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Cleveland Clinic offers online informational web chat events that give you an opportunity to get answers to any health concerns from Cleveland Clinic physicians and professionals. These popular online health chats cover a wide range of medical topics, from dieting and exercise to cancers and checkups...and more. Cleveland Clinic also offers electronic newsletters that cover a wide range of topics designed to keep you informed about the latest news in healthcare.

Treatment Guides

For reliable information on specific diseases, conditions and treatments, Cleveland Clinic offers many free guides and newsletters covering a broad range of health information.

Health Conditions Common in African-American Women

For more information about the common diseases and health conditions in African-American women, click on a topic below.

Clinical Trials

Uterine Fibroids

Currently we are enrolling patients in a study to gauge the effectiveness of new therapies for uterine fibroids. Get more information and find out if you qualify.

Other Programs Available

Cleveland Clinic's Be Well Moms SM program will give you the information you need to optimize your weight and health before and during pregnancy, and after delivery. Too often, women who are significantly overweight feel there is nothing they can do about it – they’ve tried everything. Our goal is to educate and empower you on what a healthy weight for you is.

In the News


Frequently Asked Health Questions

Following are some of the more frequently asked women's health issue questions and answers from our on-line health chat archives.

Birth Control

Q: I have been getting the Depo Provera shots for two years now, and will not be getting another one as my husband and I are going to try to have a baby. How long does it take for the Depo to get out of my system? How long before I could conceivably become pregnant?

A: Dr. Bradley: Depo Provera is an excellent method of birth control. Usually, the method will be effective for 12-16 weeks. However, it is not uncommon have the effects on the menstrual cycle for 6 -18 months following the last injection. If you are planning for pregnancy soon, I would recommend that you stop the Depo Provera shots soon.

Q: How young can a girl safely go on birth control pills, when being used to help regulate her period? How long can she stay on it?

A: Dr. Natalie Bowersox: At the risk of sounding vague-that depends! I have had patients as young as 13 on a birth control pill to manage their periods. There is not a time limit of how long it is "safe" to be on birth control pills. I usually tell patients that they should stay on the pill until their symptoms are controlled or until they do not need it anymore.

Q: Any new contraceptives on the market?

A: Dr. Linda_Bradley: Mirena® (progesterone only intrauterine contraception - IUC) have gained renewed interest by physicians and marketing (commercials.) It is very safe method of contraception, inserted by a health care professional in the office and provides 5 years of hassle free contraception. Additional benefits include very light menstrual cycles, decreased menstrual cramps and 99.9% pregnancy avoidance. It is reversible. The other newer contraception is Implanon®, a single rod is inserted in the arm and provides 3 years of contraception. There are also 2 new sterilization procedures that do not require incisions on the abdomen. They are performed with a hysteroscope (Essure® and Adiana® procedures.) The Adriana procedure was just released July 6, 2009. These two sterilization procedures take less than 20 min. to perform in the office by a qualified gynecologist.

Q: Regarding the new sterilization procedures, how do they work to prevent pregnancy?

A: Dr. Linda_Bradley: Both sterilization procedures block the fallopian tubes. The Essure® procedure utilizes a metal coil with a matrix embedded that will block the fallopian tube. The Adiana® device utilizes heat plus a matrix that blocks the tube. Both require a confirmation test - HSG (hysterosalpingogram) 3 months after hysteroscopic sterilization. Patients must use a contraceptive method for 3 months after the procedure until the HSG confirms tubal occlusion.

Q: Is it common for IUD removal to delay normally-regular cycles? If so, are there an average number of cycles it takes to return to normal?

A: Dr. Linda Bradley: There are two types of IUD's currently available. One is the copper IUD which usually when removed results in regular menstrual cycle. The progesterone IUD may require 2-3 months before re-establishing normal menses. However, again, if you are perimenopausal periods may skip. Also you need to check for pregnancy if your IUD has been removed and your periods have not returned to normal.

Breast Health

Q: Two years ago I had a breast reduction (Size Double I to B). They had to remove my nipples and put them back on. During the healing process, they were black and it was unsure if they would take. After about 3 weeks they were turning pink. Now, I am getting a smelly discharge from them. Is this normal, or does it indicate a problem?

A: Dr. Bradley: Any discharge from the breast related or even unrelated to surgical procedures should always be evaluated. Is it normal? There are very few reasons for having a discharge i.e. recent breast feeding or recent surgery less than six months. It is recommended to see your doctor for an examination and additional testing.

Q: What are the current recommendations for breast cancer screening?

A: Dr. Devorah Wieder: Monthly self-exams have been under fire lately, but the truth is, most women find breast lumps themselves. The best time to examine your breasts is after your menstrual cycle is finished. Have your breasts examined by a healthcare provider at least once every three years after age 20, and every year after age 40. Have a baseline mammogram at 35 if there is a family history of breast cancer, and a screening mammogram every year after 40 in all women.

Fibroids

Q: My GYN doctor has mentioned I have some small fibroids but they are not clinically significant. If they begin to grow or cause problems, what type of symptoms will they cause?

A: Dr. Linda Bradley: Fibroids are found in 50-80% of women. Luckily, most women have no symptoms. Most common symptoms can be change in menstrual bleeding (intensity, quantity & duration), cramps, infertility and cosmetic effects (markedly enlarged abdomen). And urinary frequency, constipation and pelvic pain. As you can imagine there are many conditions that can mimic fibroid related symptoms. It is best to check with your doctor to determine if the fibroid are a culprit for symptoms. We do not endorse therapies such as hysterectomy or fibroid removal when patients are asymptomatic. We believe "if fibroids do not bother you, we do not bother them."

Fecal Incontinence

Q: I have two children (both delivered vaginally). The last birth required the use of forceps and now I have a mild rectocele and have difficulty with incontinence (mostly urine, sometimes stool). What types of treatment are available to help with this?

A: Dr. Megan_Tarr: The mild rectocele and the fecal incontinence may or may not be related. I would advise that you seek consultation from a pelvic reconstructive surgeon. Many times, fecal incontinence can improve with dietary manipulations and medications. Fixing the rectocele may help reduce the stool trapping and reduce the sensation that a bulge is present.

Fertility

Q: My husband and I have been trying to get pregnant for well over a year. I am concerned that we may have a problem. What is our next step?

A: Dr. Julie Tan: Difficulty conceiving a child is not uncommon. There are millions of couples each year that are unable to become pregnant without medical assistance. Infertility is generally defined as not conceiving after one year of unprotected intercourse. At this point, couples may benefit from an infertility evaluation. Standard testing done by our Cleveland Clinic fertility specialists includes some blood work for hormone level, a hysterosalpingogram (HSG) to evaluate the uterine cavity and document that the fallopian tubes are open, and ,for your husband, a semen analysis to assess the number and quality of the sperm. The HSG is performed in the X-ray department by injecting X-ray dye through the cervix while observing on a TV monitor. Additional tests may be recommended by fertility specialists based on the individual patients’ history, physical examination and the results of previous testing. These may include additional blood work, ultrasound of the uterus and ovaries or laparoscopy.

Q: What is a desired range of progesterone levels for pregnancy to occur?

A: Dr Cynthia Austin: I assume that you are asking how high a woman's progesterone should be during the second half of her cycle. The answer is that there is no right level. Progesterone levels rise and fall throughout the day so measuring the level does not tell us if there is enough progesterone. If your progesterone level is checked, it is either in the post-ovulatory range or it is not (indicating that you did not ovulate). The more important issue is how long your cycle is between ovulation and the onset of your next period. It should be 12 to 14 days.

Q: Does taking birth control pills for a long time have an effect on fertility? How about the Depo-Provera® (medroxyprogesterone) shot?

A: Dr Cynthia Austin: Birth control pills do not cause infertility. In some cases, women may ovulate best when they first stop taking birth control pills. Women who have irregular periods and go on birth control medications to regulate their cycle often have the same irregular cycles when they come off. If a woman is having irregular cycles, she is either not ovulating or not ovulating regularly. Depo-Provera is an injection of synthetic progesterone. It does not damage fertility, but it can take a long time for it to wear off. If a woman was given Depo-Provera to treat irregular bleeding, she will probably have that same problem when it wears off.

Q: What vitamins/herbal supplements if any do you recommend for women experiencing conditions such as endometriosis and diminished ovarian reserve (DOR)?

A: Dr Cynthia Austin: All women attempting pregnancy should take vitamins containing 400 mcg of folic acid. Unfortunately, herbal supplements do not improve either endometriosis or DOR. Some herbal supplements may contain estrogen, which you would not want to be taking in addition to fertility medications.

Q: I have been temping during my treatments still to help detect ovulation. I am on Clomid now. Does Clomid mess with your temperatures during use?

A: Dr Cynthia Austin: Have your doctor or nurse take a look at your charts. If you are having regular cycles on Clomid you are almost certainly ovulating. Temperature charts are not perfect, but at least they are free.

Q: Is there any possibility of becoming pregnant if the female has one blocked fallopian tube? If so, what is the percentage rate?

A: Dr Cynthia Austin: Women with one normal functioning tube usually get pregnant almost as well as other women. In other words, if a normal fertile woman has one tube removed, she usually does not have trouble becoming pregnant. If a woman having difficulty becoming pregnant has one blocked tube, it may suggest that the other tube, while not blocked, is also damaged.

Healthy Eating Choices

Q: What foods do you recommend to be filling, low in calories and nutritious?

A: Dr. Margaret_McKenzie: Oh those vegetables – fibrous: brussel sprouts, cabbage, sweet peppers, romaine lettuce, onions, radishes, beets. Eat veggies with every meal and yes have all veggie days weekly. Get creative with flavors to help keep them not being so boring and try various prep methods such as stir fry, raw, broil after marinating, etc. Remember when we do raw we tend to add dressings, so stick with low calorie ones. (Note I did not say low fat.)

Q: What advise can you offer someone who is extremely overweight that mostly eats proteins, fruits & veggies (pretty much lives on salads and vegetables) that cannot exercise except in a pool due to other health conditions?

A: Dr. Margaret_McKenzie: Limit the number of fruits per day to 2 - 1 in the morning 1 hour after breakfast and 1 hour after lunch. Make it a hard chew: apple, pear etc. Stay away from high sugar fruits like mandarin oranges, grapes, cherries, watermelon etc. as we tend to over eat them.

HPV (Human papillomavirus)

Q: Can you please talk about the safety of the HPV vaccine? My daughter (who is 14) has gotten the first shot. A coworker told me the she didn't want her daughter (who is 12) to have it because of safety reason. I am now rethinking my decision.

A: Dr. Linda_Bradley: The HPV vaccine represents one of the greatest bench to bedside breakthroughs for women. Just think about it - we have eradicated Polio, chicken pox, measles, mumps and rubella infections all with a vaccine. We now know that cervical cancer is caused by a HPV virus. This vaccination helps prevent cervical cancer. While there are minor aches, pains, redness in the inoculated area, major safety issues have not been raised.

Q: Is there any relation between chronic cervicitis and HPV?

A: Dr. Linda_Bradley: Chronic cervicitis is a non-specific finding on PAP smears. If it coexists with a vaginitis (bacterial vaginosis, yeast, trich) then cervicitis may be noted. However, if there are no vaginal complaints, the HPV virus is not present and there are no cervical lesions then we ignore these findings.

Q: I have had a cone biopsy for dysplasia. Would that be from HPV?

A: Dr. Linda_Bradley: Most causes of dysplasia are due to the HPV virus. It is only recently that we have been able to test for the presence of the HPV virus. If you have had a cone biopsy (or LEEP procedure) then make sure that you get PAP smears regularly as well as HPV testing.

Q: Is there value to testing for HPV in the absence of any clinical findings?

A: Dr. Linda_Bradley: Yes - the current recommendation is to begin HPV testing at age 30 years when the traditional PAP is performed. HPV is very common. Approximately 50-70% of women will acquire an HPV infection during her lifetime. For most women, the virus clears up.

HPV testing is done until 65-70 years unless sexually active.

Hysterectomy

Q: After having a hysterectomy in 2001, I sometimes experience the same symptoms as before (abdominal pain, swelling, nausea). If the hysterectomy was done to eliminate the possibility of getting cysts and tumors again, what could be happening to me? Can they actually come back after a hysterectomy?

A: Dr. Bradley: A hysterectomy only removes the uterus and cervix. This is called a partial hysterectomy. Your ovaries are left intact and still function. Therefore, some women after a hysterectomy will still have PMS-like physical and emotional symptoms such as bloating, abdominal pain, swelling, nausea and mood swings. Luckily, there are medicines for PMS. See your physician. The reason for not removing the ovaries is that they serve a vital function. The ovaries make estrogen. Currently most gynecologists do not remove the ovaries until age 55 if a hysterectomy is needed. Premature removal of the ovaries often causes lower estrogen levels leading to hot flashes, night sweats, decreased libido, increased risk of osteoporosis and other menopause related symptoms.

Menstrual Pain

Q: How can I know if the menstruation pain is because I have tumors or ovarian (cysts)?

A: Dr. Bradley: Most women have menstrual pain (cramps) with menstrual cycles. If the pain is not easily relieved with other the counter (OTC) meds like Aleve, Motrin or Tylenol ... or if you are unable to participate in work, travel, hobbies, sports... then you should see your physician. There are many reasons for more significant menstrual pain such as fibroids, endometriosis or ovarian cysts. A physical examination and ultrasound might be required to determine the cause of the menstrual pain.

Q: My daughter is 18 and she has strong pain every month. The doctor had said she probably has some (cysts) in her ovaries. Can this be true if she is very young?

A: Dr. Bradley: Yes. Beginning with the onset of menstruation until menopause, ovarian cysts are made monthly. This is normal. Cysts are usually not cancerous and are small. When they enlarge more than 5 centimeters doctors may advise birth control pills and a repeat transvaginal ultrasound to determine if the cyst resolves. Although normal, many women do make cysts. Frequently, physicians will recommend low dose birth control pills (BCP's) to suppress the formation of cysts. Luckily, 90% of women who take BCP's will favorably respond and have decreased pain. Often a combination of BCP's and OTC products (Aleve, Motrin, and Tylenol) will relieve the menstrual cramps or pain.

Q: Is it normal to experience rectal pain during your menstrual cycle? This is the only time the pain occurs, and is sharp shooting pain and usually never lasts longer than 10 seconds... it's also more frequent when I need to release bowels.

A: Dr. Bradley: Rectal pain may be normal however endometriosis can also be the cause of rectal pain during menses. See your physician for a physical examination, including a rectal exam would be important. The physician will be checking for rectal nodules, tenderness and rectal masses. An ultrasound may also be ordered to determine the presence of masses.

Menopause

Q: When does menopause typically begin and how do you know you are in menopause?

A: Dr. Bradley: The definition of menopause is the absence of menstruation for 12 consecutive months. The average is 51 years; however by age 51 only 80% of women have stopped their periods. By age 55, 95% of women have stopped their periods. By age 58, 100% of women should stop menses. Please note that 1% of women at age 40 have stopped their periods and 10% by age 45. Our bodies are not like a light bulb. Menopause does not 'just happen.' But a 'gradual change' will occur. This time is termed Perimenopause. Premenopausal changes (hot flashes, night sweats, vaginal dryness, and menstrual irregularities) do occur 7-10 years before menstruation completely stops.

Q: Vaginal estrogen did not help painful vaginal dryness. HRT helps, but I have been on it for 10 years. Are there any other choices?

A: Dr. Bradley: There are three ways to take vaginal estrogen (vaginal creams, vaginal rings or vaginal tablets.) I would recommend switching from whatever product you are currently using to another product. Sometimes it is trial and error to determine which product will work best for you. In addition, an OTC (Over-the-Counter) vaginal moisturizer (without estrogen) will help to hydrate the vaginal tissue in combination with a vaginal estrogen product may improve symptoms. However, please note that up to 30% of women will still require a systemic (oral or patch) estrogen to improve symptoms. Unfortunately, for some women topical products will not be enough. Some OTC products include Replens, Astroglide, Lubrin or WET.

Menopause and Fibromyalgia

Q: Is Fibromyalgia part of the menopause symptoms??

A: Dr. Bradley: Some patients during menopause will experience muscle aches and joint stiffness. Fibromyalgia has many additional symptoms that are unrelated to menopause. Only your physician can differentiate between menopause and Fibromyalgia related symptoms.

Metabolism

Q: What other factors might you contribute to a person averaging eating 1300 calories per day that weighs in excess of 350#?

A: Dr. Margaret_McKenzie: Slow metabolism! Just not consuming enough calories, you will be starving at this low caloric intake and then you will overeat at the next meal. Also, how much fiber is in those 1300 calories? The more the better! Ask for help from a doctor and nutritionist, who usually treat weight challenged patients and they can help you figure this out.

Organ Prolapse

Q: I've heard horror stories about women having problems with the synthetic mesh used in many sling procedures. How common are mesh problems?

A: Dr. Megan_Tarr: This is a very important topic in pelvic reconstructive surgery. The concern is mainly focusing on synthetic meshes that are placed vaginally for prolapse repair. The recent reports focus on the high rates of the mesh coming through the vaginal wall over time, resulting in pain with sex and vaginal discharge/bleeding. These particular uses of synthetic mesh should be differentiated from the midurethral tapes (or slings) that are used to treat stress incontinence. These have a much lower risk profile and are used as the first line of treatment for stress incontinence by most practitioners. In addition, vaginally placed mesh for prolapse repair should also be differentiated from abdominally placed meshes for prolapse repair.

Q: What types of diagnostic tests are needed to determine if someone has a 'dropped bladder' or other organ? Can it be done without an MRI?

A: Dr. Megan Tarr: A simple office exam by a physician experienced in treating pelvic organ prolapse is usually sufficient to diagnose prolapse ("dropped bladder"). Oftentimes, we will do a standing exam, as the prolapse is largest when you are able to bear down with the assistance of gravity.

Q: I have uterus prolapse; will I also need to have a bladder lift? If yes, is it common to have these procedures done at the same time?

A: Dr. Megan Tarr: This question is best answered with an analogy. Think of the vagina as a sock suspended inside your pelvis by various support ligament. Prolapse occurs when there is a loss of support of the vagina. Consequently, there are several structures that prolapse simultaneously. Most commonly, the very top or apex of the vagina (or cervix in women with a uterus) loses support, and the front wall (where the bladder is located) and the back wall (where the rectum is located) follow. Consequently, many prolapse surgeries focus on fitting these multiple sites where pelvic floor support has been lost.

Q: I have vaginal prolapse, no incontinence (yet). My OB/GYN is aware but seems unconcerned. I am 72. I have had it for about three years. Are there exercises that can help?

A: Dr. Megan Tarr: Prolapse can be watched over time, as it may or may not progress. Non-surgical treatments usually involve a pessary. Pelvic floor physical therapy can help prolapse symptoms, especially if there is a mild degree of prolapse and one's doctor notes pelvic floor muscle tenderness upon exam.

Pap Tests

Q: I go regularly, every year, for my pap test and everything is fine. My doctor suggested that I have a sonogram, a procedure that inserts into you a camera to check your ovaries. He said it might show something that doesn't show up in a regular pap. Is that something you would recommend to have done when no problems are evident?

A: Dr. Bradley: I would recommend that you follow the instructions for an ultrasound as requested by your physician. The ultrasound can check for the size of the uterus and the presence of fibroids or ovarian cysts. Ultrasound is not a routine test at a check-up. It is usually requested if the physician is concerned about a mass in the pelvis or to evaluate pain in the abdomen. The PAP test only screens for precancerous tissues and cancer of the cervix.

These are two completely different tests that assess the health of the female pelvic organs.

Q: At what age can you stop getting PAP tests?

A: Dr. Bradley: Women should begin PAP tests within 3 years of sexual activity. If someone is not sexually active, PAP tests should begin by age 21. The current recommendation for interval screening is an annual PAP test for 3 years. If negative, the test is done every 3 years. The cause of cervical cancer is due to the HPV virus. In addition to the PAP test, physicians are also checking for the presence of the HPV virus. Therefore, when the PAP and HPV tests are negative ("double negative PAP smear") the every 3 year interval is advisable. If a woman has the presence of HPV, the annual PAP tests are advised. If you have had a hysterectomy and removal of your cervix for a non- cervical reason, then you do not need to have a PAP test again. Currently we stop screening at age 65 if all the PAP tests have been normal. However, if you are over 65 and began with a new sexual partner or resumed sexual activity, I would recommend continuation of screening as described above.

STD’s (Sexually Transmitted Disease)

Q: Can you get a STD from oral sex? For instance - if one person has a fever blister? Or - if a person has an STD, is oral sex still okay?

A: Dr. Linda Bradley: Yes - STD's may be transmitted orally during oral/anal sex - including GC (gonorrhea), Chlamydia, Herpes and Hepatitis. If there are blisters or ulcers or any lesions present, you should abstain from this activity.

Skin Abnormalities

Q: At times, bumps arise on my private areas (vagina, butt, between legs). They are like abscesses. They are filled with pus and blood, and are very painful. They are large in circumference, and don't get any better until they are drained. What are these bumps called, why are they present, and what can be done about them?

A: Dr. Bradley: The 'private areas' have oil glands and hair follicles. Believe it or not, these areas can develop acne. Very often, these small abscesses are due to inflamed hair follicles or oil glands. This could also be seen in the underarm area and beneath the breast. It can also be seen in men who have beards. This is called folliculitis. In general a dermatologist can evaluate the skin area. They might advise antibiotics or ointments to the affected area. Other treatments may also be needed. This is an easy problem for dermatologists to fix.

Urinary Incontinence

Q: One week after a spinal, I experienced slight incontinence with coughing. If nerve was injured or affected, what can be done? Years later, I now have frequent urinary leakage beginning.

A: Dr. Bradley: This is most likely a coincidence, but is unrelated. There are many causes of frequent urination including diabetes, urinary tract infection (UTI), too much caffeine or water. A very common cause of urinary frequency is due to an overactive bladder. There are tests (urodynamics) that can be ordered by your gynecologist. These tests are very easy and help determine the cause of frequent urination. Additionally, daily medication may also decrease urinary frequency and urgency.

Q: What can I do to get a full night sleep? I am up 4 or more times going to the bathroom every night.

A: Dr. Natalie_Bowersox: I would make an appointment to see your physician. Getting up that many times during the night can be due to many reasons ranging from pregnancy to drinking too much fluid in the evening, to issues with bladder control.

Q: After my third child, I now have issues with urinary incontinence. More so, I have to go to the bathroom all the time. I will go, and then ten to twenty minutes later I have to go again. When I do go, there is not a lot of volume, which I would expect the opposite to be true? I have tried doing the Kegel exercises, but they don’t seem to work. What else can I do?

A: Dr. Natalie_Bowersox: I think this would be a great time to discuss this with your gyn. Some of us do treat incontinence or they may refer you to a urogynecologist (a GYN with additional training in urologic problems) to evaluate your concerns. Sometimes medications can help treat the symptoms that you are experiencing and can make a big difference.

Q: When I go to the bathroom, I almost always have to urinate again within about 10 minutes. Does this mean I am not fully emptying my bladder the first time? What can I do about this? It is very annoying; especially when I am going somewhere, have a meeting at work, etc.

A: Dr. Megan_Tarr: Urinary urgency without incontinence is often best approached with the use of vaginal pelvic floor physical therapy and behavioral therapy. Many times, women with urinary urgency feel that they are not completely emptying their bladder. After it is assured that a woman is completely emptying her bladder, it is important to assess how much she is drinking during the day and to make sure that she does not have a urinary tract infection. With proper training through physical therapy, women can often gradually prolong their intervals between voiding, as some of this becomes a behavioral issue.

Q: Do you have any suggestions to help a woman empty her bladder completely when urinating?

A: Dr. Megan_Tarr: In order to answer this question, I would have to know why you feel that your bladder is not emptying completely. If it is due to a past incontinence surgery, you may find that sitting backwards on a toilet or attempting to relax your pelvic floor muscles while urinating may be helpful. Sometimes, a specialized pelvic floor physical therapist can teach you how to train your pelvic floor muscles to relax more completely during voiding. Alternatively, if you have pelvic organ prolapse, you can simply reduce the prolapse bulge with your fingers and more fully empty your bladder.

Q: I am 52 and prone to urinary tract infections. What can I do decrease/stop getting them?

A: Dr .Megan_Tarr: When women have recurrent urinary tract infections, it is very important to obtain urine specimens for culture at each doctor visit. This tells us if the urinary infection is cleared with antibiotic treatment or if it is a persistent infection with the same/different organisms. After reviewing the causative organism, some physicians will initiate women on daily suppressive antibiotic therapy for several months at a time. It is also important to make sure that the woman is emptying her bladder well. In addition, foreign bodies in the urinary tract, such as stones or mesh from a past pelvic surgery can also harbor microbes and result in recurrent urinary tract infections.

Q: How are stress incontinence and overactive bladder different?

A: Dr. Megan_Tarr: Stress incontinence refers to urine leakage that occurs with an elevation of intra-abdominal pressure (during coughing, sneezing, lifting, or laughing). Urge incontinence is urine leakage that occurs after one feels an "urge" to urinate. Many women have symptoms of both. As urogynecologists, we like to differentiate them because they are treated differently.

Q:: At what point should I seek the advice of my doctor? I am 50 and have to wear pads every day due to urinary leakage. I am annoyed with the problem!

A: Dr. Megan_Tarr: Although urinary incontinence is more common as women age, it should not be considered a "normal" part of aging. Feel free to seek a consultation for this issue at any time in your life. If it is bothersome to you, please seek treatment.

Q: Does atrial fibrillation contribute to frequent urination? Will slowing the heart rate reduce the urges?

A: Dr. Megan_Tarr: This is a bit of a complex question. The atrial fibrillation may be causing the heart to excrete atrial natriuretic peptide (which often occurs in sleep apnea), which will ultimately cause the kidneys to excrete more urine. This may then cause you to urinate more frequently, due to the increased urine production. There are many complex hemodynamic changes that occur with cardiac function and the medications used to treat cardiac issues, so it is not certain that treatment of the atrial fibrillation will improve your urinary symptoms.

Q: I have three children that were born naturally. I now have some incontinence, but mostly very frequent urination. I have been told that pregnancy can cause this. How is this? I know that therapy can help with the incontinence, but can it also help with the frequent urination?

A: Dr. Megan_Tarr: Urinary urgency is best helped with pelvic floor physical therapy. These specialized therapists do myofascial release (just like when you have a back massage) and help retrain the muscles to both relax and contract when you need them to do so. We believe that urinary urgency is often due to spasm of the pelvic floor muscles, and your brain cannot discern this spasm from urinary urgency.

Vaginal Discharge

Q: I am a 36 year old woman. Due to ovarian cysts, fibroid tumors, excessive bleeding, pain, and troubled pregnancies, I had a hysterectomy back in 2001. This past weekend, after sex, I experienced pain in the lower abdomen, followed by a dark brown vaginal discharge. I know this is usually the body cleansing itself of dead blood, but with me having had a hysterectomy, what could this have been? It has cleared up now, but do I still need to go see a doctor?

A: Dr. Bradley: It is not normal to have vaginal bleeding after a hysterectomy. Sometimes bleeding may be due to endometriosis that can still occur after a hysterectomy because you still have your ovaries. I would advise that you see your gynecologist for a physical examination to determine if there are any vaginal infections, or scar tissue or an ovarian cyst. It is likely that a more comprehensive evaluation with a transvaginal ultrasound will be needed.

Water Weight

Q: It seems like I am puffy - water weight. Does 'water weight' really make a difference and how can I get it off without medications.

A: Dr. Margaret_McKenzie: Water weight typically happens just before our period and is related to one of the hormones we make that cause us to retain. Consuming high sugar and high sodium foods also make us retain. Limiting sodium intake and switching to birth control pills to turn off those hormones are the only 2 things I know that helps. Many of my patients gain up to 5 lbs per month during this part of the cycle and plateau on weight loss programs during this week of the month. Knowing it will happen can help you keep your mind focused so you don't cheat if you perceive you are failing on your weight loss program. It usually resolves after the cycle. If it persists after, check with your doctor to see if any medical condition is contributing to this persistent water weight gain.If you are menopausal and your sodium intake is ok please check with your doctor to make sure no other medical condition exists.

Q: When a person loses weight fast, someone always says - 'Oh, that's just water weight.' What exactly does this mean and is this true?

A: Dr. Margaret McKenzie: Initially, when you first limit your calories, we tend to see most of the weight we lose is related to water weight just by cutting back. When you start exercising, this slows down and you may tend to even plateau or gain weight as you breakdown fat and build muscle.

Weight Loss: Why is it so hard?

Q: The older I get the harder it is to lose or even maintain my weight, what can I do?

A: Dr. Margaret McKenzie: This is expected as we have 3 things working against us: our genes (what family members look like as they age), our habits (the poor food choices or portion sizes we have gotten used to) and our slowing metabolic rate (we can't use up food fast enough and so our bodies store the excess calories). So our approach has to be 3 fold: if you have family members with weight issues (we all have), pay attention and note that this will be your tendency, so start with good habits early. Secondly, we can no longer have the luxury of eating anything we want. We have to make choices about the number of calories we consume daily, and how and when we consume carbs as well as the amount of fat we consume. Thirdly we have to move. Tailored regular exercise helps us to use up excess calories and stop the storage. Once we lose the weight we have to then stick to an approach or program to keep it off. This is the hardest part, so getting a good support system like friends and family to verbally keep you on track when you are regaining, cheating etc., will help you stay on target. Journaling and paying attention to EVERYTHING you consume daily is very helpful as well as making exercise like brushing your teeth: first thing in the morning and don't leave home without doing it! Keeping track daily also helps me: I simply pinch my waist skin daily and so can keep track effortlessly of if I am gaining there again. Weighing every day initially helps as well, until you get your hands around keeping the weight off long term. Old rule: "balance what goes in (our mouth) with what you work off (exercise off)" - still is true. Helpful website: Sparkpeople (I have no ties)

Q: I have hit a plateau with my weight loss - but I still need to take off at least 20 lbs. I am eating right, exercising etc. How can I get jump started again? I am getting discouraged.

A: Dr. Margaret_McKenzie: Don't get discouraged! Kudos for losing so much! Plateaus mean we need to tweak something else. Usually it is carb consumption at the wrong time or hidden sugars in your food. Carbs are best consumed by noon as we slow down the rate at which we consume them as the day progresses. True for every human alive. Also, this may be the time to introduce interval training thus mixing up your workout as your body is good at adapting to the same old workouts and meal patterns. Here is where your doctor can help you! We could help with appetite suppressants and this can sometimes help. But don't give up. It is just time to re-analyze and reset new targets and patterns of eating and exercise.

Q: I am menopausal and my waist line is thickening. It is harder to lose weight especially when I crave nothing but sweets. I am staying away from them and eating healthy - but why at this age is it so much harder?

A: Dr. Margaret_McKenzie: For the same reasons that we have been chatting about. Our metabolism simply slows down! Removing simple carbs from the diet removes the craving. See South Beach- he has a good program to help overcome the cravings. (no ties)

Q: It seems really hard losing weight since menopause. Any suggestions?

A: Dr. Margaret_McKenzie: Menopause is a time of slowing of our metabolism, both for reasons related to hormones and also aging. The best approach is to anticipate that you too will be a victim of this slowing metabolism and start a solid balanced exercise program, such as walking 45 -60 minutes daily and strength training 1 or 2 days a week. We can no longer consume the same amount of food and the calorie dense foods we used to, without storing them, so modification is important. Check with a good nutritionist to help you plan for this inevitable change in all our lives.

Q: Is it true that women gain weight after a hysterectomy? Does is matter whether or not you take hormone replacement therapy (HRT)?

A: Dr. Margaret_McKenzie: Only if the ovaries are removed at the same time, as you become postmenopausal instantly and your metabolism starts to slow down. Anticipate this and work out and mind the caloric intake and you can avoid it!