Spotting or bleeding between periods (breakthrough bleeding) can occur with any birth control pill, especially during the first few months of use. However, breakthrough bleeding is more likely with continuous and extended-cycle regimens than with the traditional 28-day schedule. Breakthrough bleeding can also occur when taking normal 28-day birth control pills in a continuous manner.

What causes breakthrough bleeding with oral contraceptives isn't always clear. It may simply take time for your body to adjust to the hormones in the pill or for your uterus to transition to a thinner lining (endometrium).

You're more likely to experience breakthrough bleeding if you:

• Miss a pill
• Start a new medication, such as certain antibiotics, or take supplements, such as St. John's wort, that may interfere with the contraceptive
• Become ill with vomiting or diarrhea, which may impair absorption of the medication

Unpredictable bleeding resulting from the use of continuous or extended-cycle birth control pills usually decreases with time. In the meantime:

• Continue taking the medication as directed. Breakthrough bleeding isn't a sign that the pill isn't working. If you stop taking it, you risk unplanned pregnancy.
• Track breakthrough bleeding in a calendar or diary. Typically, careful tracking offers reassurance that breakthrough bleeding is decreasing.
• Ask your doctor about taking a short pill-free break. If you've taken active pills for at least 21 days, your doctor may suggest that you stop for three days to allow bleeding that resembles a period and then take the pill again for at least 21 days.
• If you smoke, ask your doctor to help you quit. Women who smoke are more likely to experience breakthrough bleeding than are women who don't smoke.

If breakthrough bleeding becomes heavy or lasts more than seven days in a row, contact your doctor. He or she will consider other possible causes of breakthrough bleeding, such as an infection. Depending on the circumstances, your doctor may recommend an alternative method of contraception.

Whether eye dilation during an exam is necessary depends on the reason for your exam, your age, your overall health and your risk of eye diseases.

The eye drops used for dilation cause your pupils to widen, allowing in more light and giving your doctor a better view of the back of your eye. Eye dilation assists your doctor in diagnosing common diseases and conditions, possibly at their earliest stages. They include:

• Diabetes
• High blood pressure
• Macular degeneration
• Retinal detachment
• Glaucoma

Eye dilation also makes your vision blurry and your eyes more light sensitive, which, for a few hours, can affect your ability to drive or work. So if eye dilation is greatly inconvenient, ask your doctor about arranging another appointment. Alternatives to dilation are available, but they aren't as effective for allowing a careful examination of the back of your eye.

In determining whether eye dilation is necessary for you, your eye doctor may consider:

• Your age. The risk of eye diseases increases with age. The National Eye Institute recommends a dilated eye exam once every one to two years if you're 60 or older.
• Your ethnic background. People of certain ethnic backgrounds are at increased risk of some eye diseases. Black people and Hispanics, who are at increased risk of glaucoma, are advised to have a dilated eye exam every one to two years, starting at age 40.
• Your eye health. Having a history of eye diseases that affect the back of the eye, such as retinal detachment, may increase your risk of future eye problems.
• Your overall health. Certain diseases, such as diabetes, increase the risk of eye disease.
• The reason you are seeking an eye evaluation. Certain symptoms may require a dilated examination to determine the cause. Some conditions requiring follow-up examinations may not need dilation at every visit unless there are new symptoms or concerns.

For most people, a laser retina scan isn't required. However it does provide another tool for assessing retina and eye health, which can be helpful during technically difficult examinations. If you choose to have a laser retina scan, make sure it's a complement to — not a substitute for — a traditional eye exam with dilation.

During a traditional eye exam, an eye doctor dilates your eyes with special eyedrops and then checks your retinas for abnormalities using tools such as a slit lamp with magnifying lenses or a lighted magnifying instrument (binocular indirect ophthalmoscope). A traditional exam with dilation is especially important if you're at high risk of retinal conditions.

During a laser retina scan, such as Optomap, your eyes might or might not be dilated. A low-powered laser scans your eyes and then produces digital images of your retinas. The images can be studied to check for abnormalities and saved in your medical record to compare the condition of your retinas from year to year.

Although laser retina scans can detect some retinal abnormalities, the scans have limitations. For example, laser retina scans might not detect problems on the outside edges of the retinas, where serious problems can occur. You might also consider what the procedure costs and whether it's covered by your medical insurance.

Probably not. Several dietary supplements are marketed as eye vitamins. But little evidence supports using these products for preventing glaucoma or reversing vision loss due to glaucoma.

Few clinical trials of eye vitamins or supplements for glaucoma have been conducted. Some evidence suggests that a high intake of vitamin B through dietary sources, including green leafy vegetables, may reduce the risk of some types of glaucoma. But B complex supplements, including folic acid, vitamin B6 and vitamin B12, don't appear to offer the same benefit.

Other studies have found that antioxidants as well as natural compounds such as Ginkgo biloba, tropical fruits and green tea, among others, may slow the progression of glaucoma, but the evidence so far is weak. And while some research has found that vitamin C supplements may decrease the risk of getting glaucoma, more research is needed.

If you're interested in trying eye vitamins or supplements, discuss the benefits and risks with your eye doctor.

Micturition (or post-micturition) syncope is fainting during or, more commonly, immediately after urination due to a severe drop in blood pressure. Micturition syncope is most common in older men and usually occurs at night after a deep sleep.

The exact cause of micturition syncope isn't fully understood. But it may be related to opening (vasodilation) of the blood vessels that occurs when getting up and standing at the toilet or that occurs at the rapid emptying of a full bladder. This is thought to result in a sudden drop in blood pressure.

Other factors that may play a role in micturition syncope include:

• Alcohol
• Hunger
• Fatigue
• Dehydration
• Medical conditions, such as a respiratory infection
• Use of alpha blockers to improve urination in men with prostate problems

Preventing micturition syncope

Micturition syncope is uncommon and should be evaluated by a doctor because it may indicate an underlying medical condition. Prevention of micturition syncope depends on recognizing the factors that contribute to micturition syncope and avoiding them.

Some strategies you might suggest to your husband to avoid micturition syncope and possible resulting injury are:

• Avoid excessive drinking of alcohol
• Don't get out of bed suddenly — first, sit on the edge of the bed and move your legs, making sure you aren't dizzy or lightheaded
• Urinate sitting down
• Ask your doctor whether any medications you're taking may be causing your condition

As much as possible, ensuring the floor from your bed to the bathroom is carpeted or padded also is a good strategy for avoiding injury from a potential fall.

It depends. Falls during pregnancy are a common cause of minor injuries and, in some cases, can be harmful to you and your baby.

Your body is designed to protect your developing baby during pregnancy. The walls of your uterus are thick, strong muscles that help keep your baby safe. The amniotic fluid also serves as a cushion. During the early weeks of pregnancy, the uterus is tucked behind the pelvic bone. Minor falls during early pregnancy are typically not of concern.

However, falls during the late second trimester and early third trimester might be harmful to both you and your baby, especially if there is direct trauma to your abdomen. You could experience contractions, the loss of amniotic fluid, the separation of the placenta from the inner wall of the uterus (placental abruption) or the passage of fetal blood cells into the maternal circulation (fetomaternal hemorrhage).

If you have a minor fall during your first trimester, call your health care provider, describe the fall and discuss any symptoms you have. If you have a fall toward the end of your second trimester or anytime during your third trimester, seek immediate care from your health care provider. In addition, seek emergency care if:

• You're experiencing vaginal bleeding
• You feel abdominal pain
• You have uterine contractions
• You can't feel the baby move

Your care provider might run tests to make sure everything is OK.

Yes. The fallopian tubes are a pair of tubes that eggs travel through to get from the ovaries to the uterus. Each month, during a process called ovulation, one of the ovaries releases an egg that travels down one of the fallopian tubes, where it may or may not be fertilized by a sperm.

You might have only one fallopian tube if you've had pelvic surgery for an infection, a tumor or a past ectopic pregnancy. Occasionally, some women are born with only one tube. However, you may still be able to get pregnant with only one tube if:

• You have at least one functioning ovary
• You have monthly menstrual cycles (ovulate)
• Your remaining fallopian tube is healthy

If you're unable to get pregnant after trying to conceive, or if you have a known history of problems with your fallopian tube, see your gynecologist or a reproductive endocrinologist for evaluation.

Eating at home may have health benefits, such as eating healthier food, but if your family watches TV or other electronic screens during meals, you might be losing out on any weight-control benefit.

A recent study looked at over 12,000 adults who lived with at least one family member and ate at least one family meal at home, as well as whether those family meals were home cooked and if TV shows or videos were watched during the meal. Watching fewer TV shows or videos during family meals and eating more home-cooked family meals were each associated with a lower risk of obesity.

In fact, adults who never watched screens during family meals were 37 percent less likely to be obese. Eating family meals cooked at home lowered the odds of being obese by 26 percent. Putting factors together, adults who never watched TV or videos while eating and whose family meals had all been cooked at home had almost a 50 percent lower risk of obesity.

How can you use this information? Cook a healthy meal at home. Eat dinner with someone. Turn off the screens. It might not be possible every day, but the more you follow these practices, the bigger the possible health benefits.

The concern with fast weight loss is that it usually takes extraordinary efforts in diet and exercise — efforts that could be unhealthy and that you probably can't maintain as permanent lifestyle changes.

A weight loss of one to two pounds a week is the typical recommendation. Although that may seem like a slow pace for weight loss, it's more likely to help you maintain your weight loss for the long term.

Remember that one pound (0.45 kilogram) of fat contains 3,500 calories. So to lose one pound a week, you need to burn 500 more calories than you eat each day (500 calories x 7 days = 3,500 calories).

Also, if you lose a lot of weight very quickly, you may not lose as much fat as you would with a more modest rate of weight loss. Instead, you might lose water weight or even lean tissue, since it's hard to burn that many fat calories in a short period.

In some situations, however, faster weight loss can be safe if it's done the right way. For example, doctors might prescribe very low calorie diets for rapid weight loss if obesity is causing serious health problems. But an extreme diet such as this requires medical supervision. In addition, it can be difficult to keep this weight off.

Some diets include an initiation phase to help you jump-start your weight loss. For example, the Mayo Clinic Diet has a quick-start phase in which you might lose six to 10 pounds in the first two weeks. You can lose weight quickly with an approach like this because it combines many healthy and safe strategies at once — no gimmicks or extreme dieting.

After the initial two-week period, you transition into the recommended weight loss of one or two pounds a week, which gives you time to adopt the necessary lifestyle changes, such as eating a healthy diet and increasing your physical activity, necessary for maintaining weight loss over the long term.

Maybe. Researchers aren't sure why, but it seems that regularly fasting — severely restricting food and drink for a 24-hour period on one to two days a week — can potentially improve your risk factors related to heart health.

It's difficult to tell what effect fasting has on your heart health because many people who routinely fast often do so for health or religious reasons. These people generally tend to not smoke, which also can reduce heart disease risk.

However, at least one study has indicated that people who follow a fasting diet may have better heart health than people who don't. This may be because people who routinely fast show self-control over how many calories they eat and drink, and this behavior may translate into weight control and better eating choices when they aren't fasting.

Regular fasting and better heart health may also be linked to the way your body metabolizes cholesterol and sugar. Regular fasting can decrease your low-density lipoprotein, or "bad," cholesterol. It's also thought that fasting may improve the way your body metabolizes sugar. This can reduce your risk of gaining weight and developing diabetes, which are both risk factors for heart disease.

However there are concerns about the potential side effects of regular fasting for certain people or in specific circumstances.

• People with eating disorders may end up binge eating more after fasting.
• Fasting and exercising at the same time may lead to low blood sugar (hypoglycemia), which can cause dizziness, confusion and lightheadedness.
• Fasting by people taking diabetes medications can lead to severe hypoglycemia and can lead to serious health issues.
• Skipping breakfast may be considered fasting by some because it can result several hours without food, but skipping breakfast can be unhealthy and has been associated with obesity.

More study is needed to determine whether regular fasting can reduce your risk of heart disease. Most scientific evidence on fasting comes from animal, not human, studies. The studies that have been done on people are mostly observational, which has the lowest level of scientific evidence.

If you're considering regular fasting, talk to your doctor about the pros and cons. Keep in mind that a heart-healthy diet and exercising regularly also can improve your heart health.