Women’s Health

Heidi Godman

New guidelines recommend Kegels, other lifestyle treatments for urinary incontinence in women

New guidelines from the American College of Physicians offer drug-free ways women can use to reduce or stop urinary incontinence, a potentially embarrassing condition that affects millions of women. The guidelines recommend that women first try Kegel exercises, bladder training, exercise, and weight loss if needed. These approaches can work for both of the leading types of urinary incontinence: stress incontinence (leakage with laughter, sneezing, or other things that put pressure on the bladder) and urge incontinence, also known as overactive bladder, which is caused by unpredictable contractions of muscles in the bladder wall. Other lifestyle changes, like watch fluid intake and minimizing bladder irritants like caffeine, alcohol, carbonated drinks, and other may also help. If these approaches aren’t effective, the next step might be treatment with medication, surgery, or even an injection of botulinum toxin to relax overactive bladder muscles.

2 Minute Medicine®

Myth busted: bra wearing not linked to breast cancer

According to one persistent Internet myth, women who wear bras are more likely to develop breast cancer. Not true, says a study published online in the journal Cancer, Epidemiology, Biomarkers, and Prevention. In a study of more than 1,500 women, researchers from the Fred Hutchinson Cancer Research Center in Seattle found no links between risk of two common types of breast cancer — invasive ductal carcinoma or invasive lobular carcinoma — and any aspect of bra wearing, including cup size, use of a bra with an underwire, age at first bra use, and average number of hours per day a bra was worn. This may not be the last word on the subject, since the Fred Hutchinson study represents only the second to look at the connection between bra use and breast cancer. But until other findings appear, women worried that wearing a bra might cause cancer have one less thing to worry about.

Howard LeWine, M.D.

Expert panel says healthy women don’t need yearly pelvic exam

The annual pelvic exam, an oft-dreaded part of preventive care for women, may become the as-needed pelvic exam, thanks to new guidelines from the American College of Physicians. For decades, doctors have believed this exam may detect problems like ovarian cancer or a bacterial infection even if a woman had no symptoms. But an expert panel appointed by the American College of Physicians now says that healthy, low-risk women do not need to have a pelvic exam every year. The exam isn’t very effective at finding problems like ovarian cancer or a vaginal infection, and it often causes discomfort and distress. Sometimes it also leads to surgery that is not needed. The new guidelines only apply to the pelvic exam, and only in healthy women.

Heidi Godman

For women, sexuality changes with age but doesn’t disappear

Some people assume that women become less interested in sex as they age. That may be true for some women, but it isn’t for others. New research published in JAMA Internal Medicine reports that women between the ages of 40 and 65 who place greater importance on sex are more likely to stay sexually active as they age. In other words, if it’s important to you, you’ll keep on doing it. There are many reasons why sex may slow down for women when they get older, not least of which is menopause. It can cause decreased interest in sex and physical problems that make sex difficult, or even painful. Poor health can also get in the way of having sex. So what’s a woman to do? Seek treatment, which may not be as complicated as you think.

Howard LeWine, M.D.

New guidelines aim to help women prevent stroke

The first-ever guidelines for preventing stroke in women don’t fool around. They offer ways to prevent this disabling and potentially deadly event from adolescence to old age. More than half of the 800,000 Americans who have strokes each year are women. Nearly 4 million American women are living with the aftermath of a stroke. And because women live longer than men, their lifetime risk of having a stroke is higher. Those numbers are why stroke prevention is especially important for women. The guidelines cover the use of oral contraceptives, high blood pressure during pregnancy, the use of hormones after menopause, and migraine with aura. They also cover the fundamentals of stroke prevention, like controlling blood pressure, exercising more, eating a healthy diet, and not smoking.

Stephanie Watson

Radiation for breast cancer can increase heart risks

Radiation, on its own or coupled with other treatments, has helped many women survive breast cancer. Yet radiation therapy can cause the appearance of heart disease years later. New research published in JAMA Internal Medicine estimates that the increased lifetime risk for a heart attack or other major heart event in women who’ve had breast cancer radiation is between 0.5% and 3.5%. The risk is highest among women who get radiation to the left breast—understandable, since that’s where the heart is located. The heart effects of radiation begin emerging as soon as five years after treatment. However, future heart risk should not be the reason to abandon this important component of treatment. Cancer experts are doing more and more to minimize the amount of radiation the heart receives.

Stephanie Watson

Women often fear sex after a heart attack

A heart attack can be a frightening wake-up call with long-lasting aftereffects. It’s no surprise that women often tread gently after having a heart attack—and many don’t tread back into the bedroom for sex. Up to 60% of women are less sexually active after a heart attack, often due to worries that sex could trigger a repeat heart attack. A new study suggests that although women believe sex is important for resuming a sense of normalcy and intimacy with their partners, many are fearful that it would be too much for their hearts to take. Reassurance from a doctor is sometimes all that’s needed to ease those fears. How does a woman know if she’s physically ready for sex after a heart attack? It’s safe to have sex if you can work up a light sweat without triggering symptoms like chest pain or shortness of breath.

Howard LeWine, M.D.

For early breast cancer, lumpectomy is at least as good as mastectomy

When it comes to fighting cancer, “get it out” is a common and understandable response. It’s what prompts some women with early-stage breast cancer to choose mastectomy, an operation to remove the entire affected breast. Results from the largest-ever observational study offers reassurance to women who choose a more conservative approach—removal of just the tumor and some tissue around it (lumpectomy) followed by radiation therapy. In fact, the study showed that, as a group, women who chose lumpectomy plus radiation had lower death rates from breast cancer and all causes than women who chose mastectomy. The women who appeared to reap the biggest survival benefit from lumpectomy plus radiation therapy were those over age 50 with estrogen-positive breast cancer, with 13% lower mortality from breast cancer and 19% lower for all causes. The results were reported online today in the journal Cancer. For early-stage breast cancer, mastectomy has been proven to cure or at least retard the disease. It’s a reasonable and understandable choice, especially given how well breast surgeons today can reconstruct a breast. For women who choose to have lumpectomy plus radiation therapy, the new study provides yet more scientific reassurance that this approach is at least as good as mastectomy.

Stephanie Watson

Fear of breast cancer recurrence prompting women to choose prophylactic mastectomy

Living through the physical and emotional toll of breast cancer is so traumatic that some women can’t bear the thought of doing it again. That’s why a growing number of women who have already been diagnosed with cancer in one breast are taking the drastic measure of having both breasts removed (a procedure called prophylactic mastectomy). Yet a University of Michigan study presented last week at the American Society of Clinical Oncology’s Quality Care Symposium showed that nearly three-quarters of women who had this procedure were actually at very low risk of developing cancer in the healthy breast. In other words, many women are unnecessarily exposing themselves to the potential risks of a double mastectomy—including pain, infection, and scarring. The new study suggests that more and better information about breast cancer recurrence—and the risks and benefits of prophylactic mastectomy—are needed as women consider this procedure.

Stephanie Watson

Researchers explore blood test to detect early breast cancer

Researchers at Kansas State University have developed a blood test that rapidly detects breast cancer (as well as non-small cell lung cancer) in very early stages, long before symptoms appear or the cancer can be seen by other methods. The experimental test identifies enzyme patterns that differ from one type of cancer to another. According to the researchers, the test can detect very early breast cancers (stages 0 and 1), as well as early lung cancers (stages 1 and 2), within an hour, with 95% accuracy. However, they tested only 32 participants with various stages of breast or lung cancer, as well as 12 people without cancer. Whether finding cancer that early makes a difference for treatment and survival remains to be seen.