In Full Stride

Health and Wellness

Alcohol and Health

WHAT IS AT-RISK DRINKING?

At-risk drinking means drinking more than seven drinks a week or three drinks on a single day. At-risk drinking also includes binge drinking.

For some women, drinking any amount of alcohol is at-risk drinking. These include women who are

  • unable to keep their drinking at a moderate level
  • younger than 21 years
  • pregnant or planning to become pregnant
  • about to drive or perform a task that may result in injury
  • taking prescription or over-the-counter medications that interact with alcohol

WHAT IS BINGE DRINKING?

For women, binge drinking is having more than three drinks per occasion. Binge drinking is a major problem among women in the United States. About one in eight women 18 years and older report binge drinking in the past 30 days. For girls younger than age 18, one in five report binge drinking.

HOW DOES MY BODY PROCESS ALCOHOL?

Women and men react differently to alcohol. A chemical in the body that breaks down alcohol is less active in your body than it is in men’s bodies. This means that more of the alcohol that you drink enters your bloodstream. Women typically weigh less than men and have less body water, so the alcohol that you drink is not diluted as quickly as the alcohol a man drinks. You will become intoxicated more quickly and have a higher blood alcohol level than a man who drinks the same amount.

WHAT ARE THE HEALTH RISKS OF AT-RISK DRINKING FOR WOMEN?

Regular at-risk drinking can lead to alcohol dependence (also called alcoholism). Women who are alcohol dependent keep using alcohol even when it causes problems with their health, safety, or relationships. Increased physical risks include the following:

  • Injuries
  • Interpersonal violence
  • Sexually transmitted infections and unintended pregnancy
  • Birth defects
  • Menstrual disorders and altered fertility
  • Heart and liver disease
  • Seizures
  • Certain types of cancer

WHAT ARE THE SIGNS AND SYMPTOMS OF ALCOHOL DEPENDENCE?

The following signs and symptoms are associated with alcohol dependence:

  • Craving—A strong urge to drink
  • Loss of control—After starting to drink, not being able to stop
  • Dependence—Alcohol withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety after stopping drinking
  • Tolerance—The need to drink greater amounts of alcohol to feel the same effect

HOW CAN DRINKING ALCOHOL DURING PREGNANCY AFFECT MY BABY?

Drinking alcohol during pregnancy is a leading cause of birth defects. Alcohol can harm a fetus throughout pregnancy. This includes the first few weeks before you know you are pregnant and during the last weeks of pregnancy when the fetal brain is maturing. Even moderate alcohol use during pregnancy can cause lifelong problems with a child’s learning and behavior. Any amount is risky for women who are pregnant or trying to become pregnant. All types of alcohol are harmful, including beer and wine.

WHAT ARE FETAL ALCOHOL SPECTRUM DISORDERS (FASDS)?

Fetal alcohol spectrum disorders (FASDs) are health problems that can occur in a person whose mother drank alcohol during pregnancy.

WHAT IS FETAL ALCOHOL SYNDROME (FAS)?

The most severe FASD is fetal alcohol syndrome (FAS). FAS causes

  • problems with brain development
  • lower-than-average height and weight
  • smaller-than-normal head size
  • abnormal facial features

For every child born with FAS, many more are born with other FASDs. These children may have problems with coordination, behavior, attention, learning, and understanding consequences without any of the physical signs of FAS.

HOW CAN I PREVENT BIRTH DEFECTS RELATED TO ALCOHOL USE?

Birth defects related to alcohol are 100% preventable by not drinking during pregnancy. Prevention involves these three steps:

  1. If you do not want to get pregnant and you drink alcohol, use effective birth control.
  2. If you are planning to become pregnant, do not drink.
  3. If you are pregnant and have been drinking, stop. This will reduce the risk of harm to your baby.

WHAT IF I DRANK A SMALL AMOUNT OF ALCOHOL BEFORE I KNEW I WAS PREGNANT?

Although it is true that no amount of alcohol use is safe during pregnancy, serious harm from this kind of use is unlikely. The important thing is to not drink any alcohol for the rest of the pregnancy.

HOW CAN I GET HELP TO REDUCE MY DRINKING OR STOP DRINKING?

Your obstetrician–gynecologist or other health care professional can refer you to resources near you.

INFORMATION FROM ACOG

BRCA 1 and BRCA 2 Mutations

WHAT IS CANCER?

Normal cells in the body grow, divide, and are replaced on a routine basis. Sometimes, cells divide abnormally and begin to grow out of control. These cells may form growths or tumors. Tumors can be benign (not cancer) or malignant (cancer). Benign tumors do not spread to other body tissues. Cancer tumors can invade and destroy nearby healthy tissues, bones, and organs. Cancer cells also can spread to other parts of the body and form new cancerous areas.

WHAT CAUSES CANCER?

Cancer is caused by several different factors. A few types of cancer run in families. These types are called “hereditary” or “familial” cancer. They are caused by changes in genes that can be passed from parent to child. Changes in genes are called mutations.

WHAT IS HEREDITARY BREAST AND OVARIAN CANCER SYNDROME?

Hereditary breast and ovarian cancer (HBOC) syndrome is an inherited increased risk of breast cancer, ovarian cancer, and other types of cancer. HBOC syndrome is linked to mutations in several genes, but the most common are called BRCA1 and BRCA2.

WHAT ARE BRCA1 AND BRCA2?

BRCA1 and BRCA2 are tumor suppressor genes, which means that they keep cells from growing too rapidly. Everyone has these genes. Changes or mutations in these genes mean they do not work properly and cells can grow out of control, which can lead to cancer.

HOW MUCH DO BRCA MUTATIONS INCREASE THE RISK OF BREAST CANCER?

The risk of breast cancer for the average American woman is about 12% in her lifetime. Having a BRCA mutation greatly increases the risk. The estimated risk of breast cancer in women with a BRCA mutation is 45–85% by age 70 years.

HOW MUCH DO BRCA MUTATIONS INCREASE THE RISK OF OVARIAN CANCER?

The risk of ovarian cancer for the average American woman is about 2% in her lifetime. The estimated risk of ovarian cancer in women with a BRCA1 mutation is 39–46% by age 70 years. For women with a BRCA2 mutation, the risk of ovarian cancer by age 70 years is 10–27%.

DO BRCA MUTATIONS INCREASE THE RISK OF OTHER TYPES OF CANCER?

Yes. Women who have a BRCA mutation also have an increased risk of cancer of the fallopian tube, peritoneum, pancreas, and skin (melanoma). Men who have a BRCA mutation have an increased risk of cancer of the breast, prostate, and pancreas.

HOW COMMON ARE BRCA MUTATIONS?

About 1 in 300 people to 1 in 800 people carry a BRCA1 or BRCA2 mutation. Anyone can have these mutations, but they are found more often in certain ethnic groups. These groups include people of the following backgrounds:

  • Eastern or Central European Jewish
  • French Canadian
  • Icelandic

SHOULD I BE TESTED FOR BRCA MUTATIONS?

Your obstetrician–gynecologist (ob-gyn) or other health care professional should ask you questions about your personal and family history of breast cancer and ovarian cancer. The questions may include the following:

  • Have you had cancer of the ovary, fallopian tubes, or peritoneum?
  • Have you had breast cancer at age 45 years or younger?
  • Have you had breast cancer and do you have a close relative with breast cancer at age 50 years or younger, or a close relative with cancer of the ovary, fallopian tubes, or peritoneum?
  • Have you had breast cancer and do you have two or more close relatives with breast cancer at any age?
  • Have you had breast cancer and do you have two or more close relatives with cancer of the pancreas or prostate?
  • Have you had breast cancer and are you of Eastern or Central European Jewish ancestry?
  • Do you have a close relative with a BRCA1 or BRCA2 mutation?

If your answers to these or other questions suggest that you may have a BRCA mutation, genetic counseling and testing may be offered.

WHAT IS GENETIC COUNSELING?

Before you have genetic testing, a genetic counselor or a physician who specializes in inherited types of cancer can help you understand how the testing is done, what the results may mean, and what you may do depending on the test results.

WHY DON’T DOCTORS TEST EVERYONE FOR BRCA MUTATIONS?

BRCA testing is only recommended for people with a high risk of having BRCA mutations. It is important to remember that most cases of breast and ovarian cancer are not caused by gene mutations. If there is a low chance of finding a BRCAmutation, your ob-gyn or other health care professional may not recommend genetic testing.

HOW IS TESTING FOR BRCA MUTATIONS DONE?

Genetic testing requires a sample of blood or saliva. There are several ways that testing can be done:

  • If a relative with breast cancer or ovarian cancer is available, the relative’s BRCA genes can be analyzed. If your relative carries a mutation, you can have testing to see if you have the same mutation as your relative. This is the best way to know if you are at increased risk of cancer.
  • If no relative is available, and you and your family belong to an ethnic group with high numbers of people with a specific BRCA mutation, you can be tested for this mutation.
  • If you are not part of a high-risk ethnic group but your family history suggests there may be a hereditary mutation, another option is to have testing of your BRCA genes. If your family has a member with breast cancer or ovarian cancer, it is always best to test that relative first. But if that is not possible, you may have individual testing and counseling.

WHAT DOES A NEGATIVE TEST RESULT MEAN?

A negative test result can mean several things:

  • When a family member with cancer gives a sample and a BRCA mutation is found, you can be tested for that mutation. If you have a negative test result for that BRCA mutation, you have not inherited it and your risk of cancer is the same as the general population.
  • If you have a family history of cancer but no family member with cancer has given a sample, and you have a negative test result for a BRCAmutation, it can mean that your family has a BRCA mutation but you did not inherit it. It also can mean your family carries a mutation in a gene that researchers have not yet identified.

WHAT DOES AN UNCLEAR TEST RESULT MEAN?

An unclear test result means there is a change in a BRCA gene, but it is not known whether the change increases the risk of cancer. Researchers continue to study BRCA and other genes to find out how they may influence cancer risk. If you have an unclear result, a genetic counselor can explain strategies that may reduce your risk.

WHAT DOES A POSITIVE TEST RESULT MEAN?

A positive test result means you have a BRCA mutation for which you have been tested. That means you have an increased risk of getting cancer. It does not mean you will get cancer. There is no test that can tell which women with a BRCA mutation will develop cancer or at what age. It is important to discuss your results with your genetic counselor and learn what you can do to decrease your risk of cancer.

Having a BRCA mutation means you can pass the mutation to your children. Your siblings also may have the gene mutation. You are not obligated to tell your family members, but sharing the information could be life-saving for them. With this information, your family members can decide whether to be tested and get cancer screenings at an early age.

HOW CAN YOU PREVENT CANCER IF YOU TEST POSITIVE FOR A BRCAMUTATION?

If you test positive for a BRCA mutation, you may discuss prevention options with your ob-gyn, genetic counselor, or other health care professional. Prevention includes screening tests, medications, and surgery.

WHAT BREAST CANCER SCREENING TESTS ARE AVAILABLE?

Breast cancer screening may include the following tests for women with BRCA mutations:

  • Clinical breast exam by your ob-gyn or other health care professional every 6–12 months
  • Annual breast imaging starting at age 25 years. Magnetic resonance imaging (MRI) is recommended annually for women aged 25–29 years. Beginning at age 30 years, breast MRI and mammography are recommended annually.

WHAT OVARIAN SCREENING TESTS ARE AVAILABLE?

Currently there is no recommended screening test for ovarian cancer for average-risk patients. For high-risk patients, one ovarian cancer screening method that has been studied is a blood test that measures levels of a marker called CA 125. A marker is a substance made by cancer cells. Levels of CA 125 sometimes are increased in women with ovarian cancer. An ultrasound exam of the ovaries also may be recommended for women with a BRCA mutation. If your ob-gyn or other health care professional recommends these tests, you may begin testing between the ages of 30 years and 35 years.

It is important to know that these screening tests have a limited ability to find ovarian cancer at an early, more treatable stage. Test results may be normal even when cancer is present. There also is a high rate of false-positive results (a positive test result in someone who does not have ovarian cancer). There are ongoing studies to find an accurate and reliable screening test for ovarian cancer.

WHAT MEDICATION CAN HELP PREVENT BREAST CANCER?

A medication called tamoxifen has been shown to reduce the risk of breast cancer in women with BRCA2 mutations. Tamoxifen is a drug that blocks the effects of estrogen on cancer cells that respond to this hormone.

Tamoxifen works better in women with BRCA2 mutations because most breast cancer tumors in this group grow in response to estrogen. Tamoxifen does not appear to reduce breast cancer risk in women with BRCA1 mutations because fewer cancer tumors in this group respond to estrogen.

WHAT MEDICATIONS CAN HELP PREVENT OVARIAN CANCER?

Combined hormonal birth control pills (those that contain estrogen and progestin) have been shown to reduce the risk of ovarian cancer. The longer a woman takes the pill, the more the risk is reduced—for every 5 years on the pill, a woman reduces her risk by about 20%. But this benefit needs to be balanced against the risks of using the pill. The pill is safe for most women, but it is associated with a small increased risk of deep vein thrombosis (DVT), heart attack, and stroke. Your ob-gyn or other health care professional can help you understand how to balance the benefits and risks of using the pill.

CAN SURGERY HELP PREVENT BREAST CANCER?

Yes. Surgical removal of both breasts is called risk-reducing bilateral mastectomy. It can reduce the risk of breast cancer by 85–100% in women with a BRCA mutation. Total mastectomy, in which all breast tissue is removed, including the nipple, is the most effective surgery for reducing the risk of breast cancer. Mastectomy that removes the breast tissue and leaves the nipple also can be considered and is very effective. Some women choose to have breast reconstruction after a mastectomy.

WHAT ARE THE SIDE EFFECTS OF A MASTECTOMY?

Side effects of a mastectomy can include the following:

  • Pain, tenderness, or swelling
  • Buildup of blood or fluid in the wound or arms
  • Limited arm or shoulder movement
  • Numbness in chest or arm
  • Burning or shooting pain in the chest, armpit, or arm
  • Inability to breastfeed

CAN SURGERY HELP PREVENT OVARIAN CANCER?

Yes. The removal of both ovaries and both fallopian tubes is called risk-reducing bilateral salpingo-oophorectomy. In women with a BRCAmutation, this surgery can reduce the risk of ovarian cancer by about 80%. The surgery also reduces the risk of cancer of the fallopian tubes and peritoneum. If it is done before menopause, this surgery also can reduce the risk of breast cancer. Women with a BRCA mutation should consider this surgery between the ages of 35 years and 40 years or after they have completed childbearing. Some women may be able to delay slightly longer. Removal of the ovaries means you will not be able to get pregnant.

Researchers also are studying the removal of only the fallopian tubes (salpingectomy) to prevent ovarian cancer. Some cases of ovarian cancer may start in the fallopian tubes, so removing the tubes may help prevent ovarian cancer without putting a woman into menopause. More research is needed in this area.

WHAT ARE THE SIDE EFFECTS OF REMOVING THE OVARIES?

Removal of the ovaries before menopause will cause you to go through menopause immediately. This is called surgical menopause. Symptoms may be more severe than if you were to go through menopause naturally over several years. Menopause symptoms often can be managed with hormone therapy and other treatments. You can discuss these treatment options with your ob-gyn or other health care professional before your surgery.

WHAT ELSE SHOULD I THINK ABOUT BEFORE CHOOSING RISK-REDUCING SURGERY?

If you are thinking about having preventive surgery, you and your ob-gyn or other health care professional will discuss the risks and benefits. You should consider the psychological effects as well as short- and long-term complications. Timing of surgery should be based on your cancer risk, your desire to have children, and the effect that surgery will have on your well-being.

I AM CONCERNED ABOUT DISCRIMINATION BASED ON GENETIC TESTING RESULTS. WHAT SHOULD I KNOW?

Many people are concerned about possible employment discrimination or denial of insurance coverage based on genetic testing results. The Genetic Information Nondiscrimination Act of 2008 (GINA) makes it illegal for health insurers to require genetic testing results or use results to make decisions about coverage, rates, or preexisting conditions. GINA also makes it illegal for employers to discriminate against employees or applicants because of genetic information. GINA does not apply to life insurance, long-term care insurance, or disability insurance.

WHAT SHOULD I KNOW ABOUT DIRECT-TO-CONSUMER GENETIC TESTS?

A direct-to-consumer genetic test is a genetic test that you can order over the internet. You do not need a doctor’s order for it. The American College of Obstetricians and Gynecologists discourages use of direct-to-consumer genetic tests because the results may be misleading. For example, one test for BRCA mutations only looks for three mutations, even though there are more than 500 BRCA mutations linked to cancer. The test results could cause unnecessary fear, or a false sense that you are not at risk. You should always see a health care professional if you want a genetic test.

INFORMATION FROM ACOG

Cholesterol and Heart Health

WHAT IS CHOLESTEROL?

Cholesterol is a fatty, wax-like substance. Your body uses cholesterol to make the outer coverings of cells. Cholesterol is a part of certain hormones, including estrogen and testosterone. It also helps your body make vitamin D and produces the bile that helps you digest food.

WHERE DOES CHOLESTEROL COME FROM?

The liver makes most of the cholesterol in your body. A small amount comes from foods, such as meat and dairy products. The fat in these foods is turned into triglycerides. Triglycerides travel through the bloodstream and are stored in fat cells as a source of energy. The body also converts sugars in fruits and sugary foods into triglycerides.

WHAT IS “GOOD” AND “BAD” CHOLESTEROL?

In the body, cholesterol is packaged with a protein and triglycerides into a substance called a lipoprotein. There are two main types of lipoproteins:

  1. LDL (low-density lipoprotein)—This type of lipoprotein carries cholesterol to where it is needed in the body. If there is too much of it, it tends to collect in the walls of blood vessels. LDL sometimes is called “bad cholesterol.”
  2. HDL (high-density lipoprotein)—This type of lipoprotein picks up cholesterol in the bloodstream and takes it back to the liver. The liver breaks down cholesterol so that it can pass out of the body. HDL sometimes is called “good cholesterol.”

WHAT IS DYSLIPIDEMIA?

Having abnormal levels of cholesterol or triglycerides is called dyslipidemia. A common dyslipidemia in the United States is having an LDL cholesterol level that is too high, an HDL cholesterol level that is too low, and elevated levels of triglycerides. This type of dyslipidemia increases the risk of cardiovascular disease.

HOW DOES HAVING A HIGH LDL CHOLESTEROL LEVEL LEAD TO CARDIOVASCULAR DISEASE?

When the level of LDL is high, it can collect inside the walls of blood vessels. When the level of HDL is low, there may not be enough available to remove the “bad cholesterol” from the blood vessels. LDL within the walls of blood vessels triggers a response by the body’s immune system. Eventually, this immune response can lead to a buildup of a substance called plaque in the blood vessels. Plaque can narrow and harden the arteries, a condition called atherosclerosis.

Over time, plaque can develop into a blood clot that narrows or blocks the flow of blood in an artery. If this occurs in an artery in the heart, it can cause a heart attack. If this occurs in an artery in the brain, it can cause a stroke.

BESIDES ABNORMAL CHOLESTEROL, WHAT ARE OTHER RISK FACTORS FOR CARDIOVASCULAR DISEASE?

Other risk factors are advancing age, male sex, family history, smoking, physical inactivity, obesity, a poor diet, and medical conditions such as diabetes mellitus and high blood pressure.

WHAT ARE SOME RISK FACTORS FOR CARDIOVASCULAR DISEASE THAT ARE UNIQUE TO WOMEN?

Polycystic ovary syndrome, high blood pressure disorders that occur during pregnancy, and gestational diabetes are all risk factors for cardiovascular disease that are unique to women.

HOW ARE MY CHOLESTEROL LEVELS MEASURED?

A simple blood test can show if your cholesterol levels are healthy. A complete lipoprotein analysis measures the levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.

WHEN SHOULD MY CHOLESTEROL LEVELS BE MEASURED?

Women without risk factors should have their cholesterol levels measured every 5 years beginning at age 45 years. Women who have risk factors for cardiovascular disease may need to start cholesterol screening earlier.

WHAT LIFESTYLE CHANGES CAN I MAKE TO REDUCE MY RISK OF CARDIOVASCULAR DISEASE?

The following changes may reduce your risk of cardiovascular disease:

  • Eat a heart-healthy diet. A heart-healthy diet is one that emphasizes vegetables, fruits, beans, and low-fat dairy products; includes fish and poultry; and limits red meat, sugary foods and drinks, and sodium.
  • Exercise. Exercise strengthens your heart and promotes the health of your blood vessels. It helps boost your HDL levels and lower blood pressure levels.
  • Lose weight. Weight loss is recommended if you are overweight or obese.
  • Stop smoking. Smoking is one of the biggest risk factors for heart disease. It decreases HDL levels and may increase the level of triglycerides in your blood.

IS THERE MEDICATION THAT CAN HELP REDUCE MY CHOLESTEROL LEVELS?

Statins are drugs that cause the liver to make less cholesterol. In addition to lowering LDL levels, they also may help decrease the levels of triglycerides and increase levels of HDL.

INFORMATION FROM ACOG

High Blood Pressure

WHAT IS BLOOD PRESSURE?

Blood pressure is the force of blood pushing against the walls of the blood vessels called arteries. The arteries carry blood from your heart to your lungs, where the blood picks up oxygen, which is delivered to your organs and tissues. The organs and tissues use the oxygen to power their activities. Other blood vessels called veins bring the now oxygen-poor blood and waste products back to the heart and lungs.

HOW OFTEN SHOULD I HAVE MY BLOOD PRESSURE CHECKED?

You should have your blood pressure measured at least every 2 years if your blood pressure is normal and more often if it is higher than normal.

HOW IS MY BLOOD PRESSURE CHECKED?

A cuff with a balloon inside is wrapped around your upper arm. Air is pumped into the balloon. Your pressure reading is taken while the cuff is squeezing your arm.

WHAT DO THE NUMBERS IN MY BLOOD PRESSURE READING MEAN?

Your blood pressure reading has two numbers. Each number is separated by a slash: 110/80, for instance. You may hear this referred to as “110 over 80.” The first number is the pressure against the artery walls when the heart contracts. This is called the systolic blood pressure. The second number is the pressure against the artery walls when the heart relaxes between contractions. This is called the diastolic blood pressure.

DOES MY BLOOD PRESSURE STAY THE SAME ALL OF THE TIME?

Blood pressure can go up and down. It goes down when you sleep and goes up when you are active or nervous. This is normal. Your blood pressure is the average of several readings taken on different occasions.

HOW IS MY BLOOD PRESSURE READING CATEGORIZED?

Your blood pressure reading is classified into one of four categories: normal, prehypertension, stage 1 hypertension, or stage 2 hypertension. People who have prehypertension have twice the risk of developing hypertension compared with those who have normal blood pressure. Recognizing prehypertension is important. If you have prehypertension, you often can make lifestyle changes to prevent the development of high blood pressure.

HOW CAN HIGH BLOOD PRESSURE HARM MY BODY?

Long before high blood pressure causes symptoms, it can damage vital organs in your body:

  • Blood vessels—Long-term high blood pressure can damage the walls of the arteries. Damaged artery walls are more likely to attract a sticky substance called plaque. Plaque can build up inside blood vessel walls and, over time, cause the arteries to narrow and harden. This condition is called atherosclerosis. The combination of atherosclerosis and high blood pressure sets the stage for a stroke or heart attack.
  • Heart—As blood pressure increases, the heart has to work harder to deliver oxygen to the tissues. Over time, the heart may enlarge. Its walls may thicken or thin. The heart may no longer pump efficiently enough to keep up with the body’s demands. Tissues become starved of oxygen, causing fatigue, breathing problems, and weakness.
  • Brain—High blood pressure can cause a blood vessel in the brain to become blocked, cutting off oxygen to that part of the brain. A blood vessel also can burst. This is called a stroke. During a stroke, cells in that part of the brain may die. A stroke can cause permanent brain damage or death.
  • Kidneys—The kidneys filter the blood to remove wastes from your body. The blood vessels in the kidneys can be damaged easily by high blood pressure. When the kidneys are not working normally, their ability to control salt and water balance in the body is disrupted. This can lead to kidney failure.
  • Eyes—High blood pressure can cause the blood vessels in your eyes to constrict. This can cause vision problems and may even lead to blindness.

WHAT ARE RISK FACTORS FOR HIGH BLOOD PRESSURE THAT CANNOT BE CHANGED?

The following factors that increase the risk of high blood pressure cannot be changed:

  • Age—Blood pressure increases with increasing age.
  • Race—High blood pressure is more common in African Americans than in any other racial group.
  • Family history—High blood pressure tends to run in families.
  • Medical conditions—Certain diseases, such as diabetes and kidney disease, increase the risk of high blood pressure.
  • History of preeclampsia

WHAT LIFESTYLE HABITS CAN AFFECT MY BLOOD PRESSURE?

Lifestyle habits also can affect blood pressure. These are things you can change. You are at greater risk of high blood pressure if you

  • are overweight
  • are not physically active
  • smoke cigarettes
  • drink more than two alcoholic drinks per day
  • eat a poor diet (too much fat, not enough fruits and vegetables)
  • eat too much salt

WHAT CAN I DO TO HELP DECREASE MY RISK OF HIGH BLOOD PRESSURE?

Adopting certain lifestyle habits can decrease your risk of developing high blood pressure in the future:

  • Quit smoking.
  • Lose weight if you are overweight.
  • Limit your intake of alcohol.
  • Exercise regularly.
  • Cut back on salt.
  • Change your diet—The DASH (Dietary Approaches to Stop Hypertension) eating plan focuses on heart-healthy foods.
  • Relieve stress.

WHAT TREATMENT IS AVAILABLE IF MY BLOOD PRESSURE IS NOT LOWERED BY LIFESTYLE CHANGES?

If lifestyle changes alone do not lower your blood pressure, medications usually are recommended. Many types of medications are available that work in different ways. It is important to continue taking your medication even when you are feeling healthy. It also is important to continue your healthy lifestyle habits even if taking medication lowers your blood pressure readings into the healthy range.

CAN HIGH BLOOD PRESSURE AFFECT PREGNANCY?

High blood pressure during pregnancy can cause serious problems, including growth problems with the baby, preterm birth, and worsening of any preexisting conditions that you have because of high blood pressure. If you have chronic (long-lasting) high blood pressure and are planning to become pregnant, see your health care provider for a prepregnancy check-up. This will give you a chance to stabilize your blood pressure and to become as healthy as possible. During pregnancy, your blood pressure will be measured often. You will be monitored for signs and symptoms of preeclampsia. You may have special tests to monitor the well-being and growth of the fetus.

WHAT IS GESTATIONAL HYPERTENSION?

High blood pressure that first occurs in the second half (after 20 weeks) of pregnancy is called gestational hypertension. Management depends on how high your blood pressure is. Most women with gestational hypertension have only a mild increase in blood pressure. Some women, however, develop severe hypertension and are at risk of serious complications. All women with gestational hypertension are monitored closely to make sure their blood pressure does not go too high and to look for signs of preeclampsia.

WHAT IS PREECLAMPSIA?

Preeclampsia is a serious high blood pressure disorder that can occur during pregnancy and in the weeks after pregnancy. If it is not diagnosed and managed, it can cause severe complications in both the woman and her baby. Women who have had preeclampsia have an increased risk of developing high blood pressure and cardiovascular disease later in life.

ARE CERTAIN TYPES OF BIRTH CONTROL NOT RECOMMENDED IF I HAVE HIGH BLOOD PRESSURE?

Some birth control methods are not recommended for women with high blood pressure. These methods include the following:

  • Combined hormonal birth control methods—These methods contain estrogen and progestin and include the combined hormonal pill, patch, and ring. If you are being treated for high blood pressure—even if your blood pressure is normal—discuss the use of these methods with your health care provider.
  • Injection—This form of birth control should not be used if your systolic blood pressure is 160 or higher or if your diastolic pressure is 100 or higher.

CAN HORMONE THERAPY FOR MENOPAUSE SYMPTOMS AFFECT MY BLOOD PRESSURE?

Blood pressure usually does not change much with hormone therapy. In some women, hormone therapy actually decreases blood pressure. In others, some types of hormone therapy increase blood pressure. Because the effects of hormone therapy on blood pressure are not predictable, all women who are taking hormone therapy should have their blood pressure checked more often.

INFORMATION FROM ACOG

Deep Vein Thrombosis (DVT)

WHAT IS DEEP VEIN THROMBOSIS (DVT)?

Deep vein thrombosis is a condition in which blood clots (or thrombi) form in deep veins in the legs or other areas of the body. Veins are the blood vessels that carry blood from the body’s tissues to the heart. Deep veins are located deep in the body, away from the skin’s surface.

HOW DOES A CLOT FORM IN A VEIN?

Clotting is a normal process that helps stop bleeding, such as from a cut in the skin. A clot also can form if

  • blood flow is too slow
  • the lining of a vein is damaged
  • a problem in the blood makes it clot more easily

When a clot forms in a deep vein, blood flow in the vein slows down and causes the vein to swell. If a piece of a clot breaks free and moves through the blood vessels to the lungs, it is very serious. This condition, called pulmonary embolism (PE), can be fatal. Nearly one third of people who have DVT develop PE. It is important to find and treat DVT early in order to prevent PE.

WHO IS AT RISK OF DVT?

DVT can occur in anyone, but some factors can increase the risk. Having more than one risk factor further increases the risk. Events or conditions that increase the risk of DVT include the following:

  • Surgery
  • Trauma
  • Long periods of not moving (bed rest, sitting, long car or airplane trips)
  • Cancer and cancer therapy
  • Past history of DVT
  • Increasing age
  • Pregnancy and the 4–6 weeks after giving birth
  • Use of birth control methods that contain estrogen or hormone therapy for menopause symptoms
  • Certain illnesses, including heart failure, inflammatory bowel disease, and some kidney disorders
  • Obesity
  • Smoking
  • Varicose veins
  • Having a tube in a main vein (sometimes needed to give medications over a period of time)
  • Having a thrombophilia, one of several diseases in which the blood does not clot correctly

WHAT CAN BE DONE BEFORE AND AFTER SURGERY TO PREVENT DVT?

Your doctor may prescribe medications to prevent blood clots from forming before or after surgery. You also may be told to stop taking certain medications before surgery. At the hospital, you may wear special elastic stockings or inflatable boots. These devices squeeze the muscles to help keep blood flowing. You may need to wear them until you leave the hospital. You may be urged to get up and walk around soon after the procedure. Your feet or the foot of your bed may be raised.

HOW CAN DVT BE PREVENTED DURING PREGNANCY?

If you are pregnant, medication or other treatments may be prescribed to prevent DVT if you have certain risk factors:

  • Strong family history of DVT
  • An inherited thrombophilia
  • Need for bed rest
  • Likely to have a cesarean birth

If medication is prescribed for you, your health care provider will make sure you know how to take the medication and what you should avoid while taking it.

HOW CAN DVT BE PREVENTED DURING TRAVEL?

When planning a long trip, the following preventive steps are recommended, especially if you are pregnant or have other risk factors for DVT:

  • Drink lots of fluids.
  • Wear loose-fitting clothing.
  • Walk and stretch at regular intervals (for example, when traveling by car, make frequent stops to allow you to get out and stretch your legs).
  • Special stockings that compress the legs below the knee may help prevent blood clots from forming. However, talk to your health care provider first before you try these stockings because some people should not wear them (for example, those with diabetes or problems with blood circulation).

WHAT ARE SIGNS OF DVT?

Only about one half of people who have DVT show any signs or have symptoms. Signs and symptoms of DVT in the ankle, calf, or thigh include

  • warmth or tenderness
  • pain or sudden swelling
  • redness of the skin
  • constant pain in one leg while standing or walking

WHAT ARE SIGNS OF PULMONARY EMBOLISM (PE)?

PE can be life-threatening. If you have any of the following signs or symptoms, you should contact your health care provider or go to the emergency room:

  • A sudden cough, which may produce blood
  • Sudden shortness of breath
  • Pain in the ribs when breathing
  • Sharp chest pain under the breast or on one side
  • Burning, aching, or dull heavy feeling in the chest
  • Rapid breathing
  • Rapid heart rate

HOW IS DVT DIAGNOSED?

The following tests are used to diagnose DVT:

  • Blood tests—You may be tested for blood disorders that are known to increase the risk of DVT.
  • Doppler ultrasound—A handheld device is placed over veins that uses sound waves to check blood flow. Pressure is applied to see if the vein responds normally. This test is most often used to confirm DVT in the legs.
  • Magnetic resonance imaging (MRI)—MRI, a special type of imaging test, can show clots in the legs or pelvis.
  • Venogram—In this test, dye is put into a vein, and an X-ray is taken. The dye can show whether there is a clot in the vein.

Other tests may be done if the clot is thought to be in the lungs:

  • Spiral computed tomography (CT)—This imaging test is done to see if any clots have moved to the lungs.
  • Ventilation/perfusion (V/Q) scan—This imaging test measures how well air and blood move through the lungs. It is used to diagnose PE.

HOW IS DVT TREATED?

DVT is most often treated with medications. Drugs may include anticoagulants to prevent clots or, less commonly, thrombolytics to dissolve them.

INFORMATION FROM ACOG

Depression

WHAT IS DEPRESSION?

Depression is a common but serious illness. It is more than just feeling sad or upset for a short time or feeling grief after a loss. Depression changes your thoughts, feelings, behavior, and physical health. It can affect how you relate to your family, friends, and coworkers. It can occur at different times of life or in different situations. It also can occur as part of other disorders.

WHAT ARE THE SYMPTOMS OF DEPRESSION?

Depression causes a mix of emotional and physical symptoms. You have depression if you have five of the following symptoms most of the day, every day, during the same 2-week period. One of the symptoms must be either sad or depressed mood or loss of interest or pleasure in previously enjoyed activities:

  • Sad or depressed mood
  • Loss of interest or pleasure in activities you used to enjoy
  • Weight loss when not dieting or weight gain; decrease or increase in appetite
  • Trouble sleeping or sleeping too much
  • Moving more slowly or moving more quickly than usual
  • Fatigue or loss of energy
  • Feelings of worthlessness or guilt
  • Having trouble thinking, concentrating, or making decisions
  • Thoughts of death or suicide

ARE THERE DIFFERENT LEVELS OF DEPRESSION?

Depression can be mild, moderate, or severe. If you have mild depression, it may take extra effort to do what you have to do, but often you can still do those things. With moderate depression, you may not be able to do some of the things you need to do. If you have severe depression, you may not be able to do any of the daily tasks you need to do.

WHAT CAUSES DEPRESSION?

Researchers do not know for certain what causes depression. They do know that depression is a brain disorder in which the parts of the brain that control mood, sleep, and thinking are not functioning properly. Depression may be caused by an imbalance in certain chemicals in the brain.

WHAT FACTORS INCREASE THE RISK OF DEPRESSION?

Factors that increase the risk of depression include the following:

  • Genetics—A family history (someone in your immediate family has depression) can put you at high risk.
  • Hormonal changes—Depression in women may be related to hormonal changes that happen during the menstrual cycle, during pregnancy, after childbirth, and at menopause. When depression occurs after childbirth, it is called postpartum depression (see the FAQ Postpartum Depression).
  • Stress—Stressful circumstances such as trauma, loss of a loved one, a difficult relationship, unemployment, or abuse may trigger the onset of depression.
  • Other illnesses—Some disorders can lead to or occur with depression. Anxiety disorders often occur with depression. Alcohol and drug problems and chronic (long-lasting) pelvic pain also can occur with depression.

HOW IS DEPRESSION DIAGNOSED?

To diagnose your depression, your health care provider will discuss your symptoms, how often they occur, and how severe they are. You also will be asked about your medical history, any medications you are taking, and whether you use drugs or drink alcohol. Certain medications and health conditions, such as an infection or a thyroid disorder, can cause symptoms similar to depression.

HOW IS DEPRESSION TREATED?

Depression is treated with psychotherapy, medications called antidepressants, or both.

WHAT IS PSYCHOTHERAPY?

In psychotherapy or “talk therapy,” a therapist will work with you to identify problems and suggest ways you might change your behavior to help relieve your symptoms.

You may have one-on-one therapy (with just you and the therapist) or group therapy where you meet with a therapist and other people with problems similar to yours. Another option is family or couples therapy, in which you and family members or your partner may work with a therapist.

WHAT ARE ANTIDEPRESSANTS?

Antidepressants are medications that work to balance the chemicals in the brain that control your moods. There are many types of antidepressants. If one type does not work for you, your health care provider can prescribe another. Drugs often can be combined. It may take some time to find the drug or combination of drugs that works best for you. It often takes at least 3–4 weeks of taking the medication before you start to feel better.

CAN ANTIDEPRESSANTS CAUSE SIDE EFFECTS?

Antidepressants can cause side effects; however, most are temporary and go away after a short time. Listed are some of the most common side effects:

  • Headache
  • Nausea
  • Trouble falling asleep or waking often during the night
  • Feeling jittery
  • Loss of sex drive
  • Difficulty having an orgasm

In teenagers and young adults taking certain kinds of antidepressants, the risk of suicidal thoughts and actions is increased. Close monitoring by a health care provider is necessary while taking these medications.

CAN HERBAL SUPPLEMENTS BE USED TO TREAT DEPRESSION?

Some people believe that certain herbal supplements, such as the plant St. John’s wort, are effective in treating depression. Research has shown that St. John’s wort does not work for treating major depression. It even can be harmful because it can make some medications, including those taken to treat heart disease, seizures, and certain types of cancer, not work as they should. St. John’s wort also can make birth control pills not work as well.

INFORMATION FROM ACOG

Diabetes

WHAT IS DIABETES?

Diabetes is a disease in which the body does not make enough insulin or does not use it as it should. Insulin is a hormone that helps balance the amount of glucose in your blood.

Normally, your body changes most of the food you eat into glucose. Glucose is then carried to the body’s cells with the help of insulin. If your body does not make enough insulin, or the insulin does not work as it should, the glucose cannot enter the body’s cells. Instead, it stays in the blood. This makes your blood glucose level too high.

WHAT ARE THE TYPES OF DIABETES?

There are two types of diabetes: type 1 and type 2. A person with type 1 diabetes needs to take insulin to survive because the body makes little or no insulin on its own. In people with type 2 diabetes, insulin is produced, but it does not work as it should. The body becomes resistant to the effects of insulin and produces more insulin to keep glucose levels normal. Over time, the body cannot maintain high enough levels to keep the glucose levels normal, and diabetes occurs. Type 2 diabetes also may occur as a result of other diseases or as a side effect of certain medications.

People with type 2 diabetes may not need to take insulin. They may be able to control their glucose levels with proper diet, medication, or both.

WHAT ARE RISK FACTORS FOR DIABETES?

Diabetes may run in families or be linked to certain lifestyle factors. You should be tested if you have any of these risk factors:

  • Age 45 years or older
  • Overweight
  • Family history of diabetes
  • Physical inactivity
  • Ethnic background:
    • — Native American
    • — Asian
    • — Hispanic
    • — African American
    • — Pacific Islander
  • Previous abnormal glucose screening results
  • High blood pressure
  • High cholesterol
  • History of gestational diabetes or a baby weighing more than 9 pounds at birth
  • Polycystic ovary syndrome
  • History of cardiovascular disease

WHAT ARE THE SYMPTOMS OF DIABETES?

The symptoms of type 1 and type 2 diabetes are listed as follows:

Type 1 diabetes

  • Increased thirst or urination
  • Constant hunger
  • Weight loss without trying
  • Blurred vision
  • Extreme fatigue

Type 2

  • Any symptoms of type 1 diabetes
  • Sores that are slow to heal
  • Dry, itchy skin
  • Loss of feeling or tingling in feet
  • Infections, such as a yeast infection, that keep coming back

WHAT TESTS ARE AVAILABLE TO DETECT DIABETES?

There are three types of tests used to diagnose diabetes:

  1. Fasting plasma glucose test—This is the easiest and most common way to test for diabetes. Before the test, you must fast (not eat or drink anything but water) for at least 8 hours. One sample of blood is obtained.
  2. Random, also called casual, plasma glucose test—Your health care provider may screen you when you are not fasting by measuring your glucose levels.
  3. Oral glucose tolerance test—Before you have this test, you must fast overnight. You will first have a fasting plasma glucose test. Next, you will drink a liquid that contains glucose. Blood samples are taken to measure your blood glucose level over several hours.

IF DIABETES IS NOT CONTROLLED, WHAT PROBLEMS CAN IT LEAD TO?

If diabetes is not controlled, long-term, severe health problems may occur:

  • Kidney disease that can lead to high blood pressure or kidney failure
  • Eye problems that can lead to blindness
  • Nerve damage and blood vessel damage in the feet that can cause pain, numbness, infection, and possibly the need to remove a toe, foot, or leg
  • High blood cholesterol levels that can lead to stroke and heart disease
  • Certain infections, such as bladder or kidney infections, vaginal infections, yeast infections, and skin infections
  • Problems in pregnancy
  • Thyroid problems

HOW CAN WOMEN WITH DIABETES PREPARE FOR PREGNANCY?

If you have diabetes, preparing for pregnancy can improve your health and that of your future child. Plan to see your health care provider before you get pregnant to discuss your care. You should try to have good control over your glucose level a number of weeks before you become pregnant. Your health care provider may suggest changes in your care that will help lower your glucose to a normal range.

CAN DIABETES BE PREVENTED?

To help prevent diabetes, follow a healthy diet and get regular exercise. This also can help keep your weight down—a key part of preventing diabetes. The following steps can help prevent the disease:

  • Keep your weight in the range that is healthy for you. Many doctors use the body mass index (BMI) to assess healthy weight.
  • Eat a well-balanced diet to help keep your cholesterol, blood pressure, and weight at a healthy level.
  • Try to exercise for at least 30 minutes on most days of the week.
INFORMATION FROM ACOG

Digestive Tract Issues

WHAT ARE SOME COMMON DIGESTIVE PROBLEMS?

Common digestive problems include the following:

  • Constipation
  • Diarrhea
  • Acid reflux
  • Hemorrhoids

Most common digestive problems are short term and easy to control with lifestyle changes and sometimes medication. In some cases, these problems can be a sign of more serious medical problems.

WHAT IS CONSTIPATION?

Constipation involves having fewer than three bowel movements a week. Stools may be firm or hard to pass. Swelling or bloating of the abdomen may occur.

WHAT CAUSES CONSTIPATION?

Common causes of constipation include not eating enough fiber, not drinking enough water, certain medications, and changes in routine (such as travel). Constipation can occur during pregnancy. The increased levels of hormones during pregnancy can slow down the digestive system.

HOW CAN CONSTIPATION BE TREATED?

If constipation continues, your health care provider may suggest a laxative. Most of these products are available without a prescription.

HOW DO LAXATIVES WORK?

Different types of laxatives work in different ways:

  • Bulk-forming laxatives absorb water and expand, which increases moisture in the stool and makes it easier to pass (these are thought to be the safest laxatives).
  • Stool softeners add liquid content to the stool to soften it.
  • Stimulants use a chemical to increase bowel activity, which moves the stool through the intestines.

HOW CAN CONSTIPATION BE PREVENTED?

You can help prevent constipation by

  • drinking plenty of fluids
  • eating at least 25 grams of fiber a day
  • exercising
  • not holding your stool—using the bathroom when you feel the urge to have a bowel movement

WHAT IS DIARRHEA?

Diarrhea is having three or more loose bowel movements a day. Cramping also may occur.

WHAT CAUSES DIARRHEA?

Several things can cause diarrhea:

  • Infection with harmful bacteria or viruses, which can be caused by eating or drinking contaminated food or water
  • Drinking water or eating foods that contain germs your body is not used to (when traveling to foreign countries, for instance)
  • Consuming dairy products (if you are lactose intolerant), caffeine, artificial sweeteners, or certain additives
  • Taking medications, especially antibiotics
  • Digestive diseases, such as irritable bowel syndrome

WHAT SHOULD I DO IF I HAVE DIARRHEA?

If you have diarrhea, drink plenty of fluids to replace those that are lost. If diarrhea does not go away in a few hours, drink fluids and liquid foods that contain salt, such as sports drinks or broth. Avoid drinking dairy products, soda, and juices.

They may contain lactose, caffeine, or sugar, which may make diarrhea worse. Over-the-counter anti-diarrheal medications can be helpful. However, they should not be taken if you have a high fever or bloody diarrhea, which can be signs of a bacterial infection.

WHEN DO I NEED TO SEE MY HEALTH CARE PROVIDER ABOUT DIARRHEA?

If diarrhea lasts more than 2 days, see your health care provider. Also see your health care provider if your stools contain blood or pus or if you have a fever, severe abdominal pain, or signs of dehydration (thirst, dry skin, fatigue, dizziness, less frequent urination, or dark-colored urine).

WHAT SHOULD I KNOW ABOUT DIARRHEA IF I USE BIRTH CONTROL PILLS?

If you use birth control pills, diarrhea or vomiting may decrease their effectiveness. Call your health care provider about what to do if you have vomiting or diarrhea that lasts for 48 hours or more after taking a combined birth control pill or that lasts for 3 hours or more after taking a progestin-only pill.

WHAT IS ACID REFLUX?

Acid reflux occurs when the muscle in your esophagus that opens and closes when you swallow does not work properly. When this happens, food and digestive fluids, which contain acid, back up into your esophagus. Acid reflux can cause a burning feeling in your chest and throat, which sometimes is called heartburn.

HOW CAN I CONTROL ACID REFLUX?

You can control or even prevent acid reflux by taking these steps:

  • Elevate the head of your bed.
  • Eat small, more frequent meals.
  • Quit smoking.
  • Avoid foods and drinks that make your symptoms worse.
  • Avoid lying on your back right after eating.

HOW CAN ACID REFLUX BE TREATED?

Several over-the-counter medications are available that may help reduce your symptoms. Antacids reduce the acid content in the stomach. Other medications stop the digestive system from making too much acid. Some of these medications are available over the counter.

WHAT IF I HAVE ACID REFLUX MORE THAN TWICE A WEEK?

If acid reflux occurs more than twice a week, or if you have been taking over-the-counter medications for more than 2 weeks with no relief, you may have a condition called gastroesophageal reflux disease (GERD). Treatment includes lifestyle changes and medication. Surgery also is used to treat GERD in some cases. GERD that is not treated can lead to complications, including ulcers in the esophagus, narrowing of the esophagus, and a precancerous condition called Barrett esophagus. If you have GERD, it is important to see your health care provider regularly for treatment and follow-up.

WHAT ARE HEMORRHOIDS?

Hemorrhoids are swollen blood vessels in and around the anus and lower rectum. They can become painful, itchy, and irritated.

WHAT CAUSES HEMORRHOIDS?

Hemorrhoids can result from several factors:

  • Being overweight
  • Pregnancy
  • Standing or sitting for long periods
  • Straining during physical labor
  • Constipation

CAN HEMORRHOIDS BE TREATED?

The symptoms of hemorrhoids can be relieved with ice packs to reduce swelling. Sitting in a bath of warm water may relieve symptoms. You also may use a hemorrhoid cream or suppositories. Surgery may be needed to remove hemorrhoids in some cases. Adding fiber and fluids to your diet can help prevent hemorrhoids.

WHAT ARE EXAMPLES OF COMMON DIGESTIVE DISORDERS?

Common digestive disorders include the following:

  • Irritable bowel syndrome (IBS)
  • Celiac disease

These disorders affect more women than men. They can last for weeks or months, although symptoms can come and go.

WHAT IS IRRITABLE BOWEL SYNDROME?

Irritable bowel syndrome mainly affects women between the ages of 30 years and 50 years. Symptoms of irritable bowel syndrome may include the following:

  • Cramps
  • Gas
  • Bloating
  • Changes in bowel habits—constipation, diarrhea, or both
  • An urge to have a bowel movement that does not happen
  • Stools that have mucus in them

IBS cannot be cured, but it can be managed to reduce the symptoms. Changes in your diet, such as eating frequent small meals rather than two or three large meals a day and adding fiber to your diet, may help. Your health care provider also may suggest medications to relieve the symptoms.

WHAT IS CELIAC DISEASE?

People with celiac disease cannot tolerate gluten. Gluten is a protein found naturally in wheat, rye, and barley. When gluten is eaten, the immune system reacts by damaging the lining of the small intestine. As a result of this damage, nutrients cannot be absorbed properly. Some people with celiac disease have no symptoms. Others may have diarrhea, constipation, fatigue, or abdominal pain and bloating. If it is not treated, the disease can increase the risk of serious health problems, including osteoporosis, anemia, and cancer. Treatment involves avoiding gluten in your diet.

WHAT IS COLORECTAL CANCER?

Colorectal cancer is cancer of the rectum and colon. It often begins as a polyp—a tissue growth in the colon or rectum. Routine screening can help prevent colon cancer. Polyps that are found during routine screening can be removed easily before they become cancerous.

WHEN AND HOW SHOULD I BE SCREENED FOR COLON CANCER?

If you are at average risk of colon cancer, the preferred screening method is a colonoscopy performed every 10 years beginning at age 50 years. A colonoscopy is an exam of the entire colon using a small, lighted instrument called a colonoscope. It is recommended that you stop having colonoscopy screening if you are older than 75 years. Screening with colonoscopy for people at high risk should begin at age 40 years or at 10 years younger than the age when the youngest affected relative received the diagnosis.

HOW CAN I KNOW IF I AM AT HIGH RISK OF COLON CANCER?

You are at high risk of colon cancer if you

  • have a first-degree relative (a parent or sibling) younger than 60 years with colorectal cancer or colon polyps
  • have two or more first-degree relatives of any age with colorectal cancer or colon polyps
  • have had colorectal cancer
  • have had colon polyps
  • have a family history of familial adenomatous polyposis or hereditary nonpolyposis colon cancer

WHAT ARE THE SIGNS AND SYMPTOMS OF COLORECTAL CANCER?

Colorectal cancer usually shows no signs in the early stages of the disease. In the more advanced stages, signs and symptoms may include the following:

  • A change in bowel habits
  • Bleeding from the rectum
  • Blood in the stool
  • Stools that are more narrow than usual
  • Abdominal discomfort (bloating, cramps, or frequent gas pains)
  • A feeling that you need to have a bowel movement (that does not go away after a bowel movement)
  • Loss of appetite
  • Weakness and feeling tired

Having these symptoms does not mean that you have cancer. The same symptoms can result from other digestive disorders. Talk to your health care provider if you have any of these symptoms.

INFORMATION FROM ACOG

Sleep and Health

Sleep affects your mental and physical health. Getting good sleep helps boost your mind and mood and can help prevent health problems. Women are more likely than men to have insomnia and other sleep problems.1 Changing hormones during the menstrual cycle, pregnancy, and menopause can affect how well a woman sleeps. But there are steps you can take to get the rest you need.

HOW DOES SLEEP AFFECT MY MENTAL HEALTH?

Your mind and body are healthier when you sleep well. Your body needs time every day to rest and heal. Some sleep disorders, such as insomnia, sleep apnea, and restless leg syndrome, make it harder to fall asleep or stay asleep. This can lead to daytime sleepiness and make it more difficult to stay in good mental health.

Having a sleep problem can also trigger a mental health condition or make current mental health conditions worse. Also, mental health conditions or treatments can sometimes cause sleep problems.

HOW MUCH SLEEP DO WOMEN NEED EACH NIGHT?

Most adults need between 7 and 9 hours of sleep a night to feel refreshed, although women who are pregnant may need more and older adults may average less.

WHAT SLEEP PROBLEMS AFFECT WOMEN?

Sleep problems that affect women more or differently from men include:

  • Insomnia. More than 1 in 4 women in the United States experience insomnia, or the inability to fall asleep or stay asleep. Insomnia is also more common in people with depression and anxiety, which also affect more women than men.
  • Restless leg syndrome. More women than men experience restless leg syndrome. It can happen to women of all ages, but it happens most often during pregnancy. Also, some medicines used to treat depression can cause restless leg syndrome. Depression is more likely to affect women compared to men.
  • Sleep apnea. Sleep apnea may be underdiagnosed in women. Snoring is one of the main signs of sleep apnea. Women with sleep apnea may be underdiagnosed, because they usually report more general symptoms, such as insomnia, anxiety, and nightmares.

WHY DO WOMEN HAVE MORE SLEEP PROBLEMS?

Women may be more likely to have sleep problems because women experience hormonal changes during certain times and events that are unique to women. These include:

  • Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). Women with PMS commonly report trouble sleeping. Nearly 7 in 10 women with PMDD say they have problems going to sleep and staying asleep in the days leading up to their period.
  • Pregnancy, especially in the third trimester, when women may wake up more often than usual because of discomfort, leg cramps, or needing to use the bathroom.
  • Perimenopause, when hot flashes and night sweats often can disturb sleep. Also, about half of women report problems sleeping after menopause.

HOW DO I KNOW IF I HAVE A SLEEP DISORDER?

Talk to your doctor if:

  • You often have difficulty sleeping and the sleeping tips are not working for you
  • You awaken during the night gasping for breath
  • Your partner says that your breathing stops when you are sleeping
  • Your partner says that your legs move rapidly during sleep
  • You snore loudly
  • You have to get up more than twice during the night to urinate
  • You wake up feeling like you haven’t slept or are exhausted
  • You fall asleep often during the day

HOW ARE SLEEP DISORDERS DIAGNOSED?

To determine whether your sleep problems are caused by a sleep disorder or another mental or physical health problem, your doctor will ask you questions about your medical and sleep history. Sometimes it can take several visits to a doctor to figure out the cause of your sleep problems.

Your doctor or nurse may:

  • Ask about any new or ongoing health problems or stress.
  • Ask about your sleep habits. Consider keeping a sleep diary for 1 or 2 weeks before you see your doctor. Write down when you go to sleep, wake up, and take naps.11 Keep track of how long you sleep each night and you how feel throughout the day. Some free apps for your mobile phone may also help you track sleep.
  • Do a physical exam. This can help your doctor rule out other medical problems that might cause sleep problems. You might need blood tests to check for thyroid problems or other health problems.
  • Recommend a sleep study. If your doctor thinks a sleep disorder is causing your sleep problems, you may be asked to do a sleep study. Sleep studies may record brain activity, eye movements, heart rate, and breathing patterns while you stay overnight at a sleep center. A study can also record how much oxygen is in your blood and how much air moves through your nose while you breathe, as well as your snoring and other measurements.

CAN I TAKE AN OVER-THE-COUNTER (OTC) MEDICINE TO HELP ME SLEEP?

Yes, but talk to your doctor or nurse about your sleep problems before using an OTC product. Your sleep problem may be a symptom of a different medical problem that needs to be treated. Also, OTC products are not meant for regular or long-term use. If you decide to use a sleep medicine, doctors recommend that you:

  • Read the medicine label and directions first.
  • Use the medicine at the time of day directed by your doctor or nurse.
  • Do not drive or do activities that require you to be alert.
  • Always take only the amount your doctor or nurse tells you to take.
  • Tell your doctor or nurse about other medicines you use.
  • Call your doctor or nurse right away if you have any problems while using the medicine.
  • Do not drink alcohol or use drugs.
  • Talk to your doctor or nurse if you want to stop using the sleep medicine. Some medicines must be stopped gradually.

WHAT CAN I TRY AT HOME TO HELP ME SLEEP BETTER?

Try these tips to help improve your sleep:

  • Try to go to sleep when you feel sleepy and then get up at the same time each morning.
  • Do not take naps after 3 p.m. if you normally sleep at night.
  • Do not drink caffeinated or alcoholic drinks or smoke late in the day or at night.
  • Exercise on most days. Exercise or physical activity done too close to bedtime can make it harder to fall asleep. Experts recommend exercising at least 5 or 6 hours before your bedtime, especially if you have insomnia.
  • Do not eat or drink a lot within about 3 hours of bedtime.
  • Keep your bedroom dark, quiet, and cool. If light is a problem, try a sleeping mask. If noise is a problem, try earplugs, a fan, or a “white noise” machine to cover up the sounds.
  • Follow a routine to help relax and wind down before sleep, such as reading a book, listening to music, or taking a bath.
  • If you cannot sleep within 20 minutes of going to bed or don’t feel drowsy, get out of bed. Read or do a quiet activity until you feel sleepy. Then try going back to bed.
  • Do not do anything in your bed that could make you more awake. Using a mobile phone, watching TV, or eating in bed can make it harder for you to fall asleep in bed.
  • Do not look at lighted screens like a laptop or smartphone before bed.
  • See your doctor or a sleep specialist if you think that you have a sleep problem.
INFORMATION FROM WOMENSHEALTH.ORG

Thyroid Disease

WHAT IS THYROID DISEASE?

The thyroid gland is located at the base of your neck in front of your trachea (or windpipe). The thyroid gland makes, stores, and releases two hormones—T4 (thyroxine) and T3 (triiodothyronine). Certain disorders can cause the thyroid gland to make too much or too little hormone. Women at risk of thyroid disease include those who have or have had an autoimmune disease (such as diabetes).

WHAT IS THE FUNCTION OF THE THYROID GLAND?

Thyroid hormones control your metabolism, which is the rate at which every part of your body works. When your thyroid gland is working the way it should, your metabolism stays at a steady pace—not too fast or not too slow.

The thyroid gland is controlled by the pituitary gland (a gland in your brain). The pituitary gland makes thyroid-stimulating hormone (TSH). TSH tells the thyroid gland to make more hormone if needed.

HOW IS THYROID DISEASE DIAGNOSED?

Thyroid disease is diagnosed by your symptoms, an exam, and tests. Symptoms of thyroid disease can be much like symptoms of other health problems.

Your health care provider will examine your neck while you swallow. The thyroid gland moves when you swallow. This makes it easier for your health care provider to feel. Your health care provider also may examine your skin and eyes and check your weight and temperature.

WHAT TESTS ARE USED TO DIAGNOSE THYROID PROBLEMS?

The following tests may be used to help find the exact cause of a thyroid problem:

  • Blood tests
  • Ultrasound exam of the thyroid
  • Thyroid scan

During a thyroid scan, you drink a small amount of radioactive iodine. A special camera then detects the areas of the thyroid gland that absorb the radioactive iodine. Results of this test show areas of the thyroid gland that are underactive or overactive. This test will not be done if you are pregnant.

WHAT IS HYPOTHYROIDISM?

Hypothyroidism occurs when the thyroid gland does not make enough of the thyroid hormones to maintain your normal body metabolism.

WHAT CAUSES HYPOTHYROIDISM?

The most common cause of hypothyroidism is a disorder known as thyroiditis—an inflammation of the thyroid gland. The most common type of thyroiditis is called Hashimoto disease. In this disease, the immune system—your body’s natural defense against disease—mistakes cells in the thyroid gland for harmful invaders. Your body sends out white blood cells to destroy the thyroid gland. The pituitary gland then releases TSH to tell the thyroid gland to make more thyroid hormone. This demand on the thyroid gland can cause it to enlarge. This enlargement is called a goiter. Hypothyroidism also can result from a diet that does not have enough iodine, although this type of hypothyroidism is rare in the United States.

WHAT ARE THE SYMPTOMS OF HYPOTHYROIDISM?

The symptoms of hypothyroidism are slow to develop. Common symptoms of hypothyroidism include the following:

  • Fatigue or weakness
  • Weight gain
  • Decreased appetite
  • Change in menstrual periods
  • Loss of sex drive
  • Feeling cold when others do not
  • Constipation
  • Muscle aches
  • Puffiness around the eyes
  • Brittle nails
  • Hair loss

WHAT TREATMENT IS AVAILABLE FOR HYPOTHYROIDISM?

In most cases, hypothyroidism is treated with medication that contains thyroid hormone. The dosage of the medication is increased slowly until a normal level of thyroid hormone has been reached in the blood.

WHAT IS HYPERTHYROIDISM?

Hyperthyroidism results when the thyroid gland makes too much thyroid hormone. This causes your metabolism to speed up.

WHAT ARE THE CAUSES OF HYPERTHYROIDISM?

The most common cause of hyperthyroidism is a disorder known as Graves disease. It most often affects women between the ages of 20 years and 40 years. A late sign of Graves disease is often a wide-eyed stare or bulging eyes.

Hyperthyroidism also may result from medication. Taking too much thyroid hormone when being treated for hypo-thyroidism can lead to symptoms of an overactive thyroid. Lumps in the thyroid called hot nodules are another cause. These lumps produce excess thyroid hormone.

WHAT ARE THE SYMPTOMS OF HYPERTHYROIDISM?

Common symptoms of hyperthyroidism include the following:

  • Fatigue
  • Weight loss
  • Nervousness
  • Rapid heart beat
  • Increased sweating
  • Feeling hot when others do not
  • Changes in menstrual periods
  • More frequent bowel movements
  • Tremors

WHAT TREATMENT IS AVAILABLE FOR HYPERTHYROIDISM?

Anti-thyroid medication can be used to reduce the amount of thyroid hormone your body is making. Medications known as beta-blockers control rapid heart beat.

If these medications do not help, your health care provider may suggest treatment with high-dose radioactive iodine to destroy parts of the thyroid gland. In some cases, surgery may be needed to remove the thyroid gland.

WHAT ARE THYROID NODULES?

A nodule is a lump in the thyroid gland. When a thyroid nodule is found, it will be checked to see if it is benign (not cancer) or malignant (cancer).

Your health care provider may use ultrasound to examine the nodule. Nodules may be further examined by a procedure known as fine needle aspiration or biopsy.

If no cancer cells are found, your health care provider may either prescribe medication to decrease the size of your nodule or suggest surgery to remove it. If cancer cells are found, further treatment will be needed. Thyroid cancer usually can be treated with success.

CAN I BE TREATED FOR THYROID DISEASE IF I AM PREGNANT?

Many medications used to treat thyroid disease in pregnancy are safe for your unborn child. However, your health care provider may monitor you closely while you are being treated. Radioactive iodine, which is sometimes used to treat hyperthyroidism, cannot be taken during pregnancy. It may injure the thyroid gland of the fetus and may cause the baby to have hypothyroidism.

WHAT IS POSTPARTUM THYROIDITIS?

Some women may not have thyroid problems during pregnancy, but develop problems after childbirth. This condition is called postpartum thyroiditis. It often is a short-term problem and hormone levels quickly return to normal.

IS REGULAR SCREENING RECOMMENDED FOR THYROID DISEASE?

Regular screening for thyroid disease should be done every 5 years beginning at age 50 years. Women at risk may need to be screened earlier or more often.

INFORMATION FROM ACOG

Vaccines

Vaccines aren’t just for babies and young children. Adults also need to get vaccines.

What are vaccines?

Vaccines (sometimes called vaccinations or immunizations) are given to people to prevent disease. Vaccines are a mixture of cells and chemicals. Mostvaccines are given by injections (shots), but a few can be taken by nose, as a nasal spray.

If I am a healthy person, do I need vaccines?

Vaccines can help you stay healthy and avoid certain diseases. For example, a yearly flu shot can help keep you from catching the flu or greatly decrease the effect of the flu if you do catch it. Even though you are healthy, your work, travel, or life in general may expose you to serious illnesses like hepatitis. Vaccines can help you avoid illness, great expense, or even death.

Are there risks to vaccines?

Vaccines are very safe. Generally, being sick with the disease is much more dangerous than getting the vaccine. Most vaccines used in the United Statesare made from a killed or inactive virus, so the vaccines cannot give you the disease. People with some health conditions – like pregnancy – should notget certain vaccines. Most vaccines cause soreness at the injection site and a few can cause a flu-like feeling, which lasts for a day or so. Ask your healthcare professional which vaccines are safe for you and how you should expect to feel after getting them.

How do I know if I need any vaccines?

The table in this handout has information on which vaccines you may need as an adult. If you work or travel outside the United States, you may also needother vaccines. Your local health department or the Centers for Disease Control & Prevention (CDC) can provide information about what vaccines youwill need for travel.

a You are at risk for Hepatitis A if you: 1) live in a community that has a high incidence of Hepatitis A, 2) use street drugs, or 3) have chronic liver disease.
b You are at risk for Hepatitis B if you: 1) have had more than one sex partner in 6 months, 2) have sex or household contact with a person who has Hepatitis B, 3) use streetdrugs, or 4) are a health care or public safety worker who could have contact with body fluids.
cYou should get a flu vaccine with inactivated virus every year if you: 1) are over age 65, 2) are a health care worker, 3) are pregnant, or 4) have long-term health problems such a diabetes, asthma, kidney disease, or heart disease.

Can I get vaccines if I am pregnant?

The flu vaccine and the tetanus, diphtheria, and pertussis (Tdap) vaccine are recommended for all pregnant women. The hepatitis A and B vaccines are also recommended for women at risk for the infection. Some vaccines should not be given to pregnant women. These include the human papillomavirus (HPV), live flu, measles, mumps, and rubella (MMR), and varicella (chickenpox) vaccines. Right after pregnancy is a good time to get the hepatitis, MMR,and varicella vaccines if you need them.

FROM THE JOURNAL OF MIDWIFERY

HPV Vaccine

WHAT IS HUMAN PAPILLOMAVIRUS (HPV)?

Human papillomavirus (HPV) is a virus. Like all viruses, HPV causes infection by entering cells. Once inside a cell, HPV takes control of the cell’s internal machinery and uses it to make copies of itself. These copies then infect other nearby cells.

HOW MANY TYPES OF HPV ARE THERE?

There are more than 150 types of HPV. About 40 types infect the genital area of men and women and are spread by skin-to-skin contact during vaginal, anal, or oral sex. Genital HPV infection can occur even if you do not have sexual intercourse.

HOW COMMON IS HPV INFECTION?

HPV infection is the most common sexually transmitted infection (STI) in the United States. Almost everyone who is sexually active will get an HPV infection at some point during their life.

WHAT ARE THE SIGNS AND SYMPTOMS OF HPV INFECTION?

Like many other STIs, genital HPV infection often has no signs or symptoms. The infected person usually is not aware that he or she has been infected and can unknowingly pass the infection to others.

WHAT DISEASES ARE CAUSED BY HPV?

HPV can cause the following diseases:

  • Genital warts—About a dozen types of HPV cause genital warts. These types are called “low-risk types.” Most cases of genital warts are caused by just two low-risk types of HPV: 1) type 6 and 2) type 11. Genital warts are growths that can appear on the outside or inside of the vagina or on the penis and can spread to nearby skin. Genital warts also can grow around the anus, on the vulva, or on the cervix. Genital warts are not cancer and do not turn into cancer. Warts can be removed with medication or surgery.
  • Cancer—At least 13 types of HPV are linked to cancer of the cervix, anus, vagina, penis, mouth, and throat. Types of HPV that cause cancer are known as “high-risk types.” Most cases of HPV-related cancer are caused by just two high-risk types of HPV: 1) type 16 and 2) type 18.

DOES BEING INFECTED WITH HPV MEAN A PERSON WILL GET GENITAL WARTS OR CANCER?

No. In most people, the immune system fights most high-risk and low-risk HPV infections and clears them from the body.

WHAT HAPPENS IF THE IMMUNE SYSTEM DOES NOT FIGHT HPV INFECTION?

Infections that are not cleared from the body are called persistent infections. A persistent infection with a high-risk HPV type can cause cells to become abnormal and can lead to a condition called precancer. It usually takes years for this to happen. Cervical cancer screening can detect signs of abnormal cell changes of the cervix and allows early treatment so they do not become cancer.

WHAT IS THE BEST WAY TO PROTECT AGAINST HPV INFECTION?

A vaccine is available that can prevent infection with HPV. The vaccine protects against the HPV types that are the most common cause of cancer, precancer, and genital warts.

WHO SHOULD GET THE HPV VACCINE AND WHEN?

Girls and boys should get the HPV vaccine as a series of shots. Vaccination works best when it is done before a person is sexually active and exposed to HPV, but it still can reduce the risk of getting HPV if given after a person has become sexually active. The ideal age for HPV vaccination is age 11 years or 12 years, but it can be given starting at age 9 years and through age 26 years.

For those aged 9–14 years, two shots of vaccine are recommended. The second shot should be given 6–12 months after the first one. For those aged 15 years through 26 years, three shots of vaccine are recommended.

WHAT IF MY CHILD DOES NOT GET ALL DOSES OF THE HPV VACCINE ON TIME?

If your child has not gotten all of the recommended shots, he or she does not need to “start over.” He or she can get the next shot that is due even if the time between them is longer than recommended. This is also true for you if you have not completed the recommended number of shots through age 26 years.

HOW EFFECTIVE IS THE HPV VACCINE?

Studies show that getting all doses of the HPV vaccine before you are sexually active can reduce your risk of getting certain types of HPV-related cancer by up to 99%. If you have had sex, you may already be infected with one or more types of HPV, but you can still get the vaccine if you are younger than 26 years. The vaccine may help protect you against the other types of HPV included in the vaccine that you are not infected with.

DOES THE HPV VACCINE CAUSE ANY SIDE EFFECTS?

Millions of people have been vaccinated against HPV since the vaccine came out. There have been no reports of severe side effects or bad reactions to the vaccine. The most common side effect of the HPV vaccine is soreness and redness where the shot is given.

DO I STILL NEED REGULAR CERVICAL CANCER SCREENING IF I HAVE GOTTEN THE HPV VACCINE?

Yes. HPV vaccination helps prevent HPV infection. It is not a cure for an HPV infection that has already occurred. Women who have been vaccinated still need to have regular cervical cancer screening as recommended for their age group and health history (see FAQ085 Cervical Cancer Screening).

IN ADDITION TO THE HPV VACCINE, HOW CAN I PROTECT MYSELF AGAINST HPV INFECTION?

Even if you get the HPV vaccine, it still is important to take other steps to protect yourself against HPV and other STIs:

  • Limit your number of sexual partners. The more partners you have over the course of your life, the greater your risk of infection.
  • Use a male or female condom to reduce your risk of infection when you have vaginal, anal, or oral sex. But be aware that condoms cover only a small percentage of skin and do not completely protect against HPV infection. HPV can be passed from person to person by touching infected areas not covered by a condom. These areas may include skin in the genital or anal areas.
INFORMATION FROM ACOG

Vulvar Skin Care

GUIDELINES FOR VULVAR SKIN CARE

Laundry:

    • Use mild enzyme-free soap (such as Woolite Gentle Cycle or All Free and Clear) on any clothing that comes in contact with your vulva (use 1/3 to 1/2 the suggested amount per load). Other clothing may be washed in the soap of your choice.
    • Do not use fabric softener or dryer sheets on any clothing that comes in contact with your vulva.

Clothing:

    • Look for underwear or exercise clothes with “cool max” or breathable “wick-away” fabric. Wear all-cotton underpants—not nylon with cotton crotch.
    • Thongs may cause irritation due to mechanical rubbing.
    • Avoid pantyhose. Many manufacturers are making thigh-high stockings. Opt for these instead.
    • Avoid tight clothing and clothing made of synthetic fabrics. Remove wet bathing suits and exercise clothing as soon as you can. These will not cause a yeast infection but can mechanically irritate the vulvar area.

Bathing and Hygiene:

    • Avoid bathing soaps, body washes, lotions, gels, and other products which contain perfume. No soap is best in the vaginal region. If you must use soap, Aveeno Oatmeal and Neutrogena soaps are recommended.
    • Do not scrub vulvar skin with a washcloth; washing with your hands or running water is sufficient.
    • Avoid all bubble baths, bath salts, scented oils, and hot water.
    • Pat dry rather than rubbing with a towel.
    • Avoid all over-the-counter creams or ointments and anti-yeast medications with asking your health care provider first. Remember: anything used locally in the vaginal are has the potential to cause during irritation. Do not use Vagisil.
    • Never douche
    • Avoid the use of deodorized pads and tampons. Do not use Always pads or minipads. Tampons should only be used when the flow of blood is enough to soak one tampon in four hours or less. Tampons are safe for most women, but wearing them too long or when the flow of blood is light may result in vaginal infection, increased discharge, or toxic shock syndrome. If pads are irritating, consider using “natracare pads.” These pads can be found in health food stores.
    • Do not shave the vulvar area. Shaving may cause irritation and lead to infection
    • Avoid scented toilet paper.
    • Avoid all feminine hygiene sprays, perfumes, adult, or baby wipes. Pour lukewarm water over the vulva after urinating if urination causes burning. Pat dry rather than rubbing with a towel.

Comfort Measures:

    • Soak in lukewarm bathwater with 4-5 tablespoons of baking soda or Aveeno Oatmeal soak to soothe vulvar itching and burning. Soak 2-3 times a day for 10-15 minutes. If you are busy, a cool compress with help, as will splashing down with cool water.
    • To decrease irritation, small amounts of A&D Ointment or Crisco Shortening may be applied to the vulva as often as needed to protect skin. This may also help to decrease skin irritation during your period and after urination.
    • Dryness during intercourse may be helped by using a lubricant. A small amount of almond oil, which can be obtained at health food stores, is recommended for lubrication. Astroglide, available from the pharmacy, should be used with condoms. If you use condoms, we suggest you use non-latex polyurethane condoms, such as Avanti or Trojan (certain ones) brands. Latex condoms cannot be used with almond oil.

Birth Control:

    • The new low-dose birth control pills do not seem to increase the chances of getting a yeast infection.
    • Contraceptive jellies, creams, or sponges may cause itching and burning. A brand change may be helpful. Discuss the different brands available with your health care provider.

Smoking:

    • Smoking has anti-estrogenic properties. Stop smoking! This will contribute to vaginal health.

Weight Management

TIPS FOR WEIGHT LOSS AND EXERCISE

As health care providers, we often hear, “How can I lose this weight? I eat very little and I exercise a lot and the weight just doesn’t come off.”

Here are some tips that may help to turn this situation to your benefit.

  1. First get a good physical examination. There may be a medical reason for the weight gain. Discuss with your provider any symptoms you may be having. Also review your activity level and diet with your provider. Before your appointment, make a list of the medications and herbs that you take routinely. Discuss these meds with your provider to make sure that they are not the cause of the weight gain. Your provider may order labwork to rule out medical conditions that could impair weight loss.
  2. Monitor your heart and breathing. A simple way to monitor your output is to use the Borg Scale of Perceived Exertion. You want to make sure that you are exercising at a high enough level to get results but not push yourself so hard you are gasping for breath. The scale has a 1- 10 rating, where 1 is napping and 10 is running as fast as you can. You should be at about 6-7 on the scale—short of breathe but still able to talk and you should be sweating too. Of course, before starting any exercise program, check with your provider first if you have any medical issues.
  3. Keep a food diary. It is easy to underestimate the calories that we consume in a day. A slice of cheese, a handful of pretzels , and a latte can pack on 300-500 calories in no time. For 1 week weigh, measure and write down EVERYTHING you eat. There are great apps for smartphones and the ipod/ipad that can help you with this chore. There are also some great calories counting sites on google.com. If, after one week, you cannot figure out where to cut calories, schedule a visit with a dietician, who can help you put together a realistic plan to help you lose weight. We can direct you to these professionals if you need assistance.
  4. Use a pedometer. Many cardiologists recommend the 10,000 step program. Keep a record for 1 week of how many steps you take in your normal day, using your pedometer of course! Then try to increase your daily steps to 10,000/day. If you are already walking that much, add another 2,000 steps to get the results you want. Remember, you add lots of extra steps a day by just doing things like parking your car to the far side of a parking lot and walking from there to a store, or climbing up 1 or 2 flights of stairs instead of taking an elevator. Every little bit helps!!
  1. Add strength training. Muscle is more metabolically active than fat. Adding strength to your muscles by using free weights, resistance bands, or the machines at your gym , will increase your lean tissue and boost your overall metabolism. You should try to do weight training 2 times per week. Yoga is another way to build body strength. It can also improve your flexibility, help prevent osteoporosis, and relieve stress . Stress relief, by the way, is another way to lose weight. High cortisol levels that occur when we are under a lot of stress really can cause us to “pack on the pounds”.
  2. Change your pace. The same exercise routine daily can lead to boredom . This may be causing you to not exercise at a “fat burning” capacity. Add a few short bursts of quick-paced intensity to your routine, whether that is while you are riding your bike, taking your daily walk with your dog, or sitting on your stationary bike in front of the TV. Listening to high-energy music on your ipod can really help you pick up the pace also.
  3. Enjoy what you are doing. Find an exercise routine that you like. Get a friend to exercise with you . Don’t worry about how many pounds are coming off. Just enjoy the fact that you are making yourself healthier and, hopefully, happier too.
  4. Get plenty of rest. Sleep deprivation can actually increase fat storage in your body. Also fatigue during the day can sabotage your exercise program and cause you to eat more.

Good luck and enjoy the path to a healthier you!

*Much of the information here was excerpted from the column by Linda Buch, a personal trainer and Lancaster native, in the Lancaster Sunday News of September 11, 2011.

Nutrition Information: Fiber, Folate, Iron, Protein

FIBER

Why is fiber so important?

Fiber or roughage is the indigestible part of a plant that pushes through our digestive tract. There are two main types of dietary fiber: soluble and insoluble. Soluble fiber, such as bran, nuts, seeds and beans, holds water and turns to gel during digestion. Insoluble fiber, by contrast, speeds the passage of foods through the stomach.

You should aim for 25 grams of fiber per day.

Getting adequate fiber has many benefits:

  • relieves constipation and other digestive trouble
  • makes stool easier to pass, preventing constipation, hemorrhoids and diverticulitis (inflammation of the intestine), as well as helping some of the symptoms of irritable bowel syndrome (IBS), such as diarrhea, abdominal pain, and gas
  • aids in weight management, since high-fiber foods take longer to chew, sending the signal to your body that you are full faster
  • helps lower serum cholesterol levels, improving heart health
  • better blood sugar control

If you need to increase your fiber intake, here are some great sources from real food:

  • Fresh fruits (including skins when possible), such as apples, apricots, bananas, berries, grapes, grapefruit, oranges, peaches, pears, pineapple, and tangerines.
  • Fresh vegetables, such as asparagus, bean sprouts, broccoli, brussel sprouts, cabbage, carrots, cauliflower, celery, corn, cucumber, green beans, leafy greens, okra, peppers, potatoes (with skin), squash, sweet potatoes, tomatoes.
  • Dried fruits, such as apples, dates, figs, peaches, pears, and prunes.
  • Dried beans, peas or lentils, such as black-eyed peas, black beans, garbanzo beans, kidney beans, lima beans, navy beans, pinto beans, split peas
  • Whole grains, such as barley, bran, brown rice, buckwheat, bulgar, cornmeal, grits, graham, millet, oatmeal, oat bran, rye, whole wheat, wheat germ, wheat berries, cracked wheat, wild rice
  • Whole grain crackers, such as AK mok, sesame crackers, graham crackers, Rye Krisp, Triscuits, Stoned Wheat crackers, Wheatsworth, whole wheat/bran matzos, oat bran crackers
  • Other: bran muffins, granola bars, nuts, oatmeal cookies, popcorn, peanuts, seeds (sesame, sunflower, pumpkin), trail mix, whole wheat pasta

NOTE: increase fiber intake gradually, drink fluids liberally, avoid excessive amounts of fiber.

FOLATE

Folate, or Folic Acid, is a type of B Vitamin. It helps to:

  • make DNA
  • repair DNA
  • produce red blood cells (RBCs)

If you don’t have enough folate in your diet, you may end up with a folate deficiency. Certain drinks and foods, such as citrus juices and dark green vegetables, are particularly good sources of folate. Not eating enough folate can lead to a deficiency in just a few weeks. Deficiency may also occur if you have a disease or genetic mutation that prevents your body from absorbing or converting folate to its usable form.

Folate deficiency can cause anemia. Anemia is a condition in which you have too few RBCs. Anemia can deprive your tissues of oxygen it needs because RBCs carry the oxygen. This may affect their function.

Folate is particularly important in women of childbearing age. A folate deficiency during pregnancy can lead to birth defects. Most people get enough folate from food. Many foods now have additional folate to prevent deficiency. Nevertheless, supplements are recommended for women who may become pregnant. For more information on this, check out Oh, Baby! Prenatal Vitamins

Here are some great ways to get folate from food:

  • Fortified Breakfast Cereal
  • Black-eyes peas
  • Orange juice
  • Asparagus
  • Greens (collard, turnip, kale, mustard)
  • Pineapple juice
  • Liver, organ meats
  • Brussel sprout
  • Avocado
  • Cauliflower
  • Spinach

Vegetables should be eaten raw or cooked briefly in a small amount of water.

IRON

Low iron is the most common nutritional deficiency in the U.S. Almost 10% of women are iron deficient, according to figures from the Centers for Disease Control and Prevention, but many people do not know what a vital nutrient it is.

Iron transports oxygen through your body. Iron is an important component of hemoglobin, the substance in red blood cells that carries oxygen from your lungs to transport it throughout your body. Hemoglobin represents about two-thirds of the body’s iron.

That’s one reason why, if you are low in iron, you may feel exhausted or fatigue easily with moderate exertion. You may also have decreased brain function and an impaired immune system.

Iron is also important for healthy cells, skin, hair, and nails.

Young women, ages 9 to 13 need about 8 grams of iron. Starting in adolescence, a woman’s iron needs increase due to losing blood each menstrual cycle. Women through about age 50 need 18 grams of iron daily.

Here are some great ways to get iron through food. If this is not adequate, talk to you provider about adding an iron supplement.

  • Liver and other organ meats
  • Clams, oysters, sardines
  • Beef and pork
  • Pork and beans
  • Chili con carne
  • Spinach
  • Blackstrap molasses
  • Raisins, dried apricots/figs/prunes
  • Prune juice
  • Dried peas, beans
  • Fortified breakfast cereals (check your labels!)

PROTEIN

Protein is used by the body for building and preparing cells, muscles, and tissues, and for energy. There is some debate over how much protein a person should have every day, so you may need to experiment to find what works best for your body. The Recommended Daily Allowance (RDA) is about 10% of your daily calories. This is a minimum. Many people suggest at least 20% of daily calories or 1.6-2 grams per kilogram of body weight should come from protein.

Protein is found mostly in foods which come from animals, but some plant foods also have protein. 

Foods which are high in protein are:

Milk Products group:

  • milk
  • yogurt
  • all types of cheese, including cottage cheese

Animal Sources group:

  • poultry: chicken, turkey, duck, goose, pheasant, etc.
  • fish
  • beef
  • pork and ham
  • veal
  • lamb
  • eggs

Plant Sources group:

  • beans and peas: canned or dry including lentils, navy beans, kidney beans, garbanzo beans, pinto beans, lima beans, soybeans
  • nuts and nut butter, such as peanut, walnut, almonds, cashews, etc.

Cigarette Facts and Smoking Cessation

TOBACCO CHEMICALS

Tobacco contains over 4,000 chemicals. Here are just a few:

Ammonia: used in household cleaners and dry cleaning fluid Polonium:radiation equal to 300 chest x-rays in one year
Cadmium:found in phosphate fertilizers and batteries Nicotine: addictive drug that effects your mood and performance
Hydrazine:used in jet and rocket fuel Toluene:used in polyurethane
Formaldehyde: embalming fluid, must have a license to obtain Benzene: found in all gasoline grades; caution recommended when exposed to this chemical
Acetic Acid: found in hair dye and photo developer; gloves must be worn when handling both of these substances Acetone:used as a solvent, found in paint, fingernail polish remover
Naphthalene: ingredient in explosives, moth balls, and paint pigments Hydrogen Cyanide: found in all gas chambers
Arsenic: used in rat poison; most rats love the taste Butane: used in cigarette lighters
Carbon Monoxide: a colorless, odorless, highly poisonous gas that comes out of car exhausts Over 50 of these 4,000 chemicals can cause cancer in humans? Take control today.

IDEAS TO HELP YOU QUIT

If you smoke for stimulation, try:

  • getting enough rest
  • exercising regularly (moving is a drug-free stimulant)
  • eating regular, nutritious meals
  • drinking lots of cold water

If you smoke for pleasure, remember:

  • how good foods taste now
  • you feel and look fresh in social situations without smoking
  • how much easier it is to walk, run, and climb stairs without smoke in your lungs
  • how good it feels to be in control of the urge to smoke
  • that you can spend the money you save on something else you enjoy
  • all the myriad health benefits of quitting

If your obstacle is handling the cigarettes, try to:

  • picking up a pen or pencil
  • playing with a coin, twisting a ring, or handling any harmless object
  • eating regular meals
  • finding a hobby that keeps your hands busy
  • having a low-fat, low-sugar snack like carrot sticks, apple slices, or a bread stick

Tips for tension reduction:

  • use relaxation techniques
  • exercise regularly
  • remember that smoking does not resolve problems; figure out what will, and act
  • avoid or get out of stressful situations
  • get enough rest
  • enjoy relaxation: take a hot bath, have a massage, lay in the hammock, listen to music

To deal with cravings:

  • explore using nicotine replacement therapy
  • smoke more than you want for a day or two before you quit; this “overkill” may spoil your taste for cigarettes
  • remember that smoking even one cigarette will make you want more
  • tell family and friends that you’ve quit; ask for help, let them know what they can do
  • think of yourself as a non-smoker; hang up “No Smoking” signs
  • remember that physical withdrawal lasts about 2 weeks; you can make it, hang on!

If you are having problems dealing with the habit of smoking:

  • change your smoking routines; keep your cigarettes in a different place, smoke with the opposite hand; limit smoking to certain places
  • be aware of every cigarette you smoke; ask “do I REALLY want this cigarette?”
INFORMATION FROM THE CLEAN AIR FOR HEALTHY CHILDREN CHAPTER OF THE AMERICAN ACADEMY OF PEDIATRICS

Cigarette Withdrawal and Recovery

SMOKING WITHDRAWAL SYMPTOMS

One of the reasons that nicotine is believed to be an addictive drug is the a variety of physical symptoms and certain feels are experienced when the drug is stopped. These are called physical and psychological withdrawal or symptoms of recovery. They are signs that the body is healing and adjusting itself back to when it was nicotine-free.

Because each person’s smoking habit is unique, her recovery experience in quitting will be as well. The variation of feelings, symptoms, and degrees of discomfort will be unique to each smoker. Most symptoms are temporary and decrease sharply during the first few days of cessation, followed by a continued, but slower rate in decline in the following weeks. For some smokers, dealing with withdrawal symptoms may be like “riding a roller coaster” with sharp turns, and ups and downs. The good news is that most symptoms will pass within two to four weeks after quitting.

Remember: having even one cigarette after you have tried to qui will only cause symptoms of recovery to return and last longer.

Symptom

Cause

Duration

Management

Craving physical addition to nicotine, habits, and psychological dependence; the body misses nicotine and sends signals by giving you cravings to smoke most frequent during first 2-3 days, may continue for months or years wait out the urgedistract yourself

exercise

Nicotine Replacement Therapy (NRT)

Emotional symptoms: irritability, impatience, anger, sadness body’s physical and emotional craving for nicotine 2 to 4 weeks express your emotionsask others to be patient

relaxation techniques

walks, hot baths

NRT

Fatigue no loner have nicotine as an artificial stimulant in the body 2 to 4 weeks take napsincrease physical activity

do not push yourself

Sleep Disturbances: difficulty falling asleep, waking up too early, frequent awakenings Nicotine affects brain wave functions, influences sleep patterns; dreams about smoking are common a few days increase awake activityavoid caffeine after 6 pm

deep breathing to relax

regular sleep patterns

drink milk before bed

Dizziness or Light-headedness carbon monoxide is no longer robbing blood cells of oxygen, you are now functioning on a normal supply and need to adjust 1 to 2 days take extra cautionchange position slowly

this feeling will pass

Lack of Concentration body needs time to adjust to not having constant stimulation from nicotine a few days plan work accordinglyavoid additional stresses

avoid caffeine

BENEFITS TO QUITTING SMOKING

Hoe the body repairs itself:

After 20 minutes:

  • Blood pressure drops to normal
  • Pulse rate drops to normal
  • Body temperature of hands and feet increase to normal

After 8 Hours:

  • Oxygen level in blood increases to normal

After 24 Hours:

  • Chance of heart attack decreases
  • Less short of breath

After 36 Hours:

  • Carbon monoxide levels return to non-smoking levels

After 48 Hours:

  • Nerve endings start re-growing
  • Ability to smell and taste is enhanced

After 2-3 Weeks:

  • Circulation improves
  • Walking becomes easier
  • Lung function increases up to 30%

After 1-9 Months:

  • Coughing, sinus congestion, fatigue, shortness of breath decreases
  • Cilia re-grow in lungs, increasing ability to handle mucous, clean the lungs, and reduce infection
  • Body’s overall energy increases

After 1 Year:

  • Excess risk of coronary heart disease is half that of a smoker

After 5 Years:

  • Lung cancer death rate for average former smoker decreases by almost half
  • Stroke risk is reduced to that of a nonsmoker 5-15 years after quitting
  • Risk of cancer in the mouth, throat, and esophagus is half that of a smoker’s

After 10 Years:

  • Lung cancer death rate similar to that of non-smokers
  • Pre-cancerous cells are replaced
  • Risk of cancer of the mouth, throat, esophagus, bladder, kidney, and pancreas decreases

After 15 Years:

  • Risk of coronary heart disease is that of a non-smoker

Contraception and Conception

Contraception Choices

Method How well does it work? How to use Pros Cons
The Implant(Nexplanon) > 99% A healthcare provider places it under the skin of the upper armIt must be removed by a healthcare provider Long lasting (up to 5 years)No pill to take dailyOften decreases cramps

Can be used while breastfeeding

You can become pregnant right after it is removed

Can cause irregular bleedingAfter 1 year, you may have no period at allDoes not protect against human immunodeficiency virus (HIV) or other sexually transmitted infections (STIs)
Progestin IUD(Lilleta, Mirena, Skyla, and others) > 99% Must be placed in uterus by a health care providerUsually removed by a health care provider May be left in place 3 to 7 years, depending on which IUD you chooseNo pill to take dailyMay improve period cramps and bleeding

Can be used while breastfeeding

You can become pregnant right after it is removed

May cause lighter periods, spotting, or no period at allRarely, uterus is injured during placementDoes not protect against HIV or other STIs
Copper IUD(Paragard) > 99% Must be placed in uterus by a health care providerUsually removed by a health care provider May be left in place for up to 12 yearsNo pill to take dailyCan be used while breastfeeding

You can become pregnant right after it is removed

May cause more cramps and heavier periodsMay causespotting between periods

Rarely, uterus is injured during placement

Does not protect against HIV or other STIs

The Shot(Depo-Provera) 94% Get a shot every 3 months Each shot works for 12 weeksPrivateUsually decreases periods

Helps prevent cancer of the uterus

No pill to take daily

Can be used while breastfeeding

May cause spotting, no period, weight gain, depression, hair or skin changes, change in sex driveMay cause delay in getting pregnant after you stop the shotsSide effects may last up to 6 months after you stop the shots

Does not protect against HIV or other STIs

The Pill 91% You must take the pill daily Can make periods more regular and less painfulCan improve PMS symptomsCan improve acne

Helps prevent cancer of the ovaries

You can become pregnant right after stopping the pills

May cause nausea, weight gain, headaches, change in sex drive – some of these can be relieved by changing to a new brandMay cause spotting the first 1-2 monthsDoes not protect against HIV or other STIs
Progestin-Only Pills 91% You must take the pill daily Can be used while breastfeedingYou can become pregnant right after stopping the pills Often causes spotting, which may last for many monthsMay cause depression, hair or skin changes, change in sex driveDoes not protect against HIV or other STIs
The Patch(Ortho-Evra) 91% Apply a new patch once a week for three weeksNo patch in week 4 Can make periods more regular and less painfulNo pill to take dailyYou can become pregnant right after stopping patch Can irritate skin under the patchMay cause spotting the first 1-2 monthsDoes not protect against HIV or other STIs
The Ring(NuvaRing) 91% Insert a small ring into the vaginaChange ring each month One size fits allPrivateDoes not require spermicide

Can make periods more regular and less painful

No pill to take daily

You can become pregnant right after stopping the ring

Can increase vaginal dischargeMay cause spotting the first 1-2 months of useDoes not protect against HIV or other STIs
External Condom 82% Use a new condom each time you have sexUse a polyurethane condom if allergic to latex Can buy at many storesCan put on as part of sex play/foreplayCan help prevent early ejaculation

Can be used for oral, vaginal, and anal sex

Protects against HIV and other STIs

Can be used while breastfeeding

Can decrease sensationCan cause loss of erectionCan break or slip off
Internal Condom 79% Use a new condom each time you have sexUse extra lubrication as needed Can put in as part of sex play/foreplayCan be used for anal and vaginal sexMay increase pleasure when used for anal and vaginal sex

Good for people with latex allergy

Protects against HIV and other STIs

Can be used while breastfeeding

Can decrease sensationMay be noisyMay be hard to insert

May slip out of place during sex

Requires a prescription from your health care provider

Withdrawal(Pull-out) 78% Pull penis out of vagina before ejaculation (that is, before coming) Costs nothingCan be used while breastfeeding Less pleasure for someDoes not work if penis is not pulled out in timeDoes not protect against HIV or other STIs

Must interrupt sex

Diaphragm(Caya, Milex) 88% Must be used each time you have sexMust be used with spermicide Can last several yearsCosts very little to useMay protect against some infections, but not HIV

Can be used while breastfeeding

Using spermicide may raise the risk of getting HIVShould not be used with vaginal bleeding or infectionRaises risk of bladder infection
Fertility Awareness(Family Planning) 76% Predict fertile days by: taking temperature daily, checking vaginal mucus for changes, and/ or keeping a record of your periodsIt works best if you use more than one of theseAvoid sex or use condoms/spermicide during fertile days Costs littleCan be used while breastfeedingCan help with avoiding or trying to become pregnant Must use another method during fertile daysDoes not work well if your periods are irregularMany things to remember with this method

Does not protect against HIV or other STIs

SpermicideCream, gel, sponge, foam, inserts, film 72% Insert spermicide each time you have sex Can buy at many storesCan be put in as part of sex play/foreplayComes in many forms: cream, gel, sponge, foam, inserts, film

Can be used while breastfeeding

May raise the risk of getting HIVMay irritate vagina, penisCream, gel, and foam can be messy
Emergency Contraception PillsProgestin EC (Plan B® One-Step and others) and ulipristal acetate (ella®) 58% – 74%Ulipristal acetate EC works better than progestin EC if you are overweightUlipristal acetate EC works better than progestin EC in the 2-5 days after sex Works best the sooner you take it after unprotected sexYou can take EC up to 5 days after unprotected sexIf pack contains 2 pills, take both together Can be used while breastfeedingAvailable at pharmacies, health centers, or health care providers: call ahead to see if they have itPeople of any age can get progestin EC without a perscription May cause stomach upset or nauseaYour next period may come early or lateMay cause spotting

Does not protect against HIV or other STIs

Ulipristal acetate EC requires a prescription

May cost a lot

FROM THE REPRODUCTIVE HEALTH ACCESS PROJECT, AUGUST 2018

Depo-Provera (Birth Control Shot)

Birth Control Shot At A Glance

  • A shot in the arm or buttocks that prevents pregnancy• Safe, effective, and convenient
  • Easy to get with a prescription
  • Lasts for 3 months
  • Cost is $0-$100 per injection, plus any exam fees

Is the Birth Control Shot Right For Me?

Here are some of the most common questions we hear women ask about the birth control shot.

What Is The Birth Control Shot?

The shot (aka Depo-Provera, the Depo shot, or DMPA) is an injection you get from a nurse or doctor once every 3 months. It is a safe, convenient, and private birth control method that works very well if you get it on time as prescribed.

How Does The Birth Control Shot Work?

The birth control shot contains the hormone progestin. Progestin stops you from getting pregnant by preventing ovulation. When there is no egg in the tube, pregnancy cannot occur. It also works by making cervical mucus thicker. When the mucus on the cervix is thicker, the sperm cannot get through. And when the sperm and the egg do not get together, pregnancy cannot happen!

Does The Shot Protect Against STDs?

No. The shot is really good at preventing pregnancy, but it will not protect you from sexually transmitted infections.

Luckily, using condoms every time you have sex really lowers the chance of getting or spreading STDs. The other great thing about condoms is that they also protect against pregnancy, which means that using condoms along with the shot gives you excellent pregnancy-preventing power!

How Do I Make The Shot Work Best For Me?

To get the shot’s full birth control effects, you have to remember to get a new shot every 12-13 weeks. That’s about every 3 months, or 4 times a year. The shot must be given to you by a doctor or a nurse, so you have to make an appointment and then remember to go to the appointment. It sounds simple, but sometimes things come up, so you must plan for that.

You can start using the birth control shot whenever you want. If you get your first shot within the first 7 days after the start of your period. You’re protected from pregnancy right away. If you get it at any other time in your cycle, you need to use another form of birth control (like a condom) for the first week after getting the shot.

After your first shot, it is all about remembering to get your follow-up shots. Here are some tips to make sure you stay on top of it:

  • Use a birth control reminder app or set an alarm on your phone
  • Add it to whatever calendar you use on a daily basis
  • Ask friends, family members, or your partner to remind you

Bottom line: do whatever works for you to make sure you get your follow-up shots about every 12-13 weeks.

If you are 2 or more weeks late getting your shot, your doctor or nurse may ask you to take a pregnancy test, or tell you to use emergency contraception if you had vaginal sex in the previous 120 hours (5 days).

There Can Be Negative Side Effects While You Use the Shot

Some people may get annoying side effects while using the birth control shot, but many of them go away after 2 or 3 months. Many people use the shot with no problems at all.

Most women have some change in their periods, including bleeding more days than usual, spotting between periods, or having no period. This is most common during the first year.

Lots of women who use the shot stop getting their period altogether after about a year of using it. This, like all side effects of the shot, goes away after you stop getting the shot. Your period should go bak to normal within a few months after your last shot wears off.

Other possible side effects of the shot include:

  • nausea or mild stomach pain
  • weight gain
  • acne
  • decreased sex drive
  • headaches or joint pain
  • breast tenderness
  • hair loss or more hair on the face or body
  • depression or feeling tired or irritable
  • slight bruising where the shot was administered
  • very rarely, a small, permanent dent in the skin where the shot was given

If you get any of these side effects and they really bother you, talk with your doctor or nurse.

It may take up to 10 months after discontinuing the birth control shot to get pregnant. If you decide that you want to get pregnant right away after you stop getting the shot, you should know the shot may delay your ability to get pregnant by up to 10 months. However, some people do get pregnant soon after stopping the shot. There is no way to know how long it will take you.

How Effective Is The Birth Control Shot?

When used perfectly, the birth control shot effectiveness is more than 99%, meaning fewer than 1 out of every 100 people who use it will get pregnant each year. But when it comes to real life, the shot is about 94% effective, because sometimes people forget to get their shots on time. So in reality, about 6 out of every 100 shot users will get pregnant each year. The better you are about getting your shot on time, the better it will work. But there is a very small chance that you could still get pregnant, even if you always get the shot on time. If effectiveness is the most important thing to you when picking what birth control to use, you might want to investigate IUDs and the implant. They are the most effective kinds of birth control. But if you decide the shot is right for you, make sure you always get your follow-up shots on time.

Advantages

If you remember to get your shots on time, the shot (Depo-Provera) is a very effective method of birth control. If you want maximum protection from pregnancy, you can also use condoms along with the shot, which will then also protect you from STDs.

The Shot Is Convenient and Private

The brith control shot is easy to get and convenient. Once you get it, you only have to think about birth control four times each year. It is great for people who don’t want to deal with taking a pill every day, or who don’t want to use birth control that interrupts sex.

It is also super private because it is a shot that you get in a doctor’s office; there is no packaging or other evidence of birth control lying around. So nobody has to know that you are using it.

The shot is birth control you don’t have to use during sex, so it won’t get in the way of the action. If you use the shot correctly, you are protected from pregnancy all day, every day. Many people say the shot makes their sex lives better cease they don’t have to interrupt sex or worry about pregnancy.

The Shot Can Make You Get Your Period Less Often While You Use It

Many women like the shot because it makes their periods get lighter. Half of people who use the shot stop getting their periods completely. That usually happens after about a year of using the shot. Not getting your period is totally safe so there’s nothing to worry about. However, for the first 12 months, many women say they bleed more days than usual and have spotting between periods. Your period should go back to normal a few months after you stop using the shot.

The Shot Has Health Benefits

The shot an help protect you from cancer of the uterus and from ectopic pregnancy.

The Shot Is Temporary

Many people who use the birth control shot want to have kids when the time is right. One of the great things about the shot is that it is not permanent, so you can get pregnant after you stop using it if you want to.

While the shot doesn’t change your ability to get pregnant in the long run, it can cause a delay of about 9-10 months in being able to get pregnant after stopping it. So, if you think you will want to get pregnant within the next year or so, talk with your doctor or nurse about other birth control options.

Get Emergency Medical Help If:

  • hives
  • difficulty breathing
  • swelling of your face, lips, tongue, or throat

These are signs of an allergic reaction.

Also, please call your doctor immediately if you have any of these serious side effects:

  • menstrual periods that are heavier or longer than normal
  • sudden numbness or weakness, especially on one side of the body
  • sudden sever headache, confusion, problems with vision, speech, or balance
  • chest pain, sudden cough, wheezing, rapid breathing, coughing up blood
  • pain, swelling, warmth, or redness in one or both legs
  • fever
  • nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice• swelling in your hands, ankles, or feet
  • symptoms of depression such as sleep problems, weakness, or mood changes

Diaphragm Information

HOW TO USE A DIAPHRAGM

page1image2072

  • Hold the diaphragm as if it were a cup and apply 1 teaspoon of spermicide in the center, making a circle about the size of a quarter. Spermicide may be applied to the rim of the diaphragm to ease insertion.
  • Squeeze the diaphragm firmly between the thumb and forefinger so that it becomes narrow enough to insert into the vagina. Assume a comfortable position: standing with one foot on a chair, the bed, or the toilet seat; squatting on the floor; or lying on the bed with the knees drawn up.
  • Still squeezing the diaphragm, push it into the vagina as far down and back, as it will go. When you release the diaphragm, the rim will regain its round shape and fit around the cervix. When the diaphragm is in place, you should be comfortable and not feel the diaphragm inside. Your partner should not feel it either. If the diaphragm feels uncomfortable, remove it and try again.

REMOVING THE DIAPHRAGM

• Hook your finger or thumb over the rim toward the front, and pull the diaphragm down and out. Try to use the same position for removal that you used for insertion. If you have problems, try the squatting position. You may also try breaking the suction by slipping a finger between the diaphragm and the sides of the vaginal wall, and then pulling the diaphragm out.

IMPORTANT INFORMATION

  • To prevent pregnancy, you must use the diaphragm each time you have sexual intercourse. The diaphragm can be kept at the bedside, along with spermicide and tissues, so that it can be inserted as part of foreplay. it is not necessary to insert the diaphragm in private. Partners can insert and check the diaphragm and many couples enjoy participating together in this form of contraception. If you regularly forget to use the diaphragm, if you do not feel comfortable with it, or if you think using it is too much bother, then it is not the right birth control method for you.
  • The diaphragm with spermicide can be inserted into the vagina up to six hours before intercourse. It must be left in place for six hours after intercourse. It can then be removed.
  • If you want to have sexual intercourse again, and if it has been more than six hours since last intercourse, the diaphragm must be removed and washed. In this case, additional spermicide should be added before the diaphragm is reinserted. If it has been less than six hours since the diaphragm was first inserted, it is not necessary to add more spermicide as long as the diaphragm is still in position and has not been dislodged.
  • Do not panic if the diaphragm does not budge when you first try to remove it. Just leave it in and try again later when you are more relaxed. There is no way the diaphragm can get lost or disappear in the body. You can shower, use the toilet, walk around, work, and play with the diaphragm in place. It should not, however, be left in place for more than 24 hours. Delaying the removal until after that time will encourage a sour smell and the growth of bacteria. The bacteria can cause irritation and discharge. Removal within 24 hours is especially important for women who are prone to bladder infections. Because toxic shock syndrome has rarely been reported in diaphragm users, any symptoms of infection, such as fever, light-headedness, chills, rash, or pain should be reported to your health care provider immediately.
  • Douching is not necessary when the diaphragm is used. If you have a p problem with spermicidal cream or jelly leaking from the vagina after intercourse, use a tampon or a small pad to keep your clothes dry.
  • Keep the diaphragm clean and dry between uses. It is made of latex rubber and may wear out after one or two years. Inspect it by holding it up to the light to look for holes. If you think the diaphragm is becoming stretched or worn out, ask your health care provider to check it for you.

IUD Checklist

IUD Checklist

  • You must have a visit with a provider for counseling and to determine which IUD you choose to have inserted. You will also need to have c cultures done at this visit. You will also need to read and understand all educational information concerning the IUD.
  • You will need to contact your insurance company to determine if they will cover the cost of the IUD. Please use the following codes when discussing coverage: Mirena IUD J73.02, Paraguard IUD J7300, and insertion code 58300. When insurance coverage or lack of coverage is established, you may call for an appointment.
  • You will need to schedule this appointment during your menstrual cycle (preferably between days 1-7). If you do not get regular menstrual cycles, a pregnancy test will be done prior to insertion and you will need to abstain from intercourse (even protected intercourse) for two weeks prior to insertion.
  • You will need to have had an annual exam with a pap smear before the IUD can be inserted.

Please note that all of the above steps will need to be completed before we can actually order the IUD. It may also take a few days to a week to receive the IUD, so it may take more than one menstrual cycle to have the IUD inserted. The insurance company reimbursement for the IUD must at least cover our cost of the IUD. If the total cost of the IUD is not fully covered, we may not be able to insert the IUD.

NuvaRing Information

INSTRUCTIONS FOR NuvaRing

The NuvaRing is a great new option for birth control. It is similar to the birth control pill because it contains estrogen and progestin, the two female hormones. Like the pill, it prevents you from having an egg released from your ovaries. Unlike the pill, you do not have to remember to take it every day. You simply insert a ring into your vagina and leave it there for 21 to 24 days. On the fourth week you remove it for 4 to 7 days, during which time you will have a period. The following week you start the whole process all over again. If used correctly, the ring is about 99% effective in preventing pregnancy.

Getting started on the NuvaRing

  1. If you did not use a hormonal contraceptive the past month (i.e. the pill, the patch):a. Counting the first day of your period as day 1, insert your first NuvaRing between day 1 and day 5 of the cycle (even if you have not finished bleeding on day 5). Use an extra form of birth control (condom, spermacide) for the first week of the first month.
  2. If you are switching from the pill or patch:
    a. Insert NuvaRing anytime during the first 7 days after the last active pill or your last patch and no later than the day you would have started your last pill or patch. No extra birth control is needed.
  3. If you are switching from the Depo shot, the mini-pill, or the IUD:
    a. Mini-pill: start using NuvaRing on any day for the month. Do not skip any days between your last pill and the first day on NuvaRing.
    b. Depo-Provera shot: start using NuvaRing on the day when your next injection is due.
    c. IUD: start using NuvaRing on the same day you have your IUD removed.
  4. Your provider may also suggest the “Quick Start” method. Using this method, a ring can be inserted in the day of your office visit, after a negative pregnancy tes.Use an extra form of birth control for the first week of the first month for any of the above situations.

How do you insert NuvaRing?

  1. Remove the NuvaRing from its foil packet and pinch its opposite sides between your thumb and index finger.
  2. Choose a position you are most comfortable with (i.e. lying down, squatting, or standing with one leg up). Gently push the pinched NuvaRing into your vagina. The exact position that you insert it is not important as long as it feels comfortable. If it is not comfortable, gently push if further into your vagina. NuvaRing cannot be pushed too far and will not go into your uterus or get lost.
  3. Keep the NuvaRing in place for 21 to 24 days, as directed by your provider.
  4. On the fourth week, remove the ring for a total of 4 to 7 days (as directed by your provider), during which time you will have your period.
    • To remove the ring simply insert your index finger into your vagina and hook it around the front rim of the ring. Pull downward and out.
  1. Insert a new ring on day 5 or 8 (depending on which “period” cycle you are on) at about the same time even if you are still having a period. For example, if you took your ring out at 9:00 am on Sunday, you should put a new one in around 9:00 am the next Sunday.

Your provider may also suggest continuous cycling on the NuvaRing. With this method, you change to a new ring monthly, for 3 to 4 months, and have a period at the end with this interval. Cycling in this fashion decreases your total number of periods to 3 to 4 a year.

What if a NuvaRing falls out?

If your ring should fall out and has been out for 3 hours or less, you should still be protected from pregnancy. Wash the ring with lukewarm water and reinsert it as soon as you can.

If you have lost the ring, you must insert a new one. If it has been out of the vagina for more than 3 hours, you may not be protected from pregnancy, so a backup method must be used for 1 week.

While it is rare for the ring to fall out, this can happen if it is inserted improperly and with straining and constipation of the bowels. Make sure you are getting plenty of fiber and fluids in your diet to avoid this situation. Women who have a prolapsed (dropped) uterus may have more trouble with the ring slipping out. If this happens often, inform your healthcare provider.

What if the NuvaRing is left in the vagina too long?

If the ring has been left in the vagina for 4 weeks or less, remove it and insert a new one at your normally scheduled time. No backup method of birth control is necessary.

If the ring has been left in the vagina for more than 4 weeks, you may not be protected from pregnancy. Check a home pregnancy test. If it is negative, insert a new ring and use a backup method of birth control for one full week.

Side effects of the NuvaRing

Side effects of the NuvaRing are similar to those of the birth control pill and include the following:

  • Breast tenderness
  • Mild headaches
  • Nausea at first (eat small frequent meals)
  • Breakthrough bleeding in the first several cycles
  • Vaginal irritation
  • Vaginal discharge
  • Moodiness

Like the pill, the ring contains estrogen. This hormone can increase the risk of blood clots, heart attach and stroke. This risk is greater if you are a smoker and are over 35 years of age. If you are using these hormones, you should stop smoking.

Serious side effects that could indicate a blood clot or other adverse effect are referred to as the “ACHES” symptoms:

  • Abdominal pain
  • Chest pain
  • Headaches
  • Eye disturbances
  • Severe leg pain

Call our office immediately if you should have any of these symptoms.

What else do I need to know?

The NuvaRing can be stored at room temperature as long as it is not above 86 degrees or in direct sunlight.

Spermacide will not alter the effects of the ring. Vaginal medications and lubricants are also safe to use. You should not douche while using the ring (or at any other time, for that matter!) You should not use a diaphragm as your backup method, since this may dislodge the ring.

Call our office if you have any other questions.

Oral Contraceptives (Birth Control Pills)

Instructions for Oral Contraceptive (Birth Control Pill) Use

The birth control pill works primarily by preventing ovulation (release of an egg). if there is no egg to meet the sperm, pregnancy cannot occur. The pill also works by making cervical mucous thick and unreceptive to sperm and by making the lining of the uterus (endometrium) unreceptive to implementation of a fertilized egg, should one get as far as the uterus. The pill is one of the most effective, reversible contraceptive methods available. If taken correctly, less than one (1) woman in 100 will become pregnant over the course of one year of use. Aside from contraception, your provider may prescribe the pill for other purposes, such as to control irregular bleeding, to control cramps associated with your period, or to control mood swings or acne.

The birth control pill consists of 21 to 24 active pills, which contain your two (2) female hormones, estrogen and progesterone. A 28-day pill pack also contains 4-7 placebo (sugar pills). A 210day pill pack only contains 21 days of active pills and no placebo.

Getting Started on the Pill

1. There are several ways to start taking your pills. The two most common ways are: 1) the “Sunday Start” and 2) the “Quick Start.” Your provider will discuss with you which method you should use.

• “Sunday Start”

• Start your first pack of pills on the first Sunday after the first day of your period if that day falls on Monday through Saturday. All new packs after your first one will begin on a Sunday, unless your provider tells you otherwise. If your period begins on a Sunday when you are to start your first pack of pills you begin your pills that very day.

• “Quick Start”

• Begin your pills on the day of your office visit. We will first do a urine pregnancy test in our office as part of our protocol. Your next period will be delayed until you finish the active pills and start the placebo pills.

Whether you use the “Sunday Start” or the “Quick Start” method, you will need to use a backup form of birth control (such as a condom) for the first week of the first month that you are on the pill. Keep this backup method handy and use in case you:

  • Run out of pills
  • Forget to take your pills
  • Discontinue the pill
  • Need protection from sexually transmitted diseases (STDs). The pills DO NOT provide protection from STDs, including HIV and AIDS.

2. Take one pill a day until you finish the pack. Then, if you are using a 28-day pack, begin a new pack immediately after finishing your previous pack. Skip NO days between packs. If you are using a 21-day pack, stop taking pills for 4-7 days, and then start your new pack.

3. Try to associate taking your pill with something you do at about the same time every day, like brushing your teeth in the morning, eating a meal, or going to bed. Keep the pill near the place where you engage in the selected activity. Establishing a routine will make it easier for you to remember to take your pill. Try to take your pill at about the same time every day. Check your pack of pills each morning to make sure you took your pill the day before.

Common Side Effects of the Pill

There are some common side effects of the pill. These side effects are not harmful in most cases. Most side effects go away within three months after you begin taking the pill. If they do not go away or are severe, call your provider. Switching to another pill may help. It is important, however, in most cases, to give the pill a full three months before one should consider changing the pill. The side effects include:

• Nausea (taking a pill with a meal or before bed may help)
• Spotting or bleeding between periods
• Headaches (over the counter-the-counter pain meds often help)
• Irritability, moodiness
• Bloating
• Breast tenderness (reducing your caffeine intake may improve the symptoms)

Continuous Cycling

Your provider may suggest continuous cycling. In this situation, you take your alive pills (the ones with estrogen and progesterone) daily for a 3 to 4 month period, or perhaps longer if your provider suggests this. You then take your placebos (the sugar pills) for 4 to 7 days at the end of that prolonged cycle. This method results in a period every 3 to 4 months. It is important to understand that this method of taking your pill will NOT create any reproductive health problems with your uterus.

Breakthrough bleeding can occur with this method of cycling, especially in the first couple months. As long as you are taking the active pills daily and at the same time every day, your risk of pregnancy is minimal. If you have breakthrough bleeding and have been on your active pills for at LEAST 4 WEEKS, you can stop taking the pills for a 3 to 4 day interval and allow yourself to have a “mini” period. Restart your active pills after your 3 to 4 day interval off the pills.

Reminder: DO NOT TAKE A “MINI” PERIOD BREAK UNTIL YOU HAVE BEEN ON THE PILL FOR AT LEAST ONE MONTH.

Common Questions asked about the Pill

  1. What happens if I forget to take my pill(s)?
    • If you miss one pill, take the forgotten pill as soon as you remember it, and take that day’s pill at the regular time. No back-up method of birth control is necessary if you miss only one pill. You may get a little queasy when you take 2 pills in one day. It may help to take them with food.
    • If you miss two pills in a row in the first or second week of your pack, take 2 pills on the day you remember and 2 pills for the next day. Then take one pill a day until you finish your pack. You MUST USE A BACK-UP FORM OF BIRTH CONTROL FOR 7 DAYS after you miss 2 pills in a row.
    • If you miss two pills in a row in the third week of your active pills, keep taking 1 pill a day until Sunday. On Sunday, throw out the rest of the pack and start a new pack of pills that day. You may not have a period this month. This is normal. Use your back-up method of birth control for 7 days as discussed above. If you miss your period on the second month, contact your provider.2
  2. What happens if I have bleeding in between my periods? Does this mean that my pills aren’t working?
    •  If you have not missed any pills, the likelihood of begin pregnant is extremely small (less than 0.4%). Do not stop taking your pills. Try to take them at the same time every day. If you have spotting (light bleeding between periods) for several cycles after the first three months on the pill, call the office for advice.
  3. Is it normal for my periods to be short and light on the pills?
    • Yes, this is normal. Sometimes, you may only have a brown “smudge.” This happens because the estrogen and progesterone in your pill cause the lining of your uterus to thin out. You may also have no bleeding at all. As long as you haven’t missed any pills, your chance of being pregnant is very small. If you miss a period, however, it is a good idea to perform a home pregnancy test just to be sure. Call the office if you have any questions.
  4.  I’ve heard that you can skip the “sugar” pills and keep taking the “active” pills so that you don’t get a period every month. Is that true?
    •  Yes, this is an acceptable way to take the pill. Refer to the above section on “Continuous Cycling.” This method is especially helpful if you have bad cramps while on your period even while on the pill, if you experience premenstrual syndrome, or if you just don’t want to have a period monthly. Check with your provider before initiating this method of pill taking, to make sure it is right for you.
  5. What if I get sick with vomiting and diarrhea?
    •  If you have severe vomiting and diarrhea and are unable to keep your pills down for more than one day, use your back-up method of birth control as described above
  6. Do certain medications like antibiotics decrease the effectiveness of the pill?
    •  Most antibiotics to not decrease the effectiveness of the pills. There are some anti-tuberculosis drugs and anti-seizure drugs that do decrease the effectiveness of the pills, however. Always let your provider know that you are on the birth control pill whenever new medications need to be prescribed to you.
  7. Will I gain weight on the pill?
    • Numerous research studies have proven that most women DO NOT gain weight on the pill. Your weight may fluctuate several pounds a month around the time of your “pill period” but his also happens during your regular cycle when you are not on the pill.

Risks Associated with the Pill

For most women, taking the pill is very safe. In some women, it can cause serious illness, however. This is extremely rare. The most serious problem that may arise is a heart attack, stroke, or blood clot. The risk is highest for women who are smokers, especially if you are 35-years old or older. We WILL NOT prescribe the pill to anyone who is 35 or older and a smoker. Women who are younger and who smoke are also at risk and are STRONGLY urged to stop smoking if using the pill.

Signs of Complications

Call our office immediately if any one of these danger signs (called “ACHES”) appears:

  • Abdominal pain (severe)
  • Chest pain (severe), shortness of breath
  • Headaches (severe and persistent)
  • Eye Disturbances (blurred vision, loss of vision)
  • Severe leg pain (thigh or calf)

Finally, the pill is a safe and effective way to prevent pregnancy. It is easy to use, convenient, and reversible. The pill may protect against some cancers, including ovarian cancer, colon cancer, and endometrial cancer. This benefit lasts years beyond its use. For almost all women, the benefits of pill use far outweigh the risks. Keep in mind that it works only when used as prescribed and does not protect against STDs. If you neglect to follow these directions and think that you may have gotten pregnant within 72 hours, call the office for advice about emergency contraception.

Ortho-Evra (Birth Control Patch)

OrthoEvra (Birth Control Patch)

How the patch works

The patch works in the same way as the birth control pill. It prevents ovulation, so there is no egg tomeet the sperm, therefore, pregnancy cannot occur. But, unlike the pill, the patch transfers hormones across the skin and directly into the blood stream. The patch is very effective in preventing pregnancy. If used correctly, it is 99% effective

Getting started on the Patch

  • Sunday start
    • Start your first patch on the first Sunday after the first day of your period
  • Quick start
    • Begin your patch on the same day of your office visit. We will first do a pregnancy test in our office as part of our protocol. Your next period will be delayed until you finish the active patches.

How to apply the patch

  1. The patches can be applied your shoulder, your arm, your lower abdomen and your buttock
  2. You want to  change the location of the patch by switching sides of your body each week (i.e. left arm one week, right arm the next, etc.)
  3. You will get three patches in each box. You will wear each patch for one week, and then be patch free for a week. This will be the time you will get your period

Side effects

These are usually temporary and will go away in a few weeks or months.

  1. Breast tenderness
  2. Headache
  3. Skin irritation
  4. Bloating

Signs of Complications

For most women using the patch, it is very safe. In some women it can cause serious illness, however, this is extremely rare. The most serious problem that may arise is heart attack, stroke or blood clot. We will not prescribe the patch to women who are over 35 and smoke. The following are signs that require you to call the office. We call them the ACHES:

  • A-abdominal pain (severe)
  • C- chest pain (severe), shortness of breath
  • H-headaches (severe and persistent)
  • E-eye disturbances (blurred vision, loss of vision)
  • S- severe leg or calf pain

Progestin Only Pills (POP)

PROGESTIN ONLY BIRTH CONTROL PILLS (POP) INSTRUCTIONS

As their name implies, POPs only contain the hormone progesterone, unlike conventional pills which contain both estrogen and progesterone. POPs have a lower progesterone dose than conventional pills and then failure rate, when used correctly, is 0.3%. It is a reversible birth control method.

How they work: POPs prevent pregnancy by thickening cervical mucus, which prevents sperm from entering the uterus. This effect lasts for 24 hours, and it is important to be constant about taking this pill at the same time each day. These pills do not consistently prevent the release of an egg from the ovary (ovulation).

How to start: POPs can be started at any time if you are reasonably sure you are not pregnant. If you start within the 1st 5 days of your menstrual cycle, a back-up method of birth control is unnecessary. Condoms or other backup method should be used for the first 2 days if you start at any other time in your cycle.

Proper use: ALL pills in your pack are ACTIVE pills; there are NO sugar pills.

  • Take your pill at the same time every day
  • If you are more than 3 hours late in taking your pill, use a backup method (condoms) for the next 2 days.
  • Do not skip any pills in the pack even if you are on your period.
  • When you complete a pack, start a new pack the next day, even if you are on your period.

POPs do not protect against STDs.

If you miss a pill:

  • Take your missed pill ASAP
  • Continue taking your pill daily, at the same time each day, even if it means taking 2 pills on the same day.

Use a backup method (condoms) until you have taken your pills correctly, on time, for 2 days in a row.

Common side effects:

• Irregular bleeding
• Breast tenderness
• Mood or sex drive changes

I don’t need contraception: What Benefits of Birth Control Pills are There For Me?

Potentially LOTS:

Here’s a list of potential benefits of hormonal contraceptive that have nothing to do with not getting pregnant!

Decreased risk of endometrial, ovarian, and colorectal cancers

Improved bone mineral density in older women

Induction of amenorrhea for lifestyle considerations

Menstrual cycle regularity

Prevention of menstrual migraines

Treatment of acne

Treatment of bleeding from leiomyoma

Treatment of dysmenorrhea

Treatment of hirsutism

Treatment of menorrhagia

Treatment of pelvic pain from endometriosis

Treatment of premenstrual syndrome

FROM AMERICAN COLLEGE OF OBSTETRICS AND GYNECOLOGY (ACOG)

HERE’S SOME MORE INFORMATION ON THAT:

NONCONTRACEPTIVE BENEFITS OF BIRTH CONTROL PILLS

Most women will use birth control pills at some time in their lives. But many women don’t know that birth control pills also can be used to treat a variety of female problems and can have some surprising health benefits. Birth control pills are made of synthetic (laboratory derived) versions of the two ovarian hormones: progesterone and estradiol. Also, birth control pills can contain synthetic forms of both hormones or progesterone (progestin) only. Progestin-only pills are best for women who should not or do not want to take estrogen, but are not used as much because they have a higher rate of causing unpredictable vaginal bleeding for at least the first year.

To understand how birth control pills affect periods, it is helpful to understand how the normal menstrual cycle works. A menstrual period takes place when the uterus (womb) sheds its lining; this process is controlled by the hormones made by the ovary (estrogen and progesterone). A menstrual cycle begins with the first day of the period, lasts for about one month and is divided into two halves by ovulation (the release of an egg from the ovary). During the first half of the cycle, only estrogen is made. Under the influence of estrogen, the uterine lining grows to prepare for a potential pregnancy. During the second half of the cycle, after ovulation, progesterone is also made. Progesterone stops the lining from growing and prepares it for implantation of an embryo. If pregnancy does not occur, progesterone and estrogen levels fall, which triggers the shedding of the uterine lining and the next period begins.

REGULATION OF MENSTRUAL PERIODS:

Most combination birth control pills contain three weeks of active pills (those that contain hormones) and one week of inactive placebo pills (those that do not contain hormones). The bleeding of the period occurs when the hormones are no longer taken during the week that the sugar or placebo pills are taken. A woman can increase the length of time between periods by taking active pills for more weeks. Some drug companies make pill packs that contain up to 3 months of continuous active pills. Women on these pills only have four periods a year, which can be convenient during such times as final exams, sports activities, or social events.

TREATMENT OF IRREGULAR PERIODS:

Birth control pills can be used to make irregular or unpredictable periods occur on a monthly basis. Women who have menstrual cycles longer than 35 days might not be making progesterone, which prevents the uterine lining from growing too much. Excess growth of the uterine lining can cause heavy bleeding or increase the risk for developing abnormal patterns of growth in the uterine lining, including cancer. The most common reason for irregular and infrequent periods is Polycystic Ovary Syndrome (PCOS). Because a birth control pill contains progesterone-like medication, it can help regulate the menstrual cycle and protect the lining of the uterus against pre-cancer or cancer.

TREATMENT OF HEAVY PERIODS (MENORRHAGIA):

Birth control pills contain a progesterone-like hormone, which makes the lining of the uterus thinner and causes lighter bleeding episodes. In rare cases, some women may not experience bleeding during the period in which they take the placebo or sugar pills. Currently marketed pills allow a woman to have a period every month, every 90 days, or once per year, as desired.

TREATMENT OF PAINFUL PERIODS (DYSMENORRHEA):

A chemical called prostaglandin is produced in the uterus at the time of the period, and can cause painful menstrual periods. Prostaglandin can cause contractions of the uterus that produce the menstrual cramping that most women experience. Women who produce high levels of prostaglandin have more intense contractions and more severe cramping. Birth control pills prevent ovulation which in turn reduces the amount of prostaglandin produced in the uterus. By doing so, birth control pills relieve menstrual cramping.

TREATMENT OF ENDOMETRIOSIS:

Another cause of painful menstrual cycles is endometriosis. When the tissue lining the uterus (endometrium) grows outside of the uterus it is called endometriosis. Just as progesterone limits the growth of the uterine lining, the progesterone-like hormones in birth control pills can limit or decrease the growth of endometriosis. Because of this, birth control pills can reduce the pain associated with endometriosis for many women.

TREATMENT OF PREMENSTRUAL SYNDROME (PMS) AND PREMENSTRUAL DYSPHORIC DISORDER (PMDD):

Many women who have PMS or PMDD report an improvement in their symptoms while they are taking birth control pills. It is thought that birth control pills prevent the symptoms of PMS and PMDD by stopping or preventing ovulation from taking place.

TREATMENT FOR ACNE, HIRSUTISM (EXCESS HAIR) AND ALOPECIA (HAIR LOSS):

All birth control pills can improve acne and hair growth in the midline of the body (hirsutism) by reducing the levels of male hormones (androgens) produced by the ovary. All women make small amounts of androgens in the ovaries and adrenal glands. When these hormones are made in higher than normal amounts, or if a woman is sensitive to the androgens produced, she may start to grow hair above the lip, below the chin, between the breasts, between the belly button and pubic bone, or down the inner thigh. Birth control pills reduce production of male hormones and increase the production of the substances in the body that bind the androgens circulating in the bloodstream. Within six months of use, there is usually a reduction in the abnormal hair growth. However, when a woman has more excessive male hormone symptoms, she should see a gynecologist or primary care doctor. These symptoms may include male pattern baldness, smaller breast size, increased muscle mass, growth of the clitoris, or lowering of the pitch of the voice.

OTHER HEALTH BENEFITS OF BIRTH CONTROL PILLS:

Women who have used birth control pills have been found to have fewer cases of anemia (low red blood cells), ovarian cancer, and uterine cancer. These beneficial effects occur because the birth control pill works by decreasing the number of ovulations, amount of menstrual blood flow, and frequency of periods.

FROM REPRODUCTIVEFACTS.ORG

Menstrual Suppression: Choosing NOT to have your period.

MENSTRUAL SUPPRESSION: CHOOSING NOT TO HAVE YOUR PERIOD

What are combined birth control methods, and how do they work?

Some types of birth control contain 2 hormones (estrogen and progestin) that are like hormones all women have in their bodies naturally. ese types of birth control are called “combined birth control methods.” They come in pills you take by mouth, a ring you wear in your vagina, or a patch you wear on your skin. Combined birth control methods stop you from getting pregnant by keeping your body from ovulating (releasing eggs from your ovaries).

Why do women have monthly bleeding with the combined birth control methods?

Usually, you use a combined birth control method for 21 days. Then the next 7 days you take a pill that has no hormones in it (placebo pill), stop taking pills, or do not use the ring or patch. ese last 7 days of the month are called the hormone-free days. During these hormone-free days, you will have bleeding like a period. This bleeding is not a normal period that is caused by a cycle of hormone changes in the body. This bleeding during the hormone-free days happens because you have stopped the birth control method. It is called withdrawal bleeding because hormones have been withdrawn (stopped).

Do I have to have monthly bleeding while using combined birth control methods?

If you do not want to have bleeding once a month while using combined birth control methods, you can keep using the pills, ring, or patch every day. You do not have to take the placebo pills, stop the pill, or remove the ring or patch for the last 7 days of the month. You can skip the hormone-free days for a few months at a time, or you can skip the hormone-free days all the time. You will not have bleeding like your period (withdrawal bleeding) when you keep using the combined birth control method and skip the hormone-free days.

Why should I have monthly bleeding while using combined birth control methods?

There is no known medical reason why you need to have monthly bleeding while using combined birth control methods. The hormone-free days create monthly bleeding once every 4 weeks that is similar to monthly periods because this may seem more natural to some women.

What are reasons not to have monthly bleeding while I am using combined birth control methods?

Some women have problems such as bad cramps, bloating, and headaches when they have monthly bleeding. These problems will go away or get better if they skip the hormone-free days. Some women have other medical problems that would be helped by not having monthly bleeding such as anemia (low iron) or a blood-clotting disease. Sometimes women want to not have bleeding during a special event like a honeymoon, or because of their work, such as women in the military. And some women want to bleed less often than once a month or even never.

Are there other reasons to not have monthly bleeding?

Bleeding less often is one reason women may avoid the hormone-free days every month. Also, it may be easier to remember to use your birth control method if you do not have hormone-free days because you won’t have to remember to stop and restart your birth control method. The chance of getting pregnant while you are using combined birth control methods is very small, but it may be even smaller if you do not take the hormone-free days.

Gynecology Issues

Abnormal Uterine Bleeding

WHAT IS A NORMAL MENSTRUAL CYCLE?

The normal length of the menstrual cycle is typically between 24 days and 38 days. A normal menstrual period generally lasts up to 8 days.

WHEN IS BLEEDING ABNORMAL?

Bleeding in any of the following situations is considered abnormal uterine bleeding:

  • Bleeding or spotting between periods
  • Bleeding or spotting after sex
  • Heavy bleeding during your period
  • Menstrual cycles that are longer than 38 days or shorter than 24 days
  • “Irregular” periods in which cycle length varies by more than 7–9 days
  • Bleeding after menopause

AT WHAT AGES IS ABNORMAL BLEEDING MORE COMMON?

Abnormal bleeding can occur at any age. However, at certain times in a woman’s life it is common for periods to be somewhat irregular. Periods may not occur regularly when a girl first starts having them (around age 9–14 years). During perimenopause (beginning in the mid–40s), the number of days between periods may change. It also is normal to skip periods or for bleeding to get lighter or heavier during perimenopause.

WHAT CAUSES ABNORMAL BLEEDING?

Some of the causes of abnormal bleeding include the following:

  • Problems with ovulation
  • Fibroids and polyps
  • A condition in which the endometrium grows into the wall of the uterus
  • Bleeding disorders
  • Problems linked to some birth control methods, such as an intrauterine device (IUD) or birth control pills
  • Miscarriage
  • Ectopic pregnancy
  • Certain types of cancer, such as cancer of the uterus

Your obstetrician–gynecologist (ob-gyn) or other health care professional may start by checking for problems most common in your age group. Some of them are not serious and are easy to treat. Others can be more serious. All should be checked.

HOW IS ABNORMAL BLEEDING DIAGNOSED?

Your ob-gyn or other health care professional will ask about your health history and your menstrual cycle. It may be helpful to keep track of your menstrual cycle before your visit. Note the dates, length, and type (light, medium, heavy, or spotting) of your bleeding on a calendar. You also can use a smartphone app designed to track menstrual cycles.

You will have a physical exam. You also may have blood tests. These tests check your blood count and hormone levels and rule out some diseases of the blood. You also may have a pregnancy test and tests for sexually transmitted
infections (STIs)
.

WHAT TESTS MAY BE NEEDED TO DIAGNOSE ABNORMAL BLEEDING?

Based on your symptoms and your age, other tests may be needed. Some of these tests can be done in your ob-gyn’s office. Others may be done at a hospital or surgical center:

  • Ultrasound exam—Sound waves are used to make a picture of the pelvic organs.
  • Hysteroscopy—A thin, lighted scope is inserted through the vagina and the opening of the cervix. It allows your ob-gyn or other health care professional to see the inside of the uterus.
  • Endometrial biopsy—A sample of the endometrium is removed and looked at under a microscope.
  • Sonohysterography—Fluid is placed in the uterus through a thin tube while ultrasound images are made of the inside of the uterus.
  • Magnetic resonance imaging (MRI)—An MRI exam uses a strong magnetic field and sound waves to create images of the internal organs.
  • Computed tomography (CT)—This X-ray procedure shows internal organs and structures in cross section.

WHAT MEDICATIONS ARE USED TO HELP CONTROL ABNORMAL BLEEDING?

Medications often are tried first to treat irregular or heavy menstrual bleeding. The medications that may be used include the following:

  • Hormonal birth control methods—Birth control pills, the skin patch, and the vaginal ring contain hormones. These hormones can lighten menstrual flow. They also help make periods more regular.
  • Gonadotropin-releasing hormone (GnRH) agonists—These drugs can stop the menstrual cycle and reduce the size of fibroids.
  • Tranexamic acid—This medication treats heavy menstrual bleeding.
  • Nonsteroidal anti-inflammatory drugs—These drugs, which include ibuprofen, may help control heavy bleeding and relieve menstrual cramps.
  • Antibiotics—If you have an infection, you may be given an antibiotic.
  • Special medications—If you have a bleeding disorder, your treatment may include medication to help your blood clot.

WHAT TYPES OF SURGERY ARE PERFORMED TO TREAT ABNORMAL BLEEDING?

If medication does not reduce your bleeding, a surgical procedure may be needed. There are different types of surgery depending on your condition, your age, and whether you want to have more children.

Endometrial ablation destroys the lining of the uterus. It stops or reduces the total amount of bleeding. Pregnancy is not likely after ablation, but it can happen. If it does, the risk of serious complications, including life-threatening bleeding, is greatly increased. If you have this procedure, you will need to use birth control until after menopause.

Uterine artery embolization is a procedure used to treat fibroids. This procedure blocks the blood vessels to the uterus, which in turn stops the blood flow that fibroids need to grow. Another treatment, myomectomy, removes the fibroids but not the uterus.

Hysterectomy, the surgical removal of the uterus, is used to treat some conditions or when other treatments have failed. Hysterectomy also is used to treat endometrial cancer. After the uterus is removed, a woman can no longer get pregnant and will no longer have periods.

INFORMATION FROM ACOG

Bacterial Vaginosis

WHAT IS BACTERIAL VAGINOSIS?

Bacterial vaginosis (BV) is a condition that happens when there is too much of certain bacteria in the vagina. This changes the normal balance of bacteria in the vagina.

HOW COMMON IS BACTERIAL VAGINOSIS?

Bacterial vaginosis is the most common vaginal infection in women ages 15-44.

HOW IS BACTERIAL VAGINOSIS SPREAD?

Researchers do not know the cause of BV or how some women get it. We do know that the infection typically occurs in sexually active women. BV is linked to an imbalance of “good” and “harmful” bacteria that are normally found in a woman’s vagina. Having a new sex partner or multiple sex partners, as well as douching, can upset the balance of bacteria in the vagina. This places a woman at increased risk for getting BV.

We also do not know how sex contributes to BV.  There is no research to show that treating a sex partner affects whether or not a woman gets BV. Having BV can increase your chances of getting other STDs.

BV rarely affects women who have never had sex.

You cannot get BV from toilet seats, bedding, or swimming pools.

HOW CAN I AVOID GETTING BACTERIAL VAGINOSIS?

Doctors and scientists do not completely understand how BV spreads. There are no known best ways to prevent it.

The following basic prevention steps may help lower your risk of developing BV:

  • Not having sex;
  • Limiting your number of sex partners; and
  • Not douching.

I’M PREGNANT. HOW DOES BACTERIAL VAGINOSIS AFFECT MY BABY?

Pregnant women can get BV. Pregnant women with BV are more likely to have babies born premature (early) or with low birth weight than pregnant women without BV. Low birth weight means having a baby that weighs less than 5.5 pounds at birth.

Treatment is especially important for pregnant women.

HOW DO I KNOW IF I HAVE BACTERIAL VAGINOSIS?

Many women with BV do not have symptoms. If you do have symptoms, you may notice:

  • A thin white or gray vaginal discharge;
  • Pain, itching, or burning in the vagina;
  • A strong fish-like odor, especially after sex;
  • Burning when urinating;
  • Itching around the outside of the vagina.

HOW WILL MY DOCTOR KNOW IF I HAVE BACTERIAL VAGINOSIS?

A health care provider will examine your vagina for signs of vaginal discharge. Your provider can also perform laboratory tests on a sample of vaginal fluid to determine if BV is present.

CAN BACTERIAL VAGINOSIS BE CURED?

BV will sometimes go away without treatment. But if you have symptoms of BV you should be checked and treated. It is important that you take all of the medicine prescribed to you, even if your symptoms go away. A health care provider can treat BV with antibiotics, but BV may return even after treatment. Treatment may also reduce the risk for some STDs.

Male sex partners of women diagnosed with BV generally do not need to be treated. BV may be transferred between female sex partners.

WHAT HAPPENS IF I DON’T GET TREATED?

BV can cause some serious health risks, including:

  • Increasing your chance of getting HIV if you have sex with someone who is infected with HIV;
  • If you are HIV positive, increasing your chance of passing HIV to your sex partner;
  • Making it more likely that you will deliver your baby too early if you have BV while pregnant;
  • Increasing your chance of getting other STDs, such as chlamydia and gonorrhea. These bacteria can sometimes cause pelvic inflammatory disease (PID), which can make it difficult or impossible for you to have children.
INFORMATION FROM THE CDC

Cervical Cancer Screening (Pap Smear)

WHAT IS CERVICAL CANCER SCREENING?

Cervical cancer screening is used to find changes in the cells of the cervix that could lead to cancer. The cervix is the opening to the uterus and is located at the top of the vagina. Screening includes cervical cytology (also called the Pap testor Pap smear) and, for some women, testing for human papillomavirus (HPV).

HOW DOES CERVICAL CANCER OCCUR?

Cancer occurs when cervical cells become abnormal and, over time, grow out of control. The cancer cells invade deeper into the cervical tissue. In advanced cases, cancer cells can spread to other organs of the body.

WHAT CAUSES CERVICAL CANCER?

Most cases of cervical cancer are caused by infection with HPV. HPV is a virus that enters cells and can cause them to change. Some types of HPV have been linked to cervical cancer as well as cancer of the vulva, vagina, penis, anus, mouth, and throat. Types of HPV that may cause cancer are known as “high-risk types.”

HPV is passed from person to person during sexual activity. It is very common, and most people who are sexually active will get an HPV infection in their lifetime. HPV infection often causes no symptoms. Most HPV infections go away on their own. These short-term infections typically cause only mild (“low-grade”) changes in cervical cells. The cells go back to normal as the HPV infection clears. But in some women, HPV does not go away. If a high-risk type of HPV infection lasts for a long time, it can cause more severe (“high-grade”) changes in cervical cells. High-grade changes are more likely to lead to cancer.

WHY IS CERVICAL CANCER SCREENING IMPORTANT?

It usually takes 3–7 years for high-grade changes in cervical cells to become cancer. Cervical cancer screening may detect these changes before they become cancer. Women with low-grade changes can be tested more frequently to see if their cells go back to normal. Women with high-grade changes can get treatment to have the cells removed.

HOW IS CERVICAL CANCER SCREENING DONE?

Cervical cancer screening includes the Pap test and, for some women, an HPV test. Both tests use cells taken from the cervix. The screening process is simple and fast. You lie on an exam table and a speculum is used to open the vagina. The speculum gives a clear view of the cervix and upper vagina.

Cells are removed from the cervix with a brush or other sampling instrument. The cells usually are put into a special liquid and sent to a laboratory for testing:

  • For a Pap test, the sample is examined to see if abnormal cells are present.
  • For an HPV test, the sample is tested for the presence of 13–14 of the most common high-risk HPV types.

HOW OFTEN SHOULD I HAVE CERVICAL CANCER SCREENING AND WHICH TESTS SHOULD I HAVE?

How often you should have cervical cancer screening and which tests you should have depend on your age and health history:

  • Women aged 21–29 years should have a Pap test alone every 3 years. HPV testing is not recommended.
  • Women aged 30–65 years should have a Pap test and an HPV test (co-testing) every 5 years (preferred). It also is acceptable to have a Pap test alone every 3 years.

WHEN SHOULD I STOP HAVING CERVICAL CANCER SCREENING?

You should stop having cervical cancer screening after age 65 years if

  • you do not have a history of moderate or severe abnormal cervical cells or cervical cancer, and
  • you have had either three negative Pap test results in a row or two negative co-test results in a row within the past
    10 years, with the most recent test performed within the past 5 years.

IF I HAVE HAD A HYSTERECTOMY, DO I STILL NEED CERVICAL CANCER SCREENING?

If you have had a hysterectomy, you still may need screening. The decision is based on whether your cervix was removed, why the hysterectomy was needed, and whether you have a history of moderate or severe cervical cell changes or cervical cancer. Even if your cervix is removed at the time of hysterectomy, cervical cells can still be present at the top of the vagina. If you have a history of cervical cancer or cervical cell changes, you should continue to have screening for 20 years after the time of your surgery.

ARE THERE ANY WOMEN WHO SHOULD NOT FOLLOW ROUTINE CERVICAL CANCER SCREENING GUIDELINES?

Yes. Women who have a history of cervical cancer, are infected with human immunodeficiency virus (HIV), have a weakened immune system, or who were exposed to diethylstilbestrol (DES) before birth may require more frequent screening and should not follow these routine guidelines.

Having an HPV vaccination does not change screening recommendations. Women who have been vaccinated against HPV still need to follow the screening recommendations for their age group.

WHAT DOES IT MEAN IF I HAVE AN ABNORMAL CERVICAL CANCER SCREENING TEST RESULT?

Many women have abnormal cervical cancer screening results. An abnormal result does not mean that you have cancer. Remember that cervical cell changes often go back to normal on their own. And if they do not, it often takes several years for even high-grade changes to become cancer.

If you have an abnormal screening test result, additional testing is needed to find out whether high-grade changes or cancer actually are present. Sometimes, only repeat testing is needed. In other cases, colposcopy and cervical biopsy may be recommended to find out how severe the changes really are. If results of follow-up tests indicate high-grade changes, you may need treatment to remove the abnormal cells. You will need follow-up testing after treatment and will need to get regular cervical cancer screening after the follow-up is complete.

HOW ACCURATE ARE CERVICAL CANCER SCREENING TEST RESULTS?

As with any lab test, cervical cancer screening results are not always accurate. Sometimes, the results show abnormal cells when the cells are normal. This is called a “false-positive” result. Cervical cancer screening also may not detect abnormal cells when they are present. This is called a “false-negative” result. To help prevent false-negative or false-positive results, you should avoid douching, sexual intercourse, and using vaginal medications or hygiene products for 2 days before your test. You also should avoid cervical cancer screening when you have your menstrual period.

INFORMATION FROM ACOG

Chlamydia

Chlamydia is a sexually transmitted infection (STI). Chlamydia is one of the most common STIs in women, especially young women ages 15 to 24. If left untreated, chlamydia can cause serious health prob- lems for women, such as difficulty getting pregnant.

Q: How do you get chlamydia?

A: Chlamydia is spread through:

  • Vaginal, oral, or anal sex. Chlamydia can be spread even if there are no symptoms.
  • Genital touching. A man does not need to ejaculate for chlamydia to spread. Chlamydia can also be passed between women who have sex with women.
  • Childbirth from a mother to her baby

Q: What are the signs and symptoms of chlamydia?

A: Chlamydia is known as a “silent” infection, because most women who have chlamydia do not have signs or symptoms.

Signs and symptoms may include:

  • Bleeding between periods
  • Burning when urinating
  • Fever
  • Low back pain
  • Lower abdominal pain
  • Nausea
  • Pain during sex
  • Unusual vaginal discharge

Q: Do I need to get tested for chlamydia?

A: If you are 24 or younger and have sex, you need to get tested for chlamydia once a year.

If you are older than 24, you need to get tested if, in the past year or since your last test, you:

  • Had a new sex partner
  • Traded sex for money or drugs
  • Did not use condoms during sex and are in a relationship that is not monogamous, meaning you or your partner has sex with other people

Q: What should I do if I have chlamydia?

A: If you have chlamydia:

  • See a doctor or nurse as soon as possible.
  • Antibiotics will treat chlamydia, but they will not fix any permanent damage to your reproductive organs.
  • Take all of your medicine. Even if symptoms go away, you need to finish all of the antibiotics.
  • Tell your sex partner(s) so they can be tested and treated. If they are not tested and treated, you could get chlamydia again.
  • Avoid sexual contact until you and your partner(s) have been treated and cured. Even after you finish your antibiotics, you can get chlamydia again if you have sex with someone who has chlamydia.
  • See your doctor or nurse again if you have symptoms that don’t go away within a few days after finishing the antibiotics.

Q: How can I prevent chlamydia?
A: The best way to prevent chlamydia or any STI is to not have vaginal, oral, or anal sex.

If you do have sex, lower your risk of getting an STI with the following steps:

  • Use condoms. Condoms are the best way to pre- vent STIs when you have sex. Because a man does not need to ejaculate (come) to give or get chlamydia, make sure to put the condom on before the penis touches the vagina, mouth, or anus. Other methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs.
  • Get tested. Be sure you and your partner are tested for STIs. Talk to each other about the test results before you have sex.
  • Be monogamous. Having sex with just one partner can lower your risk for STIs. After being tested for STIs, be faithful to each other. That means that you have sex only with each other and no one else.
  • Limit your number of sex partners. Your risk of getting STIs goes up with the number of partners you have.
  • Do not douche. Douching removes some of the normal bacteria in the vagina that protect you from infection. This may increase your risk of getting STIs.
  • Do not abuse alcohol or drugs. Drinking too much alcohol or using drugs increases risky behavior and may put you at risk of sexual assault and possibly getting an STI.

The steps work best when used together. No single step can protect you from every single type of STI.

INFORMATION FROM THE CDC AND WOMENSHEALTH.GOV

Colposcopy

WHAT IS COLPOSCOPY?

Colposcopy is a way of looking at the cervix through a special magnifying device called a colposcope. It shines a light into the vagina and onto the cervix. A colposcope can greatly enlarge the normal view. This exam allows the health care provider to find problems that cannot be seen by the eye alone.

WHY IS COLPOSCOPY DONE?

Colposcopy is done when results of cervical cancer screening tests show abnormal changes in the cells of the cervix. Colposcopy provides more information about the abnormal cells. Colposcopy also may be used to further assess other problems:

  • Genital warts on the cervix
  • Cervicitis (an inflamed cervix)
  • Benign (not cancer) growths, such as polyps
  • Pain
  • Bleeding

Sometimes colposcopy may need to be done more than once. It also can be used to check the result of a treatment.

HOW IS THE PROCEDURE PERFORMED?

Colposcopy is done in a doctor’s office. You may be referred to another health care provider or to a special clinic to have it done.

The procedure is best done when a woman is not having her menstrual period. This gives the health care provider a better view of the cervix. For at least 24 hours before the test, you should not

  • douche
  • use tampons
  • use vaginal medications
  • have sex

As with a pelvic exam, you will lie on your back with your feet raised and placed on foot rests for support. A speculum will be used to hold apart the vaginal walls so that the inside of the vagina and the cervix can be seen. The colposcope is placed just outside the opening of your vagina.

A mild solution will be applied to your cervix and vagina with a cotton swab or cotton ball. This liquid makes abnormal areas on the cervix easier to see. You may feel a slight burning.

WHEN IS A BIOPSY DONE DURING COLPOSCOPY?

During colposcopy, the health care provider may see abnormal areas. A biopsy of these areas may be done. During a biopsy, a small piece of tissue is removed from the cervix. The sample is removed with a special device.

Cells also may be taken from the canal of the cervix. A special device is used to collect the cells. This is called endocervical curettage (ECC).

WHAT SHOULD I EXPECT DURING RECOVERY?

If you have a colposcopy without a biopsy, you should feel fine right away. You can do the things you normally do. You may have a little spotting for a couple of days.

If you have a colposcopy with a biopsy, you may have pain and discomfort for 1 or 2 days. Over-the-counter pain medications can be helpful. You may have some vaginal bleeding. You also may have a dark discharge for a few days. This may occur from medication used to help stop bleeding at the biopsy site. You may need to wear a sanitary pad until the discharge stops.

Your health care provider may suggest you limit your activity for a brief time. While the cervix heals, you will be told not to put anything into your vagina for a short time:

  • Do not have sex.
  • Do not use tampons.
  • Do not douche.

Call your health care provider right away if you have any of these problems:

  • Heavy vaginal bleeding (using more than one sanitary pad per hour)
  • Severe lower abdominal pain
  • Fever
  • Chills
INFORMATION FROM ACOG

Endometriosis

WHAT IS ENDOMETRIOSIS?

Endometriosis is a condition in which the type of tissue that forms the lining of the uterus (the endometrium) is found outside the uterus.

HOW COMMON IS ENDOMETRIOSIS?

Endometriosis occurs in about one in ten women of reproductive age. It is most often diagnosed in women in their 30s and 40s.

WHERE DOES ENDOMETRIOSIS OCCUR?

Areas of endometrial tissue (often called implants) most often occur in the following places:

  • Peritoneum
  • Ovaries
  • Fallopian tubes
  • Outer surfaces of the uterus, bladder, ureters, intestines, and rectum
  • Cul-de-sac (the space behind the uterus)

HOW DOES ENDOMETRIOSIS CAUSE PROBLEMS?

Endometriosis implants respond to changes in estrogen, a female hormone. The implants may grow and bleed like the uterine lining does during the menstrual cycle. Surrounding tissue can become irritated, inflamed, and swollen. The breakdown and bleeding of this tissue each month also can cause scar tissue, called adhesions, to form. Sometimes adhesions can cause organs to stick together. The bleeding, inflammation, and scarring can cause pain, especially before and during menstruation.

WHAT IS THE LINK BETWEEN INFERTILITY AND ENDOMETRIOSIS?

Almost 40% of women with infertility have endometriosis. Inflammation from endometriosis may damage the sperm or egg or interfere with their movement through the fallopian tubes and uterus. In severe cases of endometriosis, the fallopian tubes may be blocked by adhesions or scar tissue.

WHAT ARE THE SYMPTOMS OF ENDOMETRIOSIS?

The most common symptom of endometriosis is chronic (long-term) pelvic pain, especially just before and during the menstrual period. Pain also may occur during sex. If endometriosis is present on the bowel, pain during bowel movements can occur. If it affects the bladder, pain may be felt during urination. Heavy menstrual bleeding is another symptom of endometriosis. Many women with endometriosis have no symptoms.

HOW IS ENDOMETRIOSIS DIAGNOSED?

A health care provider first may do a physical exam, including a pelvic exam. However, the only way to tell for sure that you have endometriosis is through a surgical procedure called laparoscopy. Sometimes a small amount of tissue is removed during the procedure. This is called a biopsy.

HOW IS ENDOMETRIOSIS TREATED?

Treatment for endometriosis depends on the extent of the disease, your symptoms, and whether you want to have children. Endometriosis may be treated with medication, surgery, or both. When pain is the primary problem, medication usually is tried first.

WHAT MEDICATIONS ARE USED TO TREAT ENDOMETRIOSIS?

Medications that are used to treat endometriosis include pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), and hormonal medications, including birth control pills, progestin-only medications, and gonadotropin-releasing hormone agonists. Hormonal medications help slow the growth of the endometrial tissue and may keep new adhesions from forming. These drugs typically do not get rid of endometriosis tissue that is already there.

HOW CAN SURGERY TREAT ENDOMETRIOSIS?

Surgery can be done to relieve pain and improve fertility. During surgery, endometriosis implants can be removed.

DOES SURGERY CURE ENDOMETRIOSIS?

After surgery, most women have relief from pain. However, about 40–80% of women have pain again within 2 years of surgery. The more severe the disease, the more likely it is to return. Taking birth control pills or other medications after having surgery may help extend the pain-free period.

WHAT IF I STILL HAVE SEVERE PAIN THAT DOES NOT GO AWAY EVEN AFTER I HAVE HAD TREATMENT?

If pain is severe and does not go away after treatment, a hysterectomy may be a “last resort” option. Endometriosis is less likely to come back if your ovaries also are removed. If you keep your ovaries, endometriosis is less likely to come back if endometriosis implants are removed at the same time you have the hysterectomy.

There is a small chance that pain will come back even if your uterus and ovaries are removed. This may be due to endometriosis that was not visible or could not be removed at the time of surgery.

INFORMATION FROM ACOG

Genital Herpes

Genital herpes is a sexually transmitted infection (STI) caused by the herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2). HSV-1 most often causes infections of the mouth and lips, called cold sores or “fever blisters.” HSV-2 is the most common cause of genital herpes. There is no cure for genital herpes. But you can take medicine to prevent outbreaks and to lower your risk of passing genital herpes to your partner.

Q: How do you get genital herpes?

A: Genital herpes is spread through:

  • Vaginal, oral, or anal sex. The herpes virus is usually spread through contact with open sores. But you also can get herpes from someone without any symptoms or sores.
  • Genital touching
  • Childbirth from a mother to her baby
  • Breastfeeding if a baby touches an open sore

Q: What are the signs and symptoms of genital herpes?

A: Most women with genital herpes do not know they have it. But if you get symptoms with the first outbreak of genital herpes, they can be severe.

Within a few days of sexual contact with someone who has the herpes virus, sores (small red bumps that may turn into blisters) may show up where the virus entered your body, such as on your mouth or vagina. After a few days, sores become crusted and then heal without scarring.

Other early signs and symptoms of genital herpes may include:

  • Feeling of pressure in the abdomen
  • Flu-like symptoms, including fever
  • Itching or burning feeling in the genital or anal area
  • Pain in the legs, buttocks, or genital area
  • Swollen glands
  • Unusual vaginal discharge

If you have any signs or symptoms of genital herpes, see a doctor or nurse.

Q: What should I do if I have genital herpes?

A: If you have genital herpes:

  • See a doctor or nurse as soon as possible for testing and treatment. Herpes has no cure. But antiviral medicines can prevent or shorten outbreaks during the time you take the medicine.
  • Take all of the medicine. Even if symptoms go away, you need to finish all of the antiviral medicine.
  • Tell your sex partner(s) so they can be tested and treated if necessary.
  • Avoid any sexual contact while you are being treated for genital herpes or while you have an outbreak.
  • Remember that genital herpes is a lifelong disease. Even though you may not have a genital herpes outbreak for long periods of time, you can still pass the virus to another person at any time.

Q: How can I prevent genital herpes?

A: The best way to prevent genital herpes or any STI is to not have vaginal, oral, or anal sex.

If you do have sex, lower your risk of getting an STI with the following steps:

  • Use condoms. Condoms are the best way to prevent STIs when you have sex. Because a man does not need to ejaculate (come) to give or get some STIs, make sure to put the condom on before the penis touches the vagina, mouth, or anus. Other methods of birth control, such as birth control pills, shots, implants, or diaphragms, will not protect you from STIs.
  • Get tested. Be sure you and your partner are tested for STIs. Talk to each other about the test results before you have sex.
  • Be monogamous. Having sex with just one partner can lower your risk for STIs. After being tested for STIs, be faithful to each other. That means that you have sex only with each other and no one else.
  • Limit your number of sex partners. Your risk of getting STIs goes up with the number of partners you have.
  • Do not douche. Douching removes some of the normal bacteria in the vagina that protect you from infection. This can increase your risk of getting STIs.
  • Do not abuse alcohol or drugs. Drinking too much alcohol or using drugs increases risky behavior and may put you at risk of sexual assault and possible exposure to STIs.

The steps work best when used together. No single step can protect you from every single type of STI.

INFORMATION FROM THE CDC AND WOMENSHEALTH.GOV

Genital Warts

Genital warts are a type of sexually transmitted infection (STI) caused by the human papillomavirus (HPV). You can get genital warts through vaginal, oral, or anal sex. Genital warts appear as a small bump or group of bumps in the genital area. There is no treatment for HPV, but genital warts can be treated by your doctor.

Q: How do you get genital warts?

A: Nearly all cases of genital warts are caused by HPV.

Genital warts are spread most often through direct skin-to- skin contact during vaginal or anal sex. HPV, the virus that causes genital warts, can be spread even if the person does not have any genital warts that you can see.

Rarely, genital warts are spread:

  • By giving oral sex to someone who has HPV or genital warts
  • By receiving oral sex from someone who has HPV or genital warts on his or her mouth, lips, or tongue
  • During childbirth from a woman to her baby

Q: What are the signs and symptoms of genital warts?

A: Genital warts usually appear as a small bump or group of bumps in the genital area. They are esh-colored and can be at or look bumpy like cauliflower. Some genital warts are so small that you cannot see them.

In women, genital warts can grow:

  • Inside the vagina
  • On the vulva, cervix, or groin
  • In or around the anus
  • On the lips, mouth, tongue, or throat (this is very rare)

Genital warts can cause itching, burning, and discomfort. Talk to your doctor if you think you have genital warts.

Q: How are genital warts treated?

A: There is no cure for HPV, but genital warts can be removed. If you decide to have warts removed, do not use over-the-counter medicines meant for other kinds of warts. There are special, prescription-only treatments for genital warts. Your doctor or nurse must prescribe the medicine for you.

Your doctor or nurse may apply a chemical to treat the warts in the doctor’s office or may prescribe a cream for you to apply at home. Surgery is also an option. Your doctor may:

  • Use an electric current to burn off the warts
  • Use a light/laser to destroy warts
  • Freeze off the warts
  • Cut out the warts

Treatment can only remove the genital wart. Treatment does not cure HPV, the virus that causes genital warts.

Q: Do I have to treat genital warts?

A: No. Some people choose not to treat genital warts. If left untreated, genital warts may go away, stay the same, or grow in size and number. They will not turn into cancer.

Q: How can I prevent genital warts?
A: The best way to prevent genital warts or any STI is not to have vaginal, oral, or anal sex.

If you do have sex, lower your risk of getting an STI with the following steps:

  • Get vaccinated. The Food and Drug Administration recently approved one HPV vaccine (Gardasil 9) that protects against HPV types that cause most genital warts.
  • Use condoms. Condoms are the best way to prevent STIs when you have sex. Make sure to put the condom on before the penis touches the vagina, mouth, or anus. HPV, the virus that causes genital warts, can infect areas that are not covered by a condom. You can get genital warts from direct skin-to-skin contact. Other methods of birth control, such as birth control pills, shots, implants, or diaphragms, will not protect you from STIs.
  • Get tested. Be sure you and your partner are tested for STIs. Talk to each other about the test results before you have sex.
  • Be monogamous. Having sex with just one partner can lower your risk for STIs. After getting tested for STIs, be faithful to each other. That means that you have sex only with each other and no one else.
  • Limit your number of sex partners. Your risk of getting STIs goes up with the number of partners you have.
  • Do not douche. Douching removes some of the normal bacteria in the vagina that protects you from infection. This may increase your risk of getting STIs.
  • Do not abuse alcohol or drugs. Drinking too much alcohol or using drugs increases risky behavior and may put you at risk of sexual assault and possible exposure to STIs.

The steps work best when used together. No single step can protect you from every single type of STI.

INFORMATION FROM THE CDC AND WOMENSHEALTH.GOV

Gonorrhea

Gonorrhea is a sexually transmitted infection (STI) caused by the bacteria that grow in warm, moist areas of the body in women, such as the cervix, uterus (womb), and fallopian tubes. Gonorrhea can also infect the urinary tract, mouth, throat, eyes, and anus. It is usually spread by having vaginal, oral, or anal sex. Antibiotics can treat gonorrhea. If left untreated, it can cause serious health problems, including problems getting pregnant.

Q: How do you get gonorrhea?

A: Gonorrhea is spread through:

  • Vaginal, oral, or anal sex. Gonorrhea can be spread even if there are no symptoms. This means you can get gonorrhea from someone who has no signs or symptoms.
  • Genital touching. A man does not need to ejaculate for gonorrhea to spread. Touching infected fluids from the vagina or penis and then touching your eyes can cause an eye infection. Gonorrhea can also be passed between women who have sex with women.
  • Childbirth from woman to her baby

Q: What are the signs and symptoms of gonorrhea?

A: Most women with gonorrhea do not have any signs or symptoms. If you do get symptoms, they are often mild and can be mistaken for a bladder or vaginal infection.

Signs or symptoms of gonorrhea depend on where you are first infected by the gonorrhea bacteria.

Signs and symptoms in the genital area can include:

  • Pain or burning when urinating
  • More vaginal discharge than usual
  • Vaginal discharge that looks different than usual
  • Bleeding between periods
  • Pain in the pelvis or abdomen

Signs and symptoms in other parts of the body include:

  • Rectum/anus: anal itching, pus-like discharge, bright red blood on toilet tissue, or painful bowel movements
  • Eyes: pain, itching, sensitivity to light, pus-like discharge
  • Throat: sore throat, swollen glands in your neck
  • Joints (such as your knee): warmth, redness, swelling, or pain while moving

Q: Do I need to get tested for gonorrhea?

A: If you are 24 or younger and have sex, you need to get tested. Gonorrhea is most common among women between ages 15 and 24. You need to get tested if you have had any symptoms of gonorrhea since your last negative test result or if your sex partner has gonorrhea.

If you are older than 24, you need to get tested if, in the past year or since your last test, you:

  • Had a new sex partner
  • Had your sex partner tell you they have gonorrhea
  • Have had gonorrhea or another STI in the past
  • Have traded sex for money or drugs in the past
  • Do not use condoms during sex and are in a relation- ship that is not monogamous, meaning you or your partner has sex with other people

You also need to get tested if you have any symptoms of gonorrhea.

Q: What should I do if I have gonorrhea?
A: Gonorrhea is easy to treat. But you need to get tested and treated as soon as possible. If you have gonorrhea:

  • See a doctor or nurse as soon as possible. Antibiotics will treat gonorrhea, but they will not fix any permanent damage to your reproductive organs.
  • Take all of the antibiotics. Even if symptoms go away, you need to nish all of the antibiotics.
  • Tell your sex partner(s) so they can be tested and treated. If they are not tested and treated, you could get gonorrhea again.
  • Avoid sexual contact until you and your partner(s) have been treated and cured. Even after you finish your antibiotics, you can get gonorrhea again if you have sex with someone who has gonorrhea.

See your doctor or nurse again if you have symptoms that don’t go away within a few days after finishing the antibiotics.

Q: How can I prevent gonorrhea?
A: The best way to prevent gonorrhea or any STI is not to have vaginal, oral, or anal sex.

If you do have sex, lower your risk of getting an STI with the following steps:

  • Use condoms. Condoms are the best way to prevent STIs when you have sex. Because a man does not need to ejaculate (come) to give or get gonorrhea, make sure to put the condom on before the penis touches the vagina, mouth, or anus. Other methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs.
  • Get tested. Be sure you and your partner are tested for STIs. Talk to each other about your test results before you have sex.
  • Be monogamous. Having sex with just one partner can lower your risk for STIs. After being tested for STIs, be faithful to each other. That means that you have sex only with each other and no one else.
  • Limit your number of sex partners. Your risk of getting STIs goes up with the number of partners you have.
  • Do not douche. Douching removes some of the normal bacteria in the vagina and may increase your risk of getting STIs.
  • Do not abuse alcohol or drugs. Drinking too much alcohol or using drugs increases risky behavior and may put you at risk of sexual assault and possible exposure to STIs.

The steps work best when used together. No single step can protect you from every single type of STI.

INFORMATION FROM THE CDC AND WOMENSHEALTH.GOV

Heavy Menstrual Bleeding

HOW COMMON IS HEAVY MENSTRUAL BLEEDING?

Heavy menstrual bleeding is very common. About one third of women seek treatment for it. Heavy menstrual bleeding is not normal. It can disrupt your life and may be a sign of a more serious health problem. If you are worried that your menstrual bleeding is too heavy, tell your obstetrician–gynecologist (ob-gyn).

WHEN IS MENSTRUAL BLEEDING CONSIDERED “HEAVY”?

Any of the following is considered to be heavy menstrual bleeding:

  • Bleeding that lasts more than 7 days.
  • Bleeding that soaks through one or more tampons or pads every hour for several hours in a row.
  • Needing to wear more than one pad at a time to control menstrual flow.
  • Needing to change pads or tampons during the night.
  • Menstrual flow with blood clots that are as big as a quarter or larger.

HOW CAN HEAVY MENSTRUAL BLEEDING AFFECT MY HEALTH?

Heavy menstrual bleeding may be a sign of an underlying health problem that needs treatment. Blood loss from heavy periods also can lead to a condition called iron-deficiency anemia. Severe anemia can cause shortness of breath and increase the risk of heart problems.

WHAT CAUSES HEAVY MENSTRUAL BLEEDING?

Many things can cause heavy menstrual bleeding. Some of the causes include the following:

  • Fibroids and polyps
  • Adenomyosis
  • Irregular ovulation—If you do not ovulate regularly, areas of the endometrium (the lining of the uterus) can become too thick. This condition is common during puberty and perimenopause. It also can occur in women with certain medical conditions, such as polycystic ovary syndrome and hypothyroidism.
  • Bleeding disorders—When the blood does not clot properly, it can cause heavy bleeding.
  • Medications—Blood thinners and aspirin can cause heavy menstrual bleeding. The copper intrauterine device (IUD)can cause heavier menstrual bleeding, especially during the first year of use.
  • Cancer—Heavy menstrual bleeding can be an early sign of endometrial cancer. Most cases of endometrial cancer are diagnosed in women in their mid 60s who are past menopause. It often is diagnosed at an early stage when treatment is the most effective.
  • Other causes—Endometriosis can cause heavy menstrual bleeding. Other causes include those related to pregnancy, such as ectopic pregnancy and miscarriage. Pelvic inflammatory disease also can cause heavy menstrual bleeding. Sometimes, the cause is not known.

HOW IS HEAVY MENSTRUAL BLEEDING EVALUATED?

When you see your ob-gyn about heavy menstrual bleeding, you may be asked about the following things:

  • Past and present illnesses and surgical procedures
  • Pregnancy history
  • Medications, including those you buy over the counter
  • Your birth control method
  • Your menstrual cycle—If you can, use a calendar or period-tracking smartphone app to keep track of your menstrual cycle before your visit. Your ob-gyn will want to know detailed information about several menstrual cycles, including the dates that your period started, how long bleeding lasted, and the amount of flow (light, medium, heavy, or spotting).

WHAT TESTS AND EXAMS MAY BE USED TO EVALUATE HEAVY MENSTRUAL BLEEDING?

You will have a physical exam, including a pelvic exam. Several laboratory tests may be done. You may have a pregnancy test and tests for some sexually transmitted infections. Based on your symptoms and your age, additional tests may be needed:

  • Ultrasound exam—Sound waves are used to make a picture of the pelvic organs.
  • Hysteroscopy—A thin, lighted scope is inserted into the uterus through the opening of the cervix. It allows your ob-gyn to see the inside of the uterus.
  • Endometrial biopsy—A sample of the endometrium is removed and looked at under a microscope. Sometimes hysteroscopy is used to guide this test. A surgical procedure called dilation and curettage (D&C) is another way this test can be done.
  • Sonohysterography—Fluid is placed in the uterus through a thin tube while ultrasound images are made of the uterus.
  • Magnetic resonance imaging—This imaging test uses powerful magnets to create images of the internal organs.

WHICH MEDICATIONS CAN BE USED TO TREAT HEAVY MENSTRUAL BLEEDING?

Medications often are tried first to treat heavy menstrual bleeding:

  • Heavy bleeding caused by problems with ovulation, endometriosis, polycystic ovary syndrome, and fibroids often can be managed with certain hormonal birth control methods. Depending on the type, these methods can lighten menstrual flow, help make periods more regular, or even stop bleeding completely.
  • Hormone therapy can be helpful for heavy menstrual bleeding that occurs during perimenopause. Before deciding to use hormone therapy, it is important to weigh the benefits and risks (increased risk of heart attack, stroke, and cancer).
  • Gonadotropin-releasing hormone (GnRH) agonists stop the menstrual cycle and reduce the size of fibroids. They are used only for short periods (less than 6 months). Their effect on fibroids is temporary. Once you stop taking the drug, fibroids usually return to their original size.
  • Tranexamic acid is a prescription medication that treats heavy menstrual bleeding. It comes in a tablet and is taken each month at the start of the menstrual period.
  • Nonsteroidal antiinflammatory drugs, such as ibuprofen, also may help control heavy bleeding and relieve menstrual cramps.
  • If you have a bleeding disorder, your treatment may include special medications to help your blood clot.

WHICH PROCEDURES CAN BE USED TO TREAT HEAVY MENSTRUAL BLEEDING?

If medication does not reduce your bleeding, a surgical procedure may be needed:

  • Endometrial ablation destroys the lining of the uterus. It stops or reduces menstrual bleeding. Pregnancy is not likely after ablation, but it can happen. If it does, the risk of serious complications is greatly increased. You will need to use a birth control method until after menopause following endometrial ablation. Sterilization (permanent birth control) may be a good option to prevent pregnancy for women having ablation. Endometrial ablation should be considered only after medication or other therapies have not worked.
  • Uterine artery embolization (UAE) is used to treat fibroids. In UAE, the blood vessels to the uterus are blocked, which stops the blood flow that allows fibroids to grow.
  • Myomectomy is surgery to remove fibroids without removing the uterus.
  • Hysteroscopy can be used to remove fibroids or stop bleeding caused by fibroids in some cases.
  • Hysterectomy is surgical removal of the uterus. Hysterectomy is used to treat fibroids and adenomyosis when other types of treatment have failed or are not an option. It also is used to treat endometrial cancer. After the uterus is removed, a woman can no longer get pregnant and will no longer have periods.
INFORMATION FROM ACOG

Human Papilloma Virus (HPV)

Human papillomavirus, or HPV, is the most common sexually transmitted infection (STI) in the United States. About 80 percent of women will get at least one type of HPV at some point in their lifetime. It is usually spread through vaginal, oral, or anal sex. Many women do not know they have HPV, because it usually has no symptoms and usually goes away on its own. Some types of HPV can cause illnesses such as genital warts or cervical cancer. There is a vaccine to help you prevent HPV.

Q: What is HPV?

A: HPV is the name for a group of viruses that includes more than 100 types. More than 40 types of HPV can be passed through sexual contact. The types that infect the genital area are called genital HPV.

Q: How do you get HPV?

A: HPV is spread through:

  • Vaginal, oral, or anal sex. HPV can be spread even if there are no symptoms. This means you can get HPV from someone who has no signs or symptoms.
  • Genital touching. A man does not need to ejaculate for HPV to spread. HPV can also be passed between women who have sex with women.
  • Childbirth from a woman to her baby

Q: What are the signs and symptoms of HPV?

A: Most people with HPV do not have any symptoms. This is one reason why women need regular Pap tests. Experts recommend that you get your first Pap test at age 21. The Pap test can find changes on the cervix caused by HPV. If you are a woman between ages 30 and 65, your doctor might also do an HPV test with your Pap test every five years. This is a DNA test that detects most types of HPV.

Q: Can HPV be cured?

A: No, HPV has no cure. Most often, HPV goes away on its own. If HPV does not go away on its own, there are treatments for the genital warts and cervical cell changes caused by HPV.

Q: How can I prevent HPV?

A: There are two ways to prevent HPV. One way is to get an HPV vaccine. The other way to prevent HPV or any STI is to not have sexual contact with another person.

If you do have sex, lower your risk of getting an STI with the following steps:

  • Use condoms. Condoms are the best way to prevent STIs when you have sex. Although HPV can also happen in female and male genital areas that are not protected
    by condoms, research shows that condom use is linked
    to lower cervical cancer rates. The HPV vaccine does not replace or decrease the need to wear condoms. Make sure to put the condom on before the penis touches the vagina, mouth, or anus. Also, other methods of birth control, such as birth control pills, shots, implants, or diaphragms, will not protect you from STIs.
  • Get tested. Be sure you and your partner are tested for STIs. Talk to each other about the test results before you have sex.
  • Be monogamous. Having sex with just one partner can lower your risk for STIs. After being tested for STIs, be faithful to each other. That means that you have sex only with each other and no one else.
  • Limit your number of sex partners. Your risk of getting STIs goes up with the number of partners you have.
  • Do not douche. Douching removes some of the normal bacteria in the vagina that protect you from infection. This may increase your risk of getting STIs.
  • Do not abuse alcohol or drugs. Drinking too much alcohol or using drugs increases risky behavior and may put you at risk of sexual assault and possible exposure to STIs.

The steps work best when used together. No single step can protect you from every single type of STI.

Q: What is the HPV vaccine?

A: Three different types of HPV vaccines — Cervarix, Gardasil, and Gardasil 9 — are approved by the Food and Drug Administration to prevent HPV and related diseases. All types of the HPV vaccine are approved for girls and women. The HPV vaccines Gardasil and Gardasil 9 help prevent one type of HPV-related cancer and genital warts in boys and men.

Q: Do I need to get the HPV vaccine?

A: Maybe. The HPV vaccine works best when you get it before you have any type of sexual contact with anyone else.

  • HPV vaccines are approved for girls ages 9 through 26.
  • Girls should get three doses of the HPV vaccine by 11 or 12 years old.
  • Girls and women 13 through 26 years old can get vaccinated if they did not get any or all three doses when they were younger.
  • The HPV vaccine is not recommended for pregnant women.
INFORMATION FROM THE CDC AND WOMENSHEALTH.GOV

Ovarian Cysts

WHAT IS AN OVARIAN CYST?

An ovarian cyst is a sac or pouch filled with fluid or other tissue that forms in or on an ovary. Ovarian cysts are very common. They can occur during the childbearing years or after menopause. Most ovarian cysts are benign (not cancer) and go away on their own without treatment. Rarely, a cyst may be malignant (cancer).

WHAT ARE THE DIFFERENT TYPES OF CYSTS?

Types of cysts include the following:

  • Functional cyst—This is the most common type of ovarian cyst. It usually causes no symptoms. Functional cysts often go away without treatment within 6–8 weeks.
  • Teratoma—This type of cyst contains different kinds of tissues that make up the body, such as skin and hair. These cysts may be present from birth but can grow during a woman’s reproductive years. In very rare cases, some teratomas can become cancer.
  • Cystadenoma—These cysts form on the outer surface of the ovary. They can grow very large but usually are benign.
  • Endometrioma—This cyst forms as a result of endometriosis.

WHAT ARE THE SYMPTOMS OF OVARIAN CYSTS?

In most cases, cysts do not cause symptoms. Many are found during a routine pelvic exam or imaging test done for another reason. Some cysts may cause a dull or sharp ache in the abdomen and pain during certain activities. Larger cysts may cause twisting of the ovary. This twisting usually causes pain on one side that comes and goes or can start suddenly. Cysts that bleed or burst also may cause sudden, severe pain.

HOW ARE OVARIAN CYSTS DIAGNOSED?

If your obstetrician–gynecologist (ob-gyn) or other health care professional thinks that you may have a cyst, the following tests may be recommended to find out more information:

  • Ultrasound exam—This test uses sound waves to create pictures of the internal organs. An instrument called a transducer is placed in the vagina or on the abdomen. The views created by the sound waves show the shape, size, and location of the cyst. The views also show whether the cyst is solid or filled with fluid.
  • Blood tests—You may have a blood test that measures the level of a substance called CA 125. An increased level of
    CA 125, along with certain findings from ultrasound and physical exams, may raise concern for ovarian cancer, especially in a woman who is past menopause. Several other blood tests also can be used to help identify whether a mass on the ovary is concerning for ovarian cancer.

HOW ARE OVARIAN CYSTS TREATED?

There are several treatment options for cysts. Choosing an option depends on the type of cyst and other factors. Treatment options include watchful waiting and, if the cyst is large or causing symptoms, surgery.

WHAT IS WATCHFUL WAITING?

Watchful waiting is a way of monitoring a cyst with repeat ultrasound exams to see if the cyst has changed in size or appearance. Your ob-gyn or other health care professional will decide when to repeat the ultrasound exam and how long this follow-up should last. Many cysts go away on their own after one or two menstrual cycles.

WHEN IS SURGERY RECOMMENDED?

Surgery may be recommended if your cyst is very large or causing symptoms or if cancer is suspected. The type of surgery depends on several factors, including how large the cyst is, your age, your desire to have children, and whether you have a family history of ovarian or breast cancer. A cystectomy is the removal of a cyst from the ovary. In some cases, an ovary may need to be removed. This is called an oophorectomy.

HOW IS SURGERY PERFORMED?

If your cyst is thought to be benign, minimally invasive surgery is recommended. Minimally invasive surgery is done using small incisions and a special instrument called a laparoscope. This type of surgery is called a laparoscopy. Another type of surgery is called open surgery. In open surgery, an incision is made horizontally or vertically in the lower abdomen. Open surgery may be done if cancer is suspected or if the cyst is too large to be removed by laparoscopy.

INFORMATION FROM ACOG

Painful Periods (Dysmenorrhea)

WHAT IS DYSMENORRHEA?

Pain associated with menstruation is called dysmenorrhea.

HOW COMMON IS DYSMENORRHEA?

Dysmenorrhea is the most commonly reported menstrual disorder. More than one half of women who menstruate have some pain for 1–2 days each month.

WHAT ARE THE TYPES OF DYSMENORRHEA?

There are two types of dysmenorrhea: primary dysmenorrhea and secondary dysmenorrhea.

WHAT IS PRIMARY DYSMENORRHEA?

Primary dysmenorrhea is pain that comes from having a menstrual period, or “menstrual cramps.”

WHAT CAUSES PRIMARY DYSMENORRHEA?

Primary dysmenorrhea usually is caused by natural chemicals called prostaglandins. Prostaglandins are made in the lining of the uterus.

WHEN DOES THE PAIN ASSOCIATED WITH PRIMARY DYSMENORRHEA OCCUR DURING THE MENSTRUAL PERIOD?

Pain usually occurs right before menstruation starts, as the level of prostaglandins increases in the lining of the uterus. On the first day of the menstrual period, the levels are high. As menstruation continues and the lining of the uterus is shed, the levels decrease. Pain usually decreases as the levels of prostaglandins decrease.

AT WHAT AGE DOES PRIMARY DYSMENORRHEA START?

Often, primary dysmenorrhea begins soon after a girl starts having menstrual periods. In many women with primary dysmenorrhea, menstruation becomes less painful as they get older. This kind of dysmenorrhea also may improve after giving birth.

WHAT IS SECONDARY DYSMENORRHEA?

Secondary dysmenorrhea is caused by a disorder in the reproductive system. It may begin later in life than primary dysmenorrhea. The pain tends to get worse, rather than better, over time.

WHEN DOES THE PAIN ASSOCIATED WITH SECONDARY DYSMENORRHEA OCCUR DURING THE MENSTRUAL PERIOD?

The pain of secondary dysmenorrhea often lasts longer than normal menstrual cramps. For instance, it may begin a few days before a menstrual period starts. The pain may get worse as the menstrual period continues and may not go away after it ends.

WHAT DISORDERS CAN CAUSE SECONDARY DYSMENORRHEA?

Some of the conditions that can cause secondary dysmenorrhea include the following:

  • Endometriosis—In this condition, tissue from the lining of the uterus is found outside the uterus, such as in the ovaries and fallopian tubes, behind the uterus, and on the bladder (see the FAQ Endometriosis). Like the lining of the uterus, endometriosis tissue breaks down and bleeds in response to changes in hormones. This bleeding can cause pain, especially right around menstruation. Scar tissue called adhesions may form inside the pelvis where the bleeding occurs. Adhesions can cause organs to stick together, resulting in pain.
  • Adenomyosis—Tissue that normally lines the uterus begins to grow in the muscle wall of the uterus.
  • Fibroids—Fibroids are growths that form on the outside, on the inside, or in the walls of the uterus (see the FAQ Uterine Fibroids). Fibroids located in the wall of the uterus can cause pain.

WHAT TESTS ARE DONE TO FIND THE CAUSE OF DYSMENORRHEA?

If you have dysmenorrhea, your health care provider will review your medical history, including your symptoms and menstrual cycles. He or she also will do a pelvic exam.

An ultrasound exam may be done. In some cases, your health care provider will do a laparoscopy. This is a type of surgery that lets your health care provider look inside the pelvic region.

HOW IS DYSMENORRHEA TREATED?

Your health care provider may recommend medications to see if the pain can be relieved. Pain relievers or hormonal medications, such as birth control pills, often are prescribed. Some lifestyle changes also may help, such as exercise, getting enough sleep, and relaxation techniques.

If medications do not relieve pain, treatment will focus on finding and removing the cause of your dysmenorrhea. You may need surgery. In some cases, a mix of treatments works best.

WHAT MEDICATIONS ARE USED TO TREAT DYSMENORRHEA?

Certain pain relievers, called nonsteroidal anti-inflammatory drugs (NSAIDs), target prostaglandins. They reduce the amount of prostaglandins made by the body and lessen their effects. These actions make menstrual cramps less severe.

NSAIDs work best if taken at the first sign of your menstrual period or pain. You usually take them for only 1 or 2 days. Women with bleeding disorders, asthma, aspirin allergy, liver damage, stomach disorders, or ulcers should not take NSAIDs.

WHAT TYPES OF BIRTH CONTROL METHODS HELP CONTROL DYSMENORRHEA?

Birth control methods that contain estrogen and progestin, such as the pill, the patch, and the vaginal ring, can be used to treat dysmenorrhea. Birth control methods that contain progestin only, such as the birth control implant and the injection, also may be effective in reducing dysmenorrhea. The hormonal intrauterine device can be used to treat dysmenorrhea as well.

WHAT TYPES OF MEDICATION CAN BE USED TO TREAT DYSMENORRHEA CAUSED BY ENDOMETRIOSIS?

If your symptoms or a laparoscopy point to endometriosis as the cause of your dysmenorrhea, birth control pills, the birth control implant, the injection, or the hormonal intrauterine device can be tried. Gonadotropin-releasing hormone agonists are another type of medication that may relieve endometriosis pain. These drugs may cause side effects, including bone loss, hot flashes, and vaginal dryness. They usually are given for a limited amount of time. They are not recommended for teenagers except in severe cases when other treatments have not worked.

WHAT ALTERNATIVE TREATMENTS HELP EASE DYSMENORRHEA?

Certain alternative treatments may help ease dysmenorrhea. Vitamin B1 or magnesium supplements may be helpful, but not enough research has been done to recommend them as effective treatments for dysmenorrhea. Acupuncture has been shown to be somewhat helpful in relieving dysmenorrhea.

WHEN IS UTERINE ARTERY EMBOLIZATION (UAE) DONE TO TREAT DYSMENORRHEA?

If fibroids are causing your dysmenorrhea, a treatment called uterine artery embolization (UAE) may help.

WHAT IS DONE DURING UAE?

In this procedure, the blood vessels to the uterus are blocked with small particles, stopping the blood flow that allows fibroids to grow. Some women can have UAE as an outpatient procedure.

WHAT COMPLICATIONS ARE ASSOCIATED WITH UAE?

Complications include infection, pain, and bleeding.

WHEN IS SURGERY DONE TO TREAT DYSMENORRHEA?

If other treatments do not work in relieving dysmenorrhea, surgery may be needed. The type of surgery depends on the cause of your pain.

If fibroids are causing the pain, sometimes they can be removed with surgery. Endometriosis tissue can be removed during surgery. Endometriosis tissue may return after the surgery, but removing it can reduce the pain in the short term. Taking hormonal birth control or other medications after surgery may delay or prevent the return of pain.

Hysterectomy may be done if other treatments have not worked and if the disease causing the dysmenorrhea is severe. This procedure normally is the last resort.

INFORMATION FROM ACOG

Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease (PID) is an infection of a woman’s reproductive organs. Usually PID is caused by bacteria from sexually transmitted infections (STIs). Sometimes PID is caused by normal bacteria found in the vagina. If left untreated, PID can cause problems getting pregnant, problems during pregnancy, and long-term pelvic pain.

Q: Who gets PID?
A: PID affects about 5 percent of women in the United States. Your risk for PID is higher if you:

  • Have had an STI
  • Have had PID before
  • Are younger than 25 and have sex. PID is most common in women 15 to 24 years old.
  • Have more than one sex partner or have a partner who has multiple sexual partners
  • Douche. Douching can push bacteria into the reproductive organs and cause PID. Douching can also hide the signs of PID.
  • Recently had an intrauterine device (IUD) inserted. The risk of PID is higher for the first few weeks only after insertion of an IUD. PID is rare after that time period. Getting tested for STIs before the IUD is inserted lowers your risk for PID.

Q: What are the signs and symptoms of PID?

A: Many women do not know they have PID, because they do not have any signs or symptoms. When symptoms do happen, they can be mild or more serious. Signs and symptoms include:

  • Pain in the lower abdomen (this is the most common symptom)
  • Fever (100.4° F or higher)
  • Vaginal discharge that may smell foul
  • Painful sex
  • Pain when urinating
  • Irregular menstrual periods
  • Pain in the upper right abdomen (this is rare)

If you think that you may have PID, see a doctor or nurse as soon as possible.

Q: How is PID treated?

A: Your doctor or nurse will give you antibiotics to treat PID. Most of the time, at least two antibiotics are used that work against many different types of bacteria. You must take all of your antibiotics, even if your symptoms go away. This helps to make sure the infection is fully cured. See your doctor or nurse again two to three days after starting the antibiotics to make sure they are working.

Q: How can I prevent PID?

A: You may not be able to prevent PID. It is not always caused by an STI. Sometimes, normal bacteria in your vagina can travel up to your reproductive organs and cause PID.

But you can lower your risk of PID by not douching. You can also prevent STIs by not having vaginal, oral, or anal sex.

If you do have sex, lower your risk of getting an STI with the following steps:

  • Use condoms. Condoms are the best way to prevent STIs when you have sex. Because a man does not need to ejaculate to give or get STIs, make sure to put the condom on before the penis touches the vagina, mouth, or anus. Other methods of birth control, such as birth control pills, shots, implants, or diaphragms, will not protect you from STIs.
  • Get tested. Be sure you and your partner are tested for STIs. Talk to each other about the test results before you have sex.
  • Be monogamous. Having sex with just one partner can lower your risk for STIs. After being tested for STIs, be faithful to each other. That means that you have sex only with each other and no one else.
  • Limit your number of sex partners. Your risk of getting STIs goes up with the number of partners you have.
  • Do not douche. Douching removes some of the normal bacteria in the vagina that protect you from infection. Douching may also raise your risk for PID by helping bacteria travel to other areas, like your uterus, ovaries, and fallopian tubes.
  • Do not abuse alcohol or drugs. Drinking too much alcohol or using drugs increases risky behavior and may put you at risk of sexual assault and possible exposure to STIs.

The steps work best when used together. No single step can protect you from every single type of STI.

INFORMATION FROM THE CDC AND WOMENSHEALTH.GOV

Pelvic Organ Prolapse (POP)

WHAT ARE PELVIC SUPPORT PROBLEMS?

The pelvic organs include the vagina, uterus, bladder, urethra, and rectum. These organs are held in place by muscles of the pelvic floor. Layers of connective tissue also give support. Pelvic organ prolapse (POP) occurs when tissue and muscles can no longer support the pelvic organs and they drop down.

WHAT CAUSES PELVIC ORGAN PROLAPSE (POP)?

The main cause of POP is pregnancy and vaginal childbirth, which can weaken muscles of the pelvic floor. Other causes of pelvic support problems include menopause, aging, and repeated heavy lifting. Conditions that create pressure on the abdomen can cause POP, including being overweight or obese; being constipated and straining to have bowel movements; and chronic coughing caused by smoking, asthma, or other medical conditions. POP can occur at any age, but most women who develop symptoms do so after menopause.

WHAT ARE THE SYMPTOMS OF POP?

Symptoms can come on gradually and may not be noticed at first. Many women have no symptoms and do not know they have a prolapse. An obstetrician–gynecologist (ob-gyn) or other health care professional may discover a prolapse during a physical exam.

When POP is mild, sometimes a bulge can be felt inside the vagina. For severe cases of POP, organs may push out of the vaginal opening. Women with symptoms may experience the following:

  • Feeling of pelvic pressure or fullness
  • Organs bulging out of the vagina
  • Leakage of urine (urinary incontinence)
  • Difficulty completely emptying the bladder
  • Problems having a bowel movement
  • Lower back pain
  • Problems with inserting tampons or applicators

WHAT ARE THE TYPES OF POP?

There are several types of prolapse that have different names depending on the part of the body that has dropped:

  • Cystocele—bladder
  • Enterocele—small intestine
  • Rectocele—rectum
  • Uterine prolapse—uterus
  • Vaginal vault prolapse—top of the vagina

HOW IS POP DIAGNOSED?

Proper diagnosis is key to treating pelvic support problems. Your ob-gyn or other health care professional will ask for your medical history and do vaginal and rectal exams. You may be examined while lying down or while standing. You may be asked to strain or cough during the exam to see if you leak urine. You may be checked to see how completely your bladder empties.

IS TREATMENT NEEDED FOR POP?

Many women do not need treatment. At regular checkups your ob-gyn or other health care professional will keep track of the problem. If symptoms become bothersome, treatment may be needed. Treatment decisions are based on the following factors:

  • Age
  • Desire for future children
  • Sexual activity
  • Severity of symptoms
  • Degree of prolapse
  • Other health problems

No form of treatment is guaranteed to solve the problem, but the chances of getting some degree of relief are good. If treatment is recommended, you may be referred to a physician who specializes in treating pelvic support and urinary problems.

HOW CAN I RELIEVE SYMPTOMS MYSELF?

Changes in diet and lifestyle may be helpful in relieving some symptoms. If incontinence is a problem, limiting excessive fluid intake and altering the types of fluid consumed (for example, decreasing alcohol and drinks that contain caffeine), may be helpful. Bladder training (in which you empty your bladder at scheduled times) also may be useful for women with incontinence.

Women with bowel problems may find that increasing the amount of fiber in their diets prevents constipation and straining during bowel movements. Sometimes a medication that softens stools is prescribed. If a woman is overweight or obese, weight loss can help improve her overall health and possibly her prolapse symptoms.

ARE THERE EXERCISES FOR POP?

Pelvic floor exercises, also called Kegel exercises, are used to strengthen the muscles that surround the openings of the urethra, vagina, and rectum. Doing these exercises regularly may improve incontinence and may slow the progression of POP. A health care professional or physical therapist can help you be sure you are doing these exercises correctly. There also are mobile apps to help women understand their pelvic floor exercises and provide daily reminders to exercise.

HOW ARE KEGEL EXERCISES DONE?

  • Squeeze the muscles that you use to stop the flow of urine. This contraction pulls the vagina and rectum up and back.
  • Hold for 3 seconds, then relax for 3 seconds.
  • Do 10 contractions three times a day.
  • Increase your hold by 1 second each week. Work your way up to 10-second holds.

Make sure you are not squeezing your stomach, thigh, or buttock muscles. You also should breathe normally. Do not hold your breath as you do these exercises.

WHAT IS A PESSARY?

A pessary is a device that is inserted into the vagina to support the pelvic organs. Many women find immediate relief from their symptoms with pessary use. Pessaries are available in many shapes and sizes. They can be used for short-term or long-term treatment. Pessary choice is based on a woman’s symptoms and the type of prolapse.

CAN SURGERY CORRECT PELVIC SUPPORT PROBLEMS?

Surgery may be an option for women who have not found relief with nonsurgical treatments. Surgery may relieve some, but not all, symptoms. In general, there are two types of surgery: 1) surgery to repair the pelvic floor and 2) surgery to shorten, narrow, or close off the vagina.

Surgery to repair the pelvic floor helps restore the organs so they are closer to their original position. Surgery that shortens or closes off the vagina creates support for prolapsed organs. Vaginal intercourse is not possible after this procedure. Women who choose this type of surgery usually have other serious health problems and do not desire future intercourse.

CAN POP COME BACK AFTER SURGERY?

There is a risk that the prolapse will come back after surgery. The risk factors for repeated prolapse include being younger than age 60 years, being overweight, and having more advanced forms of prolapse before the first surgery.

INFORMATION FROM ACOG

POP Surgical Procedures

HOW IS PELVIC ORGAN PROLAPSE TREATED?

If you have POP symptoms, and they interfere with your normal activities, you may need treatment. Nonsurgical treatment options usually are tried first. If these options do not work and if your symptoms are severe, you may want to consider surgery.

WHAT ARE THE NONSURGICAL TREATMENTS FOR PELVIC ORGAN PROLAPSE?

Often the first nonsurgical option tried is a pessary. This device is inserted into the vagina to support the pelvic organs.

Changes in diet and lifestyle may help relieve some symptoms. For example, limiting excessive fluid intake may help with urinary incontinence. Eating more fiber may help with bowel problems. Sometimes a medication that softens stools is prescribed. If a woman is overweight or obese, weight loss can help improve her overall health and possibly her prolapse symptoms. For some women, Kegel exercises may be helpful.

WHAT FACTORS SHOULD I CONSIDER WHEN DECIDING WHETHER TO HAVE SURGERY?

A major factor in this decision is the severity of your symptoms. The following factors also should be considered:

  • Your age—If you have surgery at a young age, there is a chance that prolapse will come back and may require more treatment. If you have surgery at an older age, your overall health and history of surgeries may impact what type of surgery you have.
  • Your childbearing plans—Ideally, women who plan to have children (or more children) should postpone surgery until their families are complete to avoid the risk of prolapse happening again after corrective surgery.
  • Health conditions—Surgery may carry risks if you have a medical condition, such as diabetes mellitus, heart disease, or breathing problems, or if you smoke or are obese.

WILL SURGERY RELIEVE ALL OF MY SYMPTOMS?

There is no guarantee that any treatment—including surgery—will relieve all of your symptoms. Also, new problems may occur after surgery, such as pain during sexual intercourse, pelvic pain, or urinary incontinence.

WHAT ARE THE TYPES OF SURGERY FOR PELVIC ORGAN PROLAPSE?

In general, there are two types of surgery: 1) obliterative surgery and 2) reconstructive surgery

HOW DOES OBLITERATIVE SURGERY TREAT PELVIC ORGAN PROLAPSE?

Obliterative surgery narrows or closes off the vagina to provide support for prolapsed organs. Sexual intercourse is not possible after this procedure.

HOW DOES RECONSTRUCTIVE SURGERY TREAT PELVIC ORGAN PROLAPSE?

The goal of reconstructive surgery is to restore organs to their original position. Some types of reconstructive surgery are done through an incision in the vagina. Others are done through an incision in the abdomen or with laparoscopy.

WHAT ARE THE TYPES OF RECONSTRUCTIVE SURGERY?

The types of reconstructive surgery include the following:

  • Fixation or suspension using your own tissues (uterosacral ligament suspension and sacrospinous fixation)—Also called “native tissue repair,” this is used to treat uterine or vaginal vault prolapse. It is performed through the vagina. The prolapsed part is attached with stitches to a ligament or to a muscle in the pelvis. A procedure to prevent urinary incontinence may be done at the same time.
  • Colporrhaphy—Used to treat prolapse of the anterior (front) wall of the vagina and prolapse of the posterior (back) wall of the vagina. This type of surgery is performed through the vagina. Stitches are used to strengthen the vagina so that it once again supports the bladder or the rectum.
  • Sacrocolpopexy—Used to treat vaginal vault prolapse and enterocele. It can be done with an abdominal incision or with laparoscopy. Surgical mesh is attached to the front and back walls of the vagina and then to the sacrum (tail bone). This lifts the vagina back into place.
  • Sacrohysteropexy—Used to treat uterine prolapse when a woman does not want a hysterectomy. Surgical mesh is attached to the cervixand then to the sacrum, lifting the uterus back into place.
  • Surgery using vaginally placed mesh—Used to treat all types of prolapse. Can be used in women whose own tissues are not strong enough for native tissue repair. Vaginally placed mesh has a significant risk of severe complications, including mesh erosion, pain, infection, and bladder or bowel injury. This type of surgery should be reserved for women in whom the benefits may justify the risks.

WHAT IS INVOLVED IN RECOVERY AFTER SURGERY TO TREAT PELVIC ORGAN PROLAPSE?

Recovery time varies depending on the type of surgery. You usually need to take a few weeks off from work. For the first few weeks, you should avoid vigorous exercise, lifting, and straining. You also should avoid sex for several weeks after surgery.

INFORMATION FROM ACOG

Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age. Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs.

The exact cause of PCOS is unknown. Early diagnosis and treatment along with weight loss may reduce the risk of long-term complications such as type 2 diabetes and heart disease.

Symptoms

Signs and symptoms of PCOS often develop around the time of the first menstrual period during puberty. Sometimes PCOS develops later, for example, in response to substantial weight gain.

Signs and symptoms of PCOS vary. A diagnosis of PCOS is made when you experience at least two of these signs:

  • Irregular periods. Infrequent, irregular or prolonged menstrual cycles are the most common sign of PCOS. For example, you might have fewer than nine periods a year, more than 35 days between periods and abnormally heavy periods.
  • Excess androgen. Elevated levels of male hormone may result in physical signs, such as excess facial and body hair (hirsutism), and occasionally severe acne and male-pattern baldness.
  • Polycystic ovaries. Your ovaries might be enlarged and contain follicles that surround the eggs. As a result, the ovaries might fail to function regularly.

PCOS signs and symptoms are typically more severe if you’re obese.

WHEN TO SEE A DOCTOR

See your doctor if you have concerns about your menstrual periods, if you’re experiencing infertility or if you have signs of excess androgen such as worsening hirsutism, acne and male-pattern baldness.

Causes

The exact cause of PCOS isn’t known. Factors that might play a role include:

  • Excess insulin. Insulin is the hormone produced in the pancreas that allows cells to use sugar, your body’s primary energy supply. If your cells become resistant to the action of insulin, then your blood sugar levels can rise and your body might produce more insulin. Excess insulin might increase androgen production, causing difficulty with ovulation.
  • Low-grade inflammation. This term is used to describe white blood cells’ production of substances to fight infection. Research has shown that women with PCOS have a type of low-grade inflammation that stimulates polycystic ovaries to produce androgens, which can lead to heart and blood vessel problems.
  • Heredity. Research suggests that certain genes might be linked to PCOS.
  • Excess androgen. The ovaries produce abnormally high levels of androgen, resulting in hirsutism and acne.

Complications

Complications of PCOS can include:

  • Infertility
  • Gestational diabetes or pregnancy-induced high blood pressure
  • Miscarriage or premature birth
  • Nonalcoholic steatohepatitis — a severe liver inflammation caused by fat accumulation in the liver
  • Metabolic syndrome — a cluster of conditions including high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels that significantly increase your risk of cardiovascular disease
  • Type 2 diabetes or prediabetes
  • Sleep apnea
  • Depression, anxiety and eating disorders
  • Abnormal uterine bleeding
  • Cancer of the uterine lining (endometrial cancer)

Obesity is associated with PCOS and can worsen complications of the disorder.

INFORMATION FROM THE MAYO CLINIC

Pre-Menstrual Syndrome (PMS)

WHAT IS PREMENSTRUAL SYNDROME (PMS)?

Many women feel physical or mood changes during the days before menstruation. When these symptoms happen month after month, and they affect a woman’s normal life, they are known as PMS.

WHAT ARE SOME COMMON SYMPTOMS OF PMS?

Emotional symptoms include the following:

  • Depression
  • Angry outbursts
  • Irritability
  • Crying spells
  • Anxiety
  • Confusion
  • Social withdrawal
  • Poor concentration
  • Insomnia
  • Increased nap taking
  • Changes in sexual desire

Physical symptoms include the following:

  • Thirst and appetite changes (food cravings)
  • Breast tenderness
  • Bloating and weight gain
  • Headache
  • Swelling of the hands or feet
  • Aches and pains
  • Fatigue
  • Skin problems
  • Gastrointestinal symptoms
  • Abdominal pain

HOW IS PMS DIAGNOSED?

To diagnose PMS, a health care provider must confirm a pattern of symptoms. A woman’s symptoms must

  • be present in the 5 days before her period for at least three menstrual cycles in a row
  • end within 4 days after her period starts
  • interfere with some of her normal activities

Keeping a record of your symptoms can help your health care provider decide if you have PMS. Each day for at least 2–3 months, write down and rate any symptoms you feel. Record the dates of your periods as well.

CAN OTHER CONDITIONS MIMIC PMS?

Symptoms of other conditions can mimic PMS or overlap with PMS. Some of these conditions include the following:

  • depression
  • anxiety
  • perimenopause
  • chronic fatigue syndrome
  • irritable bowel syndrome
  • thyroid disease

Depression and anxiety disorders are the most common conditions that overlap with PMS. About one half of women seeking treatment for PMS have one of these disorders. The symptoms of depression and anxiety are much like the emotional symptoms of PMS. Women with depression, however, often have symptoms that are present all month long. These symptoms may worsen before or during their periods. Your health care provider will want to find out whether you have one of these conditions if you are having PMS symptoms.

CAN PMS MAKE OTHER CONDITIONS WORSE?

In addition to depression and anxiety, symptoms of other disorders can get worse right before your period. Examples include seizure disorders, migraines, asthma, and allergies.

WHAT IS PREMENSTRUAL DYSPHORIC DISORDER?

If PMS symptoms are severe and cause problems with work or personal relationships, you may have premenstrual dysphoric disorder (PMDD). PMDD is a severe type of PMS that affects a small percentage of women. Drugs called selective serotonin reuptake inhibitors (SSRIs) can help treat PMDD in some women. These drugs are used to treat depression.

CAN PMS BE TREATED?

If your symptoms are mild to moderate, they often can be relieved by changes in lifestyle or diet. If your PMS symptoms begin to interfere with your life, you may decide to seek medical treatment. Treatment will depend on how severe your symptoms are. In more severe cases, your health care provider may recommend medication.

CAN EXERCISE HELP LESSEN PMS SYMPTOMS?

For many women, regular aerobic exercise lessens PMS symptoms. It may reduce fatigue and depression. Aerobic exercise, which includes brisk walking, running, cycling, and swimming, increases your heart rate and lung function. Exercise regularly, not just during the days that you have symptoms. A good goal is at least 30 minutes of exercise most days of the week.

WHAT RELAXATION METHODS CAN HELP RELIEVE PMS SYMPTOMS?

Finding ways to relax and reduce stress can help women who have PMS. Your health care provider might suggest relaxation therapy to help lessen PMS symptoms. Relaxation therapy may include breathing exercises, meditation, and yoga. Massage therapy is another form of relaxation therapy that you may want to try. Some women find therapies like biofeedback and self-hypnosis to be helpful.

Getting enough sleep is important. Regular sleeping habits—in which you wake up and go to sleep at the same times every day, including weekends—may help lessen moodiness and fatigue.

WHAT DIETARY CHANGES CAN BE MADE TO HELP RELIEVE PMS SYMPTOMS?

Simple changes in your diet may help relieve the symptoms of PMS:

  • Eat a diet rich in complex carbohydrates. A complex carbohydrate-rich diet may reduce mood symptoms and food cravings. Complex carbohydrates are found in foods made with whole grains, like whole wheat bread, pasta, and cereals. Other examples are barley, brown rice, beans, and lentils.
  • Add calcium-rich foods, like yogurt and leafy green vegetables, to your diet.
  • Reduce your intake of fat, salt, and sugar.
  • Avoid caffeine and alcohol.
  • Change your eating schedule. Eat six small meals a day rather than three large ones, or eat slightly less at your three meals and add three light snacks. Keeping your blood sugar level stable will help with symptoms.

CAN DIETARY SUPPLEMENTS HELP WITH PMS SYMPTOM RELIEF?

Taking 1,200 mg of calcium a day can help reduce the physical and mood symptoms that are part of PMS. Taking magnesium supplements may help reduce water retention (“bloating”), breast tenderness, and mood symptoms. One study has shown that vitamin E may help reduce symptoms of PMS.

There are many products that are advertised to help with PMS. Most of these products have either not been tested or have not been proved to be effective. It is important to talk with your health care provider before taking any PMS product or supplement. Taking excess amounts of them or taking them with some medications may be harmful.

WHAT MEDICATIONS REDUCE PMS SYMPTOMS?

Drugs that prevent ovulation, such as hormonal contraceptives, may lessen physical symptoms. However, not all may relieve the mood symptoms of PMS. It may be necessary to try more than one of these medications before finding one that works.

Antidepressants can be helpful in treating PMS in some women. These drugs can help lessen mood symptoms. They can be used 2 weeks before the onset of symptoms or throughout the menstrual cycle. There are many kinds of antidepressants. If one does not work for you, your health care provider may prescribe another.

If anxiety is a major PMS symptom for you, an anti-anxiety drug can be tried if other treatments do not seem to help. These drugs are taken as needed when you have symptoms.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help reduce pain. Talk with your health care provider before taking NSAIDs. Long-term use of NSAIDs may cause stomach bleeding or ulcers.

Diuretics (“water pills”) are drugs that help reduce fluid buildup. Your health care provider can prescribe a diuretic if water retention is a major symptom for you. Tell your health care provider what other drugs you are taking, especially NSAIDs. Using NSAIDs and diuretics at the same time may cause kidney problems.

INFORMATION FROM ACOG

Trichomoniasis

Trichomoniasis is a sexually transmitted infection (STI) caused by a parasite. The parasite is spread most often through vaginal, oral, or anal sex. It is one of the most common STIs in the United States and affects more women than men. It is easily treated with antibiotics, but many women do not have symptoms. If left untreated, trichomoniasis can raise your risk of getting HIV.

Q: How do you get trichomoniasis?

A: Trichomoniasis is spread through:

  • Vaginal, oral, or anal sex. Trichomoniasis can be spread even if there are no symptoms. This means you can get trichomoniasis from someone who has no signs or symptoms.
  • Genital touching. A man does not need to ejaculate for trichomoniasis to spread. Trichomoniasis can also be passed between women who have sex with women.

Q: What are the signs and symptoms of trichomoniasis?

A: Most infected women have no signs or symptoms. If you do get signs or symptoms, they might appear ve to 28 days after exposure and can include:

  • Irritation and itching in the genital area
  • Thin or frothy discharge (clear, white, yellowish, or greenish) with an unusual foul odor
  • Discomfort during sex and when urinating
  • Lower abdominal pain (this is rare)

If you think you may have trichomoniasis, you and your sex partner(s) need to see a doctor or nurse as soon as possible.

Q: What should I do if I have trichomoniasis?

A: Trichomoniasis is easy to treat. But you need to be tested and treated as soon as possible.

If you have trichomoniasis:

  • See a doctor or nurse as soon as possible. Antibiotics will treat trichomoniasis.
  • Take all of your medicine. Even if symptoms go away, you need to finish all of the antibiotics.
  • Tell your sex partner(s) so they can be tested and treated.
  • Avoid sexual contact until you and your partner(s) have been treated and cured. Even after you finish your antibiotics, you can get trichomoniasis again if you have sex with someone who has trichomoniasis.
  • See your doctor or nurse again if you have symptoms that don’t go away within a few days after nishing the antibiotics.
INFORMATION FROM THE CDC AND WOMENSHEALTH.GOV

Urinary Tract Infections (UTIs)

After the cold and flu, Urinary Tract Infections (UTIs) are the most common ailment for women over age 18. About 60% of all women will have a UTI at some point in their lives, and 20% of women get them repeatedly.

The Urinary Tract includes the kidneys, where urine is made; the bladder, where urine is stored; and the urethra, which is the tube that carries urine from the bladder to the outside of your body. The most common place for a UTI is your bladder, and it may also be called a “bladder infection” or “cystitis.” You can also get a UTI in your kidneys, which is called “pyelonephritis.” This is less common and also more serious.

The symptoms of a UTI are hard to ignore and include:

  • Burning or pain when you urinate
  • A feeling of pressure in your bladder
  • A feeling like you have to urinate more often than usual, but when you try, there is little or no urine
  • Your urine is cloudy or has blood in it or smells “off”

If you experience any of the following symptoms, you may have pyelonephritis (kidney infection):

  • lower back pain
  • high fever (101 or greater)
  • nausea or vomiting
  • chills or sweats
  • These symptoms may or may not be accompanied by the symptoms of a lower UTI.

If you have any of the symptoms of a lower or upper UTI, see your doctor right away. Since UTIs are caused by bacteria, you will need to take an antibiotic to kill the bacteria and clear the infection. Take ALL the prescribed medication, even if you feel better, to make sure you completely kill the bacteria and prevent a potentially even more serious relapse. Pregnant women are at an increased risk for UTIs because of the pressure of the uterus on the bladder and urethra. But, don’t worry, there are pregnancy-safe antibiotics.

To reduce your risk of UTI, always wipe front to back after using the toilet. Additionally, you can:

  • drink 6-8 glasses of water every day to help “flush out” your bladder
  • urinate several times each day (about every 2-3 hours). Don’t delay the urge to “go.”
  • urinate after having sex to help flush out any bacteria that may have moved up to your urethra

Urinary Incontinence

Urinary incontinence — the loss of bladder control — is a common and often embarrassing problem. The severity ranges from occasionally leaking urine when you cough or sneeze to having an urge to urinate that’s so sudden and strong you don’t get to a toilet in time.

Though it occurs more often as people get older, urinary incontinence isn’t an inevitable consequence of aging. If urinary incontinence affects your daily activities, don’t hesitate to see your doctor. For most people, simple lifestyle changes or medical treatment can ease discomfort or stop urinary incontinence.

Symptoms

Many people experience occasional, minor leaks of urine. Others may lose small to moderate amounts of urine more frequently.

Types of urinary incontinence include:

  • Stress incontinence. Urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy.
  • Urge incontinence. You have a sudden, intense urge to urinate followed by an involuntary loss of urine. You may need to urinate often, including throughout the night. Urge incontinence may be caused by a minor condition, such as infection, or a more-severe condition such as a neurologic disorder or diabetes.
  • Overflow incontinence. You experience frequent or constant dribbling of urine due to a bladder that doesn’t empty completely.
  • Functional incontinence. A physical or mental impairment keeps you from making it to the toilet in time. For example, if you have severe arthritis, you may not be able to unbutton your pants quickly enough.
  • Mixed incontinence. You experience more than one type of urinary incontinence.

WHEN TO SEE A DOCTOR

You may feel uncomfortable discussing incontinence with your doctor. But if incontinence is frequent or is affecting your quality of life, it’s important to seek medical advice because urinary incontinence may:

  • Indicate a more-serious underlying condition
  • Cause you to restrict your activities and limit your social interactions
  • Increase the risk of falls in older adults as they rush to the toilet

Causes

Urinary incontinence isn’t a disease, it’s a symptom. It can be caused by everyday habits, underlying medical conditions or physical problems. A thorough evaluation by your doctor can help determine what’s behind your incontinence.

TEMPORARY URINARY INCONTINENCE

Certain drinks, foods and medications may act as diuretics — stimulating your bladder and increasing your volume of urine. They include:

  • Alcohol
  • Caffeine
  • Carbonated drinks and sparkling water
  • Artificial sweeteners
  • Chocolate
  • Chili peppers
  • Foods that are high in spice, sugar or acid, especially citrus fruits
  • Heart and blood pressure medications, sedatives, and muscle relaxants
  • Large doses of vitamin C

Urinary incontinence may also be caused by an easily treatable medical condition, such as:

  • Urinary tract infection. Infections can irritate your bladder, causing you to have strong urges to urinate, and sometimes incontinence.
  • Constipation. The rectum is located near the bladder and shares many of the same nerves. Hard, compacted stool in your rectum causes these nerves to be overactive and increase urinary frequency.

PERSISTENT URINARY INCONTINENCE

Urinary incontinence can also be a persistent condition caused by underlying physical problems or changes, including:

  • Pregnancy. Hormonal changes and the increased weight of the fetus can lead to stress incontinence.
  • Childbirth. Vaginal delivery can weaken muscles needed for bladder control and also damage bladder nerves and supportive tissue, leading to a dropped (prolapsed) pelvic floor. With prolapse, the bladder, uterus, rectum or small intestine can get pushed down from the usual position and protrude into the vagina. Such protrusions can be associated with incontinence.
  • Changes with age. Aging of the bladder muscle can decrease the bladder’s capacity to store urine. Also, involuntary bladder contractions become more frequent as you get older.
  • Menopause. After menopause women produce less estrogen, a hormone that helps keep the lining of the bladder and urethra healthy. Deterioration of these tissues can aggravate incontinence.
  • Hysterectomy. In women, the bladder and uterus are supported by many of the same muscles and ligaments. Any surgery that involves a woman’s reproductive system, including removal of the uterus, may damage the supporting pelvic floor muscles, which can lead to incontinence.
  • Obstruction. A tumor anywhere along your urinary tract can block the normal flow of urine, leading to overflow incontinence. Urinary stones — hard, stone-like masses that form in the bladder — sometimes cause urine leakage.
  • Neurological disorders. Multiple sclerosis, Parkinson’s disease, a stroke, a brain tumor or a spinal injury can interfere with nerve signals involved in bladder control, causing urinary incontinence.

Risk factors

Factors that increase your risk of developing urinary incontinence include:

  • Gender. Women are more likely to have stress incontinence. Pregnancy, childbirth, menopause and normal female anatomy account for this difference.
  • Age. As you get older, the muscles in your bladder and urethra lose some of their strength. Changes with age reduce how much your bladder can hold and increase the chances of involuntary urine release.
  • Being overweight. Extra weight increases pressure on your bladder and surrounding muscles, which weakens them and allows urine to leak out when you cough or sneeze.
  • Smoking. Tobacco use may increase your risk of urinary incontinence.
  • Family history. If a close family member has urinary incontinence, especially urge incontinence, your risk of developing the condition is higher.
  • Other diseases. Neurological disease or diabetes may increase your risk of incontinence.

Complications

Complications of chronic urinary incontinence include:

  • Skin problems. Rashes, skin infections and sores can develop from constantly wet skin.
  • Urinary tract infections. Incontinence increases your risk of repeated urinary tract infections.
  • Impacts on your personal life. Urinary incontinence can affect your social, work and personal relationships.

Prevention

Urinary incontinence isn’t always preventable. However, to help decrease your risk:

  • Maintain a healthy weight
  • Practice pelvic floor exercises
  • Avoid bladder irritants, such as caffeine, alcohol and acidic foods
  • Eat more fiber, which can prevent constipation, a cause of urinary incontinence
  • Don’t smoke, or seek help to quit smoking
INFORMATION FROM THE MAYO CLINIC

Uterine Fibroids

WHAT ARE UTERINE FIBROIDS?

Uterine fibroidsFibroids may be attached to the outside of the uterus or be located inside the uterus or uterine wall.

Uterine fibroids are benign (not cancer) growths that develop from the muscle tissue of the uterus. They also are called leiomyomas or myomas. The size, shape, and location of fibroids can vary greatly. They may be present inside the uterus, on its outer surface or within its wall, or attached to it by a stem-like structure. A woman may have only one fibroid or many of varying sizes. A fibroid may remain very small for a long time and suddenly grow rapidly, or grow slowly over a number of years.

WHO IS MOST LIKELY TO HAVE FIBROIDS?

Fibroids are most common in women aged 30–40 years, but they can occur at any age. Fibroids occur more often in African American women than in white women. They also seem to occur at a younger age and grow more quickly in African American women.

WHAT ARE SYMPTOMS OF FIBROIDS?

Fibroids may have the following symptoms:

  • Changes in menstruation

—Longer, more frequent, or heavy menstrual periods

—Menstrual pain (cramps)

—Vaginal bleeding at times other than menstruation

Anemia (from blood loss)

  • Pain

—In the abdomen or lower back (often dull, heavy and aching, but may be sharp)

—During sex

  • Pressure

—Difficulty urinating or frequent urination

—Constipation, rectal pain, or difficult bowel movements

—Abdominal cramps

  • Enlarged uterus and abdomen
  • Miscarriages
  • Infertility

Fibroids also may cause no symptoms at all. Fibroids may be found during a routine pelvic exam or during tests for other problems.

WHAT COMPLICATIONS CAN OCCUR WITH FIBROIDS?

Fibroids that are attached to the uterus by a stem may twist and can cause pain, nausea, or fever. Fibroids that grow rapidly, or those that start breaking down, also may cause pain. Rarely, they can be associated with cancer. A very large fibroid may cause swelling of the abdomen. This swelling can make it hard to do a thorough pelvic exam.

Fibroids also may cause infertility, although other causes are more common. Other factors should be explored before fibroids are considered the cause of a couple’s infertility. When fibroids are thought to be a cause, many women are able to become pregnant after they are treated.

HOW ARE FIBROIDS DIAGNOSED?

The first signs of fibroids may be detected during a routine pelvic exam. A number of tests may show more information about fibroids:

  • Ultrasonography uses sound waves to create a picture of the uterus and other pelvic organs.
  • Hysteroscopy uses a slender device (the hysteroscope) to see the inside of the uterus. It is inserted through the vagina and cervix (opening of the uterus). This permits the doctor to see fibroids inside the uterine cavity.
  • Hysterosalpingography is a special X-ray test. It may detect abnormal changes in the size and shape of the uterus and fallopian tubes.
  • Sonohysterography is a test in which fluid is put into the uterus through the cervix. Ultrasonography is then used to show the inside of the uterus. The fluid provides a clear picture of the uterine lining.
  • Laparoscopy uses a slender device (the laparoscope) to help the doctor see the inside of the abdomen. It is inserted through a small cut just below or through the navel. The doctor can see fibroids on the outside of the uterus with the laparoscope.

Imaging tests, such as magnetic resonance imaging and computed tomography scans, may be used but are rarely needed. Some of these tests may be used to track the growth of fibroids over time.

WHEN IS TREATMENT NECESSARY FOR FIBROIDS?

Fibroids that do not cause symptoms, are small, or occur in a woman who is nearing menopause often do not require treatment. Certain signs and symptoms may signal the need for treatment:

  • Heavy or painful menstrual periods that cause anemia or that disrupt a woman’s normal activities
  • Bleeding between periods
  • Uncertainty whether the growth is a fibroid or another type of tumor, such as an ovarian tumor
  • Rapid increase in growth of the fibroid
  • Infertility
  • Pelvic pain

CAN MEDICATION BE USED TO TREAT FIBROIDS?

Drug therapy is an option for some women with fibroids. Medications may reduce the heavy bleeding and painful periods that fibroids sometimes cause. They may not prevent the growth of fibroids. Surgery often is needed later. Drug treatment for fibroids includes the following options:

  • Birth control pills and other types of hormonal birth control methods—These drugs often are used to control heavy bleeding and painful periods.
  • Gonadotropin-releasing hormone (GnRH) agonists—These drugs stop the menstrual cycle and can shrink fibroids. They sometimes are used before surgery to reduce the risk of bleeding. Because GnRH agonists have many side effects, they are used only for short periods (less than 6 months). After a woman stops taking a GnRH agonist, her fibroids usually return to their previous size.
  • Progestin–releasing intrauterine device—This option is for women with fibroids that do not distort the inside of the uterus. It reduces heavy and painful bleeding but does not treat the fibroids themselves.

WHAT TYPES OF SURGERY MAY BE DONE TO TREAT FIBROIDS?

Myomectomy is the surgical removal of fibroids while leaving the uterus in place. Because a woman keeps her uterus, she may still be able to have children. Fibroids do not regrow after surgery, but new fibroids may develop. If they do, more surgery may be needed.

Hysterectomy is the removal of the uterus. The ovaries may or may not be removed. Hysterectomy is done when other treatments have not worked or are not possible or the fibroids are very large. A woman is no longer able to have children after having a hysterectomy.

ARE THERE OTHER TREATMENTS BESIDES MEDICATION AND SURGERY?

Other treatment options are as follows:

  • Hysteroscopy—This technique is used to remove fibroids that protrude into the cavity of the uterus. A resectoscope is inserted through the hysteroscope. The resectoscope destroys fibroids with electricity or a laser beam. Although it cannot remove fibroids deep in the walls of the uterus, it often can control the bleeding these fibroids cause. Hysteroscopy often can be performed as an outpatient procedure (you do not have to stay overnight in the hospital).
  • Endometrial ablation—This procedure destroys the lining of the uterus. It is used to treat women with small fibroids (less than 3 centimeters). There are several ways to perform endometrial ablation.
  • Uterine artery embolization (UAE)—In this procedure, tiny particles (about the size of grains of sand) are injected into the blood vessels that lead to the uterus. The particles cut off the blood flow to the fibroid and cause it to shrink. UAE can be performed as an outpatient procedure in most cases.
  • Magnetic resonance imaging-guided ultrasound surgery—In this new approach, ultrasound waves are used to destroy fibroids. The waves are directed at the fibroids through the skin with the help of magnetic resonance imaging. Studies show that women have improved symptoms up to 1 year after having the procedure. Whether this approach provides long-term relief is currently being studied.
INFORMATION FROM ACOG

Vaginitis

WHAT IS VAGINITIS?

Vaginitis is an inflammation of the vagina. As many as one third of women will have symptoms of vaginitis sometime during their lives. Vaginitis affects women of all ages but is most common during the reproductive years.

WHAT CAN CAUSE VAGINITIS?

A change in the balance of the yeast and bacteria that normally live in the vagina can result in vaginitis. This causes the lining of the vagina to become inflamed. Factors that can change the normal balance of the vagina include the following:

  • Use of antibiotics
  • Changes in hormone levels due to pregnancy, breastfeeding, or menopause
  • Douching
  • Spermicides
  • Sexual intercourse
  • Infection

HOW IS VAGINITIS DIAGNOSED?

To diagnose vaginitis, your health care professional will take a sample of the discharge from your vagina and look at it under a microscope. Your health care professional also may suggest other tests.

HOW IS VAGINITIS TREATED?

Treatment will depend on the cause of the vaginitis. Treatment may be either with a pill or a cream or gel that is applied to the vagina.

WHAT IS A YEAST INFECTION?

Yeast infection also is known as candidiasis. It is one of the most common types of vaginal infection.

WHAT CAUSES YEAST INFECTIONS?

A yeast infection is caused by a fungus called Candida. It is found in small numbers in the normal vagina. However, when the balance of bacteria and yeast in the vagina is altered, the yeast may overgrow and cause symptoms.

WHAT FACTORS INCREASE THE RISK OF GETTING A YEAST INFECTION?

Use of some types of antibiotics increase your risk of a yeast infection. The antibiotics kill normal vaginal bacteria, which keep yeast in check. The yeast can then overgrow. A woman is more likely to get yeast infections if she is pregnant or has diabetes. Overgrowth of yeast also can occur if the body’s immune system, which protects the body from disease, is not working well.

WHAT ARE THE SYMPTOMS OF A YEAST INFECTION?

The most common symptoms of a yeast infection are itching and burning of the area outside the vagina called the vulva. The vulva may be red and swollen. The vaginal discharge usually is white, lumpy, and has no odor. Some women with yeast infections notice an increase or change in discharge.

WHAT TREATMENTS ARE AVAILABLE FOR VAGINAL YEAST INFECTION?

Yeast infections can be treated either by placing medication into the vagina or by taking a pill.

SHOULD I USE AN OVER-THE-COUNTER MEDICATION TO TREAT A YEAST INFECTION?

Over-the-counter treatments are safe and often effective in treating yeast infections. But many women think that they have a yeast infection when they actually have another problem. In these cases, a medication for a yeast infection will not work and may cause a delay in proper diagnosis and treatment of the actual problem.

Even if you have had a yeast infection before, it may be a good idea to call your health care professional before using an over-the-counter medication to treat your symptoms. If this is the first time you have had vaginal symptoms, you should see your health care professional. If you have used an over-the-counter medication and your symptoms do not go away, see your health care professional.

WHAT IS BACTERIAL VAGINOSIS?

Bacterial vaginosis is caused by overgrowth of the bacteria that occur natually in the vagina.

WHAT ARE THE SYMPTOMS OF BACTERIAL VAGINOSIS?

The main symptom is increased discharge with a strong fishy odor. The discharge usually is thin and dark or dull gray, but may have a greenish color. Itching is not common, but may be present if there is a lot of discharge.

HOW IS BACTERIAL VAGINOSIS TREATED?

Several different antibiotics can be used to treat bacterial vaginosis. They can be taken by mouth or inserted into the vagina as a cream or gel.

WHAT IS TRICHOMONIASIS?

Trichomoniasis is a condition caused by the microscopic parasite Trichomonas vaginalis. It is spread through sex. Women who have trichomoniasis are at an increased risk of infection with other sexually transmitted infections (STIs).

WHAT ARE THE SYMPTOMS OF TRICHOMONIASIS?

Signs of trichomoniasis may include a yellow-gray or green vaginal discharge. The discharge may have a fishy odor. There may be burning, irritation, redness, and swelling of the vulva. Sometimes there is pain during urination.

HOW IS TRICHOMONIASIS TREATED?

Trichomoniasis usually is treated with a single dose of an antibiotic by mouth. Sexual partners must be treated to prevent the infection from recurring.

WHAT IS ATROPHIC VAGINITIS?

Atrophic vaginitis is not caused by an infection but can cause vaginal discharge and irritation, such as dryness, itching, and burning. This condition may occur any time when female hormone levels are low, such as during breastfeeding and after menopause. Atrophic vaginitis is treated with estrogen, which can be applied as a vaginal cream, ring, or tablet. A water-soluble lubricant also may be helpful during intercourse.

INFORMATION FROM ACOG

Vulvar Issues: Common Causes

WHAT IS THE VULVA?

The external female genital area is called the vulva. The outer folds of skin are called the labia majora and the inner folds are called the labia minora.

WHEN SHOULD I CONTACT MY HEALTH CARE PROVIDER ABOUT VULVAR SYMPTOMS?

If you see changes on the skin of the vulva, or if you have itching, burning, or pain, contact your health care provider.

WHAT WILL MY HEALTH CARE PROVIDER CHECK?

Your health care provider may examine you, ask you questions about the pain and your daily routine, and take samples of vaginal discharge for testing. In some cases, a biopsy is needed to confirm diagnosis of a disease.

WHAT ARE SOME SKIN DISORDERS THAT CAN AFFECT THE VULVA?

Some of the skin disorders that affect the vulva include folliculitis, contact dermatitis, Bartholin gland cysts, lichen simplex chronicus, lichen sclerosus, and lichen planus.

WHAT IS FOLLICULITIS?

Folliculitis appears as small, red, and sometimes painful bumps caused by bacteria that infect a hair follicle. It can occur on the labia majora. This can happen because of shaving, waxing, or even friction. Folliculitis often goes away by itself. Attention to hygiene, wearing loose clothing, and warm compresses applied to the area can help speed up the healing process. If the bumps do not go away or they get bigger, see your health care provider. You may need additional treatment.

WHAT IS CONTACT DERMATITIS?

Contact dermatitis is caused by irritation of the skin by things such as soaps, fabrics, or perfumes. Signs and symptoms can include extreme itching, rawness, stinging, burning, and pain. Treatment involves avoidance of the source of irritation and stopping the itching so that the skin can heal. Ice packs or cold compresses can reduce irritation. A thin layer of plain petroleum jelly can be applied to protect the skin. Medication may be needed for severe cases.

WHAT IS A BARTHOLIN GLAND CYST?

The Bartholin glands are located under the skin on either side of the opening of the vagina. They release a fluid that helps with lubrication during sexual intercourse. If the Bartholin glands become blocked, a cyst can form, causing a swollen bump near the opening of the vagina. Bartholin gland cysts usually are not painful unless they become infected. If this occurs, an abscess can form.

If your cyst is not causing pain, it can be treated at home by sitting in a warm, shallow bath or by applying a warm compress. If an abscess has formed, treatment involves draining the cyst using a needle or other instrument in a health care provider’s office.

WHAT IS LICHEN SIMPLEX CHRONICUS?

Lichen simplex chronicus may be a result of contact dermatitis or other skin disorder that has been present for a long time. Thickened, scaly areas called “plaques” appear on the vulvar skin. These plaques cause intense itching that may interfere with sleep. Treatment involves stopping the “itch-scratch” cycle so that the skin can heal. Steroid creams often are used for this purpose. The underlying condition should be treated as well.

WHAT IS LICHEN SCLEROSUS?

Lichen sclerosus is a skin disorder that can cause itching, burning, pain during sex, and tears in the skin. The vulvar skin may appear thin, white, and crinkled. White bumps may be present with dark purple coloring. A steroid cream is used to treat lichen sclerosus.

WHAT IS LICHEN PLANUS?

Lichen planus is a skin disorder that most commonly occurs on the mucous membranes of the mouth. Occasionally, it also affects the skin of the genitals. Itching, soreness, burning, and abnormal discharge may occur. The appearance of lichen planus is varied. There may be white streaks on the vulvar skin, or the entire surface may be white. There may be bumps that are dark pink in color.

Treatment of lichen planus may include medicated creams or ointments, vaginal tablets, prescription pills, or injections. This condition is difficult to treat and usually involves long-term treatment and follow-up.

WHAT IS VULVODYNIA?

Vulvodynia means “vulvar pain.” The pain can occur when the area is touched or it can occur without touch. There are two types of vulvodynia: generalized and localized (see FAQ127 “Vulvodynia”). With generalized vulvodynia, the pain occurs over a large area of the vulva. With localized vulvodynia, the pain is felt on a smaller area, such as the vestibule.

WHAT ARE THE SIGNS AND SYMPTOMS OF VULVODYNIA?

Vulvodynia usually is described as burning, stinging, irritation, or rawness. The skin of the vulva usually looks normal.

HOW IS VULVODYNIA TREATED?

A variety of methods are used to treat vulvodynia, including self-care measures, medications, dietary changes, biofeedback training, physical therapy, sexual counseling, or surgery.

WHAT IS GENITOURINARY SYNDROME OF MENOPAUSE?

Genitourinary syndrome of menopause is a group of signs and symptoms caused by the decreased estrogen levels that occur in perimenopause and menopause.

WHAT ARE THE SIGNS AND SYMPTOMS OF GENITOURINARY SYNDROME OF MENOPAUSE?

Signs and symptoms include soreness, irritation, and dryness. Pain may occur during sexual intercourse. The vulva becomes more sensitive to irritants. Infections may occur more easily. In severe cases, vulvar skin may crack and bleed.

HOW IS GENITOURINARY SYNDROME OF MENOPAUSE TREATED?

This condition is treated with medications containing estrogen that are applied to the skin or inserted into the vagina.

WHAT IS VULVAR INTRAEPITHELIAL NEOPLASIA (VIN)?

Vulvar intraepithelial neoplasia (VIN) is the presence of abnormal vulvar cells that are not yet cancer. VIN often is caused by human papillomavirus (HPV) infection.

WHAT ARE THE SIGNS AND SYMPTOMS OF VIN?

Signs and symptoms include itching, burning, or abnormal skin that may be bumpy, smooth, or a different color like white, brown, or red. VIN should be treated to prevent the development of cancer.

HOW IS VIN TREATED?

VIN can be treated with a cream that is applied to the skin, laser treatment, or surgery. The HPV vaccine that protects against four types of HPV and the HPV vaccine that protects against nine types of HPV can help prevent VIN caused by these HPV types.

WHAT IS CANCER?

Cancer is the growth of abnormal cells.

WHAT CAUSES VULVAR CANCER?

Vulvar cancer can be caused by infection with HPV. Other forms of cancer that can affect the vulva include melanoma (skin cancer) or Paget disease. Paget disease of the vulva may be a sign of cancer in another area of the body, such as the breast or colon.

WHAT ARE THE SIGNS AND SYMPTOMS OF VULVAR CANCER?

Signs and symptoms may include itching, burning, inflammation, or pain. Other symptoms of cancer include a lump or sore on the vulva, changes in the skin color, or a bump in the groin.

HOW IS CANCER TREATED?

The type of treatment depends on the stage of cancer. Surgery often is needed to remove all cancerous tissue. Radiation therapy and chemotherapy also may be needed in addition to surgery.

WHAT OTHER DISORDERS CAN AFFECT THE VULVA?

There are a number of disorders that may affect the vulva. Infections (such as yeast infection) and sexually transmitted infections, such as genital herpes, can cause vulvar signs and symptoms (see FAQ009 “How to Prevent Sexually Transmitted Infections” and FAQ054 “Genital Herpes”). Crohn disease is a long-term disease of the digestive system. It can cause inflammation, swelling, sores, or bumps on the vulva.

WHAT SELF-CARE MEASURES CAN HELP PREVENT OR CLEAR UP VULVAR PROBLEMS?

The following self-care measures may help prevent or clear up certain vulvar problems:

  • Keep your vulva clean by rinsing with warm water and gently patting, not rubbing, it dry.
  • Do not wear tight-fitting pants or underwear. Wear only cotton underwear.
  • Do not wear pantyhose (unless they have a cotton crotch).
  • Do not use pads or tampons that contain a deodorant or a plastic coating.
  • Do not use perfumed soap or scented toilet paper.
  • Do not douche or use feminine sprays or talcum powders.
INFORMATION FROM ACOG