Q. I've had a longstanding problem with heavy and irregular periods, so much so that I've become anemic a few times and had to take iron. My doctor checked me out and said I have an imbalance of hormones but otherwise nothing serious. For treatment, she prescribed birth control pills to keep my menstrual cycles regular.
Since starting the pill, my periods have been lighter than usual and regular. However, I was concerned about side effects; I had always thought that the pill was risky. When I discussed this with my doctor, she talked about the beneficial side effects that birth control pills have. Which view is right?
A. As the levels of estrogen in birth control pills have decreased over the years, so have the harmful side effects. For most young women, the noncontraceptive benefits of the pill far outweigh the risks.
Many women are familiar with the highly publicized risks of birth control pills, such as blood clots, heart attacks and strokes. Fortunately, these complications are very rare. It's estimated that among 100,000 women under 35 taking the pill, there would be five deaths each year from heart attack, stroke or blood clots in the lung (pulmonary embolism) that wouldn't have occurred otherwise.
To put things into perspective, the risk of dying simply from being pregnant is many times higher. In addition, studies about birth control pill risk show that smoking is a major contributor to pill-related deaths. This risk occurs mainly in women over 30 and is especially high in women over 40. Said another way, women who use birth control pills under age 30, even if they smoke, have a very low risk of serious complications.
Some researchers have gone so far as to say that if smoking is eliminated from consideration, there's little to no increased risk from taking birth control pills themselves, no matter what the age.
Lately, beneficial "side effects" of the pill have come to light. By reducing the rate of some serious diseases, birth control pills actually improve the health of some users and prevent fatal illnesses. The noncontraceptive benefits of the pill include:
Cutting the rate of cancer of the uterus and ovaries. Estimates are that 2,000 cases of uterine cancer and 1,700 cases of ovarian cancer are prevented each year.
Reducing the rate of pelvic inflammatory disease (PID) and infection of the uterus and tubes. This effect, in turn, leads to a decrease in the incidence of infertility and ectopic pregnancy (a pregnancy abnormally located in a Fallopian tube).
Improving some of the symptoms of menstrual periods (cramping), premenstrual syndrome and endometriosis (painful implants of uterine tissue in the pelvis).
Decreasing the occurrence of ovarian cysts, fibrocystic breast disease and anemia from excessive menstrual blood loss.
Keep in mind that smoking and being over 30 to 35 are the main risk factors with using birth control pills. If you're over 30 and taking the pill, don't smoke.
Q. Would you please discuss what happens to your stomach juices as you grow older? At age 69, I find I cannot eat very spicy foods or onions anymore.
A. I can tell you what happens to your stomach juices, but that may not have anything to do with your not being able to eat spicy foods.
In your later years, your stomach produces less acid. For the most part, you probably won't notice any difference in what you can or cannot eat because of this change. The rest of the digestive juices in your intestines can usually handle what you eat without any difficulty.
There are still a lot of unanswered questions about why some people can eat spicy foods without stomach upset while others cannot. Some doctors, like many other people, used to think that spicy foods were harmful to the stomach or that they irritated certain conditions like stomach ulcers.
Although many people still believe this to be true, doctors now believe that foods in themselves aren't harmful and that people with an ulcer, for example, ordinarily don't need to restrict their diet.
This is not to say that certain foods don't cause problems. Fatty foods, for instance, can aggravate a gallbladder condition or cause heartburn. However, it's not the fatty food itself irritating your intestines, it's your body's reaction to it. Eating a fatty meal stimulates your gallbladder to contract and release its digestive juices into the intestines; if you have gallstones, this contraction may give you pain or make you sick to your stomach.
The most practical advice is just good common sense: If you find a specific food that disagrees with you, don't eat it. You should also check with your doctor to make sure this isn't a sign of something wrong with your digestive system. Otherwise, there's no reason most people can't eat as much spicy food for as long as they want.
Jay Siwek, a family physician from Georgetown University, practices at the Fort Lincoln Family Medicine Center and Providence Hospital in Northeast Washington.
Consultation is a health education column and is not a substitute for medical advice from your physician.
Send questions to Consultation, Health Section, The Washington Post, 1150 15th St. NW, Washington, D.C. 20071. Questions cannot be answered individually.