Frequently Asked Questions

Please submit any questions regarding women's health issues to our e-mail page. We will update this page on a frequent basis, so be sure to return often!

I've had a hysterectomy. Do I still need PAP smears? There is some controversy over this question, but if you have never had an abnormal PAP smear prior to the hysterectomy, my current recommendation is to have PAPs every 2-3 years. There is still a slight chance of developing abnormal cells in the vagina after a hysterectomy. This can usually be detected by a PAP smear, and the incidence is increased if you have a history of abnormal PAPs.

At what age should my daughter start getting PAP smears? We recommend that a young woman begin getting PAP smears when she becomes sexually active or at about age 18.

How long do I have to take hormones after menopause? This varies from woman to woman and my recommendations will probably change as different products become available which may replace standard hormone replacement therapy (HRT). However, at the present time I recommend HRT for most of my patients and the majority of women will benefit from taking HRT indefinitely. If a woman has an increased risk of breast cancer I would recommend at least considering stopping conventional HRT after 5-10 years since studies show the risks of breast cancer starts to increase after five years of HRT.

I have noticed a significant decrease in libido since menopause. Is there anything that will help this? Decreased sex drive is a common complaint that I hear among menopausal women and is often due to decreased free testosterone levels compared with premenopausal levels. Even though testosterone is considered a male hormone, and too much of it can cause symptoms such as increased hair growth, weight gain, and acne, too little can cause a significant decrease in libido. Testosterone can safely be replaced in small doses and can help dramatically with this problem.

I’ve just started taking birth control pills and I’m bleeding during the middle of the pack. Is this normal? Yes, this is a very common occurrence for the first few months as your body adjusts to the pill. If it continues for more than three months, you should be switched to a different pill.

Is it normal to sometimes spot around the time of ovulation? This is a fairly common problem which usually occurs because of a slight dip in hormone levels that occur in some women during this time. It should only last for one to two days, and is usually very light.

Why does my back hurt so much during my period? This can be due to different things, but some common causes are a retroverted uterus, which is a uterus that is tilted backward instead of forward, endometriosis, which is implants of endometrium (lining of the uterus) found in areas outside of the uterus, and low back strain which just becomes worse around the time of menses.

What is the difference between the new Thin Prep PAP smear and the conventional smear? The Thin Prep PAP smear is processed differently. The cells from the cervix are obtained in the same way as previously but then instead of smearing the cells on a slide which is then stained and viewed through a microscope, the cells removed from the cervix are placed in a solution. The debris, blood, mucous, etc. is washed away and the collected cervical cells are then placed on a slide and viewed by the cytologist. Any abnormalities are then easier to identify since they do not have to try to view cervical cells in a mixture of other debris.

I had a tubal five years ago and I have been told it “comes undone” after five years. Is this true? No, this is not true. While it is true that failures can occur after tubal sterilization, they usually occur in the first 12 months following the procedure. Depending on what type of tubal you had, the failure rate overall is about 1 in 200-300 cases. If there is a failure, it can occur at any time, and there is nothing magic about five years.

I had my tubes tied several years ago and since then my periods have gotten heavier and more painful. Is it related to the tubal? Most of the time, the changes in the menstrual period are not related directly to the tubal. Many women are either on oral contraceptives or depo-provera prior to having a tubal and these forms of birth control usually result in decreased flow and minimal cramps. By going off the pill, many women would have experienced the increase in flow and cramps regardless of whether they had tubal sterilization surgery. However, there are cases where the tubal can affect the menstrual cycle, probably due to an interruption of part of the blood supply to the ovary, resulting in some hormonal changes.

I have a discharge that comes from both of my breasts. What does this mean and is there anything I can do about it? This is most likely a condition known as galactorrhea. It is most commonly seen in non-lactating (not breastfeeding) women during childbearing years. It is important to know what color the discharge is, whether it is intermittent or persistent, and if you have any other symptoms such as irregular menstrual cycles or excessive hair growth. This should be discussed with your health care provider and a thorough exam performed. However, it is not normally a serious problem. It can also be caused by a hormone imbalance or even certain medications.

I always have a headache when I go off of my birth control pills every month. Is this normal and can anything be done to help? Cyclic headache is a very common complaint for many women, whether on oral contraceptives or not. It is due to a decrease in estrogen levels at that time of your cycle. Possibly a change in birth control pills may be helpful.

Another option is to treat the headaches during this time with medications. Avoiding caffeine and reducing sodium intake prior to and during this time may be helpful as well.

My 12 year old daughter has a lump in her breast. What causes this and does it need to be removed? At that age it is probably the development of breast tissue called a "breast bud." The breast bud will occasionally begin to develop on one side first, just as one breast may grow faster than another. There is nothing abnormal with this, but for your reassurance it would be best for her to see her doctor to be examined.

My mother had ovarian cancer in her fifties. I am now 40 and wonder if I should have my ovaries removed? Your concern is understandable. Ovarian cancer is a fear of most women, especially when you have had a close family member with this disease. A few facts may be helpful to ease your mind somewhat:

• A history of two first generation family members is considered high risk.
• If you have ever been pregnant or taken oral contraceptives your risk is significantly decreased.

The option of removing your ovaries is a serious consideration and should be discussed with your doctor. It would not be my recommendation with just the information you have provided. However, I would consider and suggest yearly pelvic exams. A pelvic ultrasound can also be helpful.

Why do I seem to get bladder infections so frequently? The most common cause of bladder infection is from being sexually active. Bacteria is transmitted to the urethra through intercourse. The best way to avoid the infection is to empty your bladder immediately following intercourse. Even drinking an extra glass of water will help flush the bacteria out.

If you are already aware and practicing these techniques and are continuing to have problems, you should let your health care provider know so other testing may be considered.

I have breast implants. Does that increase my risk of breast cancer? There is no evidence in the literature that proves that breast implants, either saline or silicone, increase the risk of breast cancer. In some cases, especially if you have silicone implants which have hardened, it can be more difficult to palpate a lump and it can make mammography a little more difficult.

I was diagnosed last year with breast cancer at age 49. I am now going through menopause and am having terrible hot flashes, mood swings and insomnia. What can I do? First, you should consult with your surgeon about the specifics of your breast cancer concerning hormone receptor status. Some cancers are not hormone dependent and estrogen replacement may be an option.

Usually however, women with breast cancer are very reluctant to even consider hormone replacement and so I recommend they first try some natural approaches such as Vitamin E, Flax seed oil, soy supplements, and black cohosh. If these things do not help, I then would recommend medications such as Bellergal, Clonidine, or Megace.

Please explain about gene testing for breast cancer. My mother and her sister both had breast cancer. Two genes, BRCA-1 and BRCA-2, have recently been discovered which are related to the development of breast cancer. In order for these genes to cause cancer, there must be an alteration or mutation in the gene which can be passed on through generations.

Genetic testing of a woman’s blood can determine whether or not she carries one of these genes. If so, she is at significantly increased risk of developing breast cancer.

This testing is not recommended for the general population and should not be done without appropriate counseling by a genetic counselor. The National Cancer Institute (www.nci.nih.gov) maintains a directory of doctors, nurses, and genetic counselors who are experienced with this type of testing.

What can I do about the swelling in my arm since my mastectomy? Approximately 5% of women who undergo mastectomy and lymph node removal develop a condition called lymphedema. It is very important to protect the arm on the side of the mastectomy from infection which can lead to severe swelling that can be permanent.

If you do suffer from some swelling, it can be helped by decreasing the salt in your diet, wearing an elastic sleeve, and certain exercises. The American Cancer Society (www.cancer.org) has published a series of videotapes demonstrating exercises for women recovering from mastectomy which are helpful in recovering full range of motion and in decreasing swelling.

I recently had a mammogram and was told that I had a simple cyst in my breast. Why was I told to just have a routine follow-up in a year? A simple cyst means that there is a fluid filled sac present in your breast called a cyst. These are very common and they come and go, so if the radiologist only sees a simple cyst, they do not recommend any specific treatment. If the cyst is large or painful, your doctor may recommend aspirating or draining the cyst. It is extremely rare for a simple cyst to become cancerous.

If I take antibiotics do I need to use additional protection other than my birth control pills? Certain antibiotics may slightly alter the effectiveness of the low dose birth control pills, so it is a good idea to use additional protection during a cycle when you must take antibiotics.

What causes hot flashes? We are not certain of the exact cause of hot flashes. It was once believed that low estrogen levels were the cause, but that has not been proven. More likely it is the fluctuation in the levels rather than the absolute level of estrogen that is responsible.

If I develop some vaginal itching or irritation should I use one of the over-the-counter products for yeast? I do not recommend self-diagnosis and treatment of yeast infections. Numerous studies have shown that women are only right in self-diagnosing a yeast infection about 30%-40% of the time. There are numerous other causes of vaginal itching and irritation, so if it is persistent, you should have an evaluation by your health care professional.

How long should I wait after stopping the birth control pill before I try to get pregnant? I recommend that you wait at least 3 months after stopping the pill before attempting pregnancy. This is to allow your body time to reestablish regular menstrual cycles off the pill. If you do not have regular periods within three months of stopping the pill, you should see your health care professional for an evaluation.

Copyright © 1996-2000 by A Woman's View, All Rights Reserved

This page was last updated on February 19, 2000.

Back to A Woman's View home page.