I’m getting married, but I might never have children

Dr Flo,
I have had Polycystic Ovary Syndrome for many years, which was diagnosed after many tests.  I am getting married this year and I am worried that I might never have  children. I don’t know how to tell my fiancé.  Please help.
Anne

Dear Anne,
In polycystic ovary syndrome, the ovary has many cysts containing immature eggs that do not reach the stage of ovulation. Hormone levels are altered, which disrupts the menstrual cycle. Extra androgen hormones (testosterone) are also produced. The symptoms include irregular periods, heavy bleeding, acne, excessive hair growth, weight gain, hair loss on the scalp and dark patches on some areas of the skin.
It can be managed by maintaining a low glycemic index diet (get most of the carbohydrates from fruits, vegetables and whole grains), exercise, contraceptive pills and metformin.
Because ovulation rarely happens, it is difficult to conceive, but not impossible. With the help of a gynaecologist, you can get medication to induce ovulation for several cycles to see if conception will happen. If it does not, the other options include intrauterine insemination (IUI) and in vitro fertilisation (IVF). It is advisable to communicate this with your partner before you get married so that he makes an informed decision and avoid conflict later. A partner’s support is also very helpful. At the same time, your partner may also need to be tested at some point depending on the outcome of the fertility treatment.

Dr Flo,
What is osteoporosis? What of bone fractures due to calcium deficiency?
Ali

Dear Ali,
Calcium helps to build strong bones. In addition, bones are living tissue, constantly breaking down and being replaced, and calcium helps with this maintenance. When calcium levels are low, the bones have low density and are weaker. Therefore, they break or fracture easily. Osteoporosis refers to having very weak bones because the rate of breaking down is faster than replacement.
The rate of replacing a new bone starts slowing down in our 20s and we start losing bone mass at age 30. Those with a higher bone mass in their youth lose it slower than those who do not. When the bones are very weak, it is easy to fracture them even from mild stresses. You can also develop back pain and other bone pain, become shorter and bend while walking. There is a higher risk of osteoporosis in post-menopausal women, if you have a family history of osteoporosis, have a small body size, due to some hormonal disorders, liver or kidney disease, lupus, rheumatoid arthritis, inflammatory bowel disease, low calcium intake, long term use of medication for seizures, gastro-esophageal reflux, cancer treatment and long term use of steroids. You are also at higher risk if you lead a sedentary lifestyle, if you take excessive alcohol, and due to tobacco use.
To diagnose osteoporosis, an X-ray or a bone density scan is done. Some medication  strengthen the weak bones and prevent further weakening. To prevent osteoporosis or strengthen weak bones, consume adequate calcium and vitamin D, exercise (balance, weight bearing and strength training exercises), maintain a healthy weight (both being underweight and overweight are not advisable), stop smoking and take alcohol in moderation.

Dr Flo,
I have had a swelling near my right thigh for the past three years. Sometimes it disappears on its own. Other times, it disappears when I push it in. Once in a while it is painful. I have been told it is a hernia and I need to be operated on. Is there any other way to treat it, like some medicine that I can take?
Maina

Dear Maina,
A hernia occurs when underlying organs push through a weakness in the muscle or tissue that holds it in, for example, when intestines protrude through a weakness in the abdominal wall. The commonly appear in the abdomen, at the umbilicus, at the inguinal region (upper thigh), the groin or at the site of a previous abdominal surgery. Complications can arise when a part of the intestine gets trapped, causing severe pain, nausea and vomiting, and constipation. If the trapped intestine does not get blood supply, then the tissue can die which leads to perforation, serious infection and possible death.
Because it happens due to a weakness or an opening in the overlying tissue, the only way to manage it permanently is through surgery, to close up the weak or open area.

Dr Flo,
I sometimes notice blood in my stool. I do not feel any pain whenever this happens. What could be the problem?
B

Dear B,
Having blood after passing stool is a sign that something is actively bleeding at the time. This could be due to a tear in the lining of the anus or rectum, because of friction from passing large stool, hard stool or from diarrhoea. The bleeding could also be due to haemorrhoids, otherwise known as piles. These are veins that bulge in the lower part of the rectum and anus. The walls of the veins stretch and get irritated, and are easily torn, causing bleeding. They can occur due to straining when passing stool, for instance due to constipation or diarrhoea; or any activity that causes repeated high pressure in the abdominal region such as a persistent cough and lifting weights.
To manage the problem, prevent constipation by taking a lot of fluids and a high-fibre diet every day, exercise, schedule time each day for a bowel movement, and take your time; use baby wipes instead of toilet paper and, you can also take a sitz bath - sit in warm water for about 20 minutes twice a day to help soothe the injured tissue. A doctor can prescribe stool softeners and suppositories to help heal the injured tissue.
Since the bleeding has persisted for a while, you should see a surgeon, so that an examination can be done to visualise the lining of your anus, rectum and large intestines.

Send your medical questions to [email protected] for free expert advice