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Dr. Miriam on health and wellbeing

From baby first aid to weight loss, women's health to defying age, Dr. Miriam is an expert on family health. Dr. Miriam answers your questions on health and wellbeing below.

I suffer from very heavy periods which are painful, uncomfortable and at worst embarrassing. It's a real worry, and I'm sure it isn't normal. What can I do about it?

Heavier than normal menstrual bleeding is known as menorrhagia. It can take the form of an isolated bout of heavy 'flooding', or a period that lasts more than seven days, or periods that are very close together so that bleeding in any given month is excessive.

The difficulty in diagnosing heavy periods is deciding whether blood loss is heavier than what you're used to, or whether the amount of blood lost is abnormal. Between 30-50ml (1-2 fluid ounces) of blood is lost in a normal menstrual bleed compared with 80ml or more in an abnormal bleed.

Menstrual blood loss is controlled by the hormone progesterone. If levels of progesterone fall it usually means that you're not ovulating. The uterine lining will build up and eventually break down naturally with heavy, uncontrolled bleeding.

There are many treatment options available. One of the best solutions currently available is an IUD that's combined with the hormone progesterone. It provides virtually 100 percent protection against pregnancy and most women who are fitted with it have no bleeding whatsoever after six months.

If that doesn't suit you there are many more treatments you can try, so make sure you see your doctor who will refer you to a specialist if necessary.

Is it true that sex can give you cystitis? And is it good to drink cranberry juice when you have cystitis?

Yes. Unusual amounts of frequent and strenuous sexual intercourse can cause bruising to the urethra and lead to cystitis. Cystitis is inflammation of the bladder caused by bacteria - most commonly E. coli - spreading up the urethra into the bladder. Women are much more prone to cystitis than men because their urethra is much shorter. Most women get cystitis at some point in their lives, and it's not usually a danger to health. The main symptom is a burning, stinging sensation when urinating.

It's good to drink plenty of anything, provided it's bland. Avoid alcohol and strong coffee. Tea, milk and water are all ideal. Cranberry juice, though not bland, is a natural urinary antiseptic so may help to flush bacteria out of the bladder more quickly. It might be an idea to steer clear of other fruit juices as they are acidic. You should also consult your doctor who may take a urine specimen to confirm the infection and give antibiotics to treat it.

I suffer from terrible migraines but I can't pinpoint what's causing them. Can you shed any light on this?

Migraine can be triggered by a number of factors and it's important to recognise what might be triggering your attacks so that you can avoid them. The most common triggers include:

• Certain foods and drinks. Chocolate, caffeine, cheese and fortified wines such as sherry and port may trigger an attack.
• Missing or delaying meals may also bring on a migraine.
• Stress and anxiety. Any period of stress or anxiety is often followed by a migraine. It often begins just as you're beginning to relax and all your pent-up energy is released. If you have a busy lifestyle it's not unusual to have migraines at the weekend or when you go on holiday.
• Lack of sleep or too much sleep can precipitate an attack.
• Loud noises, changes in the weather, strong smells, bright lights and flickering VDUs are common environmental triggers.
• Monthly hormonal changes in women can bring migraine on at certain times.

If you're unclear about what triggers your migraines (and you may not have any trigger factors), keep a diary for a few months to try and pinpoint what sets them off.

Last week I noticed that one of the moles under my arm looks sore and inflamed. What should I do?

Most freckles and moles are of no consequence. Those that you should examine regularly are the ones that may be subject to regular friction: for instance, under your bra strap or on the side of your foot where your shoe rubs. Every two weeks you should look to see if any of the following have happened:

• If your mole has changed in shape, size or thickness
• If your mole has changed in colour
• If there are any signs of redness around your mole
• If there is any inflammation around your mole.

If you do spot any of these changes, go and see your doctor as soon as possible

I have a loving husband but lately our sex life's been just a routine and anything but satisfying. Is there any strategy I could use to start things afresh?

Sex is a highly complex part of our lives and it's influenced by our moods and emotions outside the bedroom. If we're depressed, tired or ill, we'll have little inclination for it.

Couples often seek my advice when their sex life has gone off the boil. The first question I always ask them is whether they vary the way they make love. I discover that many use a single position for lovemaking - usually with the man on top - and it's become boring.

Aside from trying a new position or two, to further reawaken your desire for sex you might consider the following pick-me-ups:

• Make love somewhere other than in bed (on a chair, sofa, etc)
• Take a bath or shower together
• Create an intimate atmosphere with music and candlelight
• Give each other a massage with scented body oils
• Make love at an unusual time
• Make love in the dark if you usually prefer some light, and vice versa
• Last, but not least, allow enough time for lovemaking.

I have an active sex life but I've never reached orgasm with my partner. Is anything wrong and what can I do? Is it my fault, or his?

In the first place, don't worry and don't blame one another. If you view lack of orgasm as a problem or as a fault, it'll become one and cause tension in your relationship.

Only a few women have impaired sexual reflexes which stop them having orgasms. So if you're having problems, the chances are that a few simple steps will go a long way towards helping you.

There are lots of reasons why you may not be able to reach orgasm. Psychologically, you may be uncertain about questions of commitment in your relationship, or you may be frightened of losing control. Physically, it may be that your partner isn't stimulating you sufficiently for orgasm to take place. If your partner doesn't take the time to find out about your preferences or needs, or if he doesn't know how to bring you to orgasm - it won't take place. But if you've had lots of stimulation and are still unable to reach a climax, this is a problem which needs attention.

Four steps to help you reach orgasm.

• It's easier for a woman to reach a climax on her own than when a partner is present. So you could find some time to be by yourself and stimulate your clitoris by masturbation.
• You should continue masturbating regularly until you are able to achieve an orgasm fairly easily.
• At this stage, you could try having sex together. But you should not try to achieve orgasm while the penis is in the vagina.
• When your partner has had an orgasm and ejaculated, he should stimulate your clitoris so that, in your own time, you too can reach orgasm. It is important that you concentrate on your own sexual sensations.