Using the contraceptive pill

Dear Dr Rainford,

I am 38 years old and would like to know how safe it is for me to use contraceptive pills. Also, is there a particular brand that doesn't cause weight gain?

Dear Reader,

The combined oral contraceptive pill is safe in a woman your age provided that you are healthy and do not smoke.

There are however, some conditions where it is advised that 'the pill' be avoided. These include deep vein thrombosis (a blood clot which forms in the deep veins of the legs or the pelvis) or pulmonary embolism (a blockage of a blood vessel in the lungs usually from a blood clot), migraine with aura, breast cancer, severe high blood pressure, if you are breast feeding and your baby is less than six weeks old, liver disease or liver tumours and heart disease.

Women who are younger than 35 years old and smoke can still use 'the pill'. However, it is clear that the health risks associated with smoking are greater than any benefits.

In general, 'the pill' is not associated with any significant weight gain and a recent review study examining this issue confirmed this finding. Another study examined women specifically on the brand Yasmin and did not find any 'clinically significant' change in weight.

Overall, most contraceptive pills are unlikely to affect your weight to any great degree. Nevertheless, it is important to be aware of the real causes of weight gain such as an unhealthy high fat intake, high carbohydrate diet and lack of exercise.

Bumps on my penis

Dear Dr Rainford,

For years now, I have had a concern but I have been too embarrassed to ask about it until today. I have some small bumps around the rim of the head of the penis. They do not hurt but I am wondering why they are there and how could I get rid of them. I had asked my doctor once about them and she said that nothing is wrong but I think that they are unsightly.

Dear Reader,

Thanks for sharing your problem. While I am unable to diagnose your problem, I can suggest a specialist who can. I would recommend that you see a urologist who is the expert in this area. Urologists are also surgeons and will be able to guide you on the safety of removing these bumps. Good luck!

Unbearable menstrual cramps

Dear Dr Rainford,

I am a Jamaican, 28 years of age and I have two sons aged 13. I have always had painful menstrual cramps but, for about two years now, I have started to feel pain during sexual intercourse.

The real problem is that I don't seem to be able to conceive. Do you think that I have fibroids? If not, what are the reasons for me being unable to conceive? I still have not seen a doctor about this. I await your response.

Dear Reader,

Both of the conditions which you have mentioned — dyspareunia (pain with intercourse) and dysmenorrhoea (painful menses) — can be caused by uterine fibroids. However, it is only in a minority of cases that fibroids affect a woman's ability to conceive.

While it is possible that you have fibroids, I doubt that is the reason why you are unable to achieve pregnancy. Endometriosis is a condition that can cause pain in both cases and is a major cause of infertility (the inability to conceive after one year of attempting pregnancy).

Endometriosis occurs when the cells that normally grow in the lining of the womb, grow in abnormal locations. These locations include the ovaries, the intestines and the lining of the pelvis. I have mentioned two possible causes of your problems but there are many more. Therefore, please consult with a gynaecologist for a thorough evaluation.

Dr Monique Rainford is a consulting obstetrician and gynaecologist; email: yourhealth@gleanerjm.com.