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Your Good Health: Autoimmune patient experiences painful menstruation

Women don’t need to have menstrual cycles for their health
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Dr. Keith Roach

Dear Dr. Roach: My 34-year-old disabled daughter has polyglandular autoimmune syndrome type 2, along with several other autoimmune diseases. Since her ovaries have never worked, she has been on hormone replacement therapy since she was 16 to protect her bones. She has had a menstrual period once every three months when the pills allow it.

Since she experiences painful menstruation, her gynecologist recently said that she doesn’t need to have a period and can skip the yellow pills. However, her father, who has never experienced painful menstruation (nor has he ever taken her to a gynecologist and discussed the issue), thinks it may hurt her to not have periods. I trust the doctor, but I would like to know what you think.

K.M.

Polyglandular autoimmune syndrome type 2 is a condition, as its name suggests, that affects many endocrine organs. It particularly affects the adrenal gland, but also the thyroid, usually causing too little thyroid hormone. It also affects the pancreas, causing Type 1 diabetes, and the reproductive glands (particularly in women), causing ovarian failure. All of these hormones may be replaced, and hormone replacement is critical to protect her bones and provide other benefits.

Of course, her gynecologist is correct; she does not need to take the placebo tablets of whatever colour. We certainly used to think that women needed to have menstrual cycles for their health, but that is no longer the case. There are the same risks and same benefits to hormone replacement whether it is taken periodically or continuously.

Most women who realize that they don’t need to have their menses choose to have fewer (such as every three months) or no menstrual periods, and compliance with medication is higher when women take it continuously.

Given her painful menstruation, I agree with your daughter’s gynecologist that she can take the active medication every day. However, I would warn you both that she may experience some bleeding at times. Ten to 25% of women on combined hormone treatment will experience some bleeding, usually lighter than a period. This is particularly the case during the first six months.

I have occasionally been disheartened by the poor level of understanding that some men have about the female anatomy and physiology.

Dear Dr. Roach: I am a 72-year-old man with an enlarged prostate. I am taking Flomax and finasteride. Will these shrink my prostate? Could my enlarged prostate affect my bladder function?

J.S.

Men often get enlarged prostate glands in their 70s. Flomax works by relaxing the muscle in the prostate to allow for better flow, while finasteride blocks a hormone that causes the prostate to grow. Thus, the prostate shrinks over time, but it takes months or even years for the medicine to reach its full effectiveness.

In most men, this combination is effective, but when it isn’t, the urologist can look at other options such as surgical, laser, heat and cold treatments to improve their symptoms.

Without treatment, the prostate can block the flow of urine severely, but it’s the kidneys, not the bladder, that are at the most risk for damage. Treatment is sometimes urgently needed to relieve pressure and save the kidneys.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu