Private health

Q:

I was diagnosed with uterine fibroids in my early 40s, but they didn’t cause problems. Now that I’m 51, they’re causing pelvic pressure, bloat and heavy bleeding with my periods. My doctor recommended a hysterectomy, but when a friend had the procedure, she had to take a month off work! Is there anything else I can do?

A:

Absolutely! Thousands of women have hysterectomies every year to resolve symptoms of uterine fibroids—noncancerous tumors that grow in or on the walls of the uterus— but I consider it a radical treatment for a benign condition. During perimenopause, your reproductive organs still produce hormones that give protective benefits to your heart, bones and vaginal tissue, so you don’t want to remove them unless you have to. Plus, hysterectomy usually involves a hospital stay, and as your friend found out, a recovery of four to six weeks.

What’s more, since estrogen and progesterone fluctuate during perimenopause, you’ve likely been experiencing estrogen-dominated cycles, which can trigger fibroid growth. If your symptoms aren’t too intrusive, you may be able to wait for these cycles to stop and for your fibroids to resolve naturally since the drop in estrogen that accompanies menopause may cause fibroids to stop growing and even shrink.

But if your symptoms are too bothersome to ignore, ask your doctor about uterine fibroid embolization (UFE), a procedure I recommend to my patients with fibroids. The outpatient procedure blocks the blood supply to the fibroids, shrinking them. It’s 90% effective in reducing symptoms caused by fibroids, and recovery is a matter of days. In one study, 91% of the women who had UFE would recommend the procedure to a friend.

What’s causing these bumps?

Q:

I’ve been using a scrub to clear up an acne flare-up on my rear, but it’s not working and the pimples are getting inflamed. Could it be something more serious?

A:

It most likely is folliculitis, an inflammation of the hair follicles. Warm, humid conditions, bacteria and chronic friction from wearing tight athletic wear or jeans can create this inflammation, leading to red bumps, which start small but develop into larger clusters like you’re describing when they’re irritated.

It’s a good idea to discontinue any soaps, exfoliating scrubs and loofahs you’re currently using since they can cause further irritation. When you can, wear cotton underwear and trade in spandex and denim for loose, breathable fabrics. To treat your skin, I recommend applying warm compresses and using a gentle cleanser that’s antimicrobial and antiinflammatory, like CLn Body Wash (CLnWash.com). If the bumps don’t improve in about a month, see your provider for an oral prescription.

Yes. This is a common problem: Perimenopausal women are four times as likely to develop depressive symptoms as women who haven’t gone through this transition. Since you prefer a more natural approach, try increasing your fiber intake. Research shows that doing so can reduce the risk of blue moods by up to 70%. And a new study suggests that if you eat 2,000 calories a day, increasing daily fiber intake by 2 grams results in a 10% decreased risk.

Fiber feeds healthy gut bacteria that are key to the production of 90% of the body’s serotonin and 50% of its dopamine— neurotransmitters that influence mood. To ensure you get enough, consider adding a supplement, like Benefiber, and eating fiber-rich fruit, veggies, whole grains and legumes, aiming for 30 grams a day.

I’m 46 and getting moody before my periods. My doctor suggested a low-dose antidepressant, but that seems extreme. Is there a natural

approach?