This month we discuss laser therapy for lower back pain, pregnancy during perimenopause and preventing urinary tract infections (UTIs).
Can low-level laser therapy (also known as cold laser therapy) alleviate lower back pain?
Can I get pregnant during perimenopause?
How do I prevent a UTI?
Can low-level laser therapy (also known as cold laser therapy) really alleviate low back pain?
Douglas Chang, MD, PhD, chief of physical medicine and rehabilitation service at UC San Diego Health
Although the use of low-level laser therapy (LLLT) appears safe for the treatment of low back pain, clinical trials have yet to establish its effectiveness. There are some randomized trials on LLLT and a few suggest positive results, but many studies have also concluded that there’s no difference between treatment laser and placebo laser or that LLLT is no better than exercise.
The difficulty in interpreting these studies is that it’s not like comparing apples to apples — they involve a variety of conditions, application techniques and technical characteristics of the equipment. But overall, the scientific evidence published so far simply isn’t sufficient to conclude that the use of LLLT is clinically effective for the treatment of low back pain.
Can I get pregnant during perimenopause?
Kathryn Macaulay, MD, obstetrician/gynecologist at UC San Diego Health
Yes. While the risk of pregnancy during the perimenopausal years is low, infertility cannot be assured until a woman has reached menopause, defined as 12 months without menstruation. The perimenopause, or menopause transition, is a period of ongoing ovarian follicular decline, marked initially by change in menstrual cycle length, less than seven days and later by skipped periods and symptoms, such as hot flashes and night sweats. The average age of women entering perimenopause is 47-years-old and the average duration of the transition to menopause is about four years.
While the percentage of skipping ovulation increases during the menopause transition, there is still a chance of an erratic ovulatory cycle, and therefore, risk of pregnancy. In women ages 45-49 not using contraception, the possibility of pregnancy is 2-3 percent. After age 50, the possibility of pregnancy decreases to less than 1 percent.
Therefore, women who are sexually active are generally advised to continue using contraception until they have reached menopause.
Contraceptive options for perimenopausal women are the same as for women of younger reproductive age and include barrier methods, hormonal contraceptives and intrauterine devices (IUDs). However, perimenopausal women may experience greater benefits with use of hormonal contraception (low dose oral contraceptive pills or the vaginal contraceptive ring), which can regulate periods and ease symptoms. The five year progestin releasing IUD is another good option for contraception during perimenopause, particularly if a woman has heavy menstrual bleeding. This type of IUD is highly effective in reducing menstrual blood loss and also may provide protection against development of endometrial hyperplasia and endometrial cancer.
Determining when a woman can discontinue using contraception can be challenging, as no single test exists to “diagnose” menopause. Serum FSH, which increases permanently after menopause, must be interpreted with caution during the perimenopause as levels can fluctuate. In situations where a clinical diagnosis of menopause is not possible, such as in current users of oral contraceptives or after endometrial ablation, it may be useful to check FSH levels (for pill users, wait 2-4 weeks after stopping the pill) and, if elevated, repeating level in 4-6 weeks to assure elevated FSH level persists.
How do I prevent a UTI?
Linda Brubaker, MD, urogynecologist at UC San Diego Health
For most adult women, a urinary tract infection (UTI) is a rare event, occurring a few times in their lives. Otherwise healthy women notice a relatively sudden change in their urination — a woman may notice burning when she urinates and feel that she needs to urinate suddenly and often. Most of the time, these symptoms are caused by simple bacterial infection in the urine. The symptoms typically resolve with a few days of oral antibiotics that focus on the urinary tract.
For other women, urinary tract infections become a significant health problem. UTIs may occur too often, sometimes three times or more within six months, leading to a real change in well-being and a lot of antibiotic use.
UC San Diego Health recently established a
specialty center that will help women with recurrent UTIs. Women can help prevent a UTI in the following ways:
- Keep yourself hydrated. Unless you are taking something that changes the color of your urine (some vitamins do this and lots of beets will), try to drink enough water to keep your urine a pale yellow color. When you first wake up, the urine will be darker; and as you hydrate yourself, the urine color will lighten. If your urine has no color (looks like water), you are probably taking in more than you need. Feel free to discuss this with your clinician if you have questions about your hydration
- Urinate when you need to. It is important not to hold your bladder until you are “bursting!” This is hard on the bladder and may increase your risk of a bladder problem, including possibly infections. Some women really hold their bladder to avoid a public bathroom; instead try to find a reasonable place to urinate and make yourself comfortable using a toilet seat cover, if necessary. Some women carry their own toilet seat covers so they are always prepared.
- Practice good hygiene. There is no reason to do vaginal douching; in fact, this might increase problems related to infections in the vagina and possibly the urinary system. There are good bacteria in these areas that are probably important in keeping the bad bacteria away. A balance of bacteria is part of a healthy urinary system.
- Talk with your clinician about hormonal health. After menopause, the amount of estrogen decreases in the bladder area, as well as in other parts of the body. For some women, this change triggers more urinary tract infections. If your clinician finds that your tissues may benefit from estrogen in this area, she/he may prescribe estrogen in a cream, vaginal pill or vaginal ring.
- Maintain your general health. Try to get to a normal weight and eat a healthy diet. Keep chronic conditions, such as diabetes, under control. These factors can help keep your immune system healthy — strong immune systems help fend off infections of all kinds, including urinary tract infections. Some people take cranberry products to prevent UTI, although recent studies suggest that this isn’t as helpful as people thought. If you eat a reasonable amount of cranberry-based foods, be careful with the calories and sugar in them.
To learn more about the featured medical specialties, please visit:
Obstetrics and Gynecology
Women's Pelvic Medicine Center