Birth Control Methods
What is the best method of birth control (or contraception)?
There is no “best” method of birth control. Each method has its pros and cons.
All women and men can have control over when, and if, they become parents. Making choices about birth control, or contraception, isn’t easy. There are many things to think about. To get started, learn about birth control methods you or your partner can use to prevent pregnancy. You can also talk with your doctor about the choices.
Before choosing a birth control method, think about:
- Your overall health
- How often you have sex
- The number of sex partners you have
- If you want to have children someday
- How well each method works to prevent pregnancy
- Possible side effects
- Your comfort level with using the method
Keep in mind, even the most effective birth control methods can fail. But your chances of getting pregnant are lowest if the method you choose always is used correctly and every time you have sex.
What are the different types of birth control?
You can choose from many methods of birth control. They are grouped by how they work:
Types of Birth Control
- Contraceptive Sponge
- Diaphragm, Cervical Cap, and Cervical Shield
- Female Condom
- Male Condom
- Oral Contraceptives — Combined pill (“The pill”)
- Oral Contraceptives — Progestin-only pill (“Mini-pill”)
- The Patch
- Shot/Injection
- Vaginal Ring
- Implantable Rods
- Intrauterine Devices
- Sterilization Implant
- Surgical Sterilization
Detailed information on each type is provided in the following charts. Talk with your doctor if you have questions about any of the choices.
| Natural Family Planning/Rhythm Method |
|---|
This method is when you do not have sex or use a barrier method on the days you are most fertile (most likely to become pregnant). You can read about barrier methods in the following chart. A woman who has a regular menstrual cycle has about 9 or more days each month when she is able to get pregnant. These fertile days are about 5 days before and 3 days after ovulation, as well as the day of ovulation. To have success with this method, you need to learn about your menstrual cycle. Then you can learn to predict which days you are fertile or “unsafe.” To learn about your cycle, keep a written record of:
This method also involves checking your cervical mucus and recording your body temperature each day. Cervical mucus is the discharge from your vagina. You are most fertile when it is clear and slippery like raw egg whites. Use a basal thermometer to take your temperature and record it in a chart. Your temperature will rise 0.4 to 0.8° F on the first day of ovulation. You can talk with your doctor or a natural family planning instructor to learn how to record and understand this information. |
| Hormonal Methods — Prevent pregnancy by interfering with ovulation, fertilization, and/or implantation of the fertilized egg |
|---|
Oral Contraceptives — Combined pill (“The pill”) The pill contains the hormones estrogen and progestin. It is taken daily to keep the ovaries from releasing an egg. The pill also causes changes in the lining of the uterus and the cervical mucus to keep the sperm from joining the egg. Some women prefer the “extended cycle” pills. These have 12 weeks of pills that contain hormones (active) and 1 week of pills that don’t contain hormones (inactive). While taking extended cycle pills, women only have their period three to four times a year. Many types of oral contraceptives are available. Talk with your doctor about which is best for you. Your doctor may advise you not to take the pill if you:
Antibiotics may reduce how well the pill works in some women. Talk to your doctor about a backup method of birth control if you need to take antibiotics. |
Oral Contraceptives — Progestin-only pill (“Mini-pill”) Unlike “the pill,” the mini-pill only has one hormone –– progestin. Taken daily, the mini-pill thickens cervical mucus, which keeps the sperm from joining the egg. Less often, it stops the ovaries from releasing an egg. Mothers who breastfeed can use the mini-pill. It won’t affect their milk supply. The mini-pill is a good option for women who:
The mini-pill must be taken at the same time each day. A backup method of birth control is needed if you take the pill more than 3 hours late. Antibiotics may reduce how well the pill works in some women. Talk to your doctor about a backup method of birth control if you need to take antibiotics. |
The Patch Also called by its brand name, Ortho Evra, this skin patch is worn on the lower abdomen, buttocks, outer arm, or upper body. It releases the hormones progestin and estrogen into the bloodstream to stop the ovaries from releasing eggs in most women. It also thickens the cervical mucus, which keeps the sperm from joining with the egg. You put on a new patch once a week for 3 weeks. You don’t use a patch the fourth week in order to have a period. |
Shot/Injection The birth control shot often is called by its brand name Depo-Provera. With this method you get injections, or shots, of the hormone progestin in the buttocks or arm every 3 months. A new type is injected under the skin. The birth control shot stops the ovaries from releasing an egg in most women. It also causes changes in the cervix that keep the sperm from joining with the egg. The shot should not be used more than 2 years in a row because it can cause a temporary loss of bone density. The loss increases the longer this method is used. The bone does start to grow after this method is stopped. But it may increase the risk of fracture and osteoporosis if used for a long time. |
Vaginal Ring This is a thin, flexible ring that releases the hormones progestin and estrogen. It works by stopping the ovaries from releasing eggs. It also thickens the cervical mucus, which keeps the sperm from joining the egg. It is commonly called NuvaRing, its brand name. You squeeze the ring between your thumb and index finger and insert it into your vagina. You wear the ring for 3 weeks, take it out for the week that you have your period, and then put in a new ring. |
Can all types of birth control prevent sexually transmitted infections (STIs)?
No. The male latex condom is the only birth control method proven to help protect you from STIs, including HIV. Research is being done to find out how effective the female condom is at preventing STIs and HIV. For more information, see Will birth control pills protect me from sexually transmitted infections (STIs), including HIV/AIDS?
How well do the different kinds of birth control methods work? Do they have side effects?
All birth control methods work the best if used correctly and every time you have sex. Be sure you know the right way to use them. Sometimes doctors don’t explain how to use a method because they assume you already know. Talk with your doctor if you have questions. They are used to talking about birth control. So don’t feel embarrassed about talking to him or her.
Some birth control methods can take time and practice to learn. For example, some people don’t know you can put on a male condom “inside out.” Also, not everyone knows you need to leave a little space at the tip of the condom for the sperm and fluid when a man ejaculates, or has an orgasm.
Here is a list of some birth control methods with their failure rates and possible side effects.
| Method | Failure rate (the number of pregnancies expected per 100 women) | Some side effects and risks |
|---|---|---|
Sterilization surgery for women | Less than 1 |
|
Sterilization implant for women (Essure) | Less than 1 |
|
Sterilization surgery for men | Less than 1 |
|
Implantable rod (Implanon) | Less than 1 Might not work as well for women who are overweight or obese. |
|
Intrauterine device (ParaGard, Mirena) | Less than 1 |
|
Shot/Injection (Depo-Provera) | Less than 1 |
|
Oral Contraceptives (combination pill, or “the pill”) | 5 Being overweight may increase the chance of getting pregnant while using the pill. |
|
Oral contraceptives (continuous/extended use, or “no-period pill”) | 5 Being overweight may increase the chance of getting pregnant while using the pill. |
|
Oral contraceptives (progestin-only pill, or “mini-pill”) | 5 Being overweight may increase the chance of getting pregnant while using the pill. |
|
Skin patch (Ortho Evra) | 5 May not work as well in women weighing more than 198 pounds. |
|
Vaginal ring (NuvaRing) | 5 |
|
Male condom | 11–16 |
|
Diaphragm with spermicide | 15 |
|
Sponge with spermicide (Today Sponge) | 16–32 |
|
Cervical cap with spermicide | 17-23 |
|
Female condom | 20 |
|
Natural family planning (rhythm method) | 25 | None |
Spermicide alone | 30 It works best if used along with a barrier method, such as a condom. |
|
Emergency contraception (“morning-after pill,” “Plan B”) | 15 It must be used within 72 hours of having unprotected sex. Should not be used as regular birth control; only in emergencies. |
|
Where can I get birth control? Do I need to visit a doctor?
Where you get birth control depends on what method you choose.
You can buy these forms over the counter:
- Male condoms
- Female condoms
- Sponges
- Spermicides
- Emergency contraception pills (girls younger than 18 need a prescription)
You need a prescription for these forms:
- Oral contraceptives: the pill, the mini-pill
- Skin patch
- Vaginal ring
- Diaphragm (your doctor needs to fit one to your shape)
- Cervical cap
- Cervical shield
- Shot/injection (you get the shot at your doctor’s office)
- IUD (inserted by a doctor)
- Implantable rod (inserted by a doctor)
You will need surgery or a medical procedure for:
- Sterilization, female and male
Are there any foams or gels I can use to keep from getting pregnant?
You can buy spermicides over the counter. They work by killing sperm. They come in many forms:
- Foam
- Gel
- Cream
- Film
- Suppository
- Tablet
Spermicides are put in the vagina no more than 1 hour before having sex. If you use a film, suppository, or tablet, wait at least 15 minutes before having sex so the spermicide can dissolve. Do not douche or rinse out your vagina for at least 6 to 8 hours after having sex. You will need to use more spermicide each time you have sex.
Spermicides work best if used along with a barrier method, such as a condom, diaphragm, or cervical cap. Some spermicides are made just for use with the diaphragm and cervical cap. Check the package to make sure you are buying what you need.
All spermicides contain sperm-killing chemicals. Some contain nonoxynol-9, which may raise your risk of HIV if you use it a lot. It irritates the tissue in the vagina and anus, so it can cause the HIV virus to enter the body more freely. Some women are sensitive to nonoxynol-9 and need to use spermicides without it. Medications for vaginal yeast infections may lower the effectiveness of spermicides. Also, spermicides do not protect against sexually transmitted infections.
How effective is withdrawal as a birth control method?
Not very! Withdrawal is 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. It takes a lot of self-control.
Even if you use withdrawal, sperm can be released before the man pulls out. When a man’s penis first becomes erect, pre-ejaculate fluid may be on the tip of the penis. This fluid has sperm in it. So you could still get pregnant.
Withdrawal does not protect you from STIs or HIV.
Everyone I know is on the pill. Is it safe?
Today’s pills have lower doses of hormones than ever before. This has greatly lowered the risk of side effects. But there are still pros and cons with taking birth control pills. Pros include having:
- More regular and lighter periods
- Fewer menstrual cramps
- A lower risk of ovarian and endometrial cancers, pelvic inflammatory disease (PID), noncancerous ovarian cysts, and iron deficiency anemia
Cons include a higher chance, for some women, of:
- Heart disease, high blood pressure, and blood clots
- Nausea, headaches, sore breasts, and weight gain
- Irregular bleeding
- Depression
Many of these side effects go away after taking the pill for a few months. Women who smoke, are older than 35, or have a history of blood clots or breast or endometrial cancer are more at risk of bad side effects and may not be able to take the pill. Talk with your doctor about whether the pill is right for you.
Will birth control pills protect me from sexually transmitted infections (STIs), including HIV/AIDS?
No, they won’t protect you. Birth control pills and most other birth control methods will not protect you from STIs, including HIV (the virus that causes AIDS). They only protect against pregnancy.
The male latex condom is the best birth control method that also can protect you from STIs, including HIV. If you are allergic to latex, polyurethane condoms are a good alternative. If your partner can’t or won’t use a male condom, female condoms also create a barrier that can help protect you from STIs.
It is important to only use latex or polyurethane condoms to protect you from STIs. "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 male condoms for vaginal or anal sex, you can add lubrication with water-based lubricants (like K-Y jelly) that you can buy at a drug store. Never use oil-based products, such as massage oils, baby oil, lotions, or petroleum jelly, to lubricate a male condom. These will weaken the condom, causing it to tear or break. Use a new condom with each sex act.
I’ve heard my girlfriends talking about dental dams –– what are they?
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 STIs, including HIV, during oral-vaginal or oral-anal sex. It is placed over the opening to the vagina or the anus before having oral sex. You can buy dental dams at surgical supply stores.
Breastfeeding
Why should I breastfeed?
Breastfeeding is normal and healthy for infants and moms. Breast milk has disease-fighting cells calledantibodies that help protect infants from germs, illness, and even sudden infant death syndrome (SIDS). Breastfeeding is linked to a lower risk of various health problems for babies, including:
- Ear infections
- Stomach viruses
- Respiratory infections
- Atopic dermatis
- Asthma
- Obesity
- Type 1 and type 2 diabetes
- Childhood leukemia
- Necrotizing enterocolitis, a gastrointestinal disease in preterm infants
In moms, breastfeeding is linked to a lower risk of type 2 diabetes, breast cancer, ovarian cancer, and postpartum depression. Infant formula cannot match the exact chemical makeup of human milk, especially the cells, hormones, and antibodies that fight disease. For most babies, breast milk is easier to digest than formula. It takes time for their stomachs to adjust to digesting proteins in formula because they are made from cow's milk.
Learn more about the Benefits of Breastfeeding.
How long should I breastfeed?
It is best to give your baby only breast milk for the first six months of life. This means not giving your baby any other food or drink — not even water — during this time. Drops of liquid vitamins, minerals, and medicines are, of course, fine, as advised by your baby's doctor. It is even better if you can breastfeed for your baby's first year or longer, for as long as you both wish. Solid iron-rich foods, such as iron-fortified cereals and pureed vegetables and meats, can be started when your baby is around six months old. Before that time, a baby's stomach cannot digest them properly. Solids do not replace breastfeeding. Breast milk stays the baby's main source of nutrients during the first year. Beyond one year, breast milk can still be an important part of your child's diet.
Will breastfeeding tie me to my home?
Not at all! Breastfeeding is 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.
Learn more about the Pumping and Storage of breast milk.
Will my partner be jealous if I breastfeed?
If you prepare your partner in advance, there should be no jealousy. Explain that you need support. Discuss the important benefits of breastfeeding. Explain that not making formula means more rest. Be sure to emphasize how much money will be saved. It would cost over $300 a month to pay for formula — money that could go to bills, savings, or a vacation. Explain that breastfeeding will give the child the best start at life, with benefits that can last well into childhood. Your partner can help by changing and burping the baby, sharing chores, and simply sitting with you and the baby to enjoy the special mood that breastfeeding creates. Your partner can also feed the baby pumped milk.
Learn more about Family and Partner Support.
If I have small breasts or very large breasts, can I still breastfeed?
Of course! Breast size is not related to the ability to produce milk for a baby. Breast size is due to the amount of fatty tissue in the breast and the milk storage capacity of your breast. Small breasts make plenty of milk; they just do not store a lot of milk. Therefore babies will breastfeed often from a mother with smaller breasts. Large breasts make plenty of milk, too. Women with large breasts can have special problems with positioning and latch. They may need help from a professional to find comfortable ways to breastfeed and ways to improve the baby's latch.
Can I still breastfeed if I have had breast surgery?
How much milk you can produce depends on how your surgery was done, where your incisions are, and the reasons for your surgery. Women who have had incisions in the fold under the breasts are less likely to have problems making milk than women who have had incisions around or across the areola, which can cut into milk ducts and nerves. Women who have had breast implants usually breastfeed successfully. If you ever had surgery on your breasts for any reason, talk with a lactation consultant. If you are planning breast surgery, talk with your surgeon about ways he or she can preserve as much of the breast tissue and milk ducts as possible.
Can I breastfeed if I become ill?
Yes! Most common illnesses, such as colds, flu, or diarrhea, can't be passed through breast milk, and your milk will have antibodies in it to help protect your baby from getting the same sickness.
Do I have to restrict my sex life while breastfeeding?
No. But, if you are having vaginal dryness, you can try more foreplay and water-based lubricants. You can feed your baby or express some milk before lovemaking so your breasts will be more comfortable and less likely to leak. During sex, you also can put pressure on the nipple when it lets down or have a towel handy to catch the milk.
Do I still need birth control if I am breastfeeding?
Breastfeeding can delay the return of normal ovulation and menstrual cycles. But, like other forms of birth control, breastfeeding is not a sure way to prevent pregnancy. You should still talk with your doctor or nurse about birth control choices that are compatible with breastfeeding.
Can I breastfeed if I smoke?
If you smoke tobacco, it is best for you and your baby if you try to quit as soon as possible. If you can't quit, it is still better to breastfeed since your baby is at higher risk of having respiratory problems and for sudden infant death syndrome (SIDS). Breastfeeding lowers the risk of both of these health problems in your baby. Be sure to smoke away from your baby and change clothes to keep your baby away from the secondhand smoke and chemicals on your clothing.
Learn more about Smoking and How To Quit.
Can I breastfeed if I drink alcohol?
You should avoid drinking large quantities of alcohol if you are a breastfeeding mother. If you have an occasional drink of alcohol, you should wait for about two hours to pass before breastfeeding. Also, many babies don't like the taste of your milk after you have had alcohol and will breastfeed more once the alcohol is out of your system.
I heard that breast milk can have toxins in it from my environment. Is it still safe for my baby?
While certain chemicals have appeared in breast milk, breastfeeding remains the best way to feed and nurture young infants and children. The advantages of breastfeeding far outweigh any possible risks from environmental pollutants. Infant formula is usually not a better choice. The formula itself, the water it is mixed with, and/or the bottles or nipples used to give it to the baby can be contaminated with bacteria or chemicals. To date, the effects of such chemicals have only been seen in babies whose mothers themselves were ill because of them.
Will my baby get enough vitamin D if I breastfeed?
All infants and children, including those who are exclusively breastfed and those who are fed formula, should have at least 400 International Units (IU) of vitamin D per day, starting during the first two months of life, to help them build strong bones. New research suggests that mothers should be getting 200-400 IU of vitamin D per day to ensure plenty of vitamin D in her milk and for her own health. You can buy vitamin D supplements for infants at a drug store or grocery store. Sunlight can be a major source of vitamin D, but it is hard to measure how much sunlight your baby gets. Ask your doctor and your baby's doctor about vitamin D as well as sun exposure.
Does my breastfed baby need vaccines? Is it safe for me to get a vaccine when I'm breastfeeding?
Yes. Vaccines are very important to your baby's health. Breastfeeding may also enhance your baby's response to certain immunizations, providing more protection. Follow the schedule your doctor gives you and, if you miss any, check with him or her about getting your baby back on track. Breastfeeding while the vaccine is given to your baby — or immediately afterwards — can help relieve pain and sooth an upset baby. Most nursing mothers may also receive vaccines. Breastfeeding does not affect the vaccine, and vaccines are not harmful to your breast milk.
What should I do if my baby bites me?
If your baby starts to clamp down, you can put your finger in his or her mouth and take him or her off of your breast with a firm, "No." Try not to yell as it may scare the baby. If your baby continues to bite you, you can try a few things:
- Stop the feeding immediately so the baby is not tempted to get another reaction from you. Don't laugh. This is part of your baby learning limits.
- Offer a teething toy, or a snack or drink from a cup instead.
- Put your baby down for a moment to show that biting brings a negative consequence. You can then pick him up again to give comfort.
I just found out that I’m pregnant. Can I still breastfeed my toddler or other baby?
Breastfeeding during your next pregnancy is not a risk to either the breastfeeding toddler or to the new developing baby. If you are having some problems in your pregnancy such as uterine pain or bleeding, a history of preterm labor, or problems gaining weight during pregnancy, your doctor may advise you towean. Some women also choose to wean at this time because they have nipple soreness caused by pregnancy hormones, are nauseous, or find that their growing stomachs make breastfeeding uncomfortable. Your toddler also may decide to wean on his own because of changes in the amount and flavor of your milk. He or she will need additional food and drink because you will likely make less milk during pregnancy.
If you keep nursing your toddler after your baby is born, you can feed your newborn first to ensure he or she gets the colostrum. Once your milk production increases a few days after birth you can decide how to best meet everyone's needs, especially the new baby's needs for you and your milk. You may want to ask your partner to help you by taking care of one child while you are breastfeeding. Also, you will have a need for more fluids, healthy foods, and rest because you are taking care of yourself and two small children.
Can I breastfeed if I adopted my baby?
Many mothers who adopt want to breastfeed their babies and can do it successfully with some help. Many will need to supplement their breast milk with donated breast milk or infant formula, but some adoptive mothers can breastfeed exclusively, especially if they have been pregnant before. Lactation is a hormonal response to a physical action, and so the stimulation of the baby nursing causes the body to see a need for and produce milk. The more the baby nurses, the more a woman's body will produce milk.
If you are adopting and want to breastfeed, talk with both your doctor and a lactation consultant. They can help you decide the best way to try to establish a milk supply for your new baby. You might be able to prepare by pumping every three hours around the clock for two to three weeks before your baby arrives, or you can wait until the baby arrives and start to breastfeed then. Devices such as a supplemental nursing system (SNS) or a lactation aid can help ensure that your baby gets enough nutrition and that your breasts are stimulated to produce milk at the same time.
Depression During and After Pregnancy
What is depression?
Depression is more than just feeling “blue” or “down in the dumps” for a few days. It’s a serious illness that involves the brain. With depression, sad, anxious, or “empty” feelings don’t go away and interfere with day-to-day life and routines. These feelings can be mild to severe. The good news is that most people with depression get better with treatment.
How common is depression during and after pregnancy?
Depression is a common problem during and after pregnancy. About 13 percent of pregnant women and new mothers have depression.
How do I know if I have depression?
When you are pregnant or after you have a baby, you may be depressed and not know it. Some normal changes during and after pregnancy can cause symptoms similar to those of depression. But if you have any of the following symptoms of depression for more than 2 weeks, call your doctor:
- Feeling restless or moody
- Feeling sad, hopeless, and overwhelmed
- Crying a lot
- Having no energy or motivation
- Eating too little or too much
- Sleeping too little or too much
- Having trouble focusing or making decisions
- Having memory problems
- Feeling worthless and guilty
- Losing interest or pleasure in activities you used to enjoy
- Withdrawing from friends and family
- Having headaches, aches and pains, or stomach problems that don’t go away
Your doctor can figure out if your symptoms are caused by depression or something else.
What causes depression? What about postpartum depression?
There is no single cause. Rather, depression likely results from a combination of factors:
- Depression is a mental illness that tends to run in families. Women with a family history of depression are more likely to have depression.
- Changes in brain chemistry or structure are believed to play a big role in depression.
- Stressful life events, such as death of a loved one, caring for an aging family member, abuse, and poverty, can trigger depression.
- Hormonal factors unique to women may contribute to depression in some women. We know that hormones directly affect the brain chemistry that controls emotions and mood. We also know that women are at greater risk of depression at certain times in their lives, such as puberty, during and after pregnancy, and during perimenopause. Some women also have depressive symptoms right before their period.
Depression after childbirth is called postpartum depression. Hormonal changes may trigger symptoms of postpartum depression. When you are pregnant, levels of the female hormones estrogen (ESS-truh-jen) and progesterone (proh-JESS-tur-ohn) increase greatly. In the first 24 hours after childbirth, hormone levels quickly return to normal. Researchers think the big change in hormone levels may lead to depression. This is much like the way smaller hormone changes can affect a woman’s moods before she gets her period.
Levels of thyroid hormones may also drop after giving birth. The thyroid is a small gland in the neck that helps regulate how your body uses and stores energy from food. Low levels of thyroid hormones can cause symptoms of depression. A simple blood test can tell if this condition is causing your symptoms. If so, your doctor can prescribe thyroid medicine.
Other factors may play a role in postpartum depression. You may feel:
- Tired after delivery
- Tired from a lack of sleep or broken sleep
- Overwhelmed with a new baby
- Doubts about your ability to be a good mother
- Stress from changes in work and home routines
- An unrealistic need to be a perfect mom
- Loss of who you were before having the baby
- Less attractive
- A lack of free time
Are some women more at risk for depression during and after pregnancy?
Certain factors may increase your risk of depression during and after pregnancy:
- A personal history of depression or another mental illness
- A family history of depression or another mental illness
- A lack of support from family and friends
- Anxiety or negative feelings about the pregnancy
- Problems with a previous pregnancy or birth
- Marriage or money problems
- Stressful life events
- Young age
- Substance abuse
Women who are depressed during pregnancy have a greater risk of depression after giving birth.
If you take medicine for depression, stopping your medicine when you become pregnant can cause your depression to come back. Do not stop any prescribed medicines without first talking to your doctor. Not using medicine that you need may be harmful to you or your baby.
What is the difference between “baby blues,” postpartum depression, and postpartum psychosis?
Many women have the baby blues in the days after childbirth. If you have the baby blues, you may:
- Have mood swings
- Feel sad, anxious, or overwhelmed
- Have crying spells
- Lose your appetite
- Have trouble sleeping
The baby blues most often go away within a few days or a week. The symptoms are not severe and do not need treatment.
The symptoms of postpartum depression last longer and are more severe. Postpartum depression can begin anytime within the first year after childbirth. If you have postpartum depression, you may have any of the symptoms of depression listed above. Symptoms may also include:
- Thoughts of hurting the baby
- Thoughts of hurting yourself
- Not having any interest in the baby
Postpartum depression needs to be treated by a doctor.
Postpartum psychosis (seye-KOH-suhss) is rare. It occurs in about 1 to 4 out of every 1,000 births. It usually begins in the first 2 weeks after childbirth. Women who have bipolar disorder or another mental health problem called schizoaffective (SKIT-soh-uh-FEK-tiv) disorder have a higher risk for postpartum psychosis. Symptoms may include:
- Seeing things that aren’t there
- Feeling confused
- Having rapid mood swings
- Trying to hurt yourself or your baby
What should I do if I have symptoms of depression during or after pregnancy?
Call your doctor if:
- Your baby blues don’t go away after 2 weeks
- Symptoms of depression get more and more intense
- Symptoms of depression begin any time after delivery, even many months later
- It is hard for you to perform tasks at work or at home
- You cannot care for yourself or your baby
- You have thoughts of harming yourself or your baby
Your doctor can ask you questions to test for depression. Your doctor can also refer you to a mental health professional who specializes in treating depression.
Some women don’t tell anyone about their symptoms. They feel embarrassed, ashamed, or guilty about feeling depressed when they are supposed to be happy. They worry they will be viewed as unfit parents.
Any woman may become depressed during pregnancy or after having a baby. It doesn’t mean you are a bad or “not together” mom. You and your baby don’t have to suffer. There is help.
Here are some other helpful tips:
- Rest as much as you can. Sleep when the baby is sleeping.
- Don’t try to do too much or try to be perfect.
- Ask your partner, family, and friends for help.
- Make time to go out, visit friends, or spend time alone with your partner.
- Discuss your feelings with your partner, family, and friends.
- Talk with other mothers so you can learn from their experiences.
- Join a support group. Ask your doctor about groups in your area.
- Don’t make any major life changes during pregnancy or right after giving birth. Major changes can cause unneeded stress. Sometimes big changes can’t be avoided. When that happens, try to arrange support and help in your new situation ahead of time.
How is depression treated?
The two common types of treatment for depression are:
- Talk therapy. This involves talking to a therapist, psychologist, or social worker to learn to change how depression makes you think, feel, and act.
- Medicine. Your doctor can prescribe an antidepressant medicine. These medicines can help relieve symptoms of depression.
These treatment methods can be used alone or together. If you are depressed, your depression can affect your baby. Getting treatment is important for you and your baby. Talk with your doctor about the benefits and risks of taking medicine to treat depression when you are pregnant or breastfeeding.
What can happen if depression is not treated?
Untreated depression can hurt you and your baby. Some women with depression have a hard time caring for themselves during pregnancy. They may:
- Eat poorly
- Not gain enough weight
- Have trouble sleeping
- Miss prenatal visits
- Not follow medical instructions
- Use harmful substances, like tobacco, alcohol, or illegal drugs
Depression during pregnancy can raise the risk of:
- Problems during pregnancy or delivery
- Having a low-birth-weight baby
- Premature birth
Untreated postpartum depression can affect your ability to parent. You may:
- Lack energy
- Have trouble focusing
- Feel moody
- Not be able to meet your child’s needs
As a result, you may feel guilty and lose confidence in yourself as a mother. These feelings can make your depression worse.
Researchers believe postpartum depression in a mother can affect her baby. It can cause the baby to have:
- Delays in language development
- Problems with mother-child bonding
- Behavior problems
- Increased crying
It helps if your partner or another caregiver can help meet the baby’s needs while you are depressed.
All children deserve the chance to have a healthy mom. And all moms deserve the chance to enjoy their life and their children. If you are feeling depressed during pregnancy or after having a baby, don’t suffer alone. Please tell a loved one and call your doctor right away.
Douching
What is douching?
The word "douche" means to wash or soak in French. Douching is washing or cleaning out the vagina(birth canal) with water or other mixtures of fluids. Most douches are prepackaged mixes of water and vinegar, baking soda, or iodine. You can buy these products at drug and grocery stores. The mixtures usually come in a bottle and can be squirted into the vagina through a tube or nozzle.
Why do women douche?
Women douche because they mistakenly believe it gives many benefits. Women who douche say they do it to:
- Clean the vagina
- Rinse away blood after monthly periods
- Get rid of odor
- Avoid sexually transmitted infections (STIs)
- Prevent pregnancy
How common is douching?
Douching is common among women in the United States. It’s estimated that 20 to 40 percent of American women 15 to 44 years old douche regularly. About half of these women douche each week. Higher rates of douching are seen in teens, African-American women, and Hispanic women.
Is douching safe?
Most doctors and the American Congress of Obstetricians and Gynecologists (ACOG) recommend that women don’t douche. Douching can change the delicate balance of vaginal flora (organisms that live in the vagina) and acidity in a healthy vagina. One way to look at it is in a healthy vagina there are both good and bad bacteria. The balance of the good and bad bacteria help maintain an acidic environment. Any changes can cause an over growth of bad bacteria which can lead to a yeast infection or bacterial vaginosis. Plus, if you have a vaginal infection, douching can push the bacteria causing the infection up into the uterus, fallopian (fuh-LOH-pee-uhn) tubes, and ovaries.
What are the dangers linked to douching?
Research shows that women who douche regularly have more health problems than women who don’t. Doctors are still unsure whether douching causes these problems. Douching may simply be more common in groups of women who tend to have these issues. Health problems linked to douching include:
- Vaginal irritation
- Bacterial vaginosis (vaj-uh-NOH-suhs) (BV)
- STIs
- Pelvic inflammatory disease (PID)
Some STIs, BV, and PID can all lead to serious problems during pregnancy. These include infection in the baby, problems with labor, and early delivery.
Should I douche to clean inside my vagina?
No. The American Congress of Obstetricians and Gynecologists suggests women avoid douching completely. In most cases the vagina’s acidic environment “cleans” the vagina. If there is a strong odor or irritation it usually means something is wrong. Douching can increase your chances of infection. The only time you should douche is when your doctor tells you to.
What is the best way to clean my vagina?
Most doctors say it’s best to let your vagina clean itself. The vagina cleans itself naturally by making mucous. The mucous washes away blood, semen, and vaginal discharge. You should know that even healthy, clean vaginas may have a mild odor.
Keep the outside of your vagina clean and healthy by washing regularly with warm water and mild soap when you bathe. You should also avoid scented tampons, pads, powders, and sprays. These products may increase your chances of getting a vaginal infection.
Should I douche to get rid of vaginal odor, discharge, pain, itching, or burning?
No. You should never douche to try to get rid of vaginal odor, discharge, pain, itching, or burning. Douching will only cover up odor and make other problems worse. It’s very important to call your doctor right away if you have:
- Vaginal discharge that smells bad
- Thick, white, or yellowish-green discharge with or without an odor
- Burning, redness, and swelling in or around the vagina
- Pain when urinating
- Pain or discomfort during sex
These may be signs of an infection, especially one that may be sexually transmitted. Do not douche before seeing your doctor. This can make it hard for the doctor to figure out what’s wrong.
Can douching after sex prevent sexually transmitted infections (STIs)?
No. It’s a myth that douching after sex can prevent STIs. The only sure way to prevent STIs is to not have sex. If you do have sex, the best way to prevent STIs is to practice safer sex:
- Be faithful. Have sex with only 1 partner who has been tested for STIs and is not infected.
- Use latex or female condoms every time you have sex.
- Avoid contact with semen, blood, vaginal fluids, and sores on your partner’s genitals.
Can douching after sex stop me from getting pregnant?
No. Douching does not prevent pregnancy. It should never be used for birth control.
Can douching hurt my chances of having a healthy pregnancy?
Douching may affect your chances of having a healthy pregnancy. Limited research shows that douching may make it harder for you to get pregnant. In women trying to get pregnant, those who douched more than once a week took the longest to get pregnant.
Studies also show that douching may increase a woman's chance of damaged fallopian tubes and ectopic (ek-TOP-ik) pregnancy. Ectopic pregnancy is when the fertilized egg attaches to the inside of the fallopian tube instead of the uterus. If left untreated, ectopic pregnancy can be life threatening. It can also make it hard for a woman to get pregnant in the future.
Emergency Contraception (Emergency Birth Control)
What is emergency contraception?
Emergency contraception, or emergency birth control, is used to help keep a woman from getting pregnantafter she has had sex without using birth control or if the birth control method failed. If you are already pregnant, emergency contraception will not work.
Use emergency contraception if:
- You didn’t use birth control.
- You were forced to have sex.
- The condom broke or came off.
- Your diaphragm slips out of place.
- He didn’t pull out in time.
- You missed at least two or three active birth control pills in a row (depending on which pill brand you use).
- You were late getting your shot.
- You have reason to think your regular birth control might have failed.
Emergency contraception should not be used as regular birth control. Other birth control methods are much better at keeping women from becoming pregnant. Talk with your doctor to decide which one is right for you.
What are the types of emergency contraception and how do they work?
There are two types:
- Emergency contraceptive pills (ECPs)
- Intrauterine device (IUD)
With ECPs, higher doses of the same hormones found in regular birth control pills prevent pregnancy by keeping the egg from leaving the ovary or keeping the sperm from joining the egg. While it is possible that ECPs might work by keeping a fertilized egg from attaching to the uterus, the most up-to-date research suggests that ECPs do not work in this way. In the United States, there is only one FDA-approved pill that is specially made to be used as an ECP. It is called Plan B. However, when used in a certain way, some regular birth control pills also can be used as ECPs.
- Plan B — Plan B is a progestin-only ECP. It is made for use as emergency contraception. Plan B is like progestin-only birth control pills, but contains higher levels of the hormone. The instructions for Plan B say to take the two pills 12 hours apart. But research has shown that taking both pills at the same time works just as well and does not increase side effects.
- Higher dose of regular birth control pills — The number of pills in a dose is different for each pill brand, and not all brands can be used for emergency contraception. For more information on birth control pills that can be used for emergency contraception, visit the Emergency Contraception Website (not-2-late.com). The pills are taken in 2 doses (1 dose right away, and the next dose 12 hours later). Always use the same brand for both doses, and be sure to use the active pills, not the reminder pills.
You should always take ECPs as soon as you can after having unprotected sex, but they can work up to 5 days later. Women who are breastfeeding or cannot take estrogen should use progestin-only ECPs (like Plan B). Some women feel sick and throw up after taking ECPs. If you throw up after taking ECPs, call your doctor or pharmacist.
Intrauterine device (IUD)The IUD is a small, T-shaped device placed into the uterus by a doctor within 5 days after having unprotected sex. The IUD works by keeping the sperm from joining the egg or keeping a fertilized egg from attaching to the uterus. Your doctor can remove the IUD after your next period. Or, it can be left in place for up to 10 years to use as your regular birth control method.
How well does emergency contraception work?
When used correctly, emergency contraceptive pills (ECPs) work very well at preventing pregnancy. Consider that about 8 in 100 women who have unprotected sex one time during the fertile part of their cycle will become pregnant. If these 100 women take progestin-only ECPs (like Plan B), about 1 will become pregnant. If 100 women take ECPs with estrogen and progestin, about 2 will become pregnant. The IUD works even better. Only 1 in 1,000 women who have an IUD put in after having unprotected sex will become pregnant.
The sooner you use emergency contraception after unprotected sex, the more likely it will prevent pregnancy. But you must use it correctly. For regular birth control pills used as ECPs, take the first dose within 3 days of having unprotected sex, but no later than 5 days. Take the second dose 12 hours later. For Plan B, both pills can be taken at the same time.
Does emergency contraception have side effects?
Some women feel sick and throw up after taking ECPs. Headache, cramps, and fatigue also can occur. Progestin-only ECPs cause fewer side effects than combined pills that also contain estrogen. The over-the-counter drug Dramamine 2 can reduce the risk of feeling sick and throwing up. Take two of these pills 30 minutes before taking ECPs. If you throw up after taking ECPs, call your doctor or pharmacist.
IUD placement has risks of pelvic infection or harming the uterus. But these risks are quite rare. If the IUD is left in place to be used as birth control, it can cause side effects such as cramps and heavy bleeding during your period.
Will emergency contraception protect me from sexually transmitted infections (STIs)?
No. Emergency contraception can only lower the risk of becoming pregnant after having unprotected sex. Always use condoms to lower your risk of getting an STI.
Are emergency contraceptive pills (ECPs) the same thing as the "morning after pill"?
Yes. ECPs are often called the "morning after pill," which is wrong because ECPs don’t have to be taken the morning after. You should always take ECPs as soon as you can after having unprotected sex, but they can work up to 5 days later.
How do I get emergency contraceptive pills (ECPs)?
You can get Plan B at drugstores and stores with a licensed pharmacist. The FDA recently approved Plan B for sale without a prescription to 17-year-olds. Women and men must show proof of age to buy Plan B. If you are younger than 17 and need emergency contraception, you will need a prescription, so act quickly. Talk to your parents, your doctor, or visit a family planning clinic and ask for help. In some states (Alaska, California, Hawaii, Maine, Massachusetts, New Hampshire, New Mexico, Vermont, and Washington), some pharmacists can provide Plan B to women younger than 17 without a prescription. If you live in one of these states, call your pharmacy to see if this is an option for you.
I heard that 17-year-olds can now buy ECPs without a prescription — is that true?
Yes. Plan B is currently available for sale over the counter to people 17 and older. It remains prescription-only for those under 17. Take proof of your age with you, and call ahead to make sure your pharmacy stocks emergency contraception.
Can I get emergency contraceptive pills (ECPs) before I need them?
Yes. Your doctor should bring up ECPs at your annual exam (when you have a Pap test). If your doctor does not talk about emergency contraception at your next exam, ask your doctor about it.
What do I need to do after I take emergency contraceptive pills (ECPs)?
After you have taken ECPs, your next period may come sooner or later than normal. Most women will get their period within 7 days of the expected date. Your period also may be heavier, lighter, or more spotty than normal. If you do not get your period in 3 weeks or if you think you might be pregnant after taking ECPs, get a pregnancy test to find out for sure.
Use another birth control method if you have sex any time before your next period starts. Talk to your doctor about how to choose a birth control method that is right for you.
My girlfriend took emergency contraceptive pills (ECPs), and they did not work. If she stays pregnant, will there be something wrong with her baby?
No. Studies have been done with women who did not know they were pregnant and kept taking regular birth control pills. These studies have found no greater risk for birth defects. Your girlfriend should see a doctor right away to talk about her options.
Are emergency contraceptive pills (ECPs) the same thing as the abortion pill?
No. Emergency contraception works before pregnancy begins. It will not work if a woman is already pregnant. Abortion takes place after a fertilized egg has attached to the uterus. The abortion pill (Mifeprex, also called RU-486) makes the uterus force out the egg, ending the pregnancy.
Endometriosis
What is endometriosis (en-doh-mee-tree-OH-suhs)?
Endometriosis is a common health problem in women. It gets its name from the word, endometrium (en-doh-MEE-tree-um), the tissue that lines the uterus or womb. Endometriosis occurs when this tissue grows outside of the uterus on other organs or structures in the body.
Most often, endometriosis is found on the:
- Ovaries
- Fallopian tubes
- Tissues that hold the uterus in place
- Outer surface of the uterus
- Lining of the pelvic cavity
Other sites for growths can include the vagina, cervix, vulva, bowel, bladder, or rectum. In rare cases, endometriosis has been found in other parts of the body, such as the lungs, brain, and skin.
What are the symptoms of endometriosis?
The most common symptom of endometriosis is pain in the lower abdomen or pelvis, or the lower back, mainly during menstrual periods. The amount of pain a woman feels does not depend on how much endometriosis she has. Some women have no pain, even though their disease affects large areas. Other women with endometriosis have severe pain even though they have only a few small growths.
Symptoms of endometriosis can include:
- Very painful menstrual cramps; pain may get worse over time
- Chronic pain in the lower back and pelvis
- Pain during or after sex
- Intestinal pain
- Painful bowel movements or painful urination during menstrual periods
- Spotting or bleeding between menstrual periods
- Infertility or not being able to get pregnant
- Fatigue
- Diarrhea, constipation, bloating, or nausea, especially during menstrual periods
Recent research shows a link between other health problems in women with endometriosis and their families. Some of these include:
- Allergies, asthma, and chemical sensitivities
- Autoimmune diseases, in which the body’s system that fights illness attacks itself instead. These can include hypothyroidism, multiple sclerosis, and lupus.
- Chronic fatigue syndrome (CFS) and fibromyalgia
- Being more likely to get infections and mononucleosis (ma-no-nu-klee-OH-suhs)
- Mitral valve prolapse, a condition in which one of the heart's valves does not close as tightly as normal
- Frequent yeast infections
- Certain cancers, such as ovarian, breast, endocrine, kidney, thyroid, brain, and colon cancers, and melanoma and non-Hodgkin’s lymphoma
Why does endometriosis cause pain and health problems?
Growths of endometriosis are benign (not cancerous). But they still can cause many problems. To see why, it helps to understand a woman's menstrual cycle. Every month, hormones cause the lining of a woman's uterus to build up with tissue and blood vessels. If a woman does not get pregnant, the uterus sheds this tissue and blood. It comes out of the body through the vagina as her menstrual period.
Patches of endometriosis also respond to the hormones produced during the menstrual cycle. With the passage of time, the growths of endometriosis may expand by adding extra tissue and blood. The symptoms of endometriosis often get worse.
Tissue and blood that is shed into the body can cause inflammation, scar tissue, and pain. As endometrial tissue grows, it can cover or grow into the ovaries and block the fallopian tubes. Trapped blood in the ovaries can form cysts, or closed sacs. It also can cause inflammation and cause the body to form scar tissue and adhesions, tissue that sometimes binds organs together. This scar tissue may cause pelvic pain and make it hard for women to get pregnant. The growths can also cause problems in the intestines and bladder.
Who gets endometriosis?
More than five million women in the United States have endometriosis. It is one of the most common health problems for women. It can occur in any teen or woman who has menstrual periods, but it is most common in women in their 30s and 40s.
The symptoms of endometriosis stop for a time during pregnancy. Symptoms also tend to decrease with menopause, when menstrual periods end for good. In some cases, women who take menopausal hormone therapy may still have symptoms of endometriosis.
What can raise my chances of getting endometriosis?
You might be more likely to get endometriosis if you have:
- Never had children
- Menstrual periods that last more than seven days
- Short menstrual cycles (27 days or less)
- A family member (mother, aunt, sister) with endometriosis
- A health problem that prevents normal passage of menstrual blood flow
- Damage to cells in the pelvis from an infection
How can I reduce my chances of getting endometriosis?
There are no definite ways to lower your chances of getting endometriosis. Yet, since the hormone estrogen is involved in thickening the lining of the uterus during the menstrual cycle, you can try to lower levels of estrogen in your body.
To keep lower estrogen levels in your body, you can:
- Exercise regularly
- Keep a low amount of body fat
- Avoid large amounts of alcohol and drinks with caffeine
Why is it important to find out if I have endometriosis?
The pain of endometriosis can interfere with your life. Studies show that women with endometriosis often skip school, work, and social events. This health problem can also get in the way of relationships with your partner, friends, children, and co-workers. Plus, endometriosis can make it hard for you to get pregnant.
Finding out that you have endometriosis is the first step in taking back your life. Many treatments can control the symptoms. Medicine can relieve your pain. When endometriosis causes fertility problems, surgery can boost your chances of getting pregnant.
How do I know that I have endometriosis?
If you have symptoms of this disease, talk with your doctor or your obstetrician/gynecologist (OB/GYN). An OB/GYN has special training to diagnose and treat this condition. Sometimes endometriosis is mistaken for other health problems that cause pelvic pain and the exact cause might be hard to pinpoint.
The doctor will talk to you about your symptoms and health history. The doctor may also do these tests to check for clues of endometriosis:
Pelvic exam. Your doctor will perform a pelvic exam to feel for large cysts or scars behind your uterus. Smaller areas of endometriosis are hard to feel.
Ultrasound. Your doctor could perform an ultrasound, an imaging test to see if there are ovarian cysts from endometriosis. During a vaginal ultrasound, the doctor will insert a wand-shaped scanner into your vagina. During an ultrasound of your pelvis, a scanner is moved across your abdomen. Both tests use sound waves to make pictures of your reproductive organs. Magnetic resonance imaging (MRI) is another common imaging test that can produce a picture of the inside of your body.
Laparoscopy (lap-ar-OS-ko-pee). The only way for your doctor to know for sure that you have endometriosis is to look inside your abdomen to see endometriosis tissue. He or she can do this through a minor surgery called laparoscopy. You will receive general anesthesia before the surgery. Then, your abdomen is expanded with a gas to make it easy to see your organs. A tiny cut is made in your abdomen and a thin tube with a light is placed inside to see growths from endometriosis. Sometimes doctors can diagnose endometriosis just by seeing the growths. Other times, they need to take a small sample of tissue and study it under a microscope.
If your doctor does not find signs of an ovarian cyst during an ultrasound, before doing a laparoscopy, your doctor may prescribe birth control pills to control your menstrual cycle. Sometimes this treatment helps lessen pelvic pain during your period. Some doctors may offer another treatment that blocks the menstrual cycle and lowers the amount of estrogen your body makes before doing a laparoscopy. This treatment is a medicine called a gonadotropin (go-na-doh-TRO-pen) releasing hormone (GnRH) agonist, which also may help pelvic pain. If your pain improves on this medicine, the doctor will likely think that you have endometriosis.
Laparoscopy is often recommended for diagnosis and treatment if the pelvic pain persists, even after taking birth control pills and pain medicine.
What causes endometriosis?
No one knows for sure what causes this disease, but experts have a number of theories:
- Since endometriosis runs in families, it may be carried in the genes, or some families have traits that make them more likely to get it.
- Endometrial tissue may move from the uterus to other body parts through the blood system or lymphsystem.
- If a woman has a faulty immune system it will fail to find and destroy endometrial tissue growing outside of the uterus. Recent research shows that immune system disorders and certain cancers are more common in women with endometriosis.
- The hormone estrogen appears to promote the growth of endometriosis. So, some research is looking at whether it is a disease of the endocrine system, the body’s system of glands, hormones, and other secretions.
- Endometrial tissue has been found in abdominal scars and might have been moved there by mistake during a surgery.
- Small amounts of tissue from when a woman was an embryo might later become endometriosis.
- New research shows a link between dioxin exposure and getting endometriosis. Dioxin is a toxic chemical from the making of pesticides and the burning of wastes. More research is needed to find out whether man-made chemicals cause endometriosis.
- Endometrial tissue may back up into the abdomen through the fallopian tubes during a woman’s monthly period. This transplanted tissue could grow outside of the uterus. However, most experts agree that this theory does not entirely explain why endometriosis develops.
How is endometriosis treated?
There is no cure for endometriosis, but there are many treatments for the pain and infertility that it causes. Talk with your doctor about what option is best for you. The treatment you choose will depend on your symptoms, age, and plans for getting pregnant.
Pain Medication. For some women with mild symptoms, doctors may suggest taking over-the-counter medicines for pain. These include ibuprofen (Advil and Motrin) or naproxen (Aleve). When these medicines don't help, doctors may prescribe stronger pain relievers.
Hormone Treatment. When pain medicine is not enough, doctors often recommend hormone medicines to treat endometriosis. Only women who do not wish to become pregnant can use these drugs. Hormone treatment is best for women with small growths who do not have bad pain. Hormones come in many forms including pills, shots, and nasal sprays. Common hormones used for endometriosis include:
- Birth control pills to decrease the amount of menstrual flow and prevent overgrowth of tissue that lines the uterus. Most birth control pills contain two hormones, estrogen and progestin. Once a woman stops taking them, she can get pregnant again. Stopping these pills will cause the symptoms of endometriosis to return.
- GnRH agonists and antagonists greatly reduce the amount of estrogen in a woman's body, which stops the menstrual cycle. These drugs should not be used alone because they can cause side effects similar to those during menopause, such as hot flashes, bone loss, and vaginal dryness. Taking a low dose of progestin or estrogen along with these drugs can protect against these side effects. When a woman stops taking this medicine, monthly periods and the ability to get pregnant return. She also might stay free of the problems of endometriosis for months or years afterward.
- Progestins. The hormone progestin can shrink spots of endometriosis by working against the effects of estrogen on the tissue. It will stop a woman’s menstrual periods, but can cause irregular vaginal bleeding. Medroxyprogesterone (muh-DROKS-ee-proh-JESS-tur-ohn) (Depo-Provera) is a common progestin taken as a shot. Side effects of progestin can include weight gain, depressed mood, and decreased bone growth.
- Danazol (DAY-nuh-zawl) is a weak male hormone that lowers the levels of estrogen and progesterone in a woman's body. This stops a woman's period or makes it come less often. It is not often the first choice for treatment due to its side effects, such as oily skin, weight gain, tiredness, smaller breasts, and facial hair growth. It does not prevent pregnancy and can harm a baby growing in the uterus. It also cannot be used with other hormones, such as birth control pills.
Surgery. Surgery is usually the best choice for women with severe endometriosis — many growths, a great deal of pain, or fertility problems. There are both minor and more complex surgeries that can help. Your doctor might suggest one of the following:
- Laparoscopy can be used to diagnose and treat endometriosis. During this surgery, doctors remove growths and scar tissue or burn them away. The goal is to treat the endometriosis without harming the healthy tissue around it. Women recover from laparoscopy much faster than from major abdominal surgery.
- Laparotomy (lap-ar-AW-tuh-mee) or major abdominal surgery that involves a much larger cut in the abdomen than with laparoscopy. This allows the doctor to reach and remove growths of endometriosis in the pelvis or abdomen.
- Hysterectomy (his-tur-EK-toh-mee) is a surgery in which the doctor removes the uterus. Removing the ovaries as well can help ensure that endometriosis will not return. This is done when the endometriosis has severely damaged these organs. A woman cannot get pregnant after this surgery, so it should only be considered as a last resort.
How do I cope with a disease that has no cure?
You may feel many emotions — sadness, fright, anger, confusion, and loneliness. It is important to get support to cope with endometriosis. Consider joining a support group to talk with other women who have endometriosis. There are support groups on the Internet and in many communities.
It is also important to learn as much as you can about the disease. Talking with friends, family, and your doctor can help.
Female Genital Cutting
What is female genital cutting (FGC)?
The terms female genital cutting (FGC), female circumcision, and female genital mutilation (FGM) all describe the cultural practice of partially or totally removing the external female genitalia. The minor form of FGC is when the clitoris is removed. The most severe form of FGC is when all external genitalia are removed and the vaginal opening is stitched nearly closed. Only a small opening is left for urine and menstrual blood.
What is the difference between FGC, female circumcision, and FGM?
All three terms describe the procedure that cuts away part or all of the external female genitalia. Deciding what exactly to call it is still being debated. Some people fear that parents may resent the implication that they are "mutilating" their daughters by participating in this largely cultural event, and so reject the term FGM in favor of FGC. Some people point out that the word "cutting" is less judgmental and relates better to terms used in many local languages. However, many women's health and human rights organizations use the word "mutilation" not only to describe the practice, but also to point out the violation of women's human rights.
Previously, some referred to the practice as "circumcision" to link FGC to male circumcision. However, this word can hide the serious physical and psychological effects of cutting women's genitals. It also fails to show differences between the different types of cutting. For these reasons, a number of international organizations offer a compromise: "female genital mutilation/cutting (FGM/C)."
For our purposes in this fact sheet, womenshealth.gov refers to this practice as FGC.
At what ages do young women undergo FGC?
FGC is performed on infants, girls, and women of all ages. The age at which girls are cut can vary widely from country to country, and even within countries. Most often, FGC happens before a girl reaches puberty. Sometimes, however, it is done just before marriage or during a woman’s first pregnancy. In Egypt, about 90 percent of girls are cut between 5 and 14 years old. However, in Yemen, more than 75 percent of girls are cut before they are 2 weeks old. The average age at which a girl undergoes FGC is decreasing in some countries (Burkina Faso, Côte d’Ivoire, Egypt, Kenya, and Mali). Researchers think it’s possible that the average age of FGC is getting lower so that it can be more easily hidden from authorities in countries where there may be laws against it. It is also possible that FGC is performed on younger girls because they are less able to resist.
Where is FGC practiced?
The practice of FGC is a cultural tradition performed across central Africa, in the southern Sahara, and in parts of the Middle East. Most women who have experienced FGC live in one of the 28 countries in Africa and the Middle East where FGC is practiced. Almost one-half of women who have experienced FGC live in Egypt or Ethiopia. (In Egypt, 2008 Demographic and Health Survey (DHS) information notes that female genital cutting rates are declining.)
To a lesser degree, FGC is practiced in Indonesia, Malaysia, Pakistan, and India. Some immigrants practice various forms of FGC in other parts of the world, including Australia, Canada, New Zealand, the United States, and in European nations.
Is FGC part of a religion?
Although many people believe that FGC is associated with Islam, it is not. FGC is not supported by any religion and is condemned by many religious leaders. The practice crosses religious barriers. Muslims, Christians, and Jews have been known to support FGC on their girls.
No religious text requires or even supports cutting female genitals. In fact, Islamic Shari'a protects children and protects their rights. From a Christian perspective, FGC has no religious grounds either. In fact, research shows that the relationship between religion and FGC is inconsistent at best.
However, even though religious texts don’t support FGC, some people still think the two are linked and claim religious teachings support FGC.
In six of the countries where FGC is practiced — Ethiopia, Cote d'Ivoire, Kenya, Senegal, Benin, and Ghana — Muslim population groups are more likely to practice FGC than Christian groups. In Nigeria, Tanzania, and Niger, though, the prevalence is greater among Christian groups.
Why is FGC practiced?
There are many reasons FGC is practiced, including social, economic, and political reasons. Those who support FGC believe that it will empower their daughters, ensure the girls get married, and protect the family’s good name. In some groups, FGC is performed to show a girl’s growth into womanhood and, as in the Masai community, marks the start of a girl’s sexual debut. It also is performed to keep a woman’s virginity by limiting her sexual behavior. FGC is believed (by those who practice it) to stop a woman’s sexual desire. In some groups, women who are not cut are viewed as dirty and are treated badly. While FGC pre-dates both Christianity and Islam, religion is also used to promote the practice. Some communities believe that in order to be good Muslims, parents must have their daughters cut.
There are also many superstitions about FGC, such as:
- The clitoris will continue to grow as a girl gets older and so it must be removed.
- The external genitalia are unclean and can actually cause the death of an infant during delivery.
FGC is often part of a community’s tradition. Most parents who support FGC believe they are protecting their daughter’s future marriage prospects, and not hurting her. It is seen by parents as part of a girl’s upbringing.
How many women have received FGC?
It is estimated that between 100 million and 140 million girls and women worldwide have received FGC. There are more than 3 million girls at risk of having FGC each year. It is unknown how many women in the United States have received FGC.
What are the health problems caused by FGC?
FGC can cause a range of health problems, both short-term and long-term. The kinds of problems that develop depend upon the degree of the cutting, the cleanliness of the tools used to do the cutting, and the health of the girl or woman receiving the cutting. In most countries, FGC is performed in unclean conditions by mainly traditional practitioners who may use scissors, razor blades, or knives. In Egypt, though, up to 90 percent of FGC is performed by a health care professional. Almost every girl or woman who receives FGC experiences pain or bleeding.
Short-term health problems:
- Bleeding or hemorrhaging: If the bleeding is severe, girls can die.
- Infection: The wound can get infected and develop into an abscess (a collection of pus). Girls can get fevers, sepsis (a blood infection), shock, and even die, if the infection is not treated.
- Pain: Girls are routinely cut without first being numbed or having anesthesia. The worst pain tends to occur the day after, when they have to urinate onto the wound.
- Trauma: Girls are held down during the procedure, which can be physically or psychologically traumatic.
Long-term health problems (usually occurs to women with the most severe form of FGC):
- Problems going to the bathroom. In severe cases, women are left with only a small opening for urinating and menstrual bleeding. This can slow or strain the normal flow of urine, which can cause infections.
- Not being able to have sex normally. The most severe form of FGC leaves women with scars that cover most of their vagina. This makes sex very painful. These scars can also develop into bumps (cysts or abscesses) or thickened scars (keloids) that can be uncomfortable.
- Problems with gynecological health. Women who have had FGC sometimes have painful menstruation. They may not be able to pass all of their menstrual blood. They may also have infections over and over again. It can also be hard for a health care professional to examine a woman’s reproductive organs if she has had a more severe form of FGC. Normal tools cannot be used to perform a Pap test or a pelvic exam.
- Increased risk of sexually transmitted infections (STIs), including HIV. People who have no medical training, under unclean conditions, perform most forms of FGC. Many times, one tool is used for several procedures without sterilization. There is a growing concern that these conditions greatly increase the chance of spreading life-threatening infections such as hepatitis and HIV. Also, damage to the female sex organs during FGC can make the tissue more likely to tear during sex, which could also increase risk of STIs or HIV.
- Problems getting pregnant, and problems during pregnancy and labor. Infertility rates among women who have had FGC are as high as 25 to 30 percent and are mostly related to problems with being able to achieve sexual intercourse. The scar that covers the vagina makes this very difficult. Once pregnant, a woman can have drawn out labor, tears, heavy bleeding, and infection during delivery – all causing distress to the infant and the mother. Health care professionals who are unfamiliar with the scar will sometimes recommend a cesarean section. This is not necessary as women will be able to deliver vaginally once the scar is cut open. With rising numbers of young women coming to the United States from countries that practice FGC, U.S. doctors have begun caring for more and more patients who have been cut and facing some of these challenges. Based on a study of 28,000 women in 6 African countries, FGC is related to cesarean section, post-partum hemorrhage, episiotomy, extended hospital stays, the need for infant resuscitation, and death. While about 5 percent of babies born to women without FGC were stillborn or died shortly after delivery, this figure increased to 6.4 percent in babies born to women with FGC.
- Psychological and emotional stress. FGC is typically performed on very young girls. Some may not understand what is being done to them or why. The psychological effects of this painful experience are similar to those of post-traumatic stress disorder. Although very rare, girls and women who have had FGC may have problems sleeping, have more anxiety, and become depressed.
In some countries where FGC is performed, leaders have tried to lessen the physical problems caused by FGC by asking hospitals and doctors to do the surgery. This “medicalization” of FGC offends the international medical community, and is seen as a way for FGC supporters to continue the practice. Advocates have charged that doctors should not perform FGC, as their profession requires them to “do no harm” to their patients, despite cultural beliefs and practices.
Why is FGC a human rights issue?
The WHO and the United Nations Commission on Human Rights, along with several African and Asian nations, have called for an end to the practice of FGC. The WHO views the practice as a violent act against a girl that causes her serious lifetime problems. The American Medical Association (AMA) also rejects FGC and supports laws against it. There is also growing international support for condemning FGC and a call for severe penalties given to those who practice it.
Some cultures that practice FGC view it as their right. FGC supporters say that the Western practice of making breasts bigger and other plastic surgery is comparable to FGC.
What are the laws regarding FGC?
- The United States. There is a federal law that makes the practice of FGC on anyone younger than 18 years of age illegal within this country. It is a felony punishable by fines or up to a 5-year prison term.
Some argue that such sanctions only force young women to return to their homeland where the surgery may not be performed in sanitary or safe conditions. As more people from cultures practicing FGC come to Western nations, this controversy has grown.
- Internationally. International health organizations and women’s rights advocates generally believe that lasting change towards FGC can only take place with the support of the governments and local communities within affected countries. Pressure from outside those countries has little chance for success if there is no educational and legal support from within their borders.
What is being done about FGC?
These are the most popular approaches used to try to stop the practice of FGC:
- Community meetings. Group meetings may help change thoughts toward FGC. These meetings need to involve entire communities – girls, boys, women, and men – as well as nearby communities which may also practice FGC. The most successful of these meetings provide opportunities for people to discuss their knowledge of FGC, relate it to their situation, and consider other options. Some examples of these kinds of meetings include:
- Cross-generational conversations (meetings between older and younger members of a village)
- Male-female discussions
- Theatre productions
- Songs
- Community declarations
- Education. In some regions, education is slowly changing attitudes and influencing the choice to have FGC. Many programs are culturally sensitive and use respected local women to teach other women and girls in their communities about the harmful effects of FGC. Recent research shows that women in these regions are beginning to support the worldwide call to end FGC. Some of the most important research in recent years has been the work done with Islamic scholars to change the perception that FGC is required by the Koran, the Muslim holy book.
Human rights are at the heart of the abandonment of FGC by some communities. When human rights are shown to be in line with local values (for example, parents should do the best for their children and not cause them harm), attitudes toward FGC can change.
- Substitute rituals. In some countries, cultural groups have successfully replaced FGC with a ritual that does not involve cutting the genitals. In this way, the culture preserves its honor and starts new traditions that cause no harm to women. However, as girls are getting cut at younger and younger ages, often in infancy, these other rites of passage become less relevant.
- Changing attitudes. Right now, women are made to feel disloyal to their culture by choosing not to have FGC. This pressure can change if doctors and other health care workers would talk with women about the dangers of FGC and offer other options that don’t involve cutting. Some human rights advocates also suggest that men could help reduce the practice of FGC by openly marrying uncut women. Many human rights organizations are also calling on religious leaders to openly confirm that their religions do not require women to have FGC.
- Laws. The choice to have a procedure with such permanent physical and emotional effects should only be made by an adult woman for herself.
Some suggested legal actions against FGC include:- Establish laws prohibiting FGC.
- Prosecute parents who force FGC on their minor age children.
- Make health care workers report all cases of FGC.
- Classify FGC as child abuse and prosecute it as such.
- Make the criminal consequences of performing FGC more public.
Even if laws are put into place, though, they will likely do little to stop the practice of FGC. Also, in communities where FGC has a lot of support, prosecuting parents will cause extreme controversy.
Eighteen African countries enacted laws or decrees against FGC. Even countries with the highest rates of FGC have recently openly noted the need for banning this practice. Fines and jail sentences are typically minor, but most view any sanctions against FGC as a good start.
- Research. There is ongoing research into the physical and psychological effects of FGC. A number of advocacy groups hope to bring FGC out into the open to discuss the harmful effects of this procedure. Ongoing research is needed to review the many different kinds of interventions that take place to stop FGC. Since there are many differences among the communities where FGC takes place, what works to stop FGC in one community may not work in another.
Folic Acid
What is folic acid?
Folic (FOH-lik) acid is a B vitamin. It helps the body make healthy new cells. “Folic acid” and “folate” mean the same thing. Folic acid is a manmade form of folate. Folate is found naturally in some foods. Most women do not get all the folic acid they need through food alone.
Who needs folic acid?
All people need folic acid. But folic acid is very important for women who are able to get pregnant. When a woman has enough folic acid in her body before and during pregnancy, it can prevent major birth defects, including:
- Spina bifida (SPEYE-nuh BIF-ih-duh), which occurs when an unborn baby’s spinal column does not close to protect the spinal cord. As a result, the nerves that control leg movements and other functions do not work. Children with spina bifida often have lifelong disabilities. They may also need many surgeries.
- Anencephaly (an-en-SEF-uh-lee), which is when most or all of the brain does not develop. Babies with this problem die before or shortly after birth.
The results of some studies suggest that folic acid might also help to prevent other types of birth defects.
Folic acid also helps keep your blood healthy. Not getting enough can cause anemia (uh-NEE-mee-uh).
Experts think that folic acid might also play a role in:
- Heart health
- Preventing cell changes that may lead to cancer
More research is needed to know this for certain.
How much folic acid do women need?
Women able to get pregnant need 400 to 800 mcg or micrograms of folic acid every day, even if they are not planning to get pregnant. (This is the same as 0.4 to 0.8 mg or milligrams.) That way, if they do become pregnant, their babies will be less likely to have birth defects. Talk with your doctor about how much folic acid you need if:
- You are pregnant or are planning to become pregnant. Pregnant women need 400 to 800 mcg of folic acid in the very early stages of pregnancy often before they know that they are pregnant. A pregnant woman should keep taking folic acid throughout pregnancy. Women should discuss their folic acid needs with their doctors. Some doctors prescribe prenatal vitamins that contain higher amounts of folic acid.
- You are breastfeeding. Breastfeeding women need 500 mcg. Some doctors suggest that breastfeeding women keep taking their prenatal vitamins to be sure they are getting plenty of folic acid while they are breastfeeding and should they become pregnant again.
- You had a baby with a birth defect of the brain or spine and want to get pregnant again. Your doctor may give you a prescription for 4,000 mcg of folic acid. That is 10 times the normal dose. Taking this high dose of folic acid can lower the risk of having another baby with these birth defects.
- You have a family member with spina bifida. Your doctor may give you a prescription for 4,000 mcg folic acid.
- You have spina bifida and want to get pregnant.
Some people also need more folic acid. Talk to your doctor about how much folic acid you need if you:
- Are taking medicines used to treat:
- Epilepsy
- Type 2 diabetes
- Rheumatoid arthritis, lupus, psoriasis, asthma, and inflammatory bowel disease
- Have kidney disease and are on dialysis.
- Have liver disease.
- Have sickle cell disease.
- Have celiac disease.
- Often consume more than one alcoholic drink a day.
I don’t plan on getting pregnant right now, and I am using birth control. Do I still need folic acid?
Yes! Birth defects of the brain and spine happen in the very early stages of pregnancy, often before a woman knows she is pregnant. By the time she finds out she is pregnant, it might be too late to prevent those birth defects. Also, half of all pregnancies in the United States are not planned. For these reasons,all women who are able to get pregnant need 400 to 800 mcg of folic acid every day.
How can I be sure I get enough folic acid each day?
 Women can get enough folic acid by taking a vitamin pill every day. If you have a hard time swallowing pills, you might try a chewable or liquid product that has folic acid. Most U.S. multivitamins have at least 400 micrograms (mcg) of folic acid. Check the label on the bottle to be sure. Or you can take a pill that only contains folic acid. When choosing a brand of vitamins, look for “USP” or “NSF” on the label. These “seals of approval” mean that the pills have been made properly and contain the amounts of vitamins stated on the label. Also, make sure the pills have not expired. If the bottle does not have an expiration date, do not buy it. Ask your pharmacist for help selecting a product. Please note, if you already are taking a daily prenatal vitamin, you probably are getting all the folic acid you need. Check the label to be sure. |
Vitamin LabelCheck the Supplement Facts label to be sure you are getting 400 to 800 mcg folic acid.  |
What foods contain folic acid?
Folic acid is found naturally in some foods, including leafy vegetables, citrus fruits, beans (legumes), and whole grains. Folic acid is added to foods that are labeled “enriched,” such as:
- Breakfast cereals (Some have 100 percent of the Daily Value of folic acid in each serving)
- Breads
- Flours
- Pastas
- Cornmeal
- White rice
Food Label
Check the label on the package to see if the food has folic acid. The label will tell you how much folic acid is in each serving. Sometimes, the label will say “folate” instead of folic acid.
Can I get enough folic acid through food alone?
The body does not use the natural form of folic acid (folate) as easily as the manmade form. We cannot be sure that eating foods that contain folate would have the same benefits as consuming folic acid. Also, even if you eat a healthy, well-balanced diet, you might not get all the nutrients you need every day from food alone. In the United States, most women who eat foods enriched with folic acid are still not getting all that they need. That’s why it’s important to take a vitamin with folic acid every day.
How can I remember to take folic acid every day?
Take your folic acid at the same time every day, such as when you brush your teeth, eat breakfast, or give your children their daily vitamins. This way, taking folic acid becomes a routine. If you can, set up your cell phone or computer to give you a daily reminder.
Can women get too much folic acid?
You can't get too much folic acid from foods that naturally contain it. But unless your doctor tells you otherwise, do not consume more than 1,000 mcg of folic acid a day. Consuming too much folic acid can hide signs that a person is lacking vitamin B12, which can cause nerve damage. Lacking vitamin B12 is rare among women of childbearing age. Plus, most prenatal vitamins also contain B12 to help women get all that they need. People at risk of not having enough vitamin B12 are mainly people 50 years and older and people who eat no animal products.
I am no longer of childbearing age. How much folic acid do I need?
Older adults need 400 mcg of folic acid every day for good health. But older adults need to be sure they also are getting enough vitamin B12. Too much folic acid can hide signs that a person is lacking vitamin B12. People older than 50 are at increased risk of not having enough vitamin B12. If you are 50 or older, ask your doctor what vitamins and supplements you might need.
Hysterectomy
What is a hysterectomy?
A hysterectomy (his-tur-EK-tuh-mee) is a surgery to remove a woman's uterus or womb. The uterus is where a baby grows when a woman is pregnant. The whole uterus or just part of it may be removed. After a hysterectomy, you no longer have menstrual periods and cannot become pregnant.
During the hysterectomy, your doctor also may remove your fallopian tubes and ovaries. The ovaries produce eggs and hormones. The fallopian tubes carry eggs from the ovaries to the uterus. The cervix is the lower end of the uterus that joins the vagina. These organs are located in a woman’s lower abdomen, as shown in the image below.
If you have not yet reached menopause and:
- You keep your ovaries during the hysterectomy, you may enter menopause at an earlier age than most women.
- Your ovaries are removed during the hysterectomy, you will enter menopause. You can talk with your doctor about ways to manage menopausal symptoms, such as hot flashes and vaginal dryness.
Image Source: National Cancer Institute
Types of hysterectomy:
- Partial, subtotal, or supracervical (soo-pruh-SER-vi-kuhl) removes just the upper part of the uterus. The cervix is left in place.
- Total removes the whole uterus and the cervix.
- Radical removes the whole uterus, the tissue on both sides of the cervix, and the upper part of the vagina. This is done mostly when there is cancer present.
How is a hysterectomy performed?
There are different ways that your doctor can perform a hysterectomy. It will depend on your health history and the reason for your surgery.
- Abdominal hysterectomy. This is done through a 5- to 7-inch incision, or cut, in the lower part of your belly. The cut may go either up and down, or across your belly, just above your pubic hair.
- Vaginal hysterectomy. This is done through a cut in the vagina. The doctor will take your uterus out through this incision and close it with stitches.
- Laparoscopic (lap-uh-ro-SKOP-ik) hysterectomy. A laparoscope is an instrument with a thin, lighted tube and small camera that allows your doctor to see your pelvic organs. Your doctor will make three to four small cuts in your belly and insert the laparoscope and other instruments. He or she will cut your uterus into smaller pieces and remove them through the incisions.
- Laparoscopically assisted vaginal hysterectomy (LAVH). Your doctor will remove your uterus through the vagina. The laparoscope is used to guide the procedure.
- Robotic surgery. Your doctor uses a special machine to perform the surgery like laparoscopic surgery. It is most often done when a patient has cancer or is very overweight and vaginal surgery is not safe.
Why do women have hysterectomies?
Hysterectomy may be needed if you have:
- Cancer of the uterus, ovary, cervix, or endometrium (en-doh-MEE-tree-um). Hysterectomy may be the best option if you have cancer in these organs. The endometrium is the tissue that lines the uterus. If you have precancerous changes of the cervix, you might be able to have a loop electrosurgical excision procedure (LEEP) to remove the cancerous cells. Other treatment options can include chemotherapy and radiation. Your doctor will talk with you about the type of cancer you have and how advanced it is.
- Fibroids. Fibroids are non-cancerous, muscular tumors that grow in the wall of the uterus. Many women with fibroids have only minor symptoms and do not need treatment. Fibroids also often shrink after menopause. In some women, fibroids can cause prolonged heavy bleeding or pain. Fibroids can be treated with medications. There are also procedures to remove the fibroids, such as uterine artery embolization (em-boh-li-ZAE-shuhn), which blocks the blood supply to the tumors. Without blood, the fibroids shrink over time, which can reduce pain and heavy bleeding. Another procedure called myomectomy (my-oh-MEK-tuh-mee) removes the tumors while leaving your uterus intact, but there is a risk that the tumors could come back. If medications or procedures to remove the fibroids have not helped, and a woman is either near or past menopause and does not want children, hysterectomy can cure problems from fibroids.
- Endometriosis (en-doh-mee-tree-OH-suhs). This health problem occurs when the tissue that lines the uterus grows outside the uterus on your ovaries, fallopian tubes, or other pelvic or abdominal organs. This can cause severe pain during menstrual periods, chronic pain in the lower back and pelvis, pain during or after sex, bleeding between periods, and other symptoms. You might need a hysterectomy when medications or less invasive surgery to remove the spots of endometriosis have not helped.
- Prolapse of the uterus. This is when the uterus slips from its usual place down into the vagina. This can lead to urinary and bowel problems and pelvic pressure. These problems might be helped for a time with an object called a vaginal pessary, which is inserted into the vagina to hold the womb in place.
- Adenomyosis (uh-den-oh-my-OH-suhs). In this condition, the tissue that lines the uterus grows inside the walls of the uterus, which can cause severe pain. If other treatments have not helped, a hysterectomy is the only certain cure.
- Chronic pelvic pain. Surgery is a last resort for women who have chronic pelvic pain that clearly comes from the uterus. Many forms of pelvic pain are not cured by a hysterectomy, so it could be unnecessary and create new problems.
- Abnormal vaginal bleeding. Treatment depends on the cause. Changes in hormone levels, infection, cancer, or fibroids are some things that can cause abnormal bleeding. There are medications that can lighten heavy bleeding, correct irregular bleeding, and relieve pain. These include hormone medications, birth control pills, and nonsteroidal anti-inflammatory medications (NSAIDs). One procedure for abnormal bleeding is dilatation and curettage (D&C), in which the lining and contents of the uterus are removed. Another procedure, endometrial ablation (en-doh-MEE-tree-uhl a-BLAE-shuhn), also removes the lining of your uterus and can help stop heavy, prolonged bleeding. But, it should not be used if you want to become pregnant or if you have gone through menopause.
Very rarely, hysterectomy is needed to control bleeding during a cesarean delivery following rare pregnancy complications. There are other methods doctors use to control bleeding in most of these cases, but hysterectomy is still needed for some women.
Keep in mind that there may be ways to treat your health problem without having this major surgery. Talk with your doctor about all of your treatment options.
How common are hysterectomies?
A hysterectomy is the second most common surgery among women in the United States. The most common surgery in women is childbirth by cesarean section delivery.
What should I do if I am told that I need a hysterectomy?
- Ask about the possible risks of the surgery.
- Talk to your doctor about other treatment options. Ask about the risks of those treatments.
- Consider getting a second opinion from another doctor.
Keep in mind that every woman is different and every situation is different. A good treatment choice for one woman may not be good for another.
How long does it take to recover from a hysterectomy?
Recovering from a hysterectomy takes time. Most women stay in the hospital from 1 to 2 days for post-surgery care. Some women may stay longer, often when the hysterectomy is done because of cancer.
The time it takes for you to resume normal activities depends on the type of surgery. If you had:
- Abdominal surgery. Recovery takes from 4 to 6 weeks. You will gradually be able to increase your activities.
- Vaginal or laparoscopic surgery. Recovery takes 3 to 4 weeks.
You should get plenty of rest and not lift heavy objects for a full 6 weeks after surgery. About 6 weeks after either surgery, you should be able to take tub baths and resume sexual intercourse. Research has found that women with a good sex life before hysterectomy can maintain it after the surgery.
What are the risks of having a hysterectomy?
Most women do not have health problems during or after the surgery, but some of the risks of a hysterectomy include:
- Injury to nearby organs, such as the bowel, urinary tract, bladder, rectum, or blood vessels
- Pain during sexual intercourse
- Early menopause, if the ovaries are removed
- Anesthesia problems, such as breathing or heart problems
- Allergic reactions to medicines
- Blood clots in the legs or lungs. These can be fatal.
- Infection
- Heavy bleeding
Do I still need to have Pap tests after a hysterectomy?
You will still need regular Pap tests to screen for cervical cancer if you had a partial hysterectomy and did not have your cervix removed, or if your hysterectomy was for cancer. Ask your doctor what is best for you and how often you should have Pap tests.
Even if you do not need Pap tests, all women who have had a hysterectomy should have regular pelvic exams and mammograms
Infertility
What is infertility?
Infertility means not being able to get pregnant after one year of trying. Or, six months, if a woman is 35 or older. Women who can get pregnant but are unable to stay pregnant may also be infertile.
Pregnancy is the result of a process that has many steps. To get pregnant:
- A woman’s body must release an egg from one of her ovaries (ovulation).
- The egg must go through a fallopian tube toward the uterus (womb).
- A man's sperm must join with (fertilize) the egg along the way.
- The fertilized egg must attach to the inside of the uterus (implantation).
Infertility can happen if there are problems with any of these steps.
Is infertility a common problem?
Yes. About 10 percent of women (6.1 million) in the United States ages 15-44 have difficulty getting pregnant or staying pregnant, according to the Centers for Disease Control and Prevention (CDC).
Is infertility just a woman's problem?
No, infertility is not always a woman's problem. Both women and men can have problems that cause infertility. About one-third of infertility cases are caused by women’s problems. Another one third of fertility problems are due to the man. The other cases are caused by a mixture of male and female problems or by unknown problems.
What causes infertility in men?
Infertility in men is most often caused by:
- A problem called varicocele (VAIR-ih-koh-seel). This happens when the veins on a man’s testicle(s) are too large. This heats the testicles. The heat can affect the number or shape of the sperm.
- Other factors that cause a man to make too few sperm or none at all.
- Movement of the sperm. This may be caused by the shape of the sperm. Sometimes injuries or other damage to the reproductive system block the sperm.
Sometimes a man is born with the problems that affect his sperm. Other times problems start later in life due to illness or injury. For example, cystic fibrosis often causes infertility in men.
What increases a man's risk of infertility?
A man's sperm can be changed by his overall health and lifestyle. Some things that may reduce the health or number of sperm include:
- Heavy alcohol use
- Drugs
- Smoking cigarettes
- Age
- Environmental toxins, including pesticides and lead
- Health problems such as mumps, serious conditions like kidney disease, or hormone problems
- Medicines
- Radiation treatment and chemotherapy for cancer
What causes infertility in women?
Most cases of female infertility are caused by problems with ovulation. Without ovulation, there are no eggs to be fertilized. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods.
Ovulation problems are often caused by polycystic ovarian syndrome (PCOS). PCOS is a hormone imbalance problem which can interfere with normal ovulation. PCOS is the most common cause of female infertility. Primary ovarian insufficiency (POI) is another cause of ovulation problems. POI occurs when a woman’s ovaries stop working normally before she is 40. POI is not the same as early menopause.
Less common causes of fertility problems in women include:
- Blocked fallopian tubes due to pelvic inflammatory disease, endometriosis, or surgery for an ectopic pregnancy
- Physical problems with the uterus
- Uterine fibroids, which are non-cancerous clumps of tissue and muscle on the walls of the uterus.
What things increase a woman's risk of infertility?
Many things can change a woman's ability to have a baby. These include:
- Age
- Smoking
- Excess alcohol use
- Stress
- Poor diet
- Athletic training
- Being overweight or underweight
- Sexually transmitted infections (STIs)
- Health problems that cause hormonal changes, such as polycystic ovarian syndrome and primary ovarian insufficiency
How does age affect a woman's ability to have children?
Many women are waiting until their 30s and 40s to have children. In fact, about 20 percent of women in the United States now have their first child after age 35. So age is a growing cause of fertility problems. About one-third of couples in which the woman is over 35 have fertility problems.
Aging decreases a woman's chances of having a baby in the following ways:
- Her ovaries become less able to release eggs.
- She has a smaller number of eggs left.
- Her eggs are not as healthy.
- She is more likely to have health conditions that can cause fertility problems.
- She is more likely to have a miscarriage.
How long should women try to get pregnant before calling their doctors?
Most experts suggest at least one year. Women 35 or older should see their doctors after six months of trying. A woman's chances of having a baby decrease rapidly every year after the age of 30.
Some health problems also increase the risk of infertility. So, women should talk to their doctors if they have:
- Irregular periods or no menstrual periods
- Very painful periods
- Endometriosis
- Pelvic inflammatory disease
- More than one miscarriage
It is a good idea for any woman to talk to a doctor before trying to get pregnant. Doctors can help you get your body ready for a healthy baby. They can also answer questions on fertility and give tips on conceiving.
How will doctors find out if a woman and her partner have fertility problems?
Doctors will do an infertility checkup. This involves a physical exam. The doctor will also ask for both partners’ health and sexual histories. Sometimes this can find the problem. However, most of the time, the doctor will need to do more tests.
In men, doctors usually begin by testing the semen. They look at the number, shape, and movement of the sperm. Sometimes doctors also suggest testing the level of a man's hormones.
In women, the first step is to find out if she is ovulating each month. There are a few ways to do this. A woman can track her ovulation at home by:
- Writing down changes in her morning body temperature for several months
- Writing down how her cervical mucus looks for several months
- Using a home ovulation test kit (available at drug or grocery stores)
Doctors can also check ovulation with blood tests. Or they can do an ultrasound of the ovaries. If ovulation is normal, there are other fertility tests available.
Some common tests of fertility in women include:
- Hysterosalpingography (HIS-tur-oh-sal-ping-GOGH-ru-fee): This is an x-ray of the uterus and fallopian tubes. Doctors inject a special dye into the uterus through the vagina. This dye shows up in the x-ray. Doctors can then watch to see if the dye moves freely through the uterus and fallopian tubes. This can help them find physical blocks that may be causing infertility. Blocks in the system can keep the egg from moving from the fallopian tube to the uterus. A block could also keep the sperm from reaching the egg.
- Laparoscopy (lap-uh-ROS-kuh-pee): A minor surgery to see inside the abdomen. The doctor does this with a small tool with a light called a laparoscope (LAP-uh-roh-skohp). She or he makes a small cut in the lower abdomen and inserts the laparoscope. With the laparoscope, the doctor can check the ovaries, fallopian tubes, and uterus for disease and physical problems. Doctors can usually find scarring and endometriosis by laparoscopy.
Finding the cause of infertility can be a long and emotional process. It may take time to complete all the needed tests. So don't worry if the problem is not found right away.
How do doctors treat infertility?
Infertility can be treated with medicine, surgery, artificial insemination, or assisted reproductive technology. Many times these treatments are combined. In most cases infertility is treated with drugs or surgery.
Doctors recommend specific treatments for infertility based on:
- Test results
- How long the couple has been trying to get pregnant
- The age of both the man and woman
- The overall health of the partners
- Preference of the partners
Doctors often treat infertility in men in the following ways:
- Sexual problems: Doctors can help men deal with impotence or premature ejaculation. Behavioral therapy and/or medicines can be used in these cases.
- Too few sperm: Sometimes surgery can correct the cause of the problem. In other cases, doctors surgically remove sperm directly from the male reproductive tract. Antibiotics can also be used to clear up infections affecting sperm count.
- Sperm movement: Sometimes semen has no sperm because of a block in the man’s system. In some cases, surgery can correct the problem.
In women, some physical problems can also be corrected with surgery.
A number of fertility medicines are used to treat women with ovulation problems. It is important to talk with your doctor about the pros and cons of these medicines. You should understand the possible dangers, benefits, and side effects.
What medicines are used to treat infertility in women?
Some common medicines used to treat infertility in women include:
- Clomiphene citrate (Clomid): This medicine causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovarian syndrome (PCOS) or other problems with ovulation. This medicine is taken by mouth.
- Human menopausal gonadotropin or hMG (Repronex, Pergonal): This medicine is often used for women who don't ovulate due to problems with their pituitary gland. hMG acts directly on the ovaries to stimulate ovulation. It is an injected medicine.
- Follicle-stimulating hormone or FSH (Gonal-F, Follistim): FSH works much like hMG. It causes the ovaries to begin the process of ovulation. These medicines are usually injected.
- Gonadotropin-releasing hormone (Gn-RH) analog: These medicines are often used for women who don't ovulate regularly each month. Women who ovulate before the egg is ready can also use these medicines. Gn-RH analogs act on the pituitary gland to change when the body ovulates. These medicines are usually injected or given with a nasal spray.
- Metformin (Glucophage): Doctors use this medicine for women who have insulin resistance and/orPCOS. This drug helps lower the high levels of male hormones in women with these conditions. This helps the body to ovulate. Sometimes clomiphene citrate or FSH is combined with metformin. This medicine is usually taken by mouth.
- Bromocriptine (Parlodel): This medicine is used for women with ovulation problems due to high levels of prolactin. Prolactin is a hormone that causes milk production.
Many fertility drugs increase a woman's chance of having twins, triplets, or other multiples. Women who are pregnant with multiple fetuses have more problems during pregnancy. Multiple fetuses have a high risk of being born too early (prematurely). Premature babies are at a higher risk of health and developmental problems.
What is intrauterine insemination (IUI)?
Intrauterine insemination (IUI) is an infertility treatment that is often called artificial insemination. In this procedure, the woman is injected with specially prepared sperm. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI.
IUI is often used to treat:
- Mild male factor infertility
- Women who have problems with their cervical mucus
- Couples with unexplained infertility
What is assisted reproductive technology (ART)?
Assisted reproductive technology (ART) is a group of different methods used to help infertile couples. ART works by removing eggs from a woman's body. The eggs are then mixed with sperm to make embryos. The embryos are then put back in the woman's body.
How often is assisted reproductive technology (ART) successful?
Success rates vary and depend on many factors. Some things that affect the success rate of ART include:
- Age of the partners
- Reason for infertility
- Clinic
- Type of ART
- If the egg is fresh or frozen
- If the embryo is fresh or frozen
The U.S. Centers for Disease Prevention (CDC) collects success rates on ART for some fertility clinics. According to the 2006 CDC report on ART, the average percentage of ART cycles that led to a live birth were:
- 39 percent in women under the age of 35
- 30 percent in women aged 35-37
- 21 percent in women aged 37-40
- 11 percent in women aged 41-42
ART can be expensive and time-consuming. But it has allowed many couples to have children that otherwise would not have been conceived. The most common complication of ART is multiple fetuses. But this is a problem that can be prevented or minimized in several different ways.
What are the different types of assisted reproductive technology (ART)?
Common methods of ART include:
- In vitro fertilization (IVF) means fertilization outside of the body. IVF is the most effective ART. It is often used when a woman's fallopian tubes are blocked or when a man produces too few sperm. Doctors treat the woman with a drug that causes the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman. They are put in a dish in the lab along with the man's sperm for fertilization. After 3 to 5 days, healthy embryos are implanted in the woman's uterus.
- Zygote intrafallopian transfer (ZIFT) or Tubal Embryo Transfer is similar to IVF. Fertilization occurs in the laboratory. Then the very young embryo is transferred to the fallopian tube instead of the uterus.
- Gamete intrafallopian transfer (GIFT) involves transferring eggs and sperm into the woman's fallopian tube. So fertilization occurs in the woman's body. Few practices offer GIFT as an option.
- Intracytoplasmic sperm injection (ICSI) is often used for couples in which there are serious problems with the sperm. Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg. Then the embryo is transferred to the uterus or fallopian tube.
ART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who can not produce eggs. Also, donor eggs or donor sperm is sometimes used when the woman or man has a genetic disease that can be passed on to the baby. An infertile woman or couple may also use donor embryos. These are embryos that were either created by couples in infertility treatment or were created from donor sperm and donor eggs. The donated embryo is transferred to the uterus. The child will not be genetically related to either parent.
Surrogacy
Women with no eggs or unhealthy eggs might also want to consider surrogacy. A surrogate is a woman who agrees to become pregnant using the man's sperm and her own egg. The child will be genetically related to the surrogate and the male partner. After birth, the surrogate will give up the baby for adoption by the parents.
Gestational Carrier
Women with ovaries but no uterus may be able to use a gestational carrier. This may also be an option for women who shouldn't become pregnant because of a serious health problem. In this case, a woman uses her own egg. It is fertilized by the man's sperm and the embryo is placed inside the carrier's uterus. The carrier will not be related to the baby and gives him or her to the parents at birth.
Recent research by the Centers for Disease Control showed that ART babies are two to four times more likely to have certain kinds of birth defects. These may include heart and digestive system problems, and cleft (divided into two pieces) lips or palate. Researchers don’t know why this happens. The birth defects may not be due to the technology. Other factors, like the age of the parents, may be involved. More research is needed. The risk is relatively low, but parents should consider this when making the decision to use ART.
Menopause and Menopause Treatments
What is menopause?
Menopause is the time in a woman's life when her period stops and she can no longer become pregnant. It is a normal change in a woman's body. A woman will know she has reached menopause when she has not had a period for 12 months in a row (and there are no other causes, such as pregnancy or illness, for this change). This happens for most women after age 45.
Menopause is sometimes called, "the change of life." In the years leading up to menopause, a woman’sovaries slowly make less and less of the hormones estrogen and progesterone. You might not be aware of the changes happening in your body. Or, you might have symptoms as you near menopause. Many women wonder if these symptoms are normal, and many are confused about how to treat their symptoms.
You will feel better by learning all you can about menopause and talking with your doctor about your health and your symptoms. If your symptoms are causing you discomfort or concern, your doctor can teach you about treatment options and help you to make wise choices.
What are the symptoms of menopause?
Menopause affects every woman differently. Your only symptom may be your period stopping. You may have other symptoms, too. Many symptoms at this time of life happen because you are getting older. But some are due to menopause. It’s not always possible to tell if symptoms are related to aging, menopause, or both. Some changes you might notice as you near menopause include:
- Change in pattern of periods (They can be shorter or longer, lighter or heavier, or there may be more or less time between periods.)
- Hot flashes (sometimes called hot flushes), night sweats (sometimes followed by a chill)
- Trouble sleeping through the night (with or without night sweats)
- Vaginal dryness
- Mood swings, feeling crabby, or crying spells
- Trouble focusing, "fuzzy thinking," or forgetfulness
- Hair loss or thinning on your head or more hair growth on your face
Does menopause cause bone loss?
Both men and women lose bone as they grow older. But dropping estrogen levels around the time of menopause also leads to bone loss in women. Estrogen helps to build and maintain bone. After menopause, bone loss speeds up for several years as estrogen levels rapidly decrease. Bone loss can cause bones to weaken. Weak bones can break more easily. When bones weaken a lot, the condition is called osteoporosis (OSS-tee-oh-puh-ROH-suhss).
How do I manage symptoms of menopause?
Many women do not need any special treatment for menopause. Eating healthy foods and keeping physically fit are important to feeling your best in the years leading up to menopause and beyond. But women who are bothered by some menopausal symptoms might want to try treatment. Several treatment options, including menopausal hormone therapy (MHT), are available depending on your symptoms and other factors. Talk to your doctor about the risks and benefits of treatment so you can choose what’s best for you. There is no one treatment that is good for all women.
- Hot flashes. Some women report that eating or drinking hot or spicy foods, alcohol, or caffeine, feeling stressed, or being in a hot place can bring on hot flashes. Try to avoid any triggers that bring on your hot flashes. Dress in layers, and keep a fan in your home or workplace. If you are bothered by hot flashes or night sweats, ask your doctor about MHT. MHT works best at treating hot flashes and night sweats. If MHT is not an option for you, ask your doctor about trying antidepressant or epilepsy medicine. There is proof that these can relieve hot flashes for some women.
- Vaginal dryness. A water-based, over-the-counter vaginal lubricant (like K-Y® Jelly) can be helpful if sex is painful. A vaginal moisturizer (also over-the-counter) can provide lubrication and help keep needed moisture in vaginal tissues. Really bad vaginal dryness may need MHT. If vaginal dryness is the only reason for considering MHT, an estrogen product for the vagina is the best choice. Vaginal estrogen products (creams, tablet, ring) treat only the vagina.
- Problems sleeping. One of the best ways to get a good night's sleep is to be physically active. But, don’t exercise close to bedtime. Also avoid large meals, smoking, and working right before bedtime. Caffeine and alcohol should be avoided after noon. Drinking something warm before bedtime, such as herbal tea (no caffeine) or warm milk, might help you to feel sleepy. Keep your bedroom dark, quiet, and cool, and use your bedroom only for sleeping and sex. Avoid napping during the day, and try to go to bed and get up at the same times every day. If you wake during the night and can't get back to sleep, get up and read until you’re sleepy. Don't just lie there. If hot flashes are the cause of sleep problems, treating the hot flashes will usually improve sleep.
- Mood swings. Some women report mood swings or "feeling blue" during the menopause transition. Women who had mood swings (PMS) before their periods or postpartum depression after giving birth may have more mood swings around the time of menopause. These are women who are sensitive to hormone changes. Often the mood swings will go away with time. If a woman is using MHT for hot flashes or another menopause symptom, sometimes her mood swings will get better, too. Also, getting enough sleep and staying physically active will help you to feel your best. Mood swings are not the same as depression.
- Trouble focusing, “fuzzy thinking,” forgetfulness. Some women complain of these symptoms in midlife. But studies suggest that natural menopause has little effect on memory or other “brain” functions. Also, recent studies suggest that women should not use MHT to protect against memory loss or brain diseases, including dementia, and Alzheimer’s disease. Getting enough sleep and keeping physically active might help improve symptoms. But if memory problems are really bad, talk to your doctor right away.
Can menopausal hormone therapy (MHT) help treat my symptoms?
If used properly, menopausal hormone therapy (MHT) (once called hormone replacement therapy or HRT) can be very good at relieving moderate to severe menopausal symptoms and prevents bone loss. But MHT also has some risks, especially if used for a long time.
MHT can help with menopause by:
MHT can help with menopause by:
- Reducing hot flashes and night sweats, and related problems such as poor sleep and irritability
- Treating vaginal symptoms, such as dryness and discomfort, and related effects, such as pain during sex
- Slowing bone loss
- Possibly easing mood swings and mild depressive symptoms (MHT is not an antidepressant and is not effective in treating depression.)
For some women, MHT may increase their chance of:
- Blood clots
- Heart attack
- Stroke
- Breast cancer
- Gall bladder disease
Who should not take menopausal hormone therapy (MHT) for menopause?
Women who:
- Think they are pregnant
- Have problems with vaginal bleeding
- Have had certain kinds of cancers (such as breast and uterine cancer)
- Have had a stroke or heart attack
- Have had blood clots
- Have liver disease
- Have heart disease
MHT can also cause these side effects:
- Vaginal bleeding
- Bloating
- Breast tenderness or swelling
- Headaches
- Mood changes
- Nausea
Can menopausal hormone therapy (MHT) prevent heart disease or Alzheimer’s disease?
Some research has shown that women who start estrogen or certain types of hormone therapy around the time of menopause are less likely to get heart disease. But a very large study by the U.S. National Institutes of Health (NIH) had different results. The NIH research found that:
- Estrogen alone didn’t affect the risk of a heart attack. Estrogen did increase the risk of stroke. Estrogen also increased the risk of blood clots in the legs.
- Estrogen plus progestin may have slightly increased the risk of a heart attack. Progestin is a manmade form of the female hormone progesterone. Estrogen plus progestin raised the risk of stroke and blood clots in the legs and lungs.
Researchers continue to study this issue. The age at which MHT is started may be the key to whether this therapy reduces your chanc es of getting heart disease. Most of the women in the NIH study did not start MHT until after the age of 60. Yet menopause happens for most women after the age of 45. Some experts think that many of the women in the NIH study may have already de veloped narrowing and hardening of the arteries because of many years in which their estrogen levels were low. This would explain why estrogen did not protect against heart disease in the study.
More research on younger women may support the use of some kind of MHT to prevent heart disease. And more research will be need ed to ensure that the benefits of such a therapy outweigh its risks. For now, the safest option for meno pausal hormone therapy is to stick with the lowest dose for the shortest time to treat menopausal symptoms or treat bone loss, but not to prevent heart disease.
Studies on the effects of MHT on memory and other brain functions also have had mixed results. For now, MHT should not be used to prevent memory loss, dementia or Alzheimer’s disease.
To learn more about recent studies involving MHT and its benefits and risks, go tohttp://www.nhlbi.nih.gov/health/women/index.htmAre there "natural" treatments available for menopause?
Some women try herbal or other plant-based products to help relieve hot flashes. Some of the most common ones are:
- Soy. Soy contains phytoestrogens (estrogen-like substances from a plant). But, there is no proof that soy — or other sources of phytoestrogens — really do make hot flashes better. And the risks of taking soy — mainly soy pills and powders — are not known. The best sources of soy are foods such as tofu, tempeh, soymilk, and soy nuts.
- Other sources of phytoestrogens. These include herbs such as black cohosh, wild yam, dong quai, and valerian root. Again, there is no proof that these herbs (or pills or creams containing these herbs) help with hot flashes.
What is "bioidentical" hormone therapy?
This term means different things to different people. It’s really manmade hormones that are just the same as the hormones the body makes. There are several products with hormones like this that are on the market and are well-tested. But this term is most often used to mean drugs that are custom-made from a doctor’s order. These custom-made products are also known as bioidentical hormone replacement therapy (BHRT). Despite product claims, there is no proof that BHRT products are better or safer than MHT drugs approved by the Food and Drug Administration (FDA). BHRT also can be expensive as many insurance and prescription programs do not pay for these drugs because they are viewed as experimental.
How much physical activity should I do?
An active lifestyle can lower your risk of early death from a variety of causes and help you maintain a healthy weight. It also might improve your mood and help you to sleep better. For older adults, activity can improve mental function. Health benefits are gained by doing the following each week:
- 2 hours and 30 minutes of moderate-intensity aerobic physical activity
or - 1 hour and 15 minutes of vigorous-intensity aerobic physical activity
or - A combination of moderate and vigorous aerobic activity
and - Muscle-strengthening activities on 2 or more days of the week
I'm having a hysterectomy soon. Will this cause me to enter menopause?
Sometimes, younger women need a hysterectomy to treat health problems such as endometriosis or cancer. A hysterectomy is an operation to remove a woman’s uterus. Often one or both ovaries are removed at the same time the hysterectomy is done. If you haven’t reached menopause, a hysterectomy will stop your period. But, you will reach menopause only if both ovaries are removed, called surgical menopause. Because surgical menopause is instant menopause, it can cause more severe symptoms than natural menopause. Menopause that is natural occurs as part of the natural aging process. You should 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 reach menopause at the time of surgery because their ovaries will continue to make hormones. But, because the uterus is removed, they will no longer have their periods and they cannot become pregnant. Later on, they might reach natural menopause a year or two earlier than expected.What is premature menopause?
Menopause is called "premature" if it happens at or before the age of 40. For some women, it happens naturally. This could be due to family history of premature menopause. For other women, it is brought on by medical means, such as:
- Medical treatments, such as surgery to remove the ovaries
- Cancer treatments, such as chemotherapy or radiation to the pelvic area that damage the ovaries — although menopause does not always occur
For women who want to have children, premature menopause can be a source of great distress. Women who still want to become pregnant can talk with their doctors about other ways of having children, such as donor egg programs or adoption.
Having premature menopause puts a woman at more risk for osteoporosis later in her life. If you have premature menopause, talk to your doctor about whether MHT might be an option for you. We don’t know for sure how MHT might affect younger women. But some researchers think that for these younger women, the risks of MHT use are likely to be smaller and the benefits greater than those in older women who begin MHT at or beyond the typical age of menopause.
What is postmenopause?
Postmenopause is the term for all the years beyond menopause. It begins after you have not had a period for 12 months in a row, whether your menopause was natural or brought on by treatment for a condition.
The Environment and Women's Health
The Environment
What do you mean by “the environment”?
The environment is everything around you, indoors or outdoors. The air you breathe, water you drink, the ground you walk on, and food you eat are all part of your environment. It’s important that you know what things in the environment can affect your health and what you can do to help protect yourself and your family.
How can the environment affect women's health?
Chemicals and other substances in the environment can cause serious health problems in women, such as cancer, lung disease, or reproductive system problems. They can also make health conditions worse. Scientists are studying the ways toxins in the environment may play a role in conditions such as breast cancer, endometriosis, and menopause. This fact sheet offers information about these toxins and steps you can take to limit exposure.
How can the environment affect children’s health?
Many types of environmental exposures are more harmful for children than for adults. There are many reasons for this:
- Relative to their body weight, children eat, breathe, and drink more than adults do. So children take in higher concentrations of any toxins in their food, water, or air.
- As organs develop, they are more likely to be damaged by exposure to toxins.
- The ways that toxins are removed from the body are not fully developed in children.
- Children spend more time outdoors, where they may be exposed to outdoor air pollution and ultraviolet radiation.
- Children do more intense physical activity, causing them to breathe air pollutants more deeply into their lungs.
- Young children tend to put their hands, dirt, or objects into their mouths.
How can the environment affect women who are pregnant or nursing?
Exposure to some toxic substances — including lead, mercury, arsenic, cadmium, pesticides, solvents, and household chemicals — can increase the risk of miscarriage, preterm birth, and other pregnancy complications. These and other environmental toxins can also harm the developing bodies of fetuses and infants. Women who are pregnant or nursing or who plan to become pregnant should take special care to avoid exposure to certain chemicals discussed here.
How can the environment affect older women?
Pollutants in the environment can contribute to some illnesses that are more common in older adults. Indoor and outdoor air pollution can aggravate the symptoms of cardiovascular and lung diseases, including high blood pressure, chronic obstructive pulmonary disease, and asthma. These conditions are more common in women over the age of 50 than in men over 50.
Older adults may be more susceptible to the health effects of toxic chemicals. People who are exposed to pollutants over the course of a lifetime may have health problems when they are older. For instance, long-term exposure to pesticides may cause cancer or dementia.
Lead is a toxic metal that may be stored in bones. In postmenopausal women who were exposed to lead early in life, bone loss can release lead into the bloodstream. This may cause kidney damage, increase the risk of high blood pressure, and decrease cognitive functions.
Outdoor Air Pollution
What is outdoor air pollution and how can I be exposed to it?
There are many sources of pollution outdoors, such as:
- Emissions from cars and trucks
- Power plants that burn fossil fuels
- Factories and forest fires
What are the health effects of outdoor air pollution?
Outdoor air pollution can cause your eyes and nose to burn, your throat to itch, and even breathing problems. Exposure to air pollutants at high levels over a long period of time may lead to cancer, birth defects, brain and nerve damage, and long-term injury to the lungs and breathing passages.
Air pollution affects everyone. Children are especially susceptible to the effects of air pollution because their lungs are developing. They also spend more time active outdoors. People with lung and heart diseases are also more sensitive to outdoor air pollution.
The U.S. Environmental Protection Agency (EPA) sets limits on certain air pollutants throughout the United States. Ground-level ozone and particle pollution are two of the most common pollutants and pose the greatest threat to human health in the United States.
What can I do to reduce exposure to outdoor air pollution?
To find out about the level of outdoor air pollution in your community, you can check the daily Air Quality Index (AQI). The AQI is a measure of five pollutants: ozone (OH-zohn), particle pollution, sulfur dioxide (SUHL-fur deye-OKS-eyed), nitrogen oxide (NEYE-troh-jen OKS-eyed), and carbon monoxide (kar-bun moh-NOKS-eyed). Many newspaper, radio, and television weather forecasts also include the AQI. Learn more about the AQI, see color-coded air quality maps, and find your local AQI online athttp://www.airnow.gov.
When the levels of air pollution are high, you can protect yourself and your family by limiting outdoor physical activity. This is because physical activity can cause you to take faster, deeper breaths, inhaling more pollutants into your lungs.
What is ground-level ozone and how can I be exposed to it?
Ozone is a gas that is naturally found in earth’s upper atmosphere, where it forms the ozone layer. The ozone layer blocks some of the sun’s harmful ultraviolet (UV) rays. To learn more, see UV Radiation below.
Ground-level ozone is ozone in the lower atmosphere, close to the Earth’s surface. This is one of the main components of smog. Ground-level ozone is formed when sunlight and heat cause chemical reactions between nitrogen oxides and volatile organic compounds (VOCs). VOCs are pollutants released by motor vehicles, factories and power plants, and chemicals such as paints and cleaners. Ground-level ozone is a pollutant that can harm the environment, crops, and human health.
What are the health effects from exposure to ground-level ozone?
High levels of ground-level ozone can make it difficult to breath deeply, cause coughing and throat irritation, and even damage the lining of your lungs. People with chronic lung conditions such as asthma, emphysema, and bronchitis may be more sensitive to the effects of ozone. Ozone can also have a greater impact on the health of children and adults who are physically active outdoors when ozone levels are high.
What is particle pollution and how can I be exposed to it?
Particle pollution are tiny solid particles and liquid droplets in the air. This is also called particle matter or PM. These particles come from dust, fires, motor vehicles, power plants, and factories. Many types of particle pollution are too small to be seen with the naked eye. Particle pollution causes haze.
What are the health effects from exposure to particle pollution?
Exposure to particle pollution can irritate your eyes, nose, and throat. Inhaling these particles can cause coughing and wheezing, even if you are healthy. Long-term exposures to particle pollution can reduce lung function and lead to chronic bronchitis. High levels of particle pollution may aggravate symptoms of lung and heart diseases.
What is "acid rain?"
“Acid rain” is a term used to describe rain, snow, fog, dry gases, and particles containing acids. Sulfur dioxide and nitrogen oxides released by power plants, cars and trucks, and other sources are the primary cause of acid rain. Acid rain harms plants, animals, fish, and building surfaces.
What are the health effects from acid rain?
Acid rain does not directly affect human health. But the main components of acid rain — sulfur dioxide and nitrogen oxides — do. These gases contribute to particulate pollution, which can affect the heart and lungs. High levels of sulfur dioxide can aggravate lung and heart diseases. Nitrogen oxides increase levels of ground-level ozone, react with other chemicals to form toxins, and contribute to global warming.
What is global warming?
Global warming is an increase in the Earth’s average temperature. This increase can cause a variety of changes in local climates around the world, such as changes in rainfall patterns and a rise in sea level. It also triggers a wide range of changes in plants, wildlife, and human life.
“Greenhouse gases,” including carbon dioxide and methane, trap the heat of the Earth. In the last 200 years, human activities — like burning fossil fuels — have increased the levels of greenhouse gases in the atmosphere. This has caused average temperatures to rise. Temperatures are expected to continue to rise in the future.
What are the health effects of global warming?
Scientists predict that global warming may affect human health in many ways:
- Extremely high summer temperatures may lead to more heat-related deaths.
- Warmer climates can increase the spread of some infectious diseases.
- Climate change may lead to more extreme weather events, such as hurricanes and floods.
- Higher temperatures can increase concentrations of ozone and particulate pollution.
What can I do to reduce outdoor air pollution and global warming?
Motor vehicles and power plants that burn fossil fuels are major sources of air pollution. They also releasegreenhouse gases that lead to climate change. But there are many steps you can take to use less energy and reduce air pollution and greenhouse gases. Many of these steps can also save you money.
- Replace incandescent (in-kand-ESS-ent) light bulbs with compact fluorescent (flor-ESS-ent) bulbs.
- Turn off lights and appliances when they’re not in use.
- Reuse and recycle to conserve raw materials and energy.
- Buy ENERGY STAR appliances.
- Choose a vehicle with good fuel economy and low emissions.
- Drive less. Carpool, walk, bike, or use public transportation if you can.
To learn more about:
- Reducing air pollution, visit EPA's Web page on how you can help clean the air athttp://www.epa.gov/air/actions
- Reducing your greenhouse gas emissions, visit EPA’s Personal Emissions Calculator athttp://www.epa.gov/climatechange/wycd/calculator/ind_calculator.html
- Energy-saving appliances, visit the government's Web site on products and design athttp://www.energystar.gov
- Low-emissions vehicles, visit EPA’s Green Vehicles Guide at http://www.epa.gov/greenvehicles
Indoor Air Pollution
What is indoor air pollution and how can I be exposed to it?
Most people spend about 90 percent of their time indoors. Therefore, indoor air pollution is as great a concern as outdoor air pollution.
Sources of indoor air pollution include:
- Gases from burning oil, gas, coal, or wood for heating and cooking
- Smoke from tobacco products
- Building materials, such as asbestos insulation and products made from pressed wood
- Outdoor pollutants, such as radon, that can accumulate indoors
- Chemicals used for cleaning, pest control, and painting
- Personal care products such as hair spray and nail polish remover
- Biological contaminants, such as bacteria, molds and mildew, and pet dander
What are the health effects of exposure to indoor air pollution?
Indoor air pollution can cause immediate effects. It can irritate your eyes, nose and throat; cause headaches; and make you feel dizzy or tired. These symptoms may be mistaken for symptoms of a cold or flu, but if the symptoms disappear when you are away from home, they may signal an indoor air problem.
Indoor air pollution can also cause more serious health problems, such as heart and lung diseases and cancer. These problems may develop many years after you were exposed to the pollution or after years of repeated exposures.
Some people are more sensitive to indoor air pollution than others are. As with outdoor air pollution, children, the elderly, and people with heart or lung conditions are more likely to be affected.How can I improve the indoor air quality in my home?
The best way to reduce indoor air pollution is to get rid of potential sources of pollution. You can also improve the ventilation in your home by running exhaust and attic fans and opening doors and windows. This is especially important when you are using products, like paints and cleaners, that may increase levels of indoor air pollution for a short time. Air cleaners may also help remove indoor air pollutants. The effectiveness of air cleaners varies. To learn more about air cleaning systems, read the EPA booklet, “Residential Air Cleaning Devices,” available online at http://www.epa.gov/iaq/pubs/residair.html.What are combustion products and how can I be exposed to them?
Stoves, heaters, fireplaces, and chimneys need to be vented correctly. If not, they can release dangerous amounts of carbon monoxide, nitrogen dioxide, and particle pollution into your home. Fuel-burning appliances may also release formaldehyde (form-AL-duh-hyd) (see "What are the health effects from exposure to VOCs?").
What are the health effects of exposure to combustion products?
Carbon monoxide and nitrogen dioxide are colorless, odorless gases. Carbon monoxide can cause headaches, dizziness, nausea, or fatigue. Breathing air with high levels of carbon monoxide may cause you to lose consciousness and may be deadly. Nitrogen dioxide can irritate your eyes, nose, and throat, and make it difficult to breathe. Eventually, it may contribute to lung infections and diseases.
What can I do to reduce exposure to combustion products?
You can minimize the emissions from fuel-burning stoves and heaters.
- If you use unvented space heaters, follow the manufacturer’s directions and open a window or door to increase ventilation.
- Use exhaust fans, vented to the outdoors, over gas stoves and ranges.
- In your woodstove, use wood that is aged and dried and is not treated with chemicals.
- Have a trained contractor inspect, clean, and tune-up furnaces, flues, chimneys, and gas appliances every year. Repair any leaks as soon as you can. Change filters at least once every month during periods of use.
Do not operate cars, trucks, lawn mowers, snow blowers, and other machines with gasoline-powered engines in enclosed spaces. These engines release carbon monoxide.
Installing a carbon monoxide detector can also help protect you and your family from this dangerous gas.
What is secondhand tobacco smoke and how can I be exposed to it?
The smoke from burning tobacco products and the smoke exhaled by smokers are called secondhand smoke. These products include cigarettes, cigars, and pipes.
What are the health effects of exposure to secondhand tobacco smoke?
Nonsmokers who are exposed to secondhand smoke have an increased risk of lung cancer. Children of parents who smoke are more likely to suffer from pneumonia, bronchitis, ear infections, asthma, andsudden infant death syndrome (SIDS).
What can I do to reduce exposure to secondhand tobacco smoke?
To help protect yourself and your family from the harmful effects of secondhand smoke:
- Don’t smoke in your home or car or allow others to do so.
- Ask smokers to smoke outside. Ventilation (opening windows, running exhaust fans, etc.) cannot completely protect nonsmokers and children from exposure to secondhand smoke.
- Don’t smoke, or allow others to smoke, around children, especially infants and toddlers.
What is radon and how can I be exposed to it?
Uranium (yoor-AYN-ee-um) is a natural radioactive substance found in many types of rocks and soil. As uranium decays, it releases radon (ray-don). Radon is a colorless, odorless, and tasteless radioactive gas. Small amounts of radon are present in outdoor air. High levels of radon can accumulate in enclosed spaces. Because radon comes out of the ground, it is more likely to accumulate in basements and the lower floors of buildings.
It is estimated that one out of every 15 homes in the United States may have high radon levels. Radon can enter any type of home through small gaps and cracks in walls and floors. In some areas, radon may also be present in groundwater.
What are the health effects of exposure to radon?
Exposure to high levels of radon can cause lung cancer.
How can I tell if my home has a radon problem?
You can test the air in your home for radon. Hardware stores and other retailers sell many types of inexpensive radon test kits that allow you to test your home yourself. You can also hire a qualified radon testing professional. The EPA recommends that all homes should be tested below the third floor.
Two types of radon tests are available: short-term tests and long-term tests. Short-term tests provide results in less than 90 days. However, because radon levels may vary throughout the year, long-term tests, lasting more than 90 days, will give you a better idea of the average radon levels in your home year-round.
If a short-term test finds radon levels of 4 picoCuries per liter (pCi/l) of air or higher, you should conduct a second test. You should fix your home to reduce radon levels if the second test is:
- A long-term test, showing radon levels of 4 pCi/l or higher
- A short-term test, and the average of the first and second tests was 4 pCi/l or higher
What can I do to reduce exposure to radon?
A qualified radon contractor can fix your home to reduce radon levels. Costs can range from $800 to $2,500. If radon levels are high in your indoor air and you have a private well, you should also have your water tested and treated if need be.
Your state radon office can provide information about radon in the ground and water in your area. They can also refer you to qualified radon testers and radon contractors. You can find contact information for your state radon office at http://www.epa.gov/iaq/whereyoulive.html.
What is asbestos and how can I be exposed to it?
Asbestos (ass-BESS-tohs) is a fiber that has been used in insulation and fireproofing materials. The EPA has banned many asbestos products. Many companies have also cut down on their use of asbestos. Today, asbestos is most often found in:
- Older homes (in building, pipe, and insulation materials)
- Textured paints
- Floor tiles
Asbestos fibers are released into the air when asbestos-containing materials are disturbed. The most dangerous asbestos fibers are too small to see.
What are the health effects from exposure to asbestos?
After asbestos fibers are inhaled, they can remain in the lungs. Asbestos can cause:
- Lung cancer
- Lung scarring (asbestosis)
- Cancer of the chest and stomach lining (mesothelioma)
These health problems may develop many years after exposure.
What can I do to reduce exposure to asbestos?
Asbestos should only be removed by trained professionals. Do not attempt to remove asbestos-containing materials yourself. If asbestos-containing materials are in good condition, it may be safest to leave them alone.
If you think your house may contain asbestos that has been disturbed, contact a trained contractor. A professional may recommend removing the materials or sealing them off to keep fibers out of the air. Call the EPA’s Toxic Substances Control Act Hotline at (202) 554-1404 to find out if your state has a program to train and certify contractors who specialize in removing asbestos.
What are volatile organic compounds (VOCs), and how can I be exposed to them?
Volatile organic compounds (VOCs) are emitted as gases from certain solids or liquids. VOCs include a variety of chemicals. Many types of household products contain VOCs, including paints, paint strippers, adhesives, cleaners, pesticides, building materials, and office equipment.
What are the health effects from exposure to VOCs?
VOCs may cause eyes, nose, and throat irritation; dizziness and nausea; and memory loss. Some VOCs are more toxic than others. Some of these chemicals can damage the liver, kidneys, or central nervous system or cause cancer. The health effects may depend on the amount and length of exposure.
Some common VOCs that can affect your health are listed below.
- Formaldehyde is a strong-smelling, colorless gas found in some building materials and household products. It can irritate your eyes and respiratory tract, cause nausea, and trigger allergic reactions or asthma attacks. Formaldehyde has also been shown to cause cancer in animals and may cause cancer in humans. Pressed-wood products — commonly used in paneling, shelving, furniture, and cabinets — are major sources of formaldehyde in homes. When these products are new, they release more formaldehyde into the air. Heat and humidity also increase emissions. Smoke from unvented, fuel-burning appliances and tobacco products may also contain formaldehyde.
- Methylene chloride (meth-ih-LEEN KLOR-eyed), found in paint and adhesive removers and aerosol spray paints, is known to cause cancer in animals. Exposure can also cause symptoms similar to carbon monoxide poisoning.
- Benzene (BEN-zeen) is found in secondhand smoke, stored fuels, paint supplies, and car emissions. It is a known carcinogen.
- Perchloroethylene (known as "perc"), used in dry cleaning, has been shown to cause cancer in animals and is likely to be a human carcinogen. It also causes reproductive effects and neurological damage and can harm a developing fetus.
What can I do to reduce exposure to VOCs?
- When using cleaners, painting supplies, and other household chemicals, read the warnings on the label and follow the directions carefully.
- Use products outside or in well-ventilated areas.
- Gases may leak from products stored in closed containers. Store chemicals in well-ventilated areas, out of the reach of children.
- Dispose of old or unneeded products. Some chemicals can contaminate the environment. So it is important to dispose of chemicals properly. Follow the instructions on the label. Contact local government agencies, waste services, or community organizations to find out if there are programs to collect hazardous household chemicals in your area.
- Properly vent garages and fuel-burning appliances so that combustion products do not contaminate indoor air.
- Check the formaldehyde content of pressed-wood products before you buy them. You can also reduce formaldehyde in the air by increasing ventilation, keeping your house cool, and using a dehumidifier.
- Use a dry cleaner that uses alternative cleaners, or make sure your drycleaner properly dries your clothes before returning them. The clothes should not have a strong chemical odor.
What are biological pollutants and how can I be exposed to them?
Biological pollutants include viruses, bacteria, animal dander, cockroach and rodent droppings, dust mites, mold, and mildew.
What are the health effects from exposure to biological pollutants?
These pollutants are small enough to be inhaled and may trigger allergies, asthma, or flu-like symptoms.
What can I do to reduce exposure to biological pollutants?
Many biological pollutants grow well in warm, moist areas. You can reduce moisture in your home by using ventilation fans and dehumidifiers to keep indoor humidity between 30 and 50 percent. Regularly empty and clean evaporation trays in dehumidifiers, refrigerators, and air conditioners. If carpets or building materials become water damaged, they should be thoroughly cleaned and dried or removed to get rid of mold.
You can also reduce biological pollutants by regularly cleaning to remove dust, pet dander, and other allergens.
Workplace Environment
How does the environment at work affect my health?
Some occupations and industries involve the use or production of chemicals or substances that may be toxic or hazardous to unprotected workers. Some workers may also carry dangerous substances home on their hands or clothes. To find information about health hazards in the workplace and what you can do to protect yourself from dangerous exposures, visit the Occupational Safety and Health Administration's (OSHA) web site at http://www.osha.gov or call 1-800-321-6742.
What is "sick building" syndrome?
"Sick building syndrome" describes a situation in which people spending time in a building experience a range of symptoms that they believe are related to that building. Poor indoor air quality may be the cause of these symptoms. But other factors such as lighting, noise, poorly designed workstations, and psychological and social factors may contribute to sick building syndrome.
Common indoor air pollutants (see Indoor Air Pollution) can affect air quality in the workplace, including biological contaminants such as mold and mildew and VOCs from cleaners, adhesives, office machines, furniture, or building materials.
Many office buildings built since the 1970s were designed to maximize energy efficiency by allowing very little outdoor air into the building through windows or ventilation systems. Poor ventilation and heat and air conditioning systems can lead to the buildup of indoor air pollution.
Symptoms of sick building syndrome may include irritation of the eyes, nose, or throat; dizziness; nausea; headaches; or fatigue. In some cases, the symptoms may appear when you enter the building and go away after you leave. In other cases, the symptoms may continue after exposure.
If you think indoor air pollution could be causing your health problems, report your concerns. Talk to the employee health nurse or safety officer on your job site. Also, talk with your doctor. The National Institute for Occupational Safety and Health (NIOSH) can give you information on how to have your office tested. Call 800-35NIOSH. You can also contact the Occupational Safety and Health Administration (OSHA) at 800-321-OSHA (6742).
UV Radiation
What is UV radiation?
Sunlight contains ultraviolet (UV) rays, a type of radiation.
What are the health effects of exposure to UV radiation?
Too much exposure to UV radiation can damage your skin and may lead to skin cancer. Sunburns during childhood may increase your chances of developing the most severe form of skin cancer, melanoma, later in life. Overexposure to UV rays can also cause cataracts and weaken your immune system.
How does the ozone layer protect us from UV radiation?
The ozone layer is a naturally occurring concentration of ozone molecules in the upper atmosphere. Unlike ground-level ozone, ozone in the upper atmosphere is not a pollutant and does not damage human health. The ozone layer protects us from harmful UV rays.
The use of synthetic ozone depleting substances (ODS) has reduced ozone levels in the upper atmosphere. These are chemicals that were once used in refrigeration, fire extinguishers, and aerosols. Because the ozone layer is thinner than it used to be, more UV rays reach the Earth’s surface, leading to higher rates of skin cancer.
The United States and other countries are working to phase out the use of ODS. Thanks to these efforts, the ozone layer has not become thinner since 1998 and has started to recover. Because ODS can remain in the atmosphere for 50–100 years, scientist predict that ozone will not return to pre-1980 levels until the second half of the 21st century.
Car and home air conditioners and refrigerators may contain ODS. You can help protect the ozone layer by making sure these systems are in good repair and do not leak. Have them serviced by an EPA-certified technician who can recover and recycle the refrigerant. When purchasing new appliances, make sure the refrigerants are not ODS.
What can I do to reduce exposure to UV radiation?
You can prevent overexposure to UV radiation.
- UV radiation levels are highest in the middle of the day. Limit your time outdoors between 10 a.m. and 4 p.m.
- A half hour before spending time outdoors, apply a sunscreen with a sun protection factor (SPF) of at least 15. Follow the package directions and reapply as needed. Even waterproof or water-resistant sunscreens should be reapplied after swimming or sweating.
- Protect your face and neck by wearing a wide-brimmed hat.
- Shield your skin from UV rays by wearing tightly woven, loose-fitting clothing.
- Protect your eyes by wearing sunglasses that block 100 percent of UV rays.
- Avoid sunlamps and tanning beds.
The UV index is a forecast of UV levels in your area. The higher the number, the greater your risk of overexposure to UV radiation. You should take extra precautions to protect yourself and your family when UV levels are very high. To learn more about the index or to find the UV forecast for your area, visithttp://www.epa.gov/sunwise/uvindex.html.
Water Contamination
What is water contamination and how can I be exposed to it?
Tap water, well water, and even bottled water may contain small amounts of contaminants such as:
- Bacteria and parasites
- Minerals and metals, such as lead (see section on lead below)
- Sources of radiation, such as radon
- Pesticides
- VOCs
- Disinfectants (cleaning products) and disinfectant byproducts
What are the health effects from exposure to water contamination?
As long as levels of these contaminants are low enough to meet EPA standards, your water is safe to drink. People with weakened immune systems from HIV/AIDS, chemotherapy, or organ transplants may be more sensitive to microbes. Microbes are small organisms such as parasites. Infants and children are also more vulnerable to microbes and other types of water contamination.
What can I do to reduce exposure to water contamination?
The EPA regulates contaminants in public water systems to make sure water is safe to drink. If you get your water from a public system, your water supplier is required to send you an annual report about the quality of your water. You can visit http://www.epa.gov/safewater/ccr/whereyoulive.html to find out if your water quality report is posted online.
If there is a problem with your drinking water, your water supplier is required to notify you by mail or through newspaper, radio, and television announcements. The supplier should tell you what steps to take to ensure your water is safe to drink.
The EPA does not regulate well water. If you get your water from a private well, you should have your water tested at least once a year. To find more information about how to make sure well water is safe, visithttp://www.epa.gov/safewater/privatewells.
If you are concerned about your water quality, talk to your doctor about whether you should take additional steps, such as:
- Boiling your water for one minute to kill any microbes
- Filtering your tap water
- Drinking bottled water that has been treated by distillation, reverse osmosis (os-MOHS-iss), UV light, or filtration with an absolute one-micron filter
Should I drink bottled water instead of tap water?
Bottled water is required to meet the same standards as tap water. Both bottled water and tap water are safe to drink if they meet these standards. Bottled water is not necessarily safer than tap water, unless it has been specially treated to remove more contaminants.
If you have a weakened immune system and wish to drink bottled water instead of boiling or filtering your tap water, read bottled water labels or contact bottlers to find out how the water was treated. Look for water that has been treated in one of the following ways:
- Distillation
- Reverse osmosis
- UV light
- Micron filtration with a filter in which the holes are one micron or smaller (absolute one-micron filter)
What are the health effects of fluoride in water?
Many public water systems add fluoride to water to help prevent cavities. According to the Centers for Disease Control and Prevention, water with 0.7–1.2 milligrams/Liter (mg/L) of fluoride is safe and effective.
Water may also contain natural fluoride. Some water sources contain more natural fluoride than others. Studies have shown that water with more than 2 mg/L of fluoride may pose health risks, including enamel fluorosis in children under the age of 8. This is staining and pitting of tooth enamel. Studies have also shown an increased risk of bone fractures in people who drink high-fluoride water all their lives.
Contact your water supplier to find out how much fluoride is in your water. Most bottled waters do not contain added fluoride.
Lead
What is lead and how can I be exposed to it?
In the past, lead was commonly used in products such as gasoline and paint. By the 1980s, the use of lead in consumer products was limited or banned in the United States. Today, some common sources of lead are:
- Lead-based paint in houses built before 1978
- Soil and household dust, especially if it is contaminated by chips or dust from lead-based paints
- Water from pipes that contain lead or lead solder
Although the use of lead-based paints in toys was banned in the United States in 1978, other countries may still use paints that contain lead. Paint on imported toys and toys manufactured in the United States before 1978 may pose a risk to children. Lead is also used in some plastic toys. The U.S. Consumer Product Safety Commission issues recalls for toys that may expose children to lead. Visithttp://www.cpsc.gov or call 800-638-2772 to find information about toys that have been recalled.
What are the health effects from exposure to lead?
Lead is a toxic metal that can cause health effects in both adults and children. Infants and children under 6 years old are at the greatest risk of health problems due to lead poisoning. In children, lead can harm the brain and nervous system, causing learning problems and lowered intelligence quotients (IQs). Lead can also harm a developing fetus, so it is important for pregnant women to avoid lead exposure.
Adults exposed to lead may experience health effects such as reproductive problems, high blood pressure,artherosclerosis (ah-thuh-roh-skluh-ROH-suhss), muscle and joint pain, problems with memory or concentration, and decreased cognitive function. Lead is stored in the body in bone. Osteoporosis (oss-tee-oh-puh-RO-sis) causes bones to break down, releasing lead into the blood. After menopause, women are more likely to lose bone mass, increasing the risk of lead exposure. Women who were exposed to high levels of lead earlier in their lives are especially at risk.
Lead is dangerous when it is inhaled or ingested. When lead-based paint is disturbed or removed, it may release fine dust that is dangerous if inhaled. Small children have a high risk of lead exposure because they put so many things in their mouths. Children’s lead levels are often highest at age 2.
How can I find out if my children or I have been exposed to lead?
Talk to your doctor about testing you or your children for lead. Children with blood lead levels higher than 10 micrograms per deciliter (µg/dL) are considered to have excess lead exposure. However, studies have shown that lower blood lead levels can affect children’s IQs and learning abilities. No level of lead is considered safe for children.
How is lead poisoning treated?
There are medicines that can reduce high levels of lead in the blood. But treatments cannot reverse damage caused by lead poisoning. This is why it is important to prevent exposure to lead.
What can I do to reduce exposure to lead?
You can have your home tested for lead. This is especially important if your home was built before 1978 and if the paint is flaking, chipping, or cracking. If lead-based paint is in good condition, it may not be hazardous. If you plan to remove lead paint or perform other renovations, hire a contractor specially trained to deal with lead paint. You should leave the house until renovations are completed and the house is cleaned to remove any lead dust. The National Lead Information Center at 800-424-LEAD (5323) can provide information about professionals in your area who are trained in lead testing and removal.
Lead may be present in the water service lines or plumbing of older homes. Contact your local health department to find out if you should be concerned about lead in your drinking water. Boiling water will not remove lead. However, you can take steps to reduce the amount of lead in your drinking water.
- Never use hot water from the faucet to make baby formula or for cooking.
- Run cold water for at least a minute before using it.
- Use a water filter certified by NSF International to remove lead.
You can take other steps to prevent you or your children from being exposed to lead:
- Keep areas where children play as dust-free and clean as you can.
- Mop floors and wipe window ledges and frames weekly.
- Wash children’s hands and things children put in their mouths — bottles, pacifiers, and toys — often.
- Prevent children from eating dirt or paint chips and from chewing on painted surfaces such as windowsills.
- Serve meals high in iron and calcium; these nutrients block the absorption of lead.
Mercury
What is mercury and how can I be exposed to it?
Mercury (MERK-yoor-ee) is a toxic metal found in many types of rock, including coal. When coal is burned, mercury is released into the air. Coal-fired power plants are a major source of mercury emissions in the United States. This mercury makes its way into lakes, rivers, and oceans, where microorganisms convert it into methylmercury (meth-ihl MERK-yoor-ee). Microorganisms are very small and can only be seen with a microscope. Fish eat these microorganisms, and the methylmercury becomes concentrated in the bodies of fish and shellfish. Eating fish and shellfish is the main way humans are exposed to this toxin.
What are the health effects from exposure to mercury?
Children, infants, and unborn babies are most sensitive to mercury. High levels can damage the developing nervous system. In both children and adults, high levels of mercury may affect the brain, heart, kidneys, lungs, and immune system.
Is it safe to eat fish?
Fish and shellfish contain protein, omega-3 fatty acids, and other nutrients that have important health benefits. However, small amounts of mercury are found in most types of fish and shellfish. Different kinds of fish contain different amounts, depending on how long they live and what they eat. Choosing fish low in mercury can help you limit your mercury exposure. This is especially important for pregnant women and young children.
What can I do to reduce exposure to mercury?
You can limit the amount of mercury consumed from fish. The EPA and the U.S. Food and Drug Administration (FDA) recommend that women who may become pregnant, women who are pregnant or nursing, and young children follow these guidelines:
- Don’t eat shark, swordfish, king mackerel, or tilefish. These fish are high in mercury.
- Limit your consumption of fish low in mercury to 12 ounces — or about 2 meals — each week. Fish that are low in mercury include shrimp, canned light tuna, salmon, pollock, and catfish.
- Limit your consumption of albacore (white) tuna to 6 ounces or 1 meal each week. Albacore tuna contains higher levels of mercury than canned light tuna.
- Before eating fish caught in your area, check local fish safety advisories. If you can’t find information about the safety of local fish, eat no more than 6 ounces a week and do not eat any other fish that week.
Pesticides
What are pesticides and how can I be exposed to them?
Pesticides (PESS-tih-syds) are chemicals used to kill pests such as insects, rodents, weeds, mold, and bacteria. Yet these chemicals can also cause health problems in people.
What are the health effects from exposure to pesticides?
Health effects will depend on the type of pesticide, the amount of exposure, and the frequency of exposure. These health effects may include birth defects, nerve damage, and cancer. Health problems might not appear until many years after exposure.
Pesticides pose greater health risks for children than adults because children’s organs are still developing, they eat more food relative to their body weight, and they are more likely to put contaminated objects in their mouths.
What can I do to reduce exposure to pesticides?
First, the EPA limits the amount of pesticides that may be used to grow food and may remain on food sold to consumers.
You can also take steps to limit your exposure to pesticides from food.
- Reduce the pesticides on your fruits and vegetables by washing and scrubbing them under running water, peeling off the skin, and trimming outer leaves.
- In meat, pesticide chemicals may be stored in fat. Trimming the fat can reduce your exposure.
- You can choose organic foods, which are grown without the use of synthetic pesticides. You can find more information about organic foods at the National Organic Program Web site,http://www.ams.usda.gov/AMSv1.0/nop.
- Eating a variety of foods can prevent high levels of exposure to a single pesticide.
It is important to use care when using pesticides in and around your home.
- Be sure to read all labels and warnings before using a pesticide. Follow the instructions carefully.
- Only use the recommended amount.
- Store and dispose of unused pesticides safely.
- Before using pesticides, remove children and pets from the area.
- Keep pesticides out of reach of children, preferably in cabinets or sheds with locks or child-proof latches.
- If someone is exposed to pesticides and still conscious, having trouble breathing, or having convulsions, contact the National Poison Control Center at 800-222-1112. In case of emergency, call 911 or your local emergency service first.
You can also reduce your pesticide use by preventing pest infestations and controlling pests with methods other than pesticides.
- Take steps to prevent infestations inside and outside. This includes removing water or food that may attract pests, destroying areas where pests may hide or breed, and sealing entry holes.
- Use biological methods to control pests, such as attracting birds and bats to eat insects.
- Use manual pest control methods, like pulling weeds or setting traps.
- Consider natural pesticides that do not contain synthetic chemicals.
If you hire a pest control company, make sure they inspect your home, let you know which chemicals they will use, and address your safety concerns before you sign a contract.
Environmental hormones
What are environmental hormones and how can I be exposed to them?
Environmental hormones are also called endocrine disruptors. These are chemicals that can act like or interfere with natural hormones in the human body.
What are the health effects from exposure to environmental hormones?
These chemicals can reduce fertility. They may also play a role in the development of cancers and reproductive disorders like endometriosis. In infants and fetuses, environmental hormones can also affect the developing reproductive and nervous systems and organs.
Some common environmental hormones known to affect human health are:
- Dichloro-diphenyl-trichloroethane (DDT), a pesticide now banned in the United States, and some other pesticides.
- Polychlorinated biphenyls (PCBs), chemicals that are banned for most uses in the United States but remain in soil and water.
- Diethylstilbestrol (DES), a drug used to prevent miscarriages until it was banned in the 1970s. Some daughters of women who took DES have developed reproductive problems and vaginal and cervical cancer.
- Phthalates (THAL-ayts) and bisphenol A (BPA), endocrine disruptors commonly used in plastics. Research suggests these chemicals may affect fetal development. Scientists are still studying these substances in order to understand their impacts on human health.
What can I do to reduce exposure to environmental hormones?
Researchers are studying the health effects of known and suspected environmental hormones. They are developing ways to prevent too much exposure to these chemicals. The following steps may reduce your exposure to environmental hormones:
- Take steps to minimize your exposure to pesticides.
- Public water systems are required to test water for PCBs and notify you if dangerous levels are present in your water. If you have a private well, have your water tested (see Water Contamination).
- Boiling, microwaving, or using the dishwasher to clean hard plastic plates, bottles, or other food containers may cause BPA to be released, increasing your risk of exposure. Discard any item that has small cracks on its surface.
- Because infants are most likely to be sensitive to BPA, parents can take steps such as using:
- BPA-free plastic bottles and training cups
- Glass bottles
- Bottles with BPA-free plastic liners
- Microwave-safe glass or paper dishes covered with paper towels in the microwave
- Some plastic medical devices may expose people to phthalates. The FDA recommends that phthalate-free equipment be used in certain medical procedures, when possible. Animal studies suggest that phthalates may affect the development of the male reproductive system, so this is especially important for women who are pregnant or breastfeeding, male infants, and male children who are near the age of puberty.
- Since 1999, U.S. manufacturers have not used phthalates in toys infants put in their mouths, such as pacifiers and teethers. The State of California banned the sale of toys and baby products containing phthalates, starting in 2009.
Ovarian Cysts
What are ovaries?
The ovaries (OH-vuh-reez) are a pair of organs in the female reproductive system. They are located in the pelvis, one on each side of the uterus. The uterus (YOO-tur-uhss) is the hollow, pear-shaped organ where a baby grows. Each ovary is about the size and shape of an almond. The ovaries produce eggs and female hormones. Hormones are chemicals that control the way certain cells or organs function.
Every month, during a woman's menstrual (MEN-stroo-uhl) cycle, an egg grows inside an ovary. It grows in a tiny sac called a follicle (FAH-lih-cull). When an egg matures, the sac breaks open to release the egg. The egg travels through the fallopian (fuh-LOH-pee-ihn) tube to the uterus for fertilization. Then the sac dissolves. The empty sac becomes corpus luteum (LOO-tee-uhm). Corpus luteum makes hormones that help prepare for the next egg.
The ovaries are the main source of the female hormones estrogen (ESS-truh-juhn) and progesterone (proh-JESS-tuh-rohn). These hormones affect:
- the way breasts and body hair grow
- body shape
- the menstrual cycle
- pregnancy
What are ovarian cysts?
A cyst is a fluid-filled sac. They can form anywhere in the body. Ovarian cysts (sists) form in or on the ovaries. The most common type of ovarian cyst is a functional cyst.
Functional cysts often form during the menstrual cycle. The two types are:
- Follicle cysts. These cysts form when the sac doesn't break open to release the egg. Then the sac keeps growing. This type of cyst most often goes away in 1 to 3 months.
- Corpus luteum cysts. These cysts form if the sac doesn't dissolve. Instead, the sac seals off after the egg is released. Then fluid builds up inside. Most of these cysts go away after a few weeks. They can grow to almost 4 inches. They may bleed or twist the ovary and cause pain. They are rarely cancerous. Some drugs used to cause ovulation, such as Clomid® or Serophene®, can raise the risk of getting these cysts.
Other types of ovarian cysts are:
- Endometriomas (EN-doh-MEE-tree-OH-muhs). These cysts form in women who have endometriosis (EN-doh-MEE-tree-OH-suhss). This problem occurs when tissue that looks and acts like the lining of the uterus grows outside the uterus. The tissue may attach to the ovary and form a growth. These cysts can be painful during sex and during your period.
- Cystadenomas (siss-tahd-uh-NOH-muhs). These cysts form from cells on the outer surface of the ovary. They are often filled with a watery fluid or thick, sticky gel. They can become large and cause pain.
- Dermoid (DUR-moid) cysts. These cysts contain many types of cells. They may be filled with hair, teeth, and other tissues that become part of the cyst. They can become large and cause pain.
- Polycystic (pol-ee-SISS-tik) ovaries. These cysts are caused when eggs mature within the sacs but are not released. The cycle then repeats. The sacs continue to grow and many cysts form. For more information about polycystic ovaries, refer to our FAQ about Polycystic Ovary Syndrome.
What are the symptoms of ovarian cysts?
Many ovarian cysts don't cause symptoms. Others can cause:
- pressure, swelling, or pain in the abdomen
- pelvic pain
- dull ache in the lower back and thighs
- problems passing urine completely
- pain during sex
- weight gain
- pain during your period
- abnormal bleeding
- nausea or vomiting
- breast tenderness
If you have these symptoms, get help right away:
- pain with fever and vomiting
- sudden, severe abdominal pain
- faintness, dizziness, or weakness
- rapid breathing
How are ovarian cysts found?
Doctors most often find ovarian cysts during routine pelvic exams. The doctor may feel the swelling of a cyst on the ovary. Once a cyst is found, tests are done to help plan treatment. Tests include:
- An ultrasound. This test uses sound waves to create images of the body. With an ultrasound, the doctor can see the cyst's:
- shape
- size
- location
- mass—if it is fluid-filled, solid, or mixed
- A pregnancy test. This test may be given to rule out pregnancy.
- Hormone level tests. Hormone levels may be checked to see if there are hormone-related problems.
- A blood test. This test is done to find out if the cyst may be cancerous. The test measures a substance in the blood called cancer-antigen 125 (CA-125). The amount of CA-125 is higher with ovarian cancer. But some ovarian cancers don't make enough CA-125 to be detected by the test. Some noncancerous diseases also raise CA-125 levels. Those diseases include uterine fibroids (YOO-tur-ihn FEYE-broidz) and endometriosis. Noncancerous causes of higher CA-125 are more common in women younger than 35. Ovarian cancer is very rare in this age group. The CA-125 test is most often given to women who:
- are older than 35
- are at high risk for ovarian cancer
- have a cyst that is partly solid
How are cysts treated?
Watchful waiting. If you have a cyst, you may be told to wait and have a second exam in 1 to 3 months. Your doctor will check to see if the cyst has changed in size. This is a common treatment option for women who:
- are in their childbearing years
- have no symptoms
- have a fluid-filled cyst
It may be an option for postmenopausal women.
Surgery. Your doctor may want to remove the cyst if you are postmenopausal, or if it:
- doesn't go away after several menstrual cycles
- gets larger
- looks odd on the ultrasound
- causes pain
The two main surgeries are:
- Laparoscopy (lap-uh-ROSS-kuh-pee)—done if the cyst is small and looks benign (noncancerous) on the ultrasound. While you are under general anesthesia, a very small cut is made above or below your navel. A small instrument that acts like a telescope is put into your abdomen. Then your doctor can remove the cyst.
- Laparotomy (lap-uh-ROT-uh-mee)—done if the cyst is large and may be cancerous. While you are under general anesthesia, larger incisions are made in the stomach to remove the cyst. The cyst is then tested for cancer. If it is cancerous, the doctor may need to take out the ovary and other tissues, like the uterus. If only one ovary is taken out, your body is still fertile and can still produce estrogen.
Birth control pills. If you keep forming functional cysts, your doctor may prescribe birth control pills to stop you from ovulating. If you don’t ovulate, you are less likely to form new cysts. You can also use Depo-Provera®. It is a hormone that is injected into muscle. It prevents ovulation for 3 months at a time.
Can ovarian cysts be prevented?
No, ovarian cysts cannot be prevented. The good news is that most cysts:
- don't cause symptoms
- are not cancerous
- go away on their own
Talk to your doctor or nurse if you notice:
- changes in your period
- pain in the pelvic area
- any of the major symptoms of cysts
When are women most likely to have ovarian cysts?
Most functional ovarian cysts occur during childbearing years. And most of those cysts are not cancerous. Women who are past menopause (ages 50 –70) with ovarian cysts have a higher risk of ovarian cancer. At any age, if you think you have a cyst, see your doctor for a pelvic exam.
Pelvic Inflammatory Disease
What is pelvic inflammatory disease (PID)?
Pelvic inflammatory disease (PID) is an infection of a woman's pelvic organs. The pelvic organs include theuterus (womb), fallopian (fuh-LOH-pee-uhn) tubes (tubes), ovaries, and cervix.
What causes PID?
A woman can get PID if bacteria (germs) move up from her vagina and infect her pelvic organs. Many different types of bacteria can cause PID. But, most cases of PID are caused by bacteria that cause 2 common sexually transmitted infections (STIs) — gonorrhea (gah-nuh-REE-uh) and chlamydia (kluh-MI-dee-uh). It can take from a few days to a few months for an infection to travel up from the vagina to the pelvic organs.
You can get PID without having an STI. Normal bacteria found in the vagina and on the cervix can sometimes cause PID. No one is sure why this happens.
How common is PID?
Each year in the United States, more than 1 million women have an episode of PID. More than 100,000 women become infertile each year because of PID. Also, many ectopic pregnancies that occur are due to problems from PID.
Are some women more likely to get PID?
Yes. You’re more likely to get PID if you:
- Have had an STI
- Are under 25 years of age and are having sex
- Have more than 1 sex partner
- Douche. Douching can push bacteria into the pelvic organs and cause infection. It can also hide the signs of an infection.
- Have an intrauterine device (IUD). You should get tested and treated for any infections before getting an IUD. This will lower your risk of getting PID.
How do I know if I have PID?
Many women don't know they have PID because they don't have any symptoms. For women who have them, symptoms can range from mild to severe. The most common symptom of PID is pain in your lower abdomen (stomach area). Other symptoms include:
- Fever (100.4˚F or higher)
- Vaginal discharge that may smell foul
- Painful sex
- Painful urination
- Irregular periods (monthly bleeding)
- Pain in the upper right abdomen
PID can come on fast with extreme pain and fever, especially if it’s caused by gonorrhea.
Are there any tests for PID?
If you think that you may have PID, see a doctor right away. If you have pain in your lower abdomen (stomach area), your doctor will perform a physical exam. This will include a pelvic (internal) exam. Your doctor will check for:
- Abnormal discharge from your vagina or cervix
- Lumps called abscesses near your ovaries and tubes
- Tenderness or pain in your pelvic organs
Your doctor will also test you for STIs, including HIV and syphilis (SI-fuh-luhs), urinary tract infection, and if needed, pregnancy. If needed, your doctor may do other tests.
- Ultrasound (sonogram) — a test that uses sound waves to take pictures of the pelvic area.
- Endometrial (en-duh-MEE-tree-uhl) (uterine) biopsy — the doctor removes and tests a small piece of the endometrium (the inside lining of the womb).
- Laparoscopy (lap-uh-RAHS-kuh-pee) — the doctor inserts a small, lighted tube through your abdomen (stomach area) to look at your pelvic organs.
These tests will help your doctor find out if you have PID, or if you have a different problem that looks like PID.
How is PID treated?
PID can be cured with antibiotics (drugs that kill bacteria). Most of the time, at least 2 antibiotics are used that work against a wide range of bacteria. Your doctor will work with you to find the best treatment for you.You must take all your medicine, even if your symptoms go away. This helps to make sure your infection is fully cured. You should see your doctor again 2 to 3 days after starting treatment to make sure the antibiotics are working.
Without treatment, PID can lead to severe problems like infertility, ectopic pregnancy, and chronic pelvic pain.
Any damage done to your pelvic organs before you start treatment likely cannot be undone. Still, don't put off getting treatment. If you do, you may not be able to have children. If you think you may have PID, see a doctor right away.
Your doctor may suggest going into the hospital to treat your PID if you:
- Are very sick
- Are pregnant
- Don’t respond to or cannot swallow pills. If this is the case, you will need intravenous (in the vein or IV) antibiotics.
- Have an abscess (sore) in a tube or ovary
If you still have symptoms or if the abscess doesn't go away after treatment, you may need surgery. Problems caused by PID, such as constant pelvic pain and scarring, are often hard to treat. But, sometimes they get better after surgery.
What if my partner is infected?
Even if your sex partner doesn't have any symptoms, she or he could still be infected with bacteria that can cause PID. Take steps to protect yourself from being infected again.
- Encourage your sex partner(s) to get treated, even if she or he doesn't have symptoms.
- Don't have sex with a partner who hasn't been treated.
My friend was told she can't get pregnant because she has PID. Is this true?
The more times you have PID, the more likely it is that you won't be able to get pregnant. When you have PID, bacteria infect the tubes or cause inflammation of the tubes. This turns normal tissue into scar tissue. Scar tissue can block your tubes and make it harder to get pregnant. Even having just a little scar tissue can keep you from getting pregnant without infertility treatment.
How can I keep myself from getting PID?
PID is most often caused by an STI that hasn't been treated. You can keep from getting PID by not getting an STI.
- The best way to prevent an STI is to not have sex of any kind.
- Have sex with 1 partner who doesn't have any STIs.
- Use condoms every time you have vaginal, anal, or oral sex. Read and follow the directions on the package. Condoms, when used the right way, can lower your chances of getting an STI.
- Don't douche. Douching removes some of the normal bacteria in the vagina that protect you from infection. This makes it easier for you to get an STI.
- If you're having sex, ask your doctor to test you for STIs. STIs are easier to treat if they are found early.
- Learn the common symptoms of STIs. If you think you might have an STI, see your doctor right away.
What should I do if I think I have an STI?
If you think you may have an STI, see a doctor right away. You may feel scared or shy about asking for information or help. Keep in mind, the sooner you seek treatment, the less likely the STI will cause you severe harm. And the sooner you tell your sex partner(s) that you have an STI, the less likely they are to infect you again or spread the disease to others.
To learn about STIs or get tested, contact your doctor, local health department, or an STI and family planning clinic. The American Social Health Association (ASHA) keeps lists of clinics and doctors who provide treatment for STIs. Call ASHA at 800-227-8922. You can get information from the phone line without leaving your name.
Perimenopause
What is perimenopause?
Perimenopause is the time leading up to menopause when you start to notice menopause-related changes--plus the year after menopause. Perimenopause is what some people call "being in menopause" or "going through menopause." But menopause itself is only one day--the day you haven’t had a period for 12 months in a row. During perimenopause, your ovaries start to shut down, making less of certain hormones (estrogen and progesterone), and you begin to lose the ability to become pregnant. This change is a natural part of aging that signals the ending of your reproductive years.
When does perimenopause start?
Women normally go through perimenopause between ages 45 and 55, but some women start perimenopause earlier, even in their 30s. When perimenopause starts, and how long it lasts varies from woman to women. You will likely notice menopause-related symptoms, such as changes in periods.
What are some of the signs and symptoms?
Menopause affects every woman differently. Your only symptom may be your period stopping. You may have other symptoms, too. Many symptoms at this time of life are because of just getting older. But some are due to approaching menopause. Menopause-related symptoms you might have during perimenopause include:
- Changes in pattern of periods (can be shorter or longer, lighter or heavier, more or less time between periods)
- Hot flashes (sudden rush of heat in upper body)
- Night sweats (hot flashes that happen while you sleep), often followed by a chill
- Trouble sleeping through the night (with or without night sweats)
- Vaginal dryness
- Mood changes, feeling crabby (probably because of lack of sleep)
- Trouble focusing, feeling mixed-up or confused
- Hair loss or thinning on your head, more hair growth on your face
When you visit your doctor, take along a diary about what’s happening with your period. For a few months before your visit, record when your period starts and stops each day, and indicate whether it is light of heavy. Also note any other symptoms you have.
Is there any treatment for perimenopause? What can I do?
Some women take oral contraceptives (birth control pills, or "the pill") to ease perimenopausal symptoms--even if they don't need them for birth control. These hormone treatments of combined estrogen and progestin can help keep your periods regular plus ease all the symptoms listed above. Talk with your doctor to see if this option is for you. If you are over 35, you should not take birth control pills if you smoke or have a history of blood clots. You need a prescription to get oral contraceptives.
After a woman reaches menopause, if she still needs treatment for menopause symptoms, she should switch from birth control pills to menopause hormone therapy (HT). HT contains much lower doses of hormones, and thus has less risk for bad side effects.
Making some changes in your life can also help ease your symptoms and keep you healthy.
- Eat Healthy. A healthy diet is more important now than before because your risks of osteoporosis (extreme bone loss) and heart disease go up at this stage of life. Eat lots of whole-grain foods, vegetables, and fruits. Add calcium-rich foods (milk, cheese, yogurt) or take a calcium supplement to obtain your recommended daily intake. Get adequate vitamin D from sunshine or a supplement. Avoid alcohol or caffeine, which also can trigger hot flashes in some women.
- Get Moving. Regular exercise helps keep your weight down, helps you sleep better, makes your bones stronger, and boosts your mood. Try to get at least 30 minutes of exercise most days of the week, but let your doctor recommend what’s best for you.
- Find healthy ways to cope with stress. Try meditation or yoga--both can help you relax, as well as handle your symptoms more easily. Our "Stress and Your Health" FAQ can be a good resource as well.
Can I get pregnant while in perimenopause?
Yes, you can get pregnant until you’ve gone 12 months in a row without a period. Talk to your doctor about your birth control options. Keep in mind that birth control pills, shots, implants, or diaphragms will not protect you from STIs or HIV. If you use one of these methods, be sure also to 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 STIs and HIV--the only sure protection is abstinence (not having sex of any kind). But making sure to always use--and correctly use--latex condoms and other barrier methods can help protect you from STIs.
Polycystic Ovary Syndrome (PCOS)
What is polycystic ovary syndrome (PCOS)?
Polycystic (pah-lee-SIS-tik) ovary syndrome (PCOS) is a health problem that can affect a woman's:
- Menstrual cycle
- Ability to have children
- Hormones
- Heart
- Blood vessels
- Appearance
With PCOS, women typically have:
- High levels of androgens (AN-druh-junz). These are sometimes called male hormones, though females also make them.
- Missed or irregular periods (monthly bleeding)
- Many small cysts (sists) (fluid-filled sacs) in their ovaries
How many women have PCOS?
Between 1 in 10 and 1 in 20 women of childbearing age has PCOS. As many as 5 million women in the United States may be affected. It can occur in girls as young as 11 years old.
What causes PCOS?
The cause of PCOS is unknown. But most experts think that several factors, including genetics, could play a role. Women with PCOS are more likely to have a mother or sister with PCOS.
A main underlying problem with PCOS is a hormonal imbalance. In women with PCOS, the ovaries make more androgens than normal. Androgens are male hormones that females also make. High levels of these hormones affect the development and release of eggs during ovulation.
Researchers also think insulin may be linked to PCOS. Insulin is a hormone that controls the change of sugar, starches, and other food into energy for the body to use or store. Many women with PCOS have too much insulin in their bodies because they have problems using it. Excess insulin appears to increase production of androgen. High androgen levels can lead to:
- Acne
- Excessive hair growth
- Weight gain
- Problems with ovulation
What are the symptoms of PCOS?
The symptoms of PCOS can vary from woman to woman. Some of the symptoms of PCOS include:
- Infertility (not able to get pregnant) because of not ovulating. In fact, PCOS is the most common cause of female infertility.
- Infrequent, absent, and/or irregular menstrual periods
- Hirsutism (HER-suh-tiz-um) — increased hair growth on the face, chest, stomach, back, thumbs, or toes
- Cysts on the ovaries
- Acne, oily skin, or dandruff
- Weight gain or obesity, usually with extra weight around the waist
- Male-pattern baldness or thinning hair
- Patches of skin on the neck, arms, breasts, or thighs that are thick and dark brown or black
- Skin tags — excess flaps of skin in the armpits or neck area
- Pelvic pain
- Anxiety or depression
- Sleep apnea — when breathing stops for short periods of time while asleep
Why do women with PCOS have trouble with their menstrual cycle and fertility?
The ovaries, where a woman’s eggs are produced, have tiny fluid-filled sacs called follicles or cysts. As the egg grows, the follicle builds up fluid. When the egg matures, the follicle breaks open, the egg is released, and the egg travels through the fallopian tube to the uterus (womb) for fertilization. This is called ovulation.
In women with PCOS, the ovary doesn't make all of the hormones it needs for an egg to fully mature. The follicles may start to grow and build up fluid but ovulation does not occur. Instead, some follicles may remain as cysts. For these reasons, ovulation does not occur and the hormone progesterone is not made. Without progesterone, a woman's menstrual cycle is irregular or absent. Plus, the ovaries make male hormones, which also prevent ovulation.
Does PCOS change at menopause?
Yes and no. PCOS affects many systems in the body. So, many symptoms may persist even though ovarian function and hormone levels change as a woman nears menopause. For instance, excessive hair growth continues, and male-pattern baldness or thinning hair gets worse after menopause. Also, the risks of complications (health problems) from PCOS, such as heart attack, stroke, and diabetes, increase as a woman gets older.
How do I know if I have PCOS?
There is no single test to diagnose PCOS. Your doctor will take the following steps to find out if you have PCOS or if something else is causing your symptoms.
Medical History. Your doctor will ask about your menstrual periods, weight changes, and other symptoms.
Physical Exam. Your doctor will want to measure your blood pressure, body mass index (BMI), and waist size. He or she also will check the areas of increased hair growth. You should try to allow the natural hair to grow for a few days before the visit.
Pelvic Exam. Your doctor might want to check to see if your ovaries are enlarged or swollen by the increased number of small cysts.
Blood Tests. Your doctor may check the androgen hormone and glucose (sugar) levels in your blood.
Vaginal Ultrasound (sonogram). Your doctor may perform a test that uses sound waves to take pictures of the pelvic area. It might be used to examine your ovaries for cysts and check the endometrium (en-do-MEE-tree-uhm) (lining of the womb). This lining may become thicker if your periods are not regular.
How is PCOS treated?
Because there is no cure for PCOS, it needs to be managed to prevent problems. Treatment goals are based on your symptoms, whether or not you want to become pregnant, and lowering your chances of getting heart disease and diabetes. Many women will need a combination of treatments to meet these goals. Some treatments for PCOS include:
Lifestyle modification. Many women with PCOS are overweight or obese, which can cause health problems. You can help manage your PCOS by eating healthy and exercising to keep your weight at a healthy level. Healthy eating tips include:
- Limiting processed foods and foods with added sugars
- Adding more whole-grain products, fruits, vegetables, and lean meats to your diet
This helps to lower blood glucose (sugar) levels, improve the body's use of insulin, and normalize hormone levels in your body. Even a 10 percent loss in body weight can restore a normal period and make your cycle more regular.
Birth control pills. For women who don't want to get pregnant, birth control pills can:
- Control menstrual cycles
- Reduce male hormone levels
- Help to clear acne
Keep in mind that the menstrual cycle will become abnormal again if the pill is stopped. Women may also think about taking a pill that only has progesterone (proh-JES-tuh-rohn), like Provera, to control the menstrual cycle and reduce the risk of endometrial cancer (See “Does PCOS put women at risk for other health problems?”). But, progesterone alone does not help reduce acne and hair growth.
Diabetes medications. The medicine metformin (Glucophage) is used to treat type 2 diabetes. It has also been found to help with PCOS symptoms, though it isn’t approved by the U.S Food and Drug Administration (FDA) for this use. Metformin affects the way insulin controls blood glucose (sugar) and lowers testosterone production. It slows the growth of abnormal hair and, after a few months of use, may help ovulation to return. Recent research has shown metformin to have other positive effects, such as decreased body mass and improved cholesterol levels. Metformin will not cause a person to become diabetic.
Fertility medications. Lack of ovulation is usually the reason for fertility problems in women with PCOS. Several medications that stimulate ovulation can help women with PCOS become pregnant. Even so, other reasons for infertility in both the woman and man should be ruled out before fertility medications are used. Also, some fertility medications increase the risk for multiple births (twins, triplets). Treatment options include:
- Clomiphene (KLOHM-uh-feen) (Clomid, Serophene) — the first choice therapy to stimulate ovulation for most patients.
- Metformin taken with clomiphene — may be tried if clomiphene alone fails. The combination may help women with PCOS ovulate on lower doses of medication.
- Gonadotropins (goe-NAD-oh-troe-pins) — given as shots, but are more expensive and raise the risk of multiple births compared to clomiphene.
Another option is in vitro fertilization (IVF). IVF offers the best chance of becoming pregnant in any given cycle. It also gives doctors better control over the chance of multiple births. But, IVF is very costly.
Surgery. "Ovarian drilling" is a surgery that may increase the chance of ovulation. It’s sometimes used when a woman does not respond to fertility medicines. The doctor makes a very small cut above or below the navel (belly button) and inserts a small tool that acts like a telescope into the abdomen (stomach). This is called laparoscopy (lap-uh-RAHS-kuh-pee). The doctor then punctures the ovary with a small needle carrying an electric current to destroy a small portion of the ovary. This procedure carries a risk of developing scar tissue on the ovary. This surgery can lower male hormone levels and help with ovulation. But, these effects may only last a few months. This treatment doesn't help with loss of scalp hair or increased hair growth on other parts of the body.
Medicine for increased hair growth or extra male hormones. Medicines called anti-androgens may reduce hair growth and clear acne. Spironolactone (speer-on-oh-LAK-tone) (Aldactone), first used to treat high blood pressure, has been shown to reduce the impact of male hormones on hair growth in women. Finasteride (fin-AST-uhr-yd) (Propecia), a medicine taken by men for hair loss, has the same effect. Anti-androgens are often combined with birth control pills. These medications should not be taken if you are trying to become pregnant.
Before taking Aldactone, tell your doctor if you are pregnant or plan to become pregnant. Do not breastfeed while taking this medicine. Women who may become pregnant should not handle Propecia.
Other options include:
- Vaniqa (van-ik-uh) cream to reduce facial hair
- Laser hair removal or electrolysis to remove hair
- Hormonal treatment to keep new hair from growing
Other Treatments. Some research has shown that bariatric (weight loss) surgery may be effective in resolving PCOS in morbidly obese women. Morbid obesity means having a BMI of more than 40, or a BMI of 35 to 40 with an obesity-related disease. The drug troglitazone (troh-GLIT-uh-zohn) was shown to help women with PCOS. But, it was taken off the market because it caused liver problems. Similar drugs without the same side effect are being tested in small trials.
Researchers continue to search for new ways to treat PCOS. To learn more about current PCOS treatment studies, visit the clinicaltrials.gov Web site. Talk to your doctor about whether taking part in a clinical trial might be right for you.How does PCOS affect a woman while pregnant?
Women with PCOS appear to have higher rates of:
- Miscarriage
- Gestational diabetes
- Pregnancy-induced high blood pressure (preeclampsia)
- Premature delivery
Babies born to women with PCOS have a higher risk of spending time in a neonatal intensive care unit or of dying before, during, or shortly after birth. Most of the time, these problems occur in multiple-birth babies (twins, triplets).
Researchers are studying whether the diabetes medicine metformin can prevent or reduce the chances of having problems while pregnant. Metformin also lowers male hormone levels and limits weight gain in women who are obese when they get pregnant.
Metformin is an FDA pregnancy category B drug. It does not appear to cause major birth defects or other problems in pregnant women. But, there have only been a few studies of metformin use in pregnant women to confirm its safety. Talk to your doctor about taking metformin if you are pregnant or are trying to become pregnant. Also, metformin is passed through breastmilk. Talk with your doctor about metformin use if you are a nursing mother.
Does PCOS put women at risk for other health problems?
Women with PCOS have greater chances of developing several serious health conditions, including life-threatening diseases. Recent studies found that:
- More than 50 percent of women with PCOS will have diabetes or pre-diabetes (impaired glucose tolerance) before the age of 40.
- The risk of heart attack is 4 to 7 times higher in women with PCOS than women of the same age without PCOS.
- Women with PCOS are at greater risk of having high blood pressure.
- Women with PCOS have high levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol.
- Women with PCOS can develop sleep apnea. This is when breathing stops for short periods of time during sleep.
Women with PCOS may also develop anxiety and depression. It is important to talk to your doctor about treatment for these mental health conditions.
Women with PCOS are also at risk for endometrial cancer. Irregular menstrual periods and the lack of ovulation cause women to produce the hormone estrogen, but not the hormone progesterone. Progesterone causes the endometrium (lining of the womb) to shed each month as a menstrual period. Without progesterone, the endometrium becomes thick, which can cause heavy or irregular bleeding. Over time, this can lead to endometrial hyperplasia, when the lining grows too much, and cancer.I have PCOS. What can I do to prevent complications?
If you have PCOS, get your symptoms under control at an earlier age to help reduce your chances of having complications like diabetes and heart disease. Talk to your doctor about treating all your symptoms, rather than focusing on just one aspect of your PCOS, such as problems getting pregnant. Also, talk to your doctor about getting tested for diabetes regularly. Other steps you can take to lower your chances of health problems include:
- Eating right
- Exercising
- Not smoking
How can I cope with the emotional effects of PCOS?
Having PCOS can be difficult. You may feel:
- Embarrassed by your appearance
- Worried about being able to get pregnant
- Depressed
Getting treatment for PCOS can help with these concerns and help boost your self-esteem. You may also want to look for support groups in your area or online to help you deal with the emotional effects of PCOS. You are not alone and there are resources available for women with PCOS.
Pregnancy and Medicines
Is it safe to use medicine while I am pregnant?
There is no clear-cut answer to this question. Before you start or stop any medicine, it is always best to speak with the doctor who is caring for you while you are pregnant. Read on to learn about deciding to use medicine while pregnant.
How should I decide whether to use a medicine while I am pregnant?
When deciding whether or not to use a medicine in pregnancy, you and your doctor need to talk about the medicine's benefits and risks.
- Benefits: what are the good things the medicine can do for me and my growing baby (fetus)?
- Risks: what are the ways the medicine might harm me or my growing baby (fetus)?
There may be times during pregnancy when using medicine is a choice. Some of the medicine choices you and your doctor make while you are pregnant may differ from the choices you make when you are not pregnant. For example, if you get a cold, you may decide to "live with" your stuffy nose instead of using the "stuffy nose" medicine you use when you are not pregnant.
Other times, using medicine is not a choice — it is needed. Some women need to use medicines while they are pregnant. Sometimes, women need medicine for a few days or a couple of weeks to treat a problem like a bladder infection or strep throat. Other women need to use medicine every day to control long-term health problems like asthma, diabetes, depression, or seizures. Also, some women have a pregnancy problem that needs treatment with medicine. These problems might include severe nausea and vomiting, earlier pregnancy losses, or preterm labor.
Where do doctors and nurses find out about using medicines during pregnancy?
Doctors and nurses get information from medicine labels and packages, textbooks, and research journals. They also share knowledge with other doctors and nurses and talk to the people who make and sell medicines.
The Food and Drug Administration (FDA) is the part of our country's government that controls the medicines that can and can't be sold in the United States. The FDA lets a company sell a medicine in the United States if it is safe to use and works for a certain health problem. Companies that make medicines usually have to show FDA doctors and scientists whether birth defects or other problems occur in baby animals when the medicine is given to pregnant animals. Most of the time, drugs are not studied in pregnant women.
The FDA works with the drug companies to make clear and complete medicine labels. But in most cases, there is not much information about how a medicine affects pregnant women and their growing babies. Many prescription medicine labels include the results of studies done in pregnant animals. But a medicine does not always affect growing humans and animals in the same way. Here is an example:
A medicine is given to pregnant rats. If the medicine causes problems in some of the rat babies, it may or may not cause problems in human babies. If there are no problems in the rat babies, it does not prove that the medicine will not cause problems in human babies.
The FDA asks for studies in two different kinds of animals. This improves the chance that the studies can predict what may happen in pregnant women and their babies.
There is a lot that FDA doctors and scientists do not know about using medicine during pregnancy. In a perfect world, every medicine label would include helpful information about the medicine's effects on pregnant women and their growing babies. Unfortunately, this is not the case.
How do prescription and over-the-counter (OTC) medicine labels help my doctor choose the right medicine for me when I am pregnant?
Doctors use information from many sources when they choose medicine for a patient, including medicine labels. To help doctors, the FDA created pregnancy letter categories to help explain what is known about using medicine during pregnancy. This system assigns letter categories to all prescription medicines. The letter category is listed in the label of a prescription medicine. The label states whether studies were done in pregnant women or pregnant animals and if so, what happened. Over-the-counter (OTC) medicines do not have a pregnancy letter category. Some OTC medicines were prescription medicines first and used to have a letter category. Talk to your doctor and follow the instructions on the label before taking OTC medicines.
Prescription Medicines
The FDA chooses a medicine's letter category based on what is known about the medicine when used in pregnant women and animals.
| Pregnancy Category | Definition | Examples of Drugs |
|---|---|---|
| A | In human studies, pregnant women used the medicine and their babies did not have any problems related to using the medicine. |
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| B | In humans, there are no good studies. But in animal studies, pregnant animals received the medicine, and the babies did not show any problems related to the medicine. Or In animal studies, pregnant animals received the medicine, and some babies had problems. But in human studies, pregnant women used the medicine and their babies did not have any problems related to using the medicine. |
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| C | In humans, there are no good studies. In animals, pregnant animals treated with the medicine had some babies with problems. However, sometimes the medicine may still help the human mothers and babies more than it might harm. Or No animal studies have been done, and there are no good studies in pregnant women. |
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| D | Studies in humans and other reports show that when pregnant women use the medicine, some babies are born with problems related to the medicine. However, in some serious situations, the medicine may still help the mother and the baby more than it might harm. |
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| X | Studies or reports in humans or animals show that mothers using the medicine during pregnancy may have babies with problems related to the medicine. There are no situations where the medicine can help the mother or baby enough to make the risk of problems worth it. These medicines should never be used by pregnant women. |
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The FDA is working hard to gather more knowledge about using medicine during pregnancy. The FDA is also trying to make medicine labels more helpful to doctors. Medicine label information for prescription medicines is now changing, and the pregnancy part of the label will change over the next few years. As this prescription information is updated, it is added to an online information clearinghouse called DailyMed (http://dailymed.nlm.nih.gov) that gives up-to-date, free information to consumers and health care providers.
OTC medicines
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All OTC medicines have a Drug Facts label. The Drug Facts label is arranged the same way on all OTC medicines. This makes information about using the medicine easier to find. One section of the Drug Facts label is for pregnant women. With OTC medicines, the label usually tells a pregnant woman to speak with her doctor before using the medicine. Some OTC medicines are known to cause certain problems in pregnancy. The labels for these medicines give pregnant women facts about why and when they should not use the medicine. Here are some examples:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin (acetylsalicylate), can cause serious blood flow problems in the baby if used during the last 3 months of pregnancy (after 28 weeks). Also, aspirin may increase the chance for bleeding problems in the mother and the baby during pregnancy or at delivery.
- The labels for nicotine therapy drugs, like the nicotine patch and lozenge, remind women that smoking can harm an unborn child. While the medicine is thought to be safer than smoking, the risks of the medicine are not fully known. Pregnant smokers are told to try quitting without the medicine first.
What if I'm thinking about getting pregnant?
If you are not pregnant yet, you can help your chances for having a healthy baby by planning ahead. Schedule a pre-pregnancy checkup. At this visit, you can talk to your doctor about the medicines, vitamins, and herbs you use. It is very important that you keep treating your health problems while you are pregnant. Your doctor can tell you if you need to switch your medicine. Ask about vitamins for women who are trying to get pregnant. All women who can get pregnant should take a daily vitamin with folic acid (a B vitamin) to prevent birth defects of the brain and spinal cord. You should begin taking these vitamins before you become pregnant or if you could become pregnant. It is also a good idea to discuss caffeine, alcohol, and smoking with your doctor at this time.
Is it safe to use medicine while I am trying to become pregnant?
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It is hard to know exactly when you will get pregnant. Once you do get pregnant, you may not know you are pregnant for 10 to 14 days or longer. Before you start trying to get pregnant, it is wise to schedule a meeting with your doctor to discuss medicines that you use daily or every now and then. Sometimes, medicines should be changed, and sometimes they can be stopped before a woman gets pregnant. Each woman is different. So you should discuss your medicines with your doctor rather than making medicine changes on your own.
What if I get sick and need to use medicine while I am pregnant?
Whether or not you should use medicine during pregnancy is a serious question to discuss with your doctor. Some health problems need treatment. Not using a medicine that you need could harm you and your baby. For example, a urinary tract infection (UTI) that is not treated may become a kidney infection. Kidney infections can cause preterm labor and low birth weight. You need an antibiotic to cure a UTI. Ask your doctor whether the benefits of taking a certain medicine outweigh the risks for you and your baby.
I have a health problem. Should I stop using my medicine while I am pregnant?
If you are pregnant or thinking about becoming pregnant, you should talk to your doctor about your medicines. Do not stop or change them on your own. This includes medicines for depression, asthma, diabetes, seizures (epilepsy), and other health problems. Not using medicine that you need may be more harmful to you and your baby than using the medicine.
For women living with HIV, the Centers for Disease Control and Prevention (CDC) recommends usingzidovudine (AZT) during pregnancy. Studies show that HIV positive women who use AZT during pregnancy greatly lower the risk of passing HIV to their babies. If a diabetic woman does not use her medicine during pregnancy, she raises her risk for miscarriage, stillbirth, and some birth defects. If asthma and high blood pressure are not controlled during pregnancy, problems with the fetus may result.
Are vitamins safe for me while I am pregnant?
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Women who are pregnant should not take regular vitamins. They can contain doses that are too high. Ask about special vitamins for pregnant women that can help keep you and your baby healthy. These prenatal vitamins should contain at least 400 - 800 micrograms (µg) of folic acid. It is best to start taking these vitamins before you become pregnant or if you could become pregnant. Folic acid reduces the chance of a baby having a neural tube defect, like spina bifida, where the spine or brain does not form the right way. See our information on folic acid. Iron can help prevent a low red blood cell count (anemia). It's important to take the vitamin dose prescribed by your doctor. Too many vitamins can harm your baby. For example, very high levels of vitamin A have been linked with severe birth defects.
Are herbs, minerals, or amino acids safe for me while I am pregnant?
No one is sure if these are safe for pregnant women, so it's best not to use them. Even some "natural" products may not be good for women who are pregnant or breastfeeding. Except for some vitamins, little is known about using dietary supplements while pregnant. Some herbal remedy labels claim that they will help with pregnancy. But, most often there are no good studies to show if these claims are true or if the herb can cause harm to you or your baby. Talk with your doctor before using any herbal product or dietary supplement. These products may contain things that could harm you or your growing baby during your pregnancy.
In the United States, there are different laws for medicines and for dietary supplements. The part of the FDA that controls dietary supplements is the same part that controls foods sold in the United States. Only dietary supplements containing new dietary ingredients that were not marketed before October 15, 1994 submit safety information for review by the FDA. However, unlike medicines, the FDA does not approve herbal remedies and "natural products" for safety or for what they say they will do. Most have not even been evaluated for their potential to cause harm to you or the growing fetus, let alone shown to be safe for use in pregnancy. Before a company can sell a medicine, the company must complete many studies and send the results to the FDA. Many scientists and doctors at the FDA check the study results. The FDA allows the medicine to be sold only if the studies show that the medicine works and is safe to use.
In the future, will there be better ways to know if medicines are safe to use during pregnancy?
At this time, drugs are rarely tested for safety in pregnant women for fear of harming the unborn baby. Until this changes, pregnancy exposure registries help doctors and researchers learn how medicines affect pregnant mothers and their growing babies. A pregnancy exposure registry is a study that enrolls pregnant women who are using a certain medicine. The women sign up for the study while pregnant and are followed for a certain length of time after the baby is born. Researchers compare babies of mothers who used the medicine while pregnant to babies of mothers who did not use the medicine. This type of study compares large groups of pregnant mothers and babies to look for medicine effects. A woman and her doctor can use registry results to make more informed choices about using medicine while pregnant.
Pregnancy Tests
How do pregnancy tests work?
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| Am I Pregnant? |
All pregnancy tests work by detecting a certain hormone in the urine or blood that is only there when a woman is pregnant. This hormone is called human chorionic gonadotropin (kohr-ee-ON-ihk goh-NAD-uh-TROH-puhn), or hCG. It is also called the pregnancy hormone.
hCG is made when a fertilized egg implants in the uterus. This usually happens about six days after the egg and sperm merge. But studies show that in up to 10 percent of women, implantation does not occur until much later, after the first day of the missed period. The amount of hCG rapidly builds up in your body with each passing day you are pregnant.Are there different types of pregnancy tests?
Yes. There are two types of pregnancy tests. One tests the blood for the pregnancy hormone, hCG. You need to see a doctor to have a blood test. The other checks the urine for the hCG hormone. You can do a urine test at a doctor’s office or at home with a home pregnancy test (HPT).
These days, many women first use an HPT to find out if they are pregnant. HPTs are inexpensive, private, and easy to use. HPTs also are highly accurate if used correctly and at the right time. HPTs will be able to tell if you're pregnant about one week after a missed period.
Doctors use two types of blood tests to check for pregnancy. Blood tests can pick up hCG earlier in a pregnancy than urine tests can. Blood tests can tell if you are pregnant about six to eight days after youovulate (or release an egg from an ovary). A quantitative blood test (or the beta hCG test) measures the exact amount of hCG in your blood. So it can find even tiny amounts of hCG. This makes it very accurate. A qualitative hCG blood test just checks to see if the pregnancy hormone is present or not. So this test gives a yes or no answer. The qualitative hCG blood test is about as accurate as a urine test.
How do you do a home pregnancy test?
There are many different types of home pregnancy tests (HPTs). Most drugstores sell HPTs over the counter. They are inexpensive. But the cost depends on the brand and how many tests come in the box.
Most HPTs work in a similar way. Many instruct the user to hold a stick in the urine stream. Others involve collecting urine in a cup and then dipping the stick into it. At least one brand tells the woman to collect urine in a cup and then use a dropper to put a few drops of the urine into a special container. Then the woman needs to wait a few minutes. Different brands instruct the woman to wait different amounts of time. Once the time has passed, the user should inspect the "result window." If a line or plus symbol appears, you are pregnant. It does not matter how faint the line is. A line, whether bold or faint, means the result is positive. New digital tests show the words “pregnant” or “not pregnant.”
Most tests also have a "control indicator" in the result window. This line or symbol shows whether the test is working properly. If the control indicator does not appear, the test is not working properly. You should not rely on any results from a HPT that may be faulty.
Most brands tell users to repeat the test in a few days, no matter what the results. One negative result (especially soon after a missed period) does not always mean you're not pregnant. All HPTs come with written instructions. Most tests also have toll-free phone numbers to call in case of questions about use or results.
How accurate are home pregnancy tests?
Home pregnancy tests (HPTs) can be quite accurate. But the accuracy depends on:
- How you use them — Be sure to check the expiration date and follow the instructions. Wait ten minutes after taking the test to check the results window. Research suggests that waiting 10 minutes will give the most accurate result.
- When you use them — The amount of hCG or pregnancy hormone in your urine increases with time. So, the earlier after a missed period you take the test, the harder it is to spot the hCG. Many HPTs claim to be 99 percent accurate on the first day of your missed period. But research suggests that most HPTs do not always detect the low levels of hCG usually present this early in pregnancy. And when they do, the results are often very faint. Most HPTs can accurately detect pregnancy one week after a missed period. Also, testing your urine first thing in the morning may boost the accuracy.
- Who uses them — Each woman ovulates at a different time in her menstrual cycle. Plus, the fertilized egg can implant in a woman’s uterus at different times. hCG only is produced once implantation occurs. In up to 10 percent of women, implantation does not occur until after the first day of a missed period. So, HPTs will be accurate as soon as one day after a missed period for some women but not for others.
- The brand of test — Some HPTs are more sensitive than others. So, some tests are better than others at spotting hCG early on.
How soon after a missed period can I take a home pregnancy test and get an accurate result?
Many home pregnancy tests (HPTs) claim to be 99 percent accurate on the first day of your missed period. But research suggests that most HPTs do not always spot pregnancy that early. And when they do, the results are often so faint they are misunderstood. If you can wait one week after your missed period, most HPTs will give you an accurate answer. Ask your doctor for a more sensitive test if you need to know earlier.
My home pregnancy test says I am pregnant. What should I do next?
If a home pregnancy test is positive and shows that you are pregnant, you should call your doctor right away. Your doctor can use a more sensitive test along with a pelvic exam to tell for sure if you're pregnant. Seeing your doctor early on in your pregnancy will help you and your baby stay healthy.
My home pregnancy test says that I am not pregnant. Might I still be pregnant?
Yes. So, most home pregnancy tests (HPTs) suggest women take the test again in a few days or a week if the result is negative.
Each woman ovulates at a different time in her menstrual cycle. Plus, the fertilized egg can implant in a woman’s uterus at different times. So, the accuracy of HPT results varies from woman to woman. Other things can also affect the accuracy. Sometimes women get false negative results when they test too early in the pregnancy. This means that the test says you are not pregnant when you are. Other times, problems with the pregnancy can affect the amount of hCG in the urine.
If your HPT is negative, test yourself again in a few days or one week. If you keep getting a negative result but think you are pregnant, talk with your doctor right away.
Can anything affect home pregnancy test results?
Most medicines should not affect the results of a home pregnancy test (HPT). This includes over-the-counter and prescription medicines, including birth control pills and antibiotics. Only medicines that have the pregnancy hormone hCG in them can give a false positive test result. A false positive is when a test says you are pregnant when you're not. Sometimes medicines containing hCG are used to treat infertility (not being able to get pregnant).
Alcohol and illegal drugs do not affect HPT results. But do not use these substances if you are trying to become pregnant or are sexually active and could become pregnant.
Prenatal Care
What is prenatal care?
Prenatal care is the health care you get while you are pregnant. Take care of yourself and your baby by:
- Getting early prenatal care. If you know you're pregnant, or think you might be, call your doctor to schedule a visit.
- Getting regular prenatal care. Your doctor will schedule you for many checkups over the course of your pregnancy. Don't miss any — they are all important.
- Following your doctor's advice.
Did you know?
Several types of health care professionals can help pregnant women and deliver babies. They include obstetricians, family physicians, midwives, and nurse-midwives. This fact sheet calls all health care professionals "doctor" only to keep the information as easy to read as possible.
Several types of health care professionals can help pregnant women and deliver babies. They include obstetricians, family physicians, midwives, and nurse-midwives. This fact sheet calls all health care professionals "doctor" only to keep the information as easy to read as possible.
Why do I need prenatal care?
Prenatal care can help keep you and your baby healthy. Babies of mothers who do not get prenatal care are three times more likely to have a low birth weight and five times more likely to die than those born to mothers who do get care.
Doctors can spot health problems early when they see mothers regularly. This allows doctors to treat them early. Early treatment can cure many problems and prevent others. Doctors also can talk to pregnant women about things they can do to give their unborn babies a healthy start to life.
I am thinking about getting pregnant. How can I take care of myself?
You should start taking care of yourself before you start trying to get pregnant. This is called preconception health. It means knowing how health conditions and risk factors could affect you or your unborn baby if you become pregnant. For example, some foods, habits, and medicines can harm your baby — even before he or she is conceived. Some health problems also can affect pregnancy.
Talk to your doctor before pregnancy to learn what you can do to prepare your body. Women should prepare for pregnancy before becoming sexually active. Ideally, women should give themselves at least 3 months to prepare before getting pregnant.
The five most important things you can do before becoming pregnant are:
- Take 400 micrograms (400 mcg or 0.4 mg) of folic acid every day for at least 3 months before getting pregnant to lower your risk of some birth defects of the brain and spine. You can get folic acid from some foods. But it's hard to get all the folic acid you need from foods alone. Taking a vitamin with folic acid is the best and easiest way to be sure you're getting enough.
- Stop smoking and drinking alcohol. Ask your doctor for help.
- If you have a medical condition, be sure it is under control. Some conditions include asthma,diabetes, depression, high blood pressure, obesity, thyroid disease, or epilepsy. Be sure your vaccinations are up to date.
- Talk to your doctor about any over-the-counter and prescription medicines you are using. These include dietary or herbal supplements. Some medicines are not safe during pregnancy. At the same time, stopping medicines you need also can be harmful.
- Avoid contact with toxic substances or materials at work and at home that could be harmful. Stay away from chemicals and cat or rodent feces.
I'm pregnant. What should I do — or not do — to take care of myself and my unborn baby?
Follow these dos and don’ts to take care of yourself and the precious life growing inside you:
Health Care Dos and Don’ts
Health Care Dos and Don’ts
- Get early and regular prenatal care. Whether this is your first pregnancy or third, health care is extremely important. Your doctor will check to make sure you and the baby are healthy at each visit. If there are any problems, early action will help you and the baby.
- Take a multivitamin or prenatal vitamin with 400 micrograms (mcg or 0.4 mg) of folic acid every day.
- Ask your doctor before stopping any medicines or starting any new medicines. Some medicines are not safe during pregnancy. Keep in mind that even over-the-counter medicines and herbal products may cause side effects or other problems. But not using medicines you need could also be harmful.
- Avoid x-rays. If you must have dental work or diagnostic tests, tell your dentist or doctor that you are pregnant so that extra care can be taken.
- Get a flu shot if your baby’s due date is between March and July. Pregnant women can get very sick from the flu and may need hospital care.
Food Dos and Don’ts
- Eat a variety of healthy foods. Choose fruits, vegetables, whole grains, calcium-rich foods, and foods low in saturated fat. Also, make sure to drink plenty of fluids, especially water.
- Get all the nutrients you need each day, including iron. Getting enough iron prevents you from getting anemia, which is linked to preterm birth and low birth weight. Eating a variety of healthy foods will help you get the nutrients your baby needs. But ask your doctor if you need to take a daily prenatal vitamin or iron supplement to be sure you are getting enough.
- Protect yourself and your baby from food-borne illnesses, including toxoplasmosis (TOK-soh-plaz-MOH-suhss) and listeria (lih-STEER-ee-uh). Wash fruits and vegetables before eating. Don’t eatuncooked or undercooked meats or fish. Always handle, clean, cook, eat, and store foods properly.
- Don’t eat fish with lots of mercury, including swordfish, king mackerel, shark, and tilefish.
Lifestyle Dos and Don’ts
- Gain a healthy amount of weight. Your doctor can tell you how much weight gain you should aim for during pregnancy.
- Don’t smoke, drink alcohol, or use drugs. These can cause long-term harm or death to your baby. Ask your doctor for help quitting.
- Unless your doctor tells you not to, try to get at least 2 hours and 30 minutes of moderate-intensity aerobic activity a week. It’s best to spread out your workouts throughout the week. If you worked out regularly before pregnancy, you can keep up your activity level as long as your health doesn’t change and you talk to your doctor about your activity level throughout your pregnancy. Learn more about how to have a fit pregnancy.
- Don’t take very hot baths or use hot tubs or saunas.
- Get plenty of sleep and find ways to control stress.
- Get informed. Read books, watch videos, go to a childbirth class, and talk with moms you know.
- Ask your doctor about childbirth education classes for you and your partner. Classes can help you prepare for the birth of your baby.
Environmental Dos and Don’ts
- Stay away from chemicals like insecticides, solvents (like some cleaners or paint thinners), lead, mercury, and paint (including paint fumes). Not all products have pregnancy warnings on their labels. If you're unsure if a product is safe, ask your doctor before using it. Talk to your doctor if you are worried that chemicals used in your workplace might be harmful.
- If you have a cat, ask your doctor about toxoplasmosis. This infection is caused by a parasite sometimes found in cat feces. If not treated toxoplasmosis can cause birth defects. You can lower your risk of by avoiding cat litter and wearing gloves when gardening.
- Avoid contact with rodents, including pet rodents, and with their urine, droppings, or nesting material. Rodents can carry a virus that can be harmful or even deadly to your unborn baby.
- Take steps to avoid illness, such as washing hands frequently.
- Stay away from secondhand smoke.
pregnancy dos and don'ts (PDF, 176 Kb).I don't want to get pregnant right now. But should I still take folic acid every day?
All sexually active women should get 400 micrograms (mcg or 0.4 mg) of folic acid every day. Even women with a small chance of getting pregnant should get their daily dose of folic acid. This is because many pregnancies are not planned. Often women don't know they are pregnant for a number of weeks. And some birth defects happen in the very first weeks of pregnancy.
Taking 400 mcg of folic acid every day will lower the risk of some birth defects that happen in early pregnancy. If a woman doesn't start taking vitamins until 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.How often should I see my doctor during pregnancy?
Your doctor will give you a schedule of all the doctor's visits you should have while pregnant. Most experts suggest you see your doctor:
- about once each month for weeks 4 through 28
- twice a month for weeks 28 through 36
- weekly for weeks 36 to birth
What happens during prenatal visits?
During the first prenatal visit, you can expect your doctor to:
- ask about your health history including diseases, operations, or prior pregnancies
- ask about your family's health history
- do a complete physical exam, including a pelvic exam and Pap test
- take your blood and urine for lab work
- check your blood pressure, height, and weight
- calculate your due date
- answer your questions
At the first visit, you should ask questions and discuss any issues related to your pregnancy. Find out all you can about how to stay healthy.
Later prenatal visits will probably be shorter. Your doctor will check on your health and make sure the baby is growing as expected. Most prenatal visits will include:
- checking your blood pressure
- measuring your weight gain
- measuring your abdomen to check your baby’s growth (once you begin to show)
- checking the baby's heart rate
I am in my late 30s and I want to get pregnant. Should I do anything special?
As you age, you have an increasing chance of having a baby born with a birth defect. Yet most women in their late 30s and early 40s have healthy babies. See your doctor regularly before you even start trying to get pregnant. She will be able to help you prepare your body for pregnancy. She will also be able to tell you about how age can affect pregnancy.
During your pregnancy, seeing your doctor regularly is very important. Because of your age, your doctor will probably suggest some extra tests to check on your baby's health.
More and more women are waiting until they are in their 30s and 40s to have children. While many women of this age have no problems getting pregnant, fertility does decline with age. Women over 40 who don't get pregnant after six months of trying should see their doctors for a fertility evaluation.
Experts define infertility as the inability to become pregnant after trying for one year. If a woman keeps having miscarriages, it’s also called infertility. If you think you or your partner may be infertile, talk to your doctor. Doctors are able to help many infertile couples go on to have healthy babies.
Uterine Fibroids
What are fibroids?
Fibroids are muscular tumors that grow in the wall of the uterus (womb). Another medical term for fibroids is "leiomyoma" (leye-oh-meye-OH-muh) or just "myoma". Fibroids are almost always benign (not cancerous). Fibroids can grow as a single tumor, or there can be many of them in the uterus. They can be as small as an apple seed or as big as a grapefruit. In unusual cases they can become very large.
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Why should women know about fibroids?
About 20 percent to 80 percent of women develop fibroids by the time they reach age 50. Fibroids are most common in women in their 40s and early 50s. Not all women with fibroids have symptoms. Women who do have symptoms often find fibroids hard to live with. Some have pain and heavy menstrual bleeding. Fibroids also can put pressure on the bladder, causing frequent urination, or the rectum, causing rectal pressure. Should the fibroids get very large, they can cause the abdomen (stomach area) to enlarge, making a woman look pregnant.
Who gets fibroids?
There are factors that can increase a woman's risk of developing fibroids.
- Age. Fibroids become more common as women age, especially during the 30s and 40s through menopause. After menopause, fibroids usually shrink.
- Family history. Having a family member with fibroids increases your risk. If a woman's mother had fibroids, her risk of having them is about three times higher than average.
- Ethnic origin. African-American women are more likely to develop fibroids than white women.
- Obesity. Women who are overweight are at higher risk for fibroids. For very heavy women, the risk is two to three times greater than average.
- Eating habits. Eating a lot of red meat (e.g., beef) and ham is linked with a higher risk of fibroids. Eating plenty of green vegetables seems to protect women from developing fibroids.
Where can fibroids grow?
Most fibroids grow in the wall of the uterus. Doctors put them into three groups based on where they grow:
- Submucosal (sub-myoo-KOH-zuhl) fibroids grow into the uterine cavity.
- Intramural (ihn-truh-MYOOR-uhl) fibroids grow within the wall of the uterus.
- Subserosal (sub-suh-ROH-zuhl) fibroids grow on the outside of the uterus.
Some fibroids grow on stalks that grow out from the surface of the uterus or into the cavity of the uterus. They might look like mushrooms. These are called pedunculated (pih-DUHN-kyoo-lay-ted) fibroids.
What are the symptoms of fibroids?
Most fibroids do not cause any symptoms, but some women with fibroids can have:
- heavy bleeding (which can be heavy enough to cause anemia) or painful periods
- feeling of fullness in the pelvic area (lower stomach area)
- enlargement of the lower abdomen
- frequent urination
- pain during sex
- lower back pain
- complications during pregnancy and labor, including a six-time greater risk of cesarean section
- reproductive problems, such as infertility, which is very rare
What causes fibroids?
No one knows for sure what causes fibroids. Researchers think that more than one factor could play a role. These factors could be:
- hormonal (affected by estrogen and progesterone levels)
- genetic (runs in families)
Because no one knows for sure what causes fibroids, we also don't know what causes them to grow or shrink. We do know that they are under hormonal control—both estrogen and progesterone. They grow rapidly during pregnancy, when hormone levels are high. They shrink when anti-hormone medication is used. They also stop growing or shrink once a woman reaches menopause.
Can fibroids turn into cancer?
Fibroids are almost always benign (not cancerous). Rarely (less than one in 1,000) a cancerous fibroid will occur. This is called leiomyosarcoma (leye-oh-meye-oh-sar-KOH-muh). Doctors think that these cancers do not arise from an already-existing fibroid. Having fibroids does not increase the risk of developing a cancerous fibroid. Having fibroids also does not increase a woman's chances of getting other forms of cancer in the uterus.
What if I become pregnant and have fibroids?
Women who have fibroids are more likely to have problems during pregnancy and delivery. This doesn't mean there will be problems. Most women with fibroids have normal pregnancies. The most common problems seen in women with fibroids are:
- Cesarean section. The risk of needing a c-section is six times greater for women with fibroids.
- Baby is breech. The baby is not positioned well for vaginal delivery.
- Labor fails to progress.
- Placental abruption. The placenta breaks away from the wall of the uterus before delivery. When this happens, the fetus does not get enough oxygen.
- Preterm delivery.
Talk to your obstetrician if you have fibroids and become pregnant. All obstetricians have experience dealing with fibroids and pregnancy. Most women who have fibroids and become pregnant do not need to see an OB who deals with high-risk pregnancies.
How do I know for sure that I have fibroids?
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. The doctor can feel the fibroid with her or his fingers during an ordinary pelvic exam, as a (usually painless) lump or mass on the uterus. 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 16 weeks pregnant. Or the fibroid might be compared to fruits, nuts, or a ball, such as a grape or an orange, an acorn or a walnut, or a golf ball or a volleyball.
Your doctor can do imaging tests to confirm that you have fibroids. These are tests that create a "picture" of the inside of your body without surgery. These tests might include:
- Ultrasound - uses sound waves to produce the picture. The ultrasound probe can be placed on the abdomen or it can be placed inside the vagina to make the picture.
- Magnetic Resonance Imaging (MRI) - uses magnets and radio waves to produce the picture
- X-rays - uses a form of radiation to see into the body and produce the picture
- Cat Scan (CT) - takes many X-ray pictures of the body from different angles for a more complete image
- Hysterosalpingogram (hiss-tur-oh-sal-PIN-juh-gram) (HSG) or sonohysterogram (soh-noh-HISS-tur-oh-gram)—An HSG involves injecting x-ray dye into the uterus and taking x-ray pictures. A sonohysterogram involves injecting water into the uterus and making ultrasound pictures.
You might also need surgery to know for sure if you have fibroids. There are two types of surgery to do this:
- Laparoscopy (lap-ar-OSS-koh-pee) - The doctor inserts a long, thin scope into a tiny incision made in or near the navel. The scope has a bright light and a camera. This allows the doctor to view the uterus and other organs on a monitor during the procedure. Pictures also can be made.
- Hysteroscopy (hiss-tur-OSS-koh-pee) - The doctor passes a long, thin scope with a light through the vagina and cervix into the uterus. No incision is needed. The doctor can look inside the uterus for fibroids and other problems, such as polyps. A camera also can be used with the scope.
What questions should I ask my doctor if I have fibroids?
- How many fibroids do I have?
- What size is my fibroid(s)?
- Where is my fibroid(s) located (outer surface, inner surface, or in the wall of the uterus)?
- Can I expect the fibroid(s) to grow larger?
- How rapidly have they grown (if they were known about already)?
- How will I know if the fibroid(s) is growing larger?
- What problems can the fibroid(s) cause?
- What tests or imaging studies are best for keeping track of the growth of my fibroids?
- What are my treatment options if my fibroid(s) becomes a problem?
- What are your views on treating fibroids with a hysterectomy versus other types of treatments?
A second opinion is always a good idea if your doctor has not answered your questions completely or does not seem to be meeting your needs.
How are fibroids treated?
Most women with fibroids do not have any symptoms. For women who do have symptoms, there are treatments that can help. Talk with your doctor about the best way to treat your fibroids. She or he will consider many things before helping you choose a treatment. Some of these things include:
- whether or not you are having symptoms from the fibroids
- if you might want to become pregnant in the future
- the size of the fibroids
- the location of the fibroids
- your age and how close to menopause you might be
If you have fibroids but do not have any symptoms, you may not need treatment. Your doctor will check during your regular exams to see if they have grown.
Medications
If you have fibroids and have mild symptoms, your doctor may suggest taking medication. Over-the-counter drugs such as ibuprofen or acetaminophen can be used for mild pain. If you have heavy bleeding during your period, taking an iron supplement can keep you from getting anemia or correct it if you already are anemic.
If you have fibroids and have mild symptoms, your doctor may suggest taking medication. Over-the-counter drugs such as ibuprofen or acetaminophen can be used for mild pain. If you have heavy bleeding during your period, taking an iron supplement can keep you from getting anemia or correct it if you already are anemic.
Several drugs commonly used for birth control can be prescribed to help control symptoms of fibroids. Low-dose birth control pills do not make fibroids grow and can help control heavy bleeding. The same is true of progesterone-like injections (e.g., Depo-Provera®). An IUD (intrauterine device) called Mirena® contains a small amount of progesterone-like medication, which can be used to control heavy bleeding as well as for birth control.
Other drugs used to treat fibroids are "gonadotropin releasing hormone agonists" (GnRHa). The one most commonly used is Lupron®. These drugs, given by injection, nasal spray, or implanted, can shrink your fibroids. Sometimes they are used before surgery to make fibroids easier to remove. Side effects of GnRHas can include hot flashes, depression, not being able to sleep, decreased sex drive, and joint pain. Most women tolerate GnRHas quite well. Most women do not get a period when taking GnRHas. This can be a big relief to women who have heavy bleeding. It also allows women with anemia to recover to a normal blood count. GnRHas can cause bone thinning, so their use is generally limited to six months or less. These drugs also are very expensive, and some insurance companies will cover only some or none of the cost. GnRHas offer temporary relief from the symptoms of fibroids; once you stop taking the drugs, the fibroids often grow back quickly.
Surgery
If you have fibroids with moderate or severe symptoms, surgery may be the best way to treat them. Here are the options:
If you have fibroids with moderate or severe symptoms, surgery may be the best way to treat them. Here are the options:
- Myomectomy (meye-oh-MEK-tuh-mee) - surgery to remove fibroids without taking out the healthy tissue of the uterus. It is best for women who wish to have children after treatment for their fibroids or who wish to keep their uterus for other reasons. You can become pregnant after myomectomy. But if your fibroids were imbedded deeply in the uterus, you might need a cesarean section to deliver. Myomectomy can be performed in many ways. It can be major surgery (involving cutting into the abdomen) or performed with laparoscopy or hysteroscopy. The type of surgery that can be done depends on the type, size, and location of the fibroids. After myomectomy new fibroids can grow and cause trouble later. All of the possible risks of surgery are true for myomectomy. The risks depend on how extensive the surgery is.
- Hysterectomy (hiss-tur-EK-tuh-mee) - surgery to remove the uterus. This surgery is the only sure way to cure uterine fibroids. Fibroids are the most common reason that hysterectomy is performed. This surgery is used when a woman's fibroids are large, if she has heavy bleeding, is either near or past menopause, or does not want children. If the fibroids are large, a woman may need a hysterectomy that involves cutting into the abdomen to remove the uterus. If the fibroids are smaller, the doctor may be able to reach the uterus through the vagina, instead of making a cut in the abdomen. In some cases hysterectomy can be performed through the laparoscope. Removal of the ovaries and the cervix at the time of hysterectomy is usually optional. Women whose ovaries are not removed do not go into menopause at the time of hysterectomy. Hysterectomy is a major surgery. Although hysterectomy is usually quite safe, it does carry a significant risk of complications. Recovery from hysterectomy usually takes several weeks.
- Endometrial Ablation (en-doh-MEE-tree-uhl uh-BLAY-shuhn) - the lining of the uterus is removed or destroyed to control very heavy bleeding. This can be done with laser, wire loops, boiling water, electric current, microwaves, freezing, and other methods. This procedure usually is considered minor surgery. It can be done on an outpatient basis or even in a doctor's office. Complications can occur, but are uncommon with most of the methods. Most people recover quickly. About half of women who have this procedure have no more menstrual bleeding. About three in 10 women have much lighter bleeding. But, a woman cannot have children after this surgery.
- Myolysis (meye-OL-uh-siss) - A needle is inserted into the fibroids, usually guided by laparoscopy, and electric current or freezing is used to destroy the fibroids.
- Uterine Fibroid Embolization (UFE), or Uterine Artery Embolization (UAE) - A thin tube is thread into the blood vessels that supply blood to the fibroid. Then, tiny plastic or gel particles are injected into the blood vessels. This blocks the blood supply to the fibroid, causing it to shrink. UFE can be an outpatient or inpatient procedure. Complications, including early menopause, are uncommon but can occur. Studies suggest fibroids are not likely to grow back after UFE, but more long-term research is needed. Not all fibroids can be treated with UFE. The best candidates for UFE are women who:
- have fibroids that are causing heavy bleeding
- have fibroids that are causing pain or pressing on the bladder or rectum
- don't want to have a hysterectomy
- don't want to have children in the future
Are other treatments being developed for uterine fibroids?
Yes. Researchers are looking into other ways to treat uterine fibroids. The following methods are not yet standard treatments; so your doctor may not offer them or health insurance may not cover them.
- MRI-guided ultrasound surgery shrinks fibroids using a high-intensity ultrasound beam. The MRI scanner helps the doctor locate the fibroid, and the ultrasound sends out very hot sound waves to destroy the fibroid. The ExAblate® 2000 System is a medical device that uses this method to destroy uterine fibroids.
- Some health care providers use lasers to remove a fibroid or to cut off the blood supply to the fibroid, making it shrink.
- Mifepristone®, and other anti-hormonal drugs being developed, could provide symptom relief without bone-thinning side effects. These are promising treatments, but none are yet available or FDA approved.
- Other medications are being studied for treatment of fibroids.
Vaginal Yeast Infections
What is a vaginal yeast infection?
A vaginal yeast infection is irritation of the vagina and the area around it called the vulva (vul-vuh).
Yeast is a type of fungus. Yeast infections are caused by overgrowth of the fungus Candida albicans. Small amounts of yeast are always in the vagina. But when too much yeast grows, you can get an infection.
Yeast infections are very common. About 75 percent of women have one during their lives. And almost half of women have two or more vaginal yeast infections.
What are the signs of a vaginal yeast infection?
The most common symptom of a yeast infection is extreme itchiness in and around the vagina.
Other symptoms include:
Other symptoms include:
- burning, redness, and swelling of the vagina and the vulva
- pain when passing urine
- pain during sex
- soreness
- a thick, white vaginal discharge that looks like cottage cheese and does not have a bad smell
- a rash on the vagina
You may only have a few of these symptoms. They may be mild or severe.
Should I call my doctor if I think I have a yeast infection?
Yes, you need to see your doctor to find out for sure if you have a yeast infection. The signs of a yeast infection are much like those of sexually transmitted infections (STIs) like Chlamydia (KLUH-mid-ee-uh) and gonorrhea (gahn-uh-REE-uh). So, it's hard to be sure you have a yeast infection and not something more serious.
If you've had vaginal yeast infections before, talk to your doctor about using over-the-counter medicines.
How is a vaginal yeast infection diagnosed?
Your doctor will do a pelvic exam to look for swelling and discharge. Your doctor may also use a swab to take a fluid sample from your vagina. A quick look with a microscope or a lab test will show if yeast is causing the problem.
Why did I get a yeast infection?
Many things can raise your risk of a vaginal yeast infection, such as:
- stress
- lack of sleep
- illness
- poor eating habits, including eating extreme amounts of sugary foods
- pregnancy
- having your period
- taking certain medicines, including birth control pills, antibiotics, and steroids
- diseases such as poorly controlled diabetes and HIV/AIDS
- hormonal changes during your periods
Can I get a yeast infection from having sex?
Yes, but it is rare. Most often, women don’t get yeast infections from sex. The most common cause is a weak immune system.
How are yeast infections treated?
Yeast infections can be cured with antifungal medicines that come as:
- creams
- tablets
- ointments or suppositories that are inserted into the vagina
These products can be bought over the counter at the drug store or grocery store. Your doctor can also prescribe you a single dose of oral fluconazole (floo-con-uh-zohl). But do not use this drug if you are pregnant.
Infections that don’t respond to these medicines are starting to be more common. Using antifungal medicines when you don't really have a yeast infection can raise your risk of getting a hard-to-treat infection in the future.
Is it safe to use over-the-counter medicines for yeast infections?
Yes, but always talk with your doctor before treating yourself for a vaginal yeast infection if you:
- are pregnant
- have never been diagnosed with a yeast infection
- keep getting yeast infections
Studies show that two-thirds of women who buy these products don’t really have a yeast infection. Using these medicines the wrong way may lead to a hard-to-treat infection. Plus, treating yourself for a yeast infection when you really have something else may worsen the problem. Certain STIs that go untreated can cause cancer, infertility, pregnancy problems, and other health problems.
If you decide to use these over-the-counter medicines, read and follow the directions carefully. Some creams and inserts may weaken condoms and diaphragms.
If I have a yeast infection, does my sexual partner need to be treated?
Yeast infections are not STIs, and health experts don’t know for sure if they are transmitted sexually. About 12 to 15 percent of men get an itchy rash on the penis if they have unprotected sex with an infected woman. If this happens to your partner, he should see a doctor. Men who haven’t been circumcised are at higher risk.
Lesbians may be at risk for spreading yeast infections to their partner(s). Research is still being done to know for sure. If your female partner has any symptoms, she should also be tested and treated.
How can I avoid getting another yeast infection?
To help prevent vaginal yeast infections, you can:
- avoid douches
- avoid scented hygiene products like bubble bath, sprays, pads, and tampons
- change tampons and pads often during your period
- avoid tight underwear or clothes made of synthetic fibers
- wear cotton underwear and pantyhose with a cotton crotch
- change out of wet swimsuits and exercise clothes as soon as you can
- avoid hot tubs and very hot baths
If you keep getting yeast infections, be sure and talk with your doctor.
What should I do if I get repeat yeast infections?
Call your doctor. About 5 percent of women get four or more vaginal yeast infections in 1 year. This is called recurrent vulvovaginal candidiasis (RVVC). RVVC is more common in women with diabetes or weak immune systems. Doctors most often treat this problem with antifungal medicine for up to 6 months.
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