In a normal menstrual cycle there is regular hormone production and thickening of the lining of the uterus. This cycle primes the endometrium (uterine lining) for implantation of a developing embryo. If no implantation occurs, the lining sheds, resulting in a menstrual period. There are two phases in the menstrual cycle: the follicular phase and the luteal phase. The follicular phase occurs prior to ovulation and involves thickening of the lining of the uterus. This phase usually lasts 10 to 14 days. The luteal phase is the period of time from ovulation to the onset of menses when the lining of the uterus undergoes stabilization prior to menses. This phase usually lasts 14 days.

During the first 2 years after the onset of menstruation, cycles are often irregular. These early cycles are often anovulatory-there is no ovulation during the menstrual cycle and therefore the luteal phase does not occur properly. Because of this a woman will experience irregular bleeding. As long as the menstrual cycles are no longer than 35 days, no shorter than 21 days, and the duration of bleeding is no longer than 7 days, this is considered normal in a woman who has recently started menstruating.

If irregular bleeding lasts longer than 2 years or the blood flow is excessive, your physician may suggest further evaluation.

Despite all the advertising by manufacturers of feminine hygiene products, there are no practical reasons for women to douche on a regular basis.

Premenstrual Syndrome (PMS) is a disorder experienced by many women. This syndrome has many associated symptoms. One of these symptoms is bloating. This often begins approximately 1 to 2 weeks prior to menses and is characterized by bloating and weight gain. Often women notice a significant reduction in their weight immediately after menses.

Initial treatment for PMS is lifestyle changes such as exercise and changing your diet to decrease salt, caffeine, and chocolate intake. If you have a significant amount of bloating prior to your menses and it is affecting your daily life. You may consult your physician. Although no good studies support their use, many women report improvement in symptoms with the use of birth control pills.

What you are describing is a normal pattern of menstruation and a normal menstrual period. A normal menstrual period last about 5 to 7 days, the bleeding is heaviest during the first couple of days and then slows for the remaining 3 or 4 days. As your bleeding slows, the blood clots. This could be what you are seeing. Another possibility is that you are seeing a portion of the uterine lining (endometrium) which is the tissue that is shed during menstruation. In short, you should be reassured that your period is normal.

Females should have their first gynecological exam by the age of 25, or when they become sexually active. At this point they should begin having yearly pap smears and pelvic exams. Many pediatricians are comfortable taking care of their patients' gynecological problems. If this is the case, your pediatrician may continue to see you for your gynecological exams. If you or your pediatrician feel that it would be more comfortable for you to see a gynecologist, you may be given a referral to one. Should your gynecological issues become more difficult, seeing a gynecologist may be to your benefit.

Periods are also known as menstrual cycles. The onset of menstrual cycles (menarche) occurs during the teenage years. Menstruation continues until a women is in her 50s and reaches menopause. The average age of menarche in the United States is 9 to 17 years of age, with a median age of 13.

Primary amenorrhea is a condition where a woman fails to start her menstrual cycles. If you have other signs of puberty, such as breast development or pubic hair, but fail to start your menses by the age of 16, you should see a physician. If you have no signs of puberty by age 14, you should see a physician.

Over the last twenty years the number of women waiting until their 40s to conceive has nearly doubled. One of the main determinates of having a healthy pregnancy is being healthy as you enter pregnancy. However, no matter how healthy you are, there are still risks beyond your control. Medical conditions such as high blood pressure and diabetes are more common when a woman reaches her 40s. Also, the number of chromosomal disorders, such as Down syndrome, increases as your age increases. For example, the risk of Down syndrome at age 25 is one in 250. At age 35 is the risk is about one in 300. At age 45 the risk is one in 30, and at age 49 the risk is one in 11. Your total risk for chromosome abnormalities is a bit higher too. At age 35 it is one in 200, while at age 45 the risk increases to one in 21, and to 1 in 8 at age 49. Women in their 30s and 40s have an increased risk of miscarriage. This is most likely due to the increase in chromosomal disorders. In addition, it appears that older women also have an increased risk of requiring a cesarean section.

Contraceptive options for women over age 40 are similar to those for a younger woman. Types of contraception include:

Barrier contraception

• Spermicide - spermicide is a jelly or cream that is toxic to sperm. It is placed into the vagina before each episode of intercourse. The effectiveness rate is 74% to 94%.
• Condoms - condoms are devices, often made of latex, that are placed over the penis to provide a barrier between the penis and the vagina. This form of birth control is the only method that also provides protection from sexually transmitted diseases. The effectiveness rate is 86% to 97%.
• Diaphragm - A diaphragm is a round rubber shield that is inserted into the vagina and placed against the cervix. This device is used in conjunction with spermicide. It may be inserted up to 2 hours prior to intercourse and must be left in place for at least 6 hours after intercourse. The effectiveness rate is 80% to 94%.

Barrier methods of contraception are useful for women of all ages, and are as effective for women in their 40s as they are for younger women.

Intrauterine Device An intrauterine device (IUD) is an extremely effective form of contraception. IUDs are inserted into the uterus by a physician. These devices release a small amount of copper or progesterone that cause an inflammatory response within the uterine cavity. This inflammatory response provides the contraceptive benefit. The effectiveness rate is 98% to 99.9%. This form of birth control is a good choice for someone in a monogamous relationship, and is often a good choice for older women.

Methods

• Oral Contraceptive Pills - Oral contraceptive pills are a common form of contraception. Oral Contraceptives are well tolerated in older women unless they are over 35 and smoke, or have high blood pressure. These factors increase the risk of cardiovascular complications. The effectiveness rate of birth control pills is 97% to 99.9%. There has been no evidence in the literature that contradicts oral contraceptives in general in older women, nor is there associated increased risk of breast cancer. Oral contraceptive use is safe all the way to menopause.
• DepoProvera - DepoProvera is injected progesterone. Injections are administered every 3 months. Effectiveness rate is 99.7%. The greatest complaint from users of DepoProvera is irregular bleeding.
• Implanon - Implanon is a small, thin, implantable hormonal contraceptive that is effective for up to three years. It was approved in July, 2006 by the U.S. Food and Drug Administration.

All the hormonal forms of birth control have been shown to be safe for a healthy woman in her 40s. Discuss with your physician which of the above options is best for you.

Chlamydia is one of the most commonly reported sexually transmitted diseases in the United States. The CDC estimates approximately 4 million new cases per year. Several methods are often used to test for chlamydial infection. The most common method is the use of the DNA probe–a test similar to a Pap smear. This test has a sensitivity of 65% to 70 % meaning that 65% to 70% of people who test positive truly have the disease. It has a specificity of 95% to 99% meaning the 95% to 99% of people who test negative truly do not have the disease.

If you tested negative for chlamydia by DNA probe, it is unlikely that you had chlamydia at the time of test. If later you had a positive test, it would be most likely that you acquired chlamydia during that time frame. It is possible to harbor chlamydia in the tissues for a long period of time, and therefore it is possible that your sexual partner may have had the infection and just recently passed it on to you. To date, there does not appear to be a significant incubation period for chlamydia. It is a sexually transmitted disease.

Painful intercourse is also known as dyspareunia.Causes of painful intercourse range from simple problems that are easy to treat, to more complex problems that may require extensive testing and treatment.

One of the most common causes of painful intercourse is lack of adequate lubrication. This situation can be remedied by longer foreplay prior to intercourse, or by using lubricating agents such as K-Y jelly or Astroglide.

Another common cause of painful intercourse is vaginal infection or irritation. Yeast infections, trichomonas vaginitis, and bacterial vaginosis may all have associated pain with intercourse. Also, certain douches, spermicides, and condoms have agents that are irritating and result in inflammation with associated painful intercourse.

Women who experience pain on deep penetration during intercourse may have a pelvic infection, pelvic mass, endometriosis, or bowel problems. If you have pain with deep penetration you should see your physician for further evaluation.

Finally, some women experience dyspareunia due to psychological factors. Factors leading to the pain may include prior unpleasant sexual experiences and/or prior sexual abuse. Relationship difficulties may also lead to pain with intercourse.

Lack of desire is the sexual problem most frequently reported by women. It manifests as a disinterest in or avoidance of sex, and in many cases is reflected as a discrepancy in the couple's desired frequency of sexual contact. Lack of sexual desire is a problem that presents both partners in a relationship with a confusing dilemma. Couples often question the level of commitment and caring for one another when one or both lack sexual interest. A cycle often develops resulting in their undergoing increasing levels of stress in daily interactions that negatively impact problem-solving skills and communication patterns.

Physiological and/or medical problems may contribute to a decrease in sexual functioning. Medical evaluations often focus on assessing hormone levels, thyroid function, use of medications such as anti-hypertensive medications, vaginal infections, or any other illnesses or conditions that may affect sexuality. In addition, the use of alcohol, drugs and the excessive use of chemicals can drastically decrease sexual interest and may be confused with sexual dysfunction. The lack of sexual desire is a frustrating problem for many couples regardless of the cause.

Once all physiological components have been ruled out, you should focus on communication, sexual expectations, stress levels, and the amount of time set aside for emotional and sexual contact.

Lichen sclerosus is a benign inflammatory condition of the skin of the vulva. It can occur in women of any age, but is most common in postmenopausal women. Symptoms include itching and burning with associated pain during intercourse. The surface of the vulvar skin is often extremely thin and may have a paper-like appearance. Because of this, the skin may tear during intercourse and cause pain or bleeding.

Standard initial treatment of lichen sclerosus is application of creams containing high-potency steroids to the affected area. The most common steroid cream is known as clobetasol or Temovate. This cream should be applied to the area twice a day for approximately 2 to 3 weeks, then tapered to once a day, and finally down to occasional use. Most women notice an improvement in symptoms within 1 month of use of the steroid cream. This treatment may be continued on a long-term basis.

Breast cancer is the second leading cause of death in women. About 5% of breast cancers have a genetic component-a possible mutation in the BRCA1 or BRCA2 gene. These genes are normally involved in suppression of tumor cells. Women who have the BRCA1 mutation have an approximately 80% risk of developing breast cancer. They also have an approximately 40% risk of developing ovarian cancer.

If you have a strong family history of breast cancer with multiple first degree relatives with the disease, get tested for mutations in the BRCA1 or BRCA2 genes. A family member with the disease must be tested first. If that person has the mutant gene, tests will be done on you to look for the same mutation. If you are found to have the mutation, you may want to consider mastectomies (removal of your breasts) or oopherectomy (removal of your ovaries) as a preventative measure.

At this point, BRCA1 and BRCA2 testing is not beneficial as a screening tool unless you have a strong family history of the disease. In addition, negative tests do not rule out the possibility of developing breast or ovarian cancer later.

Fibrocystic changes of the breasts are very common, especially from the ages of 20 to 50, and are thought to be directly related to estrogen. Fibrocystic breast masses usually occur on a cyclic basis in relation to the menstrual cycle. They can be quite painful and often appear rapidly with the onset of menses, and then disappear afterward.

The most important characteristic of a fibrocystic lesion of the breast is that it resolves on its own. If your masses/cysts do not resolve, especially after a menstrual cycle, you need to see your physician so that the mass can be further evaluated to assure that it is not a cancerous lesion. This evaluation may necessitate cyst aspiration or biopsy of the mass.

Often people with fibrocystic changes of the breasts notice associated breast tenderness. This pain may be alleviated by wearing a tight bra for support. Although there is no good evidence to support its use, many physicians advocate use of vitamin E and reduction of caffeine to alleviate some of the symptoms.

If you have cysts under the skin, rather than in your breast tissue, you may need other treatments. You should see your physician to exclude this possibility.

It is thought that 45% to 75% of women experience yeast infections (also known as vulvovaginal candidiasis) in their lifetime. It is thought that 45% to 75% of women experience yeast infections (also known as vulvovaginal candidiasis) in their lifetime. In over 80% of cases, infection is caused by an orgainism known as Candida albicans. This is a fungus that resides in the vagina of a significant number of women. Several situations allow overgrowth of Candida albicans including recent antibiotic use, pregnancy, and diabetes.

The signs and symptoms of a vaginal yeast infection often include itching, a thick white vaginal discharge often described as being similar to cottage-cheese, and redness of the vulvar and vaginal areas.

Treatment of a yeast infection is variable. The most common treatment involves using a topical antifungal cream in the vaginal area (such as Gyne-Lotrimin or Monistat). An applicator full of cream is placed in the vagina at bedtime from 1 to 7 days. The medication can be obtained over-the-counter, but should only be used by someone who has been diagnosed by a physician or has had similar symptoms in the past where a diagnosis was made. An oral treatment is now available by prescription.

If you have chronic yeast infections, your physician may start you on a monthly regimen of treatment, usually for a total of 6 months.

Blood in the urine is called hematuria and should never be ignored. It is important to determine exactly where the blood is coming from. In women, the blood may appear to be in the urine when it is actually coming from the vagina or rectum. Discoloration from drugs or foods can mimic hematuria. A catheterized urine sample is an important diagnostic test to make sure that the discoloration is really blood and that the bleeding is coming from the bladder. Also, there is a condition called microscopic hematuria, in which the urine has microscopic amounts of blood that cannot be seen with the naked eye. In the majority of cases tests will be negative and no treatment is necessary. However, before you can make this diagnosis, other more serious causes must be eliminated.

Blood in the urine should never be ignored. It is important to see your physician and have the problem isolated and treated.

Dysplasia is considered a precancerous cell type. However, if the dysplasia is classified as low-grade squamous dysplasia, then about 30% of the time, the abnormal cells will disappear without treatment.

Endometriosis is a condition in which tissue that normally lines the inside of the uterus (the endometrium) spreads and implants in areas outside of the uterus. Often the site of the implantation is somewhere in the abdominal cavity. In patients with endometriosis, these implants of endometrium grow on a cyclic basis just as the normal endometrium does. When the normal endometrium sheds during your menstrual cycle causing your period, so do these endometrial implants. They can cause a small amount of bleeding within your abdominal cavity which results in pain.

Symptoms of endometriosis are often described as menstrual cramping and pain that begins before the onset of menstrual bleeding, and continues through the menstrual cycle. The severity of endometriosis often does not correlate with the degree of pain experienced with endometriosis. Often women with a small amount of endometriosis will have significant cyclic pain, and often women with a large amount of endometriosis will have minimal pain. Endometriosis is often seen in women who previously had pain-free menstrual cycles, and have gradually noticed a worsening in their pain.

The definitive diagnosis of endometriosis can only be made through surgery where the endometriotic lesions can be seen and sometimes biopsied to make the diagnosis.

Bladder infections or urinary tract infections are also known as cystitis. Women often notice an abrupt onset of symptoms, which include burning with urination, urinating more frequently than usual, and abdominal pain. If a urinary tract infection has spread to the kidneys (also known as pyelonephritis) a woman may experience fever and back pain.

Urinary tract infections are caused by spread of bacteria that normally reside in the rectum into the urethra and bladder. Several situations increase your risk of getting a urinary tract infection, among them, recent intercourse, delayed emptying of your bladder after intercourse, and use of a diaphragm.

Many women with one urinary tract infection will have multiple urinary tract infections. Your physician will grow out your urine before and after treatment to be sure treatment is completely irradicating the bacteria. Additionally, it may be helpful to empty your bladder completely after each episode of intercourse. The ultimate treatment for recurrent urinary tract infections will be up to your doctor. She may recommend staying on a medicine that suppresses bacteria consistently, taking medication after intercourse, or taking medication as soon as you notice symptoms.

Some antibiotics and certain other medications have the potential to reduce the effectiveness of birth control pills. Some antibiotics slightly reduce the amount of hormones absorbed by the system.

Among the suspect antibiotics are those in the penicillin family, including penicillin, amoxicillin, and ampicillin; tetracycline, and related drugs such as doxycycline and erythromycin. Some epilepsy drugs, tranquilizers, barbiturates, anti-inflammatories, and laxatives may also reduce the effectiveness of oral contraceptives. The same effect may also occur if you have an intestinal illness that causes diarrhea or vomiting.

The difference between oral hormones and transdermal hormones involves the route of absorption. Oral hormones are absorbed in the gastrointestinal tract and metabolized in the liver. Transdermal hormones, however, are directly absorbed into the blood stream. Therefore the difference between the two routes may account for some difference in gastrointestinal symptoms. Additionally, for people with elevated triglyceride levels, transdermal hormones have been found to be beneficial.

To date, hormone replacement therapy has not been linked to weight loss or weight gain. There is also no evidence to suggest hair loss or acne are related to the low levels of hormones supplied by hormone replacement therapy. The progesterone component of hormone replacement therapy has been associated with bloating. However, it is not safe to take estrogen without progesterone unless you have had a hysterectomy. Sometimes changing the type of progesterone used can be of benefit.

It is unlikely that changing from oral to transdermal hormone replacement therapy will improve all of your symptoms.

Polycystic Ovarian Syndrome is a condition associated with anovulation and was first described in 1935 by Drs. Stein and Leventhal. Thus, the condition is also known as Stein Leventhal Syndrome. As originally described, the condition was associated with decreased menstrual flow, hirsutism, and obesity. However, we now know that the condition is much more complex than originally described. The cause or the event that precipitates the problem is unknown. Because you are not ovulating on a regular basis, you are less likely to conceive. As a result, many women with Polycystic Ovarian Syndrome require medication in order to precipitate ovulation. In general, if you have no other problems that would contribute to infertility, the majority of women are pregnant within three to five cycles. As they say, 'individual results may vary' since everyone is a bit different. With this said, you should feel encouraged. Most women with Polycystic Ovarian Syndrome can have a very successful and healthy pregnancy.

The first day of my last period was on the 28th. I had unprotected sex on the third. I took a pregnancy test on the 11th. The result was negative. How long should I wait for an accurate result?

If your periods are normally every 28 days, then you will ovulate on Day 14. With that in mind, you would ovulate on the 10th. Again, if your periods occur every 28 days, your next period would be on the 25th. The home pregnancy test will detect pregnancy on or about the time for your next period. I would wait and see if your period starts on time. If it does, then obviously you are not pregnant. If it doesn’t, then repeat the pregnancy test.

This a very common question asked by many women who are currently taking oral contraceptives. Women who use oral contraceptives have no reduction in their fertility once they stop taking the pill. There are a number of myths or misconceptions about the use of oral contraceptives. For example, you do not have to stop the pill or switch pills after a certain period of time. In fact, there is no reason to stop the pill until you are ready to have children. Furthermore, there is some evidence that using oral contraceptives actually helps to preserve a woman’s future fertility. For example, women taking oral contraceptives have a reduced incidence of endometriosis and have a reduced incidence of ovarian cyst formation. Unless you experience side-effects with the pill or you are ready to become pregnant, you should continue your oral contraceptives without fear of them reducing your future fertility.

It is not at all unusual for it to take several months for your body to get back to normal after childbirth.

Most women ovulate approximately 14 days prior to the onset of their menstrual cycle. Therefore, if you have regular 28-day periods, you should be ovulating on approximately Day 14. The best chance of pregnancy is 3 to 4 days before ovulation and approximately 2 days after ovulation. Therefore, intercourse during this time frame would have the highest likelihood of being successful. There are ways to test for ovulation such as measuring your basal body temperature or testing your urine for a luteinizing hormone (LH) surge. This may help a woman determine the time of ovulation if her cycle is irregular.