DEAR DR. DONOHUE: I am 25. Ever since I began to have menstrual periods, they have been quite heavy. I didn’t realize it because I thought my periods were the same as everyone else’s. My doctor discovered I was anemic, and one thing led to another. A hematologist determined I have von Willebrand’s disease. I am now on birth control pills but will be given a nasal spray if my periods do not normalize. What spray? – S.J.

ANSWER: Von Willebrand’s disease is the most common bleeding disorder. It’s inherited. I bet that if you track down aunts and cousins, you’ll find others who have heavy menstrual periods.

This is not a purely female disease. Males can have it as well.

Blood contains a number of proteins called clotting factors. Along with blood platelets, clotting factors seal with a clot any breach in a blood vessel. The von Willebrand factor is one of the clotting proteins. Without it, brisk bleeding can occur from minor mishaps, such as a bleeding nose. For women, excessive menstrual bleeding is a major clue.

By regulating menstrual periods, birth control pills can often put a stop to heavy menstrual bleeding.

The spray you allude to is desmopressin, DDAVP. It raises blood levels of von Willebrand factor by flushing it out of body storage sites. In severe bleeding, injections of the factor are necessary.

You must tell every doctor you see that you have this problem. In particular, you must let your doctors know about it if you are scheduled to have surgery.

All women who have profuse menstrual bleeding ought to be screened for von Willebrand’s disease.

DEAR DR. DONOHUE: I have a Bible bump on the back of my wrist. It’s supposed to disappear if you hit it with a Bible. Done that. No result. What’s next? – J.W.

ANSWER: The lump you call a Bible bump is a ganglion. Ganglions are cystic structures that arise from joints or tendons, and the wrist is the most common spot to find one.

They can arise for no reason, or they can blossom due to repeated stress on the joints or tendons. Gymnasts, for example, are prone to having ganglions because they fly from one bar to another and catch themselves with their hands. Their wrists take a beating.

If a ganglion doesn’t hurt or doesn’t interfere with joint function, it can be left alone. If it causes trouble, doctors can draw off the gelatinous material within the ganglion with a needle and syringe. Then, they can inject cortisone to prevent it from reforming.

Surgery is the ultimate cure. Even with surgery, however, a ganglion can come back.

In years gone by, treatment of a ganglion was to smash it with a heavy book. I take it that’s how the “Bible bump” name came to be. Don’t even think about doing such a thing again. It can cause complications, and it rarely works.

DEAR DR. DONOHUE: My husband and I have five children, and the oldest is 10. This is enough children for us. I want my husband to have a vasectomy. He wants me to take birth control pills or have my tubes tied. I did take the pill before, but I had to go off it because it made me sick. I don’t relish the idea of having my tubes tied. My husband says he’s reluctant to have a vasectomy because it can cause heart trouble and prostate cancer. Is this true or false? – P.W.

ANSWER: It’s false.

About 30 years ago, a study reported that animals who had had vasectomies developed blockages in their heart arteries and eventually had heart attacks. Their nonvasectomized brothers did not suffer such problems. Since then, further work has shown that the heart-vasectomy link does not exist. It made for headlines at the time.

The prostate cancer link to vasectomies is another unfounded bit of information.

A vasectomy is much less traumatic than a tubal ligation.

DEAR DR. DONOHUE: How safe and effective is the estrogen ring? Do you have to take any other medicine when you have a ring? – M.F.

ANSWER: The estrogen ring is a compressible, round band that a woman can easily insert into the vagina. For the next three months it releases small amounts of estrogen. Women can forget daily pill-taking.

The ring is intended for postmenopausal women who suffer genito-urinary tract symptoms. Those symptoms are vaginal dryness, vaginal itching, painful intercourse or painful urination. It does a good job for those problems. The ring does not alleviate other menopausal symptoms, such as hot flashes.

Usually when women take replacement estrogen, they also take another hormone – progestin. The progestin protects women from uterine cancer, which estrogen therapy can give rise to. But in this case, the ring’s content of estrogen is so small that the uterine cancer threat is zero or very close to zero.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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