Wednesday, April 25, 2018
Health

Mayo Clinic Q&A: a low diastolic number; slowing a heavy period

GETTING A READ ON A LOW DIASTOLIC NUMBER

What is considered "low" for the diastolic number in a blood pressure reading? What would a low reading mean? If the systolic number is within normal range, what can be done to alter the diastolic number?

A blood pressure reading has two numbers, given in millimeters of mercury. The first, or upper, number measures the pressure in your arteries when your heart beats. That's systolic pressure. The second, or lower, number measures the pressure in your arteries between beats. That's the diastolic pressure.

In general, diastolic blood pressure is considered to be low if it is 60 millimeters of mercury or less. Normal blood pressure varies from one person to another though. If your diastolic blood pressure is consistently below 60 millimeters of mercury, but you aren't experiencing any problems from it, you may not need to do anything. Noticeable symptoms of low blood pressure generally include dizziness, lightheadedness or fainting. If you're having these or other symptoms that could be related to low blood pressure, more investigation may be required to uncover the possible cause and provide appropriate treatment.

In some cases, medications can cause low diastolic blood pressure. In particular, medications intended to lower blood pressure, called antihypertensives, may go too far in the other direction, reducing blood pressure beyond a healthy level. These antihypertensives include diuretics (sometimes called water pills), alpha blockers and beta blockers. Other medications also may lead to low blood pressure, such as drugs for Parkinson's disease, certain types of antidepressants and the drug sildenafil, particularly in combination with heart medication (e.g., nitroglycerine).

An underlying medical condition could trigger low blood pressure, as well. For example, heart problems, such as extremely low heart rate, heart valve problems and heart failure, may cause low blood pressure because they prevent the body from being able to circulate enough blood. Endocrine disorders, such as adrenal insufficiency, also can trigger low blood pressure.

Other conditions, including dehydration, blood loss, severe infection and a severe allergic reaction, can lead to low blood pressure. But, these disorders usually cause a sudden, dramatic drop in pressure, rather than a sustained low blood pressure reading over time.

Another possible cause for low diastolic blood pressure is extremely stiff arteries. Very often, at around age 55 or 60, arteries begin to lose some of their flexibility. That can increase systolic blood pressure and cause discordantly low diastolic blood pressure. In some cases, stiff arteries could be a symptom of vascular disease.

When your diastolic blood pressure is consistently below normal, it may need to be evaluated. In young healthy people who do not take medications or have any symptoms, no treatment may be needed. But, it's still a good idea to talk to your doctor about it. If you do take medications, ask your doctor to review your current medication list to see if they could be contributing to low blood pressure.

If your doctor suspects that an underlying disorder could be the source of the problem, then additional tests may be necessary. It also would be worthwhile to talk with your doctor about managing any vascular risk factors you may have that can be changed, such as smoking, high cholesterol, diabetes and obesity. When a medical condition leads to low diastolic blood pressure, successfully treating that problem may eliminate the low blood pressure, too.

Sandra Herrmann, M.D., nephrology, Mayo Clinic, Rochester, Minn.

AN IUD ISN'T THE ONLY OPTION FOR TREATMENT OF HEAVY MENSES

After almost a year of having a period that is much heavier than normal, my gynecologist recommended an IUD as treatment. How does this work, and is it safe? I am 38, and I'm done having children.

Many types of intrauterine devices, or IUDs, are available. The specific kind that has been approved by the U.S. Food and Drug Administration for treatment of heavy menses releases the hormone progestin. This type of IUD is safe and highly effective for easing periods that are heavier than normal. IUDs are not the only option for treating this condition though. Before you move forward, consider talking with your doctor about the range of treatment choices available to you.

Hormonal IUDs are small, T-shaped plastic devices placed in the uterus that release progestin over time. Typically, IUDs are used to prevent pregnancy. But, research has shown hormonal IUDs to be useful for easing heavy periods, too. That's because they not only thicken cervical mucus to prevent sperm from reaching or fertilizing an egg, they also thin the lining of the uterus. That decreases menstrual blood flow and cramping.

One of the main benefits of using an IUD to reduce heavy periods is that, once placed, an IUD is effective for three to five years. The exact amount of time it can be left in place depends on the brand you choose. Little, if any, followup care is needed to manage the IUD during that time.

Side effects usually are minimal. Some women may notice headaches, acne, breast tenderness, mood changes and weight gain when they are using a hormonal IUD. There is a small risk of tearing the uterus when the IUD is placed. But, that's rare, particularly when the procedure is performed by an experienced physician.

If you prefer not to have an IUD, or if you would like to explore other possible treatment options, there are alternatives. Some women take birth control pills to manage heavy menstrual bleeding. This also can be an effective treatment. Keep in mind, however, that taking the pill is not a good choice if you smoke. Your doctor should review your medical and family history before you start taking birth control pills to make sure you're an appropriate candidate for them.

If, as in your situation, birth control is not needed, another option for controlling menstrual bleeding is to take a pill 10 to 12 times a month that contains only progestin. The medication reduces bleeding by correcting the hormone imbalance that usually contributes to heavy periods.

If treatment with an IUD or medication is not successful, a variety of surgical options also can be used to decrease menstrual blood flow. Most of these procedures can be done on an outpatient basis and do not require an overnight hospital stay.

Before you make a decision, it would be a good idea to take time to review all the possible treatment options with your doctor. Talk about your preferences, and discuss your medical and family background. Go over the risks and benefits of each option. That conversation can help you get a better idea of the treatment choice that's right for you and help you find the one that best fits your situation.

Bonnie Maffi, M.D., gynecology, Mayo Clinic, Scottsdale, Ariz.

Mayo Clinic Q & A is an educational resource and doesn't replace regular medical care. Email a question to MayoClinicQ[email protected] For more information, visit mayoclinic.org. © 2016 Mayo Foundation for Medical Education and Research. Distributed by Tribune Content Agency LLC. All rights reserved.

Comments
Residents went three days without running water at unlicensed ALFs

Residents went three days without running water at unlicensed ALFs

ST. PETERSBURG — Three days.That’s how long residents of two unlicensed assisted living facilities went without running water before the authorities shut the facilities down last week.The Public Works Department said it turned off the water at 3418 a...
Published: 04/24/18
Exercise myths persist, so let’s fight them

Exercise myths persist, so let’s fight them

When it comes to fitness, can you tell the difference between fact and fiction? Misinformation abounds, and research is continually disproving it. Some myths, like "no pain, no gain," are fading away, but there are plenty more that persist. It’s impo...
Published: 04/24/18

Veteran who survived blast receives unusual penis transplant

WASHINGTON — A veteran who lost his genitals from a blast in Afghanistan has received the world’s most extensive penis transplant, and doctors said Monday he’s recovering well and expected to leave the hospital this week. Saying they wanted to addres...
Published: 04/23/18
Do not eat any romaine lettuce, the CDC warns

Do not eat any romaine lettuce, the CDC warns

Public health officials are now telling consumers to avoid all types of romaine lettuce because of an E. coli outbreak linked to the vegetable that has spread to at least 16 states and sickened at least 60 people, including eight inmates at an Alask...
Published: 04/20/18
Florida hits a milestone: More than 100,000 people are registered to use medical marijuana here

Florida hits a milestone: More than 100,000 people are registered to use medical marijuana here

Florida has hit a milestone of sorts as it slowly moves toward wider availability of medical marijuana.The number of patients in the state who are registered to use the substance has surpassed 100,000 for the first time, according to Florida Departme...
Published: 04/20/18
Florida Hospital Carrollwood spending $17.5 million to expand emergency department

Florida Hospital Carrollwood spending $17.5 million to expand emergency department

Florida Hospital Carrollwood is expanding its emergency department. The hospital, 7171 North Dale Mabry Highway in Tampa, is spending $17.5 million to add 15 new private treatment rooms, new pediatric rooms and waiting areas, and new technology, acco...
Published: 04/18/18
Barbara Bush’s end-of-life decision stirs debate over ‘comfort care’

Barbara Bush’s end-of-life decision stirs debate over ‘comfort care’

As she nears death at age 92, former first lady Barbara Bush’s announcement that she is seeking "comfort care" is shining a light — and stirring debate — on what it means to stop trying to fight terminal illness.Bush, the wife of former President Geo...
Published: 04/17/18
Preparing for the worst, staffers at Johns Hopkins All Children’s learn through simulation

Preparing for the worst, staffers at Johns Hopkins All Children’s learn through simulation

When the patient got violent, Dr. Michelle Hidalgo didn’t have time to think. She had to react. The woman was moving strangely and seemed erratic. Hidalgo had to make a tough call — it was time to physically restrain her for everyone’s safety.Then th...
Published: 04/16/18
Updated: 04/17/18

Lung cancer patients live longer with immune therapy

The odds of survival can greatly improve for people with the most common type of lung cancer if, along with the usual chemotherapy, they are also given a drug that activates the immune system, a major new study has shown.The findings should change me...
Published: 04/16/18
Thousands of pounds of prepackaged salad mixes may have been tainted with E. coli, officials say

Thousands of pounds of prepackaged salad mixes may have been tainted with E. coli, officials say

A Pennsylvania food manufacturer is recalling 8, 757 pounds of ready-to-eat salad products following an E. coli outbreak that has spread to several states and sickened dozens of people.Fresh food Manufacturing Co., based in Freedom, Pennsylvania, is ...
Published: 04/15/18