Doc, my wife has never conceived after seven years of trying

Both parties may have a health problem contributing to the delay in getting pregnant.
Both parties may have a health problem contributing to the delay in getting pregnant.
Photo credit: SHUTTERSTOCK

What you need to know:

  • She can get medication to induce ovulation for several cycles to see if conception will happen.
  • If it doesn’t, the other options include intrauterine insemination and in vitro fertilisation


 I  have been married for seven years, and my wife has never conceived. Her menstrual periods have been on and off but after a while they disappeared. Someone advised us on using some family planning pills and the periods came back. But after stopping taking pills, she started missing the periods again and now she only  menstruates upon taking the pills. What might be the problem?


Dear John,
The absence of periods is called amenorrhoea. It can happen naturally due to pregnancy, breastfeeding or menopause. It can also happen due to hormonal imbalance due to polycystic ovarian disease, thyroid disease, a growth/tumour on the pituitary gland, premature menopause and other hormonal disorders. It can also be caused by some medications, for example, some contraceptives, some anti-depressants, some allergy medication, some blood pressure medication or cancer treatment. Amenorrhoea can also develop because of having very low body weight, excessive exercise or too much stress.

It is advisable for her to be reviewed by a gynaecologist for examination. She will also have some tests done including a pelvic ultrasound scan and hormone levels. She can get medication to induce ovulation for several cycles to see if conception will happen. If it doesn’t, the other options include intrauterine insemination and in vitro fertilization. It is also good to be aware that both parties may have a health problem contributing to the delay in getting pregnant.

Hello Doc,
I have two questions on oestrogen.  
. When oestrogen levels are high in a 21-year-old individual who has size D++ breast size, what medication can they use to help lower oestrogen? Are there pills or injectables?

. When oestrogen levels are lowered due to family planning methods, particularly the implant, does it affect the joints? Perhaps the synovial fluid at the joints or bones? Because I've been having more instances of joint pain from my feet up to the pelvic area. Is calcium deficiency a risk as a result of this method and is my bone density likely to deplete faster because of this family planning method?

Dear Khaleya,
Oestrogen is a sex hormone present in both men and women, though in higher levels in women. Together with other hormones, it regulates the monthly cycle and affects the entire reproductive system in women. Oestrogen levels can be high due increased oestrogen production or changes in the way oestrogen is broken down or removed from the body, leading to hormonal imbalance. Contributory factors for this may be polycystic ovarian syndrome, obesity, stress, excessive alcohol intake, exposure to some medications and some chemicals, intestinal dysbiosis (there are more of the harmful bacteria than beneficial bacteria in the large intestines) and some cancers.

When the oestrogen levels are very high, there may be weight gain, irregular periods, severe pre-menstrual symptoms, anxiety, depression, fatigue, low sex drive, uterine fibroids, breast pain and swelling, breast lumps (fibrocystic growths), bloating, headaches, hair loss, sleep disturbances, problems with memory, cold hands or feet. Prolonged exposure to high oestrogen levels also raises the risk of developing some cancers. Having large breasts may be due to genetics or increased sensitivity of the cells to the several hormones, not necessarily due to elevated oestrogen levels alone.

Treatment of high oestrogen levels is done by treating the cause. If there is no treatable cause identified, then lifestyle changes may be helpful such as having a diet rich in vegetables and fruits, taking more omega-3, maintaining a healthy weight, reducing stress, limiting alcohol intake, avoiding treatments that have oestrogen and avoiding xenoestrogen chemicals such as BPA in some plastics and phthalates in plastics, soaps, shampoos and hair sprays.

There are medications that can lower oestrogen levels such as aromatase inhibitors and synthetic luteinising hormone-releasing hormone. However, these are used in specific circumstances and are prescribed by specialist doctors. They also carry the risk of causing early menopause and infertility.

The implant is a contraceptive method that has a type of the hormone progestin. It has not been found to have significant effect on bone density, particularly if the oestrogen (estradiol) levels are between 30 and 50pg/ml. It would be advisable for you to see a doctor for examination and tests to determine the exact cause of the pain in your lower limbs. In case of calcium deficiency, there are calcium supplements and you can take a diet rich in calcium (dairy products, legumes, nuts and seeds, spinach, broccoli).

What is Alzheimer’s disease? Does it afflict only the aged? Is one consequence of this ailment loss of memory?

Dear Alnashir,
Alzheimer’s is a disease of the brain where there is progressive shrinking of the brain and death of brain cells. It causes dementia - a continuous decline in memory, thinking, making judgements, behaviour and personality changes that eventually affect a person’s ability to take care of him/herself and interact with others. In the last stages, the disease affects normal bodily functions like swallowing, bladder control, and balance and increase the risk of developing other health problems like falls, poor nutrition, dehydration, constipation, diarrhoea and recurrent infections, which can eventually lead to death. Alzheimer’s is the most common cause of memory loss and dementia, though there are other possible causes.

There is no exact known cause of the disease. There is a higher risk of developing the disease if you are above  65 years, if you have a first-degree relative with the disease (parent or sibling), history of head injury, excessive alcohol consumption, poor sleep habits, long-term air pollution, smoking or exposure to second hand smoke, lack of exercise, obesity, high cholesterol levels, high blood pressure and uncontrolled diabetes.

On the other hand, lifelong learning and continuous social engagement lowers the risk of developing Alzheimer’s disease.

Alzheimer’s disease is diagnosed from an explanation of the symptoms, examination and brain imaging tests. There are some medications given which may temporarily improve or slow down disease progression, but there is no cure for it.

The most important thing is to provide support for the individual at whatever stage of the disease, and provide a safe environment, good nutrition, exercise, social interaction and engaging activities. Those caring for an Alzheimer’s patient also need support.

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