a more serious problem. It can also seriously affect your quality of life, especially if you are restricting your activities and limiting social interactions.

What Causes Urinary Incontinence?

Incontinence can be temporary or permanent, mild or severe. It can be caused by a number of different things. Sometimes, temporary incontinence or isolated incidents can be caused by alcohol, caffeine, or over-hydration; it can also be caused by a UTI and in this case, it goes away as soon as the infection is treated.

When incontinence is persistent, it may be caused by an underlying physical condition or problem, such as an undiagnosed urinary tract infection , pregnancy, hysterectomy, neurological disorders, or obstruction of the urinary tract by a stone or tumor.  The most common reason is just aging and not pregnancy or the mode of delivery.   As stated here back in May, nuns have the same prevalence of urinary incontinence as mothers.


See Your Doctor for a Solution

Often, women with urinary incontinence are most comfortable talking to their gynecologists first. In most cases, your gynecologist can help you with this problem; in certain cases, he or she may need to refer you to a urogynecologist or other specialist. When you go to your appointment to discuss your problem, be prepared with some information that your doctor is sure to ask you for. For example, your symptoms in detail and a list of all medications you take (including vitamins). Also write down questions you have so you don’t forget them once you are in the doctor’s office.

The type of treatment recommended will depend on your individual symptoms and the type of incontinence you are experiencing. Your doctor will most likely suggest the least invasive treatments first, and often, these are quite effective. He or she may suggest that you try certain techniques such as bladder training, double voiding, diet and fluid management, or Kegel exercises.

If these are not effective, there are medications available that can help. There are also medical devices such as urethral inserts and pessaries that can be helpful. Sometimes, urinary continence may require surgical treatment.

To reduce your risk of developing urinary incontinence or to prevent yours from worsening, maintain a healthy weight, do regular Kegel exercises, don’t smoke, and avoid foods known to irritate the bladder such as caffeine and alcohol. You will almost certainly be glad that you talked to your doctor about your incontinence. Go make your appointment now and you’ll be one step closer to relief.

– Yvonne S. Thornton, M. D., M. P. H.

Preventing HPV Infection

Monday, December 23rd, 2013

Human papillomavirus (HPV) is the most common sexually transmitted infection (STI). HPV can lead to a number of serious health problems, such as genital warts and some types of cancer. Many people who have HPV do not know it, because it often causes no symptoms. HPV should not be confused with either herpes or HIV. While these can all be transmitted through sex, they cause different problems and produce different symptoms.

Anyone who has ever had sex has potentially been exposed to HPV. Remember – not everyone who has it is even aware they have it. At least half of all people who are sexually active will get HPV at some point. This statistic remains constant even in the case of people who have only one sexual partner in their entire lifetime.

Most commonly, HPV is transmitted through vaginal and anal sex. It does not discriminate between straight and homosexual couples. Furthermore, even if years have passed since contact with an infected person, HPV infection can still be present. In rare instances, HPV can be passed from a pregnant woman to her baby during delivery. In addition, one person can contract more than one type of HPV.

In most cases, HPV will go away on its own without causing any serious problems. Sometimes, however, the infection will stick around and cause serious issues such as genital warts, cervical cancer, or other types of cancer.

According to the CDC (Centers for Disease Control), HPV is the main cause of cervical cancer in women. There are about 12,000 new cervical cancer cases each year in the United States. Cervical cancer causes about 4,000 deaths in women each year in the United States. There are about 15,000 HPV-associated cancers in the United States that may be prevented by vaccines each year in women, including cervical, anal, vaginal, vulvar and oropharyngeal cancers.  In addition, about 7,000 HPV-associated cancers in the United States may be prevented by vaccine each year in men.  Approximately 1 in 100 sexually active adults in the United States have genital warts at any given time.


Should You or Your Daughter Get an HPV Vaccine?

Individuals can reduce their risk of getting HPV by getting vaccinated. As with any newer vaccine, there have been rumors regarding dangerous side effects. However, the fact is that the HPV vaccine has been shown to be safe and effective, and since at least 70% of all cervical cancers are caused by HPV, it is absolutely recommended that people who are able to get the vaccine do so. Gardasil is one vaccine that should be given to girls and young women between 11 and 26 years of age. Another available vaccine is Cervarix. The vaccines are given in the form of three doses (injections) administered over a period of six months; for the best protection, it is important to receive all of the doses (injections).

Sexually active individuals can also choose to lower their risk by using condoms. It is possible for HPV to affect areas that the condom does not cover, so realize that condoms are not 100% effective against the transmission of HPV. A vaccination is recommended even for people who always use condoms and plan to continue to do so.

Gardasil is also licensed, safe, and effective for males ages 9 through 26 years. CDC recommends Gardasil for all boys aged 11 or 12 years, and for males aged 13 through 21 years, who did not get any or all of the three recommended doses when they were younger. All men may receive the vaccine through age 26, and should speak with their doctor to find out if getting vaccinated is right for them.


The vaccine is also recommended for gay and bisexual men (or any man who has sex with men) and men with compromised immune systems (including HIV) through age 26, if they did not get fully vaccinated when they were younger.


Finally, limiting the number of sexual partners a person has can reduce their risk of being exposed to HPV; so can choosing a partner with few or no previous partners. But again, even if only have one sexual partner ever, you still have at least a 50% chance of contracting HPV – so, in you are in the appropriate age range, you should still receive the vaccine if possible.

– Yvonne S. Thornton, M. D., M. P. H.

Everything Old is New Again when it comes to Morning Sickness

Thursday, December 19th, 2013

Back in the 60s, and 70s, when I was a medical student, resident and perinatal Fellow, the drug of choice of morning sickness was Bendectin.  Bendectin, Bendectin, Bendectin.  It was prescribed like jellybeans to pregnant women in their first trimester to treat nausea and vomiting of pregnancy (morning sickness). It worked!!  I don’t think I would have gotten through my certification Boards without Bendectin when I was eight weeks pregnant with my daughter.

Then, all of a sudden, its was unceremoniously removed from the market and was unobtainable in 1983.  Why? Because the original manufacturer, Merrell Dow, could not continue to defend the lawsuits brought against the drug for supposedly causing birth defects.   After numerous horrific episodes of birth defects due to Thalidomide (which was not FDA approved in this country), women were quicker to blame medications taken during pregnancy for complications and birth defects.  Unfortunately, attorneys set their sights on Bendectin, which became the “whipping boy” for medications taken during early pregnancy and soon the mounting lawsuits (which were unfounded) resulted in its removal from the market.  In other words, this very effective medication was removed totally based on fear.

However, those of us who knew that the ingredients were just an antihistamine (doxylamine) and Vitamin B6 (pyridoxine), continued to direct our patients to the over-the-counter combination of Unisom and Vitamin B6.  In 2004, the American College of Obstetricians and Gynecologists sanctioned this jerry-rigged, improvised approach to “homemade” Bendectin as a first-line treatment for nausea and vomiting of pregnancy (morning sickness).

Well, thirty years later, a “new” drug, under a new manufacturer, called Diclegis (the brand name for doxylamine succinate and pyridoxine hydrochloride) was approved by the FDA earlier this year for use in pregnant women for the treatment of nausea and vomiting.  The drug is exactly the same as Bendectin.  However, this time, it has been categorized as Class A by the FDA, which means that there is no evidence that the drug causes birth defects in the human fetus.  With this FDA category of Class A, hopefully, it will reduce the threat of lawsuits.

As you are probably aware if you are or have been pregnant, so-called “morning” sickness can actually strike at any time of day, even lasting all day long in some cases. There are simple self-care strategies to try that are effective in many cases: avoiding fatty foods, eating smaller, more frequent meals, and avoiding smells that seem to trigger nausea. However, more often than not, these measures are not enough. Diclegis offers a welcome solution for many women.

Studies have shown Diclegis to be effective and safe. 261 women who had been pregnant for anywhere from seven to 14 weeks, were all 18 years old or older, and were all experiencing nausea or vomiting, were evaluated. In the study, there was more of a decrease in nausea and vomiting seen in women who took Diclegis than in women who took a placebo. The drug was also found to be completely safe for the fetus.

Women whose doctors prescribe Diclegis can expect to take two pills at night to start with. If this does not improve symptoms, the dose can be increased to a total of four pills per day (one in the morning, one in the afternoon, and two at night). Drowsiness is among the possible side effects (because of the antihistamine), so women who take the drug should not drive. If you have questions about Diclegis or need further information on morning sickness, see my book, Inside Information for Women, and talk to your doctor. He or she can help you decide if Diclegis is the right choice for you.

Pregnant women who suffer from morning sickness may be worried that their babies aren’t getting enough nutrition, but in most cases, there is no cause for concern. The caloric needs of a fetus are tiny, especially in the first trimester, when the majority of morning sickness occurs. Occasionally a woman develops hyperemesis gravidarum, which is a very severe form of morning sickness in which she may not even be able to keep water down and may need to be hospitalized. Diclegis has not been tested on women with this form of severe nausea and vomiting.

– Yvonne S. Thornton, M. D., M. P. H.

Diagnosing Menopause

Thursday, December 12th, 2013

Thousands of women enter menopause each day. With average life expectancy increasing, the average woman will live out a third of her life after menopause. Menopause begins anywhere between 48 and 55 years old, but the average is 52. What does it mean to enter menopause, though, and what changes lead up to the official beginning of menopause?

Estimating when menopause will begin is more important than simply predicting the final menstrual period (FMP). In the year leading up to this, bone loss accelerates and cardiovascular risk factors increase. Until fairly recently, there was no reliable way to predict when the FMP would occur. Now, we are beginning to learn ways to estimate whether a woman is within a year or two of her FMP. These models are not used in clinical settings yet, but work in this area is promising.

Perimenopause begins several years (four, on average) before menopause. This is a transitional stage that includes several physiologic changes, including:

1. Irregular menstrual periods. A woman’s menstrual cycle undergoes marked changes in the years leading up to menopause. Typically this is a gradual lightening and spacing out of periods, but it can include heavier, more frequent periods, or sporadic combination of both.  

2. Hot flashes. Hot flashes are an extremely common symptoms of menopause, occurring in up to 80 percent of women.  These generally last several minutes and are characterized by a sudden sensation of heat that spreads out from the chest and face. Sweating and heart palpitations can accompany hot flashes, which are sometimes followed by feeling cold and shivering. Hot flashes may occur less often than daily, or they may occur several times in one day. They happen particularly often at night.

3. Sleep disturbances. Sometimes, hot flashes cause sleep problems, but often, sleep problems occur even without hot flashes. Feelings of anxiety or depression may contribute to sleep disturbances.

4. Vaginal dryness. As estrogen decreases, the vaginal lining thins, resulting in atrophic vaginitis, which can cause vaginal dryness, itching, and dyspareunia (painful intercourse) due to insufficient natural lubrication. A water-based lubricant can easily solve this problem.

5. Depression. Perimenopausal women are more likely to experience depression than premenopausal women, and sometimes this is new-onset depression. Then, in early postmenopause, the risk decreases.

Other symptoms can be present during the menopausal transition, including problems with sexual function, cognitive changes such as memory loss or difficulty concentrating, joint aches and pains, breast tenderness, headaches, and long-term issues such as bone loss and the increased risk of cardiovascular disease. A woman may experience only one or two menopausal symptoms or she may get every symptom in the book.

After several years of menstrual irregularity, menses eventually ceases altogether. Clinical menopause is defined as the absence of menstrual periods for at least six months. All of the symptoms of menopause can be treated and quality of life improved. Talk to your doctor about treatments for individual symptoms, or the possibility of hormone replacement therapy. You can also find more information on this topic in my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.

What Is a Normal Period?

Monday, November 18th, 2013

Women, especially younger women, are usually anxious to know whether their bodies are normal. After all, the menstrual cycle isn’t something you bring up every time you meet another women, so it’s not likely you’ve conducted your own informal research to find out how your cycle compares to those of your friends. Many women have read in books or heard from someone else, like their mother or a doctor, that a “normal” cycle last 28 days and that bleeding lasts for five days. So when their cycle fails to match this textbook version, they worry. Or, women who have always had “normal” cycles see frequency or duration changes happen in their 20s, 30s, or 40s and become concerned that something is wrong.

The truth is that there is a wide range of normal (http://www.mayoclinic.com/health/menstrual-cycle/MY01541) when it comes to the menstrual cycle. “Average” means just that – the average of all the possibilities. In the majority of cases where a woman goes to her doctor concerned about menstrual changes or problems, there is nothing wrong. Irregular periods, especially in adolescents, are almost always normal. Even when a cycle is regular, it may be a 25-day cycle or a 40-day cycle, anything in between, or even something outside of this range.

It is a very good idea for women to maintain a calendar or chart in order to keep track of her cycle. This is imperative if a woman is trying to conceive, but even if she’s not, a chart can give her something more reliable than her memory to fall back on should she need to see a gynecologist for any related reason. She will need to be able to tell her doctor when her last period was, whether her cycle is usually regular, and any other information her doctor might need.

When a sudden change in a woman’s menstrual cycle does happen, there are several things that can cause it, such as weight gain or loss, beginning a new exercise program, stress, an interruption of the woman’s normal routine, or even just routine changes that happen with age.

When Concern May be Warranted

If a 16-year-old girl has had no periods at all, there may be a hormonal issue that needs attention. Likewise, when periods suddenly stop in women who have previously had regular periods, and pregnancy can be ruled out, an examination is in order to discover the underlying cause. Unusually frequent bleeding should be investigated to rule out polyps or hormonal issues. Severely painful cramps or unusually heavy bleeding should also prompt a woman to check with her doctor.

Anytime you have a question about whether or not something is normal, check with your gynecologist to be on the safe side. But realize that what constitutes a “normal” period simply means what is normal for your individual body.  Using that as an internal standard is the best definition of “normal”.  And, if something is different “your” normal, then you should seek medical attention as soon as possible.

– Yvonne S. Thornton, M. D., M. P. H.