Ask the doctor - sexual and reproductive health

Read expert medical advice with doctors' questions and answers from Prima, SHE and Good Housekeeping

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My breasts hurt!

I experience terrible breast tenderness before my period. I've tried wearing specially fitted bras, but I'm still uncomfortable. Have you any suggestions?

AAbout 60 per cent of women suffer from breast pain before their period, which is part of the premenstrual syndrome. You're right to wear a well-fitting bra and you should stick to a low-fat diet (to avoid cravings for naughty treats, which makes matters worse), and stay off caffeine during this time. You might also need painkillers such as paracetamol or ibuprofen. If the problem persists, talk to your GP about taking the combined oral contraceptive pill, which will help balance your hormones at a steady level during your cycle. Alternative therapies can be effective too, in particular evening primrose oil - you need about 3g a day. There's also evidence that chaste tree (Vitex agnus-castus) and flaxseed (Linum usitatissimum) may help.

Dr Louise Selby, SHE (Aug 09) 

 

New pill, good pill?
I've heard there's a new type of Pill that contains real oestrogen. How is this different? I thought all versions of the Pill contained oestrogen?

Since its launch nearly 50 years ago, the Pill has contained an artificial type of oestrogen called ethinylestradiol. Although similar to natural oestrogen, it differs slightly in ways that may account for the side effects some women experience. Scientists have now worked out how to use a type of oestrogen called estradiol, which is identical to that found in the body. The new Pill (called Qlaira) is taken for 26 days instead of the usual 21. And, rather than having seven Pill-free days, you have just two hormone-free days during which you take a dummy pill (so you don't forget to start the next pack on the right day). Some of the pills taken throughout the 26 days also contain varying doses of a progestogen hormone (dienogest). Qlaira appears to cause significantly less spotting than traditional Pills, and results in a lighter period. As it contains a more natural oestrogen, it may be specially helpful for those women who want to continue using the Pill right up to the menopause.

Dr Sarah Brewer, Prima (Sept 09) 

 

Now that our family is complete, my husband and I are thinking of sterilisation. I've heard about two new ultra-fast techniques for women - what do you think?

Traditionally sterilisation is performed under general anaesthetic with the surgeon making abdominal cuts in order to clip off the Fallopian tubes. But with two new procedures, this looks set to change. The Ovabloc and Adiana systems block the tubes, as in a standard sterilisation, but the tubes are accessed via the vagina rather than the abdomen, which means there's no general anaesthetic and the recovery time is much faster. With the Ovabloc system, liquid siloxane is inserted into the Fallopian tubes, which effectively blocks them. With the Adiana method, radio signals make a lesion in each tube before a piece of silicone is inserted. Within 12 weeks, body tissue grows around the silicone and blocks the tubes. Both techniques are about 99 per cent successful. Visit ovabloc.com and adiana.co.uk.

Dr Louise Selby, SHE (Aug 09)

 

Will I still need a smear?

I need a hysterectomy for heavy periods and fibroids. Will I still need cervical smears afterwards? A friend of mine does, which I find confusing - surely the cervix is removed?

A total hysterectomy removes the whole uterus, including the cervix. Another type of operation, called a partial, or sub-total, abdominal hysterectomy removes just the body of the uterus, leaving the cervix and vagina intact. A woman who has a sub-total hysterectomy must continue having routine cervical smears as there is still a normal risk of developing cervical cancer in the future. Sub-total hysterectomy was thought to reduce the chance of future sexual difficulties or urinary leakage. Recent research has found no evidence of differences in the outcomes between these two operations, although a subtotal hysterectomy is a faster operation, with less blood loss and a lower risk of infection. Your surgeon will advise which type of operation you are having, and whether or not you'll need to continue having smears.

Dr Sarah Brewer, Prima (July 09)

 

How can I help my husband to get an erection?

My partner has had difficulty getting an erection ever since an operation to remove a cyst between his testicles two years ago, which was complicated by a nasty infection. His GP says it's natural at his age (he's 50) but it's affecting our relationship.

I am so sorry that your partner has been having these difficulties. It seems likely that loss of confidence in his performance, rather than the infection, is the real problem. Having said that, it's important for men to be checked physically if they have problems with erections, in case it's caused by a medical problem like atherosclerosis (linked to heart disease) or diabetes. If he has had these problems excluded, he is highly likely to benefit from tablets such as Cialis or Viagra. His GP can issue a prescription for these without charging for a private consultation. He might like to get in touch with the Sexual Dysfunction Association, Suite 301, Emblem House, London Bridge Hosiptal, 27 Tooley Street, London SE1 2PR. They have a confi dential helpline - 0870 774 3571 (Monday, Wednesday and Friday, 10-4pm) - or he could email them at info@sda.uk.net.

Dr Sarah Jarvis, Good Housekeeping (July 09)

 

Is my diet making me more bloated?

I get such severe water retention before my periods that I can't fit into half my clothes. Could my diet be making this worse?

First, seek medical advice to rule out other causes, but if your water retention is indeed caused by premenstrual syndrome (PMS), take regular exercise, cut your intake of salt, sugars and fatty foods, and have more fruit, vegetables and juices. Try supplements that include magnesium and vitamin B6, such as Magnesium-OK (£4.62 for 30 tablets, from pharmacies), or natural herbal diuretics, such as Aqualette (£5.86 for 80 tablets, from pharmacies). Do not take diuretics when pregnant, breastfeeding or on medication, or if you have kidney problems. It's common to feel a little bloated before your period, but changes to your diet should ease the water retention so you feel less discomfort.

Dr Sarah Brewer, Prima (May 09)

 

 

Should I go back on the Pill?

I recently stopped taking the contraceptive pill after eight years, because I worried it was linked to my legs becoming very swollen after flying. My practice nurse has told me to start taking it again as I have nothing to worry about. Should I take her advice? My period is late - is that because I've stopped taking hormones?

From your description of the problems you had with your legs after flying, a deep vein thrombosis (clot) needs to be ruled out before you resume taking the Pill. It's important to talk to the GP who prescribes your contraceptive pills, as they, not the nurse, are responsible for advising you on whether you should continue using this method of contraception. Stopping may have contributed to your late period, but it's also very important to rule out pregnancy before taking it again.

Dr Sarah Brewer, Prima (Apr 09) 

 

My periods are agony

 

I suffer severe period pains, especially around my left ovary. An ultrasound scan has ruled out cysts, while painkillers and the oral contraceptive pill have failed to help. What could be causing it?

If the pain continues, it's important to tell your GP so your symptoms can be investigated further. One of the most common causes of painful periods is endometriosis - a condition that means some womb-lining cells migrate to elsewhere in the body, usually in the abdominal cavity. Because these cells stay sensitive to the monthly hormone cycle, they swell each month to cause pain, inflammation and scarring. Pain can be severe, even if a scan fails to reveal evidence of the condition. Diagnosis is confirmed by laparoscopy (telescopic examination of the abdominal cavity under general anaesthetic). You can obtain more information from the Endometriosis SHE Trust. Visit www.shetrust.org.uk or call 08707 743665.

Dr Sarah Brewer, Prima (Apr 09)

 

Less frequent smear tests

 

I had my last smear three years ago, but my GP says I only need one every five years now that I'm over 50. Is this safe?

Cervical smears pick up possible changes that may go on to cause cancer. Almost invariably, these changes are caused by a wart virus called HPV. It's very common - four out of five women who have ever been sexually active are exposed to it. Fortunately, the majority of women get rid of it through their immune systems without any ill effects. If you've reached the age of 50 without developing cervical cancer, the chances of you getting HPV for the first time, and of it going on to cause problems, is greatly reduced. So your risk of cervical cancer drops as you get older and you need less frequent checks. In fact, once you're past the age of 64 you won't need to have them any more at all. That's why, in England, you'll be invited every three years until you're 50, then every five years. If you live in Scotland you'll be invited every 3-5 years, but will stop being invited past the age of 60. If you live in Wales, you'll be invited every three years until the age of 64 and in Northern Ireland, it's every 3-5 years until the age of 65.

Dr Sarah Jarvis, Good Housekeeping (Apr 09)

 

Am I on the right breast cancer drug?

 

I've been taking tamoxifen ever since I was diagnosed with breast cancer three years ago. Is this the best drug for me, and how long should I be on it for?

Breast cancers can be divided by whether or not they respond to the female hormone oestrogen - most of them do. If they do, tamoxifen reduces the chance of the cancer returning in the longer term. However, there is another group of drugs called the aromatase inhibitors or AIs, but these tablets can be taken only if you have absolutely, definitely passed the menopause. Your doctor can do a blood test to check if there is any doubt about this. These may reduce your risk even more, and don't cause the same problem with hot flushes. The National Institute for Clinical Excellence, NICE, has recommended that all women should have the pros and cons of the different drugs explained to them and be given the option of choosing an AI. Worryingly, a new survey shows that more than seven out of 10 hospitals haven't formally identified all women for whom this alternative could be an option. So if you're taking tamoxifen, talk to your GP or specialist.

Dr Sarah Jarvis, Good Housekeeping (Apr 09)

 

Should I stop HRT?

 

I‘ve been taking HRT for two years (I'm 53), but now I've heard that it can increase the risk of a heart attack. I know that heart conditions run in my family, so should I stop taking it?

 

HRT is generally taken to ease the symptoms of the menopause, such as night sweats and hot flushes. Studies have shown that HRT can help protect against diseases such as osteoporosis and bowel cancer. A US study of over 10,000 women who took oestrogen plus progesterone found a slight increase in their risk of heart disease, breast cancer, stroke and blood clots.

However, last year an international panel of experts decided that HRT was safe. But the debate has been raised again by a recent European report on almost 700,000 women. This study found that women who were taking HRT in their early fifties were 24 per cent more likely to suffer a heart attack than women who had never been on it.

Ultimately, women who have a family history of heart disease, breast cancer or blood clots should probably avoid taking HRT for more than five years. Many swear by popular herbal remedies - natural phytoestrogens that are thought to have a weak oestrogen-like action.

They're definitely worth trying - there's wild yam, £3.69 for 500mg, red clover, £22.99 for 430mg and black cohosh, £10.79 for 40mg, all from www.hollandandbarrett.com.

Many women also find that lifestyle changes can help, such as stopping smoking.

Dr Louise Selby, SHE (Feb 09)

 

Allaboutyou adds: see our guide to making it through the menopause

 

Should I try a natural contraceptive?

 

I've heard that wild yam is a natural contraceptive. How effective is it?

Wild yam is rich in a substance called diosgenin, which was originally used to make synthetic forms of progesterone used in the first oral contraceptive pills. Wild yam does not contain progesterone itself, however, and should not be used as a contraceptive. In fact, when taken in small quantities, it may even promote female fertility. Wild yam extracts should not be taken in pregnancy except under medical supervision.

Dr Sarah Brewer, Prima (Feb 09)

 

 

Am I HIV-positive?

 

I keep getting blisters that scab and heal to leave a red mark. My doctor thinks they're ringworm, but asked if I had a sore throat, as HIV can start like this. I'm now terrified I'm HIV positive.

 

Offhand comments like this are very worrying, and I'm sure your doctor said this without thinking. A long list of conditions can cause a sore throat and blisters, of which HIV is right at the bottom. As you are understandably concerned, either go back to your doctor and tell him how much his comment upset you (so he can apologise and get any necessary investigations under way) or visit a genito-urinary medicine clinic. They will quickly arrange for you to have an HIV test if you want to put your mind at rest. They can also provide a useful second opinion, given that your doctor is so uncertain.

Dr Sarah Brewer, Prima (Feb 09)

 

My periods are painful

 

I suffer severe period pains, especially around my left ovary. An ultrasound scan ruled out cysts, while painkillers and the oral contraceptive pill haven't helped. What could be causing it?

Tell your GP so your symptoms can be investigated further. One of the most common causes of painful periods is endometriosis, where womb-lining cells are found elsewhere in the body, usually in the abdominal cavity. Because these cells remain sensitive to the monthly hormone cycle, they swell each month to produce pain, inflammation and scarring. Pain can be severe, even if there's no evidence of endometriosis on ultrasound. Diagnosis is confirmed by laparoscopy. Find out more from the SHE Trust (visit www.shetrust. org.uk or call 0870 774 3665).

Dr Sarah Brewer, Prima (Jan 09)

 

Do I need to have my coil replaced?

I've been using a coil for contraception for years, and had my current one fitted four years ago - I'm now 48. Do I still need to get it changed after five years? My periods are getting more erratic and slightly heavier than they used to be, but other than that it's not causing any problems.

 

I'm delighted to say that the guidance on coil replacement has changed in the past few years. If you have a coil fitted after the age of 40 (after the age of 45 if you have the Mirena IUS coil) you can leave it in until you no longer need it for contraception. Unfortunately, many women find that their periods become more unpredictable in the years running up to the menopause, as they stop ovulating regularly. It's unlikely that this is caused by the coil. However, the coil can make periods somewhat heavier, so if it becomes an issue, talk to your GP. We also used to recommend that you have your coil checked every year. Now it's recommended that you don't need to get a routine annual check after the first few months unless you're having problems. One less thing to worry about!
Dr Sarah Jarvis, Good Housekeeping

 

Will coffee prevent me conceiving?

I'm in my early forties and about to start IVF treatment. Should I avoid drinking coffee?

 

A recent study looked at several different lifestyle factors such as smoking, alcohol intake, weight and the amount of caffeine consumed in over 8000 women who'd previously had IVF treatment. They found that drinking four or more cups of caffeinated drinks per day did reduce the chance of conceiving again naturally in the future, as did smoking one or more cigarettes per day, drinking alcohol three or more times per week, and being overweight. More advice is available in my book, Planning a Baby: A Complete Guide to Preconceptual Care (Vermilion, £8.99).
Dr Sarah Brewer, Prima

 

My womb is painful

I've been getting cramps that feel like period pains, and my doctor says I have a womb that tilts backwards instead of forwards. Why am I experiencing discomfort?

 

A tilted womb - also known as a retroverted uterus - is common, and affects at least one in five women. You can be born with it, or it can develop after giving birth, or as a result of conditions such as adhesions or fibroids. It is often symptomless but is sometimes linked with painful periods, pain during sex or urinary leakage. If the pain persists, your GP will probably refer you to a gynaecologist for assessment.
Dr Sarah Brewer, Prima  

 

The Pill is lowering my libido

I've been taking the contraceptive pill for ten years, and I've lost interest in sex. Can you help?

 

The blend of hormones in some contraceptive pills can reduce sex drive in some women. When this happens, it's usually necessary to change to a pill that has a higher oestrogen level, or to change to a different method of contraception. If your family is complete, you may want to consider the Mirena coil, which releases a very low dose of progestogen hormone. Do have a chat with your GP about all the options available now. You'll also find information at the Talk Choice website, www.contraceptivechoices.co.uk.
Dr Sarah Brewer, Prima

 

My husband won't discuss our sex life

My husband is 46 and we've always had a good love life. In recent months, he's been experiencing performance problems and just refuses to talk about it. What can I do?

 

Why am I not surprised? There's a huge stigma attached to erectile dysfunction, or ED, which makes men scared to seek help - in fact, in a recent survey, 71% of men thought it wasn't a ‘proper' medical condition. Yet not only is it a very real problem, but it's also incredibly common, affecting about 40% of men over 40. However, the good news is that ED is very treatable, with a range of effective remedies available. But please don't let your husband buy online - a recent survey showed that well over half of the products available over the internet are useless, and, what's more, could actually be dangerous. ED can also be a symptom of underlying high blood pressure, heart problems or diabetes. In fact, by getting himself checked out now, your husband could be saving not just his love life, but his life as well. He'll be feeling very vulnerable right now, so it's crucial not to make him feel it's his fault. A new website, 40over40.com, can help.
Dr Sarah Jarvis, Good Housekeeping

Is my coil causing side effects?

I had a Mirena coil fitted a year ago. Since then, I’ve felt tired, my hair is thinning, and I’m putting on weight. My periods have also stopped. Do you have any advice?

Around one in five women stop having periods within a year of starting with Mirena, but most don’t mind. The other side effects you list are not usually associated with Mirena. However, everyone is different and adverse reactions can occur, though the level of hormone released from the coil is very low. See your doctor, as you may need tests for other causes of the symptoms, like an underactive thyroid.
Dr Sarah Brewer, Prima

Sex after prostate surgery

My husband, who's 50, was diagnosed with prostate cancer last year and had a radical prostatectomy, where surgeons removed his prostate gland. He's now had the all clear, but our sex life is non-existent. Could Viagra help?

Your husband's problems are likely to be multifaceted. He's had a difficult operation, which will have left physical and mental scars. The prostate is a small gland in the pelvis located between the penis and the bladder and surrounds the urethra. When the prostate is removed, the surrounding tissues such as the urethra, nerves and blood vessels can get damaged, causing erectile dysfunction and urinary incontinence. It's important for you to be understanding and patient; he'll need time to fully recover before even contemplating intercourse. If he does have difficulty, have a chat with your GP or specialist and discuss the variety of treatments, including Viagra, which may be suitable for him. Visit www.prostate-cancer.org.uk; 0800 074 8383
Dr Louise Selby, SHE

 

Several years ago I had surgery for fibroids and now I'm worried as the symptoms of heavy periods and pain have returned. Could the fibroids have grown back and will I need another operation? I'm 45 and have already had my family.

Fibroids, which are benign growths in the womb muscle, affect around one in five women (one in two black women) and are more common as you reach the end of your reproductive years. They grow back in about 25% of cases after a myomectomy operation such as yours.

First, visit your doctor for an examination and to arrange an ultrasound scan to confirm a recurrence of your fibroids. Then, as you do not want any more children, you'll be offered a wide range of treatment options - whether you choose to have further surgery depends on the severity of your symptoms.

Meanwhile, try Boots Multivitamins, Minerals and Iron Tablets (£1.99 for 30) to boost your blood count and counteract the effects of heavy bleeding.
Dr Louise Selby, SHE

Fewer smear tests

I’ve just turned 50, and my GP says that from now on I need only have a cervical smear every five years. Is this safe?

Yes, I’m delighted to say that it is, as long as you haven’t been needing more frequent tests because of an abnormal result in the past. The risk of developing cervical cancer actually drops with age. In fact, once you reach the age of 65, as long as your most recent three smears have been normal, you can safely stop having them. Who says everything about getting older is bad!
Dr Sarah Jarvis, Good Housekeeping
 

How often do I need a smear now?

I’ve just turned 50, and my GP says that from now on I need only have a cervical smear every five years. Is this safe?

I’m delighted to say that it is, as long as you haven’t been needing more frequent tests because of an abnormal result in the past. The risk of developing cervical cancer actually drops with age. In fact, once you reach the age of 65, as long as your most recent three smears have been normal, you can safely stop having them. Who says everything about getting older is bad!
Dr Sarah Jarvis, Good Housekeeping

 

Sex after hysterectomy

Over the past few years I’ve suffered from severe vaginal bleeding and have finally decided to have a hysterectomy. However, friends have told me certain kinds of hysterectomy can affect your sex drive more than others. Is this true?

This is a surprisingly common belief that probably comes from the idea that the nerves in your vaginal area will be damaged during a hysterectomy. I can reassure you, however, because it's finally been disproved in a recent study. The researchers studied a large group of women who'd had one of three types of hysterectomy: subtotal abdominal (where part of the cervix is left) vaginal, or total abdominal hysterectomy (both of which remove the whole womb and cervix). They found that sexual pleasure and sexual activity actually improved after all three types of hysterectomy - and there was no difference between the three with respect to sexual pleasure. Of course, this doesn't necessarily make hysterectomy the right choice for all women with heavy periods, as there are less drastic surgical options and drug treatments that are usually tried first, but it's good news if you do feel you need this operation.
Dr Sarah Jarvis, Good Housekeeping

Vitamin B6 and PMT

I suffer from terrible premenstrual tension and take vitamin B6 to ease my symptoms. I’ve always taken 100mg a day, but my doctor says I shouldn’t take more than 10mg a day as it might be bad for me. Why is this?

Vitamin B6 can be bought over the counter at doses much higher than 10mg and it's used very commonly by women with PMT. A few people who've taken higher doses than this, however, have suffered nerve damage, with loss of feeling in their arms and legs. For this reason, doctors don't recommend higher doses - the side effect may be rare, but with so many people taking this supplement, it's not worth the risk. Dr Sarah Jarvis, Good Housekeeping
 

Catching genital herpes

Can you catch genital herpes by using a bath straight after someone who has the condition?

I'm happy to tell you that the risk of you getting genital herpes in this way is virtually non-existent because it's passed from one person to another by close sexual contact. This usually means sexual intercourse, although it's worth remembering it can also be transmitted by having oral sex with someone who has a cold sore.
Dr Sarah Jarvis, Good Housekeeping
 

Treatment for herpes

About 12 years ago, I contracted herpes and suffered from a flu-like illness and small, painful blisters. The symptoms come back a couple of times a year, but I’m too embarrassed to talk to my GP about it, and I’ve read that no medication can help anyway.

I'm delighted to be able to tell you there is medicine that can help. There's no cure for herpes, but there are creams and tablets that can reduce the severity of an attack. And if these start to happen more often, it may be possible to take regular tablets to reduce their frequency. It really is worth talking to your doctor: don't forget he or she is used to dealing with ‘embarrassing' problems and won't think twice about it.
Dr Sarah Jarvis, Good Housekeeping
 

Contraceptive injections

I used to have heavy periods and my doctor suggested I change to the Depo-Prova contraceptive injection. I’ve been using it for the past three years, and my periods have stopped but I worry it could harm my health in the long term.

You're quite right to have some concerns about your Depo-Prova contraceptive injection, although it is only recently that issues have come to light. The Committee on Safety of Medicines has just issued a warning that using this form of contraception can increase your risk of osteoporosis, or thinning of the bones. It recommends that any woman using it for more than two years should be counselled about the risks, and that if they have any other contributing factors for osteoporosis - such as being underweight, smoking, or having a female family history of hip fracture - they should consider another method of contraception. I suggest you make an appointment with your doctor for advice.
Dr Sarah Jarvis, Good Housekeeping

 
Treatment for PMS

Every month I get the most terrible PMS. One of my friends swears by the hormone treatment progesterone but, when I asked my doctor, she said it doesn’t work. Who’s right?

Actually, in this instance, your doctor is right. Even though progesterone has been given to thousands of women over the years to treat PMS, there's no evidence it works. Recently, all the studies of women taking different treatments for PMS were examined, and it turned out that progesterone was no better than a placebo - a similar-looking pill that doesn't contain any active medicine at all. So, although many women swear by progesterone, they probably feel better because they think it will help (known as the placebo effect), not because there's any hard evidence that it actually does. In fact, there isn't much evidence for any effective PMS treatment - although regular exercise, 10mg a day of vitamin B6 and one daily tablet of agnus castus fruit extract (both available from health food shops) are all worth trying.
Dr Sarah Jarvis, Good Housekeeping
 

Thrush infections

I've had repeated thrush infections. They’ve responded in the past to over-the-counter tablets from my local chemist, but now the pharmacist won’t give me any more until I get myself checked out by my GP. Should I just go to another chemist?

Your pharmacist deserves full marks for their advice. Recurrent infections, such as thrush, can be an early sign of diabetes, and there may also be a different vaginal infection that is causing such frequent symptoms. Make a morning appointment with your GP, and don't eat anything from the night before, in case you need to under-go a fasting blood test for diabetes.
Dr Sarah Jarvis, Good Housekeeping

 

Morning-after pill

My husband and I recently had a condom accident on a Saturday night. I rang my GP on the Monday, only to be told I could have got emergency contraception from my pharmacist over the weekend. Is the pill from the pharmacist just as effective?

Not only is it as effective but you'd have been even safer if you'd gone to your pharmacist rather than waiting. While the emergency contraceptive tablet is licensed for up to 72 hours after unprotected intercourse, it's most effective if it's taken in the first 24 hours. These days, pharmacists can provide lots of medicines which were previously available only on prescription and they'll always be happy to give you advice if you ask.
Dr Sarah Jarvis, Good Housekeeping

 

Delaying your period

Can I put my period off for a week? My period is due to fall in the middle of my holiday. Is there a way of putting it off?

If you’re not on the Pill, your doctor can prescribe a hormone tablet (norethisterone) that you take three times per day starting about three days before your period is due. You can take this for as long as you want to postpone the period, and then stop treatment three days before you want your period to come on again. If you’re on the Pill, your doctor will explain whether or not you can start a new pack immediately after stopping your previous one, without the usual seven-day break. Exactly how you do this depends on what type of pill you’re taking, so always seek medical advice and don’t do it on your own in case contraception is lost.
Dr Sarah Brewer, Prima
 

Coping with hot flushes

Will natural remedies help with hot flushes? I'm getting menopausal symptoms. Are there any natural alternatives to HRT?
 
The most popular natural alternatives are isoflavones (from red clover, soy or Japanese arrowroot), which have an oestrogen-like action in the body; wild yam, which has a progesterone-like action (and can be used together with isoflavones); and black cohosh. The latter is one of the most widely researched medical herbs and has a direct action on the brain to help normalise the body's own hormone production, as well as reducing the over-dilation of blood vessels that's linked with hot flushes and sweating. These supplements are available from selected health food shops and chemists.
Dr Sarah Brewer, Prima
 

Beat thrush naturally

How do I get rid of recurrent yeast infection? I've tried live yogurt and washing internally three times a day, but my thrush just won't clear up. Can you recommend anything else to try?

It's important to have thrush (candida) diagnosed, as other conditions such as bacterial vaginosis cause similar problems but need different treatment. It's best to visit a genito-urinary medicine (GUM) clinic for a full screening. If thrush is confirmed, avoid wearing tight underwear, nylon pantyhose or tight trousers. Stockings and cotton underwear are recommended. It's worth boiling cotton underwear or hot-ironing gussets. This is because modern low-temperature washing machine cycles do not kill candida spores. Don't wash yourself out internally, as this flushes away the healthy bacteria that protect against thrush. Use a pH-balanced external wash, such as Lactacyd, instead. Some women with recurrent thrush have reduced levels of iron. This is diagnosed by a blood test. Supplements that might help include probiotics, Lapacho (also known as Pau D'arco) and grapefruit seed extracts.
Dr Sarah Brewer, Prima
 

Reducing the effects of PMT

How to cope with severe PMTI have severe PMT - I scream at my husband for two weeks out of four. I've tried vitamin B6 and evening primrose oil but they haven't helped. What else can I try?

Alterations in calcium and magnesium levels play a role in mood disturbances, and blood levels of these minerals appear to be lower in women with PMT than in those without. When 33 women with PMT took 1000mg calcium for three months, they experienced significant improvements in mood, water retention and pain, compared with a placebo. Taking 200mg magnesium for two months has also been shown to improve symptoms linked with fluid retention. The best evidence for herbal remedies lies with Agnus castus. Trials found that it reduced moodiness, breast fullness and headaches. Plus, it can be taken safely with calcium and magnesium supplements.
Dr Sarah Brewer, Prima
 

Is candida a genuine condition?

I recently went to see an alternative therapist as I've been experiencing muscle aches, thrush and bloating. She said I was suffering from candida but my doctor told me there's no such thing. Is that true?

Candida is a yeast that exists naturally on the skin and is usually not a problem. A healthy immune system and harmless bacteria generally stop it from thriving, but when conditions are warm, moist and airless, candida can multiply and cause thrush. The mouth, vagina and groin areas are prone to the condition. You're more likely to suffer from thrush if you're pregnant, have diabetes, take antibiotics or have a poor immune system. There are various treatments including anti-yeast medicines such as clotrimazole and fenticonazole. You can buy anti-thrush creams at pharmacies (Canesten AF Cream 15g, £2.95, Boots).
Many alternative therapists argue that candida can multiply in the body; symptoms include aches, migraines, allergies or chronic tiredness. You could try Dida (£19.95 for 90 capsules, Boots), a supplement containing cinnamon oil and anti-fungal ingredients to maintain a healthy balance of candida albicans in the body.
Find a list of alternative practitioners at www.candida-society.org.uk; 01689 813039.
Dr Louise Selby, SHE
 

Sex is so painful

Two years ago, I came off HRT (after taking it for four years) because of the scares relating to breast cancer. My hot flushes haven’t been too bad, but I have awful vaginal dryness, which makes sex with my husband a misery. I need to do something as I’m worried he thinks I don’t care about him any more, but I’m too embarrassed to see my GP.

You’re certainly not alone – a recent survey showed that two in five women have similar experiences after the menopause, yet more than three in five post-menopausal women avoid talking about intimate problems. There’s still some anxiety about an increase in the risk of breast cancer with long-term use of HRT (five to 10 years), but the absolute increase is probably not more than two in 100 women. For some who suffer severely with flushes, this risk has to be weighed against the benefits of HRT, which is very effective at treating menopausal symptoms. If your main problem is vaginal dryness, however, a topical oestrogen cream, pessary or ring could make all the difference. Please don’t suffer in silence – your GP will be happy to help. Dr Sarah Jarvis, Good Housekeeping
 

My daughter has problem periods

My 16-year-old daughter has very heavy, painful periods. Our GP suggested putting her on the Pill. Are there any other options?

Troublesome periods in the first few years after the onset of menstruation are usually caused by hormone imbalances linked with lack of ovulation. Drug treatments such as ibuprofen or mefenamic acid (on prescription) often help to reduce blood flow. It’s worth eating more sources of omega-3 essential fatty acids (such as oily fish, flaxseed and evening primrose oil). Taking magnesium supplements can also reduce back pain and lower abdominal pain – especially on the second and third days of a period – due to its muscle-relaxant effect. In extreme cases, doctors often suggest taking the oral contraceptive pill, as this is usually effective in reducing symptoms, but you will need to weigh up the possible risks of unwanted side effects.
Dr Sarah Brewer, Prima
 

No sex life

I’ve always had great sex with my husband but last year, at 52, he was diagnosed with type 2 diabetes, and our sex life has died. He’s slimmer now – and looks great – so I’m worried he’s looking elsewhere.

Late-onset type 2 diabetes (which affects two million people in the UK) can cause a variety of physical and emotional problems. Your husband has dramatically improved his health by losing weight and changing his lifestyle, but a symptom of diabetes is impotence due to narrowing of the blood vessels to the penis, making it difficult to maintain an erection.
I wouldn’t assume that he is cheating on you; more likely he has a physical problem leading to a lack of confidence. Don’t accuse him of having an affair, as he is likely to need lots of reassurance. If he has difficulty maintaining an erection, his GP may prescribe medication such as Viagra, Cialis or Levitra.

Both hypnotherapy and acupuncture may also help. But herbal remedies to improve blood flow, such as ginseng and yohimbine, should be avoided by those with diabetes or hypertension – they can increase heart rate, blood pressure and the risk of heart attack or stroke. For support, try the Sexual Dysfunction Association (www.sda.uk.net).
Dr Louise Selby, SHE

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The answers to specific problems may not apply to everyone and are not substitutes for professional medical advice. If you're worried, see your GP. For more information, visit www.netdoctor.co.uk

 

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