Women with severe obstructive sleep apnea may be at increased risk of dying from a cardiovascular event such as a stroke or heart attack, and treatment with a therapy called continuous positive airway pressure, or CPAP, may reduce that risk. These are the findings of the first study to examine the relationship between obstructive sleep apnea and cardiovascular death exclusively in women. Obstructive sleep apnea causes pauses in breathing during sleep, with symptoms that include snoring and daytime sleepiness. Studies have shown that severe apnea raises the risk of fatal cardiovascular events in men, and that CPAP is protective, but until now, data on women have been lacking. Results were published in the Jan. 17, 2012, issue of Annals of Internal Medicine.

The study. The participants were 1,116 women (average age 57) referred to sleep clinics at two hospitals in Spain between 1998 and 2007. All of the women underwent sleep studies to determine whether they had obstructive sleep apnea. If they did, and if it was sufficiently severe (scoring 30 or higher on a measure called the apnea-hypopnea index, or AHI) or was moderate but accompanied by daytime sleepiness, the women were offered CPAP treatment. CPAP use was tracked by reading a time counter on the device. On the basis of the sleep study and CPAP recommendations, participants were divided into five groups: those without sleep apnea, those with mild to moderate sleep apnea treated with CPAP, those with severe sleep apnea treated with CPAP, those with mild to moderate sleep apnea not treated with CPAP, and those with severe sleep apnea not treated with CPAP. The women were monitored for six years.

Ask the doctor

What can I do about an anal fissure?

Q. I had pain and some bleeding during bowel movements. My doctor says it's an anal fissure. What is that, and what's the best way to treat it?

A. An anal fissure is a tear in the tissue that lines the anal canal, usually resulting from trauma, such as the passage of hard stool. It causes sharp, tearing pain while passing a bowel movement, often accompanied by a small amount of blood on the toilet tissue or surface of the stool. Anal fissures are common and can easily become chronic, because after the first tear, bowel movements reinjure the area. The sphincter muscle beneath the tear goes into spasm, pulling the edges of the tear apart. A cycle of spasm and pain further damages the tissue and prevents healing.

Bedtime is far from relaxing for women with this common condition.

Restless legs syndrome (RLS) is a sensory-motor disorder that causes an irresistible urge to move the legs, often accompanied by an uncomfortable "creepy-crawly" sensation. RLS affects 3% to 5% of adults and is twice as common in women as in men. Symptoms typically flare at night, just as you're settling down in bed, but they may also arise when you're resting in a chair. RLS not only causes discomfort and distress, but can also wreak havoc on sleep, causing daytime sleepiness and mood changes. Fortunately, certain lifestyle strategies can help you manage milder forms of RLS, and several medications can provide relief for more serious symptoms.

Women who undergo breast-conserving surgery (lumpectomy) for early-stage breast cancer usually receive radiation therapy as a part of their treatment. Radiation kills cancer cells left behind after surgery and helps prevent them from causing a recurrence or spreading to other tissues. For example, in a 2011 study in The Lancet involving more than 10,000 women treated with breast-conserving surgery, radiation cut the 10-year recurrence rate by one-third to one-half. Numerous studies have found that mastectomy (which removes the entire breast) is no more effective than lumpectomy plus radiation in improving survival rates. (Radiation may also be given after mastectomy, depending on the size of the cancer or extent of its spread.)

The main serious downside of radiation is potential damage to the heart. Several studies have found that women who receive radiation for breast cancer have an increased risk of heart disease and death from cardiac causes. It's a special concern for women with left-sided breast cancer, because the heart is mostly in the left chest. Since the early 1990s, technical advances have been introduced to lower the risk of exposing the heart to radiation. But it's unclear how much these newer techniques help — partly because heart disease usually develops more than 10 years after exposure, and follow-up studies have been too short. Also, it hasn't been clear exactly how radiation damages the heart.

Aging can be a challenge to body image. For some women, it may bring on — or rekindle — an eating disorder.

Many baby boomers are experiencing a disconnect between how old they feel and the birth date on their driver's licenses. In a 2009 Pew Research Center survey, half of people in their late 60s and early 70s said they felt at least 10 to 20 years younger than their actual age.

Q. I am 76 years old and still get hot flashes. Is it true that women who have hot flashes many years after menopause are more likely to experience heart problems than those whose symptoms end early in menopause?

A. If there is a relationship between hot flashes and the risk of heart disease, it is not very strong, and you shouldn't worry about it.

Q. I have varicose veins and would like to get rid of them. Could that lead to venous insufficiency?

A. Having varicose veins removed doesn't make you any more likely to develop venous insufficiency. It might even help to reduce the likelihood of developing chronic venous insufficiency by removing a source of increased pressure in the leg veins. Whether you go ahead with treatment or not, there are some things you can do to help reduce the risk of vein problems progressing or recurring.

Eating disorders don’t afflict only adolescents and young women, but plague older women, too, and may be shrouded in even greater shame and secrecy. Many women don’t seek help, especially if they fear being forced to gain weight or stigmatized as having a “teenager’s disease.” As reported in the February 2012 Harvard Women’s Health Watch, clinicians are reporting an upswing in requests from older women for help with eating disorders. For some of these women, the problem is new; others have struggled with anorexia, bulimia, binge eating, or another eating disorder for decades. Eating problems at midlife and beyond stem from a variety of causes, ranging from grief and divorce to illness, shifting priorities, and heightened awareness of an aging body.

Women over age 50 are having sex — and developing STIs — at a higher rate than commonly believed.

The notion that women lose interest in sexual activity after menopause has collapsed under scientific scrutiny. In a survey of 27,000 women enrolled in the Women's Health Initiative (WHI), more than 60% of women in their 50s, 45% of those in their 60s, and 28% of women in their 70s reported that they were sexually active, and almost two-thirds said they were happy with their level of sexual activity. Of those who were dissatisfied, more than half said they would prefer having sex more often. The study was reported in Menopause: The Journal of the North American Menopause Society (November 2011).

Q. Ten years ago, I had uterine artery embolization to get rid of uterine fibroids. How long do the plastic particles they inject into the arteries stay in the body? Do they dissolve?

A. Uterine artery embolization (UAE), also called uterine fibroid embolization, is a minimally invasive treatment that shrinks uterine fibroids by cutting off their blood supply. During UAE, an interventional radiologist inserts a catheter into the femoral artery through a small nick in the skin at the groin and guides it into one of the two uterine arteries, which supply blood to the uterus. Contrast dye is injected to help visualize the uterine artery as well as the smaller branching vessels that feed the fibroid. The radiologist then injects tiny synthetic particles, or beads, which concentrate in the smaller vessels, forming a clot that cuts off the fibroid's blood supply. Lacking blood, the fibroid gradually shrinks.