Dear Dr. Roach: My cousin is having irregular periods. Her last聽one was three months ago. She was given Provera for 10聽days to help, but after she stopped it, she had a very heavy period. Is that normal?
T.R.
Provera is a brand of a type of progesterone, a female hormone. This hormone is high in early pregnancy: It promotes retention of the thick lining of the uterus, giving the developing embryo a place to develop, and preventing menstruation, the shedding of the lining of the uterus that normally takes place every month (or so) a woman is not pregnant.
Some women have irregular periods, and this isn鈥檛 necessarily abnormal. One test that women鈥檚 health specialists do if concerned about irregular periods (after ruling out pregnancy) is to give a patient 10 mg of medroxyprogesterone (Provera) for 10 days, then stop. When levels of progesterone go down, the body 鈥渞ealizes鈥� it isn鈥檛 pregnant, and will shed the thick lining of the uterus. That is the normal response. This period may be heavy if the lining had been there for three months.
If there is no period after stopping the Provera, it suggests there may be a blockage in the uterus. It鈥檚 also possible the lining of the uterus (which requires estrogen) never built up in the first place, so further evaluation would be required.
Dear Dr. Roach: I am a 55-year-old woman. I have a leg with atrophied muscles due to having meningitis as a child. Consequently, I fall a lot. I fell and broke my wrist recently, and last year I broke my foot. I had a scan done for osteoporosis, and my T-score was -2.5. The doctor suggested I start medication for osteoporosis. I am hesitant to take such medication due to side effects. Does the number warrant taking medication? Is osteoporosis a condition that worsens over time, or will it stay at -2.5, which appears to be not too egregious, without the medication? Are there lifestyle changes that help this condition?
T.C.
The T-score is a statistical measure of how a person鈥檚 bone density compares with a normal, healthy young person of peak bone mass. Someone with higher-than-average bone density will have a positive score: A score of less bone density will be negative. A T-score below -2.5 is defined as osteoporosis, so you are just at the border. However, that still puts you at greater risk for fractures, and a history of wrist fracture (even with a fall) means more risk of future fracture than someone with the same T-score and no previous fracture. Treatment is appropriate for a score this low, but that does not necessarily mean medication is the starting point for all people.
Initial treatment should include adequate calcium and vitamin D intake. Most people in North America have a hard time getting adequate vitamin D in the winter. There are few good food sources (swordfish is one); vitamin D is mostly made in the skin, and only with adequate sunlight. I聽often test vitamin D levels for my patients. Another reasonable approach is to give supplemental vitamin D-3 (cholecalciferol), such as 1,000 IU daily.
Exercise is another important treatment, and having balance problems is a challenge. However, any kind of exercise can be helpful, and some, such as tai chi,聽have been shown to improve both balance and bone density. If聽these are not enough, I do recommend treatment with an聽anti-resorptive agent, such as聽risedronate (Actonel) for most women in your situation. There are side effects, but these are outweighed by the benefits of reducing fracture risk. A three- to聽five-year course is appropriate for most women before re-evaluation.
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 [email protected]