Young and On Your Way

Reproductive Development

Breast Health

Women’s breasts come in many shapes and sizes. There is no perfect shape or size for breasts. Normal breasts can be large or small, smooth or lumpy, and light or dark.

Your breasts start growing when you begin puberty. During puberty the hormone levels in your body change, which causes your breasts to develop and your periods to start. Many factors affect when you are going to begin puberty and develop breasts, including heredity (the way certain characteristics are passed down from generation to generation), weight, exercise, nutrition, stress, and chronic illnesses.


The inside of your breasts is made up of fatty tissue and milk-producing glands, called mammary glands. The dark area of your breast around your nipple is called the areola. As your body starts to develop, a small lump grows under the areola and nipple. This lump is called the breast bud. As the buds get larger and rounder, the breasts grow.

As your breasts develop, the areolae get bigger and darker. Areolae and nipples can range in color from light pink to purplish to light gray depending on your skin color.


Your breasts start growing when you begin puberty and the hormone levels in your body change, causing your breasts to develop and your menstrual periods to start. Heredity (the way certain features are passed down from generation to generation), nutrition, weight, exercise, and chronic illness determine when you are going to begin puberty and develop breasts. Most girls’ breasts begin growing when they are about 9 or 10 years old, but some girls may start developing breasts earlier or later than this age.


It takes different people different amounts of time to develop breasts, usually between 3 and 5 years. The age when you start to develop does not have an effect on the final size of your breasts. For example, if you develop earlier than most girls, this doesn’t mean that you will have bigger breasts than most girls.


No. It’s normal for some girls to start to develop breasts when they’re 8 or 9 years old, while others don’t start until they’re 11 or 12. Every girl has her own “clock” that her body follows. For example, girls who do gymnastics, dance, track, or another very active sport may go through puberty at a later age. Even if your development is normal, it can be hard if you seem to be either the first or the last one among your classmates or friends to develop breasts. Talk to a parent or an adult that you trust and tell him/her how you are feeling. If you develop early, remember that other girls will soon catch up.


Heredity is the most important factor in determining breast shape and size. No creams, special exercises, or clothing will permanently change your breast size. Your breasts may change with weight loss or gain or after a pregnancy, but for the most part, the size of your breasts stays the same once you’ve finished puberty. Also, breast size has no effect on whether a woman will be able to breastfeed her baby.


Inside a woman’s breasts are tiny pockets called alveoli. After a woman gives birth, her brain’s hormones tell the alveoli to produce milk. When her baby sucks on her nipple, the sucking draws milk from the alveoli through the milk ducts and out small holes in the nipple. When the mother stops breast-feeding her baby, her alveoli slowly stop making milk.



It’s very common for your breasts to grow at different rates while they’re developing. Usually, they’ll look about the same size by the time they’re done growing. If you have a size difference and it bothers you, try a foam or gel insert that fits into your bra or bathing suit. These inserts are sold at specialty bra and lingerie shops and in department stores.

Most women have breasts that are not exactly the same size. However, sometimes breasts can be noticeably uneven (different by more than a cup size) after you have started your periods and your breast development has finished (3-5 years from when they started developing). If you are unhappy about the difference in your breasts’ sizes, you can talk with your primary care provider about using gel inserts and about the benefits and risks of corrective surgery.


Some girls feel that their breasts are too large. Often, they’re not worried about how they look, but they’re bothered by breast pain, back pain, shoulder pain, dents in the shoulders from bra straps, rashes, skin problems under the breasts, or difficulties with exercising. Girls can also feel badly or self-conscious if they are teased about their large breasts.

If your breasts are very large, there are some options that can help.

  • First, find a well-fitting bra to minimize and support your breasts. Look for a bra that has wide shoulder straps and supportive cups. If you need help with measuring for a bra, see a trained salesperson working at a department store or a lingerie store for help.
  • If you are overweight, working to reach a healthy weight may also help.
  • The last option is to have breast reduction surgery. This type of surgery, which is done by a plastic surgeon, removes some of the extra breast tissue to decrease pain. It’s a serious decision and operation. Talk to your primary care provider to get more information.


Some girls have hair around their nipples. This is completely normal. If the hair bothers you, it’s best to cut it with small scissors. Plucking or shaving the hair can cause infection.


If your nipples point inward instead of out, you have “inverted nipples.” Between 10%-20% of all girls have an inverted nipple on at least one breast. This is normal and will not affect your health in any way. If you have inverted nipples, it’s important to keep them clean to avoid getting an infection in the folds of skin around your nipple.


Stretch marks are red or purplish spoke-like lines that appear on the skin during times of rapid physical growth (such as puberty or pregnancy). During puberty, stretch marks on the breasts are very common and completely normal. Other common places for stretch marks are on the hips and thighs. Over time, the stretch marks will fade to match your normal skin color.


Usually, yes. A rash can be a sign of an infection, especially if one breast is swollen and tender, if there’s discharge, or if you have a fever. You can also get a rash on the skin under your breasts, which is usually either a heat rash or a yeast infection. If any of these signs of infection are present, call your primary care provider. Sometimes a hair root around your nipple area can become infected. When this happens, one or more tiny red bumps appear. The tiny red bumps are called folliculitis.


You may feel a tingling or aching in your chest when your breast buds start developing. After you start to get your periods you may notice that your breasts become tender or sore a few days before you get your period each month. Not everyone has soreness. If your breasts are tender, check with your primary care provider. Your HCP may suggest taking over-the-counter pain medicine (such as ibuprofen) to help with the symptoms. Older teens who are bothered by breast pain before periods may benefit from taking low dose oral contraceptive pills. Some, but not all, individuals have found relief after quitting caffeine.


Discharge from your breast(s) could mean that your breast(s) are infected, that a breast duct is dilated (widened), or that you have a hormone imbalance. The discharge may be on just one side or from both breasts. When a milky discharge comes from a young woman’s breast when she is not breast feeding, it’s called galactorrhea. This condition can result from taking certain medications such as birth control pills or medicine for mood disorders, from being pregnant or recently being pregnant, from low thyroid hormone levels, or rarely from a benign (not cancerous) pituitary tumor. Your body may be making extra amounts of prolactin, which can cause galactorrhea. A brown or bloody discharge may come from dilated breast ducts or small polyps in the breast ducts or glands beneath the areola (Montgomery glands). There may also be a blue area under the nipple. A small amount of yellow discharge sometimes occurs around the time a girl starts her period. You should call your primary care provider if you have breast discharge and/or local breast tenderness, pain, redness, or fever.


These bumps are normal. The medical term for them is “periareolar glands of Montgomery.” They play a role during lactation (during the time when a woman’s body makes breast milk). If these glands become inflamed, red, and/or you notice drainage of clear to brownish fluid, you should make an appointment with your health care provider.


Body Image and Media


Images of what the media believes are “ideal” women are everywhere—on TV, in movies, online, in magazines, in ads, and in video games. You may begin to believe that these images show what is normal. But the weights and body types of women you see in the media are not normal. Only about 5% of American women have the genetics to make it possible to look like these images. For most people, trying to look like these images can be unhealthy. It can cause depression, eating disorders, and low self-esteem.

It’s hard not to compare how you look with these images. You may not like what you see in the mirror and look for ways to “fix” yourself. Diets, makeup, and clothes are sold to make women look more like the images they see in the media. Ads for these products may be designed to make you feel insecure. This is just a way to sell more products. It’s not the truth of how a woman should look. Understanding how the media works is an important step in not letting these images control how you feel about yourself.


Most of the actresses on TV playing teenagers are in their 20s. By hiring older actors, studios don’t have to worry about shorter working hours and on-set schooling for minors. The actresses you see playing girls your age on TV are older than you in real life. Very few of them look like real teenagers.


Sometimes friends and parents think they are helping when they make certain comments, but they aren’t. Often these comments can do more harm than good. You may need to change some things in your life to be healthy, but you don’t need to listen to everyone’s opinion about your body. Try responding to negative comments with these statements:

  • “It hurts my feelings when you make comments about my food/weight/body.”
  • “I know you mean well, but I’d appreciate it if you would keep those thoughts to yourself.”
  • “How nice. Thanks for sharing that.”
  • “How would you feel if I said something like that to you? Your comments about my food/weight/body are not helpful.”


You may have an unhealthy body image if you

  • view yourself only in terms of how you look
  • compare how you look with people on TV or in magazines
  • use negative words to describe your body
  • get depressed or sad about how you look
  • constantly think about ways to improve your body or looks


Body mass index (BMI) is a number calculated from height and weight that is used to determine whether a person is underweight, normal weight, overweight, or obese. When your BMI falls into the normal range, you are at a healthy body weight:

  • BMI <18.5 is underweight.
  • BMI 18.5–24.9 is normal weight.
  • BMI 25.0–29.9 is overweight.
  • BMI 30.0 and higher is obese.

To find out your BMI, use the online calculator at


Most teenagers should exercise for a total of 60 minutes on most days of the week. The activities you choose should be of moderate or vigorous intensity. Examples of moderate-intensity activities include brisk walking, dancing, bicycle riding, or hiking. Examples of vigorous-intensity activities include running, swimming, jumping rope, or soccer.

Exercise is good for your mind and your body. Staying active relieves stress, helps you sleep better, and can help ease depression and anxiety.


Many teenage girls who think they should go on a diet actually are a normal, healthy weight. But if your BMI is not in the healthy range, you may need to lose weight. To lose weight, you need to use up more calories than you take in. You can do this through regular physical activity combined with a program of healthy eating. You may have heard that you can lose weight more quickly with a “crash” diet, but these diets are not meant to be permanent. You are more likely to gain back the weight you lose if you go on a crash diet than if you make long-term lifestyle changes. Talk to your doctor about the best way to change your eating habits. The U.S. Department of Agriculture’s web site “MyPlate” ( also can help you plan a balanced diet.


Teenagers who diet on their own may develop bad habits called disordered eating. These habits include

  • fasting
  • skipping meals
  • extreme dieting
  • binge eating
  • making yourself vomit
  • using diuretics, laxatives, or stimulants

Disordered eating occurs on a spectrum. When disordered eating becomes severe, it may be called an eating disorder.


An eating disorder is a medical illness. If not treated, it can be life-threatening. People with eating disorders can be any weight. For example, it is possible to be a normal weight and still have an eating disorder.

People with eating disorders are very critical of their bodies. Some eating disorders include the following:

  • Anorexia nervosa—A distorted body image leads a person to diet too much and sometimes exercise too much. People with anorexia usually are very underweight.
  • Bulimia—A person who wants to lose weight or is afraid of gaining weight who binges on food, then forces vomiting or abuses laxatives. He or she also may exercise too much. People with bulimia usually are normal weight or slightly overweight.
  • Binge eating—A person binges on food but does not vomit. People who binge eat usually are overweight or obese.


During puberty, your body changes. You grow taller and your hips get wider. You may get acne or pimples. Your breasts and vulva change as well. These changes may cause you to wonder if your body looks “normal.” You may compare yourself with images you see online. You may even think about getting surgery to change parts of your body that you are not happy with. But it is important to remember that there is a wide range of normal when it comes to your body’s appearance. Things like breast and labia size vary from woman to woman. All of these differences are normal. If you are worried about these changes in your body, talk to your doctor.


The following may help you build confidence and maintain a healthy body image:

  • Be aware of how the media affects the way you think about yourself. Understanding that the media’s standard of beauty is unrealistic will help you stop comparing yourself with something that is not real.
  • Pay attention to how much media you consume every day. Take breaks from it.
  • Understand that there is a wide range of normal body types.
  • Eat a healthy diet and exercise regularly. Treating your body well will make you feel stronger and happier.
  • Focus on achievement, not appearance. Find role models who do the same.
  • Find friends who have similar values.

Reproductive Organs

Image result for female reproductive system labeled

Hair (Unwanted)

Hair: You can color it, curl it, straighten it, braid it, cut it, etc., but what about unwanted hair? If you have noticeable hair above your upper lip, chin, neck, toes, belly, or even your back you can probably relate. Having to deal with the embarrassment of unwanted hair is no joke. Depending on the amount of extra hair you have, it can range from being mildly annoying to severely distressing.


Girls make both male and female hormones, but the amount of male hormones is normally low. If the levels are too high or your body is sensitive to the normal levels, excess hair can grow. This extra hair tends to be coarse and dark. The medical word for too much or unwanted hair is “hirsutism”.

Heredity: “Heredity” refers to things about your body that are inherited, or passed along from generation to generation. Girls and women of Mediterranean descent often have darker and thicker hair on their arms, legs, upper lips, toes, etc. Hirsutism also runs in families.

Endocrine disorders such as PCOS (short for Polycystic Ovary Syndrome) can cause hirsutism. Girls with PCOS make extra amounts of male hormones called “androgens”. Although all women make both female and male hormones, girls with PCOS make more of the androgens (male hormones). One type of androgen called testosterone (pronounced test-toss-ter-own) is mostly to blame for excess hair in girls with PCOS.

Sometimes the cause of extra or unwanted hair is unknown.


There are a variety of hair removal methods ranging from temporary to permanent. The methods vary in effectiveness and cost.

Over-the-counter creams such as depilatories work by dissolving the proteins that make up hair. The average cost of this type of product is a few dollars per application. They are the least effective of the temporary hair removal options.

Shaving is basically like trimming or cutting the hair. It doesn’t affect hair growth at all. In fact, it’s a myth that shaving hair causes it to grow back thicker. When a hair is cut off it grows back without the fine point, making it feel thicker. It doesn’t cost much, but shaving can cause ingrown hairs, which can lead to “folliculitis” (inflammation of a hair follicle), ranging from a few red bumps on the skin to a severe rash. To avoid problems, you should always shave in the direction that the hair grows, don’t repeat strokes, and wet the hair or use a shaving cream before you begin.

Tweezing is the cheapest method of hair removal, but it can take a lot of time and it hurts, so it’s not a good option for large areas. If you use a decent pair of tweezers, you can pull out the hair at the root, but the hair will eventually grow back at the same thickness. Sometimes girls can develop an irritation where they tweeze which can become infected.

Waxing is considered an older method, however soy-based wax is now available. Soy-based wax is better than older waxes because the wax doesn’t stick to your skin, only the hair. Some people feel a sting for a couple of seconds when the wax is pulled off of the skin. Although fairly inexpensive to do at home (a few dollars per application), waxing is best done in a salon or spa where the temperature of the wax is controlled so there’s less of a chance of burning your skin, which can cause scarring. Since waxing removes the entire hair root, your skin may get pink or red and feel tender. You should apply an antibacterial lotion after each treatment.

Laser treatments can be pricey and take 6-8 sessions on average for 80% improvement in permanent hair reduction. This method destroys the hair, not the root. The hair doesn’t come out right away, but it eventually falls out. This method lasts a longer time but the hair eventually grows back.

Electrolysis is the only permanent hair removal method, because it destroys the hair follicles. This procedure needs to be done weekly and it can take a couple of years for permanent hair removal. Therefore, it can be very costly.

Bleaching hair isn’t the same as removing it, but it’s a popular and inexpensive way to make dark hair on the places such as the face, arms, and neck less noticeable. Be aware though, that bleach is a chemical which can cause irritation and burns.

Medications that lessen hair growth: All of the options listed below require a prescription. All of the oral medications take 6-9 months for you to see an improvement.

  • Birth control pills are typically prescribed to treat PCOS. The Pill is used to make the menstrual cycle regular and balance the hormones. The levels of androgens (the male hormones linked with excess hair growth) are lowered.
  • Metformin is a medication that is often prescribed to help lower insulin levels in women with PCOS. High levels of insulin stimulate the ovaries to make androgens, so by decreasing these levels, hair growth can be lessened, but not as much as with the Pill.
  • Spironolactone is another medication that is often used to treat hirsutism. It works by blocking androgen hormones from working. Possible side effects can include; irregular periods, frequent urination, loose bowel movements, rash, dry mouth, tiredness, and headaches. The side effects are temporary and go away when spironolactone is stopped.
  • Vaniqa® is a topical cream that requires a prescription. It works by slowing the rate of hair growth. It’s safe to use with oral contraceptives. The cost of the cream may vary depending on your health insurance coverage, but is usually not covered. Vaniqa is recommended for small areas such as the upper lip, chin, and side burns, but would not be practical for use on large areas of the body. You have to use it every day for it to work.


Having to get rid of unwanted hair is definitely something you’d rather not have to deal with, but there are safe ways to make it go away, at least temporarily. It’s still very important to be aware that certain methods of hair removal are NOT SAFE for all skin types and colors. You’ll need to talk with your health care provider first and then test a small area before applying the hair removal product on larger areas.





tampon insertion

Vulvar and Vaginal Care

Your First Period

Your First GYN Visit

Pelvic Exam and Pap Test

Your First Pelvic Exam

Inside the female reproductive organs

Vaginal area

Pap test



Puberty is the time when your body changes and becomes more like an adult.


It is normal for changes to start as early as 8 years old or as late as 13 years old. Puberty starts when your brain sends signals to certain parts of the body to start growing and changing. These signals are called hormones. Hormones are chemicals that control body functions.


During puberty, hormones cause the following changes:

  • You grow taller and gain weight.
  • Your hips may get wider.
  • Your breasts grow.
  • You grow hair under your arms and around the vulva.
  • Your body odor may change.
  • You may get acne or pimples.
  • You get your first menstrual period (also called menstruation).


As your breasts start to change, the darker areas around the nipples (called the areolas) may look swollen. The breasts also grow rounder and fuller. One breast may seem a little larger than the other. They may feel sore at times. This is all normal.


Beginning in puberty, every month, your body will prepare for a possible pregnancy. Hormones signal the ovaries to release an egg each month. The egg moves into one of the fallopian tubes. At the same time, the lining of the uterus begins to grow and thicken. If the egg is not fertilized by a man’s sperm, pregnancy does not occur. The lining breaks down and flows out of the body through the vagina. This is called menstruation, the menstrual period, or just your “period.”


Most girls in the United States start between the ages of 12 years and 14 years, but some start earlier or later.


Periods usually last between 2 days and 7 days. They normally come every 21–45 days. They often are not regular at first. You may miss a period. You may have two periods in 1 month. This is normal. It can take about 6 years after your first period for your body to get on a regular cycle. Keep in mind that if you have had sexual intercourse, a missed period can be a sign that you are pregnant.


It is best to be prepared for your period, even if you have not started yet. Have pads or tampons ready at home and carry them with you to school.


Pads attach to the inside of your underwear. They absorb the blood as it leaves the vagina. Tampons are inserted into the vagina. They catch the blood before it leaves the body.


You should change your pad or tampon at least every 4–8 hours. On the first days of your period, you may need to change it more often because your flow may be heavier.


Some girls have cramps (tightness and pain) in the lower abdomen and back at the start of their periods. Some girls get headaches or feel dizzy. Some get diarrhea.


To help ease cramps, you can try the following:

  • Take ibuprofen or naproxen sodium (if you do not have an allergy to aspirin or severe asthma).
  • Exercise.
  • Place a heating pad on your abdomen or lower back.


Talk to your doctor or your parents about your period for any of these reasons:

  • You are 15 years old and have not had a period.
  • Your periods were regular each month and then they stopped being regular.
  • Your period comes more often than every 21 days or less often than every 45 days.
  • Your periods come 90 days apart (even if that happens only once).
  • Your periods last more than 7 days.
  • Your periods are so heavy that you have to change pads or tampons often (more than once every 1–2 hours).
  • You have bad cramps that keep you from doing your regular activities and they are not helped by pain relievers.


An obstetrician–gynecologist is a doctor who specializes in the health care of women. Girls should have their first gynecologic visit between the ages of 13 years and 15 years. The first visit may be just a talk between you and your doctor. You can find out what to expect at future visits and get information about how to stay healthy. You can ask questions about your body, growing up, and sex.


Acne is caused by overactive glands in the skin. They make a natural oil called sebum. During puberty, these glands make extra sebum that can clog the pores in your skin.


Wash your face often with water and mild cleanser to help get rid of the extra sebum. This will help reduce pimples and acne. Avoid products that dry or irritate your skin. Do not scrub or pick at your skin. If you have concerns about acne or pimples, some medications can help. Talk to your doctor about your concerns.



PMS stands for Premenstrual Syndrome; “pre” means “before” and “menstrual” refers to the menstrual cycle or periods. Not all girls will get PMS. Most girls and women with PMS have symptoms during the week before their period that lessen or disappear within 1-2 days after their period starts. Symptoms can usually be treated with lifestyle changes such as exercise and relaxation therapy and over-the-counter medicine. If these aren’t effective, prescription medicines are sometimes prescribed.

PMDD stands for Premenstrual Dysphoric Disorder. This diagnosis is reserved for young and adult women who have: five or more of the most common PMS symptoms during the week before their period, for at least two menstrual cycles in a row, and symptoms are not due to a medical condition such as thyroid disease. Symptoms such as mood swings, irritability, depression and fatigue are usually so severe that the young/adult woman misses school, work and/or avoids her regular social activities.


PMS symptoms usually occur 5-7 days before a girl/woman’s menstrual period. There are actually a total of 150 known symptoms of PMS. The most common symptoms include: mood swings, breast soreness, bloating, acne, cravings for certain foods, increased hunger and thirst, and fatigue. Other symptoms may include constipation or diarrhea, irritability, and feeling blue or down in the dumps. If you have any of these symptoms and they happen during the week before your period starts and go away when your period arrives or a few days later, you may have PMS. If you feel blue or down in the dumps and these feelings last longer than the week before your period, it’s probably not related to PMS. In this situation, it’s particularly important to ask your primary care provider if you should talk to a counselor or therapist.

Since there are so many possible symptoms of PMS, it’s a good idea to keep track of them. Remember to note if the symptoms are mild, moderate, or severe. Use a period and symptom tracker for 2-3 months and then bring it to your next medical appointment. A record of your symptoms can help your health care provider figure out the best treatment choices for you.


There are apps that you can download to help you track your periods. One approved by the American College of Obstetrics and Gynecology is CLUE and is an easy way to keep track of your menstrual flow, and it’s also a way to keep track of cramps, and/or PMS and period symptoms (if you have them) each month.


Scientists are still trying to figure out what causes PMS. We know that during the second half of the menstrual cycle, progesterone (female hormone) levels increase. Then, just before the period comes, progesterone and estrogen (another female hormone) levels drop. It is believed that changes in hormone levels result in PMS symptoms. Other factors may have an effect on PMS symptoms; for example, you may notice that your symptoms are better if you get plenty of sleep and exercise regularly. Although PMS can be frustrating, there are things you can do that may help relieve your symptoms.


There are no specific tests such as a blood test to diagnose PMS. The diagnosis is based on specific symptoms. If you see your health care provider (HCP), he/she will likely ask you a lot of questions. Some questions will be about your period and when you have symptoms, how long they last, etc. and if your symptoms get better or disappear when your period starts. Your HCP will also ask about what medicines you take including any over-the-counter medicine, vitamins and dietary supplements. He/she may order tests to make sure your symptoms are not caused by another condition such as a problem with your thyroid gland. Also, your HCP may ask you if you have ever been treated for a mood or anxiety disorder, substance abuse, headaches, chronic fatigue or other medical conditions that can sometimes get worse a few days before a woman’s menstrual period.


Nutrition and lifestyle changes are a first step. The following suggestions are healthy recommendations for everyone and are particularly helpful for young women with PMS symptoms, according to research.

Nutrition Changes:

  • Eat whole grains that are high in fiber (such as whole grain breads, whole wheat pasta, and high fiber cereals instead of white bread, white pasta, and sugary cereals). Whole grains help to keep blood sugar levels more stable compared to refined grains such as white bread, which could keep cravings under control and prevent mood changes associated with PMS.
  • Cut back on sugar and fat. Even though your body may be craving sweets or fast foods that are high in fat, try to limit these foods since they may add to your PMS symptoms such as bloating.
  • Limit foods high in salt (sodium) for the few days before your period. For example, avoid: canned soups, Chinese food, hotdogs, chips, and pizza which are very high in sodium. Cutting down on sodium may help to control bloating by lowering the amount of fluid your body retains.
  • Keep hydrated. Drink plenty of water to reduce bloating and help with digestion.
  • Cut back on caffeine. Reducing the amount of caffeine you eat and drink (soda, coffee drinks, and chocolate) may help you feel less tense and may also ease irritability and breast soreness.
  • Try eating up to 6 small meals a day instead of 3 large ones and include a balance of foods and nutrients (lean protein, whole grain carbohydrates, fruits/veggies, and healthy fats such as olive oil or avocado) at each small meal. This will help keep your blood sugar levels even, which will give you energy that lasts.
  • Don’t forget calcium!
  • Don’t forget calcium! Research studies have shown that getting 1300 mg of calcium per day helps with PMS symptoms such as mood swings, headaches, and irritability. This means you should eat or drink three to four servings of high calcium foods (such as milk, fortified OJ, or soy milk) each day or take calcium supplements.

Lifestyle Changes:

  • Fit in exercise. Do aerobic exercise (such as running, dancing, or jump roping) for 30-60 minutes a day, 4 to 6 times a week.
  • Catch your ZZZ’s. If you’re a teen, you need about 9 hours of sleep each night.
  • Try to maintain a regular schedule. This includes meals, exercise, and bedtime.
  • Keep stress to a minimum. If possible, try to schedule events that you think could be stressful during the week after your period.
  • Avoid alcohol. Drinking alcohol before your period can make you feel more depressed.


If your symptoms don’t improve with a few nutrition and lifestyle changes, talk with your health care provider. He/she may be able to prescribe medicine that will help lessen or get rid of your discomforts. There are many different medicines that are currently used to treat PMS symptoms. The most commonly prescribed are oral contraceptives (birth control pills) which prevent ovulation and keep hormone levels even. Most pills (particularly those that are low in progestin or contain drospirenone) can improve symptoms. Sometimes symptoms can improve even more if the pill is taken continuously (one active pill every day and no placebo pills). Other medications include ibuprofen or naproxen sodium that can help to relieve lower back discomfort and headaches and mild diuretics such as Spironolactone to lessen bloating and mood changes. If depression is a significant issue, your health care provider may prescribe antidepressants such as Fluoxetine, Sertraline, or other SSRI medicines either for the 7 days before your period or daily.


Although more research studies are needed, there are certain vitamins and minerals that may help PMS symptoms. Several research studies show that calcium can significantly decrease many of the symptoms associated with PMS. Make sure that you are getting the recommended 1300 mg/day from calcium-rich foods or drinks or from supplements. Other supplements that could help with PMS symptoms are magnesium (400 mg/day), vitamin B6 (100 mg/day), and vitamin E (400 IU/day), but more research needs to be done. Check with your health care provider about whether you should try them and how much you should take because taking high doses of supplements can have unpleasant or dangerous side effects. For example, high doses of magnesium may cause diarrhea in some people.



You may feel nervous about using a tampon for the first time. It’s normal to feel nervous, especially if you have any unanswered questions about tampons.


Tampons are products used to absorb your menstrual flow. They are made of soft cotton pressed together to form a cylinder-like shape, so that they can be easily inserted into the opening of the vagina. A tampon absorbs your menstrual flow, or blood, before it has a chance to leave the body so they are considered “internal” protection whereas pads are “external” period protection. Tampons come in all different sizes and absorbencies. You can buy them at most pharmacies and grocery stores.


It’s a good idea to use the “slender” size tampon when you are learning how to use them for the first time. It’s also easier to insert it when your menstrual flow is moderate to heavy as this allows the tampon to glide in more easily.


By following the simple guidelines below, as well as the instructions that come with the tampons, your first experience with tampons should be easy. Remember, the more you relax, the easier the insertion will be. When you are nervous, your muscles tense up, which can make inserting the tampon more difficult.

Getting ready: Before you insert the tampon, let’s review your anatomy so you know where to insert it.

It’s a good idea to use a mirror to look at your vulva or outside area, which is all of your female genitalia (parts) that you can see. The urethra is where your urine (pee) comes out, the anus is where feces (poop) come out and right in the middle is your vaginal opening. This is where you will insert the tampon into your vagina. It’s normal to feel nervous the first time you use a tampon. It does get easier though.

Instructions for inserting a tampon with a built-in applicator:

tampon insertion

  1. Wash your hands with soap and water. With dry hands, unwrap the tampon. If you drop the tampon on the floor, throw it away and begin again with a new tampon.
  2. Sit or stand in a comfortable position. Some women prefer to place one leg on the toilet seat or tub, while others prefer to squat down. After you find a position that is most comfortable for you, hold the tampon with the fingers that you write with. Hold the middle of the tampon, at the spot where the smaller, inner tube inserts into the larger, outer tube. Make sure the string is visible and pointing away from your body.
  3. With your other hand, open the labia (the folds of skin around the vaginal opening) and position the tampon in the vaginal opening. (See picture 1)
  4. Gently push the tampon into the opening, aiming for the small of your back. Stop when your fingers touch your body and the applicator, or outer tube, is completely inside the vagina. (See picture 2)
  5. Once the applicator or outer tube is inside your vagina, use your index or “pointer” finger to push the inner tube (the tube where the removal string is visible) through the outer tube. This pushes the tampon into the vagina.
  6. Once the inner tube is all the way in, use your thumb and middle finger to remove the applicator or outer tube. (See picture 3) Make sure that the string hangs outside of your vaginal opening. Later, when you are ready to remove the tampon, hold the string and gently pull it downward until the entire tampon is out.
  7. Remember to wash your hands before and after you insert and remove a tampon.

Instructions on how to insert a non-applicator tampon:

  1. Wash your hands with soap and water. With dry hands, unwrap the tampon. If you drop the tampon on the floor, throw it away and begin again with a new tampon. The tampon should be completely sealed in plastic wrap. If not, select another tampon and unwrap it with clean hands.
  2. Read the directions on the tampon box.
  3. With clean hands, unwrap a tampon and tug on the string to make sure the string is firmly attached to the tampon.
  4. Sit or stand in a comfortable position. Some women prefer to place one leg on the toilet seat or tub, while others prefer to squat down. After you find a position that is most comfortable for you, hold the end of the tampon, at the spot where the tampon dents in. Make sure the string is visible and pointing away from your body.
  5. With your other hand, open the labia (the folds of skin around the vaginal opening) and position the tampon in the vaginal opening. (See picture 1.)
  6. Gently push the tampon into the opening, aiming for the small of your back.
  7. Once the tampon is inside of your vagina, use your index or “pointer” finger to push the tampon in.
  8. Make sure that the string hangs outside of your vaginal opening. Later, when you are ready to remove the tampon, hold the string and gently pull it downward until the entire tampon is out.
  9. Remember to wash your hands before inserting a tampon and again after you take one out.

If the tampon is inserted correctly, you should not feel it. If you feel uncomfortable in any way, you may have inserted the tampon incorrectly or the tampon may not be placed far enough into your vagina. If this happens, just remove the tampon and start again with a new tampon. Remember that practice makes perfect. If you don’t get it on the first try, your second try will most likely be successful. Instead of getting frustrated and giving up, relax and try again!


If you’re not able to insert a tampon after several tries, make an appointment with your health care provider. One reason for this is that you may have been born with a very small opening in your hymen, which prevents you from inserting tampons. This is true in only about 2% of teens, but it could be a problem.

A mirror is often helpful when you’re trying to insert a tampon for the first time, so that you can see exactly where your vaginal opening is. You can also try using a small amount of vaginal lubricant (K-Y Jelly) on the end of the tampon to help it glide in.


TSS stands for Toxic Shock Syndrome. It’s rare but a dangerous infection if you get it. It can occur in girls who wear tampons.

Tampons themselves do not cause TSS. TSS is caused by bacteria, usually called Staphylococcus aureus. When a tampon is in your vagina, it creates a perfect environment for different types of bacteria, including Staphylococcus aureus, to grow. The bacteria make a toxin that causes severe illness. Younger teens are less likely to have antibodies against the toxin made by these bacteria. You will probably never get TSS, but it’s good to know what the symptoms are and how to lessen your risk.

To lessen your risk of developing TSS, follow these tips when using tampons:

  • Use care in inserting tampons. Wash your hands before inserting or removing your tampon. (Make sure your fingernails are not sharp or jagged to avoid tearing your skin).
  • Change your tampons at least every 4-6 hours or more often if necessary.
  • Choose the correct tampon absorbency. Use smaller sized tampons when your flow is lighter. TSS is very rare but more likely with super-absorbent tampons only when you have a heavy flow. Don’t use these unless your menstrual flow is heavy.
  • Alternate between pad and tampon use. Try using pads at night, and tampons in the daytime.
  • Don’t use tampons to absorb anything other than your menstrual flow. Only insert a tampon once menstrual blood is present.

Symptoms of TSS-Toxic Shock Syndrome usually come on quickly and may include:

  • Flu-like symptoms (muscle aches, headache, redness of your eyes, mouth, and throat
  • Sudden high fever
  • Dizziness, fainting, or lightheadedness
  • Vomiting
  • A sunburn-like rash
  • Diarrhea

Vulvar and Vaginal Care

You may be confused by the feminine hygiene products that claim to keep your vagina smelling like “springtime.” Caring for your vulvar and vagina is actually very simple because you don’t need to buy fancy soaps or liquids. In fact, these products can be very irritating and can cause vaginitis.

First let’s review the female structures located on the outside of a female’s body.

The vulva includes the female genitals that are located on the outside, but near the opening of the vagina (see diagram below).

  • Mons pubis or “mons” (the mound of tissue above the pubic bone that is usually covered with pubic hair)
  • Clitoris (located above the vagina and typically feels good when it is touched. The clitoral “hood” is a small piece of skin that covers the clitoris)
  • Urethra (opening to the urinary canal, where urine/pee comes out)
  • Labia majora (larger pads of skin on either side of the vagina, protects the vagina from injury)
  • Labia minora (thinner flaps on either side of the vagina, sometimes called “lips”)
  • Anus (opening to the rectum, where bowel movements come out of)

The vagina is a tube or canal made of tissue and muscle on the inside of a female’s body that is connected to the cervix, which is attached to the uterus.


  • When showering or bathing, wash your vulva with warm water and mild or unscented soap. Make sure the water isn’t too hot and remember to rinse off all the soap.
  • Separate your labia and let the warm soapy water clean all around the clitoral hood and between your labia. This will rinse off any secretions that get stuck in between skin folds.
  • Rinse completely and pat dry your vulva with a soft dry towel.
  • In between baths or showers, you may wish to use a facecloth or a “peri-care” bottle to clean your vulva. This plastic bottle holds water and is also good to use during your period. You can usually find them at your local pharmacy for about a dollar or less.
  • While on your period, change your tampon/pad often.

The vagina cleanses itself naturally. The cells in the vagina keep it at a normal pH so you should NEVER douche or use any sprays in your vagina (unless your health care provider prescribes it).

  • Use mild soap and warm water to clean around the opening to your vagina.

Vaginal and Vulvar Hygiene Tips

  • Wash all new underwear before you wear it and then use a small amount of mild unscented detergent for routine washing. Rinse laundry well or use the extra rinse cycle on your washing machine to remove all of the detergent.
  • Wear underwear with a cotton crotch. Avoid wearing thong style underwear as they can irritate your vulva.
  • NEVER douche or use feminine deodorant sprays, bubble bath, wipes, bath oils or other perfumed products on your vulva or in your vagina as they can cause irritation, allergic reactions, or remove the natural fluid that keeps your vagina clean. These products are NOT necessary and may be harmful.
  • Avoid tight fitting clothing.


Every female has a natural vaginal scent that can change throughout her menstrual cycle. Normal vaginal discharge is usually clear, white, light yellow and sometimes sticky. Your vagina and vulva area are usually healthy if you do NOT have an odor that is different for you or fishy smelling, itchiness, redness, or burning. It is important to know that some vaginal infections such as gonorrhea and chlamydia can cause no symptoms.


If you have a discharge that smells different for you, your vagina or the area around it is itchy, red or sore, you should make an appointment with your health care provider and get treated.

Not all vaginal odors are caused by an infection. Poor hygiene (not washing your vulva/vagina regularly with warm water and soap) can cause an unpleasant smell. Wearing tight fitting clothing or underwear made of nylon that doesn’t breathe can cause sweat and bacteria to get trapped which can also cause an unpleasant odor.


Your First Period


Puberty is a time when your body begins to change to become more like an adult’s. Starting your menstrual period is one of these changes.


When puberty begins, your brain signals your body to produce hormones. Some of these hormones prepare your body each month for a possible pregnancy. This is called the menstrual cycle. Hormones cause the lining of the uterus to become thicker with extra blood and tissue. One of your ovaries then releases an egg. This is called ovulation. The egg moves down one of the two fallopian tubes toward the uterus.

If the egg is not fertilized with a man’s sperm, pregnancy does not occur. The lining of the uterus breaks down and flows out of the body through your vagina. The discharge of blood and tissue from the lining of your uterus is your menstrual period (also called “your period”).


Most girls start their periods between the ages of 12 years and 14 years, but some start earlier or later.


When you first start having your period, it may last only a few days. Your first few periods may be very light. You may only see a few spots of reddish brown blood. Anywhere from 2 to 7 days is normal.


A menstrual cycle is counted from the first day of bleeding in one month to the first day of bleeding in the next month. The average menstrual cycle is about 28 days, but cycles that are 21–45 days also are normal. It may take 6 years or more after your period starts for your cycle to get regular.


If you do this every month, you may notice a pattern. It may become easier to tell when you will get your next period. Check online or on your smart phone for apps that can help you track your period.


To track your period on a calendar, mark the first day your bleeding starts on a calendar with an “X.” Put an X on each of the following days that you have bleeding. Count the first “X” as day 1. Keep counting the days until you have your next period.


Pads are used to soak up the menstrual flow. Tampons and menstrual cups catch the flow from inside your vagina. Pads, tampons, and menstrual cups can be used at different times. Some also can be used together.


Pads are worn inside your underwear to collect your menstrual flow. They come in different sizes, styles, and thicknesses. Some have extra material on the sides called “wings” that fold over the edges of your underwear to help keep the pad in place and give better protection. A thinner, shorter version of a pad is a “panty liner.” Some girls wear panty liners on the last days of their periods when the flow is light or on days when they think their periods will come.


Change your pad at least every 4–8 hours or whenever it seems full or feels wet and uncomfortable. Some girls change their pads each time they urinate.


Some tampons have a plastic or cardboard applicator tube that helps slide the tampon in place. Some tampons do not have applicators and are inserted with just your fingers. A short string attached to the end of the tampon hangs out of your vagina to help you remove it later.


Just like pads, tampons come in different sizes for heavier and lighter periods. The tampon package will tell you how much fluid it will absorb. A “super” tampon, for example, is thicker and is meant for heavy flow. A “slim” or “junior” tampon is slender and is meant for lighter flow.


You should change your tampon at least every 4–8 hours. Leaving a tampon in for a long time has been linked to toxic shock syndrome. When your flow is heavier, you may need to change it more often.


Menstrual cups are made of plastic or rubber. They are inserted into the vagina to catch the menstrual flow. You remove and empty the cup every 8–12 hours. Some cups are used only once and thrown away. Others can be washed and reused.


Some girls have a cramping pain in the lower abdomen or back or breast tenderness just before and during their periods. Some girls get headaches or feel dizzy. Some get nausea or diarrhea.

To help ease cramps, you can try the following:

  • Take ibuprofen or naproxen sodium (if you do not have an allergy to aspirin or severe asthma). Always follow the directions on the bottle about how much to take.
  • Exercise.
  • Place a heating pad, heat wrap, or other source of heat on your abdomen or lower back.


Amenorrhea means not having a period. It is normal for some girls not to start their periods until age 16 years. However, your doctor may want to see you if you have not started by age 15 years. You also should see your doctor if you have started your period but it then stops for more than 3 months.


If you are bleeding so much that you need to change your pad or tampon every 1–2 hours or if your period lasts for more than 7 days, you should see your doctor. See your doctor right away if you are light-headed, dizzy, or have a racing pulse.


You should tell your doctor if your periods are usually regular but then become irregular for several months. You also should see your doctor if your period comes more often than every 21 days or less often than every 45 days.


Your First GYN Visit


An obstetrician–gynecologist (ob–gyn) is a doctor who specializes in the health care of women. Girls should have their first gynecologic visit between the ages of 13 years and 15 years.


It is normal to feel nervous about your first visit. It may help if you talk about it with your parents or someone else you trust. You may want to let your doctor know you are nervous. He or she can help put you at ease.


The first visit may be just a talk between you and your doctor. You can find out what to expect at future visits and get information about how to stay healthy. You also may have certain exams.

Your doctor may ask a lot of questions about you and your family. Some of them may seem personal, such as questions about your menstrual period or sexual activities (including vaginal, oral, or anal sex). If you are concerned about confidentiality, you and your doctor should talk about it before you answer any questions. Much of the information you share can be kept confidential.


You may have certain exams at the first visit. If you choose, a nurse or family member may join you for any part of the exam. Most often, these exams are performed:

  • General physical exam
  • External genital exam

You usually do not need to have a pelvic exam at the first visit unless you are having problems, such as abnormal bleeding or pain. If you are sexually active, you may have tests for certain sexually transmitted infections (STIs). Most of the tests that teens need can be done by the doctor with a urine sample. You also may have certain vaccinations.


During the general exam, your height, weight, and blood pressure will be checked. You also will be examined for any health problems you may have.


In this exam, the doctor looks at the vulva. He or she may give you a mirror so that you can look at the vulva as well. This exam is a good way to learn about your body and the names for each part.


Even though you probably will not have a pelvic exam, you should know what one is. Another test that you will have later (at age 21 years) is a Pap test. This test checks for abnormal changes in the cervix that could lead to cancer.

The pelvic exam has three parts:

  1. Looking at the vulva
  2. Looking at the vagina and cervix with a speculum
  3. Checking the internal organs with a gloved hand

The doctor will use a speculum to look at your vagina and cervix. When you have a Pap test, a sample of cells is taken from your cervix with a small brush.

To check your internal organs, the doctor will place one or two gloved, lubricated fingers into the vagina and up to the cervix. The other hand will press on the abdomen from the outside.

Pelvic Exam and Pap Test


Vaccinations or immunizations protect against certain diseases. The following vaccines are given to all young women aged 11–18 years on a routine basis:

  • Tetanus–diphtheria–pertussis (Tdap) booster
  • Human papillomavirus vaccine
  • Meningococcal vaccine
  • Influenza vaccine (yearly)

In addition to routine vaccines, special vaccines may be given to young women who are at an increased risk for certain diseases. Listed are some of these vaccines:

  • Hepatitis A virus vaccine
  • Pneumococcal vaccine


Many young women share the same health concerns. Most of these concerns are a normal part of growing up:

  • Cramps and problems with menstrual periods
  • Acne
  • Weight
  • Sex and sexuality
  • Birth control
  • STIs
  • Alcohol, drugs, and smoking
  • Emotional ups and downs


Making good lifestyle choices can help you to be strong and healthy for years to come:

  • Maintain a healthy weight by eating a well-balanced diet and exercising often.
  • Avoid smoking, drinking alcohol, and using illegal drugs.
  • Seek help if you have emotional ups and downs or feel depressed.
  • Use birth control if you are having sex and do not want to have a baby.
  • Protect yourself from STIs by using a latex condom. Know your partners and limit their number.
  • Keep up with routine exams, tests, and immunizations.

Your First Pelvic Exam

You may be worried about your first pelvic exam. It’s very normal to be uneasy about something when you don’t know what to expect. It’s also normal to feel embarrassed. Hopefully after reading this information, you will be reassured that it’s simple, not painful, and takes only about 3-5 minutes. Your health care provider (HCP) should be sensitive and gentle, help you relax, and answer any questions you have.


A pelvic exam is a way for your health care provider to examine your female organs and check for any gynecological problems.


Inside the female reproductive organs

Inside the female reproductive organs

Most health care providers agree that you should have your first exam when you have symptom such as discharge or pain, or when you turn 21, whichever comes first. There are other important reasons that you may need a pelvic exam. Your HCP will decide if an exam is needed to figure out the cause of your concerns.

These may include:

  • Unexplained pain in your lower belly or around the vulva area.
  • Vaginal discharge or wetness on your underwear that causes itching , burns or smells bad, especially if you’ve had sex
  • No menstrual periods by age 15 or 3 years after your breast development begins
  • Vaginal bleeding that lasts more than 10 days
  • Missed periods, especially if you are having sex
  • Menstrual cramps so bad that you miss school

Remember, it doesn’t matter how old you are or if you are sexually active, if you have any of the symptoms listed above, you should make an appointment with your health care provider or gynecologist.


Even if you’re a virgin (you’ve never had vaginal intercourse), you may need a pelvic exam if you are having certain problems. Having a pelvic exam doesn’t change anything, just as using tampons doesn’t change your hymen (the skin that partly covers the opening to your vagina).


  • When you make your appointment, be sure to let the scheduler or nurse know that this is your first pelvic exam. The nurse can answer your questions and help explain what to expect so you won’t be worried.
  • Do NOT have sex, use vaginal creams or douche for 24 hours before the exam.


Your HCP will ask you questions about:

  • Your general health, allergies and medications you are taking
  • Your menstrual period, such as how old you were when you first got it, how long it lasts, how often it comes, how much you bleed, the first day that your last period started, if you have cramps; and at what age your breasts started to develop
  • Whether you have ever had sexual contact or have been sexually abused or assaulted
  • If you have vaginal itchiness or an unusual discharge (drainage) or odor from your vagina

Getting Ready:

  • If you find it helpful, your mom, sister or friend can stay with you. There may also be a nurse or a medical or nursing assistant in the room, too.
  • After you have given your medical history, been weighed and had your blood pressure checked, you will be asked to put on a hospital gown.
  • You will need to remove your clothes including your underwear and bra. A breast exam is often done as a routine part of this check-up.


  • Your health care provider will explain the different parts of the exam and ask you to lie down on the exam table. You will be given a sheet to put over your stomach and legs.
  • You will then be asked to move down to the end of the table and place your feet in “stirrups” (these are holders for your feet).
  • With your knees bent, you will be asked to let your knees fall to each side allowing your legs to spread apart.

This is usually the part when some young women feel embarrassed. Your HCP will make you feel at ease. It’s important to tell him/her if you are scared, nervous, or uncomfortable.

There are usually 3 parts to a pelvic exam. Sometimes not all the parts are necessary. Ask your health care provider which part(s) will be done for your exam.

Vaginal area

Vaginal area

The External Exam (Part 1): Your health care provider will first look at the area outside of your vagina (clitoris, labia, vaginal opening, and anus).

The Speculum Exam (Part 2):

  • The speculum is an instrument made of metal or plastic. Your HCP will gently place the speculum into your vagina. After it’s inserted, it will be gently opened so that your health care provider can see your vaginal canal and your cervix (the opening to your uterus). If you like, you can ask your HCP for a mirror so that you can see what your cervix looks like.
  • After checking your vagina and cervix, your HCP may take a thin plastic stick and a special tiny brush (that looks like a super tiny broom) and gently wipe away some of the cells from your cervix. This is a Pap test, which can find early changes of the cervix before they become cancer. Most girls have normal Pap tests. Normally, a young woman will have her first Pap test at age 21. It’s possible that you might need one earlier if you have specific symptoms.
  • If you are having vaginal discharge, your HCP will take another sample to check for yeast and other causes of discharge.
  • If you’re having sex, your HCP will take another sample from the cervix and/or vagina and/or a urine test to check for sexually transmitted infections. When samples have been taken, your HCP will close the speculum and gently take it out of your vagina.

Pap testThe Bimanual Exam (Part 3):

  • The last part of the pelvic exam is done to check your female organs (your tubes, ovaries and uterus or womb). Your HCP will insert one or two gloved fingers into your vagina. With the other hand, he or she will gently apply pressure to the lower part of your belly. You may feel slight discomfort or pressure when he or she presses in certain places, but it shouldn’t hurt. If you do feel pain, it’s important to tell your HCP.
  • Sometimes your provider will do a rectal exam. This involves inserting one finger into your anus (the opening where bowel movements leave your body). This is usually done at the end of the bimanual exam. Like other parts of the exam, if you relax and take slow deep breaths, it should not be uncomfortable.


When the exam is over, your HCP will tell you what he/she found, if your exam is normal, if you need to take any medications, how to get the results of the Pap test and/or other tests, and when to make your next appointment.



Birth Control 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 daily

Often 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 all

Does 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 daily

May 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 placement

Does 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 daily

Can be used while breastfeeding

You can become pregnant right after it is removed

May cause more cramps and heavier periodsMay cause

spotting 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 weeksPrivate

Usually 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 shots

Side 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 symptoms

Can 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 months

Does 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 drive

Does 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 daily

You can become pregnant right after stopping patch

Can irritate skin under the patchMay cause spotting the first 1-2 months

Does not protect against HIV or other STIs

The Ring(NuvaRing) 91% Insert a small ring into the vaginaChange ring each month One size fits allPrivate

Does 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 use

Does 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/foreplay

Can 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 erection

Can 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 sex

May 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 noisy

May 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 time

Does 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 use

May 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 infection

Raises 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 these

Avoid sex or use condoms/spermicide during fertile days

Costs littleCan be used while breastfeeding

Can help with avoiding or trying to become pregnant

Must use another method during fertile daysDoes not work well if your periods are irregular

Many 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/foreplay

Comes in many forms: cream, gel, sponge, foam, inserts, film

Can be used while breastfeeding

May raise the risk of getting HIVMay irritate vagina, penis

Cream, 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 overweight

Ulipristal 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 sex

If 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 it

People of any age can get progestin EC without a perscription

May cause stomach upset or nauseaYour next period may come early or late

May cause spotting

Does not protect against HIV or other STIs

Ulipristal acetate EC requires a prescription

May cost a lot


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.


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



  • 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.


• 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.


  • 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.



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.


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

POP (Progestin Only Pills)


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 are there of Birth Control Pills 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




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.


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.


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.


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.


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.


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.


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.


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.


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.


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.

What happens to the blood in my uterus (womb) if I do not bleed monthly while using combined birth control methods?

When you are using combined birth control methods, the lining of your uterus, which is called the endometrium, does not thicken each month as it does when you are not using these methods. ere is no blood building up inside of your uterus if you do not have withdrawal bleeding monthly.

Are there any side effects of not taking hormone-free days on combined birth control methods?

The main side effect is that you can have slight spotting or bleeding on days when you are using your pills, ring, or patch. This is called breakthrough bleeding. It can happen even when you take hormone-free days monthly, but it is more common if you skip the hormone-free days. Breakthrough bleeding usually happens less often the longer you are on the pills, patch, or ring. If you are not taking hormone-free days and are having breakthrough bleeding for a few days, it may help to take 3 or 4 hormone-free days then restart your birth control method.

The other side effects of combined birth control methods are the same whether or not you take the hormone-free days. These side effects include nausea, breast tenderness, headache, and bloating. You will be able to get pregnant again once you stop using a combined birth control method. This is not affected by whether or not you take the hormone-free days.

Are there any women who should not take hormone-free days on combined birth control methods?

Some women want to have monthly bleeding so they can be certain they are not pregnant. They would rather take the hormone-free days every month. Some women should not use combined birth control methods at all. These include women who have had a blood clot or high blood pressure and are aged over 35 years and smoke cigarettes. Talk to your health care provider about whether it is safe for you to use combined birth control methods. Your provider also can give you more information about skipping the hormone-free days.


Nutrition Information


Diabetes is a chronic (long-term) condition that occurs when your body doesn’t make enough insulin, or when your body has trouble using the insulin that it does make. About 1 in 400 young people have this condition.


Insulin is a hormone made by a gland called the pancreas. The pancreas is located behind the stomach.

Whenever you eat food, your body digests the food (breaks it down) into vitamins, minerals, sugar (called “glucose”), fat, and protein. Your body then uses glucose for energy. Glucose is the body’s major source of energy. Insulin is the hormone that helps glucose enter the cells of your body so it can be used as energy.

If your body doesn’t make enough insulin, or if your body has difficulty using the insulin that it makes, the glucose from your food does not get changed into energy. Instead, the glucose stays in your blood, causing your blood glucose (also called “blood sugar”) to rise.


High blood sugar is a problem because it can cause serious damage to the body. Some of the most serious, long term problems are loss of vision, kidney problems, heart problems, damage to circulation and stroke. This kind of damage happens slowly over many years and can be delayed or prevented if you take good care of your diabetes.

There are also short-term problems that come from high blood sugar.

Some common short term-problems (caused from high blood sugar) are:

  • Being thirsty
  • Having to urinate (pee) more often
  • Feeling irritable or exhausted
  • Weight loss

If your blood sugar gets too high due to not having enough insulin, you can experience a very serious condition called *diabetic ketoacidosis.

Signs of ketoacidosis are:

  • Rapid deep breathing
  • Stomach pain or chest pain and/or vomiting
  • Confusion
  • Loss of consciousness (coma)

*Diabetic ketoacidosis is life-threatening and requires emergency medical treatment.


No. The glucose that your body uses for energy comes from many kinds of food, not just sugary foods. In fact, the major source of glucose for the body is not from sugar at all, but from foods such as cereal, bread, rice, pasta, and other grains. These foods are called carbohydrates. Dairy products, fruits, and vegetables all contain carbohydrates as well.

Carbohydrates are necessary to give your body enough energy to make it through the day. For this reason, it’s important for you to eat a balanced diet that includes moderate amounts of carbohydrate containing foods.


The two most common types of diabetes are type I and type II.

Type I diabetes is the kind of diabetes most commonly found in young people. Type I diabetes is an autoimmune disease caused by the body’s immune system (the disease fighting part of your body) attacking the cells of the pancreas that make insulin. There are some genes (information in your cells that usually come from mom or dad) that make a person more likely to develop type I diabetes. Even if you have a gene that makes you more likely to get diabetes, there probably still has to be another event that upsets and “activates” the immune system. The immune system then attacks and destroys the beta cells (insulin producing cells) of the pancreas. This stops your body from being able to make insulin on its own, and you get type I diabetes.

Once you develop type I diabetes it never goes away. There is no cure for diabetes at this time. To stay healthy, you must take insulin shots or use an insulin pump every day to help your body use the sugars in your food. People with type I diabetes can live long and healthy lives if they take their insulin and keep their blood sugars under control.

Type II diabetes is most common in adults, but more teens have type II diabetes now than ever before. You get type II diabetes when you develop “insulin resistance,” which means that your body needs higher than usual amounts of insulin because it cannot use the insulin efficiently and you are not able to make enough extra insulin to keep blood sugars normal. You are most likely to develop type II diabetes if you have a family history of diabetes and are overweight.

With type II diabetes, you can often keep your blood sugar under control by eating a healthy diet, exercising, and taking pills that help your body to either make more insulin or do a better job using the insulin that it already makes. Sometimes people with type II diabetes also need to take insulin shots to keep their blood sugar under control.


Some symptoms of diabetes are:

  • Being extremely thirsty
  • Having to urinate (pee) often
  • Losing weight (even though you may be eating more food than usual)
  • Nausea and/or vomiting
  • Feeling very tired

Many teens with Type II diabetes have no symptoms, which is why if you are overweight and at risk for diabetes, your health care provider will do lab tests to screen for diabetes every couple of years.


Doctors can diagnose diabetes through a blood or urine test.


For people with type I diabetes, you must keep your blood sugar under control by taking insulin injections or using an insulin pump. This is because your body cannot make its own insulin. eating a healthy diet is also very important for keeping your blood sugar under control.

For people with type II diabetes, a healthy diet, regular exercise, and oral medication (pills) are often enough to help keep your blood sugar at a healthy level.


There are many different types of insulin and several different ways that you can take it.

“Short-acting insulin” starts working very quickly and only stays in your body for a few hours. “Long-acting insulin” takes several hours to start working and stays in your body for as long as 24 hours. You may need only one kind of insulin, or you may need a combination of short andlong-acting insulins.

Choices for how you can take your insulin include:

Disposable syringes (needles)

An insulin pen: The insulin pen looks like a large pen. It’s filled with insulin and is used with disposable needle tips.

An insulin pump: “The pump” delivers insulin continuously just under the skin. It is a small device (about the size of a pager) that you wear all day long. It gives you insulin throughout the day through a tiny needle. Many young people with diabetes choose to use the pump because they feel it gives them more freedom than other methods do.

You and your health care provider will work together to find the insulin therapy that is best for you. A member of your health care team will teach you the right way to use whatever method(s) you choose.


For both type I and type II diabetes it is important to eat a healthy, balanced diet. You will work together with your health care provider and usually a dietitian to choose an eating plan that’s right for you. You will learn about how different foods affect your blood sugar and about how to choose foods that will help keep your blood sugar at a healthy level all day long.


Exercise is an important part of keeping your body healthy and your blood sugar at a healthy level. Your health care provider will work with you on an exercise plan. It’s important to talk with your provider about sports and exercise because they can have a big effect on the way your body uses insulin, and on your blood sugars. People who take insulin can sometimes have low blood sugars during and after exercise.


You’ll need to check your blood sugar several times each day using a special device called a glucose monitor (or “glucometer“). Your glucose monitor will tell you whether your blood sugar is too high, too low, or within your target range by measuring the amount of sugar in a tiny sample of blood. The blood sample is taken by pricking your finger or inner arm with a very thin needle called a lancet.

Your health care provider will teach you how to use your glucose monitor and how to keep track of your blood sugars in a log-book or an app that you will bring to your appointments. Keeping track of your numbers will help you and your provider see changes in your blood sugar levels over time. This can help you to notice any patterns in your blood sugar, which can help you and your health care provider to decide whether you need to make any changes to your insulin doses.

Some people with diabetes wear a continuous glucose monitor that measures the glucose levels in the skin layer every few minutes throughout the day.


Talk with your health care provider about what to do if your blood sugar is too high (called hyperglycemia). You might need to take an extra shot of insulin, or, if your blood sugar is extremely high, you may need medical help.


If your blood sugar is too low (called hypoglycemia), you’ll need to eat or drink some sugar to “spike” your blood sugar back up. You might have glucose tablets for this purpose, or you might have a sugary drink like soda or juice. You should always carry a source of sugar with you in case your blood sugar drops.

If your blood sugar is very low, you could pass out and need emergency medical help. For this reason you should always carry a card or wear a bracelet or necklace that lets people know that you have diabetes. This will help you get the proper treatment right away.

Some signs of low blood sugar are:

  • Shaking
  • Dizziness
  • Sweating
  • Confusion
  • Pale skin color
  • Clumsiness
  • Rapid heart rate

If you feel like you have low blood sugar, but you are not able to check your blood sugar, you should eat your glucose tablets or drink some soda/juice just to be safe, then check your blood sugar as soon as you can. It’s important to treat low blood sugar right away.


Although diabetes never goes away, many people with Type I diabetes experience a “honeymoon period” soon after they find out they have the disease. During this time, which typically lasts between a few months and a year, a person may need little insulin to have normal blood glucose levels. This is because their body is still making some insulin. As the diabetes progresses, the person will slowly make less insulin until their body stops making it altogether. At this point they’ll need to rely on regular doses of insulin.


Diabetes is serious because it never goes away and because you must take proper care of yourself to stay healthy. However, that doesn’t mean you can’t live a normal life! People with diabetes can do almost anything that people without diabetes can do. You just need to take special care with your diet, exercise, and medication in a way that other people your age might not need to.

The longer you have diabetes, the higher your risk for certain problems such as heart disease, poor vision, kidney disease, and circulatory problems. The better you keep your blood sugar under control, the better chance you have of delaying or preventing these problems when you’re older.


It takes a team to take care of diabetes: at home you work with your parents or the adults you live with to make sure you get your insulin injections, monitor your blood sugars, and eat regular meals. At school, the school nurse may help out. The nurses, doctors, nutritionists, and counselors who help you take care of your diabetes are part of your team too! You should feel comfortable talking to any one of them about worries that you might have.


  • It’s important to do the best you can to keep your body healthy and your blood sugar under control. For young people, this can be a challenge. The changes in your hormones at puberty can sometimes make it hard to keep your blood sugar under tight control and this can be frustrating. It can also feel frustrating to have to think so much about food and your blood sugar while most other people your age don’t have to worry about it.
  • If you’re feeling overwhelmed, there are resources available to help you cope with your diabetes. It might help you to talk with someone who understands what you’re going through. Your health care provider or your parents can help you find a counselor or support group in your community.
  • Remember that staying healthy includes avoiding smoking and alcohol. This is important for all teens, but especially for teens with diabetes. Smoking can cause serious damage to your circulation, and drinking alcohol can lead to dangerously low blood sugar.
  • If you have diabetes and you are sexually active, be sure to use an effective birth control method so that you do not have an unplanned pregnancy.
  • If you become pregnant, you’ll need to pay close attention to your diabetes and check your blood sugar levels frequently. Insulin doses often need to be adjusted more frequently during pregnancy. This is important for both the health of the mother and her baby.


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, 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.


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 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.

Weight Management


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 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.

General Wellness



Acne is a common and treatable skin condition that causes pimples or “zits” and other skin problems. About 70-90% of teens (girls and guys) will have some kind of acne breakout. Acne most often occurs on the face, back, and chest; however, you can also have acne on your neck, shoulders, upper arms and buttocks (bum).


Acne is caused by clogged pores (also called hair follicles), which are small openings in the skin through which hair grows. Deep inside each follicle is a hair shaft attached to small glands called “sebaceous glands.” These glands make an oily substance called sebum to moisten our hair and skin. When too much sebum is made, it can mix with dead skin cells (that we are constantly shedding) to create a sticky plug, which clogs the hair follicle. This is very common during the teenage years because of normal changes in hormone levels.


  • Squeezing pimples and picking at your skin
  • Tight headbands, helmets or wool hats
  • Greasy lotions, hair products, and oily makeup
  • Grease-filled air in restaurant kitchens — if you work in this type of environment, be sure to wash your face when you get home.
  • Stress. When you’re emotionally stressed your body makes extra hormones that can cause breakouts.
Normal vs clogged hair follicle

Normal vs. clogged hair follicle


Trapped bacteria grow very fast in plugged hair follicles and make chemicals that can cause swelling, redness, and irritation. Eventually the plugged follicle can burst and spill everything – oil, dead skin cells, and bacteria – onto the surrounding skin leading to different types of acne–whiteheads, blackheads, pimples, and cysts.


  • Whiteheads are pores that are bulging with dead skin cells and sebum.
  • Blackheads happen when a clogged pore is open and a chemical reaction causes the surface to darken. The blackhead isn’t dirt, so it can’t be washed away. It’s actually caused from a buildup of melanin-a skin pigment. Rubbing the skin or using harsh cleansers can cause further irritation.
  • Pimples occur when a clogged pore becomes infected by bacteria causing a red, raised bump to appear on the skin. Pimples can have a pus filled top, which is the body’s way of reacting to a bacterial infection. Pimples, also called “zits,” can be tender to the touch.
  • Cysts occur when clogged up pores break under the skin causing bigger and often very painful bumps. If left untreated, these cysts can cause scarring.


According to the Academy of Dermatologists (AAD), acne is the most common skin condition in the United States and 85% of young people between the ages of 12 and 24 will experience at least minor acne. Most teens will get acne sometime during their teenage years, because puberty is the time when there are many hormonal changes. Hormones are chemicals that are responsible for all of the physical changes that happen when you go from being a child to an adult. Teens who have a family history of acne (their parents had acne when they were teens) are more likely to get it, but most teens who get acne will be free of it by the time they are young adults.

Teen girls often complain of acne just before their periods. The medical term for this is called “premenstrual acne” and it’s usually due to the hormones that are active before your period. Some girls are more sensitive to these hormones than others. So even if you’re careful about taking good care of your skin, chances are you may have a mild to moderate breakout before your period. The good news is that once your period is over the acne usually goes away.

Acne is also common in girls who have polycystic ovary syndrome (PCOS). PCOS can cause weight problems, acne, excess hair growth and irregular periods. So check with your health care provider if you have any of the symptoms.


Over-the-counter (no prescription is required) acne medicine that contains benzoyl peroxide (such as Clearasil®, ProActiv® and Oxy®), resorcinol, salicylic acid or sulfur often help with mild acne. Each product works slightly differently. Products come in soaps, cleansing pads, creams, gels, or lotions. Acne preparations may cause a rash or redness. Your skin may sting or burn if the medicine is too strong.


  • Stop the acne medicine if you have any side effects.
  • It can take up to 2-3 months of using a product to see an improvement in your acne.
  • Be careful to keep the medicine away from your eyes, mouth, and inside your nose.
  • Don’t scrub acne too hard or use products that dry your skin too much–these will make acne worse.
  • Makeup and foundation that claim to clear acne while making your pimples less visible may just cover them up. Sometimes the ingredients in some kinds of makeup can actually cause pimples. Look for oil-free, “non-comedogenic” products.
  • If you have been taking good care of your skin for at least 2 months (washed it twice a day, avoided products that can clog pores, and tried nonprescription acne medicine) and you don’t see any improvement (pimples aren’t going away), don’t worry—make an appointment with your health care provider or dermatologist (skin specialist) to talk about stronger (prescription) medicine that may be helpful.


Your health care provider may prescribe products with benzoyl peroxide, retinoid products such as Retin A®, Differin®, Avita®, Tazorac®, and antibiotics such as tetracycline, erythromycin, minocycline, doxycycline, and trimethoprim-sulfamethoxazole (Bactrim).

Benzoyl Peroxide: Health care providers who prescribe this kind of medicine usually tell teens to start out slowly, using it 2-3 times a week and working up to every night. Wash and dry your face completely before applying it. You should use a very small amount-about the size of a pencil eraser. It’s common to have red or dry skin at first. If your skin becomes so dry that it peels, your health care provider will probably tell you to cut down on the number of days a week that you use it. Benzoyl peroxide has a “bleach-like” quality, which means that it may cause white marks on towels, pillowcases, and clothing. Make sure you rinse your face completely after using it so you don’t accidentally bleach any of your clothes! If you are leaving the medication on overnight, sleep on a white pillowcase.

Retinoid products: are very helpful for mild to moderate acne (whiteheads and blackheads). Apply a thin layer of this medicine after you have gently washed and dried your face. People who use this medicine sometimes say that their acne got slightly worse before it got better. To treat moderate to severe acne (pimples, cysts, and scars), your health care provider may prescribe additional medication.

Antibiotics: may be applied directly to your face (lotion or gel) or taken by mouth. In some products, benzoyl peroxide and a topical antibiotic are mixed together. They help treat the bacteria that can cause pimples and cysts. If you’re taking oral antibiotics, follow the instructions on your prescription bottle. Some antibiotics require that you take them on an empty stomach while other kinds say you can take them any time. If you’re taking oral antibiotics, you may get a vaginal yeast infection.

Oral Contraceptive Pills: may be prescribed for moderate to severe acne when over-the-counter and prescription medications don’t work. The hormones in oral contraceptive pills can help stop acne from forming.


If your acne doesn’t get better with over-the-counter medicine or the usual prescription medicines, your primary care doctor or dermatologist may consider prescribing Accutane® (the brand name) or Isotretinoin (the generic name). It’s a pill that is swallowed twice a day for about 15-20 weeks. The exact dose will depend on your body weight. Accutane® is reserved for severe acne (the kind that causes scarring) that doesn’t improve with other treatments.


  • Should NOT HAVE sexual intercourse or SHOULD USE two methods of birth control (if sexually active), including 1 month before starting Accutane®, during treatment, and 1 month after treatment has stopped. Taking Accutane® during pregnancy causes birth defects.
  • Should AVOID THE SUN AND TANNING BEDS. Use 30 SPF sunscreen or higher because of the risk of severe sunburn. That includes tanning beds/booths too! Accutane® and other acne medicine can make your skin burn faster. Sunburns can also make your acne get worse.
  • Should be MONITORED BY THEIR DOCTOR including regular check-ups!

Tips for Taking Care of Your Skin:


  • Wash your skin twice a day (morning and before bed) with a mild soap-free cleanser such as Purpose®, Basis®, or Neutrogena® to remove oil. Having an acne skin regimen is extremely important if you want to get rid of your spots for good!!
  • Wash your face after you exercise and after sweating as oil builds up and can clog pores.
  • Wash your face well after you come in contact with oils or grease such as working in a fast food restaurant. Use your fingertips and a mild cleanser to wash your face instead of a rough facecloth or sponge. Rinse with cool to warm water (not hot).
  • Wash your hands before touching or rubbing your face and try not to rest your chin, cheek, or forehead on your hand. Just think of all of the things you may have touched during the day with your hands! Breaking this habit may help to clear up most of your problem areas.
  • Wash your hair regularly especially if it’s oily. Oil from your hair can make your face and neck extra oily.
  • Use “oil-free” sunscreen when you know you’ll be outside in the sun. Antibiotics and other acne medicine can make your skin burn faster with sun exposure.


  • Don’t scrub your face or use harsh soaps; you can’t scrub acne away but you can make your acne worse if you are too rough when washing your face.
  • Do not use alcohol based cleansing products. Products with a high percentage of alcohol can make your skin very dry and irritated. It actually can cause your body to make more oil that can result in more acne.
  • Don’t pick, pop or squeeze pimples or anything on your face no matter how tempting! All that poking can cause more inflammation and possibly leave you with a scar.
  • Do not use moisturizers or sunscreens that have oil in them. Look for a label that says “oil free” and make sure you use a “facial” moisturizer, not a “body” moisturizer.
  • Keep hair gels, hairspray and other hair products away from your face as they can clog your pores. Wash your face after you use these products to keep oils away.


Asthma is a chronic condition of the lungs that affects how you feel and breathe. It’s not contagious–you can’t get asthma from someone else (like a cold), and you can’t pass it on to anyone else. You can have symptoms that occur every day, weekly, every few months, or hardly at all. Some children seem to outgrow it, but most teens with asthma will continue to have symptoms as an adult. Most importantly with the proper treatment, people with asthma can have normal and active lives.


When you have asthma, the airways in your lungs are swollen and inflamed. The airways are the tubes that carry air in and out of your lungs. When you are exposed to something that irritates the airways, they start to narrow, getting smaller with less air able to move in and out. Muscles in and around the swollen airways get tight and more mucous is made. This causes you to have trouble breathing, with chest tightness, coughing, and sometimes “wheezing”, or a whistling sound when you breathe.


  • Coughing, especially during the night, early morning, when outside in the cold air or while exercising
  • Wheezing that can be heard when you breathe
  • Shortness of breath or trouble breathing
  • Chest tightness or pain which may feel like someone is sitting on your chest or squeezing it

If you have any of these symptoms, talk to your health care provider!

Asthma symptoms can range from mild to severe – from being a little annoying to seriously affecting how you are feeling. When symptoms are severe, asthma can be life threatening.


Studies have shown that asthma usually does not go away, and that the swelling in your lungs actually stays there even when your asthma is not bothering you. This is important to know because you need to pay attention to how you feel and if your breathing changes.

It’s true that some people only have asthma as a child and never seem to have symptoms again. Others can have symptoms their whole lives. Finally, there are other people who have no symptoms for years and then have it bother them again, many years later. It’s important to remember that asthma is a chronic condition, which means it can keep coming back, unlike a common cold which is temporary. As a teen with asthma, you will probably have it as you grow into adulthood.



No one knows for sure what causes asthma, but doctors have found that certain things in the environment can irritate a person’s breathing and cause symptoms. Asthma runs in families, and teens who are overweight are more likely to have asthma. Most teens who are diagnosed with asthma have allergies that can aggravate their breathing.


Triggers are things in the environment that bring on asthma symptoms or “asthma flare-ups” (sometimes called asthma attacks). Some triggers such as pollen will only affect people with asthma during certain seasons and not throughout the year. Others may have symptoms only when they are around a cat, for example.

The following categories and list of “triggers” can cause asthma symptoms for some people.

Allergens (things that you’re sensitive to that cause a type of allergic reaction):

  • Dust mites
  • Animal dander – (which is from skin, fur or feathers of animals)
  • Cockroach and rodent droppings
  • Pollen from trees, grasses, weeds, and flowers
  • Mold and mildew

Irritants (smells and other things that you might inhale (breathe in) through your nose, mouth and into your lungs):

  • Cigarette smoke – both smoke from your own cigarette or someone else’s
  • Strong smells – perfumes, make up, cleaning products, scented candles, fresh paint, room deodorizers, gasoline
  • Chalk dust, wood smoke
  • Air pollutants-smog, diesel fuel and factory emissions


  • Cold air
  • Hot temperatures, humidity or “sticky weather”


  • Sports and other physical activities (such as running) that cause sudden and rapid breathing

Viral infections:

  • Colds and flu or other infections of the nose, throat, lungs, etc. that can cause coughing, sore throat, and/or trouble breathing


The thing about triggers is that one type of trigger (let’s say dust mites) may cause your friend’s asthma symptoms, but another kind of trigger (such as dog dander) may bring on your symptoms. Triggers can vary among people. While taking your medicine and avoiding your triggers is the best way to control asthma and prevent symptoms, you can’t always avoid triggers in the environment.

You can, however, be proactive about certain things such as:

  • If you are allergic to dust, keep your bed and bedroom as dust free as possible. (Carpets, drapes, and stuffed animals collect dust and dust mites – get rid of these items if possible.)
  • Cover your mattress with a protective zippered case to keep dust mites out.
  • Wash your sheets in hot water at least once a week.
  • Vacuum and dust your sleeping and living areas at least once a week.
  • Don’t buy scented health and beauty products or cleaning products with strong scents.
  • Quit if you smoke.
  • Stay in an air conditioned place if the air quality outside is especially bad (on humid/hot days).
  • Get a yearly flu shot.
  • WASH YOUR HANDS often – This is the #1 way to lower your risk of catching colds or the flu.

Try keeping a symptom diary. Jot down what the weather was like, what you were doing, what time of day it was, etc. when you have asthma symptoms. That way, you and your health care provider can better make a plan to control your asthma.


Cigarette Facts and Smoking Cessation Tips


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.


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?”

Cigarette Withdrawal and Recovery


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.





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


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


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


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


Understanding HPV

Human papillomavirus (HPV) is a virus that causes warts. It can be hard to detect, so many people never even know they have it. Some strains (types) of HPV may cause warts on the hands, legs, or other parts of the body. These can spread from person to person. Other strains of HPV cause warts in the genital area. Of these, a few strains can lead to cancer in the area where the uterus and vagina meet (the cervix) and the genitals, as well as some other places. Treating genital forms of HPV now can help prevent serious health problems in the future.

HPV is very common in both men and women and it can’t be cured. But there are treatments to remove warts.

What to look for

Some types of HPV cause warts. Others don’t. You can also have more than one type of HPV at a time. Here are some things to look out for:

  • Painless lumps or bumps. Warts may be bumpy, cauliflower-shaped, or flat. They can appear in or around the genitals or anus.
  • In girls, an abnormal Pap smear. Over time, HPV can cause abnormal cell changes (dysplasia) on the cervix. These increase your chances of getting cervical cancer. If you have an abnormal Pap smear, you may need a follow-up test to look for HPV.

How warts form

HPV lives inside skin and mucous membrane, including in the mouth and vagina. The virus can make skin cells reproduce more often than they should. These extra skin cells build up into warts.

  1. HPV invades the skin.
  2. DNA from the virus enters skin cells.
  3. HPV causes infected skin cells to multiply and form warts.
  4. The virus sheds, allowing it to be passed to others.


Warts can be removed by a doctor. But the virus stays in the body. Both males and females can pass on HPV even when warts aren’t visible. If a female has an abnormal Pap smear, she may have other tests or treatment. Regular checkups can help make sure the cervix is healthy.

If you don’t get treated

HPV can cause cell changes that increase the chance of getting cervical cancer. This health problem can sometimes cause death. If you are sexually active, you may need to be screened for cervical cancer by having a Pap test and an HPV test. At age 21, it’s recommended women have a Pap test. A Pap test can help spot warning signs of cancer early on—when treatments work best. Discuss cervical cancer screening guidelines and tests with your doctor.

HPV can also raise the risk for cancers in boys and men. These cancers include anal, penile, and head and neck cancers. Although boys and men aren’t at risk for cervical cancer, they can pass on HPV to their partners.


An HPV vaccine helps protect both men and women from the types of HPV that are most likely to lead to cancer. Most boys and girls should get the HPV vaccine around age 11 to 12. It can be given as early as age 9. The vaccine is given in two doses, with the second dose 6 to 12 months after the first. Teens ages 15 and older and young adults who missed getting the vaccine should get a 3-dose series. The second dose is given 1 to 2 months after the first dose, and third dose 6 months after the first. Ask your doctor whether this vaccine is right for you.


HPV Vaccine



Genital HPV is a common virus that is passed from one person to another through direct skin-to-skin contact during sexual activity. Most sexually active people will get HPV at some time in their lives, though most will never even know it. HPV infection is most common in people in their late teens and early 20s. There are about 40 types of HPV that can infect the genital areas of men and women. Most HPV types cause no symptoms and go away on their own. But some types can cause cervical cancer in women and other less common cancers — like cancers of the anus, penis, vagina, and vulva and oropharynx. Other types of HPV can cause warts in the genital areas of men and women, called genital warts. Genital warts are not life-threatening. But they can cause emotional stress and their treatment can be very uncomfortable. Every year, about 12,000 women are diagnosed with cervical cancer and 4,000 women die from this disease in the U.S. About 1% of sexually active adults in the U.S. have visible genital warts at any point in time.


HPV vaccination is recommended for 11 and 12 year-old girls. It is also recommended for girls and women age 13 through 26 years of age who have not yet been vaccinated or completed the vaccine series; HPV vaccine can also be given to girls beginning at age 9 years. CDC recommends 11 to 12 year olds get two doses of HPV vaccine to protect against cancers caused by HPV. For more information on the recommendations, please see:


Ideally females should get the vaccine before they become sexually active and exposed to HPV. Females who are sexually active may also benefit from vaccination, but they may get less benefit. This is because they may have already been exposed to one or more of the HPV types targeted by the vaccines. However, few sexually active young women are infected with all HPV types prevented by the vaccines, so most young women could still get protection by getting vaccinated.


The vaccine is not recommended for pregnant women. Studies show that the HPV vaccine does not cause problems for babies born to women who were vaccinated while pregnant, but more research is still needed. A pregnant woman should not get any doses of the HPV vaccine until her pregnancy is completed.

Getting the HPV vaccine when pregnant is not a reason to consider ending a pregnancy. If a woman realizes that she got one or more shots of an HPV vaccine while pregnant, she should do two things:

  • Wait until after her pregnancy to finish any remaining HPV vaccine doses.
  • Call the pregnancy registry [800-986-8999 for Gardasil and Gardasil 9, or  888-825-5249 for Cervarix].


Girls and women do not need to get an HPV test or Pap test to find out if they should get the vaccine. However it is important that women continue to be screened for cervical cancer, even after getting all recommended shots of the HPV vaccine. This is because the vaccine does not protect against ALL types of cervical cancer.


The HPV vaccine targets the HPV types that most commonly cause cervical cancer and can cause some cancers of the vulva, vagina, anus, and oropharynx. It also protects against the HPV types that cause most genital warts. The HPV vaccine is highly effective in preventing the targeted HPV types, as well as the most common health problems caused by them.

The vaccine is less effective in preventing HPV-related disease in young women who have already been exposed to one or more HPV types. That is because the vaccine prevents HPV before a person is exposed to it. The HPV vaccine does not treat existing HPV infections or HPV-associated diseases.


Research suggests that vaccine protection is long-lasting. Current studies have followed vaccinated individuals for ten years, and show that there is no evidence of weakened protection over time.


The vaccine does not protect against all HPV types— so they will not prevent all cases of cervical cancer. Since some cervical cancers will not be prevented by the vaccine, it will be important for women to continue getting screened for cervical cancer. Also, the vaccine does not prevent other sexually transmitted infections (STIs). So it will still be important for sexually active persons to lower their risk for other STIs.


The HPV vaccine has been licensed by the Food and Drug Administration (FDA). The CDC has approved this vaccine as safe and effective. The vaccine was studied in thousands of people around the world, and these studies showed no serious safety concerns. Side effects reported in these studies were mild, including pain where the shot was given, fever, dizziness, and nausea. Vaccine safety continues to be monitored by CDC and the FDA. More than 60 million doses of HPV vaccine have been distributed in the United States as of March 2014.

Fainting, which can occur after any medical procedure, has also been noted after HPV vaccination. Fainting after any vaccination is more common in adolescents. Because fainting can cause falls and injuries, adolescents and adults should be seated or lying down during HPV vaccination. Sitting or lying down for about 15 minutes after a vaccination can help prevent fainting and injuries.


HPV vaccination is not currently recommended for women over age 26 years. Clinical trials showed that, overall, HPV vaccination offered women limited or no protection against HPV-related diseases. For women over age 26 years, the best way to prevent cervical cancer is to get routine cervical cancer screening, as recommended.


HPV vaccine is licensed for use in boys and men. It has been found to be safe and effective for males 9 -26 years. ACIP recommends routine vaccination of boys aged 11 or 12 years with with a series of doses. The vaccination series can be started beginning at age 9 years. Vaccination is recommended for males aged 13 through 21 years who have not already been vaccinated or who have not received all recommended doses. The vaccine is most effective when given at younger ages; males aged 22 through 26 years may be vaccinated. CDC recommends 11 to 12 year olds get two doses of HPV vaccine to protect against cancers caused by HPV.


Health insurance plans cover the cost of HPV vaccines. If you don’t have insurance, the Vaccines for Children (VFC) program may be able to help.


The Vaccines for Children (VFC) program helps families of eligible children who might not otherwise have access to vaccines. The program provides vaccines at no cost to doctors who serve eligible children. Children younger than 19 years of age are eligible for VFC vaccines if they are Medicaid-eligible, American Indian, or Alaska Native or have no health insurance. “Underinsured” children who have health insurance that does not cover vaccination can receive VFC vaccines through Federally Qualified Health Centers or Rural Health Centers. Parents of uninsured or underinsured children who receive vaccines at no cost through the VFC Program should check with their healthcare providers about possible administration fees that might apply. These fees help providers cover the costs that result from important services like storing the vaccines and paying staff members to give vaccines to patients. However, VFC vaccines cannot be denied to an eligible child if a family can’t afford the fee.


Yes, vaccinated women will still need regular cervical cancer screening because the vaccine protects against most but not all HPV types that cause cervical cancer. Also, women who got the vaccine after becoming sexually active may not get the full benefit of the vaccine if they had already been exposed to HPV.


Regular cervical cancer screening (Pap and HPV tests) and follow-up can prevent most cases of cervical cancer. The Pap test can detect cell changes in the cervix before they turn into cancer. The HPV test looks for the virus that can cause these cell changes. Screening can detect most, but not all, cervical cancers at an early, treatable stage. Most women diagnosed with cervical cancer in the U.S. have either never been screened, or have not been screened in the last 5 years.


For those who are sexually active, condoms may lower the chances of getting HPV, if used with every sex act, from start to finish. Condoms may also lower the risk of developing HPV-related diseases (genital warts and cervical cancer). But HPV can infect areas that are not covered by a condom—so condoms may not fully protect against HPV.

People can also lower their chances of getting HPV by being in a faithful relationship with one partner; limiting their number of sex partners; and choosing a partner who has had no or few prior sex partners. But even people with only one lifetime sex partner can get HPV. And it may not be possible to determine if a partner who has been sexually active in the past is currently infected. That’s why the only sure way to prevent HPV is to avoid all sexual activity.


Indoor Tanning (Don’t Do It!)

You probably know that too much sun exposure can be harmful to your skin and may lead to wrinkles and skin cancer, but what about indoor tanning? Since you’re not getting direct exposure from the sun, it has to be safer – right? Wrong! Not only is indoor tanning unsafe, it can actually be worse for you than being out in the sun without sunscreen. The World Health Organization has classified tanning devices as something that can cause cancer in humans. Harmful UV rays also cause wrinkles, age spots and premature aging.


Indoor tanning includes all “artificial” (fake) light sources. Tanning beds or booths give off ultraviolet light called UV rays, which go through many layers of skin. These rays can cause severe damage; including wrinkles, eye damage, and over time can lead to skin cancer. UV rays from tanning devices are classified by the International Agency for Research on Cancer as a “group one carcinogen” – part of the same group that tobacco is in. A carcinogen is something that causes cancer. The special lights used in tanning salons give off as many as 12 times more UV rays than the sun does, so you’re getting a lot more exposure in a shorter amount of time.


Unlike tanning beds or booths, sunless tanners, self-tanning lotions or bronzers don’t harm your skin. Sunless tanning products come in a variety of forms, such as: lotions, sprays, gels and towelettes. These products are usually cheaper compared to the cost of tanning indoors and the color will last about 3-5 days. Look for the seal of approval from the Skin Cancer Foundation. Products with this seal have been reviewed and meet specific criteria that evaluate safety and effectiveness.


Spray Tanning: Spray tanning or sunless tanning can give your skin a tan-like color by using a chemical known as dihydroxyacetone or (DHA). DHA is approved by the Federal Food and Drug Administration (FDA) for EXTERNAL use only. DHA interacts with dead surface cells in the first layer of your skin (epidermis) and darkens the color of your skin, resulting in a fake tan. Typically, the “tan” lasts 5 to 7 days. It’s important to remember that most sunless tanners do not contain SPF, so you’ll need to apply sunscreen before heading outdoors.

Whether a salon offers an automatic self-tanner done by a machine or by hand, be sure that your eyes, nose, mouth, and ears are protected. If the salon does not offer protection such as goggles, ear plugs, etc. find another salon that does. Although the chemicals are considered safe for external use DHA can be dangerous if you inhale or consume it.

Tanning Pills: There are pills sold in some stores that promote a sunless tan. These pills are NOT approved by the FDA, which means that they have not been tested and approved according to the US government standards. These pills contain a harmful chemical known as canthaxanthin which can change the color of the skin anywhere from orange to brown. Canthaxanthin can cause allergic reactions, serious eye problems, nausea, cramping, diarrhea, severe itching welts, and can damage your liver.

If you decide you must have a tan using UV light (even though you know that it comes with serious risks), make sure you follow these safety precautions:

  • Check to see if the staff at the tanning salon know how to set the timer on the tanning equipment based on the manufacturer-recommended exposure times, and know about various skin types and what you need to do to protect your eyes from the UV light.
  • Before tanning, make sure that the bed or booth has a safety power shut-off feature, and know where it is.
  • Always wear protective eye goggles that fit securely. Make sure they aren’t cracked.
  • Clean the tanning bed with a safe disinfectant before and after you use it – the tanning salon should provide the cleaner and paper towels.
  • Don’t buy unlimited tanning packages, even if it seems like a good deal. Limit the number of times you tan. Remember, it takes up to 48 hours for a tan to appear on your skin.
  • Make a list of any medication you are taking, and ask your health care provider if it’s okay to visit a tanning salon. Some medicines cause sensitivity to UV light. For example: Accutane® (used to treat acne), and antibiotics such as Doxycycline will make your skin more sensitive to the UV rays, causing your skin to burn faster.


Everyone has trouble sleeping once in a while. However, some people have more frequent trouble falling asleep or staying asleep to the point where it affects their normal daily life.


The symptoms of insomnia are:

  • Trouble falling asleep
  • Waking up a lot during the night
  • Waking up too early in the morning and not being able to get back to sleep
  • Not feeling rested when you wake up
  • Sleep problems that last at least one month

Insomnia can affect a person even when they’re not sleeping. For example, feeling tired during the day because of lack of sleep can make it hard to go to school or work, drive a car, play sports, or do activities with family and friends.

In addition to feeling tired or exhausted, a person might:

  • Have a hard time concentrating or paying attention
  • Feel grouchy or irritable
  • Be less motivated and make more mistakes at school or work
  • Drive less safely
  • Have more aches and pains and not feel as well physically


Short-term (or acute) insomnia lasts for less than 3 months, and usually happens when something in your life is really bothering you. For example, a person with insomnia might find it hard to fall asleep or to stay asleep if they have a lot of things on their mind or are adjusting to a new environment.

Stressful things that might interfere with sleep include:

  • Moving to a new home, school, or job
  • Getting into arguments with family members or friends
  • Having big tests or projects coming up
  • Anything else in your life that makes you worry a lot

Other times, things that might not seem very stressful can still disrupt your sleep, such as:

  • Consuming caffeine, nicotine, or alcohol
  • Withdrawing from caffeine, nicotine, or alcohol
  • Traveling to a different time zone (jet lag)
  • Working the night shift
  • Traveling to high altitude

Long-term insomnia causes trouble sleeping for months or even years. Long-term insomnia can be caused by:

  • Poor “sleep hygiene,” or bad habits related to sleeping
  • Worry about sleep-this can lead to a cycle of lying in bed worrying about why you are not able to sleep, which makes falling asleep even harder
  • Genetics-people in some families have a harder time with sleep than others
  • Certain medications that affect sleep
  • Alcohol and illegal drugs
  • Some medical conditions or illnesses can make sleeping difficult


Here are some suggestions for ways to improve your “sleep hygiene,” or your habits related to sleep:

During the daytime:

  • Exercise regularly, but not within 3 hours of bedtime
  • Avoid caffeine (found in coffee, energy drinks, some sodas, and chocolate) after lunch time
  • Avoid napping during the daytime unless you’re sick
  • Don’t use your bed for anything other than sleeping (for example, don’t watch TV in bed or use your bed to do schoolwork)

When you’re getting ready for bed:

  • Make sure your bedroom is dark, quiet, and a comfortable temperature
  • Have a small snack so you’re not hungry or too full
  • Avoid upsetting conversations
  • Don’t watch TV, play video games, or use your laptop or phone, because these things stimulate your brain and can make it harder to fall asleep
  • Have a pre-sleep routine, such as taking a warm bath, reading, or meditating just before going to bed

Going to sleep:

  • Go to sleep at the same time every night (including weekends)
  • Try to relax
  • Make sure you are in a comfortable position
  • If you don’t fall asleep within 15-20 minutes, get up and do a quiet activity in a different room like reading or listening to calm music until you feel tired enough to try to sleep again

In the morning:

  • Wake up at the same time each morning-even on weekends (using weekends as times to sleep in will make it hard to fall asleep when the weekdays return)
  • Expose yourself to natural light immediately after you wake up by opening the shades or turning on the lights to help your body adjust to a good schedule


If you’re having trouble sleeping, tell your health care provider (HCP). He or she will likely ask you questions about your sleeping habits, such as:

  • What kinds of things do you do before going to bed? (Watching TV, texting, playing video games, etc.)
  • What time do you go to bed each night?
  • How long does it take you to fall asleep?
  • Do you ever wake up during the night?
  • How many hours of sleep do you usually get?
  • Do you feel rested in the morning?
  • Do you drink any caffeine?
  • Do you smoke?
  • Is there anything in your life that stresses you out?
  • Do you take any medications, vitamins, or supplements?
  • Do you exercise?

Based on your answers to these questions, your HCP will likely be able to tell if you have insomnia, and what can be done to help you. Your HCP may recommend relaxation techniques, other things you can change about your sleep routine, or may prescribe a medication to help you sleep better. Although you may be tempted to try over-the-counter sleep medicine, NEVER do this before talking with your health care provider.


Meningococcal Vaccine

Although meningococcal infections are rare, they are very serious diseases that can cause death. Luckily, there is a vaccine to protect you against many of the meningococcal infections.


The meningococcal vaccine protects against the meningococcal bacteria which can cause serious infections such as meningitis (pronounced men-in-ji-tis), a brain fluid infection, and blood stream infections. The meningococcal vaccines help protect people against the most common types of meningococcal disease that are seen in the United States: Serogroups B, C and Y.

Basically, there are 2 categories or types of meningococcal vaccine. One type protects against Serogroups A, C, W and Y meningitis and another category that protects against Serogroup B meningitis. The Serogroup B (meningococcal) vaccine may be recommended by your health care provider in addition to the vaccine for A, C, W, and Y if there is an outbreak of meningitis, if you work in a lab that studies meningococcal bacteria or if you have certain medical conditions such as a problem with your spleen, or before you go to college.


The vaccine is made up of parts of the meningococcal bacteria that cannot cause infection. When you get the vaccine, your body makes antibodies to fight the meningococcal bacteria. These antibodies then help protect your body from infection if you come in contact with someone who has meningococcal disease.


Most preteens (boys and girls) get a meningococcal vaccine when they are between 11-12 years old. A booster shot is recommended at age 16 or between 16-18.

Other people who should get vaccinated are those who plan to travel to places where meningococcal disease is common (such as certain regions of Africa), people who may have come in contact with meningitis, anyone who has a disorder of their immune system, anyone whose spleen has been damaged or had surgery to remove it, and anyone who studies this disease in a lab.


Yes! Since the meningitis vaccine is thought to be effective for only about five years, you’ll need a booster vaccine about 4- 5 years after you got your first (meningococcal) vaccine. If you were 11 or 12 years old when you were vaccinated (against meningococcal disease), you should have a booster vaccine when you are 16. If you missed your vaccine when you were a preteen, it’s not too late to get vaccinated. Talk with your health care provider. Teens who are at high risk for meningitis should receive a booster shot every 5 years. College freshman living in dormitories who received the MPSV4 (another type of meningococcal vaccine) 5 or more years ago should receive a dose of MCV4.

If you have been in close contact with someone who has been diagnosed with meningococcal disease, it’s important to tell your health care provider. Ask if you had the vaccine and if you need to take antibiotics or another vaccine. This is true even if you have been vaccinated!


It’s very uncommon to have side-effects from vaccines.

The most common side effects are:

  • Redness and/or soreness where the shot was given
  • Mild swelling around the area of the shot
  • Slight fever


Most pre-teens and teens get the meningococcal vaccine without any problems. However, there are some reasons when you should wait or not get it.

You should not get the meningococcal vaccine if you:

  • Have had an allergic or bad reaction to the meningococcal vaccine in the past
  • Have had a serious allergic reaction to any part of the vaccine (for example, the vaccine fluid)
  • Are very sick when you are scheduled to get the shot (call your health care provider and reschedule your appointment)


Yes. It’s a good idea to ask your health care provider about your vaccine history.

Questions to ask may include:

  1. Are there any reasons why I shouldn’t get the meningococcal vaccine?
  2. Do I have any known allergies to any medicine or vaccine?
  3. What should I do if I come in contact with someone who has meningococcal disease?

Check with your health care provider about whether you are immunized and whether you need to take preventive antibiotics or vaccines for meningococcal Type B.



Meningococcal disease is a serious illness and the leading cause of bacterial meningitis in children 2-18 years old (in the United States). Bacterial meningitis infects the covering of the brain and the spinal cord.


The meningococcal bacteria is usually spread by coming in contact with respiratory secretions when an infected person coughs or sneezes or by having contact with saliva (fluid in the mouth) when drinking from a water bottle, sharing cigarettes, and kissing. The bacteria may live in the throat without causing any symptoms, or may cause an infection of the blood or the fluid that surrounds the brain and spinal cord. The most common early symptoms are: high fever, chills, headache, tiredness, stiff neck and later, sensitivity to light, nausea, and vomiting.

According to the Center for Disease Control (CDC), about 1200 people living in the United States will get meningococcal disease each year. Of these people infected with the bacteria, 10-15% will die, (even with treatment). The good news is most types of meningococcal disease can be prevented by getting vaccinated.


Anybody at any age living anywhere can get meningococcal disease; the disease is most common in children younger than 5 years  (infants are particularly at risk), teens 16-21 and people over 65 are at a higher risk. College students or anyone living in crowded living conditions are at a higher risk because the meningococcal bacteria are easily spread from one person to another. About 1000 people become infected with meningococcal disease in the U.S. each year. It is a very serious disease and even with treatment, about 1 in 10 people will die from it. For those who survive, about 20% may have permanent damage such as deafness, seizures, mental retardation, or loss of fingers and toes.


Meningococcal disease is treated with antibiotics such as penicillin. Early treatment is very important! The best form of protection against this serious disease is PREVENTION – getting vaccinated!



Have you ever heard of “the kissing disease”? Mononucleosis (pronounced mon-o-nuke-lee-o-sis, or “mono” for short) got this nickname because people can pass it through their saliva when they kiss. Kissing isn’t the only way you can catch mono, though.


Mono is the name of an infection that is usually caused by the Epstein-Barr virus (EBV). EBV is a very common virus that many people are exposed to when they’re young. The greatest number of people get mono when they are between 15 and 17 years old. Some people with EBV might not have symptoms, but may still carry the virus and infect other people, causing them to develop mono.


Kissing a person that has the Epstein Barr virus (EBV) is just one way of getting mono. There are other ways you can get it, and they all involve coming in contact with body fluids (especially saliva) of someone who has the virus.

The virus can be passed through:

  • A drink (water bottle, cup, etc.)
  • A toothbrush
  • A fork or spoon
  • Lip balm, lip gloss, or lipstick
  • Sexual contact

According to the Center for Disease Control (CDC), viruses that cause mono can also be spread through blood and semen during sexual contact, blood transfusions and organ transplantations. Most often however, mono is spread through saliva.


People who have mono may have different combinations of symptoms, including:

  • Swollen glands (neck and armpits)
  • Fever
  • Sore throat
  • Extreme tiredness/weakness
  • Decreased appetite
  • Headache
  • Sore muscles/body aches
  • Swollen spleen and/or liver (in advanced cases)


Your health care provider (HCP) may suggest that you are likely to have mono based on your symptoms and examination such as sore throat, swollen tonsils with white patches, swollen lymph nodes (in your neck), fever and fatigue. Your liver and spleen may be enlarged and sore, and some people get a rash especially if taking antibiotics such as amoxicillin. To make a diagnosis of mono, your HCP will check your blood count and a special “mono spot test.” This test can be negative the first week of illness and occasionally longer. This test may also stay positive for a year after mono so if your HCP is not sure about whether you have mono, he/she may order a blood test that can show whether you have antibodies against EBV (Epstein Barr Virus) which can cause mono. There are other causes of mono-like illnesses such as HIV, CMV (cytomegalovirus), other viruses, and some drugs.


If you have a fever it will usually go away within 10 days. If you have an enlarged liver or spleen, it will usually become normal in 4-6 weeks. Other mono symptoms go away after 2-4 weeks (the length of time varies for each person), but you may continue to feel very tired for about 3-6 months, or even longer. Research has shown that even when a person (who has had mono) feels better, they can still have the virus in their body for a long time.


Unfortunately there isn’t a medicine or pill that can get rid of mono, but there are things you can to do feel better.

Things you can do to help yourself feel better while you have mono:

  • Get lots of rest
  • Drink plenty of fluids
  • Eat healthy foods
  • Gargle with salt water (but don’t swallow), drink tea with honey, try throat lozenges, or suck on an ice pop if you have a sore throat
  • Ask your health care provider if you can take a small dose of acetaminophen or ibuprofen for pain or fever


You can go back to school when you feel better, which may take a few days to a few weeks. However, you’ll probably still feel tired for a few weeks. Most people get better within a month, but you may need to talk with your teachers or principal if your mono symptoms are severe and are causing you to miss a lot of school. Tell your health care provider (HCP) about all the different types of physical activities you usually participate in. Your HCP will decide what activities are safe for you to do and when. In general, most doctors agree that people who have had mono should not participate in sport activities during the first 3-4 weeks or until you are completely well, to lessen the chance of your spleen (an organ in the body that filters blood) getting hurt.


You can’t always prevent getting mono, but you can lessen your chance by: not sharing your toothbrush, dishes, utensils, and water bottles, and don’t share drinks. If someone you know has mono, be very careful not to share any of these items with them and don’t kiss them either.


To prevent giving the virus to someone else:

  • Cover your mouth if you cough or sneeze
  • Don’t share your food, drinks, eating utensils, tooth brush, or any kind of lip product
  • Don’t kiss while you are sick (mono can spread through saliva)
  • Don’t have sexual contact with someone who has mono

Sun Safety

Most of us enjoy the warm rays of the sun. The sun feels nice on our skin and helps our bodies make vitamin D, which is important for calcium absorption and healthy bones. Yet sun exposure can be harmful to our skin and may lead to wrinkles and skin cancer. Sunburn can happen quickly (within 15 minutes), and skin damage can occur even before your skin turns red. In fact, specialists admit that just one blistering sunburn can double a person’s risk for developing melanoma, a severe type of skin cancer. So, the best way to get enough vitamin D is to take a daily supplement or daily vitamin.


Anyone who spends time in the sun, especially without sunscreen, is at risk of having serious damage to their skin, which includes skin cancer. In fact, the EPA (Environmental Protection Agency) reports that more than 3.5 million new cases of skin cancer are diagnosed each year. Children are particularly at risk.

Some people are at a higher risk due to the following:

  • Fair skin, light colored eyes, blonde or red hair
  • Multiple moles: typically twenty five or more
  • Exposure to UV rays from the sun or indoor tanning beds
  • A history of frequent or severe sunburns
  • A family history of melanoma (a type of skin cancer) or other skin cancers
  • Certain medicines (such as doxycycline) can cause the skin to burn more easily


UVA and UVB rays are types of sunlight that can cause the skin to tan, damage, and burn. Sunburns are particularly harmful to the skin, and there are three types.


First Degree Burn

  • Pinkness to redness
  • Skin that is painful to touch
  • Pain usually lasts 48 to 72 hours and then goes away
  • Peeling Skin

Second Degree Burn

  • Blisters
  • Deep redness
  • Burned area may appear wet and shiny
  • Skin that is painful to touch
  • Burn may be white or discolored in an irregular pattern

Third Degree Burn (Most Severe)

  • Dry and cracked skin
  • Black, white, brown, or yellow skin
  • Swelling
  • Lack of pain (nerve endings destroyed)


You can lower the risk of damage to your skin by doing the following:

  • Find shade. Try to limit time in direct sunlight to 15 minutes or less.
  • Use a sunscreen with an SPF (sun protection factor) of at least 30 or more even on cloudy days. Choose a sunscreen that protects against both UVA and UVB rays. Apply to any part of your skin that might be exposed to the sun, including your scalp.
  • Apply sunscreen (an ounce or enough to cover the palm of your hand) BEFORE you go out in the sun, even on cloudy days. Remember to reapply sunscreen every 2 hours, after swimming, sweating, and toweling off.
  • Limit sun exposure between the hours of 10 am and 2 pm when the sun’s UV rays are the strongest.
  • Cover up with clothing, a hat, and sunglasses that block UVA and UVB light. There are special brands of swimwear and clothing made to block the sun.
  • Avoid tanning beds/booths. Tanning beds/booths use UV light that can damage your skin just as much as the sun’s rays.
  • Check your skin regularly. Know your birthmarks, moles, and, freckles, on your skin. Make an appointment with your health care provider or dermatologist if you notice any changes or have concerns.


  • Do NOT depend on cosmetics with SPF alone, unless you can reapply them every 2 hours
  • Do NOT apply sunscreen to open wounds or rashes such as eczema. Talk with your health care provider to see what products are safe to use


  • If you notice that your skin is getting pink or red, get out of the sun right away so that your skin doesn’t continue to burn
  • Take a cool (but not cold) shower or apply cool washcloths (wet a towel with cool water then squeeze) apply to red sunburned skin
  • Drink lots of water to prevent dehydration
  • Take acetaminophen for pain
  • Keep skin moist with cooling lotion or aloe gel
  • Do NOT pop blisters or pick peeling skin. The skin underneath the blistered or peeling skin may be tender and can become infected


You should see your health care provider or go for emergency care if:

  • You have a fever, headache, chills, confusion, dizziness, or if you feel faint
  • You have swelling of your face, eyes, mouth, etc.
  • You have severe pain that is not relieved with acetaminophen
  • Your sunburn covers a large part of your body
  • You have blisters

Teens and Exercise

  • Children and adolescents should have 60 minutes (1 hour) or more of physical activity daily.
    • Aerobic: Most of the 60 or more minutes a day should be either moderate- or vigorous-intensity aerobic physical activity and should include vigorous-intensity physical activity at least 3 days a week.
      • Aerobic activity is the kind that gets the heart and lungs pumping. Most of kids’ 60 minutes a day should be this type. Good ways to get it include walking to school, hiking, or skateboarding. At least 3 days a week, children should do vigorous aerobic activity, meaning it makes them breathe more heavily than normal. They can run, swim, or do fast-paced dancing.
    • Muscle-strengthening: As part of their 60 or more minutes of daily physical activity, children and adolescents should include muscle-strengthening physical activity on at least 3 days of the week.
      • Muscle strengthening. Three days a week, kids should work their muscles. At any age, they can do activities that use their body weight as resistance — like gymnastics, push-ups, playing tug-of-war, or climbing rocks and trees. With the right coaching, older children and teens can work their muscles with resistance bands or weights.
    • Bone-strengthening: As part of their 60 or more minutes of daily physical activity, children and adolescents should include bone-strengthening physical activity on at least 3 days of the week.
      • Weight-bearing exercise, like jumping, skipping, and running, at least 3 days a week will help them build strong bones.
  • Does all of this sound like a lot? Don’t worry — many types of exercises fall into more than one of the categories, so it shouldn’t be hard to fit them all into your child’s week.
  • It is important to encourage young people to participate in physical activities that are appropriate for their age, that are enjoyable, and that offer variety.

Teens and Athletics


Playing sports is a great way to get the exercise you need while practicing physical skills. It is good for both your body and your mind. It also gives you a chance to make friends, have fun, and compete. But even with all of these benefits, you should be aware of certain health problems that can come with being a female athlete.


Girls who play sports are very active at a time when their bodies are still growing and changing. You may be more likely to injure yourself because your body hasn’t finished developing yet. Intense physical activity also can affect things like hormone levels. Hormones are the chemical messengers in your body. Female hormones, like estrogen and progesterone, help regulate your menstrual period. Estrogen also is needed to help keep your bones strong. Changes in estrogen levels brought on by strenuous physical activity can affect your overall physical development, your period, and bone health.

Some girls who play sports develop an intense focus on their weight. There’s often a lot of pressure from your coach or parents to succeed if you play sports. You may feel responsibility to your teammates. You may feel a need to be “perfect.” This type of thinking can put you at risk of developing bad eating habits (called “disordered eating”).


Disordered eating is an unhealthy way of eating that sometimes happens when people try to lose weight. Examples of disordered eating include the following:

  • Fasting
  • Skipping meals
  • Extreme dieting
  • Making yourself vomit
  • Using diuretics, laxatives, or stimulants

Disordered eating is not the same thing as an eating disorder, such as anorexia nervosa or bulimia, but it can be serious. Disordered eating also puts you at risk of a true eating disorder.


The female athlete triad refers to three problems that often are found together in girls who play sports:

  1. Weight loss or being underweight (often because of disordered eating)
  2. Irregular or missed periods
  3. Low bone mass (weakened bones)


In women, weight, estrogen levels, and bone density are all related. Losing too much weight can reduce how much energy you have to fuel your body’s activities. Drastic weight loss causes you to lose fat, but you also will lose muscle mass. Fat is the tissue in your body that stores energy. If you lose too much fat, your body starts to use muscle for energy instead. Your body also will try to conserve energy by reducing the levels of estrogen in your body. Decreasing estrogen levels can put you at risk of weakened bones and stress fractures. Your immune system also may be affected, and you may get sick more often. In fact, if your body’s systems aren’t working as they should, your athletic performance could suffer.


The following can be warning signs for the female athlete triad or other problems:

  • Irregular or missed periods
  • Changes in weight, especially a lot of weight loss
  • Feeling tired
  • Excessive focus on your weight
  • Feelings of guilt if you don’t exercise
  • Limiting your food intake, fasting, or purging
  • Eating in secret
  • Stress fractures


As a teen, your menstrual cycle may not always be regular, so it can be hard to tell if a change in your cycle is normal or not normal. But there are a few changes in your menstrual cycle that may signal that something is wrong. If you have any of the following changes, see your doctor:

  • You get a period more frequently than every 21 days or the time between periods is longer than 45 days.
  • Your periods last longer than 7 days.
  • Your periods were regular and now are irregular.
  • You haven’t had a period in 3 months.

Sometimes an athlete’s body fat and estrogen levels are so low that she doesn’t start her period. If you are age 14 years, you are an athlete, and you’ve never had a period, it is time to talk to your doctor.


Bone mass is the amount of healthy bone tissue that is in your bones. Having enough bone mass ensures that your bones stay strong. Most of your bone mass is created when you are a child and a teen. It is affected by nutrition and estrogen. Adding bone mass is not something you can do later.

This is where healthy eating comes in. You need to eat enough healthy foods to create energy to grow bone mass. Getting enough nutrition also affects estrogen levels. Estrogen helps keeps bones healthy. If you are having regular periods, your estrogen levels are probably good. But once you start missing periods, your estrogen levels may decrease and bone lossmay occur.

Eating healthy means getting a combination of proteins, carbohydrates, and fats. Every day you should be eating grains, fruits, vegetables, protein, and dairy. Protein provides the nutrients needed to grow and repair muscles. Carbohydrates fuel your daily activity. Fats help your immune system function well, and they help your body use important vitamins.


Yes. Low levels of estrogen can affect your future reproductive health. You may have problems with fertility (your ability to get pregnant) later. Low levels of estrogen can lead to low bone density and osteoporosis. This can lead to fractures (broken bones).


If you have any warning signs of the female athlete triad or other problems, you should talk to your parents and your coach. You also should see your doctor.

Sometimes it is hard to talk to your parents or a coach. You may feel like you cannot change your behavior without disappointing them. It is OK to want to excel, but not at the expense of your health. Your parents and coach should understand this. Your long-term health and safety are the main concerns.

Working together, you, your parents, coach, doctor, and a sports nutritionist can come up with a plan for you to stay healthy and continue to play sports.


In some ways, treating the female athlete triad is easy. It is simply a matter of making sure you’re getting enough caloriesand nutrition to support the amount of physical activity that you do. You may need to eat more healthy foods and maybe spend less time training. Many committed athletes will find it hard to train less, but it is important to try. You may find that your sports performance improves when your nutrition is better and your body is healthier. You also need to weigh enough to have periods to protect your reproductive system and bones. Other ways to keep your bones healthy include getting
1,300 mg of calcium daily from calcium-rich foods and making sure you get 600 international units of vitamin D every day.


Ask your doctor what a healthy weight for you is, and don’t go below that weight. Be sure you are taking in enough calories and eating healthy foods. Make sure you recognize what disordered eating is, and if you start behaving this way, seek help. Pay close attention to your periods, and tell your doctor if you notice changes.


Probably not. Exercise and sports are good for you. But you may have to change your level of activity and your eating habits.


Teens and Sleep

Sleep Deprivation in Teens: A Common Problem

Teens on average need about 8 to 10 hours of sleep at night. But most don’t get the amount of sleep they need. School, friends, homework, activities, television, and the computer may all have a higher priority for a teen than sleep. Sleep deprivation can have serious consequences for a teen’s health and well-being. Here’s how to better understand your child’s sleep needs and what you can do to help.

A teen’s natural sleep rhythms

Teens tend to stay up late and want to sleep late in the morning. This isn’t due to laziness or stubbornness. It’s actually due to natural rhythms of the teen’s body. Body chemicals in teens work to make the teen naturally want to go to bed around midnight or later and wake up in the late morning. Early school start times conflict with these natural body rhythms. And pressures on a teen’s time after school keep him or her from going to bed early to compensate. The result is often a sleep-deprived teen.

Why should I be concerned?

Teens who don’t get enough sleep may have trouble focusing in class and have lower grades than they are capable of. A chronic lack of sleep in teens has been linked with an increased risk of being overweight, developing diabetes or heart disease, and getting infections. Teens who are sleep deprived may fall asleep in class or other inappropriate places. And for teens who are driving, being sleepy can raise the risk of a serious accident.

Signs that your teen needs more sleep

Is your teen sleep deprived? Watch for the following signs:

  • Daytime sleepiness
  • Trouble concentrating or remembering
  • Irritability
  • Need for caffeine or other stimulants to stay awake
  • Need for naps after school
  • Poor grades
  • Trouble sleeping (problems falling asleep or staying asleep)

What you can do

Tips to help your child get more sleep and be more alert during the day:

  • Encourage your teen to get a full night’s sleep on a regular basis. Try to set a regular bedtime. Help your teen avoid staying up late to do homework or study. If extracurricular activities after school are too time-consuming, consider cutting back.
  • Have your teen get up at the same time every morning. Discourage sleeping in on weekends to “catch up on sleep.” This does more harm than good by throwing sleep rhythms off.
  • Limit caffeine intake. Don’t let your child have caffeine after lunchtime.
  • Discourage doing anything in bed other than sleeping, such as reading, writing, eating, watching TV, talking on the phone, or playing videos or other games.
  • Restrict TV and computer use (which can be stimulating) for at least an hour before bedtime. Instead, encourage reading, listening to quiet music, writing in a journal, or other calming activity during this time.
  • Give your teen a warm, noncaffeinated beverage (such as milk) before bed.
  • Make the bedroom conducive to sleep. Take the TV, computer, and phone out of the bedroom. Make sure the bedroom is cool and as dark and quiet as possible.
  • Turn a bright light on in the child’s room in the morning. The bright light helps the body wake up and shuts down production of sleep hormones. Alarm clocks with a light feature are available on the Internet.

When should I call my healthcare provider?

The following can be signs of a more serious problem that can be treated. Let the child’s healthcare provider know if your child:

  • Falls asleep during the day
  • Has leg twitching or moving when trying to fall asleep, or extremely restless sleep
  • Sleepwalks
  • Snores loudly
  • Has insomnia (trouble falling asleep or staying asleep) often