Women's Health Archive

Q.I am 53. I've had fibroids for some time but have experienced heavy menstrual bleeding lately. A recent ultrasound showed fibroids and polyps. What are my options?

A. As you know, you're almost certainly in perimenopause, the four to eight years leading up to menopause and the complete cessation of menstruation. Every woman's script for the transition to menopause is a little bit different, but it's very common for the menstrual cycle to be irregular and the amount of blood flow to vary. Erratic ovulation — the release of eggs from the ovaries — may result in hormonal changes that cause the lining of the uterus (the endometrium) to become thicker than usual, so when it sloughs off, the menstrual bleeding is heavier and more prolonged than women are used to.

With summer's approach come plans for travel, including flying long distances. But the prospect of a long flight often raises health concerns. Especially in passengers who are older or have certain conditions, air travel and the related stress can have an impact on health. Here are a few trouble areas and some precautions you can take.

Deep-vein thrombosis (DVT). Not all experts agree on an association between DVT (blood clots in the legs) and air travel. Symptoms may not occur for several days, so it's difficult to establish a cause-and-effect relationship. If there is one, it's likely due to prolonged inactivity. Limited airline space can discourage moving about. Dry cabin air may also increase the risk of DVT.

Overall risk is very small, and older women who used hormonal contraceptives many years ago aren't likely to have a higher risk.

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Hormonal birth control — whether it comes as pills, injections, a ring, an intrauterine device (IUD), or an implant — may raise your risk of breast cancer, according to a study published Dec. 7, 2017, in The New England Journal of Medicine.

If you're like many women who currently use one of these contraceptive methods, or if you used one for years in the past, should you be worried?

Increasingly, doctors are turning to prevention for this hard-to treat cancer.

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Ovarian cancer is a challenging foe. It's often found at an advanced stage when it's difficult to treat.

In recent years, researchers have learned that many cases of ovarian cancer don't even start in the ovaries. "It turns out that ovarian cancer is a bit of a misnomer. We think a portion of ovarian cancers actually arise from cells in the fallopian tubes," says Shelley Tworoger, adjunct associate professor of epidemiology at Harvard Medical School and associate center director of population science at the Moffitt Cancer Center.

A new study suggests that hormone therapy might help with perimenopausal depression. But is it safe for you?

Hormone therapy has long been a controversial topic, and a new study about the role of hormones in depression is adding some fodder to the debate. A study published in the January 10 issue of JAMA Psychiatry determined that hormone therapy may help ward off symptoms of depression in women. Researchers found that perimenopausal and early postmenopausal women who were treated with hormones were less likely to experience symptoms of depression than women in the study who were given a placebo.

But while the findings of the study are important — particularly considering that a woman's risk of depression doubles or even quadruples during the menopausal transition — that doesn't mean hormone therapy should be widely used for preventing depression in women at this stage of life, says Dr. Hadine Joffe, the Paula A. Johnson Associate Professor of Psychiatry in Women's Health at Harvard Medical School, who wrote an editorial accompanying the study. "It's not a 'never,' but it shouldn't be a standard approach; in general, all of medicine has moved away from using hormones for prevention," she says.

This treatment approach may help provide relief for many women with chronic pelvic pain and urinary symptoms.

The exact cause of pelvic pain for many women can be elusive, despite lots of tests and scans. In some cases, the symptoms are related to a problem that is often overlooked, says Dr. Eman Elkadry, an instructor in obstetrics, gynecology, and reproductive biology at Harvard Medical School. Pelvic pain may stem from a pelvic floor muscle problem that can be helped by a specialized form of physical therapy known as pelvic physical therapy.

"Although pelvic physical therapy may not work for everyone, it can be quite effective for certain individuals," says Dr. Hye-Chun Hur, director of the Division of Minimally Invasive Gynecologic Surgery at Harvard-affiliated Beth Israel Deaconess Medical Center and associate faculty editor of Harvard Women's Health Watch. She stresses that pelvic physical therapy is normally undertaken by a trained female practitioner.

This challenging skin condition causes dark patches on the skin that can last for years.

By October, your summer tan is probably almost gone, but a glance in the mirror may still show some darkened patches on your skin that seem to be sticking around. These brown or grayish-brown blotches, typically on the forehead, chin, cheeks, upper lip, or nose, may signal a condition called melasma.

Melasma is sometimes referred to as the mask of pregnancy, because it is sometimes triggered by an increase in hormones in pregnant women. But while the condition may be common among pregnant women, it isn't limited to them.

Bleeding indicates cancer only in a small percentage of cases, even though endometrial cancers are on the rise in American women.

You've gone through menopause and you thought your periods were a thing of the past — but suddenly, you're bleeding again, more than a year after your last period.

Should you be concerned?

The good news according to an analysis published in JAMA Internal Medicine, is that most likely your bleeding is caused by a noncancerous condition, such as vaginal atrophy, uterine fibroids, or polyps. But the study also reinforces the idea that postmenopausal bleeding should always be checked out by your doctor to rule out endometrial cancer, a cancer of the uterine lining, says Dr. Ross Berkowitz, William H. Baker Professor of Gynecology at Harvard Medical School.

Research we're watching

While cesarean delivery may mean longer recovery time after your baby is born, it may make it less likely that someday you'll need to cross your legs when you cough or sneeze.

A study in the Dec. 18, 2018, issue of JAMA found that women who delivered their first baby by cesarean had half the risk of developing stress urinary incontinence (which causes urine to leak when you cough or sneeze) or overactive bladder, compared with first-time moms who had a spontaneous vaginal birth.