June 2009

Q. My question is regarding about my mother. My mother received for the first time the shot called Depo-Provera birth control good for 3 months. She was taking the low estrogen birth control pill one every day. The doctor said that she should stop taking birth control pill because she will be 50 in August. That it would be easier to take the shot that is good for 3 months called Depo-Provera. I am worry because the doctor said before the shot that her period would lasted for one week. Now she had her period for 3 months and constant spotting is her main issue also she has a fibroid that has caused heavy periods. Is this happening because the lining of the uterus is thinning and will cause her to have a period for 3 months? And the doctor told her that she needs another shot to stop the bleeding and is that safe? She is getting tired of having her period for 3 month is that normal? I need your help to get more information about this drug.

A. Thanks so much for taking the time to ask this question about your mother. It is hard for me to answer precisely as I don't know your mother's medical history, however I do have some comments and questions. Why is your mother on estrogen - and now Depo Provera? Is it for bleeding and/or birth control/or both? Fibroids are common, but doctors usually prefer not to give a woman with fibroids at her age additional estrogen as this could encourage it to grow (the progestin in Depo-Provera however will not cause it to grow). She is right to be concerned about birth control as long as she is still menstruating. On the other hand, most likely your mother is perimenopausal and has a very thin uterine lining already from the low dose estrogen (which also contains progestins too which will thin the lining of the uterus) pill. THe Depo-Provera is pure synthetic progestin which commonly causes unpredictable bleeding for months if notlonger. Although it is good for birth control, it can also be used to help stop perimenopausal bleeding in women who have heavier periods as they approach menopause. However since your mom was already on the low dose pill, I suspect as mentioned her uterine lining is already thin.

I would strongly suggest that your mother talk to her doctor about having an office biopsy of her uterine lining to be sure it is okay and perhaps to consider a pelvic ultrasound if there are any other concerns. I would also be hesitant to give her any more hormone or birth control treatment until she knows that all is well - and that her bleeding is simply from the thinned uterine lining which is shedding even more from the Depo-Provera.

Q. I read an article Dr. Savard wrote on Feb.11,2009 about young women having mammograms. She was talking about yearly mammograms, correct? I had one mammogram when I was 28 1/2 years old in 1976, it turned out fine, no problems, but I have worred that I might develop breast cancer from having that one mammogram. I have never had any lumps or any other problems. Would you please ask Dr. Savard if she thinks I would ever develop breast cancer from having had that one mammogram in 1976, at the age of 28 1/2?

A. The risk of radiation is "linear" which means that the risk accumulates over time - and each time we have radiation/an x-ray - it adds to the risk. That is why the concern in young women - young women who are given yearly mammograms (and many other type x-rays too such as CT scans) will accumulate a fair amount of radiation which could potentially increase their risk of breast cancer (and other cancers, such as thyroid cancer depending on what part of the body the x-rays were taken) when they are much older. You are right that one mammogram at a young age (281/2 is young) would not be nearly enough radiation to increase your risk of breast or any other cancer. However too many people don't think twice before having x-rays and I felt it important to make the point that there are often downsides to things we do in medicine. I hope that answers your question.

Q. My wife & I saw your taking supplements segment on Good Morning America Monday - you mentioned taking a name brand fish oil but didn't mention any - what do you recommend? - my wife said some make your breath smell, etc. so anything brands you can suggest would be appreciated. We're OK with the multivitamin because we use Centrum which you had on TV.

A. Thanks for watching the segment - and for reaching out to learn more about fish oil supplements. I have researched this question a few years ago and found that no single brand stood out - yet the costs varied quite a lot. Experts seem to think that when it comes to fish oil supplements, the precise brand may not matter. I personally have found the quality of Costco's Kirkland products are excellent and of good value - consumer reports has reviewed them previously. So as you may guess, I take the Kirkland fish oil brand. Most fish oil supplements have the potential to give a slight "fish oil" regurgitation (they repeat on you) - and refrigerating them will minimize the symptom. I have found that as long as I stay upright after swallowing them - don't exercise or bend which could increase chances they reflux back up into your esophagus - they seem to be okay.

Q. I'm currently reading your book and though I am charged up about following your advice to a healthy lifestyle I feel as though you relentless point and make examples of Apples to your beloved Pears! I've felt less-human or less-feminine my entire life because of my apple-shape, my own mother still teases me about it, she's a happy pear, she doesn't know the pain! any way I feel as though your book is no different! "Come look Pears... this is what you'll become if you don't watch it!.. a hideous diseased APPLE!" well fine. You must be a pear yourself or else your book would have an equal amount of encouragement to both audiences. I've also noticed that all your good reviews are from pears who've been glorified in your book. You make us seem very helpless no matter what. It got tiring after awhile reading over and over how doomed the apple women are, I'm skipping straight to the diet part now! and am encouraging myself since your book failed at that!

A. Oh, I am so sorry and yet I must confess you are not the first person to give me that feedback. The book was inspired by my "apple" sister who didn't know about her borderline diabetes or multiple other health risks based on her abnormal blood lipid profile and I felt that if she had been aware to pay more attention things may have been different. On the other hand, I found so many women and girls in my practice hating their "pear-shaped bodies" - dieting and developing eating disorders - that I wanted to remind them that their bodies actually presented a health benefit. Since we all become apples over time (I am now a postmenopausal "almost" apple - many women call that a "papple"...I can understand your frustration with the tone of my book. Again, I am sorry that I allowed my concerns for apple-shaped women like my sister cloud my usual optimism. In the end, there is so much we can all do i.e. lifestyle, sleep, low stress (easier said than done) to minimize the risks of our genetics and family history and live the fullest and longest life possible.