Ask the doctor: How can I control the negative effects of contraceptives?

My sister uses contraceptives and is healthy. However, sometimes, she becomes constipated and her feet and fingers darken. What can I do to help her? Gerald

Dear Gerald,

One’s skin can turn darker, especially in patches because of a number of conditions including pregnancy, use of contraceptives, allergic reactions to drugs (such as septrin), diseases of the thyroid gland, previous or present use of cosmetics or skin lightening substances and skin conditions, including eczema.

Your sister could have developed dark areas because of contraceptive pills although this usually happens in areas of the face that are exposed to the sun. However, it can also affect the feet and fingers if they are also exposed to the sun. Also, it is possible that your sister may not have taken the pills properly and is now pregnant, pregnancy being blamed for darkening skin (or dark patches). 

Not every woman who is pregnant or taking contraceptives gets dark patches on her skin because this seems to be genetic. Pregnancy hormones found in contraceptive pills seem to stimulate melanocytes (melanin-producing skin cells) to produce more pigment, especially in those genetically prone and in areas exposed to the sun. In some cases, the darkening may disappear after one stops taking the pills. 

Please advise her to go back to her family planning clinic to switch to another method of family planning such as Depo Provera or a coil (IUCD).

Why do my private parts itch after a period?

Nowadays, when my period starts, my private parts itch and this happens every month.  What could be the problem? Celione

Dear Celione,

Itching of the vagina can happen before, during and after a period. In some women, this can happen every month and depending on its timing, it may have different causes. This so called cyclic vulvovaginitis could be related to hormonal fluctuations related to the menstrual cycle. These affect vaginal acidity, causing overgrowth of vaginal small organisms resulting in vaginal itching. 

Overgrowth of vaginal candida as well as the vaginal bad bacteria then may cause vaginal candidiasis and bacterial vaginosis respectively. Since both can cause vaginal itching, they can be addressed using antifungal treatment and/or flagyl.

 Also, hormonal changes before a period can make the vagina dry and itchy until one starts their period and the blood moistens the area, relieving the itching. 

Some women may use different things as sanitary towels risking itching of the vagina during a period. Some may be allergic to pads, especially those containing synthetic material necessitating a change to pure cotton pads. Others shave their pubic hair before a period causing itching as the hair grows. 

Avoiding shaving altogether or cutting hair short (to stem itchy ingrown hairs) helps prevent itching and burning of the pubic area. 

Autoimmune progesterone dermatitis (APD) is a rare skin condition  (skin rash and itching) which, in women, recurs corresponding to one’s period  and is said to be a response of the skin to a woman’s own hormone  progesterone changes related to the period. 

Vaginal itching can lead to poor health, embarrassment, stress and can break up a family because of infidelity suspicions, and therefore requires addressing urgently, ideally by a gynaecologist.