Women's Health Archive

Ask the doctors

Q. I was recently diagnosed with a uterine fibroid. My doctor told me that the type I have is called a submucosal fibroid. What does this mean?

A. Uterine fibroids are common, affecting some 70% or more women. Doctors describe fibroids based on where in the uterus they are growing. There are three main types:

Ask the doctors

Q. I am 89 years old, and several months ago I was plagued by frequent urinary tract infections. The infections were treated, but is there anything I can do to avoid experiencing this problem again?

A. Urinary tract infections, or UTIs, are common infections that can occur when urine pools in the bladder and bacteria start to grow. These infections can be more common in older women for several reasons, including thinning of vaginal tissue, pelvic organ prolapse, incontinence, or difficulty with emptying the bladder completely. In addition, estrogen helps to maintain a healthy balance of bacteria in the vagina, which can protect against UTIs. But this natural protection may wane when estrogen levels drop after menopause. One of the best ways to prevent UTIs is to stay hydrated by drinking plenty of water. This flushes out potentially harmful bacteria before it can cause a problem. You'll know you are drinking enough if your urine looks clear or light yellow. Some other strategies include fully emptying your bladder when urinating, urinating after sexual intercourse, and wiping from front to back after using the toilet. Also talk to your doctor about replacing estrogen in the vagina with a cream, tablet, or vaginal insert. Your doctor may also want to examine you for pelvic organ prolapse.

The FDA may require mammography facilities to notify patients about this breast cancer risk factor, but women don't know what to do with this information.

Do you know how dense your breasts are? If you don't, a new proposal by the FDA may mean you will soon find out.

The agency proposed a change that, if approved, will require mammography facilities to send letters informing women about their breast density — a measure of the proportion of active tissue versus fat in their breasts (see "The FDA proposal").

Research we're watching

Transvaginal mesh, which has been used in transvaginal pelvic organ prolapse procedures since the 1990s, can no longer be sold in the United States because of concerns over safety and efficacy, according to the FDA. The number of women reporting problems related to these mesh products has grown over the past several years. The FDA said it made the decision because the companies that manufacture the mesh couldn't demonstrate that surgical procedures with their products work better than those without the mesh. They also failed to submit evidence that the mesh is safe and effective over the long term, said the FDA.

Women who have had procedures using mesh and are experiencing complications such as groin pain, persistent vaginal bleeding, pain during sex, or vaginal discharge should notify their doctor. Women who had procedures using mesh but aren't having any issues don't need to take any action aside from having their usual check-ups, said the FDA.

Q. For two years in a row, the lab that handles my Pap smears has reported "insufficient cell count." My doctor says it's nothing to worry about, but my health insurance company considers these "abnormal" Paps and has put me in a higher-risk category because of it. Should I be concerned?

A. When lab pathologists evaluate Pap tests for abnormal cells, the goals are to identify cancer that should be removed and precancerous conditions that should be followed closely to watch for any changes. Sometimes the results are unclear because the lab sample doesn't contain enough cells to evaluate ("insufficient cell count") — or because the cells are obscured by inflammation, mucus, or blood from a heavy menstrual period. In these cases, the Pap test is not necessarily abnormal; the specimen is simply inadequate to make any determination.

When it comes to hormone therapy, estrogen gets all the attention. But testosterone is also a player in a woman's sexual response, and testosterone therapy is occasionally considered as a way to treat low sexual desire in postmenopausal women if there is no other treatable explanation for the problem, such as conflict in the relationship, fatigue, depression, or vaginal dryness.

It's important to note, however, that although testosterone may influence certain aspects of sexual response, large studies in women of all ages have not identified a clear link between testosterone levels and sexual desire and satisfaction.

Vaginal dryness is one of the most irritating symptoms of menopause. Here are some ways to relieve it.

Within a few years of menopause, roughly 50% of women develop symptoms related to vaginal atrophy, also called atrophic vaginitis — the deterioration of vaginal tissues due to loss of estrogen. The most common symptoms of vaginal atrophy are dryness, irritation, and pain during intercourse.

Although menopause is the most common cause, vaginal atrophy can result from anything that lowers estrogen production. That includes chemotherapy, radiation, removal of the ovaries during hysterectomy, and use of anti-estrogenic therapies such as aromatase inhibitors, tamoxifen (Nolvadex), and drugs like leuprolide (Lupron) and nafarelin (Synarel), which are used to treat fibroids and endometriosis. Unlike hot flashes, which usually subside with time, vaginal atrophy is likely to persist and become worse without treatment.

Digital breast tomosynthesis may also reduce the number of unnecessary and nerve-racking callbacks for additional testing.

If you're in your 40s, you may want to consider switching from digital mammography to digital breast tomosynthesis (DBT) for your next breast cancer screening, say the authors of a study published online February 28 by JAMA Oncology.

A review of more than 170,000 screening mammograms using the two technologies determined that DBT — sometimes referred to as 3D mammography — did a better job at accurately detecting cancers in women of all ages. The advantages were most pronounced for women in their 40s. DBT was also better at finding cancers in women with high breast density, which can make cancers more difficult to spot on screening exams. High density indicates a larger proportion of active tissue in the breast and is a risk factor for breast cancer.