DEAR DR. DONOHUE: I am 15 and haven’t had a period. All my friends have. My two older sisters got their periods when they were 12 and 13. I am worried about what might be wrong with me. Won’t I be able to have a family? What’s going on? — N.C.

ANSWER: First and foremost, you have to get your mom involved in this and tell her how anxious you are. The median age for a first period is 12 years 5 months. By age 14, 90 percent of girls are menstruating, and by age 15, 98 percent are. If a girl hasn’t menstruated by age 15 or within three years of the first signs of breast development, a doctor should launch an investigation into the reason why.

Certain milestones will determine the direction the investigation takes. One is breast development. Another is pubic hair. If neither has taken place, the search takes a different course than it would if they had occurred.

Genes, a sluggish thyroid gland, ovary problems and an overactive adrenal gland have to be considered. Menstruation involves the complicated interplay of hormones coming from the hypothalamus (a part of the brain), the pituitary gland at the base of the brain and the ovaries. The doctor has to check for abnormalities of the uterus. The list of possibilities is long. It includes a harmless delay that rights itself in time. A girl who is quite thin or who is extremely athletic can have late menstruation

With a doctor’s exam and with a few lab tests, you’ll find the cause of why this is happening to you. Most of the time, such situations can be remedied. I believe you can expect to have as large a family as you want.

DEAR DR. DONOHUE: I have a bunion on the side of my right big toe. What caused it? It hurts when I walk, but I am not looking forward to surgery. What else can be done for one? — H.S.

ANSWER: A bunion is a swollen bursa. Bursas are disks placed between tendons and bones to decrease friction as the tendon rubs against the bone. That’s part of the bursa. The other part of the cause is a drift of the big toe toward the other toes, and it might overlap the neighboring toe.

More women than men get bunions. For this reason, some blame them on fashionable shoes that leave too little room for the toes. This can’t be the universal explanation, because many women wearing those shoes don’t get bunions, and men who never wear such shoes do. Bunions can be a family affair — a genetic influence.

Bunion pads protect the inflamed bursa; they are found in all drugstores. Your shoes should have ample room for the toes, and then a bit more. Low-heeled shoes take pressure off the bunion. Foot supports, specially fashioned for your foot, bring relief. They’re called orthotics. A podiatrist is the doctor to see.

DEAR DR. DONOHUE: I had an uncle who just died of breast cancer. Could he have had some kind of hormone disorder? He was a very masculine-acting person, and had four children. — K.M.

ANSWER: Men develop breast cancer, but do so rarely in comparison to women. Female victims of breast cancer outnumber men by 100-to-1. Male breast cancer starts out as a painless breast lump. Men ignore such things since the thought of cancer doesn’t dawn on them. They take too long to see a doctor.

The reason why breast cancer occurs in men quite often cannot be determined. In some, there is an imbalance in the production of female and male hormones. It’s not such a great imbalance that the affected man develops feminine traits. It’s detectable only through blood tests.

Just as in female breast cancer, mammograms and needle biopsy of the breast mass furnish definite information on a suspicious male breast lump.

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. Readers may also order health newsletters from www.rbmamall.com.

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