Dr. Keith Roach, syndicated columnist
Dear Dr. Roach: My 34-year-old disabled daughter has polyglandular autoimmune syndrome type 2 and several other autoimmune diseases. Her ovaries never worked, so she has been on hormone replacement therapy since age 16 to protect her bones. She has her menstruation once every 3 months, as long as taking the pills allows.
She suffers from menstrual pain, so her gynecologist recently told her that she doesn't need menstruation and doesn't need to take the yellow pill. However, her father has never experienced her menstrual pain (nor has he ever taken her to her gynecologist and discussed the issue) and is therefore concerned about her not having her period. I think it might hurt her. I trust my doctor but would like to know your opinion. — K.M.
Answer: Polyglandular autoimmune syndrome type 2, as the name suggests, is a condition that affects many endocrine organs. It particularly affects the adrenal glands, but also the thyroid gland, usually resulting in a deficiency of thyroid hormone. It also affects the pancreas, causing type 1 diabetes, and the gonads (especially in women), causing ovarian failure. All of these hormones can be replaced, and hormone replacement is essential to protect her bones and provide other benefits.
Of course, her gynecologist was right. She does not need to take any colored placebo pills. We certainly thought women needed to have menstrual cycles for health, but that's no longer the case. Whether taken regularly or continuously, hormone replacement has the same risks and the same benefits.
Most women who recognize that they do not need menstruation choose to have fewer periods (for example, every 3 months) or not to menstruate, and adherence is higher when women take their medications consistently.
Considering her menstrual pain, I agree with your daughter's gynecologist that she can take active medication daily. However, I would like to warn you both that it may bleed from time to time.
Between 10 and 25 percent of women taking combination hormone therapy experience bleeding, which is usually lighter than a period. This is especially true during her first 6 months.
I am sometimes discouraged by the low level of understanding that some men have about female anatomy and physiology.
Dear Dr. Roach: I am a 72-year-old man with benign prostatic hyperplasia. He is on Flomax and Finasteride. Do these shrink the prostate? Can an enlarged prostate affect bladder function? — JS
Answer: Men often develop an enlarged prostate in their 70s. Flomax works by relaxing the prostate muscles to improve blood flow, and finasteride blocks the hormones that cause prostate growth. Therefore, the prostate will shrink over time, but it may take months or even years for the drug to take full effect.
For most men, this combination is effective, but if it isn't, your urologist will consider other options to improve your symptoms, such as surgery, laser therapy, heat therapy, or cold therapy.
Without treatment, the prostate gland can significantly block the flow of urine, but it is the kidneys, not the bladder, that are most at risk of damage.
Urgent treatment may be needed to relieve pressure and protect the kidneys.
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