PAP SMEAR AFTER HYSTERECTOMY
Question: My uterus was removed 24 years ago at age 36. All other reproductive organs were left intact. Since that time, I’ve received conflicting advice about the need to have an annual Pap smear when there’s no uterus. Can you clarify?
Answer: If your cervix was left in place when your uterus was removed, you definitely should still have an annual Pap smear to screen for cervical cancer. However, when the cervix is removed along with the uterus, there’s no longer any need to have the test. While some doctors perform Pap smears even in those women to screen for vaginal cancer^ that form of cancer is extremely rare and doesn’t warrant an annual smear.
ANNUAL PAP SMEAR
Question: How often should a woman get a Pap smear? And what time of month gives the most accurate results?
Answer: The venerable Pap smear is one of the most important cancer-detection tests. A woman should begin having an annual Pap smear at age 18 (or earlier, if she is sexually active). Some gynecologists recommend that women at high risk for cervical cancer be tested even more frequently. (Risk factors include multiple sex partners, herpes simplex virus type 2 infection, and venereal warts.)
Pap smears should not be done during the menstrual peri-od. Some recent data suggest that the test is more accurate during the first half of the cycle if you use oral contraceptives. Midcycle is preferred for most other menstruating women.
Regardless of the timing, the technician reading the smear must know if you’re taking oral contraceptives or estrogen replacement therapy, and the date of your last menstrual period.
CONCERN ABOUT ABNORMAL PAP TESTS
Question: My Pap tests have shown “slightly abnormal” cells for nearly two years now. Other than recommending more-frequent testing, my doctors have not suggested any treatment. Recently I read in a newspaper column that “aggressive treatment” is necessary for premalignant stages of cervical neoplasia. What do you recommend?
Answer: Although “slightly abnormal” changes are not necessarily premalignant, you should nonetheless seek another opinion. Reasons for an abnormal Pap test result can range from vaginal or cervical infection to true cancer of the cervix. If the cause is an infection, treatment will usually lead to a normal Pap test; if not, the abnormality should be investigated further.
ANTIBIOTICS AND YEAST
Question: Every time I take antibiotics, I end up with a yeast infection. How can I prevent this?
Answer: Whether or not yeast infections can be prevented is a matter of controversy. Since you always seem to get an infection when taking antibiotics, you could try using an antifungal vaginal cream at the same time. Those creams include buto-conazole (Femstat3), clotrimazole (FemCare, Gyne-Lotrimin), and miconazole (Monistat 3), all sold over the counter.
Question: For breast tenderness, my gynecologist recommended 1,200 IU of vitamin E a day for life. He also recommended cutting back on caffeine. Are those treatments effective?
Answer: There’s no convincing evidence that eliminating caffeine or adding vitamin E helps relieve breast pain, which is usually caused by fluid retained just before menstruation. If your pain does precede menstruation, you might try taking a mild diuretic during the few days before your period. An over-the-counter pain reliever and a supportive bra might also help.
SOY AND BREAST CANCER
Question: I have read that the plant estrogens in soybeans may e safe for postmenopausal women. My oncologist “felt* that consuming soy was “probably” OK. But having had breast cancer, I don’t want to follow feelings or “probablys“.
Answer: There’s not enough hard evidence to make a definitive statement about the health effects of soy-based estrogens. Some observational studies have found that women who consume the most plant-based estrogens have a lower risk of breast can-cer than women who consumed the least. But there’s also at least a theoretical concern that those compounds may stimulate tumor growth in women who have estrogen-responsive breast cancer, particularly postmenopausal women.
The overall pattern of your diet matters more than any one particular food. So we agree with Clare Hasler, Ph.D., a phytochemical researcher and executive director of the Functional Foods for Health program at the University of Illinois, who says it’s OK for women—including postmenopausal women with breast cancer—to eat soy-based foods in moderate amounts as part of a balanced diet (low in animal fat, high in produce). But she would not recommend soy supplements until we know more about the health impact of high concentrations of soy compounds.
ESTROGEN AFTER HYSTERECTOMY
Question: Four years ago, at age 30,1 had a complete hysterectomy,. After taking estrogen in several forms, I continue to have severe mood swings, hot flashes, depression, severe headaches, nervous conditions, and sharp pains in both of my breasts. Help!
Answer: Your persistent hot flashes suggest that your dose of estrogen may be too low. Young women who have had a hysterectomy sometimes need more estrogen than older women going through menopause, in order to relieve the uncomfortable symptoms of abrupt hormonal decline. Your physician should work with you to find the dosage that is most effective.
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