Women’s Health as Seen by a Woman Gynecologist
As a woman, Dr. Lucienne Lanson knows all the questions women ask, or want to, about their bodies. As a top gynecologist, she knows all the answers.
Her object: to give women a better understanding of how their bodies work, how and why certain things happen, what is normal and abnormal, and when to seek help.
In these extracts, Dr. Lanson asks and answers some vital questions:
CAN DIETS AFFECT YOUR PERIODS?
If you plan to limit your weight loss to a mere five kilograms (ten pounds), then the following need not concern you. But if you suddenly decide that those 25kg (50lb) of excess baggage must vanish instantly, you may be asking for trouble.
Crash diets that transcend the boundaries of sanity can bring your menstrual periods to a screeching halt. Long before achieving your desired silhouette, a too-rapid weight loss or continuous poor nutrition can adversely inhibit the hypothalamic and pituitary centers – and then, goodbye periods, hello amenorrhoea.
AMENORRHOEA: Prolonged absence of periods. HYPOTHALAMUS and PITUITARY: powerful glands that cause the release or withdrawal of certain hormones, the growth hormone, and the female sex hormones. ESTROGEN and PROGESTERONE.
Even with a return of sensible eating habits, it may be months before hormonal balance and menstruation are established.
If you have just changed your mind about going on a radical reduction diet, you should also know that being obese is another threat to regular menstruation.
CAN OBESITY AFFECT PERIODS?
Lack of Ovulation (the release from the ovaries of an ovum or egg) and irregular bleeding in some women have been linked to an excess of body fat.
Your ovaries may be perfectly normal and produce ample amounts of estrogen, but if too much estrogen is being stored in body fat, you may actually have too little circulating in your bloodstream.
This can mean a relative estrogen deficiency, severe enough to disrupt the normal hormonal balance necessary for ovulation and regular periods. For some women, just losing that extra weight can restore ovulation and menstruation.
WHAT IS A HYSTERECTOMY?
Despite the prevalence of this procedure, much confusion still exists about what a hysterectomy really entails. Whether your doctor chooses to call the operation a simple hysterectomy, a complete hysterectomy, a pan-hysterectomy, or a total hysterectomy, all of these terms mean or should mean, exactly the same thing; namely, removal of the body of the uterus plus its cervix (neck).
Unfortunately, even doctors sometimes become casual in their terminology and may at times use one of these terms to include removal of the tubes and ovaries. Regardless of the qualifying adjective preceding the term hysterectomy, the procedure should refer only to the removal of the entire uterus.
The two exceptions are the so-called partial hysterectomy and radical hysterectomy. In the partial hysterectomy, the cervix is left in place and only the body or upper portion of the uterus is removed. A radical hysterectomy, on the other hand, implies the removal of the uterus plus adjacent pelvic lymph nodes. This extensive surgical procedure is reserved strictly for certain pelvic malignancies.
Having a hysterectomy, therefore, means no more periods and no more pregnancies. Other than that, a hysterectomy will not interfere with ovarian function or female hormone production. In other words, you will not go through the menopause any sooner than nature intended simply by losing the uterus.
DOES ESTROGEN THERAPY HELP?
Contrary to what many women believe, taking estrogen (in synthetic form) will neither delay the onset of the menopause nor prolong this normal period of transition. The primary purpose of estrogen replacement during the menopausal years is to help women go through this temporary phase more smoothly and to retard and perhaps even prevent the later development of other estrogen-related deficiency problems.
With or without supplemental estrogen, the body will still follow its own biological timetable and adapt normally and naturally to waning ovarian function.
Women who expect estrogen to stop the clock, or prevent hair from turning grey, or skin from wrinkling, will be sorely disappointed.
Nevertheless, if a true estrogen deficiency does exist, estrogen can help keep the skin, hair, and blood vessels in better health. Breast tissue will also keep its firmness and elasticity longer than it would otherwise. Taking estrogen will also help avoid the redistribution of fat or that “middle-age spread,” provided, of course, that you watch your diet and exercise regularly.
WHAT DOES THE ESTROGEN DO?
With estrogen therapy, hot flushes and sweats, in particular, can frequently be eliminated or markedly reduced in frequency and intensity. Less common complaints, such as tingling sensations, insomnia, and heart palpitations, can also be controlled if due to estrogen deficiency.
Thus, in many instances, nervousness, irritation, and even depression stemming from these physical stresses can be relieved by estrogen.
In cases where various psychosomatic complaints masquerade as hormonal deficiencies, estrogen therapy may prove disappointing. In women who manifest extreme anxiety or nervousness (not related to estrogen deficiency) the temporary use of tranquilizers or mild sedatives can afford needed relief.
THAT PREMENSTRUAL TENSION
Does your personality change for the worse seven to ten days before your period comes? It could be pre-menstrual tension.
The extent to which each woman reacts during this phase of her cycle depends in part upon her basic personality. For the average woman, these emotional upheavals tend to remain mild and well under control most of the time. But a few women have pre-menstrual tension of such serious proportions that they can be blasted out of orbit – in extreme cases, way out. Four out of five major crimes committed by women are perpetrated during that time. (Risk of suicide or a fatal accident are also highest then.)
Fortunately, such severely afflicted women are in the minority. However, even a stable, well-adjusted woman may on occasion suffer symptoms related to pre-menstrual tension.
WHAT KIND OF SYMPTOMS?
That heavy, bloated, puffy feeling for one thing. And just about any part of your anatomy can be affected. In fact, during the week prior to menstruation, some women may carry as much as one to three kilograms (three to five pounds) of extra fluid, and in extreme cases may tip the scales 5kg (10lb) heavier.
Extra fluid can also cause your stomach to stick out and your waist to expand overnight. Studies have shown that the walls of the intestine temporarily store excess fluid and actually become waterlogged. There is also a shift of fluid from the bowel passageway to the walls of the intestine. As a result, your stools may become somewhat harder.
But don’t reach too quickly for your favorite laxative. As soon as your period gets underway and body fluid readjusts itself, you are likely to have the reverse situation – loose bowel movements. That too can be normal.
WHERE DOES FLUID COME FROM?
Blame it on your hormones. Part of the explanation may have to do with estrogen (a hormone produced by the ovaries, responsible for female sexual characteristics). In addition to all these glorious effects on your body, estrogen also influences another physiological function – salt and water exchange. The more estrogen in your system, the less salt, and water pass through the kidneys.
Thus, the higher the estrogen level, the greater will be the salt and water retention. Therefore, just after ovulation, when the estrogen level is high, the kidneys will filter less water. Result? You will pass less urine. The water that bypassed the kidneys goes back into your tissues.
Another complaint caused by fluid retention is headaches – terrible pounding headaches. Surprisingly enough, the culprit responsible for true pre-menstrual tension headaches may well be water retention within the brain tissues. In fact, many of these emotional upheavals – irritability, nervous tension, insomnia, depression, and so on – have been attributed to “water on the brain.”
HOW LONG CAN SYMPTOMS LAST?
Until the estrogen level dips to its lowest point just prior to the onset of menstruation. Then you pass more urine, and as your body rids itself of excess fluids, all these unpleasant symptoms will disappear.
IS YOUR SEX DRIVE AFFECTED?
Given the right partner, the right setting, and the inclination, any woman can be sexually aroused regardless of what her ovaries are doing. For some women, there may be an increased sex drive.
WHAT ABOUT OVER-TIREDNESS?
Contrary to those old television commercials, all women do not drag around because of iron-poor blood. That listless, knocked out, shaky feeling may well be related to pre-menstrual changes in carbohydrate metabolism, and more specifically to a lower blood sugar level. So that irresistible craving for sweets may actually be a physiological need to raise your blood sugar level.
SO WHAT CAN BE DONE ABOUT IT?
Even though some investigators deny the importance of water retention as a cause of pre-menstrual tension, many women do experience relief by eliminating some of that excess tissue fluid. For those of you with only minor discomfort, the simple expedient of restricting your salt intake seven to ten days before your period can work a small miracle.
But hiding the salt shaker is not enough. You must also learn to know and avoid foods normally high in sodium. Diuretics (water pills) may also be indicated. (Here, you should follow the instructions of your doctor. He may also prescribe a mild tranquilizer.)
If diuretics and tranquilizers don’t work, there is still hope. The unusual woman who fails to be relieved by the use of diuretics and tranquilizers may find hormone therapy to be of value.
THOSE SKIN BLEMISHES
Teenagers aren’t the only ones plagued with complexion problems. Prior to menstruation, there is a normal increase in sebaceous, or oil, gland activity, partially kept in check by estrogen. In women with oily skin especially, excessive production of sebum (oil) together with a cyclic drop in estrogen output can result in recurrent small outbreaks of pre-menstrual pimples.
If by now you are beginning to appreciate how changing hormonal levels can affect you, it is time to broach the subject of dysmenorrhoea.
WHAT IS DYSMENORRHOEA?
Painful menstrual cramps. Although most of the cramps are probably contractions of the uterus, some of the discomforts may be caused by spasms of tiny arteries within the wall of the uterus.
Women’s menstrual cramps are not always given full consideration. Therapy is limited to aspirin, and if that proves unsuccessful, the usual advice. “Wait until you have a baby,” is often a substitute for proper evaluation and treatment.
Radical approaches in cases of severe dysmenorrhoea are fortunately rare, but they do occur, as with a patient who said “When I try to talk to my family physician about it, his only answer is hysterectomy. At the age of 19, this seems to be a pretty drastic step.”
At the other extreme, for a handful of psychiatrists, the universal solution is psychiatric help. Since most of these experts have never experienced the cramps, as far as they are concerned, the majority of girls suffering from severe dysmenorrhoea are undoubtedly maladjusted and neurotic. In short, these physicians feel that is all in the head.
ARE CRAMPS ALL IN YOUR HEAD?
Some maybe, but most are located much further down. In fact, a good case of dysmenorrhoea installs itself in the middle of the lower abdomen and is frequently accompanied by a heavy aching sensation localized in the lower back and radiating down both legs. An acutely uncomfortable feeling of intense vulvar fullness and pressure is not uncommon. In even more serious cases, nausea, vomiting, diarrhea, and headaches are additional distresses.
WHAT CAUSES THESE CRAMPS?
Nobody knows for sure, but ovulation is certainly involved. Without ovulation, and the formation of a lush uterine lining prior to menstruation, dysmenorrhoea rarely occurs in a young woman. But there is no substitute for a detailed history and thorough physical examination in determining the cause.
Giving birth to that first child definitely relieves some women. Home-remedies include heat, mild analgesics, alcohol, or appropriate exercises.
If all fails, do check with your favorite gynecologist. You have nothing to lose but your cramps.