By: Tammy McCarrus, M.D.

Irregular Menstrual Cycles/Uterine Bleeding

Q: What causes long or irregular periods?
A: Periods can be longer than average for many reasons, including hormonal imbalances due to irregular or skipped ovulation, medications you are taking, weight changes (both up and down), stress, problems with the cervix and uterine growths like fibroids.

Missed periods must first be addressed by ruling out pregnancy. If you’re not pregnant, then the most likely cause of a skipped period is an ovulation irregularity. You simply skipped a month. Taking birth control pills can also cause such light bleeding that it may seem you skip bleeding all together some months.

Spotting outside of your menstrual cycle should be checked by your doctor. It is usually nothing serious but could indicate a cervical problem that a pap smear would detect, or it could be an infection you are unaware of having.

Any menstrual irregularity — too much blood, too long a flow, too little blood, absent blood, spotting — should be reported to your gynecologist and based upon your history and duration of symptoms, you will be advised accordingly. Just make the call and don’t be afraid.

Fibroids

Q: What are fibroids?
A: Fibroids are benign growths in the uterus that may cause a variety of symptoms. Scientists do not know why fibroids grow, but it has been established that fibroid tissue is identical to the muscle tissue of the rest of the uterus. An unknown factor seems to “turn on” one unique muscle cell and that muscle cell multiplies at a much quicker rate than the other muscle cells of the uterus and forms the fibroid.

Q: Do all fibroids require treatment?
A: Some fibroids require absolutely no treatment while others require surgery. Most patients who end up with surgery are very much aware there is a problem, usually due to heavy or prolonged periods, pain, or difficulty in conceiving. Patients with no symptoms usually are not aware that they even have fibroids. They are often found during a regular checkup.

Q: Who gets fibroids?
A: All women are susceptible to fibroids. They are very common. African-American women have the highest rates when compared to Caucasian and Hispanic women.

Q: What can I do to prevent fibroids?
A: There is nothing you can do to completely avoid getting fibroids. There’s is no way to test for susceptibility.

Q: What are the most effective types of treatment?
A: Treatments range from watchful waiting to surgery. Surgery may involve simply removing the fibroid itself (a procedure called a myomectomy) or removal of the entire uterus (hysterectomy). Less invasive procedures designed to shrink or cut off the blood supply to the fibroid may be used as well. The best treatment will depend on many factors including a woman’s age, whether or not she is experiencing severe symptoms, such as heavy bleeding, and whether she still wants to have children.

Menopause

Q: What is menopause and how do I know when it has occurred?
A: Menopause is the time in a woman’s life when her periods cease and she is no longer able to become pregnant. Menopause is defined as one year without a period. It occurs because the ovaries have stopped producing a monthly cycle. Menopause typically occurs between ages 50-52. Some women go through menopause at younger ages than others. Family history can be helpful in identifying these patients. Unless there has been surgery to remove the ovaries, radiation therapy to the pelvis or serious insult to the pelvis via trauma, the timetable for menopause is set by genetics.

Q: What are the most common symptoms of menopause and the best forms of treatment?
A: Many women experience hot flashes, night sweats, sleeplessness and vaginal dryness, as well as an increasing loss of bone density due to lowered estrogen levels. Hormone Replacement Therapy, HRT, is considered the only viable treatment, but recent studies show it can contribute to your risk of ovarian and breast cancer and possible heart disease. The best way to determine if HRT is right for you is to discuss the therapy with your physician.

Birth Control

Q: What’s the best way to select birth control?
A: Have a long talk with your gynecologist about your options. Be sure to weigh all important factors, including potential health risks, effectiveness, your lifestyle, any health problems you may have and whether you are planning to start a family in the near future.

It is pretty safe to say that all forms of hormonal contraception can have side effects, although most patients do quite well. The barrier methods tend to have minimal side effects. Other methods include birth control pills, as well as newer pills that are designed to make you completely skip your period for a month or several months.

The most important thing to remember is that no form of birth control is 100 percent effective, so follow instructions carefully. There is no side-effect free form of birth control for every woman; even condoms may trigger latex allergies in some women. Diaphragms can cause urinary tract infections. Hormonal forms — pills, Depo-Provera shots, patches, IUDs with progesterone — can cause menstrual irregularities, headache, weight gain and bloating initially and other problems. IUDs may also cause cramping and heavy periods.

If you want to avoid pills or products altogether, the rhythm method is still a viable means of natural birth control. You must be having regular periods and be able to keep track of your cycles for this method to be most effective. This method can be utilized to help prevent pregnancy as well as maximize pregnancy chances, depending upon your situation.

And of course the most effective type of birth control is surgical — tubal ligations or vasectomies are equal in terms of their effectiveness–99 percent. Tubal ligation requires anesthesia and surgery and has more inherent risks as the female fallopian tubes lie within the pelvic cavity. The male vas deferens lie on the outside of the body, therefore less invasion is required to surgically cut them. Tubal ligation carries more health risks than a vasectomy.

AVOIDING COMMON HEALTH RISKS

Breast Exams

Q: How important is a monthly breast exam?
A: Your monthly breast exam is an important part of your breast cancer early-detection program. You should perform the test once a month, about two weeks after your period. If you no longer have a period, pick a day of the month that you will remember and mark it on your calendar. The tub or shower is the ideal place to perform your breast exam as you are already nude and the slippery texture of suds makes it easier for you to feel any irregularity of the breast. It acts as a lubricant to help your fingers glide over the tissue easily and smoothly. The recommendation is that women start doing monthly breast exams at 18 years of age. The only concern you should have about your self-breast exam is if you forget to do it every month. If you feel anything that seems unusual, or feel something new, you should call your doctor. They will make a recommendation about what you should do. You may be told to watch the area for one menstrual cycle and repeat the exam at that time, or you may need to come in to the office to be checked. Either way, isn’t it better to be safe than sorry?! Doctors do not consider these types of phone calls to be a bother.

Q: What about mammograms?
A: The latest recommendations for mammography are: one every one to two years starting at age 40, and every year starting at age 50. Of course, you should start earlier or have an exam more often if you have a higher than average risk of breast cancer that may be indicated by a family history of the disease.

There is no diet or lifestyle that uniquely maintains the health of the breasts but things that promote general health do have a positive impact upon breast health. Don’t smoke, exercise, keep your weight down, drink alcohol only in moderation, stick with a low-fat diet, and take a multivitamin.

Q: How important are pelvic exams and Pap smears?
A: Pelvic exams are recommended for all girls and women on an annual basis. They should be started no later than three years after the initiation of sexual intercourse and no later than 21 years of age. Pelvic exams screen for cervical problems (the Pap smear), uterine problems, ovarian problems, vaginal problems, outer genital problems, infections, etc.

Q: How will I know if I’ve contracted a Sexually Transmitted Disease, or STD?
A: When it comes to STDs, the best defense is a good offense, so always practice safe sex (use a condom) to protect yourself from HIV/AIDS and other risks. Most STDs are accompanied with symptoms such as vaginal discharge, growths or bumps on the external genitalia, burning with urination, sores or ulcers of the genitalia, fever, or pelvic pain. However, some STDs cause no early symptoms at all (such as HIV/AIDS). If for any reason you think you have been exposed or are at risk, talk to your physician and get tested.

One particular dangerous STD to watch for is the Human Papilloma Virus, or HPV. We now know that HPV not only causes genital warts, it causes most forms of cervical cancer. There is now a vaccine for HPV (currently only in use in young women) so ask your doctor if you or your daughter are good candidates for the vaccine. The vaccine not only prevents genital warts but 80 percent of all cervical cancers. HPV can be detected by pelvic exam if genital warts are seen or during a pelvic exam. It’s very common, more than 90 percent of the population is affected.