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| Barbara Kantrowitz and Pat Wingert |
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Questions and Answers
Q: I'm an African-American woman, and I've heard that we're much less likely to get osteoporosis than Caucasian or Asian women. Is this true even if I'm tall and thin?
A: Generally speaking, African-American (and Hispanic) women are less likely than Caucasians to get osteoporosis. Among women 50 and older, about 20 percent of non-Hispanic Caucasian and Asian women develop osteoporosis, and 52 percent have low bone mass. About 10 percent of Hispanic women have osteoporosis and 49 percent have low bone mass, whereas only 5 percent of African-American women have osteoporosis and 35 percent have low bone mass. Overall, African-American women experience only a third as many fractures as white women do.
But you're smart to zero in on your body type. The main reason that fewer African-American women are diagnosed with osteoporosis is that they tend to have higher bone mass. But this isn't true of all African-American women. Because of the stereotype that osteoporosis is a Caucasian woman's disease, health-care providers are less likely to focus on detection and prevention of bone mineral density problems in minority women. Even after sustaining a fracture, African-American and Hispanic women are less likely than Caucasians and Asians to get referrals for treatment of osteoporosis. So be proactive and bring up the subject with your doctor.
Posted 10/1/2007
Q: I've read that abnormal bleeding is the most common symptom of endometrial cancer, but doesn't every perimenopausal have abnormal bleeding? How do I know when to mention it to my doctor? I'm afraid he'll say, "Of course you have abnormal bleeding, you're going through menopause," and I'll feel like an idiot.
A: You're right that irregular bleeding is typical during perimenopause and that it's a common warning sign of gynecological cancer. The fact that you're in perimenopause does not mean you can't also have cervical, ovarian, vaginal, endometrial, or uterine cancer too. In fact, many of these cancers become most prevalent between ages 45 and 65. But it's also true that most irregular bleeding is not a sign of cancer. Only your doctor can assure you that your current bleeding pattern is no big deal. Depending on your particular situation, your doctor will likely do a pelvic exam and run some blood tests, and maybe request a biopsy or an ultrasound. You may also be asked to wait a few weeks or months to see if the abnormal pattern continues before you have more tests.
If a biopsy or ultrasound indicates that you're unlikely to have cancer, take that as reassuring news; however if the abnormal pattern continues it's your job to keep brining it up to your doctor. Some cancers take years to develop to the point where they can be detected. If abnormal bleeding continues, you may need to be repeatedly re-tested. About a third of premature malignant growths are discovered on the second, third, or fourth round of testing. The trick here is to be vigilant without assuming the worst. Chances are, this is nothing to worry about—but you want to keep this issue on your doctor's radar screen.
Finally, you should be able to bring up any concern with your doctor without fearing ridicule. If you don't feel comfortable doing that, it's time to think about finding a new doctor.
Posted 9/24/2007
Q: I'm noticing a drop in sexual desire, but I don't want to use hormones, drugs, or herbs. Are there any alternatives?
A: Sexual desire involves a lot more than hormones, as you no doubt came to realize long ago. The quality of your relationships, your upbringing, how you feel about your body, the amount of stress you have, whether you are depressed, and how much sleep you're getting all play a huge part. Try to assess how long you've had this problem. Is it constant, or does it come and go? For some perimenopausal women, hormone levels can zigzag from month to month, causing temporary problems that may disappear on their own, only to reappear again. If that's not your situation, make a list of what's going on in your life that may be dampening your enthusiasm for sex. If you have a partner talk openly about your concerns and ask for feedback. Remember that when you don't discuss these things, your partner may misinterpret your lack of interest as rejection.
You can also consider doing some of those things that you should be doing anyway, like losing a little weight, cutting back on fatty foods, or drinking less alcohol. These steps may help a lot. And then there's exercise which increases blood flow throughout your body, including the genital area. If sleep deprivation is on your list, try some relaxation. Take the time and trouble to set up romantic interludes. Rethinking your priorities may mean putting a romantic weekend getaway at the top of your to-do list.
Another option is a consultation with a certified sex therapist or a counselor who can tailor a program to your situation and recommend effective exercises to help you increase intimacy. Some therapists encourage overstressed women (in otherwise healthy relationships) whose libidos are flagging to simply "do it." They believe that even if you're not in the mood, the act of having sex is likely to put you more in the mood. On the other hand, if you think depression, anxiety, or relationship problems are the barrier, consider therapy.
Make sure that your disinterest in drug therapy doesn't keep you from talking about this problem with your doctor. There are lots of medical issues beyond hormones that could be at work here—everything from chronic fatigue syndrome to depression to a serious vitamin or mineral deficiency. After going over your medical history for clues and making sure that none of your medications is the culprit, your doctor may refer you to a specialist for more help. Be sure to bring along some notes so you can discuss what you've tried on your own.
Posted 9/17/2007
Q: I'm 49 and having periods every couple of months. I'm also having hot flashes. What's the best remedy?
A: You should first try non-drug measures: get more exercise, stop smoking, learn stress-reduction techniques. If none of these work and hot flashes are really interfering with your normal functioning, your doctor may suggest medication. As long as you're ovulating and could get pregnant, you still need to worry about contraception. A low-dose birth-control pill would solve both problems for now. Generally, doctors do not prescribe menopausal hormone therapy for women in your situation because the estrogen wouldn't be potent enough to inhibit ovulation and you could still get pregnant.
Many women in their 40s and 50s may be reluctant to take birth-control pills because they remember that, many years ago, the pills were considered dangerous if you took them after age 35. That's no longer the case. Today's lower-dose pills are considered safe for midlife women who need contraception, as long as they don't smoke and are not at risk for blood clots. And birth-control pills can have some health benefits as well. Research has shown that they may reduce the risk of ovarian cancer, endometrial cancer, and pelvic inflammatory disease.
Posted 9/10/2007
Q: Pregnancy tests can tell if you're pregnant. Can a menopause test tell you that you're not going to have any more periods?
A: Neither a single blood test at the doctor's nor one over-the-counter kit can definitively confirm that you've reached menopause. What you can learn is whether you have an elevated FSH level at the exact time of the test. But because FSH levels fluctuate considerably during the course of a month (and because your cycles become less predictable during perimenopause), no single test can give you the whole picture. You might just happen to test on a day when your FSH is high, and it could fall again the next day. As a result, clinicians look for more than an elevated FSH level to determine whether or not you've reached menopause.
Posted 9/4/2007
Excerpted from the book IS IT HOT IN HERE? OR IS IT ME?
© by Pat Wingert and Barbara Kantrowitz
Workman Publishing
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