Women's Health Archive

When should you see a clinician about excessive or unexpected bleeding?

Abnormal uterine bleeding (AUB) is a common problem for women of all ages, accounting for up to one-third of gynecologic office visits. The two main types are heavy bleeding that occurs at an appropriate or expected time, such as a heavy menstrual period (menorrhagia), and any type of bleeding that occurs unexpectedly (metrorrhagia). The absence of regular menstrual periods for several months (amenorrhea) is also considered an abnormal bleeding pattern. AUB can be tricky to identify, because what's normal depends on a woman's reproductive age.

New research again links increased breast cancer risk to longer use of hormone therapy.

The link between hormone therapy and breast cancer has been recognized for years. But an analysis published Aug. 29, 2019, in The Lancet has added some additional information to the discussion. The analysis looked at 58 studies that included information on the type and timing of hormone use in individual women, and their body mass index. Researchers began gathering the studies in 1992 and continued until 2018.

We asked Dr. Wendy Chen, an assistant professor of medicine at Harvard Medical School, to help us sort through both the old and new information on hormone use and breast cancer and what it means for women considering starting hormone therapy.

Research we're watching

Doing genetic tests on all women with breast cancer, as compared with the typical practice of just testing those with a family history of the disease, is worth the extra cost, according to a study published online Oct. 3, 2019, by JAMA Oncology. The study authors say their findings should prompt the expansion of genetic testing to all women diagnosed with breast cancer. It's clear that testing breast cancer patients for genetic variants that raise breast cancer risk (such as BRCA1, BRCA2, and PALB2) would enable doctors to identify more women who carry these variants and who might benefit from preventive strategies. But researchers wondered whether doing so would be too costly. To answer that question, they used a computer model to analyze data from more than 11,000 women. They found that not only would the cost of testing all American women with breast cancer be balanced out by later savings on health care services, but also that just one year of testing could prevent an estimated 9,700 new cases of breast and ovarian cancer and 2,400 deaths.

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This symptom is common in menopause, but frequent or persistent episodes could be a sign of higher risk for heart attack or stroke.

Researchers have begun to pay more attention to cardiovascular risk factors that are unique to women, such as early menopause (before age 40) and certain pregnancy complications. Recently they turned their attention to a common menopausal symptom that affects up to 85% of women: hot flashes.

Study results presented in September 2019 to the North American Menopause Society from the Study of Women's Health Across the Nation (SWAN) found that women who experience frequent or persistent hot flashes may be more likely than women who don't to experience a heart attack or stroke or other serious cardiovascular problems. (Researchers defined "frequent" hot flashes as having them six or more days in the previous two-week period. Women with "persistent" hot flashes reported those frequent hot flashes at 25% or more of study visits.)

Ask the doctors

Q. I suffer from mild urinary incontinence. A friend suggested that I try bladder training. Is this a real treatment?

A. Yes, some women with urinary frequency and overactive bladder might benefit from bladder training. The idea behind bladder training is to teach your body to respond more appropriately to bladder signals.

Ask the doctors

Q. I know that osteoporosis is linked to hereditary factors that I can't change. But are there things I can do to reduce my risk?

A. It's true that many risk factors for osteoporosis, such as your sex, age, and genes, are not things you can change. But there are things you can do to improve your bone health. This includes adopting a healthy diet that is rich in calcium and getting enough vitamin D, which can help maintain and improve bone health. Regular exercise can also help strengthen your bones or prevent bone loss. In particular, activities that put stress on your bones, such as jumping, running, and weight-bearing exercises, can stimulate bone cells to produce proteins that bolster bone strength. In children, these activities can actually increase bone density. While adults don't gain the same degree of benefit that kids do, exercise can still have moderate effects on bone, helping to maintain strength that might otherwise be lost. To further protect bone health, cut down on unhealthy habits, such as smoking or drinking excess amounts of alcohol. If you have risk factors for osteoporosis, you might also want to talk to your doctor about whether any of your medications might be harming your bone health.

Probiotics are being promoted as a way for women to improve vaginal health, but unlike with the gut and digestion, there is almost no evidence for any benefit.

Although hard-to-read heart attacks happen to both men and women, they are more common in women. One reason for this is that men's symptoms initially set the standard for recognizing heart trouble. Now a growing body of research shows that women can experience heart attacks differently than men.

Understanding sex differences in heart disease is important. Heart disease is the leading cause of death for women. Although it mostly affects older women, it isn't rare in younger women. One in 10 of all women who die from heart disease or a stroke are under age 65, and this age group accounts for one-third of heart- or stroke-related hospitalizations. Even so, younger women and their doctors don't necessarily suspect a heart attack even when all the signs are there.