Dear doctor

On preparations for pregnancy and aspirin concerns.
  
  


Maybe baby

I want to come off the pill and get pregnant, but I've read that you should wait several months before trying to conceive. Is that true? If so, how long should I leave before getting pregnant? And why? Also, how long before should I be taking folic acid?

It is a myth that you need to "wash out" the contraceptive pill from your system before trying to conceive. It is a good idea for you and your partner to have a health check with your GP before throwing away your contraception. It is wise to include a blood test to check that you are immune to rubella (vaccination in adolescence doesn't necessarily mean you are immune; if you're not, it is better to be revaccinated before pregnancy).

Any pre-existing medical conditions should be stabilised. If you or you partner take any prescription drugs, you can check they're safe in pregnancy. Quit smoking, dump any drugs or excess alcohol intake and aim for a balanced diet with moderate chunks of exercise in the run-up to conception. Once you're ready, finish the packet of pills rather than abandoning it in the middle to avoid erratic vaginal bleeding.

Start taking folic acid as soon as you come off the pill. Then you can go for it; your body returns to normal each pill-free week that you have between packets. Some women find their periods don't return immediately but they usually had irregular cycles prior to being on the pill. Fertility often takes time. The average couple takes up to a year to conceive. If you're over 35 and never been pregnant or have reason to think your fertility might need a helping hand, you may want to get medical advice after six months of trying. Good luck!

Ulcer prevention

Twenty-five years ago I had a duodenal ulcer which was cured with a course of ranitidine (Zantac). At that time the treatment was so new that I was recruited to a clinical trial which lasted for a year. Since then I have assumed that I should never take aspirin, as my consultant then advised. However, I believe that it is now established that ulcers of the digestive tract are caused by a bacterium, the treatment for which is antibiotics. I have been prescribed one or two short courses since I had the treatment. Should I continue to avoid aspirin, even though it is now widely used to prevent strokes?

It is true that the bacterium helicobacter pylori has been implicated as a possible cause of stomach ulcers, but not everyone who has an ulcer has helicobacter, and vice versa. Also, the short courses of single antibiotics that you have been given are unlikely to have eradicated helicobacter if you have it. So it is not safe to assume that you are no longer at risk of ulcers, and I should imagine most doctors would advise you to steer clear of aspirin unless there is a pressing reason to take it.

My eight-year-old son has been diagnosed as dyspraxic. What exactly is dyspraxia, how can I get help and is evening primrose oil, mentioned by a friend, any use?

Dyspraxia is now a well-recognised cause of problems that affect kids, especially boys. It is thought to be due to an immaturity of the brain resulting in messages not being properly transmitted to the body. It can account for slowness of toddlers to feed or dress themselves, poor posture, an awkward gait, confusion about which hand to use, difficulties throwing or catching a ball, dislike of being touched, discomfort in certain clothes and materials such as wool, poor short-term memory, difficulty riding a bike and hopping and skipping, reading and writing difficulties and a poor sense of direction.

Speech may be delayed or hard to understand and obsessive behaviour can make the child with dyspraxia hard to cope with. Your son may hate having his nails cut, hair brushed or teeth cleaned, so getting to school in the mornings can be a battle. Kids with dyspraxia don't always fit in in the playground and teachers need to be on guard against bullying. They can be of average or above-average intelligence but are often behaviourally immature.

You are fortunate that your son has been diagnosed because early intervention will improve his outlook. Occupational therapists, physiotherapists and extra help at school can all help him to learn the skills he needs.

Evening primrose oil and cod liver oil are sources of a fatty acid (EPA) known to be involved in the development and functioning of our nervous system. Given in the recommended doses, they won't cause any harm, though firm evidence of their benefits in dyspraxia is awaited. If my child were dyspraxic, I'd be tempted to try some.

Contact the Dyspraxia Foundation helpline on 01462 454986.

• These answers are intended to be as accurate and full as possible, but should never be used as a substitute for visiting a doctor and seeking medical help. If you have a question for Dr Robinson, email drann@dircon.co.uk or write to her c/o The Health Editor, The Guardian, 119 Farringdon Road, London EC1R 3ER. She regrets that she cannot enter into personal correspondence.

 

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