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Menstruation is a woman's monthly bleeding. It is also called menses, menstrual period, or period. When a woman has her period, she is menstruating. The menstrual blood is partly blood and partly tissue from the inside of the uterus (womb). It flows from the uterus through the small opening in the cervix, and passes out of the body through the vagina. Most menstrual periods last from three to five days.
Menstruation is part of the menstrual cycle, which helps a woman's body prepare for the possibility of pregnancy each month. A cycle starts on the first day of a period. The average menstrual cycle is 28 days long. However, a cycle can range anywhere from 23 days to 35 days.
The parts of the body involved in the menstrual cycle include the brain, pituitary gland, uterus and cervix, ovaries, fallopian tubes, and vagina. Body chemicals called hormones rise and fall during the month and make the menstrual cycle happen. The ovaries make two important female hormones, estrogen and progesterone. Other hormones involved in the menstrual cycle include follicle-stimulating hormone (FSH) and luteinizing hormone (LH), made by the pituitary gland.
In the first half of the menstrual cycle, levels of estrogen rise and make the lining of the uterus grow and thicken. In response to follicle-stimulating hormone, an egg (ovum) in one of the ovaries starts to mature. At about day 14 of a typical 28-day cycle, in response to a surge of luteinizing hormone, the egg leaves the ovary. This is called ovulation.
In the second half of the menstrual cycle, the egg begins to travel through the fallopian tube to the uterus. Progesterone levels rise and help prepare the uterine lining for pregnancy. If the egg becomes fertilized by a sperm cell and attaches itself to the uterine wall, the woman becomes pregnant. If the egg is not fertilized, it either dissolves or is absorbed into the body. If pregnancy does not occur, estrogen and progesterone levels drop, and the thickened lining of the uterus is shed during the menstrual period.
In the illustration below, an egg has left an ovary after ovulation and is on its way through a fallopian tube to the uterus.
During the menstrual period, the thickened uterine lining and extra blood are shed through the vaginal canal. A woman's period may not be the same every month, and it may not be the same as other women's periods. Periods can be light, moderate, or heavy, and the length of the period also varies. While most menstrual periods last from three to five days, anywhere from two to seven days is considered normal. For the first few years after menstruation begins, periods may be very irregular. They may also become irregular in women approaching menopause. Sometimes birth control pills are prescribed to help with irregular periods or other problems with the menstrual cycle.
Sanitary pads or tampons, which are made of cotton or another absorbent material, are worn to absorb the blood flow. Sanitary pads are placed inside the panties; tampons are inserted into the vagina.
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Women can have various kinds of problems with their periods, including pain, heavy bleeding, and skipped periods.
Amenorrhea - the lack of a menstrual period. This term is used to describe the absence of a period in young women who haven't started menstruating by age 16, or the absence of a period in women who used to have a regular period. Causes of amenorrhea include pregnancy, breastfeeding, and extreme weight loss caused by serious illness, eating disorders, excessive exercising, or stress. Hormonal problems (involving the pituitary, thyroid, ovary, or adrenal glands) or problems with the reproductive organs may be involved.
Dysmenorrhea - painful periods, including severe menstrual cramps. In younger women, there is often no known disease or condition associated with the pain. A hormone called prostaglandin is responsible for the symptoms. Some pain medicines available over the counter, such as ibuprofen, can help with these symptoms. Sometimes a disease or condition, such as uterine fibroids or endometriosis, causes the pain. Treatment depends on what is causing the problem and how severe it is.
Abnormal uterine bleeding - vaginal bleeding that is different from normal menstrual periods. It includes very heavy bleeding or unusually long periods (also called menorrhagia), periods too close together, and bleeding between periods. In adolescents and women approaching menopause, hormone imbalance problems often cause menorrhagia along with irregular cycles. Sometimes this is called dysfunctional uterine bleeding (DUB). Other causes of abnormal bleeding include uterine fibroids and polyps. Treatment for abnormal bleeding depends on the cause.
Menarche is another name for the beginning of menstruation. In the United States, the average age a girl starts menstruating is 12. However, this does not mean that all girls start at the same age. A girl can begin menstruating anytime between the ages of 8 and 16. Menstruation will not occur until all parts of a girl's reproductive system have matured and are working together.
Women usually continue having periods until menopause. Menopause occurs around the age of 51, on average. Menopause means that a woman is no longer ovulating (producing eggs) and therefore can no longer become pregnant. Like menstruation, menopause can vary from woman to woman and may take several years to occur. Some women have early menopause because of surgery or other treatment, illness, or other reasons.
You should consult your health care provider for the following:
Sanitary napkins (pads) should be changed as often as necessary, before the pad is soaked with menstrual flow. Each woman decides for herself what is comfortable. Tampons should be changed often (at least every 4-8 hours). Make sure that you use the lowest absorbency of tampon needed for your flow. For example, do not use super absorbency on the lightest day of your period. This can put you at risk for toxic shock syndrome (TSS). TSS is a rare but potentially deadly disease. Women under 30, especially teenagers, are at a higher risk for TSS. Using any kind of tampon - cotton or rayon of any absorbency - puts a woman at greater risk for TSS than using menstrual pads. The risk of TSS can be lessened or avoided by not using tampons, or by alternating between tampons and pads during your period.
The Food and Drug Administration (FDA) recommends the following tips to help avoid tampon problems:
If you experience any of the following symptoms while you are menstruating and using tampons, you should contact your health care provider immediately:
Yeast infections are a common cause of irritation of the vagina and vulva (area around the opening to the vagina). About 75 percent of women have a vaginal yeast infection during their lives.
A kind of fungus called Candida causes vaginal yeast infections. It is normal to have some yeast in your vagina. Usually yeast is in balance with other organisms. But sometimes the balance is lost, and yeast overgrowth occurs. Hormonal changes can affect the acidity of the vagina and lead to yeast overgrowth. Another common cause of yeast infections is taking antibiotics.
Symptoms of vaginal yeast infections in women may be mild or very uncomfortable. Symptoms may include:
Conditions that may make yeast infections more likely include:
Yeast infections seem to be only rarely passed from one person to another through sexual contact. A male partner of a woman with a yeast infection usually will have no symptoms, but some men may get an itchy rash on the penis.
Your health care provider will examine you and use a swab to take a sample from the affected area. A lab test of the sample will show if yeast is the cause of your symptoms.
Yeast infections are treated with antifungal drugs, such as clotrimazole or miconazole. There are creams and tablets used in the vagina, skin ointments, and pills.
Antifungal drugs usually work well to treat a vaginal yeast infection. But infections that do respond to treatment are becoming more common. Taking antifungal drugs when they are not needed can help make yeast resistant to the drugs. For this reason, you should not use antifungal drugs unless you are sure that you have a yeast infection.
If you are sure that you have a yeast infection, you can buy over-the-counter products to treat the infection. Be sure to follow the directions for using the product. If you are not sure whether you have a yeast infection or another type of infection or problem, you should see your health care provider. You should also see your health care provider if you have recurring yeast infections.
Don't use douches, perfumed vaginal sprays, or other scented products that irritate the vagina. Wear cotton underpants and pantyhose with a cotton crotch to help keep the genital area ventilated. If you have a problem with recurring yeast infections, ask your health care provider about ways to prevent them.
BV is a type of vaginal infection that any woman can get. Chances are you have heard more about yeast infections than BV, but BV (not yeast) is the most common type of vaginal infection in women of childbearing age. BV is often confused with yeast infections they are not the same thing and they require different types of treatment. BV is linked to normal bacteria (germs) in the vagina getting out of balance. All women have mostly "good" and some "harmful" bacteria present in their vaginas. When harmful bacteria in the vagina increase, or overgrow, BV can develop. Yeast infections are caused by the yeast Candida, which also overgrows when the normal balance of the vagina becomes disturbed.
The main sign of BV is vaginal discharge (fluid from the vagina) with a fish-like odor. Some women say the odor is stronger after having sex. The discharge can be white (milky) or gray and it can be thin. Burning or pain when urinating can occur. While not common, itching around the outside of the vagina and redness can also occur. It is important to know, though, that many women with BV have no symptoms at all.
Any woman can get BV. While not much is known about how a woman gets BV, some things can upset the normal balance of bacteria in the vagina and put women more at risk:
The only way to know for sure if you have BV is to have a lab test. Your health care provider will take a sample of fluid from your vagina and send it to a lab to check for bacterias that are linked to BV.
In most cases, BV doesn't cause any problems. But, there can be some serious risks when a woman has BV:
BV is treated with antimicrobial medicines you get from your doctor, such as metronidazole or clindamycin. Both of these drugs can be used when you are pregnant. The dosage (or amount of the drug) will differ when you are pregnant. Women who are HIV positive and have BV get the same treatment as women who are HIV negative.
Most of the time, male sex partners of women with BV are not treated. But, your doctor might want to treat the man if the woman's infection is not cleared up with drugs. Many women don't get treated for BV. But, BV will not go away on its own and must be treated to relieve symptoms and prevent problems such as PID. It is important to know that you can get BV again.
Even though much is not known or understood about BV, it has been linked with sexual intercourse. Having BV can increase your chances of getting infected with HIV or other STDs. Here are some things you can do to lower your risk for getting an STD:
If you have BV:
Sometimes a person may be too scared or embarrassed to ask for information or help. But, keep in mind most STDs are easy to treat. Early treatment of STDs is important. The quicker you seek treatment, the less likely the STD will cause you severe harm. And the sooner you tell your sex partners about having an STD, the less likely they are to spread the disease to others (because they can get treated).
Doctors, local health departments, and STD and family planning clinics have information about STDs. The American Social Health Association (ASHA) has free information and keeps lists of clinics and doctors who provide treatment for STDs. Call ASHA at (800) 227-8922. You can get information from the phone line without leaving your name.
Douching is rinsing or cleaning out the vagina (also called the birth canal) by squirting water or other solutions (such as vinegar, baking soda, or douching solutions you can buy at drug and grocery stores) into the vagina. The water or solutions are held in a bottle and squirted into the vagina through tubing and a nozzle.
Douching is a practice that is thought to have been around since ancient times. Reasons women have given for using douches include to: rinse away blood after a menstrual period; clean the vagina after sex to avoid sexually transmitted diseases (STDs) and wash away semen to prevent pregnancy; and reduce odors.
Douching is a common practice among women in the United States. 37% of American women between the ages of 15 to 44 douche regularly. Of these women, about half douche on a weekly basis.
Health care providers do not recommend douching to clean the vagina. Douching changes the delicate chemical balance in the vagina (and the vaginal flora), which can make a woman more prone to bacterial infections. It also can spread existing vaginal or cervical infections up into the pelvic organs (uterus, fallopian tubes, and ovaries).
Research shows that women who douche on a routine basis tend to have more problems than women who do not douche or who rarely douche. These problems include vaginal irritation, infections (called bacterial vaginosis or BV), and sexually transmitted diseases (STDs). Women who douche often are also more at risk for getting pelvic inflammatory disease (PID). PID is an infection of a woman's pelvic organs. It is caused by bacteria, which can travel from a woman's vagina and cervix up into her pelvic organs. If left untreated, PID can lead to infertility (not being able to get pregnant) and ectopic pregnancy
(pregnancy in the fallopian tube instead of the uterus). Both BV and PID can lead to serious problems during pregnancy, such as infection in the baby, problems with labor, and early delivery.
Douching after sex does not prevent pregnancy. But, research has shown that douching may affect a woman's ability to get pregnant. In women trying to become pregnant, those who douched the most often (more than once per week) had the lowest pregnancy rate. Other research has shown a link between frequent douching and having low birth-weight babies. Studies also show that douching greatly increases the chance of ectopic pregnancy, which can be a life-threatening condition. Ectopic pregnancy is when the fertilized egg attaches inside of the fallopian tube instead of in the uterus.
Because the chemical balance of the vagina is very sensitive, it is best to let the vagina clean itself. The vagina takes care of cleaning itself naturally through secretions of mucous. Warm water and gentle, unscented soap during the bath or shower is the best way to clean the outside areas of the vagina. Products like feminine hygiene soaps, powders and sprays are not necessary, and may be harmful.
It is important to see your health care provider right away when you have any vaginal pain, itching, burning, or a foul odor; pain when urinating; a vaginal discharge that is not normal, such as thick and white (like cottage cheese) or yellowish-green. You may have a yeast infection, urinary tract infection, or bacterial infection, all of which can be treated. Do not clean the vagina or douche before an exam with a health care provider. This will wash away the vaginal discharge, which helps the health care provider to determine the type of infection.
Uterine fibroids are tumors or growths, made up of muscle cells and other tissues that grow within the wall of the uterus (or womb). Although fibroids are sometimes called tumors, they are almost always benign (not cancerous). The medical term for fibroids is uterine leiomyomata (you-ter-in lie-oh-my-oh-mah-tah). Fibroids can grow as a single growth or in clusters (or groups). Their size can vary from small, like an apple seed (or less than one inch), to even larger than a grapefruit, or eight inches across or more.
Uterine fibroids are the most common, benign tumors in women of childbearing age, but no one knows exactly what causes them. They can be frustrating to live with when they cause symptoms. Not all women with fibroids have symptoms, but some have pain and heavy menstrual bleeding. Fibroids also can put pressure on the bladder, causing frequent urination.
More research is being done to figure out who is at risk for fibroids. But it is known that:
Doctors put fibroids into three groups based on where they grow, such as just underneath the lining of the uterus, in between the muscles of the uterus, or on the outside of the uterus. Most fibroids grow within the wall of the uterus. Some fibroids grow on stalks (called peduncles) that grow out from the surface of the uterus, or into the cavity of the uterus.
Most fibroids do not cause any symptoms, but some women with fibroids can have:
No one knows for sure what causes fibroids. Researchers have some theories, but most likely, fibroids are the result of many factors interacting with each other. These factors could be hormonal (affected by estrogen levels), genetic (running in families), environmental, or a combination of all three. Because no one knows for sure what causes fibroids, we also don't know what causes them to grow or shrink. For the most part, fibroids stop growing or shrink after menopause. But, this is not true for all women with fibroids.
Fibroids are almost always benign, or not cancerous, and they rarely turn into cancer (less than 0.1 percent of cases). Having fibroids does not increase a woman's chances of getting cancer of the uterus.
Your doctor may find that you have fibroids when you see her or him for a regular pelvic exam to check your uterus, ovaries, and vagina. Often, a doctor will describe how small or how large the fibroids are by comparing their size to the size your uterus would be if you were pregnant. For example, you may be told that your fibroids have made your uterus the size it would be if you were 8 weeks pregnant.
Your doctor can do imaging tests, or tests that create a "picture" of the inside of your body without surgery, in order to confirm that you have fibroids. These tests might include:
Besides imaging tests, you also might need a surgery to know for sure if you have fibroids. These could include:
Talk with your doctor about the best way to treat your fibroids. She or he will consider a number of things before helping you choose a treatment. Some of these things include:
If you have fibroids, but do not have any symptoms, you may not need any treatment. But your
doctor will check during your regular exams to see if they have grown.
If you have fibroids and have mild symptoms, your doctor might only suggest pain medication. Over-the-counter anti-inflammatory drugs, such as ibuprofen, or other painkillers such as acetaminophen can be used for mild pain. If pain becomes worse, your doctor can prescribe a stronger painkiller.
Other drugs used to treat fibroids are called gonadotropin releasing hormone agonists
(GnRHa). These drugs can decrease the size of the fibroids. Sometimes they are used before surgery, to
shrink the fibroids, making them easier to remove. Side effects can include hot flushes, depression, not
being able to sleep, decreased sex drive, and joint pain. Anti-hormonal agents, such as a drug called
mifepristone, also can stop or slow the growth of fibroids. These drugs only offer temporary relief from the
symptoms of fibroids; once you stop the therapy, the fibroids often grow back.
If you have fibroids with moderate or severe symptoms, surgery may be the best way to treat them. Here are the options:
Myomectomy - a surgery to remove fibroids without taking out the healthy tissue of the uterus. There are many ways a surgeon can perform this procedure. It can be major surgery (with an abdominal incision) or minor surgery. The type, size, and location of the fibroids will determine what type of procedure will be done. Talk with your doctor about the different types of this surgery.
Hysterectomy - a surgery to remove the uterus. This surgery is the only sure way to cure uterine fibroids. This surgery is used when a woman's fibroids are large, or if she has heavy bleeding, and is either near or past menopause and does not want children. There are various types of hysterectomy that differ in how invasive they are. Sometimes, if the fibroids are large, a woman might need a hysterectomy that involves cutting into the abdomen to remove the uterus. If the fibroids are smaller, the surgeon might be able to reach the uterus through the vagina, instead of making a cut in the abdomen.
Endometrial ablation the endometrial lining of the uterus is destroyed. This surgery controls very heavy bleeding, but afterwards a woman cannot have children.
Mylosisa procedure in which an electrical needle is inserted into the uterus through a small
incision in the abdomen to destroy the blood vessels feeding the fibroids.
Uterine fibroid embolization (UFE) is a treatment that cuts off the blood supply to the uterus and the fibroids so they shrink. UFE is proving to be an alternative to hysterectomy and myomectomy. The recovery time is also shorter, and there is a much lower risk of needing a blood transfusion than for these surgeries. Many women can have UFE and go home the same day. There is a small risk of infection in the treated fibroid, but these are usually managed with antibiotics. Recent studies also suggest that most fibroid tumors are not likely to re-grow after UFE, although more long-term data is needed.
Not all fibroids can be treated with UFE. All patients must first be evaluated with ultrasound or MRI to make sure the fibroids will respond well to this treatment. Doctors called interventional radiologists perform UFE. The best candidates for UFE are women who:
Sometimes after UFE, the particles that are put into the fibroids to cut off their blood supply have traveled to the ovaries. In a few women, the ovaries then stop working for a short time or permanently. Although researchers know that UFE may affect how ovaries function, they are unsure of how exactly UFE affects fertility. If you want to have children in the future, you should talk with your doctors about the small, but definite risk of UFE causing you to go into early menopause. Too few women have gotten pregnant after UFE for researchers to know if there is an increased risk of pregnancy complications.
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The ovaries are the organs that produce the eggs in the female reproductive system. Polycystic ovary syndrome (PCOS) is a syndrome in which the ovaries are enlarged and have several fluid-filled sacs or cysts. These cysts may look like a string of pearls or a pearl necklace. A woman can develop one cyst or many cysts. Polycystic ovaries are usually 1.5 to 3 times larger than normal. Women with PCOS may experience a number of other symptoms as well. PCOS is a leading cause of infertility and is the most common reproductive syndrome in women of childbearing age.
An estimated five to 10% of women of childbearing age have PCOS (ages 20-40). At least 30% of women have some symptoms of PCOS.
Eggs grow, develop, and mature in the ovaries and then are released during ovulation, part of the monthly menstrual cycle that occurs during the childbearing years. Ovarian cysts are fluid-filled sacs that form on the ovaries when the follicles (sacs) on the ovary that contain the egg mature, but do not release the egg into the fallopian tube where it would be fertilized.
This is an area of disagreement among medical professionals. While most women with PCOS have polycystic ovaries, some doctors will diagnose a woman with PCOS based on other physical symptoms or hormone abnormalities.
What are the other symptoms of PCOS?
Some of the other symptoms of PCOS include:
No one knows the exact cause of PCOS, but studies are looking at whether it is caused by genetics. Also, because many women with PCOS also have diabetes, studies are examining the relationship between PCOS and the body's ability to produce insulin. There is a lot of evidence that high levels of insulin contribute to increased production of androgen, which worsens the symptoms of PCOS. Lastly, the medication valproate, used to treat seizures may cause or worsen the symptoms of PCOS. Switching medications seems to help the condition.
Diagnosing PCOS involves several steps. Your doctor will take a detailed medical history about your menstrual cycle and reproductive history, including information about methods of birth control and pregnancies. You also will receive a pelvic and physical exam. During a pelvic exam, the doctor is able to feel the swelling of the cysts on your ovary. Once cysts are found, the doctor may perform a vaginal ultrasound, or a screening to examine the cysts and the endometrium (lining of the uterus). If your doctor suspects you have PCOS, he or she may recommend having blood tests to measure hormone levels. Women with PCOS can have high levels of hormones, such as testosterone. Your doctor also may test your insulin and glucose levels, to look for diabetes or insulin resistance (inefficient use of insulin in the body). Many women with PCOS have these conditions. Lastly, your doctor may test your levels of cholesterol and triglycerides since they often are abnormal in women with PCOS. Once your doctor makes a diagnosis, you will work together to decide how to best treat and manage your condition.
PCOS can negatively affect fertility since it can prevent ovulation. Some women with PCOS have menstrual periods, but do not ovulate. A woman with PCOS may be able to take fertility drugs, such as Clomid, or injectable fertility medications to induce ovulation. To help ovulation occur, women also can take insulin-sensitizing medications or steroids (to lower androgen levels). Some research also shows that taking low doses of aspirin, which helps prevent blood clotting in the uterine lining and improves blood flow, can improve chances of pregnancy.
There appears to be a higher rate of miscarriage in women with PCOS (possibly by 45%). The reason for this is being studied. Elevated levels of leuteinizing hormone, which aids in secretion of progesterone, may play a role. Elevated levels of insulin and glucose may cause problems with development of the embryo. Insulin resistance and late ovulation (after day 16 of the menstrual cycle) also may reduce egg quality, which can lead to miscarriage. The best way to prevent miscarriage in women with PCOS is to normalize hormone levels to improve ovulation, and normalize blood sugar, glucose, and androgen levels. Recently, more doctors are prescribing the drug metformin to help with this.
Since PCOS causes high glucose levels, it can be helpful for pregnant women with PCOS to have earlier screenings for gestational diabetes during pregnancy. Gestational diabetes occurs when a woman's ability to process glucose is impaired. The baby also has trouble processing glucose, which can lead to a large baby, immature lungs, and birthing problems. Although a carefully balanced diet and/or insulin injections have been used to control gestational diabetes, there is new evidence that high insulin levels also can be damaging. Some doctors allow pregnant women with PCOS to continue taking metformin in pregnancy, while others won't prescribe it to women trying to conceive. There is no evidence that it causes birth defects, but the long-term effects on the baby are not known. Women and their doctors should discuss the risks and benefits of medications. Women taking medication usually are monitored more closely. After pregnancy, many women with PCOS develop normal menstrual cycles and find it easier to become pregnant again.
Women with PCOS can be at an increased risk for developing several other conditions.
Irregular menstrual periods and the absence of ovulation cause women to produce estrogen, but not progesterone. Without progesterone, which causes the endometrium to shed each month as a menstrual period, the endometrium may grow too much and undergo cell changes. This is a pre-cancerous condition called endometrial hyperplasia. If the thickened endometrium is not treated, over a long period of time it may turn into endometrial cancer. PCOS also is linked to other diseases that occur later in life, such as insulin resistance, Type II diabetes, high cholesterol, hardening of the arteries (atherosclerosis), high blood pressure, and heart disease.
Depression or mood swings also are common in women with PCOS. Although more research is needed to find out about this link, there are studies linking depression to diabetes. Therefore, in PCOS, depression may be related to insulin resistance. It also could be a result of the hormonal imbalances and the cosmetic symptoms of the condition. Acne, hair loss, and other symptoms of PCOS can lead to poor self-esteem. Infertility and miscarriages also can be very stressful. Medications that restore the balance to hormone levels or antidepressants can help these feelings.
Because there is no cure for PCOS, it needs to be managed to prevent further problems. There are many medications to control the symptoms of PCOS. Doctors most commonly prescribe the birth control pill for this purpose. Birth control pills regulate menstruation, reduce androgen levels, and help to clear acne. Your doctor will talk to you about whether the birth control pill is right for you and which kind to take. Other drugs can help with cosmetic problems. There also are drugs available to control blood pressure and cholesterol. Progestins and insulin-sensitizing medications can be taken to induce a menstrual period and restore normal cycles. Eating a balanced diet low in carbohydrates and maintaining a healthy weight can help lessen the symptoms of PCOS. Regular exercise helps weight loss and also aids the body in reducing blood glucose levels and using insulin more efficiently.
Although it is not recommended as the first course of treatment, surgery called ovarian drilling is available to treat PCOS. This involves laparoscopy, which is done under general anesthesia on an outpatient basis. A very small incision is made above or below the navel, and a small instrument that acts like a telescope is inserted into the abdomen. During laparoscopy, the doctor then can make punctures in the ovary with a small needle carrying an electric current to destroy a small portion of the ovary. The success rate is less than 50% and there is a risk of developing adhesions or scar tissue on the ovary.
Endometriosis is a common disease that can affect any menstruating woman from the time of her first period to menopause. Sometimes, the disease can last after menopause. There is no cure for endometriosis and it can be hard for a health care provider to figure out if a woman has it. It can also be hard to figure out the best way to treat it if a woman has the disease. Endometriosis can affect a woman in many ways, such as her ability to work and have children, and her relationships with her partner, children, friends, and co-workers. Researchers are working to find out both causes and ways to manage this disease, so that women who have it can lead full lives.
When a woman has endometriosis, the tissue that lines her uterus, called the endometrium, grows outside of the uterus. No one is sure why this happens. When this tissue grows outside of the uterus, it is mostly found in the pelvic cavity, usually in one or more of these places: on or under the ovaries, behind the uterus, on the tissues that hold the uterus in place, or on the bowels or bladder. In very rare cases, endometriosis areas can grow in the lungs or other parts of the body.
As the tissue grows, it can develop into growths, also called tumors or implants. These growths are usually benign (not cancerous) and rarely are associated with cancer. Growths can cause mild to severe pain, infertility (not being able to get pregnant), and heavy periods.
The endometriosis growths are affected by the monthly menstrual cycle. Each month, the lining of the uterus thickens to get ready for pregnancy. If a woman does not become pregnant, the lining of the uterus sheds and the woman bleeds. When a woman has endometriosis, the growths outside of the uterus also bleed during her period. But there is no way for the blood to leave her body, and inflammation and scar tissue can develop. Blockage or bleeding in the intestines and problems with bladder function may also occur.
A common symptom of endometriosis is pain, mostly in the abdomen, lower back, and pelvic areas. The amount of pain a woman feels is not linked to how much endometriosis she has. Some women have no pain even though their disease affects large areas, or there is scarring. Some women, on the other hand, have severe pain even though they have only a few small areas of endometriosis.
General symptoms of endometriosis can include (but are not limited to):
Also, women who have endometriosis may have gastrointestinal symptoms that are like those of a bowel disorder, as well as fatigue.
If you think you might have this disease, talk with your OB/GYN (obstetrician/gynecologist), since she or he is the only type of doctor trained to look for this condition. There are a number of tests a doctor can perform to try to find out if you have endometriosis. Sometimes, imaging tests are used to make a "picture" of the inside of the body, which allows a doctor to locate larger endometriosis areas. The two most common imaging tests are ultrasound, a machine that uses sound waves to make the picture, and magnetic resonance imaging (MRI), a machine that uses magnets and radio waves to make the picture.
The only way to know for sure if you have endometriosis is to have a laparoscopy. This is a surgery with general anesthesia in which a tube with a light is placed inside your abdomen. The surgeon can then check your organs and see any growths or tissue from endometriosis. This procedure will show the location, extent, and size of the growths and help you and your doctor make better treatment decisions. Before surgery, you will need to discuss your medical history with your doctor, and have a physical (pelvic) exam.
No one knows for sure what causes this disease. One theory is that during menstruation some of the menstrual tissue backs up through the fallopian tubes into the abdomen, where it implants and grows. Another theory suggests that endometriosis may be genetic, or runs in families.
Researchers also are looking at the role of the immune system and how it either stimulates or reacts to endometriosis. It may be that a woman's immune system does not remove the menstrual fluid in the pelvic cavity properly, or the chemicals made by areas of endometriosis may irritate or promote growth of more areas. Results from a recent study showed that women who have the disease are more likely than other women to have immune system disorders in which the body attacks its own tissues. This study also found that women with endometriosis are more likely to have chronic fatigue syndrome and to suffer from fibromyalgia syndrome - a disease involving pain in the muscles, tendons, and ligaments. These women also are more likely to have asthma, allergies, and the skin condition eczema. So, researchers feel that further study of the immune system in endometriosis may give important clues to finding the causes of and treatment for the disease.
Other researchers are looking into endometriosis as a disease of the endocrine system, the body's system of glands, hormones, and other secretions, since estrogen appears to promote the growth of the disease. Other research is looking at whether environmental agents, such as exposure to man-made chemicals, cause the disease. More research is trying to understand what, if any, factors affect the course of the disease.
Another important area of research is the search for endometriosis markers. These markers are substances in the body made by or in response to the disease, and can be measured in the blood or urine. If markers are found by a blood or urine test, then a diagnosis for endometriosis could be made without surgery.
There is no cure for endometriosis. But there are many treatments, each of which has pros and cons. It is important to build a good relationship with your doctor, so you can decide what option is best for you.
For some women with mild symptoms, no further treatment other than medication for pain may be needed. For women with minimal endometriosis who want to become pregnant, doctors are saying that, depending on the age of the woman and her amount of pain from the disease, the best thing to do is to have a trial period of unprotected sex for six months to one year. If she does not get pregnant in that time, then further treatment may be needed.
For patients who do not wish to become pregnant, but need treatment for their disease, their doctors may suggest hormone treatment. Hormone treatment is most effective when growths are small. Hormones can come in pill form, by shot or injection, or in a nasal spray. There are several hormones used for this treatment including a combination of estrogen and progestin such as birth control pills, a progestin alone, Danocrine (a weak male hormone), and GnRH agonists (gonadotropin releasing hormone).
Birth control pills control the growth of the tissue that lines the uterus and often decrease the amount of menstrual flow. They usually contain two hormones, estrogen and progestin. Once a woman stops taking them, the ability to become pregnant returns, but the symptoms of endometriosis also may return. Some women take birth control pills continuously, without using the sugar pills that signal the body to go through menstruation. When birth control pills are taken in this way, the menstrual period may stop altogether, which can reduce pain or get rid of it entirely. Some birth control pills contain only progestin, a progesterone-like hormone. Women who can't take estrogen use these pills to reduce menstrual flow. With these pills, some women may not have pain for several years after stopping treatment. All birth control pills might cause some mild side effects like weight gain, bleeding between periods, and bloating.
Danocrine has become a more common treatment choice than either progestin or combination hormone pills. Side effects with Danocrine include oily skin, pimples or acne, weight gain, muscle cramps, tiredness, smaller breasts, breast tenderness, headaches, dizziness, weakness, hot flashes, or a deepening of the voice. Women on Danocrine probably will only get a period now and then, or might not get it at all. Women who take Danocrine also should take steps to prevent pregnancy because it can harm a baby growing in the uterus. Because other hormones, like birth control pills, should be avoided, health care providers recommend that you use condoms, a diaphragm, or other "barrier" methods to prevent pregnancy.
GnRH agonists (used daily in a nose spray, or as an injection given once a month or every three months) prevent the body from making certain hormones to prevent menstruation. Without menstruation, the growth of endometriosis is slowed or stopped. These medications can cause side effects, such as hot flashes, tiredness, problems sleeping, headaches, depression, bone loss, and vaginal dryness. Most health care providers recommend that a woman stay on a GnRH agonist for about six months. After that time, the body will start having a period again and a woman could get pregnant. But, after that time, about half of women have some return of their endometriosis symptoms.
Surgery is usually the best choice for women with extensive endometriosis, or those with severe pain. There are both minor and major surgeries that can help. Your doctor might suggest one of the following surgical treatments:
You may feel many emotionssadness, fright, anger, confusionand feel alone. It is important to get the support you need to cope with endometriosis. It is also important to learn as much as you can about the disease. Talking with friends, family, and your health care provider can help. You might want to join a support group to talk with other women who are going through the same thing.
Colposcopy is a procedure that uses a special microscope (called a colposcope) to look into the vagina and to look very closely at the cervix (the opening to the uterus, or womb).
The colposcope magnifies, or enlarges, the image of the outer portion of the cervix. It is somewhat like looking through a pair of binoculars. This allows the health care provider to see the outer portion of the cervix better. Sometimes a small sample of tissue (called a biopsy) is taken for further study. The tissue samples help the health care provider to figure out how to treat any problems found. And, if cancer of the cervix is found early, or a precancerous change of cells is found, it can be treated and almost always can be cured. Also, for precancers and early cancers of the cervix, sometimes removal of part of the cervix may be the only treatment needed.
Colposcopy is usually done when a woman has an abnormal Pap test. (Pap tests are done on a regular basis to screen for cancer of the cervix and other problems.) Other reasons a woman may need a colposcopy is when, during a pelvic exam, the cervix, vagina, or vulva ("lips," or opening to the vagina) looks abnormal to the health care provider.
When you have a colposcopy, you will lie on an exam table just like you do when you have a regular pelvic exam. The health care provider uses an instrument called a speculum to spread the walls of the vagina apart. She or he then places the colposcope, which is like a microscope with a light on the end, at the opening of the vagina. The colposcope does not enter the vagina. The health care provider will look inside the vagina to locate any problem areas on the cervix (opening to the uterus, or womb) or in the vagina. If any areas are of concern, the health care provider may take a small tissue sample (called a biopsy). When this is done, the health care provider first numbs the area but you may feel a slight pinch or cramp. The tissue is then sent to a lab for further study.
Most women feel fine after a colposcopy. You may feel a little lightheaded and if you had a biopsy, you may have some light bleeding. Talk to your health care provider about how to take care of yourself after the procedure and when you need to return for a checkup.
There is a very small risk of infection when you have a colposcopy. You may have mild pain and cramping during the procedure and light bleeding afterwards. This most often happens when a biopsy (a small sample of tissue taken from the cervix) is done. If you have heavy bleeding, a fever, or severe pain after the procedure, you should contact your health care provider right away.
A hysterectomy is an operation to remove a woman's uterus (womb). The uterus is where a baby grows when a woman is pregnant. Sometimes the fallopian tubes, ovaries, and cervix are removed at the same time the uterus is removed. These organs are located in a woman's lower abdomen (see image below). The cervix is the lower end of the uterus. The ovaries are organs that produce eggs and hormones. The fallopian tubes carry eggs from the ovaries to the uterus.
If you haven't reached menopause yet, a hysterectomy will stop your monthly bleeding (periods). You also won't be able to get pregnant.
There are several types of hysterectomy:
Often one or both ovaries and fallopian tubes are removed at the same time a hysterectomy is done. When both ovaries and both tubes are removed, it is called a bilateral salpingo-oophorectomy.
If the ovaries are removed in a woman before she reaches menopause, the sudden loss of her main source of female hormones will cause her to suddenly enter menopause (surgical menopause). This can cause more severe symptoms than a natural menopause.
Hysterectomy is the second most common major surgery among women in the United States. (The most common major surgery that women have is cesarean section delivery.) Each year, more than 600,000 hysterectomies are done. About one third of women in the United States have had a hysterectomy by age 60.
Hysterectomies are done through a cut in the abdomen (abdominal hysterectomy) or the vagina (vaginal hysterectomy). Sometimes an instrument called a laparoscope is used to help see inside the abdomen. The type of surgery that is done depends on the reason for the surgery. Abdominal hysterectomies are more common than vaginal hysterectomies and usually require a longer recovery time.
Hysterectomies are most often done for the following reasons:
Uterine fibroids. Fibroids are common, benign (noncancerous) tumors that grow in the muscle of the uterus. More hysterectomies are done because of fibroids than any other problem of the uterus. Fibroids often cause no symptoms and need no treatment, and they usually shrink after menopause. But sometimes fibroids cause heavy bleeding or pain.
There are alternatives to hysterectomy to treat fibroids, which may be especially important for younger women who hope to have children. Sometimes fibroids are treated with medicine or other treatments designed to shrink the fibroids. But, this is only temporary - when the medicine is stopped, the fibroids will grow again. A type of surgery to remove only the fibroids without removing the uterus is called a myomectomy. A relatively new procedure to shrink fibroids is called uterine artery embolization. It involves placing small plastic particles in the blood vessels feeding the fibroids.
Endometriosis. This is another benign condition that affects the uterus. Endometriosis is the second leading reason for hysterectomies. It is most common in women in their thirties and forties, especially in women who have never been pregnant. It occurs when endometrial tissue (the inside lining of the uterus) begins to grow on the outside of the uterus and on nearby organs. This condition may cause painful menstrual periods, abnormal vaginal bleeding, and sometimes loss of fertility (ability to get pregnant). Endometriosis is usually not a problem for women after menopause.
Women with endometriosis are often treated with hormones and medicines that lower their levels of estrogen. Surgery to remove the patches of endometrial tissue causing the symptoms may be done using a laparascope or through a larger cut in the abdomen (laparatomy). A hysterectomy is generally not done unless other treatment has failed.
Uterine prolapse. This is a benign condition in which the uterus moves from its usual place down into the vagina. Uterine prolapse is due to weak and stretched pelvic ligaments and tissues. Other organs such as the bladder can also be affected. Childbirth, obesity, and loss of estrogen after menopause may contribute to this problem. Uterine prolapse accounts for about 16 percent of hysterectomies.
Treatment may include estrogen therapy, exercises to strengthen pelvic floor muscles, or use of a pessary, a plastic ring inserted into the vagina to help support the uterus. In more severe cases, surgery can restore the sagging organs to their normal location and repair the supporting tissues. Sometimes a hysterectomy may be done if the prolapse is causing severe problems.
Cancers affecting the pelvic organs account for only about ten percent of all hysterectomies. Endometrial cancer (cancer of the lining of the uterus), uterine sarcoma, cervical cancer (cancer of the cervix), and cancer of the ovaries or fallopian tubes often require hysterectomy. Depending on the type and extent of the cancer, other kinds of treatment such as radiation or hormonal therapy may be used as well.
Other reasons why hysterectomies are done include chronic pelvic pain, heavy bleeding during or between periods, and chronic pelvic inflammatory disease.
What should I do if I am told that I need a hysterectomy?
If you have a condition that is not cancer, such as fibroids, endometriosis, or uterine prolapse, there are often other treatments that should be tried first. In most cases, a hysterectomy need not be done immediately. There is time for you to get more information and look into possible alternatives.
In cases of serious disease, such as cancer, a hysterectomy may not be optional and may be a life-saving choice. Before you decide what to do, it is important that you understand your condition and your options for dealing with it.
If you are suffering from continuing, severe problems with pelvic pain and abnormal uterine bleeding, and other treatments have not helped, a hysterectomy may provide welcome relief. Studies have shown that a hysterectomy often improves sexual functioning and quality of life for women suffering from these problems.
On the other hand, some women suffer serious complications from hysterectomy, even death. Most complications are less serious, and may include reactions to anesthetics, pain, infection, bleeding, and fatigue. Sometimes other pelvic organs such as the bladder and bowel are injured during a hysterectomy. Hysterectomy is also linked to urinary incontinence (problems holding your urine) and loss of ovarian function and early menopause. Some women experience depression and sexual dysfunction after hysterectomy.
If you are told that you should have a hysterectomy:
If you have had a total hysterectomy, in which the cervix was removed along with the uterus, you will not usually require Pap testing. An exception is if your hysterectomy was done because of cervical cancer or its precursors. Ask your health care provider if you need to have periodic Pap tests. It is important for all women who have had a hysterectomy to have regular gynecologic exams as part of their health care.
All pregnancy tests look for a special hormone in the urine or blood that is only present when a woman is pregnant. This hormone, human chorionic gonadotropin (hCG), is also called the pregnancy hormone.
There are two types of pregnancy tests - blood and urine tests. Both tests look for the presence of hCG, the pregnancy hormone. Today, many women use a urine test, or home pregnancy test (HPT), to find out if they are pregnant. HPTs do not cost a lot, are easy to use, can be done at home, and are private. When a woman has a positive result on an HPT, she needs to see her health care provider right away. The health care provider can confirm a positive HPT result with a blood test and a pelvic exam.
There are two types of blood tests you can get from a health care provider. A quantitative blood test (or the beta hCG test) measures the exact amount of hCG in the blood. This means it can pick up very small amounts of hCG, making it a very accurate test. A qualitative hCG blood test gives a simple yes or no answer to whether you are pregnant. This test is more like a urine test in terms of its accuracy.
Blood tests can pick up hCG earlier in a pregnancy than urine tests can. Blood tests can tell if you are pregnant about 6 to 8 days after you ovulate (or release an egg from an ovary). Urine tests can determine pregnancy about 2 weeks after ovulation. Some more sensitive urine tests can tell if you are pregnant as early as 6 days after you conceive, or one day after you miss a menstrual period.
There are many types of home pregnancy tests, or HPTs, that can be bought over-the-counter at drug or discount stores. Some involve collecting your urine in a cup and dipping a stick into the urine, or putting some of the urine into a special container with an eyedropper. Others are done by placing a stick into your urine stream. Tests vary in how long you have to wait for the stick or container to turn a certain color or have a symbol on it (like a plus or a minus). All tests come with written instructions. Most tests also have toll-free phone numbers to call if you have any questions about how to do the test or read the results.
Home pregnancy tests (HPTs) are very accurate. Most brands of HPTs say they are 97% to 99% accurate, but this can vary with actual use. Each brand varies in how sensitive it is in picking up the pregnancy hormone hCG. If a test is not done correctly, it will be less accurate. And, always check the package to make sure it is not past its expiration date - if it is, it will not be accurate. Most brands of HPTs tell users to do the test again in a few days, no matter what the results.
If you use an HPT too early in your pregnancy, you may not have enough of the pregnancy hormone hCG in your urine to have a positive test result. Most HPTs will be accurate if you test yourself around the time your period is due (about 2 weeks after you ovulate, or release an egg from your ovary). You can get a negative test result if you are not pregnant or if you ovulated later than you thought you did. You may also have problems with the pregnancy, which affects the amount of hCG you have in your urine. If your HPT is negative, test yourself again within a few days to 1 week. If you keep getting a negative result and think you are pregnant, talk with a health care provider right away.
Most medications, both over-the-counter and prescription drugs, including birth control pills and antibiotics, should not affect the results of a home pregnancy test (such as Profasi, Pregnyl or Novarel). Only those drugs that have the pregnancy hormone hCG in them can give a false positive test result (where the test says you are pregnant when you actually are not). Drugs that have hCG in them can be used for treating infertility (not being able to get pregnant). Alcohol and illegal drugs do not affect HPT results, but you should not be using these substances if you are trying to get pregnant.
Prenatal care means health care during your pregnancy before your baby is born. Take care of yourself and your baby by:
Prenatal care is important because, by seeing you regularly, your health care provider has the chance to find problems early so that they can be treated as soon as possible. Other problems might also be prevented. Many studies have shown that early and regular prenatal care is important for the health of both mothers and their babies.
Taking care of yourself before you get pregnant helps you have a healthy pregnancy and lowers your chances of having a baby born with a birth defect. Here are ways to take care of yourself before you get pregnant:
Here are ways to take care of yourself and the precious new life growing inside you:
All women of childbearing age, with even a remote chance of getting pregnant, should try to make sure they get enough folic acid. The reason is that many pregnancies are not planned. Many women don't know they are actually pregnant early in their pregnancies, and certain birth defects happen in the very early part of pregnancy. Taking 400 micrograms (mcg) of folic acid every day will help prevent certain birth defects that happen in the early part of pregnancy. If a woman begins taking vitamin pills in the second or third month of pregnancy, it may be too late to prevent birth defects. Folic acid may also have other health benefits for women besides preventing birth defects.
Your health care provider will give you a schedule for your prenatal visits. You will have visits more often as you get closer to the end of your pregnancy. An average pregnancy lasts about 40 weeks. A typical schedule includes visiting your health care provider:
If you are over 35 or your pregnancy is high risk because you have certain health problems (like diabetes or high blood pressure), your health care provider will probably want to see you more often.
At your first prenatal visit, your health care provider will talk to you about your health history and your family health history and do a physical exam. The physical exam will include checks of your blood pressure, height and weight, and an exam of your pelvic organs. There will be tests of your blood and urine. Your health care provider will be able to tell you when to expect that your baby will be born. This visit is also a chance for you to learn about staying healthy during pregnancy.
At your later prenatal visits, your health care provider will check how you are doing and how the baby is developing. You may have a number of tests done as your pregnancy progresses. Ultrasound exams are often used to check on the baby's growth and health. You may have more urine and blood tests as well as special tests if needed. Visit our "Healthy Pregnancy" pages on the NWHIC web site http://www.4woman.gov for more information on prenatal care and pregnancy.
As you get older, there is more chance of having a baby born with a birth defect. However, most women in their late thirties and early forties have healthy babies. See your health care provider on a regular basis before you get pregnant and be sure to go for exams throughout your pregnancy. Your health care provider probably will want to do some special tests to check on your baby's health.
Women today are often delaying having children until later in life, when they are in their thirties and forties. While many women in their thirties and forties have no difficulty getting pregnant, fertility does decline with age. For women over 40 who cannot get pregnant after six months of trying, it is recommended that they see their health care provider for a fertility evaluation. It is not uncommon to have trouble becoming pregnant or experience infertility (inability to become pregnant after trying for one year). If you think that you or your partner may be infertile, you can discuss this with your health care provider who can recommend treatments such as drugs, surgery, or assisted reproductive technology.
Even before pregnancy begins, nutrition is a primary factor in the health of mother and baby. If you are eating a well-balanced diet before you become pregnant, you will only need to make a few changes to meet the nutritional needs of pregnancy.
According to the American College of Obstetricians and Gynecologists (ACOG), pregnant women should increase their usual servings of a variety of foods from the four basic food groups to include the following:
Eating a well-balanced diet while you are pregnant will help to keep you and your baby healthy. Most physicians agree that the Recommended Daily Allowances (RDAs), except those for iron, can be obtained through a proper diet.
The following is a chart that outlines the RDAs for by age group as well as the RDAs for pregnant women.
| Female RDA (by age) | 15-18 | 19-24 | 25-50 | 51+ | Pregnant |
| Calories | 2200 | 2200 | 2200 | 1900 | +300 |
| Protein | 44 | 46 | 50 | 50 | 60 |
| Vitamin E | 8 | 8 | 8 | 8 | 10 |
| Vitamin K | 55 | 60 | 65 | 65 | 65 |
| Vitamin C | 60 | 60 | 60 | 60 | 70 |
| Thiamin | 1.1 | 1.1 | 1.1 | 1.0 | 1.5 |
| Riboflavin | 1.3 | 1.3 | 1.3 | 1.2 | 1.6 |
| Niacin | 15 | 15 | 15 | 13 | 17 |
| Vitamin B6 | 1.5 | 1.6 | 1.6 | 1.6 | 2.2 |
| Folate | 180 | 180 | 180 | 180 | 400 |
| Vitamin B12 | 2.0 | 2.0 | 2.0 | 2.0 | 2.2 |
| Iron | 15 | 15 | 15 | 10 | 30 |
| Zinc | 12 | 12 | 12 | 12 | 15 |
| Selenium | 50 | 55 | 55 | 55 | 65 |
The nutritional requirements for pregnant women vary based on individual needs. Discuss whether you need to take a multi-vitamin with your doctor.
Iron is needed in larger doses, especially in the later stages of pregnancy. This mineral is essential to the formation of healthy red blood cells. It is difficult for a woman to consume enough of it from foods to maintain an adequate supply from the mother, often leaving her anemic and exhausted. Anemia can make the mother less able to fight off infections and unable to handle hemorrhaging during the birth. An iron supplement can alleviate this condition, but first discuss whether you need additional iron with your doctor.
Pregnancy doubles a woman's need for folate (folic acid or folacin). Folic acid has been shown to be important in preventing neural tube defects, such as spina bifida and anencephaly and is essential to the formation of red blood cells. Severe folate deficiency can result in a condition called megaloblastic anemia, which occurs most often in the last trimester of pregnancy. In this condition, the mother's heart, liver and spleen may become enlarged which can threaten the life of the fetus. Folic acid can be found in many foods, including kidney beans, leafy green vegetables, peas, and liver. Women in their childbearing years should consume plenty of these foods. In fact, folate is so important to the health of women and their babies that the Food and Drug Administration (FDA) recently required the addition of folic acid to prepackaged bread and cereals.
However, there is no universal agreement on the necessity of folate supplements for all pregnant women. Some doctors prescribe the supplements primarily for pregnant women who are smokers, drug users, alcohol drinkers or strict vegetarians. While research continues, your doctor will continue to recommend supplements based on your individual health profile.
Remember that what you eat and drink can affect your baby. Avoid drinking any alcoholic beverages while you are pregnant. Alcohol can cause Fetal Alcohol Syndrome (FAS), which is an condition that can affect your baby for its entire life. FAS is a preventable cause of birth defects and mental retardation.
Caffeine is a stimulant found in colas, coffee, tea, chocolate, cocoa, and some over-the-counter (OTC) and prescription drugs. Consumed in large quantities, caffeine may cause irritability, nervousness and insomnia as well as low-birth-weight babies. Caffeine is also a diuretic and can dehydrate the pregnant woman's body of valuable water. Some studies do indicate that caffeine intake during pregnancy can harm the fetus. Until more is known, caffeine should be avoided. Caffeine is an ingredient in many OTC and prescription drugs. Before taking any drugs, a pregnant woman should consult her physician.
As a pregnant woman, you need more nutrients to help your baby grow and be healthy. Besides folic acid and iron, which we have already discussed, there are other dietary additions you will need:
Calcium: Pregnant and lactating adult women require an additional 40% of calcium a day (1200-1500 mg per day). Almost all of the extra calcium goes into the baby's developing bones. To get this extra calcium, 3 extra servings (3 cups) of milk or dairy products are needed. If you are lactose intolerant, you can still get this extra calcium. There are several low-lactose or reduced-lactose products available. In some cases, your doctor might even prescribe a calcium supplement.
Sodium: This is important during pregnancy. 2,000 to 8,000 milligrams of sodium a day is recommended during pregnancy. There are 2,325 milligrams of sodium in one teaspoon of salt, and because salt is in most foods, the increased need for it during pregnancy is not too difficult to achieve. Sodium helps to regulate the water in the body.
Fluids: Drink plenty of fluids, especially water, during pregnancy. A woman's blood volume increases dramatically during pregnancy. Drinking at least eight glasses of water a day can help prevent common problems such as dehydration and constipation.
To find out what other nutrients are important during pregnancy and how much you need, ask your healthcare provider any questions you may have.
The "pickles and ice cream" choices and other appetite cravings of pregnant women may be reflections of the changes in nutritional needs. The fetus needs nourishment and the mother's body begins to absorb and metabolize nutrients differently. These changes help ensure normal development of the baby and fill the demands of lactation (nursing) after the baby is born.
While you are pregnant, you will need additional nutrients to keep you and your baby healthy. However, that does not mean you need to eat twice as much. An increase of only 300 calories per day is recommended. For example, a baked potato has 120 calories, so getting those extra 300 calories should not be that difficult. Make sure not to restrict your diet during pregnancy because you might not be getting the right amounts of protein, vitamins, and minerals that are necessary to properly nourish your unborn baby. Low-calorie intake can cause the mother's stored fat to break down, leading to the production of substances called ketones. Ketones, which can be found in the mother's blood and urine, are a sign of starvation or a starvation-like state. Constant production of ketones can result in a mentally retarded child.
What about diabetes and pregnancy?
Diabetic women should be closely monitored to make sure their blood sugar levels are at or near normal. If maternal blood sugar rises too high, the increased sugar crossing into the placenta can result in a large, over developed fetus with defects or an infant with blood sugar level abnormalities. Diabetic women may also suffer from a greater loss of some nutrients. It is important to maintain tight control of blood sugar before and during pregnancy.
Gestational diabetes is a form of diabetes that begins during pregnancy and usually goes away after the birth of the baby. If you have gestational diabetes, this means that you have a high amount of sugar in your blood. This form of diabetes can be controlled through diet, medication and exercise but if left untreated, gestational diabetes can cause health problems for both you and your baby.
Weight gain during pregnancy should be gradual with the most weight being gained in the last trimester. According to the ACOG, you should gain about 2 to 4 pounds during the first three months of pregnancy and then 3 to 4 pounds per month for the rest of your pregnancy. Total weight gain should be about 25 to 30 pounds. This will decrease the risk of delivering a low-birth-weight baby. The Institute of Medicine recommends that women who have a low Body Mass Index (BMI) - the ratio of weight to height - should gain 28 to 40 pounds during pregnancy and women who have a higher BMI should gain 15 to 25 pounds. Check with your doctor to determine how much weight gain during pregnancy is healthy for you.
Weight gained includes 6 to 8 pounds for the weight of the baby. The remaining weight consists of a higher fluid volume, larger breasts, larger uterus, amniotic fluid, and the placenta. Make sure to visit your doctor throughout your pregnancy for an assessment of your weight gain. Your doctor can make recommendations about how much weight you should be gaining to ensure that your pregnancy is progressing smoothly and that you are getting the right amount of nutrients.
It can be if there is too much weight gain. During pregnancy, fat deposits may increase by more than a third of the total amount a woman had before she became pregnant. If the weight gain was normal, most women lose this extra weight in the birth process and in the weeks and months after birth. Breastfeeding helps to deplete the fat deposited during pregnancy. A woman who breastfeeds expends at least 500 more calories than one who doesn't. The woman who nurses her baby also has increased needs for specific nutrients, and should not be on a weight loss diet.
Morning sickness and nausea are common to about 70% of pregnant women. Most nausea occurs during the early part of pregnancy and, in most cases, will subside once you enter the second trimester. The changes in your body might cause you to become nauseous or sick when you smell or eat certain things, when you are tired or stressed, or for no apparent reason at all. For some women, it might last longer than the early stages of pregnancy or even throughout the entire nine months.
Nausea in early pregnancy is a condition that often can be managed nutritionally:
Severe nausea and vomiting in pregnancy is rare, but if it occurs, it may cause you to become dehydrated. If you feel that your nausea or vomiting is keeping you from eating right or gaining enough weight, consult your doctor.
It is probably safe but you should check with your doctor first. Although some questions have been asked about the effects of exercise on pregnant women, there is no proof that gentle exercise has any bad effects on pregnancy. Studies haven't shown any benefits for the baby, but gentle exercise might help you feel better and maintain your weight.
The most comfortable exercises are the ones that don't require your body to bear extra weight. Swimming and stationary cycling can be continued throughout pregnancy. Walking and low-impact aerobics are usually well tolerated. You and your doctor should decide what is best for you and the baby.
Be careful to avoid activities that increase your risk of falls or injury, such as contact sports or vigorous sports. Even mild injuries to the "tummy" area can be serious when you're pregnant. After 3 months of pregnancy, it is best to avoid exercising while lying on your back, since the weight of the baby may interfere with blood circulation. Also avoid long periods of standing.
When the weather is hot, exercise in the early morning or late evening to help you avoid getting overheated. If you're exercising indoors, make sure the room has enough ventilation. Consider using a fan to help keep yourself cool. Drink plenty of fluids, even if you don't feel thirsty.
Make sure you're eating a well-balanced diet. Normally, pregnancy increases your food requirements by at least 300 calories a day, even without exercise.
Folic acid is one of the B vitamins. Folate, the natural form of folic acid, is found in orange juice, other citrus fruits and juices, leafy green vegetables, beans, peanuts, broccoli, asparagus, peas, lentils and whole grain products. Synthetic (manufactured) folic acid is added to certain grain products, including flour, rice, pasta, cornmeal, bread and cereals. These foods are considered "fortified" with folic acid. There also are multivitamin pills that contain folic acid.
Taking the synthetic form of folic acid can help prevent birth defects called neural tube defects (NTDs). NTDs are defects of the spine and brain. NTDs take place in the first month after conception, before most women know they are pregnant. The two most common forms of NTDs are spina bifida and anencephaly. Babies born with spina bifida may be paralyzed or have many other problems. Babies with anencephaly do not develop a brain or have only a partial brain. These babies die before birth or soon after they are born. Up to 70 percent of NTDs can be prevented by taking folic acid before and during early pregnancy. Because the risk for NTDs is not totally eliminated by using folic acid, routine prenatal visits with a health care provider during pregnancy are still important.
Although it is not proven, folic acid also might help prevent heart disease, stroke, and colon cancer, and other kinds of cancer. Recent research suggests it also might help prevent high blood pressure during pregnancy.
All women who are capable of becoming pregnant should take 400 micrograms (0.4 milligrams) of the synthetic form of folic acid every day. The best way to do this is to take a daily multivitamin pill that contains this amount of folic acid. The Institute of Medicine also recommends:
It is recommended that you do not take more than 1 mg (1,000 micrograms) of folic acid daily. This is because a high intake of folic acid may hide a deficiency of vitamin B12. Many older people have vitamin B12 deficiency. However, folic acid is not toxic if you happen to take more than the recommended amount.
The Institute of Medicine also recommends that women eat a diet rich in foods that contain folate or folic acid. Check the labels on your food to find out the amount of folic acid it contains. And remember that the body more easily absorbs folic acid from vitamin supplements and fortified foods than it does folate from food.
It can be hard to plan exactly when you will get pregnant, in order to avoid taking any medicine. Most of the time, medicine a pregnant woman is taking does not enter the fetus. But sometimes it can, causing damage or birth defects. The risk of damage being done to a fetus is the greatest in the first few weeks of pregnancy, when major organs are developing. But researchers do not know if taking medicines during pregnancy also will have negative effects on the baby later.
Many drugs that you can buy over-the-counter (OTC) in drug and discount stores, and drugs your health care provider prescribes are thought to be safe to take during pregnancy, although there are no medicines that are proven to be absolutely safe when you are pregnant. Many of these products tell you on the label if they are thought to be safe during pregnancy. If you are not sure you can take an OTC product, ask your health care provider.
Some drugs are not safe to take during pregnancy. Even drugs prescribed to you by your health care provider before you became pregnant might be harmful to both you and the growing fetus during pregnancy. Make sure all of your health care providers know you are pregnant, and never take any drugs during pregnancy unless they tell you to.
Also, keep in mind that other things like caffeine, vitamins, and herbal teas and remedies can affect the growing fetus. Talk with your health care provider about cutting down on caffeine and the type of vitamins you need to take. Never use any herbal product without talking to your health care provider first.
The Food and Drug Administration (FDA) has a system to rate drugs in terms of their safety during pregnancy. This system rates both over-the-counter (OTC) drugs you can buy in a drug or discount store, and drugs your health care provider prescribes. But most medicines have not been studied in pregnant women to see if they cause damage to the growing fetus. Always talk with your health care provider if you have questions or concerns.
The FDA system ranks drugs as:
To help women make informed and educated decisions about using medicines during pregnancy, it is necessary to find out the effect of these medicines on the unborn baby. Pregnancy Registries are one way to do this. A Pregnancy Registry is a study that enrolls pregnant women after they have been taking medicine and before the birth of the baby. Babies born to women taking a particular medicine are compared with babies of women not taking the medicine. Looking at a large number of women and babies is needed to find out the effect of the medicine on the babies.
If you are pregnant and currently taking medicine or have been exposed to a medicine during your pregnancy you may be able to join and help with this needed information. The Food and Drug Administration's (FDA) web site (http://www.fda.gov/womens/registries/) has a list of pregnancy registries that are enrolling pregnant women.
Whether or not you should continue taking medicine during pregnancy is a serious question. But, if you stop taking medicine that you need, this could harm both you and your baby. An example of this is if you have an infection called toxoplasmosis, which you can get from handling cat feces or eating infected meat. It can cause problems with the brain, eyes, heart, and other organs of a growing fetus. This infection requires treatment with antibiotics.
For pregnant women living with HIV, the Centers for Disease Control and Prevention (CDC) recommends the drug zidovudine (AZT). Studies have found that HIV positive women who take AZT during pregnancy decrease by two-thirds the risk of passing HIV to their babies. If a diabetic woman does not take her medicine during pregnancy, she increases her risk for miscarriage and stillbirth. If asthma and/or high blood pressure are not controlled during pregnancy, problems with the fetus may result. Talk with your health care provider about whether the benefits of taking a medication outweigh the risk for you and your baby.
While some herbal remedies say they will help with pregnancy, there have been no studies to figure out if these claims are true. Likewise, there have been very few studies to look at how safe and effective herbal remedies are. Echinacea, Gingko biloba, and St. John's Wort have been popular herbs, to name a few. Do not take any herbal products without talking to your health care provider first. These products may contain agents that could harm you and the growing fetus, and cause problems with your pregnancy.
The synthetic (or man-made) estrogen, diethylstilbestrol or DES, was made in London in 1938. DES was used in the U.S. between 1938 and 1971 to prevent miscarriage (losing a pregnancy). Many women who had problems with earlier pregnancies were given DES because it was thought to be both safe and effective. Over time, it was found that not only did DES not prevent miscarriage, it also caused cancers of the vagina (birth canal) and cervix (opening to the uterus or womb).
While many women were given DES over this time, many mothers do not remember what they were given by their health care providers when they were pregnant. Some prescription prenatal vitamins also contained DES. If your mother is not sure whether she took DES, you can talk with the health care provider she went to when she was pregnant with you or contact the hospital for a copy of her medical records.
DES can affect both the pregnant woman and the child (both daughters and sons). Daughters born to women who took DES are more at risk for cancer of the vagina and cervix. Sons born to women who took DES are more at risk for non-cancerous growths on the testicles and underdeveloped testicles. Women who took DES may have a higher risk for breast cancer.
If you think or know that your mother took DES when she was pregnant with you, talk with your health care provider right away. Ask her or him about what types of tests you may need, how often they need to be done, and anything else you may need to do to make sure you don't develop any problems.
Fetal alcohol syndrome (FAS) is a group of birth defects caused by drinking alcohol during pregnancy. Children with FAS have many physical, mental and behavioral problems and may be mentally retarded. They are small, underweight babies. As they get older, they often have trouble with learning, attention, memory, and problem solving. They may have poor coordination, be impulsive, and have speech and hearing problems.
The effects of FAS last a lifetime. Most children with FAS have trouble with work and with personal relationships when they become adults. Many have legal problems. FAS cannot be reversed, but it can be prevented by not drinking alcohol when pregnant.
Children with FAS have:
All of these birth defects are caused by drinking alcohol in pregnancy.
If a child has some but not all of the alcohol-related problems of FAS, they are sometimes said to have fetal alcohol effects (FAE). Two newer terms are:
When a pregnant woman drinks beer, wine, hard liquor, or other alcoholic beverages, alcohol gets into her blood. The alcohol in the mother's blood goes to her baby through the umbilical cord. When the alcohol enters the baby's body, it can cause birth defects. Drinking alcohol in the early stages of pregnancy can cause the facial and other physical defects of FAS. Drinking alcohol at any time during pregnancy can slow down the baby's growth and affect the baby's brain. There is no time during pregnancy when there is no chance at all of hurting your baby if you drink alcohol.
No. But children with FAS can be helped. They may need hearing aids or eyeglasses. They should get regular medical care. When they go to school, they need special help. As children with FAS get older, they may need special services and support to help them live on their own.
There is no known safe level of alcohol a pregnant woman can drink and not affect her baby. It is best to drink no alcohol at all -
Not all women who drink alcohol during pregnancy will have a child born with FAS. But not drinking alcohol is the only sure way to protect your baby from FAS, ARBD and ARND. If you are pregnant and have been drinking, stop drinking now to protect your baby. If you need help to stop drinking, talk with your health care provider.
One of the best things that only you can do is to breastfeed your baby for as long as possible. The longer a mom and baby breastfeeds, the greater the benefits are for both mom and baby. Babies should be fed with breast milk only no formula for the first six months of life. Ideally, though, babies should receive breast milk through the first year of life, or for as long as both you and your baby wish. Solid foods can be added to your baby's diet, while you continue to breastfeed, when your baby is six months old. For at least the first six months, breastfed babies don't need supplements of water, juice, or other fluids. These can interfere with your milk supply if they are introduced during this time.
Some women think that when they are sick, they should not breastfeed. But, most common illnesses, such as colds, flu, or diarrhea, can't be passed through breast milk. In fact, if you are sick, your breast milk will have antibodies in it. These antibodies will help protect your baby from getting the same sickness.
A few viruses can pass through breast milk. HIV, the virus that causes AIDS, is one of them. If you are HIV positive, you should not breastfeed. Sometimes babies can be born with a condition called galactosemia, in which they can't tolerate breast milk. This is because their bodies can't break down the sugar galactose. Babies with classic galactosemia may have liver problems, malnutrition, or mental retardation. Since both human and animal milk contain the sugar lactose that splits into galactose and glucose, babies with classic galactosemia must be fed a special diet that is free of lactose and galactose.
If you are breastfeeding, you should not smoke or take illegal drugs. Some drugs, such as cocaine and PCP, can affect your baby and cause serious side effects. Other drugs, such as heroin and marijuana can cause irritability, poor sleeping patterns, tremors, and vomiting. Babies can become addicted to these drugs.
Sometimes a baby may have a reaction to something you eat, but this doesn't mean your baby is allergic to your milk. Usually, if you have eaten a food throughout pregnancy, your baby has already become used to the flavor of this food. If you stop eating whatever is bothering your baby, the problem usually goes away on its own.
Always talk with your health care provider before taking any medications. Most medications pass into your milk in small amounts. If you take medication for a chronic condition such as high blood pressure, diabetes or asthma, your medication may already have been studied in breastfeeding women, so you should be able to find information to help you make an informed decision with the help of your health care provider. Newer medications and medications for rare disorders may have less information available. The American Academy of Pediatrics has information about many prescription and over-the-counter medications posted on their web site at: www.aap.org. More information on medications and breastfeeding:
Of course! Breast size is not related to the ability to produce milk for a baby. Breast size is determined by the amount of fatty tissue in the breast, not by the amount of milk. Most women, with all sizes of breasts, can make enough milk for their babies.
When you breastfeed, your ovaries can stop releasing eggs (or ovulating), making it harder for you to get pregnant. Your periods can also stop. But, there are no guarantees that you will not get pregnant while you are nursing. The only way to make sure pregnancy does not occur is to use a method of birth control. The safest birth control pill to use when you are breastfeeding is the "mini-pill." However, talk with your health care provider about what birth control method is best for you to use while breastfeeding.
Not at all! Breastfeeding can be convenient no matter where you are because you don't have to bring along feeding equipment like bottles, water, or formula. Your baby is all you need. Even if you want to breastfeed in private, you usually can find a woman's lounge or fitting room. If you want to go out without your baby, you can pump your milk beforehand, and leave it for someone else to give your baby while you are gone.
Here are just some of the many good reasons why you should breastfeed your baby:
Yes! You can do it! Breastfeeding keeps you connected to your baby, even when you are away. Employers and co-workers benefit because breastfeeding moms often need less time off for sick babies.
More and more women are breastfeeding when they return to work. There are many companies selling effective breast pumps and storage containers for your milk. Many employers are willing to set up special rooms for mothers who pump. After you have your baby, try to take as much time off as possible, since it will help you get breastfeeding well established and also reduce the number of months you may need to pump your milk while you are at work.
If you plan to have your baby take a bottle of expressed breast milk while you are at work, it is recommended to introduce your baby to a bottle when he or she is around four weeks old. Otherwise, the baby might not accept the bottle later on. Once your baby is comfortable taking a bottle, it is a good idea to have dad or another family member offer a bottle of pumped breast milk on a regular basis so the baby stays in practice.
Let your employer and/or human resources manager know that you plan to continue breastfeeding once you return to work. Before you return to work, or even before you have your baby, start talking with your employer about breastfeeding. Don't be afraid to request a clean and private area where you can pump your milk. If you don't have your own office space, you can ask to use a supervisor's office during certain times. Or you can ask to have a clean, clutter free corner of a storage room. All you need is a chair, a small table, and an outlet if you are using an electric pump. Many electric pumps also can run on batteries and don't require an outlet. You can lock the door and place a small sign on it that asks for some privacy. You can pump your breast milk during lunch or other breaks. You could suggest to your employer that you are willing to make up work time for time spent pumping milk.
After pumping, you can refrigerate your milk, place it in a cooler, or freeze it for the baby to be fed later. You can even leave it at room temperature for up to six hours if you don't have access to a refrigerator. Many breast pumps come with carrying cases that have a section to store your milk with ice packs.
Many employers are NOT aware of state laws that state they have to allow you to breastfeed at your job. Under these laws, your employer is required to set up a space for you to breastfeed and/or allow paid/unpaid time for breastfeeding employees. To see if your state has a breastfeeding law for employers, go to http://www.lalecheleague.org/LawBills.html or call us at 1-800-994-WOMAN (9662).
Breast pumps range in price from under $50 (manual pumps) to over $200 (electrical pumps that include a carrying case and an insulated section for storing milk containers). If you're only going to be away from your baby a few hours a week, then you can purchase a manual pump, or one of the less expensive ones. If you're going back to work, it is worth investing in a good quality electric pump. Some pumps can be purchased at baby supply stores or general department stores, but most high quality automatic pumps have to be purchased or rented from a lactation consultant, at a local hospital, or from a breastfeeding organization.
You can breastfeed discreetly in public by wearing clothes that allow easy access to your breasts, such as button down shirts. By draping a receiving blanket over your baby and your breast, most people won't even realize that you are breastfeeding. It's helpful to nurse the baby before he/she becomes fussy so that you can get into a comfortable position to nurse. You also can purchase a nursing cover or baby sling for added discretion. Many stores have women's lounges or dressing rooms, if you want to slip into one of those to breastfeed.
There are several tips for making breastfeeding a good experience for both you and your baby. However, you can prevent the most common challenges or problems by following the three most important tips about breastfeeding:
Breastfeeding does not hurt. There may be some tenderness at first, but it should gradually go away as the days go by. Your breasts and nipples are designed to deliver milk to your baby. When your baby is breastfeeding effectively, it should be calming and comfortable for both of you. If breastfeeding becomes painful for you, seek help from someone who is knowledgeable about breastfeeding.
To minimize soreness, your baby's mouth should be wide open, with as much of the areola (the darker area around the nipple) as far back into his/her mouth as possible. The baby should never nurse on the nipple only. If it hurts, take the baby off of your breast and try again. The baby may not be latched on right. Break your baby's suction to your breast by gently placing your finger in the corner of his/her mouth, and re-position your baby.
Most breastfeeding counselors recommend avoiding bottle nipples or pacifiers for about the first month because they may interfere with your baby's ability to learn to breastfeed. After you and your baby have learned to breastfeed well, you can make your own decision about whether or not to offer a pacifier.
In the first few days, when you're in the hospital your baby should stay with you in your room if there are no complications with the delivery or with your baby's health. The baby will be sleepy. Don't expect the baby to wake you up when he or she is hungry. You will have to wake the baby every one to two hours to feed him or her. At first you will be feeding your baby colostrum, your first milk that is precious thick yellowish milk. Even though it looks like only a small amount, this is the only food your baby needs. In the beginning, you can expect your baby to lose some weight. This is very normal and is not from breastfeeding. As long as the baby doesn't lose more than 7 to 10% of his or her birth weight during the first three to five days, he is getting enough to eat.
You can tell your baby is getting enough milk by keeping track of the number of wet and dirty diapers. In the first few days, when your milk is low in volume and high in nutrients, your baby will have only 1 or 2 wet diapers a day. After your milk supply has increased, your baby should have 5 to 6 wet diapers and 3 to 4 dirty diapers every day. Consult your pediatrician if you are concerned about your baby's weight gain.
This chart shows the minimum number of diapers for most babies. It is fine if your baby has more.
| Baby's Age | Wet Diaper | Dirty Diapers Color and Texture |
| Day 1 (birth) | 1 | Thick, tarry and black |
| Day 4 | 2 | Thick, tarry and black |
| Day 3 | 3 | Greenish yellow |
| Day 4 | 56 | Greenish yellow |
| Day 5 | 56 | Seedy, watery mustard color |
| Day 6 | 56 | Seedy, watery mustard color |
| Day 7 | 56 | Seedy, watery mustard color |
After you and your baby go home from the hospital, your baby still needs to eat about every one to two hours and should need several diaper changes. You still may need to wake your baby to feed him or her because babies are usually sleepy for the first month. If you are having a hard time waking your baby, you can try undressing or wiping his or her face with a cool washcloth. As your milk comes in after the baby is born, there will be more and more diaper changes. The baby's stools will become runny, yellowish, and may have little white bumpy "seeds."
Overall, you can feel confident that your baby is getting enough to eat because your breasts will regulate the amount of milk your baby needs. If your baby needs to eat more or more often, your breasts will increase the amount of milk they produce. To keep up your milk supply when you give bottles of expressed breast milk for feedings, pump your milk when your baby gets a bottle of breast milk.
If you prepare him in advance, your partner should not be jealous. Explain that you need his support. You can tell him the important benefits of breastfeeding. Tell him he won't make bottles, so he'll get more rest. Be sure to emphasize how much money he'll save too. Tell him it will cost over $300 a month to pay for formula money that could go to bills, savings, or a vacation. You can tell him that breastfeeding will give his child the best start at life, with benefits that can last well into childhood. He can help with changing and burping the baby, sharing chores and by simply sitting with you and the baby to enjoy the special mood that breastfeeding creates.
All women and men should have control over if and when they become parents. Making decisions about birth control, or contraception, is not easy there are many things to think about. Learning about birth control methods you or your partner can use to prevent pregnancy and talking with your health care provider are two good ways to get started.
There is no "best" method of birth control. Each method has its own pros and cons. Some methods work better than others do at preventing pregnancy. Researchers are always working to develop or improve birth control methods.
The birth control method you choose should take into account:
Bear in mind that NO method of birth control prevents pregnancy all of the time. Birth control methods can fail. But you can greatly increase a method's success rate by using it correctly all of the time. The only way to be sure you never get pregnant is to not have sex (abstinence).
There are many methods of birth control that a woman can use. Talk with your health care provider to help you figure out what method is best for you. You can always try one method and if you do not like it, you can try another one.
Keep in mind that most birth control does NOT protect you from HIV or other sexually transmitted diseases (STDs) like gonorrhea, herpes, and chlamydia. Other than not having sex, the best protection against STDs and HIV is the male latex condom. The female condom may give some STD protection. Other birth control methods that involve using a spermicide (a cream or jelly that kills sperm) also may give some protection against chlamydia and gonorrhea.
Don't forget that all of the methods we talk about below work best if used correctly. Be sure you know the correct way to use them. Talk with your health care provider and don't feel embarrassed about talking with her or him again if you forget or don't understand.
Know that learning how to use some birth control methods can take time and practice. Sometimes health care providers do not explain how to use a method because they may think you already know how. For example, some people do not know that you can put on a male condom "inside out." Also, not everyone knows that you need to leave a "reservoir" or space at the tip of the condom for the sperm and fluid when a man ejaculates, or has an orgasm.
The more you know about the correct way to use birth control, the more control you will have over deciding if and when you want to become pregnant.
Here is a list of birth control methods with estimates of effectiveness, or how well they work in preventing pregnancy when used correctly, for each method:
These methods are 75 to 99% effective at preventing pregnancy.
Keep in mind that to practice these methods, you need to learn about your menstrual cycle (or how often you get your period). You keep a written record of when you get your period, what it is like (heavy or light blood flow), and how you feel (sore breasts, cramps). You also check your cervical mucus and take your basal body temperature daily, and record these in a chart. This is how you learn to predict, or tell, which days you are fertile or "unsafe." You can ask your health care provider for more information on how to record and understand this information.
The Male Condom Condoms are called barrier methods of birth control because they put up a block, or barrier, which keeps the sperm from reaching the egg. Only latex or polyurethane (because some people are allergic to latex) condoms are proven to help protect against STDs, including HIV. "Natural" or "lambskin" condoms made from animal products also are available. But lambskin condoms are not recommended for STD prevention because they have tiny pores that may allow for the passage of viruses like HIV, hepatitis B and herpes. Male condoms are 86 to 98% effective at preventing pregnancy. Condoms can only be used once. You can buy them at a drug store. Condoms come lubricated (which can make sexual intercourse more comfortable and pleasurable) and non-lubricated (which can also be used for oral sex). It is best to use lubrication with non-lubricated condoms if you use them for vaginal or anal sex. You can use KY jelly or water-based lubricants, which you can buy at a drug store. Oil-based lubricants like massage oils, baby oil, lotions, or petroleum jelly will weaken the condom, causing it to tear or break. Always keep condoms in a cool, dry place. If you keep them in a hot place (like a billfold, wallet, or glove compartment), the latex breaks down, causing the condom to tear or break.
Oral Contraceptives Also called "the pill," it contains the hormones estrogen and progestin. A pill is taken daily to block the release of eggs from the ovaries. It also lightens the flow of your period and protects against pelvic inflammatory disease (PID), ovarian cancer, and endometrial cancer. It does not protect against STDs or HIV. The pill may add to your risk of heart disease, including high blood pressure, blood clots, and blockage of the arteries. If you are over age 35 and smoke, or have a history of blood clots or breast or endometrial cancer, your health care provider may advise you not to take the pill. The pill is 95 to 99.9% effective at preventing pregnancy if used correctly. You will need a prescription and visits with your health care provider to make sure you are not having problems.
The Mini-Pill Unlike the pill, the mini-pill only has one hormone, progestin, instead of both estrogen and progestin. Taken daily, the mini-pill reduces and thickens cervical mucus to prevent sperm from reaching the egg. It also prevents a fertilized egg from implanting in the uterus (womb). The mini-pill also can decrease the flow of your period and protect against PID and ovarian and endometrial cancer. Mothers who breastfeed can use it because it will not affect their milk supply. The mini-pill is a good option for women who can't take estrogen or for women who have a risk of blood clots. The mini-pill does not protect against STDs or HIV. Mini-pills are 95 to 99.9% effective at preventing pregnancy if used correctly. You will need a prescription and visits with your health care provider to make sure you are not having problems.
Copper T IUD (Intrauterine Device) An IUD is a small device that is shaped in the form of a "T." Your health care provider places it inside the uterus. The arms of the Copper T IUD contain some copper, which stops fertilization by preventing sperm from making their way up through the uterus into the fallopian tubes. If fertilization does occur, the IUD would prevent the fertilized egg from implanting in the lining of the uterus. The Copper T IUD can stay in your uterus for up to 10 years. It does not protect against STDs or HIV. This IUD is 99% effective at preventing pregnancy. Requires visits with your health care provider to have it inserted and to make sure you are not having any problems. Not all health care providers insert IUDs.
Progestasert IUD (Intrauterine Device) - This IUD is a small plastic T- shaped device that is placed inside the uterus by a health care provider. It contains the hormone progesterone, the same hormone produced by a woman's ovaries during the monthly menstrual cycle. The progesterone causes the cervical mucus to thicken so sperm cannot reach the egg, and so that a fertilized egg cannot successfully implant into the lining of the uterus. The Progestasert IUD can stay in your uterus for one year. This IUD is 98% effective at preventing pregnancy. Requires visits with your health care provider to have it inserted and to make sure you are not having any problems. Not all health care providers insert IUDs.
Intrauterine System or IUS (Mirena) The IUS is a small T-shaped device like the IUD and is placed inside the uterus by a health care provider. It releases a small amount of a hormone each day to keep you from getting pregnant. The IUS stays in your uterus for up to five years. It does not protect against STDs or HIV. The IUS is 99% effective. The Food and Drug Administration approved this method in December 2000. Requires visits with your health care provider to make sure you are not having any problems. Not all health care providers insert the IUS.
The Female Condom Worn by the woman, this barrier method keeps sperm from getting into her body. It is made of polyurethane, is packaged with a lubricant, and may protect against STDs, including HIV. It can be inserted up to 8 hours prior to sexual intercourse. Female condoms are 79 to 95% effective at preventing pregnancy. There is only one kind of female condom and its brand name is Reality. Purchase at a drug store.
Implant (Norplant and Norplant 2) This product was taken off the market in July 2002. If you are using the Norplant system, you should contact your health care provider about what your contraceptive options will be after the five year expiration date of your Norplant system. Norplant consists of small stick-like devices, or "rods," that are placed under the skin. The rods release a very low, steady level of a steroid that prevents pregnancy for up to five years. However, the rods can be taken out at any time and you then can become pregnant. This method is 99.9% effective at preventing pregnancy. It does not protect against STDs or HIV. Requires visits with your health care provider to make sure you are not having any problems.
Depo-Provera With this method women get injections, or shots, of the hormone progestin in the buttocks or arm every three months. It does not protect against STDs or HIV. It is 99.7% effective at preventing pregnancy. Requires visits with your health care provider to make sure you are not having any problems.
Diaphragm or Cervical Cap These are barrier methods of birth control, where the sperm are blocked from reaching the egg. The diaphragm is shaped like a shallow latex cup. The cervical cap is a thimble-shaped latex cup. Both come in different sizes and you need a health care provider to "fit" you for one. Before sexual intercourse, you use them with spermicide (to block or kill sperm) and place them up inside your vagina to cover your cervix (the opening to your womb). You can buy spermicide gel or foam at a drug store. Spermicide will also help protect you from the STDs gonorrhea and chlamydia if they have nonoxynol-9 in them. Some women can be sensitive to nonoxynol-9 and need to use spermicides that do not contain it. The diaphragm is 80 to 94% effective at preventing pregnancy. The cervical cap is 80 to 90% effective at preventing pregnancy for women who have not had a child, and 60 to 80% for women who have had a child. Requires a visit with your health care provider for proper fitting.
The Patch (Ortho Evra) This is a skin patch worn on the lower abdomen, buttocks, or upper body. It releases the hormones progestin and estrogen into the bloodstream. You put on a new patch once a week for three weeks, then do not wear a patch during the fourth week in order to have a menstrual period. The patch is 99% effective at preventing pregnancy, but appears to be less effective in women who weigh more than 198 pounds. It does not protect against STDs or HIV. The Food and Drug Administration approved this method in 2001. You will need to visit your health care provider for a prescription and to make sure you are not having problems.
The Hormonal Vaginal Contraceptive Ring (NuvaRing) The NuvaRing is a ring that releases the hormones progestin and estrogen. You place the ring up inside your vagina to go around your cervix (the opening to your womb). You wear the ring for three weeks, take it out for the week that you have your period, and then put in a new ring. The ring is 98 to 99% effective at preventing pregnancy. The Food and Drug Administration approved this method in 2001. You will need to visit your health care provider for a prescription and to make sure you are not having problems.
Surgical Sterilization (Tubal Ligation or Vasectomy) These surgical methods are meant for people who want a permanent method of birth control. In other words, they never want to have a child or they do not want more children. Tubal ligation or "tying tubes" is done on the woman to stop eggs from going down to her uterus where they can be fertilized. The man has a vasectomy to keep sperm from going to his penis, so his ejaculate never has any sperm in it. They are 99 to 99.5% effective at preventing pregnancy.
Nonsurgical Sterilization (Essure Permanent Birth Control System) This is the first non-surgical method of sterilizing women and was approved by the Food and Drug Administration in November 2002. A thin tube is used to thread a tiny spring-like device through the vagina and uterus into each fallopian tube. Flexible coils temporarily anchor it inside the fallopian tube. A Dacron-like mesh material embedded in the coils irritates the fallopian tubes' lining to cause scar tissue to grow and eventually permanently plug the tubes. It can take about three months for the scar tissue to grow, so it is important to use another form of birth control during this time. Then you will have to return to your health care provider for a test to see if scar tissue has fully blocked your tubes. In studies of more than 600 women, followed for a year, there so far have been no pregnancies in those whose Essure devices were implanted successfully.
Emergency Contraception This is NOT a regular method of birth control and should never be used as one. Emergency contraception, or emergency birth control, is used to keep a woman from getting pregnant when she has had unprotected vaginal intercourse. "Unprotected" can mean that no method of birth control was used. It can also mean that a birth control method was used but did not worklike a condom breaking. Or, a woman may have forgotten to take her birth control pills, or may have been abused or forced to have sex when she did not want to. Emergency contraception consists of taking two doses of hormonal pills taken 12 hours apart and started within three days after having unprotected sex. These are sometimes wrongly called the "morning after pill." The pills are 75 to 89% effective at preventing pregnancy. Another type of emergency contraception is having the Copper T IUD put into your uterus within seven days of unprotected sex. This method is 99.9% effective at preventing pregnancy. Neither method of emergency contraception protects against STDs or HIV. You will need to visit your health care provider for either a prescription for the pills or for the insertion of the IUD, and to make sure you are not having problems.
You can purchase what are called spermicides in drug stores. They work by killing sperm and come in several formsfoam, gel, cream, film, suppository, or tablet. They are inserted or placed in the vagina no more than one hour before intercourse and left in place at least six to eight hours after. You may protect yourself more against getting pregnant if you use a spermicide with a male condom, diaphragm, or cervical cap. There are spermicidal products made specifically for use with the diaphragm and cervical cap. Check the package to make sure you are buying what you want.
All spermicides have sperm-killing chemicals in them. Some spermicides also have an ingredient called nonoxynol-9, which can protect you from the STDs gonorrhea and chlamydia. Nonoxynol-9 will not protect you from HIV. Some women are sensitive to nonoxynol-9 and need to use spermicides without it. Spermicides alone are about 74% effective at preventing pregnancy.
Withdrawal is not the most effective birth control method. It works much better when a male condom is used.
Withdrawal refers to when a man takes his penis out of a woman's vagina (or "pulls out") before he ejaculates, or has an orgasm. This stops the sperm from going to the egg. "Pulling out" can be hard for a man to do and it takes a lot of self-control. When you use withdrawal, you can also be at risk for getting pregnant BEFORE the man pulls out. When a man's penis first becomes erect, there can be fluid (called pre-ejaculate fluid) on the tip of the penis that has sperm in it. This sperm can get a woman pregnant. Withdrawal also does not protect you from STDs or HIV.
Today's pills have lower doses of hormones than earlier birth control pills. This has greatly lowered the risk of side effects. However, there are both benefits and risks with taking birth control pills. Benefits include having more regular and lighter periods, fewer menstrual cramps; and a lower risk for ovarian and endometrial cancer, and pelvic inflammatory disease (PID). Serious side effects include an increased chance, for some women, of developing heart disease and high blood pressure. Minor side effects include nausea, headaches, sore breasts, weight gain, irregular bleeding and depression. Many of these side effects go away after taking the pill for a few months. Women who smoke, are over age 35, or have a history of blood clots or breast or endometrial cancer are more at risk for dangerous side effects and may not be able to take the pill. Talk with your health care provider about whether the pill is right for you.
Some people wrongly believe that if they take birth control pills, they are protecting themselves not only from getting pregnant but also from infection with HIV and other sexually transmitted diseases (STDs). Birth control pills or other types of birth control, such as intrauterine devices (IUDs), Norplant, or tubal ligation will NOT protect you from HIV and other STDs.
The male latex condom is the only birth control method that is proven to help protect you from HIV and other STDs. If you are allergic to latex, there are condoms made of polyurethane that you can use. Condoms come lubricated (which can make sexual intercourse more comfortable and pleasurable) and non-lubricated (which can be used for oral sex). It is important to only use latex or polyurethane condoms to protect against HIV and other STDs. "Natural" or "lambskin" condoms have tiny pores that may allow for the passage of viruses like HIV, hepatitis B and herpes. If you use non-lubricated condoms for vaginal or anal sex, you can add lubrication with water-based lubricants that you can buy at a drug store (like KY jelly). Never use oil-based products, such as massage oils, baby oil, lotions, or petroleum jelly, to lubricate a condom. These will weaken the condom, causing it to tear or break.
It is very important to use a condom correctly and consistently which means every time you have vaginal, oral, or anal sex. If you do not know how to use a condom, talk with your health care provider. Don't be embarrassed. Also do not assume that your partner knows how to use a condom correctly. Many men have never had anyone show them how. The biggest reason condoms fail is due to incorrect use. Male condoms can only be used once. Research is being done to find out how effective the female condom is in preventing HIV and other STDs.
The dental dam is a square piece of rubber that is used by dentists during oral surgery and other procedures. It is not a method of birth control. But it can be used to help protect people from STDs, including HIV, during oral sex. It is placed over the opening to the vagina before having oral sex. Dental dams can be purchased at surgical supply stores.
Emergency contraception, or emergency birth control, is used to keep a woman from getting pregnant when she has had unprotected vaginal intercourse. "Unprotected" can mean that no method of birth control was used. It can also mean that a birth control method was used but did not work like a condom breaking. Other things can happen as well that put a woman at risk for getting pregnant. A woman may have forgotten to take her birth control pills. She may have been abused or forced to have sex when she did not want to. Emergency contraception should never be used as a regular method of birth control. There are effective methods of birth control that women can use on a regular basis to prevent pregnancy.
Emergency contraception keeps a woman from getting pregnant by stopping:
If you are already pregnant, emergency contraception will NOT work. If you have an ectopic pregnancy, where the pregnancy develops outside of the uterus, it will also not work. This can be a serious condition that can be fatal. Signs of ectopic pregnancy include extreme pain on one or both sides of the lower abdomen, spotting blood, and feeling dizzy or faint. If you think you have an ectopic pregnancy, go to an emergency room right away.
There are two types of emergency contraception available to women in the United States: emergency contraceptive pills (ECPs) and intrauterine devices (IUDs). In most states, you need to see a health care provider to get either type of emergency contraception. The health care provider may take your medical history and do a urine pregnancy test, and will talk with you about which type of emergency contraception is best for you. You should never take ECPs that belong to another family member or friend. It is very important to first talk with a health care provider.
ECPs are sometimes wrongly called the "morning after pill." This is wrong because ECPs are never taken as one pill, the "morning after." They are taken in two doses, 12 hours apart. They work best if taken within 72 hours of unprotected vaginal intercourse. ECPs contain higher doses of hormones than those contained in birth control pills. ECPs can have only one hormone, progestin, or can have two hormones, estrogen and progestin. If a woman can't take estrogen or is breastfeeding, she can use progestin-only ECPs. If you need ECPs, your health care provider will prescribe the best pill for you to use.
The other type of emergency contraception is an intrauterine device (IUD). A woman can have the Copper-T IUD, which is shaped like a "T," and placed inside her uterus (or womb) by a health care provider. This must be done within seven days after unprotected vaginal intercourse. The IUD can be taken out by a health care provider after the woman's next period. It also can be left in place for up to 10 years if the woman decides to use it as her regular method of birth control.
Take the emergency contraceptive pills (ECPs) exactly as the health care provider tells you. If you see another health care provider for any reason after taking any dose of ECPs, be sure to tell her or him that you have taken ECPs.
Some women have nausea and vomiting after taking ECPs. A health care provider can prescribe medication to help control the nausea. If you have severe nausea, it is important not to stop taking the pills. If you do not finish the pills, you may not prevent the pregnancy. After you have taken ECPs, you can expect that your first period may come sooner or later than normal. Your blood flow also may be different heavier, lighter, or more spotty than normal. You MUST use another method of birth control if you have vaginal intercourse any time before your next period starts. Now is a good time for you to start planning for the future. Learn about birth control methods and choose one you feel comfortable with. Talking with your health care provider is a good way to start. If you do not start your period within three weeks or have any signs of pregnancy after taking ECPs, see a health care provider right away.
Emergency contraceptive pills (ECPs) that contain both estrogen and progestin are about 75% effective at keeping a woman from getting pregnant. ECPs that contain only progestin are about 89% effective.
The Copper-T intrauterine device (IUD) is 99.9% effective. Timing is important to how well emergency birth control works. The sooner a woman gets emergency birth control after having unprotected vaginal intercourse, the better it works. If a woman is in the fertile part of her cycle (ovulating), or close to that time, when she uses emergency birth control, her chances of getting pregnant are greater.
Studies have been done with women who did not know they were pregnant and kept taking birth control pills. These studies have found no increased risk for birth defects. Your girlfriend should see a health care provider right away to talk about her options.
No. Emergency contraception prevents pregnancy. It works by stopping an egg from being released from the ovary and by stopping an egg from being fertilized, or reached by sperm. Emergency contraception also stops a fertilized egg from attaching, or implanting, itself to the wall of the uterus (or womb). The so-called "abortion pills" (Mifeprex (mifepristone) also called RU-486) work after a woman becomes pregnant after a fertilized egg attaches to the wall of the uterus. These pills cause the uterus to expel the egg, ending the pregnancy.
Infertility is usually defined as not being able to get pregnant despite trying for one year. A broader view of infertility includes not being able to carry a pregnancy to term and have a baby. Infertility affects about 6.1 million Americans, or 10 percent of the reproductive age population, according to the American Society for Reproductive Medicine.
Pregnancy is the result of a chain of events. A woman must release an egg from one of her ovaries (ovulation). The egg must travel through a fallopian tube toward her uterus (womb). A man's sperm must join with (fertilize) the egg along the way. The fertilized egg must then become attached to the inside of the uterus. While this may seem simple, in fact many things can happen to prevent pregnancy from occurring.
It is a myth that infertility is always a "woman's problem." About one third of infertility cases are due to problems with the man (male factors) and one third are due to problems with the woman (female factors). Other cases are due to a combination of male and female factors or to unknown causes.
Infertility in men is often caused by problems with making sperm or getting the sperm to reach the egg. Problems with sperm may exist from birth or develop later in life due to illness or injury. Some men produce no sperm, or produce too few sperm. Lifestyle can influence the number and quality of a man's sperm. Alcohol and drugs can temporarily reduce sperm quality. Environmental toxins, including pesticides and lead, may cause some cases of infertility in men.
Problems with ovulation account for most infertility in women. Without ovulation, eggs are not available to be fertilized. Signs of problems with ovulation include irregular menstrual periods or no periods. Simple lifestyle factors - including stress, diet, or athletic training - can affect a woman's hormonal balance. Much less often, a hormonal imbalance from a serious medical problem such as a pituitary gland tumor can cause ovulation problems.
Aging is an important factor in female infertility. The ability of a woman's ovaries to produce eggs declines with age, especially after age 35. About one third of couples where the woman is over 35 will have problems with fertility. By the time she reaches menopause, when her monthly periods stop for good, a woman can no longer produce eggs or become pregnant.
Other problems can also lead to infertility in women. If the fallopian tubes are blocked at one or both ends, the egg can't travel through the tubes into the uterus. Blocked tubes may result from pelvic inflammatory disease, endometriosis, or surgery for an ectopic pregnancy.
If you have been trying to have a baby without success, you may want to seek medical help. If you are over 35, or if you have reason to believe that there may be a fertility problem, you should not wait for one year of trying before seeing a health care provider. A medical evaluation may determine the reasons for a couple's infertility. Usually this process begins with physical exams and medical and sexual histories of both partners. If there is no obvious problem, like improperly timed intercourse or absence of ovulation, tests may be needed.
For a man, testing usually begins with tests of his semen to look at the number, shape, and movement of his sperm. Sometimes other kinds of tests, such as hormone tests, are done.
For a woman, the first step in testing is to find out if she is ovulating each month. There are several ways to do this. For example, she can keep track of changes in her morning body temperature and in the texture of her cervical mucus. Another tool is a home ovulation test kit, which can be bought at drug or grocery stores.
Checks of ovulation can also be done in the doctor's office, using blood tests for hormone levels or ultrasound tests of the ovaries. If the woman is ovulating, more tests will need to be done.
Some common female tests include:
Depending on the test results, different treatments can be suggested. Eighty-five to 90 percent of infertility cases are treated with drugs or surgery.
Various fertility drugs may be used for women with ovulation problems. It is important to talk with your health care provider about the drug to be used. You should understand the drug's benefits and side effects. Depending on the type of fertility drug and the dosage of the drug used, multiple births (such as twins) can occur in some women.
If needed, surgery can be done to repair damage to a woman's ovaries, fallopian tubes, or uterus. Sometimes a man has an infertility problem that can be corrected by surgery.
In vitro fertilization (IVF) is a procedure made famous with the 1978 birth of Louise Brown, the world's first "test tube baby." IVF is often used when a woman's fallopian tubes are blocked or when a man has low sperm counts. A drug is used to stimulate the ovaries to produce multiple eggs. Once mature, the eggs are removed and placed in a culture dish with the man's sperm for fertilization. After about 40 hours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized eggs (embryos) are then placed in the woman's uterus, thus bypassing the fallopian tubes.
Gamete intrafallopian transfer (GIFT) is similar to IVF, but used when the woman has at least one normal fallopian tube. Three to five eggs are placed in the fallopian tube, along with the man's sperm, for fertilization inside the woman's body.
Zygote intrafallopian transfer (ZIFT), also called tubal embryo transfer, combines IVF and GIFT. The eggs retrieved from the woman's ovaries are fertilized in the lab and placed in the fallopian tubes rather than the uterus. ART procedures sometimes involve the use of donor eggs (eggs from another woman) or previously frozen embryos. Donor eggs may be used if a woman has impaired ovaries or has a genetic disease that could be passed on to her baby.
It is the time leading up to menopause (when you have not had your period for twelve months). During perimenopause, your body starts making less of certain hormones (estrogen and progesterone), and you begin to lose the ability to become pregnant.
It varies. Women normally go through menopause between ages 45 and 55. Many women experience menopause around age 51. However, perimenopause can start as early as age 35. It can last just a few months or a few years. There is no way to tell in advance how long it will last or how long it will take you to go through it.
It could. Researchers are studying how depression in a woman's life affects the time she starts perimenopause. Some studies have found that women with a history of depression started perimenopause earlier than women without depression. Women who took antidepressants started perimenopause even earlier. If you start perimenopause early, researchers don't know if you reach menopause faster than other women or if you're just in perimenopause longer.
Some women have symptoms during this time that can be difficult. These symptoms include:
We don't know exactly what causes hot flashes. It could be a drop in estrogen or change in another hormone. This affects the part of your brain that regulates your body temperature. During a hot flash, you feel a sudden rush of heat move from your chest to your head. Your skin may turn red, and you may sweat. Hot flashes are sometimes brought on by things like hot weather, eating hot or spicy foods, or drinking alcohol or caffeine. Try to avoid these things if you find they trigger the hot flashes.
Your mood changes could be caused by a lot of factors. Some researchers believe that the decrease in estrogen triggers changes in your brain causing depression. Others think that if you're depressed, irritable, and anxious, it's influenced by other symptoms you're having, such as sleep problems, hot flashes, night sweats, and fatigue - not hormonal changes. Or, it could be a combination of hormone changes and symptoms. Other things that could cause depression and/or anxiety include:
Irregular periods are common and normal during perimenopause, but not all changes in bleeding are from perimenopause or menopause. Other things can cause abnormal bleeding. Talk to your health care provider if:
Yes. If you're still having periods, you can get pregnant. Talk to your health care provider about your options for birth control. Keep in mind that methods of birth control, like birth control pills, shots, implants, or diaphragms will not protect you from STDs or HIV. If you use one of these methods, be sure to also use a latex condom or dental dam (used for oral sex) correctly every time you have sexual contact. Be aware that condoms don't provide complete protection against STDs and HIV - the only sure protection is abstinence (not having sex of any kind). But appropriate and consistent use of latex condoms and other barrier methods can help protect you from STDs.
Menopause is a normal change in a woman's life when her period stops. That's why some people call menopause "the change of life." During menopause a woman's body slowly makes less of the hormones estrogen and progesterone. This often happens between the ages of 45 and 55 years old. A woman has reached menopause when she has not had a period for 12 months in a row (and there are no other causes for this change). As you near menopause you may have symptoms from the changes your body is making. Many women wonder if these changes are normal, and many are confused about how to treat their symptoms. You can feel better by learning all you can about menopause, and talking with your doctor about your health and your symptoms. If you want to treat your symptoms, he or she can teach you more about your options and help you make the best treatment choices.
Every woman's period will stop at menopause. Some women may not have any other symptoms. But, as you near menopause, you may have:
Sometimes, younger women need a hysterectomy (surgery to remove the uterus and ovaries) to treat health problems such as endometriosis or cancer. After your surgery, you will enter into what is known as induced or surgical menopause. This is menopause that happens to your body right away, and it is brought on by the surgery. You will no longer have periods. Since your ovaries will be removed, you may have many menopausal symptoms right away, instead of gradually. You can talk with your doctor about how to best manage these symptoms.
Women who have a hysterectomy, but have their ovaries left in place, will not have induced menopause because their ovaries will continue to make hormones. But, because their uterus is removed, they no longer have their periods and they cannot bear children. They also might have hot flashes since the surgery can sometimes disturb the blood supply to the ovaries. Later on, they also might have natural menopause a year or two earlier than expected.
Premature menopause is menopause that happens before the age of 40 - whether it is natural or induced. Some women have premature menopause because of:
Having premature menopause puts a woman at more risk for osteoporosis later in her life. It also may be a source of great distress, since many women younger than 40 still want to have children. Women who still want to become pregnant can talk with their doctor about donor egg programs.
The term postmenopause refers to all the years beyond menopause. It is the period past the time at which you have not had a period for 12 months in a row - whether your menopause was natural or induced.
Many women in perimenopause and menopause feel depressed and irritable. Some researchers believe that the decrease in estrogen triggers changes in your brain, causing depression. Others think that other symptoms you're having, such as sleep problems, hot flashes, night sweats, and fatigue cause these feelings. Or, it could be a combination of hormone changes and symptoms. But these symptoms also can have causes that are unrelated to menopause. If you are having these symptoms, and you think they are interfering with your quality of life, it is important to discuss them with your doctor. Talk openly with your doctor about the other things going on in your life that might be adding to your feelings. Other things that could cause depression and/or anxiety include:
If you need treatment for these symptoms, you and your doctor can work together to find a treatment that is best for you.
Changes in bleeding are normal as you near menopause. There are also other common causes of bleeding in the years after menopause. The decline in your body's estrogen levels can cause tissues lining the vagina to become thin, dry, and less elastic. Sometimes this lining can become broken or easily inflamed and bleed. It can also become injured during sex or even during a pelvic exam. Once you've reached menopause, though, you should report any bleeding that you have to your doctor. Uterine bleeding after menopause could be a sign of other health problems. Other things that can cause abnormal bleeding include:
For some women, many of their menopause symptoms will go away over time without treatment. Other women will choose treatment for their symptoms and to prevent bone loss that can happen near menopause. Treatments may include prescription drugs that contain types of hormones that your ovaries stop making around the time of menopause. Hormone therapy can contain estrogen alone or estrogen with progestin (for a woman who still has her uterus or womb). Estrogen therapy usually is taken by pill, skin patch, as a cream or gel, or with an intrauterine device (IUD) or vaginal ring. How estrogen is taken can depend on its purpose. For instance, a vaginal ring or cream can ease vaginal dryness, leakage of urine, or vaginal or urinary infections, but does not relieve hot flashes. If you want to prevent bone loss, you also should talk with your doctor about medicines other than hormone therapy that can help your bones.
Benefits: Hormone therapy can help with menopause by:
Do Not use hormone therapy to prevent heart attacks, strokes, memory loss or Alzheimer's disease. Remember there also are other medicines that can help your bones.
Risks: For some women, hormone therapy may increase their chance of getting:
For a woman with a uterus, taking estrogen alone, without progesterone, increases her chance of getting endometrial cancer (cancer of the lining of the uterus). Adding progesterone to the hormone therapy lowers this risk.
Hormone therapy also may cause these side effects:
Who should Not take hormone therapy for menopause:
Women who…
We know that hormone therapy may be a way to get over the symptoms of menopause if taken for only a short time and in the smallest amount. Hormones do NOT help prevent heart or bone disease, stroke, memory loss or Alzheimer's disease. If you decide to use hormones, use them at the lowest dose that helps and for the shortest time needed. Check with your doctor every 3 to 6 months to see if you still need them. Because there are both benefits and risks linked to taking them, every woman should think about these in regard to her own health and discuss these issues with her doctor. We are still trying to learn more about the long- and short-term effects of hormone therapies on women's health. For more information on the risks and benefits of hormone therapy, go to http://www.nhlbi.nih.gov/health/women/index.htm.
Some women decide to take herbal, natural, or plant-based products to help their symptoms. Some of the most common ones are:
Products that come from plants may sound like they are more natural or safer than other forms of hormones, but there is no proof they really are. There also is no proof that they are better at helping symptoms of menopause. Make sure to discuss herbal products with your doctor before taking them. You also should tell your doctor if you are taking any other medicines, since some of the herbal products can be harmful to you with other drugs.
Hot flashes. A hot environment, eating or drinking hot or spicy foods, alcohol, or caffeine, and stress can bring on hot flashes. Try to avoid these triggers. Dress in layers and keep a fan in your home or workplace. Regular exercise might also bring relief from hot flashes and other symptoms. Ask your doctor about taking an antidepressant medicine. There is proof that these can be helpful for some women.
Vaginal dryness. Use an over-the-counter vaginal lubricant. There are also prescription estrogen replacement creams that your doctor might give you. If you have spotting or bleeding while using estrogen creams, you should see your doctor.
Problems sleeping. One of the best ways to get a good night's sleep is to get at least 30 minutes of physical activity on most days of the week. But, avoid a lot of exercise close to bedtime. Also avoid alcohol, caffeine, large meals, and working right before bedtime. You might want to drink something warm, such as herb tea or warm milk, before bedtime. Try to keep your bedroom at a comfortable temperature. Avoid napping during the day and try to go to bed and get up at the same times every day.
Memory problems. Ask your doctor about mental exercises you can do to improve your memory. Try to get enough sleep and be physically active.
Mood swings. Try to get enough sleep and be physically active. Ask your doctor about relaxation exercises you can do. Ask your doctor about taking an antidepressant medicine. There is proof that these can be helpful. Think about going to a support group for women who are going through the same thing as you, or getting counseling to talk through your problems and fears.
There are a lot of ways to stay healthy during this time in your life. These steps are more likely to keep you healthy than just taking hormones:
You can use this chart to keep track of menopausal symptoms that bother you. Take it with you when you visit your doctor, so you both can figure out the best way to handle them.
| Date | Symptoms | Things I've tried to help them | Questions for my doctor | New things to try |
Agency for Healthcare Research and Quality
Phone Number(s): (800) 358-9295 for requesting publications
Internet Address: http://www.ahrq.gov/consumer/
American Academy of Family Physicians
Phone Number(s): (913) 906-6000
Internet Address: http://www.familydoctor.org
American Academy of Pediatrics
Internet Address: http://www.aap.org/
American Cancer Society
Phone Number(s): (800) 227-2345
Internet Address: http://www.cancer.org
American College of Nurse-Midwives
Phone Number(s): (888) 643-9433
Internet Address: http://www.midwife.org
American College of Obstetricians and Gynecologists
Phone: (800) 762-2264
Internet Address: http://www.acog.org/
American College of Obstetricians and Gynecologists (ACOG) Resource Center
Phone Number(s): (800) 762-2264 x 192 (for publications requests only)
Internet Address: http://www.acog.org/
American College of Surgeons
Phone Number(s): (312) 202-5000
Internet Address: http://www.facs.org
American Social Health Association
Phone Number(s): (800) 783-9877
Internet Address: http://www.ashastd.org
American Society for Colposcopy and Cervical Pathology
Phone Number(s): (800) 787-7227
Internet Address: http://www.asccp.org/
American Society for Reproductive Medicine
Phone Number(s): (205) 978-5000
Internet Address: http://www.asrm.org/
Cancer Information Service
Phone Number(s): (800) 422-6237
CDC National STD and AIDS Hotline
Phone Number(s): (800) 227-8922
Internet Address: http://www.ashastd.org/NSTD/index.html
Center for Food Safety and Applied Nutrition
Phone Number(s): (888) 723-3366
Internet Address: http://www.cfsan.fda.gov
Centers for Disease Control and Prevention
Phone Number (s): (800) 311-3435 (Public Inquiries) or (888) 232-3228 (Information Request System)
Internet Address: http://www.cdc.gov/
Centers for Disease Control and Prevention
National Center on Birth Defects and Developmental Disabilities
Phone Number(s): (770) 488-7150, (888) 232-6789
Internet Address: http://www.cdc.gov/ncbddd/
Centers for Disease Control and Prevention (CDC)
National Prevention Information Network
Phone Number(s): (800) 458-5231
Internet Address: http://www.cdcnpin.org
Emergency Contraception Hotline
Phone Number(s): (888) 668-2528
Internet Address: http://ec.princeton.edu
Endometriosis Association
Phone Number(s): (414) 355-2200
Internet Address: http://www.endometriosisassn.org/
Endometriosis Research Center
Phone Number(s): (800) 239-7280
Internet Address: http://www.endocenter.org/
Food and Drug Administration (FDA)
Office on Women's Health
Internet Address: www.fda.gov/womens/menopause
Food and Nutrition Service
Phone Number: (703) 305-2286
Web Site: http://www.fns.usda.gov/fns/
Health Information Center (NWHIC), visiting their "Healthy Pregnancy"
web site at: http://www.4woman.gov/pregnancy, or by contacting the following organizations:
Internet Address: http://cis.nci.nih.gov/
InterNational Council on Infertility Information Dissemination, Inc.
Phone Number(s): (703) 379-9178
Internet Address: http://www.inciid.org/
La Leche League
International Phone Number(s): 800-525-3243
Internet Address: http://www.lalecheleague.org/
March of Dimes Birth Defects Foundation
Phone Number(s): (888) 663-4637
Internet Address: http://www.modimes.org
Melpomene Institute
Phone: (651) 642-1951
Internet Address: http://www.melpomene.org/
National Cancer Institute
Phone: (800) 332-8615
Internet Address: http://cis.nci.nih.gov/
National Center for Birth Defects and Developmental Disabilities
Phone Number(s): (888) 232-6789
Internet Address: http://www.cdc.gov/ncbddd/folicacid/
National Center for Complementary and Alternative Medicine
Internet Address: www.nccam.nih.gov
Publication: http://nccam.nih.gov/health/alerts/menopause/
National Center for HIV, STD and TB Prevention
Internet Address: http://www.cdc.gov/nchstp/od/nchstp.html
National Cervical Cancer Coalition
Phone Number(s): (800) 685-5531
Internet Address: http://www.nccc-online.org/
National Institute of Allergy and Infectious Diseases
Phone Number (s): (800) 448-0440
Internet Address: http://www.niaid.nih.gov/
National Institute of Child Health and Human Development
Internet Address: http://www.nichd.nih.gov/
National Institute of Child Health and Human Development Clearinghouse
Phone Number(s): (800) 370-2943
Internet Address: http://www.nichd.nih.gov/publications/pubs.cfm
National Institute on Aging
Phone: (800) 222-2225, (800) 222-4225 (TTY)
Internet Address: http://www.nih.gov/nia/
National Institute on Alcohol Abuse and Alcoholism
Phone Number(s): (301) 433-3860 (Information Office)
Internet Address: http://www.niaaa.nih.gov
National Maternal and Child Health Clearinghouse
Phone Number: (703) 356-1964
Web Site: http://www.nmchc.org/
National Organization on Fetal Alcohol Syndrome
Phone Number(s): (800) 666-6327
Internet Address: http://www.nofas.org/
National Osteoporosis Foundation
Phone: (202) 223-2226
Internet Address: http://www.nof.org/
National Uterine Fibroids Foundation
Phone Number(s): (877) 553-NUFF
Internet Address: http://www.nuff.org/
National Vaginitis Association
Phone Number(s) : (800) 428-6397
Internet Address : http://www.vaginalinfections.com/
Nemours Foundation
Phone Number(s): (302) 651-4046
Internet Address: http://www.nemours.org/no/
North American Menopause Society
Phone: (440) 442-7550
Internet Address: http://www.menopause.org/
Planned Parenthood Federation of America
Phone Number (s): (800) 230-7526
Internet Address: http://www.plannedparenthood.org
The Hormone Foundation
Phone: (800) 467-6663
Internet Address: http://www.hormone.org/
The Human Lactation Center, Ltd.
Phone Number(s): (203) 259-5995 (Voice)
(203) 259-7667 (FAX)
The Nemours Foundation
Phone Number(s): (302) 651-4046
Internet Address: http://www.nemours.org/no/
Wellstart International
Phone Number(s): (619) 294-7787 (FAX)
(619) 295-5192 (Voice)
Women, Infants and Children (WIC) Program, USDA
Internet Address: http://www.fns.usda.gov/wic/