DEAR DR. ROACH: I want to point out a serious health concern. My daughter turned 40 last year and got her mammogram, which came back with a shocking diagnosis of stage 3 microinvasive carcinoma. She underwent three surgeries, the last of which was a double mastectomy.

I read that cancer incidence increases with hormone usage greater than five years in a row. My daughter’s doctor prescribed “the pill” to her for much greater than five years and never even warned her of the risk.

How many other women are unaware of the risks? These women are in many cases busy, young professionals as my daughter is. They are using the pill because it is so easy. Please warn them and their parents. — M.R.

ANSWER: The association of combined oral contraceptives with breast cancer is controversial. Many large studies, such as the Nurses’ Health Study, found no association of “the pill” with breast cancer, either while a woman is using it or after she stops.

There have been some studies that have shown an increase in risk, but the magnitude of the risk is small. In a large Danish study, the overall increase in risk was about one additional case of breast cancer in 8,000 women taking the pill for a year. For women under 35, the risk was one case in 50,000 women per year. The studies that showed a risk for breast cancer did not show an increased risk when women are taking them longer.

Oral contraceptives certainly have risks. Blood clots are more common among users. They have side effects that can be very bothersome and sometimes prevent women from using them. However, there is an overall improvement in mortality risk among users because even in 2025, having a baby puts a mother’s life at risk, and oral contraceptives are effective at preventing pregnancy.

DEAR DR. ROACH: I am a healthy male, age 65. I get 7-8 hours of sleep most nights, but during the night, I typically wake up three or four times with a very full bladder. So, I use the bathroom, then return to bed.

My question is, where do my kidneys get all the water to make so much urine? I’m not drinking during the night, and I don’t drink anything before I go to sleep. Where is it coming from? This does not happen during my waking hours. — B.F.

ANSWER: When you drink or even eat food with high water content, this fluid will be absorbed into your blood, but this takes time. Once it’s in your blood, it will be filtered by your kidneys to make urine, but this, too, takes time. In general, I tell my patients to stop drinking 4 hours or more before bedtime. People with kidneys that don’t work 100% may need an even longer time from when they stop drinking fluid so that they can urinate all the fluid out.

There are other considerations. Many men and women over 60 develop swollen legs during the day due to leaky blood vessels and valves in the veins. Taking in excess salt worsens this problem. This fluid will go back into the blood overnight, and it can easily be enough fluid to fill the bladder. Compression stockings can reduce the amount of fluid in the legs.

Finally, the body has a system for reducing urine output at night (the anti-diuretic hormone is secreted at night to prevent you from having to get up), and in some people, this system fails. The hormone can be given nasally in these cases, but since it can affect blood sodium levels, it needs to be used very judiciously.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2025 North America Syndicate Inc. All Rights Reserved