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CHAPTER 14: Women's Issues

• Women and Men
• Menstrual Problems
• Urinary Tract Infections (UTI)
• Lower Abdominal Pain
• Vaginal Discharge
• Excessive Body and Facial Hair
• Pregnancy
• Domestic Violence
• Menopause
• Hormone Replacement Therapy
• Osteoporosis
• Breast Cancer Screening
• Incontinence Control

This section is in addition to "Sexual Questions," "Health Habits Health Decisions," and "Urine Trouble," which covered Pap Tests, Birth Control, Avoidance of Sexually Transmitted Diseases, Infertility, and Urinary Tract Infections.

Women and Men

The differences between men and women can often make a difference in their health and response to medical care. Their 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. Just before menstruation, headaches, acne, panic attacks, and seizures may get worse. A diabetic woman's need for insulin may increase at this time also. Finally, women who are having a heart attack seem more likely to have upper abdomen pain, sickness to stomach or shortness of breath than men.

Common Problems and Concerns: Menstrual Problems

Cramps. Some women have cramps and aches in their abdomen, breasts, or back. Medicines such as ibuprofen and naproxen help the cramps. They work best if taken just before cramps are expected to start. (You don't need a prescription to get these.)

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."

Please contact a doctor if you notice:

Urinary Tract Infections (UTI)

If there is painful urination without a vaginal discharge, a urinary infection is possible. The treatment of a typical UTI without high fever chills or back pain is quite easy for most women -- drink a lot of fluids and take an antibiotic for a few days. The trick is finding the most convenient approach to treat second or third infections because UTIs often come back. Self-treatment for recurrences is usually very-effective and safe. (See Urine Trouble for more details).

Lower Abdominal Pain

You should contact your doctor if you notice new pain in the lower abdomen. Possible serious causes include infection of the appendix, rupture of a pregnancy that is outside of the uterus, or infection from sexually transmitted disease.

Lower abdomen pain that comes and goes over many months is very frustrating because the causes are sometimes difficult to identify. The timing of lower abdominal pain and the things that make it worse provide important clues to its cause. Does it occur mostly during sex? (See Sexual Questions) When is it worse during your menstrual cycle? Do changes in your bowel movement occur with the pain? Most often the cause of lower abdominal pain is the irritable bowel syndrome. (See the section on Pain).

Vaginal Discharge

The most common causes for a non-bloody discharge from the vagina is infection with bacteria (40-50%), yeast (20-25%), or parasites (15-20%). Except for yeast, most other causes of vaginitis are spread by sex. Therefore, the partner often has to be treated. 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. (See Skin Problems)

Evaluation by a doctor is usually needed -- particularly if you have abdominal pain or you think that it may be a disease spread by sexual intercourse.

Some women try to 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 clortrimazole. Yeast infections may follow the use of an antibiotic. When the antibiotic prescription is finished, the yeast infection usually resolves. Recurrent yeast infections may indicate sugar diabetes.

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. Your doctor also may try a medicine called spironolactone if these approaches are not helpful.

When the problem is more severe or your menstrual cycle is not regular, your doctor will look for some rare causes of excess body and facial hair.

Pregnancy

Many books are available that discuss pregnancy in great detail. If you are trying to become pregnant, to protect the baby you should:

If you become pregnant, you will need regular checkups to help yourself and your baby. You ought to know that by the last three months of pregnancy, 25-40% of women report a lot of discomfort and inability to perform their usual activities. There are many ways to reduce the way this discomfort bothers you. Please talk about these and other problems with your doctor or nurse.

Domestic Violence

Women who have troubles with their relationships and who feel "trapped", controlled may be experiencing physical or emotional abuse. You may worry about what will happen if you speak up. Keeping these feelings inside is a bigger problem. No one has the right to emotionally or physically hurt, or "trap" you. No one should have that kind of power.

Talk to someone about it: family, clergy member, counselor, or your doctor.

You can also contact the National Domestic Violence Hotline (1-800-799-SAFE).

Menopause

About 50% of 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 go away within 5 years. When a woman stops producing estrogen, her risk for heart and blood vessel disease increases. Many women have decreased vaginal lubrication. This can cause intercourse pain and may result in lack of sexual desire. A lack of estrogen can lead to bladder problems such as a frequent urge to urinate or incontinence.

Hormone Replacement Therapy is Controversial

A woman who is nearing menopause has two choices:

Most experts now do NOT recommend HRT with progesterone. For treating the short-term bothers of menopause, 5 years or less of low dose (0.3mg) estrogen is effective and is probably safe. Higher dose estrogen with progesterone can increase the risk for blood clots, breast cancer and heart disease.

Women who have unexplained vaginal bleeding, severe migraine headaches, liver disease, or a recent history of blood clots in the legs should not take HRT.

If you are having typical bothers of menopause and you are near 50 years of age, 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.

Since most menopausal problems go away without treatment, many women do not wish to have hormone replacement. Symptom control is an alternative.

Hot flashes may also be reduced in some women by soy proteins, and herbs (yams, cohatch,clover), and a medicine called clonidine. However, these approaches are quite unpredictable. Low dose estrogen creams and water soluble lubricants can be used to improve the changes in the vagina lining.

Should you use any form of HRT for more than 5 years? 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 and www.4woman.org).

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.

Osteoporosis

Osteoporosis, or thinning of bones, can be prevented by regular exercise and an adequate diet of calcium (1500mg) and vitamin D. Estrogen has an additional beneficial effect. Newer "biphosphonate" medications such as alendronate are now available. They seem to have the ability to increase bone mass without causing some of the problems of estrogen. However, their long-term effectiveness is still a subject of debate.

Women who smoke or who have had a previous fracture unrelated to trauma probably have significant bone thinning that require additional medications such as parathyroid hormone.

Tests to check for thin bones are becoming increasingly available. Women aged 50-65 who have diabetes, who smoke, or have had a recent fracture should have a test for thin bones. At age 65, most other women should consider having this test to check on their bones.

Breast Cancer Screening

The oldest studies showing that mammogram screening for breast cancer saved lives, particularly in older women. These studies also showed that breast examination was important for discovering the disease. Mammography is better for detecting cancer than breast self-examination , but mammogram alone may not be enough. However, many women forget to perform regular breast self-examination. Many women don't have regular checkups by a clinician for breast cancer.

Do try to examine your breasts every month, about 7-10 days after your menstrual period:

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. (Please see example at the end of this section.) 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.

More info? www.NAFC.org

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.