Women's Health Archive

The North American Menopause Society (NAMS) offered some reassurance that hormone therapy can be safe and effective for symptoms like hot flashes and night sweats, provided that it's prescribed with a woman's individual health in mind.

If you're over 65, you may no longer need to see your clinician for a Pap smear every year, according to new cervical cancer screening recommendations from both the U.S. Preventive Services Task Force and American Cancer Society.

Botox, the same medicine used to smooth wrinkles might also help relieve one type of incontinence overactive bladder.

Dyspareunia is a common problem for many postmenopausal women.

Millions of women experience pain before, during, or after sexual intercourse—a condition called dyspareunia (from the Greek dyspareunos, meaning "badly mated"). This condition not only saps sexual desire and enjoyment, it can also strain relationships and erode quality of life in general. For postmenopausal women, dyspareunia may also raise concerns about aging and body image.

Many women suffer in silence and don't seek the help they need, or they have trouble finding a clinician who can diagnose and treat the causes of their pain. That is unfortunate, because treatments are available for many of the problems that underlie this vexing condition.

Q. I like to look tanned, but I'm somewhat fair-skinned and can't be in the sun much. Are self-tanning lotions and sprays a good idea? Are they safe?

A. Sunless tanning sprays and lotions can make your skin look tanned without exposing it to the sun's harmful ultraviolet (UV) radiation. When you sunbathe, UV rays cause the skin to increase its production of the protective pigment melanin, which manifests itself as a tan. Despite its association with good health and good looks, a tan is actually a sign of skin cell damage, which can increase the risk for skin cancer and accelerate skin aging. The American Academy of Dermatology recommends self-tanning products as an alternative to tanning in UV light from the sun or an indoor tanning bed.

There are many treatments short of surgical replacement.

If your knees have become painful, tender, or swollen, are stiff first thing in the morning, or are making crackling noises, the probable cause is osteoarthritis, which affects more than two-thirds of women over age 60. Osteoarthritis results from the breakdown of joint cartilage, the tough, slippery tissue that protects the ends of bones (see "Anatomy of knee osteoarthritis"). Eventually, the cartilage may wear away completely, permitting bone to rub painfully against bone. The goals of osteoarthritis treatment are to reduce pain and stiffness, limit the progression of joint damage, and maintain and improve knee function and mobility.

About 5% of women in the United States over age 50 have had total knee replacement surgery, the recommended treatment when more conservative measures have failed and pain and disability are intolerable. The number of these procedures has more than doubled over the past decade, according to research presented at the 2012 annual meeting of the American Academy of Orthopaedic Surgeons (AAOS). This is partly because knee replacement works—more than 80% of patients say they're satisfied with the results. But experts say it's also a sign that people aren't fully utilizing the many noninvasive strategies that evidence suggests should be tried first—above all, weight loss and exercise.

This increasingly common disorder often goes undetected in women until serious problems arise.

Older women are learning that cardiovascular disease isn't confined to the chest. Atherosclerosis, once known as "hardening of the arteries," is the disease process at the root of most cardiovascular problems. It affects not only the vessels that feed the heart but also those that serve the rest of the body. When atherosclerotic plaque and blood clots reduce blood flow to the legs or, less often, to the arms, the condition is called peripheral artery disease (PAD). PAD makes walking painful and slows injury healing. In the worst cases, it can result in the loss of a toe, foot, or leg — or even death.

A study suggests that many older women don't need frequent testing.

Bone mineral density (BMD) testing assesses bone strength and is one of the most important factors considered in evaluating a woman's risk for an osteoporotic fracture. Current screening guidelines recommend BMD testing at the hip and spine with dual-energy x-ray absorptiometry (DXA) for all women ages 65 and over — and earlier in women whose 10-year risk of fracture is 9.3% or greater. (You can calculate your 10-year fracture risk with the Fracture Risk Assessment Tool, or FRAX, at www.shef.ac.uk/FRAX. FRAX takes into account several risk factors in addition to BMD.) But until recently, there's been little scientific evidence on how often a woman should be screened.

Options range from doing nothing to surgical repair.

Pelvic relaxation is weakness or laxity in the supporting structures of the pelvic region. Bladder, urethral, rectal, or uterine tissue may then bulge into or out of the vagina. This is called pelvic organ prolapse. It's not a dangerous condition, and it doesn't necessarily worsen over time, but it can drastically affect a woman's quality of life by causing discomfort and embarrassment and limiting sexual and physical activity.

Pelvic organ prolapse was once rarely recognized, and rarely discussed when it was recognized. But today it has become a priority because women are living longer and want to stay active. Many primary care clinicians and gynecologists routinely screen women for symptoms, and a surgical subspecialty called urogynecology has arisen to correct prolapse conditions and the urinary incontinence that often results.

Every year, hundreds of thousands of women in the United States are treated for fibroids — noncancerous growths in the uterine wall. Fibroids don't always cause problems, but when they do, the most common complaint is heavy menstrual bleeding, often accompanied by iron-deficiency anemia. Fibroids can also cause pelvic pain and pressure, and they're associated with miscarriage and infertility. Treatments for fibroids consist mostly of surgery — for example, myomectomy or hysterectomy — and minimally invasive procedures such as uterine artery embolization. Medications called gonadotropin-releasing hormone agonists — in particular, leuprolide (Lupron), given by injection — can help shrink fibroids. However, their use is limited by side effects such as bone loss, hot flashes, and depression. Now, researchers have found that an oral drug with fewer side effects is highly effective in shrinking fibroids and reducing bleeding. This drug, ulipristal acetate, is currently marketed as Ella for emergency contraception. Findings were published in the Feb. 2, 2012, issue of The New England Journal of Medicine.

The study. Belgian researchers tested ulipristal in two industry-funded trials at research centers in Europe. In the first trial, 242 women ages 18 to 50 with bothersome fibroids and bleeding were assigned at random to one of two doses of ulipristal (5 mg or 10 mg) or a placebo for 13 weeks before planned surgery. After 13 weeks, uterine bleeding was under control in 91% of the women receiving the 5-mg dose and 92% of those taking the 10-mg dose, compared with 19% of those taking a placebo. Fibroid size was also reduced — by 21% in the 5-mg group and 12% in the 10-mg group, while it increased by 3% in the placebo group. In the second trial, 307 women with excessive bleeding caused by fibroids were assigned to three months of ulipristal (5 mg or 10 mg) or monthly leuprolide injections before surgery. After 13 weeks, bleeding was under control in 90% of the women receiving 5 mg of ulipristal, 98% of those receiving 10 mg of ulipristal, and 89% of those receiving leuprolide. Women in all three groups also experienced similar reductions in fibroid size and pain. But ulipristal (at either dose) suppressed bleeding more quickly — within a week or less, compared with 21 days for leuprolide. And ulipristal had fewer side effects — especially hot flashes — than leuprolide, which has a greater effect on estrogen levels. A six-month follow-up showed that for women who chose not to undergo surgery, ulipristal was better than leuprolide at maintaining the reduced fibroid size.