CHAPTER 14: Women's Issues

Women's Issues is a snapshot of some concerns and problems that are unique to women and which do not easily fit in the sections on "Sexual Questions," "Health Habits Health Decisions," and "Urine Trouble." The other sections covered the topics of Pap Tests, Birth Control, Avoidance of Sexually Transmitted Diseases, Infertility, and Urinary Tract Infections.

Contents

CHAPTER 14: Women's Issues

Important Medical Differences from Men

Differences between men and women can make important differences in women's medical care.

Womens' smaller size generally makes women more prone to the effects -- and harmful effects -- of medications, alcohol, and cigarettes.
Depending on their age and reproductive status, women also need different amounts of calcium, iron, and folic acid than men.
Normal hormone cycles make women more likely to have worsening of some problems. For example, headaches and acne may worse before menstruation.
Similar health problems may present differently. For example women who are having a heart attack seem more likely to have upper abdomen pain, sickness to stomach or shortness of breath than men.

Breast Cancer Screening

About 2 of 100 (2%) fifty-year-old women may die of breast cancer by age 80 if her sister and mother did not have breast cancer. The chance is about 4/100 (4%) if her mother or sister had breast cancer and increases even more if they were below age 50 when the cancer was discovered. Modern treatments have reduced these chances for death.

Mammograms (breast X-rays) may also reduce these risks. For women whose mother or sisters have had breast cancer, mammograms should begin at 40. For women without a strong family history of breast cancer, routine mammography every 1-2 years is recommended beginning at least by age 50 and continuing to 80 years of age. There is a great deal of controversy about mammograms for women over age 40 who are at usual risk.

Mammography is better for detecting cancer than breast self-examination. Nevertheless, it it may be of value to perform breast self examination every month, about 7-10 days after a menstrual period:

Stand in front of the mirror. Look at your breasts with your arms raised over your head, then with your arms at your side, and then with hands on your hips with your chest muscles flexed. If you notice any change in the skin of your breast such as dimpling, or a change in the shape or position of your breast, please contact your doctor or nurse.
Lie down with a pillow under your right shoulder, place your right hand behind your head and feel your right breast with the pads of your three middle fingers. Start at the outer edge of your breast and, with a circular motion, move to the nipple. A similar approach is to think of your breast as divided into four sections. Move your fingers from the outside of each section toward the nipple. Then gently squeeze the nipple to look for fluid coming from it. Repeat this approach with your left breast. Tell a doctor if you find any liquid discharge, new lumps or thickening of your beasts.
Some women prefer to check their breasts in the shower with soapy hands because it is easier to glide over the surface of the skin.

Domestic Abuse

Women who have troubles with their relationships and who feel "trapped" or controlled may be experiencing physical or emotional abuse. Most women worry about what will happen if they speak about the problem. However, keeping these feelings inside is a bigger problem.

Women who talk to someone about domestic abuse (with family, clergy member, counselor, or your doctor) find that there are many ways to improve the situation. There are also domestic abuse hotlines.

You can also contact the United States: National Domestic Violence Hotline 1-800-799-SAFE. In Canada: 1-800-363-9010

Excessive Body and Facial Hair

Physicians seldom find a cause for mild excess of facial hair in women who have normal menstrual cycles. Treatments include bleaching, electrolysis, laser, and hair removing creams.

When the problem is severe or the menstrual cycle is not regular, a doctor will consider other causes of excess body and facial hair. A prescription medicine may also be tried.

Incontinence Control

(See Urinary Trouble for discussion of the types of incontinence and medications that can be used to treat it).

Diary. For a week keep a diary of how often you void, how often you leak, and what you are doing when you leak. You are likely to notice a pattern either in the length of time you are able to wait between episodes or the circumstances surrounding these episodes.

For example, if you find that you wet every hour or two, empty your bladder as completely as you can every 30 to 60 minutes. Try to stop the urge to void at unscheduled times by relaxing or distracting yourself. If you are home, try balancing your checkbook until the urge passes. Then void on schedule. If you need to void off schedule, that is, if you become too uncomfortable to wait until the scheduled time, go ahead and use the toilet, but void again as completely as possible at the next scheduled time.

Review your daily log to track your progress. If you note fewer incontinent episodes and have been able to void on schedule for about a week, extend the time between voiding periods by 30 minutes or so each week. Extend the intervals until you reach a comfortable schedule, such as two-and-one-half to three hours between voiding.

The bladder training technique described above can also be made even more effective if combined with pelvic exercises.

Exercise. Kegel exercises are recommended for women to help strengthen the pelvic floor muscles. Once you learn how to do these exercises, they can be done anytime, anywhere and no one will know. Try do perform them 10 times a day.

Two ways to do these exercises are the "elevator" and the "faucet." While practicing, remember that the quality of these exercises is more important than the quantity. Slowly contract the muscles as you would in making a hard fist, not just closing your finger but clenching to bring in every muscle fiber.

"The Elevator." Picture yourself riding in an elevator. As you rise to each floor, try to draw up the perineal muscles, the muscles you feel when stopping urine flow, a little more at each floor. Don't lose any of the tension that you have been progressively accumulating. When you reach the top floor don't just let go, you must go back down the same way. Gradually relax the muscles in stages.

"The Faucet." While sitting on the toilet ready to urinate, practice starting and stopping the flow of urine. During urination, stop and start the flow a few times. Break it off smoothly with no dribbling. Let a smaller amount pass each time. Always concentrate on a strong uplifting contraction of the pelvic floor muscles.

Special clothing and pads. Sometimes bladder training and pelvic exercise do not cure incontinence. In this circumstance, your doctor usually recommends specially designed absorbent underclothing and pads. Many of these garments and pads are no more bulky than normal underwear, can be worn easily under everyday clothing, and free a person from the discomfort and embarrassment of incontinence.

Lower Abdominal Pain

Lower abdominal pain in women has many more potential causes than lower abdominal pain in men. Possible serious causes unique to women include infection of the appendix, rupture of a pregnancy that is outside of the uterus, or infection from sexually transmitted disease.

Often the cause for lower abdomen pain that comes and goes over many months is difficult to identify. Clues to possible cause for recurrent lower abdominal pain include: -the timing of lower abdominal pain and the things that make it worse provide important clues to its cause. -the pain's relationship to the menstrual cycle. -changes in bowel movement occurring with the pain.

Menopause

About 50% of North American women reach menopause (the specific point in time when a woman has her last period) by age 50. Hormone levels (substances that are made by the body to control functions) go up and down. They may temporarily have effects on menstrual cycles, appetite, sleep, sexual interest, mood, and overall sense of well being. A very early sign which is very normal or typical may be "gushing" or a heavy menstruation.

Hot flashes often happen before menopause for 75% of women and almost always go away within 5 years. As estrogen levels decrease during menopause a woman's risk for heart and blood vessel disease increases and there will usually be changes in skin tone and vaginal lubrication. There may also be changes in mood and bladder function.

Medical Treatment of Menopause is Controversial

For medical treatment a woman who is nearing menopause has two choices:

1.Do I use hormone replacement therapy (HRT) for the next few years to reduce the symptoms caused by menopause (hot flashes, sleep disturbances, or thinning and drying problems of the vagina)?

For treating the short-term symptoms of menopause, 5 years or less of low dose estrogen is effective and is probably safe. Higher dose estrogen with progesterone can increase the risk for blood clots, breast cancer and heart disease. Most experts now do NOT recommend HRT with progesterone. Women who have unexplained vaginal bleeding, severe migraine headaches, liver disease, or a recent history of blood clots in the legs also should not take HRT.

No special tests are needed to guide treatment. In the first few months of treatment, hormone replacement may cause bloating, breast tenderness, leg swelling, headache, mild high blood pressure, and irritability. These problems usually decrease after a few months. All hormone replacement approaches can also cause irregular or excessive menstrual bleeding.

2.Do I continue HRT for more than five years to reduce my chances for thin bones and fractures and possibly reduce my chances for memory problems, and bladder control problems?

For women who have had their uterus surgically removed, long term use of estrogen is usually the preferred choice. For all other women the choices and decisions are more difficult. (See examples of a balance sheet in Health Habits and Health Decisions). Estrogen replacement will improve blood fat and will reduce the lifetime risk for hip fracture by about 2% from the expected lifetime risk of 15%. However, estrogen may increase the lifetime risk for uterine cancer. Risk for stroke may also be increased a small amount.

Other Menopause Treatments

Since most menopausal problems go away without treatment, many women do not wish to have hormone replacement. Symptom control is an alternative. Low dose estrogen creams and water soluble lubricants can be used to improve the changes in the vagina lining. Hot flashes may also be reduced in some women by soy proteins, and herbs (yams, cohatch,clover), and a medicine called clonidine.

Menstrual Problems

Menstrual discomfort and cramps. Many women have cramps and aches in their abdomen, breasts, or back. Heat and exercise can help the discomfort. Medicines such as ibuprofen and naproxen help the cramps. They work best if taken just before cramps are expected to start.

Bloating. Other women may gain weight or feel "bloated." Generally, it is better to avoid salt than it is to take "fluid pills" for the weight gain and "bloating."

Medical consultation is usually indicated for:

Unusual bleeding
Pain that is severe and has not been improved with ibuprofen
Spotting between periods for two periods
Missed periods.

Osteoporosis Diagnosis and Treatment is Controversial

Experts agree that osteoporosis, or thinning of bones, can be prevented by regular exercise and an adequate diet of calcium and vitamin D.

Bone density measurement tests to check for thin bones are increasingly available and recommended for women aged 50-65 who have diabetes, who smoke, or have had a recent fracture and all women at age 65. However, there is still controversy about treatment because of the lack very long term studies of medicines (called biphosphonates).

Pregnancy

Many books are available that discuss pregnancy in great detail. When trying to become pregnant, a woman can protect the baby by:

Making sure there is no sexual disease, (sugar) diabetes, or hepatitis B.
Not taking medicines or immunizations unless their safety has been discussed with a doctor or nurse. (For example, avoid live vaccine immunization within 3 months of becoming pregnant).
Not smoking or using any drugs.
Avoiding aspirin, ibuprofen, and related medications during the third trimester.
Having a rubella vaccine.
Taking folate vitamin.

During pregnancy regular checkups are essential. Plan for the fact that during the last three months of pregnancy, 25-40% of women report some discomfort and inability to perform their usual activities.

Vaginal Discharge

Causes:

The most common causes for a bothersome, non-bloody, high-volume discharge from the vagina is infection with bacteria (40-50%), yeast (20-25%), or parasites (15-20%).

Except for yeast, most causes of vaginitis are spread by sex. Therefore, the partner often has to be treated. Venereal disease (VD) should diagnosed and treated by a doctor or nurse.

Typical vaginal discharges:

Bacteria: small volume of white to gray liquid, "fishy" odor.

Yeast: itching, "cottage cheese", odorless

Trichomonas (parasite): sometimes itching, large volume of green watery discharge that may have an odor.

Some irritation of the vagina can be caused by moisture alone -- usually because of very tight-fitting undergarments or nylon underwear and stockings. Perfumed powders may cause a skin reaction.

Treatments:

Some women treat vaginal discharges by a vinegar douche for presumed yeast infection and a baking soda douche (one teaspoon to a quart of water) for all others. Since many mild vaginal discharges clear up on their own, this approach may work in some situations.

Yeast infections are best treated with over-the-counter miconzole or clotrimazole. Recurrent yeast infections may indicate sugar diabetes.

Sexually spread vaginal discharges need to be treated by a doctor or nurse.

We have tried to make the How's Your Health error-free. However, those involved in its preparation can not warrant that all of the information is accurate and complete. When you use How's Your Health as a guide for your health and medical care, be sure to discuss any questions about it with your doctor, nurse, or other health care worker.

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