GYNECOLOGY

Gynecologic Problems

Contraception

What are sexually transmitted diseases (STDs)?

Sexually transmitted diseases (STDs) are infections that are spread by sexual contact. Sexually transmitted diseases can cause severe damage to your body—even death. Except for colds and flu, STDs are the most common contagious (easily spread) diseases in the United States, with millions of new cases each year. Although some STDs can be treated and cured, others cannot.

How are STDs transmitted?

A person with an STD can pass it to others by contact with skin, genitals, mouth, rectum, or body fluids. Anyone who has sexual contact—vaginal, anal, or oral sex—with another person may get an STD. People with an STD may not have any symptoms and may not know they have it. Even if there are no symptoms, your health can be affected.

What causes STDs?

Sexually transmitted diseases are caused by bacterial or viral infections. Sexually transmitted diseases caused by bacteria are treated with antibiotics. Those caused by viruses cannot be cured, but symptoms can be treated.

What are the risk factors for STDs?

The following factors increase the risk of getting STDs:

  • More than one sexual partner
  • A partner who has or has had more than one sexual partner
  • Sex with someone who has an STD
  • History of STDs
  • Use of intravenous drugs (injected into a vein) or partner use of intravenous drugs
  • Adolescents have a higher risk of getting an STD than adults.

What are some of the most common STDs?

  • Chlamydia
  • Gonorrhea
  • Genital herpes
  • Human immunodeficiency virus (HIV) infection
  • Human papillomavirus (HPV) infection
  • Syphilis
  • Trichomoniasis
  • Hepatitis B

How can I reduce the risk of getting an STD?

There are many ways you can reduce your risk of getting an STD:

Know your sexual partners and limit their number—Your partner’s sexual history is as important as your own. The more partners you or your partners have, the higher your risk of getting an STD.

Use a latex condom—Using a latex condom every time you have vaginal, oral, or anal sex decreases the chances of infection. Condoms lubricated with spermicides do not offer extra protection. Frequent use of some spermicides can increase the risk of HIV.

Avoid risky sex practices—Sexual acts that tear or break the skin carry a higher risk of STDs. Even small cuts that do not bleed let germs pass back and forth. Anal sex poses a high risk because tissues in the rectum tear easily. Body fluids also can carry STDs. Having any unprotected sexual contact with an infected person poses a high risk of getting an STD.

Get immunized—Vaccinations are available that will help prevent hepatitis B and some types of HPV (see the FAQs Human Papillomavirus (HPV) Vaccines and Protecting Yourself Against Hepatitis B and Hepatitis C).

How can STDs affect pregnancy?

Having an STD during pregnancy can harm the baby if it is passed to him or her. Gonorrhea and chlamydia both can cause health problems in the infant ranging from eye infections to pneumonia. Syphilis may cause miscarriage or stillbirth. Human immunodeficiency virus infection can occur in a baby.

If you are pregnant and you or your partner have had—or may have—an STD, inform your health care provider. Your baby may be at risk. Tests for some STDs are offered routinely during prenatal care. It is best to treat the STD early to decrease the chances that your baby also will contract the disease. You and your partner both may have to be treated.

What are pelvic support problems?
The pelvic organs include the vagina, cervix, uterus, bladder, urethra, small intestines, and rectum. The pelvic organs are held in place by muscles of the pelvic floor. Layers of connective tissue called fascia also provide support. These supporting muscles and fascia may become torn or stretched, or they may weaken because of aging. Problems with pelvic support often are associated with pelvic organ prolapse. In this condition, the fascia and muscles can no longer support the pelvic organs. As a result, the organs that they support can drop downward.

What are the symptoms of pelvic organ prolapse?
Many women have no symptoms and are not bothered by their pelvic organ prolapse. The symptoms of those who do have problems can range from mild to severe. Listed are common symptoms of pelvic organ prolapse:

  • Feeling of pelvic heaviness or fullness
  • Bulge in the vagina
  • Organs bulging out of the vagina
  • Pulling or aching feeling or a feeling of pressure in the lower abdomen or pelvis
  • Lower back pain
  • Leakage of urine (urinary incontinence) or problems having a bowel movement
  • Needing to push organs back up into the vagina to empty the bladder or have a bowel movement
  • Sexual difficulties
  • Problems with inserting tampons or applicators
  • Pelvic pressure that gets worse with standing, lifting, or coughing or as the day goes on

What causes pelvic organ prolapse?
The main cause of pelvic organ prolapse is having had children. Women who have had a vaginal delivery have a slightly increased risk of pelvic support problems than those who have had a cesarean delivery.

Other causes of pelvic support problems include the following:

  • Prior pelvic surgery
  • Menopause
  • Aging
  • Intense physical activity
  • Factors that increase pressure in the abdomen, such as being overweight or obese, constipation and straining to have a
  • bowel movement, and chronic coughing
  • Genetic factors

What are the types of pelvic organ prolapse?
There are many types of prolapse:

Uterine prolapse—The uterus drops into the vagina.
Vaginal vault prolapse—The top of the vagina—the "vaginal vault"—drops. This problem occurs most often in women who have had a hysterectomy.
Cystocele—The bladder drops from its normal place into the vagina.
Urethrocele—A urethrocele happens when the urethra bulges into the vagina. It often occurs with a cystocele.
Enterocele—The small intestine pushes against the back wall of the vagina, creating a bulge. Enteroceles often occur with vaginal vault prolapse.
Rectocele—The rectum bulges into or out of the vagina.
What exams are performed to help diagnose pelvic support problems?
Your health care provider will do a thorough exam, including a vaginal and rectal exam. You may be examined while lying down or while standing. You may be asked to strain or cough during the exam to see if you leak urine. How completely your bladder empties also may be checked.

What are some nonsurgical ways to obtain symptom relief?
Lifestyle changes—If incontinence is a problem, limiting fluid intake, including drinks that contain caffeine (a diuretic), may be helpful. Women with bowel problems may find that increasing the amount of fiber in their diets prevents constipation and straining during bowel movements. Sometimes a laxative or medication that softens stools is prescribed.

Bladder training—In this form of therapy, you empty your bladder at scheduled times. It may be useful for women with incontinence.

Weight loss—If you are overweight or obese, weight loss can help improve your overall health and possibly your prolapse symptoms.

Kegel exercises—These exercises strengthen the muscles that surround the openings of the urethra, vagina, and rectum. Doing these exercises regularly may improve incontinence.

Pessaries—A pessary is a device that is inserted into the vagina to support the pelvic organs. A health care provider can help find the right pessary that fits comfortably.

What are Kegel exercises?
Squeeze the muscles that you use to stop the flow of urine. This contraction pulls the vagina and rectum up and back.
Hold for up to 10 seconds, then release.
Do 50 contractions a day for 4–6 weeks.
Make sure you are not squeezing your stomach, thigh, or buttocks muscles. You also should avoid holding your breath as you do these exercises.

Can surgery correct pelvic support problems?
Some pelvic support problems may be corrected by surgery to restore the normal depth and function of the vagina. Symptoms such as back pain, pelvic pressure, and painful sex may not be relieved by surgery to repair the prolapse. However, the chances of getting some degree of relief are quite good.
Prolapse can recur after surgery. The factors that caused a woman to have prolapse in the first place can cause it to occur again.

Glossary
Bladder: A muscular organ in which urine is stored.

Cervix: The lower, narrow end of the uterus, which protrudes into the vagina.

Cesarean Delivery: Delivery of a baby through incisions made in the mother’s abdomen and uterus.

Cystocele: Bulging of the bladder into the vagina.

Diuretic: A drug given to increase the production of urine.

Enterocele: Bulging of the small intestine into the upper part of the vagina.

Fascia: Tissue that supports the organs and muscles of the body.

Hysterectomy: Removal of the uterus.

Incontinence: Inability to control bodily functions such as urination.

Laxative: A product that is used to empty the bowels.

Pelvic Floor: A muscular membrane at the base of the abdomen attached to the pelvis.

Pessary: A device inserted into the vagina to support sagging organs.

Rectocele: Bulging of the rectum into the vaginal wall.

Rectum: The last part of the digestive tract.

Urethra: A tube-like structure through which urine flows from the bladder to the outside of the body.

Urethrocele: Protrusion of the urethra into the vaginal wall.

Uterine Prolapse: Sagging of the uterus into the vagina.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.

Vaginal Vault Prolapse: Bulging of the top of the vagina into the lower vagina or outside the opening of the vagina.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Glossary
Adhesions: Scarring that binds together the surfaces of tissues.

Biopsy: A minor surgical procedure to remove a small piece of tissue that is then examined under a microscope in a laboratory.

Bladder: A muscular organ in which urine is stored.

Endometriosis: A condition in which tissue similar to that normally lining the uterus is found outside of the uterus, usually on the ovaries, fallopian tubes, and other pelvic structures.

Endometrium: The lining of the uterus.

Estrogen: A female hormone produced in the ovaries.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

Gonadotropin-Releasing Hormone Agonists: Medical therapy used to block the effects of certain hormones.

Hormone: A substance produced by the body to control the functions of various organs.

Hysterectomy: Removal of the uterus.

Infertility: A condition in which a couple has been unable to get pregnant after 12 months without the use of any form of birth control.

Inflammation: Pain, swelling, redness, and irritation of tissues in the body.

Laparoscopy: A surgical procedure in which an instrument called a laparoscope is inserted into the pelvic cavity through small incisions. The laparoscope is used to view the pelvic organs. Other instruments can be used with it to perform surgery.

Ovaries: Two glands, located on either side of the uterus, that contain the eggs released at ovulation and that produce hormones.

Pelvic Exam: A physical examination of a woman’s reproductive organs.

Peritoneum: The membrane that lines the abdominal cavity and surrounds the internal organs.

Progestin: A synthetic form of progesterone that is similar to the hormone produced naturally by the body.

Rectum: The last part of the digestive tract.

Ureters: A pair of tubes, each leading from one of the kidneys to the bladder.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

How common is painful sex?
Pain during intercourse is very common—nearly 3 out of 4 women have pain during intercourse at some time during their lives. For some women, the pain is only a temporary problem; for others, it is a long-term problem.

What causes pain during sex?
Pain during sex may be a sign of a gynecologic problem, such as ovarian cysts or endometriosis. Pain during sex also may be caused by problems with sexual response, such as a lack of desire (the feeling of wanting to have sex) or a lack of arousal (the physical and emotional changes that occur in the body as a result of sexual stimulation).

Where is pain during sex felt?
You may feel pain in your vulva, in the area surrounding the opening of your vagina (called the vestibule), or within your vagina. The perineum is a common site of pain during sex. You also may feel pain in your lower back, pelvic region, uterus, or bladder.

When should I see a health care provider about painful sex?                                                                                                 If you have frequent or severe pain during sex, you should see a health care provider. It is important to rule out gynecologic conditions that may be causing your pain. Your health care provider also can help you address problems with sexual response.

What causes sexual response problems?
The following reasons are among the most common:

  • Your state of mind—Emotions such as fear, guilt, shame, embarrassment, or awkwardness about having sex may make it hard to relax. When you cannot relax, arousal is difficult, and pain may result. Stress and fatigue can affect your desire to have sex.
  • Relationship problems—Problems with your partner may interfere with your sexual response. A common relationship issue is a mismatch between partners in their level of desire for sex.
  • Medications—Many medications can reduce sexual desire, including some birth control methods. Many pain medications also can reduce sexual desire.
  • Medical and surgical conditions—Some medical conditions can indirectly affect sexual response. These conditions include arthritis, diabetes, cancer, and thyroid conditions. Some women who have had surgery find that it affects their body image, which may decrease their desire for sex.
  • Your partner—If your partner has a sexual problem, it can make you anxious about sex. If your partner is taking a drug for erectile dysfunction, he may have delayed orgasm, which can cause long, painful intercourse.

What kinds of gynecologic conditions can cause pain during sex?
Pain during sexual intercourse can be a warning sign of many gynecologic conditions. Some of these conditions can lead to other problems if not treated:

Skin disorders—Some skin disorders may result in ulcers or cracks in the skin of the vulva. Contact dermatitis is a common skin disorder that affects the vulva. It is a reaction to an irritating substance, such as perfumed soaps, douches, or lubricants. It may cause itching, burning, and pain. Treatment of skin disorders depends on the type of disorder.

Vulvodynia—This is a pain disorder that affects the vulva. When pain is confined to the vestibule (the area around the opening of the vagina), it is known as vulvar vestibulitis syndrome (VVS). There are many treatments available for vulvodynia, including self-care measures. Medication or surgery may be needed in some cases. For more information about this condition, see the FAQ Vulvodynia.

Hormonal changes—During perimenopause and menopause, decreasing levels of the female hormone estrogen may cause vaginal dryness. Hormone therapy is one treatment option. Using a lubricant during sex or a vaginal moisturizer also may be helpful.

Vaginitis—Vaginitis, or inflammation of the vagina, can be caused by a yeast or bacterial infection. Symptoms are discharge and itching and burning of the vagina and vulva. Vaginitis can be treated with medication (see the FAQ Vaginitis).

Vaginismus—Vaginismus is a reflex contraction (tightening) of the muscles at the opening of your vagina. Vaginismus may cause pain when you try to have sexual intercourse. Vaginismus can be treated with different forms of therapy.

Childbirth—Women who have had an episiotomy or tears in the perineum during childbirth may have pain during sex that may last for several months. Treatments include physical therapy, medications, or surgery.

Other causes—Pelvic inflammatory disease, endometriosis, and adhesions are all associated with pain during sex.

What can I expect when I see my health care provider about pain during sex?
Your medical and sexual history, signs and symptoms, and findings from a physical exam are important factors in determining the cause of your pain. Sometimes, tests are needed to find the cause. A pelvic exam or ultrasound exam often gives clues about the causes of some kinds of pain. Further evaluation, sometimes involving a procedure called a laparoscopy, may be needed.

You also may be asked about medications that you are taking, whether you have any medical conditions, and past events that may affect how you feel about sex, such as sexual abuse. Other health care providers may be consulted for further evaluation and treatment, such as a physical therapist or a dermatologist (a specialist in diseases of the skin).

Are there things a woman can do on her own to help with pain during sex?
If you have pain during sex, see a health care provider. However, there are some self-help measures you can try to relieve pain during sex:

Use a lubricant. Water-soluble lubricants are a good choice if you experience vaginal irritation or sensitivity. Silicone-based lubricants last longer and tend to be more slippery than water-soluble lubricants. Do not use petroleum jelly, baby oil, or mineral oil with condoms. They can dissolve the latex and cause the condom to break.

Make time for sex. Set aside a time when neither you nor your partner is tired or anxious.
Talk to your partner. Tell your partner where and when you feel pain, as well as what activities you find pleasurable.

Try sexual activities that do not cause pain. For example, if intercourse is painful, you and your partner may want to focus on oral sex or mutual masturbation.

Try nonsexual, but sensual, activities like massage.

Take pain-relieving steps before sex: empty your bladder, take a warm bath, or take an over-the-counter pain reliever before intercourse.

To relieve burning after intercourse, apply ice or a frozen gel pack wrapped in a small towel to the vulva.

Glossary

Adhesions: Scarring that binds together the surfaces of tissues.

Cyst: A sac or pouch filled with fluid or other material.

Endometriosis: A condition in which tissue similar to that normally lining the uterus is found outside of the uterus, usually on the ovaries, fallopian tubes, and other pelvic structures.

Episiotomy: A surgical incision made into the perineum (the region between the vagina and the anus) to widen the vaginal opening for delivery.

Estrogen: A female hormone produced in the ovaries.

Laparoscopy: A surgical procedure in which a slender, light-transmitting instrument, the laparoscope, is used to view the pelvic organs or perform surgery.

Masturbation: Self-stimulation of the genitals, usually resulting in orgasm.

Menopause: The time in a woman’s life when the ovaries have stopped functioning; defined as the absence of menstrual periods for 1 year.

Pelvic Exam: A manual examination of a woman’s reproductive organs.

Pelvic Inflammatory Disease: An infection of the uterus, fallopian tubes, and nearby pelvic structures.

Perimenopause: The period around menopause that usually extends from age 45 years to 55 years.

Perineum: The area between the vagina and the anus.

Ultrasound: A test in which sound waves are used to examine internal structures.

Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.

Vestibule: The space within the labia minora into which the vagina and urethra open.

Vulva: The external female genital area.

What is breast tissue made of?
Your breasts are made up of glands, fat, and fibrous tissue. Each breast has 15–20 sections called lobes. Each lobe has many smaller lobules. The lobules end in dozens of tiny glands that can produce milk.

What kinds of changes occur in breast tissue throughout life?
Your breasts respond to changes in levels of the hormones estrogen and progesterone during your menstrual cycle, pregnancy, breastfeeding, and menopause. Hormones cause a change in the amount of fluid in the breasts. This may make the breasts feel more sensitive or painful. You may notice changes in your breasts if you use hormonal contraception such as birth control pills or hormone therapy.

What are benign breast problems?
Benign breast problems are breast problems that are not cancerous. There are four common benign breast problems:

1. Fibrocystic breast changes

2. Cysts

3. Fibroadenomas

4. Mastitis

What are fibrocystic breast changes?
Some women have breasts that are swollen, lumpy, and tender. These are called fibrocystic breast changes. The condition is most common in the childbearing years but also can happen after menopause in women who are taking hormone therapy.

Is there treatment for fibrocystic breast changes?
There is no treatment, but there are things you can do to help relieve the symptoms:

  • Apply heat or ice to the breast.
  • Take an over-the-counter nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen.
  • Wear a well-fitting bra.

What are breast cysts?

Breast cysts are small sacs filled with fluid. They can be almost any size. Some cysts feel like a soft grape or water-filled balloon, but some can feel firm. You may have pain or tenderness in the area of the cyst. The cyst may get bigger just before your menstrual period. Cysts are common in women between the ages of 25 years and 50 years and they usually go away after menopause, although women who take hormone therapy may continue to have cysts.

How are breast cysts treated?
Breast cysts are treated if they are large and painful. If your cysts are causing discomfort, your health care provider may drain the fluid with a procedure called fine-needle aspiration. The cyst also may be surgically removed. Birth control pills may be used to help prevent cysts from coming back.

What are fibroadenomas?
Fibroadenomas are solid lumps that occur most often in young women. Fibroadenomas may appear in both breasts. The lumps have a well-defined smooth shape. Usually they do not cause any pain.

How are fibroadenomas treated?
In many cases, treatment is not needed for fibroadenomas. Some women, however, decide to have surgery to remove the lumps. This is called a lumpectomy.

What is mastitis?
Mastitis is an infection in the breast tissue. It most commonly happens when a woman is breastfeeding and a duct becomes clogged with milk and does not drain properly. Infection sometimes can occur unrelated to pregnancy and breastfeeding. Mastitis can cause flu-like symptoms, such as fever, aches, and fatigue. Your breasts also may be swollen, painful, have red streaks, and feel hot to the touch.

How is mastitis treated?
There are different treatments for mastitis, depending on the type of infection. These treatments include emptying your breasts of milk; taking antibiotics; or applying a warm, wet cloth to your breast for 15–20 minutes, a few times a day. If you are taking antibiotics, you usually can continue to breastfeed your baby or use a breast pump to prevent your breasts from getting engorged with milk.

What should I do if I find a lump in my breast?
If you find a lump or suspicious area in your breast, contact your health care provider. Your health care provider will probably do a physical exam of your breasts. This is called a clinical breast exam. Based on the results of this exam, more tests may be recommended.

What is mammography?
Mammography can be used as a screening test for breast cancer (screening mammography) or to help diagnose a suspicious area or problem (diagnostic mammography). An annual screening mammogram is recommended for women aged 40–75 years. Women older than 75 years should talk to their health care providers about the need to continue having this test.

What happens if a suspicious lump or area is found during a routine screening mammogram?
If a suspicious area or lump is found on a screening mammogram, you will be called back for a follow-up test to find the exact cause of the problem. Follow-up testing may be a diagnostic mammogram, an ultrasound exam, or a magnetic resonance imaging (MRI) exam.

What happens if the results of the follow-up tests to my routine screening tests are abnormal?
If the results of the follow-up tests are abnormal, you may have a biopsy. There are several types of biopsies. The type of biopsy you have depends on several factors, including the size and location of the lump or area:

Fine-needle aspiration is the removal of a small sample of tissue from the lump through a thin, hollow needle into a syringe.

A core biopsy is the removal of a sample of tissue with the use of a needle with a special tip.

A surgical biopsy or lumpectomy is a procedure in which a surgeon removes part or all of the lump.

Glossary
Antibiotics: Drugs that treat infections.

Benign: Not cancer.

Biopsy: A minor surgical procedure to remove a small piece of tissue that is then examined under a microscope in a lab.

Estrogen: A female hormone produced in the ovaries.

Fine-needle Aspiration: A procedure in which a needle and syringe are used to withdraw a small amount of tissue. The tissue sample then is examined under a microscope to look for cancer cells.

Hormone Therapy: Treatment in which estrogen, and often progestin, is taken to help relieve some of the symptoms caused by the low levels of hormones produced by the body.

Hormones: Substances produced by the body to control the functions of various organs.

Lumpectomy: Complete surgical removal of a breast lump.

Magnetic Resonance Imaging (MRI): A method of viewing internal organs and structures by using a strong magnetic field and sound waves.

Mammography: A procedure in which X-rays of the breast are used to detect breast cancer.

Menopause: The time in a woman’s life when the ovaries have stopped functioning; defined as the absence of menstrual periods for 1 year.

Progesterone: A female hormone that is produced in the ovaries and prepares the lining of the uterus for pregnancy.

Screening Test: A test that looks for possible signs of disease in people who do not have symptoms.

Ultrasound Exam: A test in which sound waves are used to examine internal structures.

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

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

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

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

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

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

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

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

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

What treatments are available for vaginal yeast infection?
Yeast infections can be treated either by placing medication into the vagina or by taking a pill.

Should I use an over-the-counter medication to treat a yeast infection?
Over-the-counter treatments are safe and often effective in treating yeast infections. But many women think that they have a yeast infection when they actually have another problem. In these cases, a medication for a yeast infection will not work and may cause a delay in proper diagnosis and treatment of the actual problem.

Even if you have had a yeast infection before, it may be a good idea to call your health care provider before using an over-the-counter medication to treat your symptoms. If this is the first time you have had vaginal symptoms, you should see your health care provider. If you have used an over-the-counter medication and your symptoms do not go away, see your health care provider.

What is bacterial vaginosis?
Bacterial vaginosis is caused by overgrowth of the bacteria that occur natually in the vagina.

What are the symptoms of bacterial vaginosis?
The main symptom is increased discharge with a strong fishy odor. The discharge usually is thin and dark or dull gray, but may have a greenish color. Itching is not common, but may be present if there is a lot of discharge.

How is bacterial vaginosis treated?
Several different antibiotics can be used to treat bacterial vaginosis, but the two that are most commonly used are metronidazole and clindamycin. They can be taken by mouth or inserted into the vagina as a cream or gel.

What is trichomoniasis?
Trichomoniasis is a condition caused by the microscopic parasite Trichomonas vaginalis. It is spread through sex. Women who have trichomoniasis are at an increased risk of infection with other STDs.

What are the symptoms of trichomoniasis?
Signs of trichomoniasis may include a yellow-gray or green vaginal discharge. The discharge may have a fishy odor. There may be burning, irritation, redness, and swelling of the vulva. Sometimes there is pain during urination.

How is trichomoniasis treated?
Trichomoniasis usually is treated with a single dose of metronidazole by mouth. Do not drink alcohol for 24 hours after taking this drug because it causes nausea and vomiting. Sexual partners must be treated to prevent the infection from recurring.

What is atrophic vaginitis?
Atrophic vaginitis is not caused by an infection but can cause vaginal discharge and irritation, such as dryness, itching, and burning. This condition may occur any time when female hormone levels are low, such as during breastfeeding and after menopause. Atrophic vaginitis is treated with estrogen, which can be applied as a vaginal cream, ring, or tablet. A water-soluble lubricant also may be helpful during intercourse.

Glossary

Antibiotics: Drugs that treat infections.

Bacterial Vaginosis: A type of vaginal infection caused by the overgrowth of a number of organisms that are normally found in the vagina.

Candidiasis: Also called yeast infection or moniliasis, a type of vaginitis caused by the overgrowth of Candida (a fungus normally found in the vagina).

Clindamycin: An antibiotic used to treat, among other kinds of infections, certain types of vaginitis.

Estrogen: A female hormone produced by the ovaries that stimulates the growth of the lining of the uterus.

Hormones: Substances produced by the body to control the functions of various organs.

Menopause: The time in a woman’s life when the ovaries stop functioning; defined as the absence of menstrual periods for 1 year.

Metronidazole: An antibiotic used to treat some vaginal and abdominal infections.

Spermicides: Chemicals that inactivate sperm. They come in creams, gels, foams, and suppositories. Some condoms are coated with spermicides.

Trichomoniasis: A type of vaginal infection caused by a one-celled organism that is usually transmitted through sex.

Vulva: The external female genital area.

What is dysmenorrhea?
Pain associated with menstruation is called dysmenorrhea.

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

What are the types of dysmenorrhea?
There are two types of dysmenorrhea: primary dysmenorrhea and secondary dysmenorrhea.

What is primary dysmenorrhea?
Primary dysmenorrhea is pain that comes from having a menstrual period, or "menstrual cramps."

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

When does the pain associated with primary dysmenorrhea occur during the menstrual period?
Pain usually occurs right before menstruation starts, as the level of prostaglandins increases in the lining of the uterus. On the first day of the menstrual period, the levels are high. As menstruation continues and the lining of the uterus is shed, the levels decrease. Pain usually decreases as the levels of prostaglandins decrease.

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

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

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

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

Endometriosis—In this condition, tissue from the lining of the uterus is found outside the uterus, such as in the ovaries and fallopian tubes, behind the uterus, and on the bladder. Like the lining of the uterus, endometriosis tissue breaks down and bleeds in response to changes in hormones. This bleeding can cause pain, especially right around menstruation. Scar tissue called adhesions may form inside the pelvis where the bleeding occurs. Adhesions can cause organs to stick together, resulting in pain.

Adenomyosis—Tissue that normally lines the uterus begins to grow in the muscle wall of the uterus.

Fibroids—Fibroids are growths that form on the outside, on the inside, or in the walls of the uterus (see the FAQ Uterine Fibroids). Fibroids located in the wall of the uterus can cause pain.

What tests are done to find the cause of dysmenorrhea?
If you have dysmenorrhea, your health care provider will review your medical history, including your symptoms and menstrual cycles. He or she also will do a pelvic exam.

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

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

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

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

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

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

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

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

When is uterine artery embolization (UAE) done to treat dysmenorrhea?
If fibroids are causing your dysmenorrhea, a treatment called uterine artery embolization (UAE) may help.

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

What complications are associated with UAE?
Complications include infection, pain, and bleeding.

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

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

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

Glossary

Adenomyosis: A condition in which the tissue that normally lines the uterus begins to grow in the muscle wall of the uterus.

Adhesions: Scarring that binds together the surfaces of tissues.

Bladder: A muscular organ in which urine is stored.

Dysmenorrhea: Discomfort and pain during the menstrual period.

Endometriosis: A condition in which tissue that lines the uterus is found outside of the uterus, usually on the ovaries, fallopian tubes, and other pelvic structures.

Estrogen: A female hormone produced in the ovaries.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

Fibroids: Benign growths that form in the muscle of the uterus.

Gonadotropin-releasing Hormone Agonists: Medical therapy used to block the effect of certain hormones.

Hormones: Substances produced by the body to control the functions of various organs.

Hysterectomy: Removal of the uterus.

Intrauterine Device: A small device that is inserted and left inside the uterus to prevent pregnancy.

Laparoscopy: A surgical procedure in which an instrument called a laparoscope is inserted into the pelvic cavity through small incisions. The laparoscope is used to view the pelvic organs. Other instruments can be used with it to perform surgery.

Ovaries: Two glands, located on either side of the uterus, that contain the eggs released at ovulation and that produce hormones.

Pelvic Exam: A manual examination of a woman’s reproductive organs.

Progestin: A synthetic form of progesterone that is similar to the hormone produced naturally by the body.

Prostaglandins: Chemicals that are made by the body that have many effects, including causing the muscle of the uterus to contract, usually causing cramps.

Ultrasound Exam: A test in which sound waves are used to examine internal organs.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

How do urinary tract infections ( UTIs) develop?
Most urinary tract infections start in the lower urinary tract, which is made up of the urethra and bladder. Bacteria from the bowel live on the skin near the anus or in the vagina. These bacteria can spread and enter the urinary tract through the urethra. If they move up the urethra, they may cause a bladder infection (called cystitis). Bacteria that have infected the bladder may travel to the upper urinary tract, the ureters and the kidneys. An infection of the kidneys is called pyelonephritis. An upper urinary tract infection may cause a more severe illness than a lower urinary tract infection.

Women are more likely than men to get UTIs because the urethra is shorter in a woman than in a man. In women, the bacteria can reach the bladder more easily.

What causes UTIs?
Women’s anatomy makes them prone to getting UTIs after having sex. The opening of the urethra is in front of the vagina. During sex, bacteria near the vagina can get into the urethra from contact with the penis, fingers, or devices.

Urinary tract infections also tend to occur in women when they begin having sex or have it more often. Using spermicides or a diaphragm also can cause more frequent UTIs.

Infections also can occur when the bladder does not empty completely. This condition may be caused by 

  • blockage (a stone) in the ureters, kidneys, or bladder that prevents the flow of urine through the urinary tract 
  • a narrowed tube (or a kink) in the urinary tract 
  • problems with the pelvic muscles or nerves

What other factors increase the risk of getting a UTI?
You are more likely to get an infection if you 

  • have had a UTI before 
  • have had several children 
  • have diabetes
  •  are obese 

Menopause also increases the risk of getting a UTI. During menopause, the level of estrogen decreases. This decrease can cause changes in the tissues around the urethra that can lead to a UTI. UTIs can occur during pregnancy. If you are pregnant and think you may have a UTI, be sure to tell your health care provider promptly. If untreated, it may cause problems for you and your baby.

What are the signs of a UTI?
One sign is a strong urge to urinate that cannot be delayed (urgency). As urine flows, a sharp pain or burning, called dysuria, is felt in the urethra. The urge to urinate then returns minutes later (frequency). Soreness may be felt in the lower abdomen, in the back, or in the sides.

Other signs may show up in the urine. It may have a strong odor look cloudy sometimes be tinged with blood Blood in the urine may be caused by a UTI, but it also may be caused by other problems. Tell your health care provider promptly if you see blood in your urine.

If the bacteria enter the ureters and spread to the kidneys, symptoms also may include

  • back pain
  • chills
  • fever
  • nausea
  • vomiting

If you have any of these symptoms, tell your health care provider right away. Kidney infections are serious. They need to be treated promptly.

Symptoms linked with a UTI, such as painful urination, can be caused by other problems (such as an infection of the vagina or vulva). Tests may be needed to confirm the diagnosis. Be sure to let your health care provider know if you have any of these symptoms.

How are UTIs diagnosed?
Your health care provider may first do a simple test, called urinalysis, to find out whether you have a UTI. For this test, you will be asked to provide a urine sample. This sample will be studied in a lab for the presence of white and red blood cells and bacteria. Normal urine should not have bacteria or blood cells in it. If either of these shows up in the urine, you may have a UTI.

The urine sample also may be grown in a culture (a substance that promotes the growth of bacteria) to see which bacteria are present. The sample also may be tested with different antibiotics to see which one destroys the bacteria best. This is called a sensitivity test.

How are UTIs treated?
Antibiotics are used to treat UTIs. The type, dose, and length of the antibiotic treatment depend on the type of bacteria causing the infection and on your medical history.

Treatment is usually quick and effective. Most symptoms go away in 1–2 days. Be sure to take all the medication even though your symptoms may go away before you finish your prescription. If you stop treatment early, the infection may still be present or it could come back after a short time.

For more severe infections, such as a kidney infection, you may need to stay in the hospital. These infections take longer to treat and you may be given medication intravenously (through a tube in a vein).

What is a recurrent infection?
If you have more than two UTIs in a year, you have a recurrent infection. The first step in treatment is finding the cause. Factors that increase the risk of recurrent infection are

  • frequent sex
  • young age at first UTI
  • spermicide use
  • diaphragm use
  • a new sexual partner

Recurrent infections are treated with antibiotics. A week or two after you finish treatment, a urine test may be done to see if the infection is cured. Changing your birth control method also may be recommended. If you often get UTIs through sexual activity, you may be given an antibiotic to take in single doses after you have sex.

How can UTIs be prevented?
There are a number of ways to prevent UTIs:

  • After a bowel movement or after urinating, wipe from front to back.
  • Wash the skin around the anus and the genital area.
  • Avoid using douches, powder, and deodorant sprays.
  • Drink plenty of fluids (including water) to flush bacteria out of your urinary system.
  • Empty your bladder as soon as you feel the urge or about every 2–3 hours.
  • Try to empty your bladder before and after sex.
  • Wear underwear with a cotton crotch.

Unsweetened cranberry juice and cranberry pills may decrease the risk of getting a UTI. The exact amount of juice or pills needed and how long you need to take them to prevent infection are being studied. Treatment with an estrogen cream or pills is being studied as a way to prevent UTIs in women past menopause.

Glossary

Antibiotics: Drugs that treat infections.

Anus: The opening of the rectum on the outside of the body.

Bladder: A muscular organ in which urine is stored.

Dysuria: Pain during urination.

Estrogen: A female hormone produced in the ovaries.

Kidneys: Two organs that cleanse the blood, removing liquid wastes.

Menopause: The process in a woman’s life when ovaries stop functioning and menstruation stops.

Recurrent Infections: Infections that occur more than once, usually within a short time, although they may be spread out over several months.

Spermicides: Chemicals (creams, gels, foams) that inactivate sperm.

Ureters: A pair of tubes, each leading from one of the kidneys to the bladder.

Urethra: A short, narrow tube that carries urine from the bladder out of the body.

Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.

Vulva: The external female genital area.

What is genital herpes?
Genital herpes is a sexually transmitted disease (STD). Genital herpes is probably best known for the sores and blisters it causes. These sores can appear around the lips, genitals, or anus. The place where the sores appear is the original site where the virus entered your body. Genital herpes can be spread through direct contact with these sores, most often during sexual activity. However, it also can be spread even if you do not see a sore.

How does genital herpes infection occur?
The herpes virus can pass through a break in your skin during vaginal, oral, or anal sex. It can enter the moist membranes of the penis, vagina, urinary opening, cervix, or anus.

Once the virus gets into your body, it infects healthy cells. Your body’s natural defense system then begins to fight the virus. This causes sores, blisters, and swelling.

Besides the sex organs, genital herpes can affect the tongue, mouth, eyes, gums, lips, fingers, and other parts of the body. During oral sex, herpes can be passed from a cold sore around the mouth to a partner’s genitals or vice versa. You even can reinfect yourself if you touch a sore and then rub or scratch another part of your body, especially your eyes.

What are the symptoms of genital herpes?
Many people infected with herpes have no symptoms. When symptoms do occur, they can be mild (only a few sores) or severe (many sores). Symptoms usually appear about 2–10 days after the herpes virus enters your body. You may feel like you have the flu. You may get swollen glands, fever, chills, muscle aches, fatigue, and nausea. You also may get sores. Sores appear as small, fluid-filled blisters on the genitals, buttocks, or other areas. The sores often are grouped in clusters. A stinging or burning feeling when you urinate also is common.

The first bout with genital herpes may last 2–4 weeks. During this time, the lesions break open and "weep." Over a period of days, the sores become crusted and then heal without leaving scars.

How is genital herpes diagnosed?
Several tests can be used to diagnose herpes. The most accurate way is to obtain a sample from the sore and see if the virus grows in a special fluid. Test results may take about 1 week. A positive result confirms the diagnosis, but a negative result does not rule it out. Blood tests also can be helpful in some cases. These tests check for the antibodies that the body makes to fight the virus. This test can help show if it is a new infection or a repeat outbreak.

How is genital herpes treated?
Oral medications help control the course of the disease. Medication can shorten the length of an outbreak and help reduce discomfort.

Can I get rid of herpes?
There is no cure for genital herpes. Although herpes sores heal in days or weeks, herpes does not leave your body. The virus travels to nerve cells near your spine. It stays there until some event triggers a new bout. The virus then travels along the nerves, back to where it first entered the body, and a new outbreak may occur. Sometimes the virus is present even when you do not see any sores.

What happens when lesions recur?
If lesions recur, you may feel burning, itching, or tingling near where the virus first entered your body. You also may feel pain in your lower back, buttocks, thighs, or knees. These symptoms are called a prodrome. A few hours later, sores will appear. There is usually no fever and no swelling in the genital area. Sores heal more quickly—within 3–7 days in most cases. Also, repeat outbreaks usually are less painful.

Is there any treatment that prevents repeat outbreaks?
If you have repeat outbreaks, taking medication on a daily basis can greatly reduce the symptoms. In many cases, it can prevent outbreaks for a long time. It also reduces the chance that you will give herpes to someone else.

How can I prevent transmission of genital herpes?
If you or your partner has oral or genital herpes, avoid sex from the time of prodromal symptoms until a few days after the scabs have gone away. Be sure that lesions and their secretions do not touch the other person’s skin. Wash your hands with soap and water after any possible contact with lesions. This will keep you from reinfecting yourself or passing the virus to someone else.

It is possible for you to pass herpes to someone else even when you do not have sores because the virus can be present without causing any symptoms. Using a condom may reduce your risk of passing or getting genital herpes, but does not protect against all cases. Although the virus does not cross through the condom, lesions not covered by the condom can cause infection. But using a condom will help protect you from other STDs.

How can having genital herpes affect pregnancy?
If you are pregnant and have herpes, tell your health care provider. During pregnancy, there are increased risks to the baby, especially if it is the mother’s first outbreak. Women who are infected for the first time in late pregnancy have a high risk (30–60%) of infecting the baby because they have not yet made antibodies against the virus. Although rare, when a newborn is infected, it most often occurs when he or she passes through the mother’s infected birth canal. A herpes infection can cause serious problems in newborns, such as brain damage or eye problems.

If you are infected with the herpes virus for the first time during pregnancy, there are medications you can take to reduce how severe the symptoms are and how long they last. If you have herpes but it is not your first infection, your health care provider may give you medication that makes it less likely that you will have an outbreak of herpes at or near the time your baby is born.

What if I have sores at the time I give birth?
If you have sores or prodromal symptoms at the time of delivery, you will need to have a cesarean delivery. A cesarean delivery may reduce the chance the baby will come in contact with the virus.

Rarely, a baby can be infected without passing through the vagina. This can occur if the amniotic sac has broken a few hours before birth. If a woman does not have sores or prodromal symptoms at the time of delivery, a vaginal birth may be possible.

Can women with herpes breastfeed?
A woman infected with genital herpes usually can breastfeed without infecting her child. The herpes virus cannot be passed to a baby through breast milk. However, the baby could get infected by touching a blister or sore on the mother’s breast.

If you have sores on your nipple, you should not breastfeed your baby on that breast. Pump or express your milk by hand from that breast until the sore is gone. Be sure the parts of your breast pump that touch the milk do not touch the sore while pumping. If this happens, the milk should be thrown away.

Glossary

Amniotic Sac: Fluid-filled sac in the mother’s uterus in which the fetus develops.

Antibodies: Proteins in the blood produced in reaction to foreign substances.

Cesarean Delivery: Delivery of a baby through an incision made in the mother’s abdomen and uterus.

Prodrome: Symptoms that precede the onset of a disease.

Sexually Transmitted Disease (STD): A disease that is spread by sexual contact, including chlamydia, gonorrhea, genital warts, herpes, syphilis, and infection with human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

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

What are some common symptoms of PMS?
Emotional symptoms include the following:

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

Physical symptoms include the following:

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

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

  • be present in the 5 days before her period for at least three menstrual cycles in a row
  • end within 4 days after her period starts
  • interfere with some of her normal activities
  • Keeping a record of your symptoms can help your health care provider decide if you have PMS. Each day for at least 2–
  • 3 months, write down and rate any symptoms you feel. Record the dates of your periods as well.

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

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

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

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

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

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

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

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

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

What dietary changes can be made to help relieve PMS symptoms?
Simple changes in your diet may help relieve the symptoms of PMS:

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

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

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

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

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

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

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

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

Glossary

Antidepressants: Medications used to treat depression.

Depression: Feeling of sadness for periods of at least 2 weeks.

Diuretics: Drugs given to increase the production of urine.

Menstruation: The monthly discharge of blood and tissue from the uterus that occurs in the absence of pregnancy.

Ovulation: The release of an egg from one of the ovaries.

Perimenopause: The period around menopause that usually extends from age 45 years to 55 years.

What is human papillomavirus (HPV)?
Human papillomavirus (HPV) is a virus that can be passed from person to person through skin-to-skin contact. More than 100 types of HPV have been found. About 30 of these types infect the genital areas of men and women and are spread from person to person through sexual contact.

How common is HPV?
HPV is a very common virus. Some research suggests that at least three out of four people who have sex will get a genital HPV infection at some time during their lives.

How is HPV infection spread?
HPV is primarily spread through vaginal, anal, or oral sex, but sexual intercourse is not required for infection to occur. HPV is spread by skin-to-skin contact. Sexual contact with an infected partner, regardless of the sex of the partner, is the most common way the virus is spread. Like many other sexually transmitted diseases , there often are no signs or symptoms of genital HPV infection.

What diseases does HPV infection cause?
Approximately 12 types of HPV cause genital warts. These growths may appear on the outside or inside of the vagina or on the penis and can spread to nearby skin. Genital warts also can grow around the anus, on the vulva, or on the cervix.

Approximately 15 types of HPV are linked to cancer of the anus, cervix, vulva, vagina, and penis. They also can cause cancer of the head and neck. These types are known as "high-risk types."

How does HPV cause cancer of the cervix?
The cervix is covered by a thin layer of tissue made up of cells. If HPV is present, it may enter these cells. Infected cells may become abnormal or damaged and begin to grow differently. The changes in these cells may progress to what is known as precancer. Changes in the thin tissue covering the cervix are called dysplasia or cervical intraepithelial neoplasia (CIN). In most women, the immune system destroys the virus before it causes cancer. But in some women, HPV is not destroyed by the immune system and does not go away. In these cases, HPV can lead to cancer or, more commonly, precancer.

Are there screening tests for cervical cancer?
It usually takes years for cervical cancer to develop. During this time, HPV infection can cause cells on or around the cervix to become abnormal. A Pap test, sometimes called cervical cytology screening, can detect early signs of abnormal cell changes of the cervix and allows early treatment so they do not become cancer (see the FAQ Cervical Cancer Screening). An HPV test also is available. It is used along with the Pap test in women 30 years and older and as a follow-up test for women whose Pap tests show abnormal or uncertain results. The HPV test can identify 13–14 of the high-risk types of HPV.

Can HPV infection be prevented?
Two vaccines are available that protect against certain types of HPV (see the FAQ Human Papillomavirus (HPV) Vaccines). The following methods also help decrease the chance of infection:

  • Limit your number of sexual partners.
  • Use condoms to reduce your risk of infection when you have vaginal, anal, or oral sex.
  • Condoms cannot fully protect you against HPV infection. HPV can be passed from person to person by touching infected areas not covered by a condom. These areas may include skin in the genital or anal areas. Female condoms
  • cover more skin and may provide a little more protection than male condoms.

Glossary

Cells: The smallest units of a structure in the body; the building blocks for all parts of the body.

Cervical Intraepithelial Neoplasia (CIN): Another term for dysplasia; a noncancerous condition that occurs when normal cells on the surface of the cervix are replaced by a layer of abnormal cells. CIN is graded as 1 (mild dysplasia), 2 (moderate dysplasia), or 3 (severe dysplasia or carcinoma in situ).

Cervix: The opening of the uterus at the top of the vagina.

Dysplasia: A noncancerous condition that occurs when normal cells are replaced by a layer of abnormal cells.

Immune System: The body’s natural defense system against foreign substances and invading organisms, such as bacteria that cause disease.

Pap Test: A test in which cells are taken from the cervix and vagina and examined under a microscope.

Sexual Intercourse: The act of the penis of the male entering the vagina of the female (also called "having sex" or "making love").

Sexually Transmitted Diseases: Diseases that are spread by sexual contact, including chlamydia, gonorrhea, human papillomavirus infection, herpes, syphilis, and infection with human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Vulva: The external female genital area.

What are gonorrhea, chlamydia, and syphilis?
Gonorrhea, chlamydia, and syphilis are sexually transmitted diseases (STDs). These three STDs can cause serious, long-term problems if they are not treated, especially for teenagers and young women.

What causes gonorrhea and chlamydia?
Both gonorrhea and chlamydia are caused by bacteria. The bacteria are passed from one person to another through vaginal, anal, or oral sex. Gonorrhea and chlamydia often occur together.

Where do these infections occur?
Gonorrhea and chlamydia infections can occur in the mouth, reproductive organs, urethra, and rectum. In women, the most common place is the cervix (the opening of the uterus).

At what age do these infections most commonly occur?
Although gonorrhea and chlamydia can occur at any age, women 25 years and younger are at greater risk of both infections.

What are the symptoms of gonorrhea and chlamydia?
Women with gonorrhea or chlamydia often have no symptoms. When symptoms from either infection do occur, they may show up 2 days to 3 weeks after infection. They may be very mild and can be mistaken for a urinary tract or vaginal infection. The most common symptoms in women include the following:

  • A yellow vaginal discharge
  • Painful or frequent urination
  • Vaginal bleeding between menstrual periods
  • Rectal bleeding, discharge, or pain

How are gonorrhea and chlamydia diagnosed?
To find out if you have gonorrhea or chlamydia, your health care provider may take a sample of cells from your throat, cervix, urethra, or rectum where the infection may occur. Gonorrhea and chlamydia also can be detected with a urine test.

What complications are associated with infection with gonorrhea and chlamydia?
Both gonorrhea and chlamydia can cause pelvic inflammatory disease (PID), an infection that occurs when bacteria move from the vagina and cervix upward into the uterus, ovaries, or fallopian tubes. After a woman is infected with gonorrhea or chlamydia and if she does not receive treatment, it can take anywhere from a few days to a few weeks before she develops PID.

How is infection with gonorrhea and chlamydia treated?
Gonorrhea and chlamydia are treated with antibiotics.

What causes syphilis?
Syphilis also is caused by bacteria. It differs from gonorrhea and chlamydia because it occurs in stages. It is spread more easily in some stages than in others.

How is syphilis spread?
The bacteria that cause syphilis enter the body through a cut in the skin or through contact with a syphilis sore known as a chancre. Because this sore commonly occurs on the vulva, vagina, anus, or penis, syphilis most often is spread through sexual contact. It also can be spread by touching the rash, warts, or infected blood during the secondary stage of infection.

What are symptoms of syphilis?
Symptoms of syphilis differ by stage:

  • Primary stage—Syphilis first appears as a painless chancre. This sore goes away without treatment in 3–6 weeks.
  • Secondary stage—The next stage begins as the chancre is healing or several weeks after the chancre has disappeared, when a rash may appear. The rash usually appears on the soles of the feet and palms of the hands. Flat warts may be seen on the vulva. During this stage, there may be flu-like symptoms. This stage is highly contagious.
  • Latent and late stages—The rash and other symptoms go away in a few weeks or months, but the disease still is present in the body. If untreated, the disease may return in its most serious form years later.

How is syphilis diagnosed?
In the early stages, discharge from open sores is examined to see if syphilis bacteria are present. In later stages, a blood test also can be done to check for antibodies to the bacteria.

What are complications of syphilis?
Late-stage syphilis is a serious illness. Heart problems, neurologic problems, and tumors may occur, leading to brain damage, blindness, paralysis, and even death. The genital sores caused by syphilis also make it easier to become infected with and transmit human immunodeficiency virus (HIV).

How is syphilis treated?
Syphilis is treated with antibiotics. If it is caught and treated early, long-term problems can be prevented. The length of treatment depends on how long a person has had the disease.

Can these diseases be prevented?
You can take steps to avoid getting gonorrhea, chlamydia, or syphilis. These safeguards also help protect against other STDs:

  • Use a condom. Both male and female condoms are sold over-the-counter in drug stores. They help protect against STDs.
  • Limit your sexual partners. The more sexual partners you have over a lifetime, the higher your risk of getting STDs.
  • Know your partner. Ask about your partner’s sexual history. Ask whether he or she has had STDs. Even if your partner has no symptoms, he or she still may be infected.
  • Avoid contact with any sores on the genitals.

Is screening for these diseases recommended?
Annual screening for gonorrhea and chlamydia is recommended for teenagers and women aged 25 years and younger who are sexually active and for women older than 25 years if they have risk factors. Teenagers and women also should be tested for syphilis if they are at high risk of this STD.

Glossary

Antibiotics: Drugs that treat certain types of infections.

Antibodies: Proteins in the blood produced in reaction to foreign substances, such as bacteria and viruses that cause infection.

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Chancre: A sore caused by syphilis and appearing at the place of infection.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body’s immune system and causes acquired immunodeficiency syndrome (AIDS).

Ovaries: Two glands, located on either side of the uterus, that contain the eggs released at ovulation and that produce hormones.

Pelvic Inflammatory Disease (PID): An infection of the uterus, fallopian tubes, and nearby pelvic structures.

Sexually Transmitted Diseases (STDs): Diseases that are spread by sexual contact.

Urethra: A tube-like structure through which urine flows from the bladder to the outside of the body.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy

Vulva: The external female genital area.

What is human papillomavirus (HPV)?

Human papillomavirus (HPV) is a virus that can be passed from person to person through skin-to-skin contact. More than 100 types of HPV have been found. About 30 of these types infect the genital areas of men and women and are spread from person to person through sexual contact.

How common is HPV?
HPV is a very common virus. Some research suggests that at least three out of four people who have sex will get a genital HPV infection at some time during their lives.

How is HPV infection spread?
HPV is primarily spread through vaginal, anal, or oral sex, but sexual intercourse is not required for infection to occur. HPV is spread by skin-to-skin contact. Sexual contact with an infected partner, regardless of the sex of the partner, is the most common way the virus is spread. Like many other sexually transmitted diseases , there often are no signs or symptoms of genital HPV infection.

What diseases does HPV infection cause?
Approximately 12 types of HPV cause genital warts. These growths may appear on the outside or inside of the vagina or on the penis and can spread to nearby skin. Genital warts also can grow around the anus, on the vulva, or on the cervix.

Approximately 15 types of HPV are linked to cancer of the anus, cervix, vulva, vagina, and penis (see the FAQ Cervical Cancer). They also can cause cancer of the head and neck. These types are known as "high-risk types."

How does HPV cause cancer of the cervix?
The cervix is covered by a thin layer of tissue made up of cells. If HPV is present, it may enter these cells. Infected cells may become abnormal or damaged and begin to grow differently. The changes in these cells may progress to what is known as precancer. Changes in the thin tissue covering the cervix are called dysplasia or cervical intraepithelial neoplasia (CIN). In most women, the immune system destroys the virus before it causes cancer. But in some women, HPV is not destroyed by the immune system and does not go away. In these cases, HPV can lead to cancer or, more commonly, precancer.

Are there screening tests for cervical cancer?
It usually takes years for cervical cancer to develop. During this time, HPV infection can cause cells on or around the cervix to become abnormal. A Pap test, sometimes called cervical cytology screening, can detect early signs of abnormal cell changes of the cervix and allows early treatment so they do not become cancer (see the FAQ Cervical Cancer Screening). An HPV test also is available. It is used along with the Pap test in women 30 years and older and as a follow-up test for women whose Pap tests show abnormal or uncertain results. The HPV test can identify 13–14 of the high-risk types of HPV.

Can HPV infection be prevented?
Two vaccines are available that protect against certain types of HPV. The following methods also help decrease the chance of infection:

Limit your number of sexual partners.
Use condoms to reduce your risk of infection when you have vaginal, anal, or oral sex.
Condoms cannot fully protect you against HPV infection. HPV can be passed from person to person by touching infected areas not covered by a condom. These areas may include skin in the genital or anal areas. Female condoms cover more skin and may provide a little more protection than male condoms.

Glossary

Cells: The smallest units of a structure in the body; the building blocks for all parts of the body.

Cervical Intraepithelial Neoplasia (CIN): Another term for dysplasia; a noncancerous condition that occurs when normal cells on the surface of the cervix are replaced by a layer of abnormal cells. CIN is graded as 1 (mild dysplasia), 2 (moderate dysplasia), or 3 (severe dysplasia or carcinoma in situ).

Cervix: The opening of the uterus at the top of the vagina.

Dysplasia: A noncancerous condition that occurs when normal cells are replaced by a layer of abnormal cells.

Immune System: The body’s natural defense system against foreign substances and invading organisms, such as bacteria that cause disease.

Pap Test: A test in which cells are taken from the cervix and vagina and examined under a microscope.

Sexual Intercourse: The act of the penis of the male entering the vagina of the female (also called "having sex" or "making love").

Sexually Transmitted Diseases: Diseases that are spread by sexual contact, including chlamydia, gonorrhea, human papillomavirus infection, herpes, syphilis, and infection with human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Vulva: The external female genital area.

What are uterine fibroids?

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

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

What are symptoms of fibroids?
Fibroids may have the following symptoms:

Changes in menstruation
—Longer, more frequent, or heavy menstrual period

—Menstrual pain (cramps)

—Vaginal bleeding at times other than menstruation

Anemia (from blood loss)

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

—During sex

Pressure

—Difficulty urinating or frequent urination

—Constipation, rectal pain, or difficult bowel movements

—Abdominal cramps

Enlarged uterus and abdomen

Miscarriages

Infertility

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

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

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

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

  • Ultrasonography uses sound waves to create a picture of the uterus and other pelvic organs.
  • Hysteroscopy uses a slender device (the hysteroscope) to see the inside of the uterus. It is inserted through the vagina and cervix (opening of the uterus). This permits the doctor to see fibroids inside the uterine cavity.
  • Hysterosalpingography is a special X-ray test. It may detect abnormal changes in the size and shape of the uterus and fallopian tubes.
  • Sonohysterography is a test in which fluid is put into the uterus through the cervix. Ultrasonography is then used to show the inside of the uterus. The fluid provides a clear picture of the uterine lining.
  • Laparoscopy uses a slender device (the laparoscope) to help the doctor see the inside of the abdomen. It is inserted through a small cut just below or through the navel. The doctor can see fibroids on the outside of the uterus with the laparoscope. 
  • Imaging tests, such as magnetic resonance imaging and computed tomography scans, may be used but are rarely needed. Some of these tests may be used to track the growth of fibroids over time.

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

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

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

  • Birth control pills and other types of hormonal birth control methods—These drugs often are used to control heavy bleeding and painful periods.
  • Gonadotropin-releasing hormone (GnRH) agonists—These drugs stop the menstrual cycle and can shrink fibroids. They sometimes are used before surgery to reduce the risk of bleeding. Because GnRH agonists have many side effects, they are used only for short periods (less than 6 months). After a woman stops taking a GnRH agonist, her fibroids usually return to their previous size.
  • Progestin–releasing intrauterine device—This option is for women with fibroids that do not distort the inside of the uterus. It reduces heavy and painful bleeding but does not treat the fibroids themselves.
    What types of surgery may be done to treat fibroids?
  • Myomectomy is the surgical removal of fibroids while leaving the uterus in place. Because a woman keeps her uterus, she may still be able to have children. Fibroids do not regrow after surgery, but new fibroids may develop. If they do, more surgery may be needed.

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

Are there other treatments besides medication and surgery?
Other treatment options are as follows:

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

Glossary

Anemia: Abnormally low levels of blood or red blood cells in the bloodstream. Most cases are caused by iron deficiency, or lack of iron.

Hysterosalpingography: A special X-ray procedure in which a small amount of fluid is injected into the uterus and fallopian tubes to detect abnormal changes in their size and shape or to determine whether the tubes are blocked.

Hysteroscopy: A surgical procedure in which a slender, light-transmitting telescope, the hysteroscope, is used to view the inside of the uterus or perform surgery.

Intrauterine Device: A small device that is inserted and left inside the uterus to prevent pregnancy.

Laparoscopy: A surgical procedure in which a slender, light-transmitting telescope, the laparoscope, is inserted into the pelvic cavity through small incisions. The laparoscope is used to view the pelvic organs. Other instruments can be used to perform surgery.

Menstruation: The monthly discharge of blood and tissue from the uterus that occurs in the absence of pregnancy.

Pelvic Exam: A manual examination of a woman’s reproductive organs.

Progestin: A synthetic form of progesterone that is similar to the hormone produced naturally by the body.

Resectoscope: A slender telescope with an electrical wire loop or rollerball tip used to remove or destroy tissue inside the uterus.

Sonohysterography: A procedure in which fluid is put into the uterus and ultrasonography is used to view the inside of the uterus.

Ultrasonography: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

Uterus: A muscular organ located in the female pelvis that contains the developing fetus during pregnancy.

What is an ovarian cyst?
An ovarian cyst is a sac or pouch filled with fluid or other tissue that forms on the ovary. Ovarian cysts are quite common in women during their childbearing years. A woman can develop one cyst or many cysts. Ovarian cysts can vary in size. In most cases, cysts are harmless and go away on their own. In other cases, they may cause problems and need treatment.

There are different types of ovarian cysts. Most cysts are benign (not cancerous). Rarely, a few cysts may turn out to be malignant (cancerous) (see the FAQ Ovarian Cancer).

What are the symptoms of ovarian cysts?
Most ovarian cysts are small and do not cause symptoms. Some cysts may cause a dull or sharp ache in the abdomen and pain during certain activities. Larger cysts may cause torsion (twisting) of the ovary that causes pain. Cysts that bleed or rupture (burst) may lead to serious problems requiring prompt treatment.

How are ovarian cysts diagnosed?
An ovarian cyst may be found during a routine pelvic exam. If your health care provider finds an enlarged ovary, tests may be recommended to provide more information:

  • Vaginal ultrasound —This procedure uses sound waves to create pictures of the internal organs that can be viewed on a screen. For this test, a slender instrument called a transducer is placed in the vagina. The views created by the sound waves show the shape, size, location, and makeup of the cyst.
  • Laparoscopy—In this type of surgery, a laparoscope—a thin tube with a camera—is inserted into the abdomen to view the pelvic organs. Laparoscopy also can be used to treat cysts.
  • Blood tests — If you are past menopause, in addition to an ultrasound exam, you may be given a test that measures the amount of a substance called CA 125 in your blood. An increased CA 125 level may be a sign of ovarian cancer in women past menopause. In premenopausal women, an increased CA 125 level can be caused by many other conditions besides cancer. Therefore, this test is not a good indicator of ovarian cancer in premenopausal women.

How are ovarian cysts treated?
Birth control pills may be prescribed to treat some types of ovarian cysts. This treatment will not make cysts you already have go away. But it will prevent new cysts from forming.

If your cyst is large or causing symptoms, your health care provider may suggest surgery. The extent and type of surgery that is needed depends on several factors:

  • Size and type of cyst
  • Your age
  • Your symptoms
  • Your desire to have children

Sometimes, a cyst can be removed without having to remove the ovary. This surgery is called cystectomy. In other cases, one or both of the ovaries may have to be removed. Your doctor may not know which procedure is needed until after the surgery begins.

Glossary

Benign: Not cancer.

CA 125: A substance in the blood that may increase in the presence of some cancerous tumors.

Cystectomy: Surgical removal of a cyst.

Laparoscopy: A surgical procedure in which a slender, light-transmitting instrument, the laparoscope, is used to view the pelvic organs or perform surgery.

Malignant: A term used to describe cells or tumors that are able to invade tissue and spread to other parts of the body.

Menopause: The process in a woman’s life when ovaries stop functioning and menstruation stops.

Ovaries: Two glands, located on either side of the uterus, that contain the eggs released at ovulation and that produce hormones.

Pelvic Exam: A manual examination of a woman’s reproductive organs.

Ultrasound: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

What is pelvic inflammatory disease (PID)?

Pelvic inflammatory disease is an infection of the female reproductive organs. It is a common illness. Pelvic inflammatory disease is diagnosed in more than 1 million women each year in the United States.

Pelvic inflammatory disease occurs when bacteria move from the vagina and cervix upward into the uterus, ovaries, or fallopian tubes. The bacteria can lead to an abscess in a fallopian tube or ovary. Long-term problems can occur if PID is not treated promptly.

What causes PID?
Two sexually transmitted diseases (STDs)—gonorrhea and chlamydia—are the main cause of PID. Gonorrhea and chlamydia may cause vague symptoms or even no symptoms in a woman. After a woman is infected with gonorrhea or chlamydia and if she does not receive treatment, it can take anywhere from a few days to a few weeks before she develops PID. Pelvic inflammatory disease also can be caused by infections that are not sexually transmitted, such as bacterial vaginosis.

What are the long-term effects of PID?
Pelvic inflammatory disease can lead to serious, long-term problems:

  • Infertility—One in ten women with PID becomes infertile. PID can cause scarring of the fallopian tubes. This scarring can block the tubes and prevent an egg from being fertilized.
  • Ectopic pregnancy—Scarring from PID also can prevent a fertilized egg from moving into the uterus. Instead, it can begin to grow in the fallopian tube. The tube may rupture (break) and cause life-threatening bleeding into the abdomen and pelvis. Emergency surgery may be needed if the ectopic pregnancy is not diagnosed early.
  • Chronic pelvic pain—PID may lead to long-lasting pelvic pain.

Who is at risk of PID?
Pelvic inflammatory disease can occur at any age in women who are sexually active. It is most common among young women. Those younger than age 25 years are more likely to develop PID. Women with the following risk factors also are more likely to have PID:

  • Infection with an STD, most often gonorrhea or chlamydia
  • Multiple sex partners—the more partners, the greater the risk
  • A sex partner who has sex with others
  • Past PID

Some research suggests that women who douche frequently are at increased risk of PID. Douching may make it easier for the bacteria that cause PID to grow. It also may push the bacteria upward to the uterus and fallopian tubes from the vagina. For this and other reasons, douching is not recommended.

What are the symptoms of PID?
Some women with PID have only mild symptoms or have no symptoms at all. Because the symptoms can be vague, many cases are not recognized by women or their health care providers. Listed are the most common signs and symptoms of PID:

  • Abnormal vaginal discharge
  • Pain in the lower abdomen (often a mild ache)
  • Pain in the upper right abdomen
  • Abnormal menstrual bleeding
  • Fever and chills
  • Painful urination
  • Nausea and vomiting
  • Painful sexual intercourse

Having one of these signs or symptoms does not mean that you have PID. It could be a sign of another serious problem, such as appendicitis or ectopic pregnancy. You should contact your health care provider if you have any of these signs or symptoms.

How is PID diagnosed?
To learn if you have PID, your health care provider will start by asking about your medical history, including your sexual habits, birth control method, and symptoms. If you have PID symptoms, you will need to have a pelvic exam. This exam can show if your reproductive organs are tender. A sample of fluid from your cervix will be taken and tested for gonorrhea and chlamydia. Blood tests may be done.

Your health care provider may order other tests or procedures. They can include ultrasonography, endometrial biopsy, and in some cases laparoscopy.

How is PID treated?
Pelvic inflammatory disease can be treated. However, treatment of PID cannot reverse the scarring caused by the infection. The longer the infection goes untreated, the greater the risk for long-term problems, such as infertility.

Pelvic inflammatory disease is treated first with antibiotics. Antibiotics alone usually can get rid of the infection. Two or more antibiotics may be prescribed. They may need to be taken by mouth or by injection. Your health care provider may schedule a follow-up visit 2–3 days after treatment to check your progress. Sometimes the symptoms go away before the infection is cured. If they do, you still should take all of the medicine for as long as it is prescribed.

Some women may need to be treated in a hospital. Hospitalization may be recommended for women who

  • do not have a clear diagnosis
  • are pregnant
  • must take antibiotics intravenously
  • are severely ill
  • have nausea and vomiting
  • have a high fever
  • have an abscess in a fallopian tube or ovary
  • In certain situations, such as when an abscess is found, surgery may be needed.

A woman’s sex partners must be treated. Women with PID may have partners who have gonorrhea or chlamydia. A person can have these STDs even if there are no signs of illness.

How can PID be prevented?
To help prevent PID, take the following steps to avoid STD infection:

Use condoms every time you have sex to prevent STDs. Use condoms even if you use other methods of birth control.
Have sex only with a partner who does not have an STD and who only has sex with you.
Limit your number of sex partners. If you or your partner has had previous partners, your risk of getting an STD is increased.
Glossary

Abscess: A collection of pus located in a tissue or organ.

Antibiotics: Drugs that treat infections.

Bacterial Vaginosis: A type of vaginal infection caused by the overgrowth of a number of organisms that are normally found in the vagina.

Cervix: The opening of the uterus at the top of the vagina.

Chlamydia: A sexually transmitted disease caused by bacteria that can lead to pelvic inflammatory disease and infertility.

Chronic Pelvic Pain: Persistent pain in the pelvic region that has lasted for at least 6 months.

Ectopic Pregnancy: A pregnancy in which the fertilized egg begins to grow in a place other than inside the uterus, usually in one of the fallopian tubes.

Endometrial Biopsy: A test in which a small amount of the tissue lining the uterus is removed and examined under a microscope.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

Gonorrhea: A sexually transmitted disease that may lead to pelvic inflammatory disease, infertility, and arthritis.

Infertility: A condition in which a couple has been unable to get pregnant after 12 months without the use of any form of birth control.

Laparoscopy: A surgical procedure in which a slender, light-transmitting instrument, the laparoscope, is used to view the pelvic organs or perform surgery.

Ovaries: Two glands, located on either side of the uterus, that contain the eggs released at ovulation and that produce hormones.

Pelvic Exam: A manual examination of a woman’s reproductive organs.

Sexually Transmitted Diseases (STDs): Diseases that are spread by sexual contact.

Ultrasonography: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.

What is the difference between outpatient surgery and inpatient surgery?
Outpatient surgery, also called ambulatory or same–day surgery, does not require an overnight stay in the hospital, meaning that you can go home the same day if your condition is stable. You will need someone to drive you home. Outpatient surgery may be done in a hospital, health care provider’s office, surgical center, or clinic. Inpatient surgery takes place in a hospital and requires an overnight stay.

What health care professionals will be involved in my surgery?
Your health care provider leads a team of health care professionals who will work together to care for you before, during, and after your operation. Nurses will assist your doctor during surgery, perform special tasks, and help make you more comfortable. A resident or fellow may help during your surgery. The anesthesiologist is the person who is in charge of giving anesthesia and checking its effects.

What can I do to help ensure my surgery will go smoothly?
If you smoke, try to stop smoking before your operation. General anesthesia affects the normal function of your lungs. If you are taking medication, ask if you should keep taking it before or after the operation. Make sure your health care provider knows all of the medications you are taking, including those that have been prescribed for you and those that are bought over-the-counter, such as vitamins, herbs, or other supplements. Follow a special diet before surgery if your health care provider suggests it. If you have diabetes, controlling your glucose levels before surgery may improve healing.

What is involved in a presurgery checkup?
A week or two before your surgery, you may need to have a physical exam and tests, which may include lab tests of your blood and urine, a chest X-ray, and an electrocardiogram. An electrocardiogram is a test of heart function with an instrument that prints out the results as a graph.

What preparation may be necessary before surgery?
Depending on the type of surgery, your health care provider may want you to use a laxative and eat lightly. Do not drink alcohol 24 hours before surgery. You also may be asked to use an enema at home a day or two before some types of surgery.

What do I need to do the day of surgery?
Remove any nail polish or acrylic nails. Do not wear make up. All jewelry usually needs to be removed from your body before the operation. If you will be staying overnight, bring only those items you will need, including a case for glasses, contact lenses, or dentures.

You will be given an ID bracelet. It will include your name, birth date, and health care provider’s name.

Be prepared to go over your health history, as well as any drug allergies, or allergies to food or latex (some surgical gloves are made of latex). You will be asked what medications you are taking.

What preoperative preparation may occur?
You will change from your clothes into a hospital gown and maybe a cap. Steps may be taken to help prevent deep vein thrombosis. You may be given special stockings to wear, or inflatable devices may be put on your legs. You may be given drugs to reduce the risk of deep vein thrombosis. You will be taken to an area to wait until the surgical team is ready for you. Your health care provider or team will confirm your name, birth date, and type of surgery before you go to the operating room. If the operation is to be done on one side of your body, the site may be marked with a special pen. An anesthesiologist will discuss which type of anesthesia you will receive during the operation. A tube called an intravenous (IV) line may be placed into a vein in your arm or wrist. It is used for supplying your body with fluids, medication, or blood during and after the surgery. You may be given medication to help you relax. You also may be given other medications that your doctor has ordered, such as antibiotics to reduce the risk of infection.

What will happen once I am in the operating room?
After you have been taken into the operating room, you will be moved to the operating table. Monitors will be attached to various parts of your body to measure your pulse, oxygen level, and blood pressure.

The surgical team may again ask you your name, date of birth, and what operation you are having. A final review of medical records and tests may be done.

If you are having general anesthesia, it will be given through your IV line. After you are asleep, a tube called a catheter may be placed in your bladder to drain urine.

What should I expect when the operation is over?
Once the operation is over, you will be moved into the recovery area. This area is equipped to monitor patients after surgery.

Many patients feel groggy, confused, and chilly when they wake up after an operation. You may have muscle aches or a sore throat shortly after surgery. These problems should not last long. You can ask for medicine to relieve them. You will remain in the recovery room until you are stable.

As soon as possible, your nurses will have you move around as much as you can. You may be encouraged to get out of bed and walk around soon after your operation. You may feel tired and weak at first. The sooner you resume activity, the sooner your body’s functions can get back to normal.

What things do I need to know before I go home?
Before you leave, a nurse or other health care provider will go over any instructions on diet, medicine, and care of your incision. You will be told what things or activities you should avoid and for how long. You should know who to call if you have a problem and what things you should call your health care provider about, such as a fever or increased vaginal bleeding.

How long will it take to recover?
If you have had major inpatient surgery, it will most likely take a month or more before you are ready to resume your normal schedule. Minor operations require less recovery time, but you may need to cut back on certain activities for a while.

Glossary
Anesthesia: Relief of pain by loss of sensation.

Antibiotics: Drugs that treat infections.

Catheter: A tube used to drain fluid or urine from the body.

Deep Vein Thrombosis: A condition in which a blood clot forms in veins in the leg or other areas of the body.

Diabetes: A condition in which the levels of sugar in the blood are too high.

General Anesthesia: The use of drugs that produce a sleep-like state to prevent pain during surgery.

Glucose: A sugar that is present in the blood and is the body’s main source of fuel.

What is urinary incontinence?
Leakage of urine is called urinary incontinence. Some women leak small amounts of urine. At other times, leakage of urine is frequent or severe.

Are there different types of urinary incontinence?
There are several types of urinary incontinence:

  • Stress urinary incontinence—Loss of urine when a woman coughs, laughs, or sneezes. Leaks also can happen when a woman walks, runs, or exercises. It is caused by a weakening of the tissues that support the bladder or the muscles of the urethra.
  • Urge incontinence—Leakage of urine caused by overactive bladder muscles that contract too often or problems with the nerves that send signals to the bladder
  • Mixed incontinence—A combination of both stress and urge incontinence symptoms
  • Overflow incontinence—Steady loss of small amounts of urine when the bladder does not empty all the way during voiding. It can be caused by an underactive bladder muscle or blockage of the urethra.

What are the symptoms of urinary incontinence?
In addition to leaking urine, a woman with incontinence also may have other symptoms:

  • Urgency—A strong urge to urinate whether or not the bladder is full, often with pelvic pressure
  • Frequency—Voiding more often than she considers usual
  • Nocturia—The need to void during hours of sleep
  • Dysuria—Painful voiding
  • Enuresis—Bed-wetting or leaking while sleeping

What causes urinary incontinence?
Urinary incontience can have short-term causes and long-term causes. Short-term causes are easier to treat and include the following:

  • Urinary tract infection—Loss of bladder control may be caused by an infection of the urinary tract. Infections of the bladder (cystitis) are common in women. These infections are treated with antibiotics.
  • Medications—Loss of bladder control may be a side effect of medications, such as diuretics.
  • Abnormal growths—Polyps, bladder stones, or less commonly, bladder cancer, can cause urinary incontinence.
  • Abnormal growths often cause urge incontinence and may be associated with blood in the urine. If you see blood in your urine, or if you are unsure about the source of any bleeding, it is important to alert your health care provider right away.

Long-term causes include the following:

  • Pelvic support problems—The pelvic organs are held in place by supportive tissues and muscles. These supporting tissues may become torn or stretched, or they may weaken because of aging. If the tissues that support the urethra, bladder, uterus, or rectum become weak, these organs may drop down, causing urine leakage or making it hard to pass urine.
  • Urinary tract abnormalities—A fistula is an abnormal opening from the urinary tract into another part of the body, such as the vagina. It can allow urine to leak out through the vagina.
  • Neuromuscular problems—These disorders can interfere with the transmission of signals from the brain and spinal cord to the bladder and urethra.

How is urinary incontinence diagnosed?
A number of steps may be needed to find the cause of urinary incontinence. In some cases, there may be more than one cause.

You may be asked to keep a voiding diary for a few days in which you record the time and amount of urine leakage. You also should note how much liquid you drank and what you were doing when a leak occurred.

A pelvic exam will be done to detect physical conditions that might be linked to the problem. Lab tests also may be done to detect a urinary tract infection. Other tests that assess how your bladder functions include the following:

  • Urodynamic tests—The bladder is filled through a catheter. These tests check the function of the urethra and bladder.
  • Postvoid residual volume test—The amount of urine that is left in the bladder after urinating is measured with an ultrasound device or by placing a catheter in the bladder.
  • Stress test—You are asked to cough a few times with a full bladder. Any loss of urine is recorded.
  • Cystoscopy—A thin, lighted tube with a lens at the end is used to look inside the bladder and urethra.
  • Dye test—A pad is worn after a nontoxic dye is put in the bladder. If the pad gets stained with the dye, there was a loss of urine.

How is urinary incontinence treated?
There are many options for treatment. Often treatments are more effective when used in combination. Treatment options include lifestyle changes, bladder training, physical therapy, devices, medications, bulking agents, and surgery.

What are some of the lifestyle changes that are used to manage urinary incontinence?
Making the following changes in your lifestyle, if they apply to you, may help the problem:

  • Lose weight. In overweight women, losing weight has been shown to decrease the frequency of urine leakage.
  • Avoid constipation. Repeated straining may damage the pelvic floor.
  • Drink less fluids and limit intake of caffeine, which is a diuretic.
  • Seek treatment for chronic coughing.
  • Stop smoking.

What is bladder training?
The goal of bladder training is to learn how to control the urge to empty the bladder and increase the times between urinating to normal intervals (every 3–4 hours during the day and every 4–8 hours at night). After a few weeks of this training, leakage may occur less often.

What types of physical therapy are used to treat urinary incontinence?
There are many types of physical therapy that can be done to treat urinary incontinence. One type, Kegel exercises, can help strengthen the pelvic muscles. Kegel exercises, along with bladder training and modifying fluid intake, are often very successful in treating stress incontinence and urge incontinence.

If you have trouble doing Kegel exercises, you may want to see a physical therapist who specializes in women’s pelvic health. Biofeedback is a training technique that may be useful if you have problems locating the correct muscles.

How are Kegel exercises done?
Kegel exercises tone your pelvic muscles. Here is how they are done:

  • Squeeze the muscles that you use to stop the flow of urine (but do not do these exercises while you are urinating).
  • Hold for up to 10 seconds, then release.
  • Do this 10–20 times in a row at least 3 times a day.
  • Be careful not to squeeze the muscles of the leg, buttock, or abdomen. Do these exercises on a regular basis. It may take 4–6 weeks to notice an improvement in urinary incontinence symptoms.

What devices are used to treat urinary incontinence?
A pessary is a device that is inserted into the vagina to treat pelvic support problems and urinary incontinence. Pessaries support the pelvic structures, and some compress the urethra. They come in all shapes and sizes. They are useful for women who do not want or cannot have surgery to correct their incontinence.

What medications are used for treatment?
Drugs that help control muscle spasms or unwanted bladder contractions can help prevent leaks associated with urge incontinence. These medications also can help reduce the frequency of urination. Your health care provider will help you decide which drug is most likely to work best for you.

What are bulking agents?
These agents may be used when the muscle surrounding the urethra is very weak and extensive surgery is not an option or has not worked. A substance is injected into the tissues around the urethra to add bulk. The urethra becomes narrowed, decreasing leakage. This procedure can be done in a doctor’s office or clinic.

What types of surgery treat urinary incontinence?
Several surgical procedures have been developed to treat stress urinary incontinence (see the FAQ Surgery for Stress Urinary Incontinence). You and your health care provider should discuss many factors, including your age, lifestyle, and general health, before choosing to have surgery.

Glossary

Antibiotics: Drugs that treat infections.

Biofeedback: A technique in which an attempt is made to control body functions, such as heartbeat or blood pressure.

Bladder: A muscular organ in which urine is stored.

Catheter: A tube used to drain fluid or urine from the body.

Cystitis: An infection of the bladder.

Diuretics: Drugs given to increase the production of urine.

Dysuria: Pain during urination.

Fistula: An abnormal opening or passage between two internal organs.

Nocturia: The need to urinate frequently during the night.

Pelvic Exam: A manual examination of a woman’s reproductive organs.

Pessary: A device inserted into the vagina to support sagging organs.

Polyps: Benign (noncancerous) growths that develop from tissue lining an organ, such as that lining the inside of the uterus.

Ultrasound: A test in which sound waves are used to examine internal structures.

Urethra: A short, narrow tube that carries urine from the bladder out of the body.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.

Voiding Diary: A daily log in which a woman keeps track of how many times she urinates, her fluid intake, and the number of times she leaks urine.

How does human immunodeficiency virus (HIV) infection occur?
Human immunodeficiency virus (HIV) enters the bloodstream through certain body fluids—in most cases, blood or semen. Once in the blood, the virus invades and kills cells of the immune system. These cells are white blood cells called CD4 cells. When these cells are destroyed, the body is less able to fight disease. The number of these white blood cells often decreases in patients with advanced HIV infection.

How is HIV infection spread?
HIV infection is spread through contact with some types of body fluids of an infected person. This contact can happen during sex or by sharing needles used to inject drugs. An infected woman who is pregnant can pass the virus to her baby. Women with HIV who breastfeed also can pass the virus to their babies. Once someone is infected, he or she always will carry the virus and can pass it to others.

HIV cannot be spread by casual contact with people and objects. The virus cannot get through skin that is not broken.

What happens after a person becomes infected with HIV?
HIV causes acquired immunodeficiency syndrome (AIDS). A person infected with HIV does not get sick with AIDS right away. The virus attacks the immune system over time. Shortly after infection, some people have a brief illness like the flu. As the immune system becomes weaker, people infected with HIV may have weight loss, fatigue, and fever.

The infection is called AIDS when a person has certain conditions or symptoms that result from a weakened immune system. It also is called AIDS when the number of a person’s CD4 cells decreases below a certain level.

How can I be tested for HIV?
A simple blood test can tell you whether you have been infected with HIV. It looks for HIV antibodies in the blood. This test is not an AIDS test. It does not tell you if you have AIDS or if you will get sick.

There are several types of HIV tests. A rapid screening test produces very quick results (in about 20 minutes). It often takes about 2 weeks to get results from the other types of screening tests. No matter what type of test is taken, if the test result is positive, another test is used to confirm the results.

Who should be tested for HIV infection?
Women and men aged 19–64 years should be tested for HIV. People in other age groups also may need to be tested depending on their risk factors. It is especially important for pregnant women to be tested for HIV as part of their prenatal care—even if they do not think they may be infected. Counseling may be given before the test, after getting the results, or both.

Is there treatment for HIV infection?
There is no vaccine to prevent HIV infection, and there is no cure for AIDS. However, there are some medications that fight HIV-related infections and help protect the immune system. In most cases, many medications are used together. Your health care provider will work with you to determine what medicines you should take, when you should take them, and how much you should take of each. It is important to take these drugs exactly as your doctor prescribes. Taking the drugs correctly can help you live a longer, healthier life.

What can I do to prevent HIV infection?
The best way to help prevent the spread of HIV infection during sex is by using latex condoms. Condoms made from natural skin or lambskin do not prevent infection. When used properly, latex condoms can reduce the chances that one partner will infect the other. For best protection, condoms should be worn every time you have sex.

Ask about your partner’s sexual history and whether he or she has ever used intravenous drugs. You and your partner may want to be tested before you begin having sex.

If you are using IV drugs, get help and try to stop. If you cannot stop, do not share needles. If you share needles, the HIV-infected blood left in the needles after injecting can get into you or your needle-sharing partner. Make sure that the needle is clean. Needles should be cleaned after every use with both laundry bleach and water.

Glossary

Acquired Immunodeficiency Syndrome (AIDS): A group of signs and symptoms, usually of severe infections, occurring in a person whose immune system has been damaged by infection with human immunodeficiency virus (HIV).

Antibodies: Proteins in the blood produced to fight off foreign substances, such as bacteria and viruses that cause infection.

Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body’s immune system and causes AIDS.

Immune System: The body’s natural defense system against foreign substances and invading organisms that can cause disease.

What is the vulva?
The external female genital area is called the vulva. The outer folds of skin are called the labia majora and the inner folds are called the labia minora.

When should I contact my health care provider about vulvar symptoms?
If you see changes on the skin of the vulva, or if you have itching, burning, or pain, contact your health care provider.

What will my health care provider check?
Your health care provider may examine you, ask you questions about the pain and your daily routine, and take samples of vaginal discharge for testing. In some cases, a biopsy is needed to confirm diagnosis of a disease.

What are some skin disorders that can affect the vulva?
Some of the skin disorders that affect the vulva include folliculitis, contact dermatitis, Bartholin gland cysts, lichen simplex chronicus, lichen sclerosus, and lichen planus.

What is folliculitis?
Folliculitis appears as small, red, and sometimes painful bumps caused by bacteria that infect a hair follicle. It can occur on the labia majora. This can happen because of shaving, waxing, or even friction. Folliculitis often goes away by itself. Attention to hygiene, wearing loose clothing, and warm compresses applied to the area can help speed up the healing process. If the bumps do not go away or they get bigger, see your health care provider. You may need additional treatment.

What is contact dermatitis?
Contact dermatitis is caused by irritation of the skin by things such as soaps, fabrics, or perfumes. Signs and symptoms can include extreme itching, rawness, stinging, burning, and pain. Treatment involves avoidance of the source of irritation and stopping the itching so that the skin can heal. Ice packs or cold compresses can reduce irritation. A thin layer of plain petroleum jelly can be applied to protect the skin. Medication may be needed for severe cases.

What is a Bartholin gland cyst?
The Bartholin glands are located under the skin on either side of the opening of the vagina. They release a fluid that helps with lubrication during sexual intercourse. If the Bartholin glands become blocked, a cyst can form, causing a swollen bump near the opening of the vagina. Bartholin gland cysts usually are not painful unless they become infected. If this occurs, an abscess can form.

If your cyst is not causing pain, it can be treated at home by sitting in a warm, shallow bath or by applying a warm compress. If an abscess has formed, treatment involves draining the cyst using a needle or other instrument in a health care provider’s office.

What is lichen simplex chronicus?
Lichen simplex chronicus may be a result of contact dermatitis or other skin disorder that has been present for a long time. Thickened, scaly areas called "plaques" appear on the vulvar skin. These plaques cause intense itching that may interfere with sleep. Treatment involves stopping the "itch-scratch" cycle so that the skin can heal. Steroid creams often are used for this purpose. The underlying condition should be treated as well.

What is lichen sclerosus?
Lichen sclerosus is a skin disorder that can cause itching, burning, pain during sex, and tears in the skin. The vulvar skin may appear thin, white, and crinkled. White bumps may be present with dark purple coloring. A steroid cream is used to treat lichen sclerosus.

What is lichen planus?
Lichen planus is a skin disorder that most commonly occurs on the mucous membranes of the mouth. Occasionally, it also affects the skin of the genitals. Itching, soreness, burning, and abnormal discharge may occur. The appearance of lichen planus is varied. There may be white streaks on the vulvar skin, or the entire surface may be white. There may be bumps that are dark pink in color.

Treatment of lichen planus may include medicated creams or ointments, vaginal tablets, prescription pills, or injections. This condition is difficult to treat and usually involves long-term treatment and follow-up.

What is vulvodynia?
Vulvodynia means "vulvar pain." The pain can occur when the area is touched or it can occur without touch. There are two types of vulvodynia: generalized and localized. With generalized vulvodynia, the pain occurs over a large area of the vulva. With localized vulvodynia, the pain is felt on a smaller area, such as the vestibule.

What are the signs and symptoms of vulvodynia?
Vulvodynia usually is described as burning, stinging, irritation, or rawness. The skin of the vulva usually looks normal.

How is vulvodynia treated?
A variety of methods are used to treat vulvodynia, including self-care measures, medications, dietary changes, biofeedback training, physical therapy, sexual counseling, or surgery.

What is vulvar atrophy?
Vulvar atrophy is the thinning of the skin of the vulva. It usually occurs in response to the decreased estrogen levels that occur in perimenopause and menopause.

What are the signs and symptoms of vulvar atrophy?
Signs and symptoms include soreness, irritation, and dryness. Pain may occur during sexual intercourse. The vulva becomes more sensitive to irritants. Infections may occur more easily. In severe cases, vulvar skin may crack and bleed.

How is vulvar atrophy treated?
This condition is treated with medications containing estrogen that are applied to the skin or inserted into the vagina.

What is vulvar intraepithelial neoplasia (VIN)?
Vulvar intraepithelial neoplasia (VIN) is the presence of abnormal vulvar cells that are not yet cancer. VIN often is caused by human papillomavirus (HPV) infection (see the FAQ Human Papillomavirus (HPV) Infection).

What are the signs and symptoms of VIN?
Signs and symptoms include itching, burning, or abnormal skin that may be bumpy, smooth, or a different color like white, brown, or red. VIN should be treated to prevent the development of cancer.

How is VIN treated?
VIN can be treated with a cream that is applied to the skin, laser treatment, or surgery. The HPV vaccine that protects against HPV types 6, 11, 16, and 18 is approved to prevent VIN caused by these four types of HPV.

What is cancer?
Cancer is the growth of abnormal cells.

What causes vulvar cancer?
Vulvar cancer can be caused by infection with HPV. Other forms of cancer that can affect the vulva include melanoma (skin cancer) or Paget disease. Paget disease of the vulva may be a sign of cancer in another area of the body, such as the breast or colon.

What are the signs and symptoms of vulvar cancer?
Signs and symptoms may include itching, burning, inflammation, or pain. Other symptoms of cancer include a lump or sore on the vulva, changes in the skin color, or a bump in the groin.

How is cancer treated?
The type of treatment depends on the stage of cancer. Surgery often is needed to remove all cancerous tissue. Radiation therapy and chemotherapy also may be needed in addition to surgery.

What other disorders can affect the vulva?
There are a number of disorders that may affect the vulva. Infections (such as yeast infection) and sexually transmitted diseases, such as genital herpes, can cause vulvar signs and symptoms. Crohn disease is a long-term disease of the digestive system. It can cause inflammation, swelling, sores, or bumps on the vulva.

What self-care measures can help prevent or clear up vulvar problems?
The following self-care measures may help prevent or clear up certain vulvar problems:

  • Keep your vulva clean by rinsing with warm water and gently patting, not rubbing, it dry.
  • Do not wear tight-fitting pants or underwear. Wear only cotton underwear.
  • Do not wear pantyhose (unless they have a cotton crotch).
  • Do not use pads or tampons that contain a deodorant or a plastic coating.
  • Do not use perfumed soap or scented toilet paper.
  • Do not douche or use feminine sprays or talcum powders.

Glossary

Abscess: A collection of pus located in tissue or an organ.

Bartholin Gland: One of two small organs that are located just under the skin at the entrance to the vagina and produce some of the lubrication during sexual excitement.

Biopsy: A minor surgical procedure to remove a small piece of tissue that is then examined under a microscope in a laboratory.

Chemotherapy: The treatment of cancer using certain drugs to destroy malignant cells.

Cyst: A sac or pouch filled with fluid.

Estrogen: A female hormone produced in the ovaries.

Genital Herpes: A sexually transmitted disease caused by a virus that produces painful, highly infectious sores on or around the sex organs.

Human Papillomavirus (HPV): The name for a group of related viruses, some of which cause genital warts and some of which are linked to cervical changes and cancer of the cervix, vulva, vagina, penis, anus, and throat.

Inflammation: Pain, swelling, redness, and irritation of tissues in the body.

Labia Majora: The outer folds of tissue of the external female genital area.

Labia Minora: The inner folds of tissue of the external female genital area.

Menopause: The time in a woman’s life when menstruation stops; defined as the absence of menstrual periods for 1 year.

Perimenopause: The period before menopause that usually extends from age 45 years to 55 years.

Radiation Therapy: Treatment with high-energy radiation.

Sexually Transmitted Diseases: Diseases that are spread by sexual contact, including chlamydia, gonorrhea, human papillomavirus infection, herpes, syphilis, and infection with human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.

Vestibule: The space within the labia minora into which the vagina and urethra open.

Vulva: The external female genital area.

Vulvodynia: Long-lasting pain of the vulva that is not caused by an infection or skin disease.

What is abnormal uterine bleeding?

  • Bleeding in any of the following situations is abnormal:
  • Bleeding between periods
  • Bleeding after sex
  • Spotting anytime in the menstrual cycle
  • Bleeding heavier or for more days than normal
  • Bleeding after menopause

Menstrual cycles that are longer than 35 days or shorter than 21 days are abnormal. The lack of periods for 3–6 months (amenorrhea) also is abnormal.

What is a normal menstrual cycle?
The menstrual cycle begins with the first day of bleeding of one period and ends with the first day of the next. In most women, this cycle lasts about 28 days. Cycles that are shorter or longer by up to 7 days are normal.

At what ages is abnormal uterine bleeding more common?
Abnormal uterine bleeding can occur at any age. However, at certain times in a woman’s life it is common for periods to be somewhat irregular. They may not occur on schedule in the first few years after a girl has her first period (around age 9–16 years). Cycle length may change as a woman nears menopause (around age 50 years). It also is normal to skip periods or for bleeding to get lighter or heavier at this time.

What causes abnormal uterine bleeding?
Abnormal uterine bleeding can have many causes. They include the following:

  • Pregnancy
  • Miscarriage
  • Ectopic pregnancy
  • Adenomyosis
  • Use of some birth control methods, such as an intrauterine device (IUD) or birth control pills
  • Infection of the uterus or cervix
  • Fibroids
  • Problems with blood clotting
  • Polyps
  • Endometrial hyperplasia
  • Certain types of cancer, such as cancer of the uterus, cervix, or vagina
  • Polycystic ovary syndrome

How is abnormal bleeding diagnosed?
Your health care provider will ask about your personal and family health history as well as your menstrual cycle. It may be helpful to keep track of your menstrual cycle before your visit. Note the dates, length, and type (light, medium, heavy, or spotting) of your bleeding on a calendar.

You will have a physical exam. You also may have blood tests. These tests check your blood count and hormone levels and rule out some diseases of the blood. You also may have a test to see if you are pregnant.

What tests may be needed to diagnose abnormal uterine bleeding?
Based on your symptoms, other tests may be needed. Some of these tests can be done in your health care provider’s office. Others may be done at a hospital or surgical center:

  • Sonohysterography—Fluid is placed in the uterus through a thin tube, while ultrasound images are made of the uterus.
  • Ultrasound—Sound waves are used to make a picture of the pelvic organs.
  • Magnetic resonance imaging—In this imaging test, powerful magnets are used to create images of internal organs.
  • Hysteroscopy—A thin device is inserted through the vagina and the opening of the cervix. It lets the health care provider view the inside of the uterus.
  • Endometrial biopsy—Using a small or thin catheter (tube), tissue is taken from the lining of the uterus (endometrium). It is looked at under a microscope.

What factors are considered when deciding on a type of treatment?
The type of treatment depends on many factors, including the cause of the bleeding, your age, and whether you want to have children. Most women can be treated with medications. Others may need surgery.

What medications are used to help control abnormal uterine bleeding?
Hormonal medications often are used to control abnormal uterine bleeding. The type of hormone you take will depend on whether you want to get pregnant as well as your age. Birth control pills can help make your periods more regular. Hormones also can be given as an injection, as a vaginal cream, or through an IUD that releases hormones. An IUD is a birth control device that is inserted in the uterus. The hormones in the IUD are released slowly and may control abnormal bleeding.

Other medications given for abnormal uterine bleeding include nonsteroidal anti-inflammatory drugs (such as ibuprofen), tranexamic acid, and antibiotics. Nonsteroidal anti-inflammatory drugs can control bleeding and reduce menstrual cramps. Tranexamic acid is a drug used to treat heavy menstrual bleeding. Infections are treated with antibiotics.

What types of surgery are performed to treat abnormal uterine bleeding?
Some women may need to have surgery to remove growths (such as polyps or fibroids) that cause bleeding. Some fibroids can be removed with hysteroscopy. Sometimes other techniques are used.

Endometrial ablation may be used to control bleeding. It is intended to stop or reduce bleeding permanently. An endometrial biopsy is needed before ablation is considered.

Hysterectomy may be done when other forms of treatment have failed or they are not an option. Hysterectomy is major surgery. Afterward, a woman no longer has periods. She also cannot get pregnant.

Glossary

Adenomyosis: A condition in which the tissue that normally lines the uterus begins to grow in the muscle wall of the uterus.

Cervix: The opening of the uterus at the top of the vagina.

Ectopic Pregnancy: A pregnancy in which the fertilized egg begins to grow in a place other than inside the uterus, usually in the fallopian tubes.

Endometrial Hyperplasia: A condition that occurs when the lining of the uterus (endometrium) grows too much.

Fibroids: Benign (noncancerous) growths that form on the inside of the uterus, on its outer surface, or within the uterine wall itself. Benign (noncancerous) growths that form on the inside of the uterus, on its outer surface, or within the uterine wall itself.

Hysterectomy: Removal of the uterus.

Intrauterine device (IUD): A small device that is inserted and left inside the uterus to prevent pregnancy.

Menopause: The process in a woman’s life when ovaries stop functioning and menstruation stops.

Miscarriage: The spontaneous loss of a pregnancy before the fetus can survive outside the uterus.

Polycystic Ovary Syndrome: A condition characterized by two of the following three features: the presence of growths called cysts on the ovaries, irregular menstrual periods, and an increase in the levels of certain hormones.

Polyps: Growths that develop from membrane tissue, such as that lining the inside of the uterus.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

What is cancer?
Cancer occurs when old cells do not die when they should or are damaged. Normally, the body repairs or destroys such cells. Sometimes, these cells may grow out of control. This causes growths or tumors to form. Tumors can be benign (not cancer) or malignant (cancer).

Benign tumors do not spread to other parts of the body. Malignant tumors can invade and destroy healthy tissues and organs. Cancer cells also can spread to other parts of the body and form new tumors.

What is cancer of the ovary?
Cancer of the ovary is a disease that affects one or both ovaries, the two glands on either side of the uterus.

How are types of ovarian cancer distinguished?
The type of ovarian cancer is based on the type of cells in which it occurs. The three main types are listed as follows:

1. Epithelial cell cancer— Epithelial cells cover the surface of the ovary. Eighty-five to ninety percent of ovarian cancer cases are this type.

2. Germ cell cancer— Germ cells are the cells in the ovary that develop into eggs. This type of cancer is more common in younger women and usually has a high cure rate.

3. Stromal cell cancer— Stromal cell cancer occurs in the connective tissue, which provides the internal structure of the ovary. It also has a high cure rate.

What are the risk factors for epithelial ovarian cancer?
Certain risk factors are associated with epithelial ovarian cancer. The following factors have been shown to increase a woman’s risk of getting cancer of the ovary:

  • Age older than 55 years
  • Family history of breast cancer, ovarian cancer, colon cancer, or endometrial cancer (cancer of the lining of the uterus)
  • Personal history of breast cancer
  • BRCA1 or BRCA2 mutation
  • Never having had children
  • Infertility
  • Endometriosis

What tests are available to screen for epithelial ovarian cancer?
The Pap test is a good way to screen for cervical cancer, but it does not detect ovarian cancer. A pelvic exam sometimes can detect problems with the ovaries. At this time, however, there is no good screening test for ovarian cancer.

Is screening recommended for women who have a high risk of epithelial ovarian cancer?
For women at high risk of epithelial ovarian cancer, such as women with BRCA1 or BRCA2 mutations, periodic tests to check for ovarian cancer may be recommended. These tests include transvaginal ultrasound to find changes in the ovaries and measurement of CA 125 levels. CA125 is a substance made by tumor cells. It sometimes is increased in women with ovarian cancer.

What are the symptoms of epithelial ovarian cancer?
If you have any of the following symptoms, and they do not go away, are frequent, or get worse over time, you should contact your health care provider:

  • Bloating or an increase in abdominal size
  • Pelvic or abdominal pain
  • Difficulty eating or feeling full quickly
  • How is ovarian cancer diagnosed?
  • If you have frequent or persistent symptoms of ovarian cancer, you will usually have a physical exam, including a pelvic exam. An imaging test of the ovaries, such as a transvaginal ultrasound exam, may be done. The level of CA 125 in your blood may be measured.

The only way to tell for certain that a woman has ovarian cancer is with a biopsy. In a biopsy, tissue is removed during surgery and is tested for cancer.

How is ovarian cancer treated?
Treatment is based on the stage of the cancer and how much the cancer has spread outside the ovary. Epithelial ovarian cancer has four stages. Stage I is the least advanced stage. Stage IV is the most advanced stage. Cancer grade also is important in ovarian cancer treatment. Ovarian tumors are graded as low-grade or high-grade.

If a woman is thought to have ovarian cancer, surgery and other tests are needed to find out the stage and grade of the cancer. Usually, surgery to remove the uterus (hysterectomy) and the ovaries and fallopian tubes (salpingo-oophorectomy) is performed. Lymph nodes and tissue from the abdomen may be removed. Surgery may be followed by chemotherapy. Chemotherapy is the use of drugs that kill cancer cells.

What tests are used to find out if the cancer has spread?
To find out whether the cancer has spread, imaging tests such as a colonoscopy, computed tomography scan, magnetic resonance imaging, and chest X-ray may be done. If possible, it is best that a doctor specially trained or experienced in cancer, such as a gynecologic oncologist, performs the surgery and evaluates test results.

What type of follow-up is needed after treatment?
Women treated for cancer of the ovary need to have regular checkups, including exams and blood tests to check CA 125 levels. Other tests, including ultrasound, chest X-ray, magnetic resonance imaging, or computed tomography, also may be done.

Glossary

Biopsy: A surgical procedure to remove a small piece of tissue that is then examined under a microscope in a laboratory.

BRCA1 and BRCA2: Genes that increase the risk of breast cancer and certain other types of cancer.

CA 125: A substance in the blood that may increase in the presence of some cancerous tumors.

Colonoscopy: An exam of the entire colon using a small, lighted instrument.

Computed Tomography: A type of X-ray procedure that shows internal organs and structures in cross section. Also known as a CT scan or CAT scan.

Endometriosis: A condition in which tissue similar to that normally lining the uterus is found outside of the uterus, usually on the ovaries, fallopian tubes, and other pelvic structures.

Computed Tomography: A type of X-ray procedure that shows internal organs and structures in cross section. Also known as a CT scan or CAT scan.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

Lymph Nodes: Small glands in the abdomen and other areas of the body that filter the flow of lymph, a nearly colorless fluid that bathes body cells. Lymph can carry abnormal cells to other parts of the body.

Magnetic Resonance Imaging: A method of viewing internal organs and structures by using a strong magnetic field and sound

Ovaries: Two glands, located on either side of the uterus, that contain the eggs released at ovulation and that produce hormones.

Pap Test: A test in which cells are taken from the cervix and vagina and examined under a microscope.

Pelvic Exam: A physical examination of a woman’s reproductive organs.

Transvaginal Ultrasound: A type of ultrasound in which a transducer specially designed to be placed in the vagina is used.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

What is cancer of the uterus?
Normally, healthy cells that make up the body’s tissues grow, divide, and replace themselves on a regular basis. This keeps the body healthy. Sometimes certain cells develop abnormally and begin to grow out of control. When this occurs, growths or tumors begin to form. Tumors can be benign (not cancer) or malignant (cancer).

Malignant tumors can invade and destroy nearby healthy tissues and organs. Cancer cells also can spread (or metastasize) to other parts of the body and form new tumors.

There are different types of cancer of the uterus. The most common type is endometrial cancer (adenocarcinoma). Endometrial cancer affects the endometrium, the lining of the uterus. Sarcomas are another type of uterine cancer. They arise from muscle and other tissue. Although rare, this type of uterine cancer is more aggressive than adenocarcinoma and has different symptoms. Because endometrial cancer is more common and its symptoms differ from those of sarcoma, this FAQ focuses on endometrial cancer.

Who is at risk of endometrial cancer?
Endometrial cancer is the most common type of gynecologic cancer in the United States. About 2 or 3 women out of every 100 women will develop endometrial cancer during their lifetimes.

Endometrial cancer is rare in women younger than 40 years. It most often occurs in women around age 60 years.

What are the risks factors for endometrial cancer?
Certain factors can increase a woman’s risk of uterine cancer:

  • Obesity
  • Irregular menstrual periods
  • Never having a baby
  • Infertility
  • Starting menstrual periods at an early age (before age 12 years)
  • Late menopause
  • History of cancer of the ovary or colon
  • Use of tamoxifen to treat or prevent breast cancer
  • Family history of endometrial cancer
  • History of diabetes, hypertension, gallbladder disease, or thyroid disease
  • Long-term use of estrogen without progesterone to treat menopause
  • Long-term use of high–dose birth control pills
  • Cigarette smoking

Some of these risk factors are related to the use of estrogen. Estrogen is a hormone produced in a woman’s ovaries. It can be taken after menopause, when a woman’s ovaries stop producing estrogen (hormone therapy). Taken alone, estrogen increases the risk of endometrial cancer, if a woman still has her uterus. When estrogen is taken with another hormone, progesterone, a woman is protected against this increase.

What are the symptoms of endometrial cancer?
Abnormal bleeding, spotting, new discharge from your vagina, or bleeding or spotting after menopause all are symptoms of endometrial cancer. These symptoms may be constant or come and go. The cause of any abnormal bleeding or discharge, especially after menopause, should be checked by your health care provider.

How is endometrial cancer diagnosed?
There are no screening tests to detect endometrial cancer in women with no symptoms. But most women who have endometrial cancer have early symptoms. Several methods may be used to detect whether endometrial cancer is present:

  • Endometrial biopsy—A test in which a small amount of the tissue lining the uterus is removed and examined under a microscope. This test will likely be the first step in checking for abnormal cells.
  • Vaginal ultrasound—A test in which sound waves are used to check the thickness of the lining of the uterus and the size of the uterus.
  • Hysteroscopy—A surgical procedure in which a slender, light-transmitting scope is used to view the inside of the uterus or perform surgery.
  • Dilation and curettage (D&C)—A procedure in which the cervix is opened and tissue is gently scraped or suctioned from the inside of the uterus.
  • For many women, a Pap test may be part of a regular checkup, but it may not always detect endometrial cancer. In fact, most women with endometrial cancer have normal Pap test results. Endometrial cancer can be diagnosed only by examining tissue from the uterus.

How is endometrial cancer treated?
Surgery usually is done to treat the disease and find out if further treatment is needed. Most patients have both hysterectomy and salpingo-oophorectomy. During surgery, the stage of disease is determined. Staging helps your doctor decide what treatment has the best chance for success. Stages of cancer range from I to IV. Stage IV is the most advanced. The stage of cancer affects the treatment and outcome.

Radiation therapy may be done after surgery based on the stage of the disease. Although rare, some women are treated with radiation alone. Radiation stops cancer cells from growing by exposing them to high-energy rays.

Other forms of treatment include chemotherapy or hormone therapy. Some women may be treated with progestin, a synthetic version of the hormone progesterone.

What type of follow-up is required after treatment?
Women who did not receive radiation therapy should see their doctors every 3–4 months for 2–3 years to make sure the treatment is working. After that, they should see their doctors twice a year. Women who did receive radiation therapy may be able to see their doctors less frequently. With stage I disease, 85–90% of women will have no sign of cancer 5 or more years after treatment. The chance of a cure decreases with more advanced disease (higher stage).

Glossary

Adenocarcinoma: Cancer arising in glandular tissue, such as the uterus.

Hormone Therapy: Treatment in which estrogen, and often progestin, is taken to help ease some of the symptoms caused by low levels of these hormones.

Hysterectomy: Removal of the uterus.

Menopause: The process in a woman’s life when ovaries stop functioning and menstruation stops.

Pap Test: A test in which cells are taken from the cervix and vagina and examined under a microscope.

Progestin: A synthetic form of progesterone that is similar to the hormone produced naturally by the body.

Salpingo-oophorectomy: Removal of the ovary and fallopian tube.

Stage: Stage can refer to the size of a tumor and the extent (if any) to which the disease has spread.

Tumors: Growths or lumps made up of cells.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

What is chronic pelvic pain?
Chronic pelvic pain is pain in the pelvic area that lasts for 6 months or longer. Chronic pain can come and go, or it can be constant. Sometimes chronic pelvic pain follows a regular cycle. For example, it may occur during menstruation. It also can occur only at certain times, such as before or after eating, while urinating, or during sex.

What causes chronic pelvic pain?
Chronic pelvic pain can be caused by a variety of conditions. Some of these conditions may not be related to the reproductive organs but to the urinary tract or bowel. Some women have more than one condition that might be the cause of their pain. For some women with chronic pelvic pain, no cause is found.

How is chronic pelvic pain diagnosed?
Your health care provider will ask about your medical history. You will have a physical exam, including a pelvic exam. Tests also may be done to find the cause. It also may be necessary to see other specialists to find out the cause of your pain, such as a gastroenterologist (a physician who focuses on digestive problems) or urogynecologist (a gynecologist specializing in urinary and related problems).

What tests may be performed to help diagnose chronic pelvic pain?
Some of the following imaging tests may be performed:

  • Ultrasound
  • Laparoscopy
  • Cystoscopy
  • Colonoscopy
  • Sigmoidoscopy

What are some methods used to relieve chronic pelvic pain?
Several pain-relief measures can be used to treat chronic pelvic pain. They include medications, physical therapy, nutritional therapy, and surgery:

  • Lifestyle changes—Good posture and regular exercise may help reduce pelvic pain.
  • Pain-relieving drugs—Nonsteroidal antiinflammatory drugs (NSAIDs) are helpful in relieving pelvic pain, especially dysmenorrhea.
  • Physical therapy—Acupuncture, acupressure, and nerve stimulation therapies may be useful in treating pain caused by dysmenorrhea. Physical therapy that eases trigger points may give relief of muscular pain. Some types of physical therapy teach mental techniques for coping with pain. Such types include relaxation exercises and biofeedback.
  • Nutrition therapy—Vitamin B1 and magnesium may be used to relieve dysmenorrhea.
  • Surgery—Pelvic pain that does not respond to other treatments can be relieved by surgery. Cutting or destroying nerves blocks pain signals from reaching tissues and organs.

Glossary

Biofeedback: A technique in which an attempt is made to control body functions, such as heartbeat or blood pressure.

Colonoscopy: An exam of the entire colon using a small, lighted instrument.

Cystoscopy: A test in which the inside of the urethra and bladder are examined.

Dysmenorrhea: Discomfort and pain during the menstrual period.

Laparoscopy: A surgical procedure in which a slender, light-transmitting instrument, the laparoscope, is used to view the pelvic organs or perform surgery.

Menstruation: The monthly discharge of blood and tissue from the uterus that occurs in the absence of pregnancy.

Pelvic Exam: A physical examination of a woman’s reproductive organs.

Sigmoidoscopy: A test in which a slender device is placed into the rectum and lower colon to look for cancer.

Ultrasound: A test in which sound waves are used to examine internal structures.

What are common signs and symptoms of polycystic ovary syndrome (PCOS)?
Common PCOS signs and symptoms include the following:

  • Irregular menstrual periods—Menstrual bleeding may be absent, heavy, or unpredictable.
  • Infertility—PCOS is one of the most common causes of female infertility.
  • Obesity—Up to 80% of women with PCOS are obese.
  • Excess hair growth on the face, chest, abdomen, or upper thighs—This condition, called hirsutism, affects more than 70% of women with PCOS.
  • Severe acne or acne that occurs after adolescence and does not respond to usual treatments
  • Oily skin
  • Patches of thickened, velvety, darkened skin called acanthosis nigricans
  • Multiple small cysts on the ovaries

What causes PCOS?
Although the cause of PCOS is not known, it appears that PCOS may be related to many different factors working together. These factors include insulin resistance, increased levels of androgens, and an irregular menstrual cycle.

What is insulin resistance?
Insulin resistance is a condition in which the body’s cells do not respond to the effects of insulin. When the body does not respond to insulin, the level of glucose in the blood increases. Higher than normal blood glucose levels may eventually lead to diabetes mellitus. Insulin resistance also may cause more insulin to be produced as the body tries to move glucose into cells. High insulin levels may cause the appetite to increase and lead to imbalances in other hormones. Insulin resistance also is associated with acanthosis nigricans.

What can high levels of androgens lead to?
When higher than normal levels of androgens are produced, the ovaries may be prevented from releasing an egg each month (a process called ovulation). High androgen levels also cause the unwanted hair growth and acne seen in many women with PCOS.

What can irregular menstrual periods lead to?
Irregular menstrual periods can lead to infertility and, in some women, the development of numerous small cysts on the ovaries.

What are the health risks for women with PCOS?
PCOS affects all areas of the body, not just the reproductive system. It increases a woman’s risk of serious conditions that may have lifelong consequences.

Insulin resistance increases the risk of type 2 diabetes mellitus and cardiovascular disease. Another condition that is associated with PCOS is metabolic syndrome. This syndrome contributes to both diabetes and heart disease.

Women with PCOS tend to have a condition called endometrial hyperplasia, in which the lining of the uterus (the endometrium) becomes too thick. This condition increases the risk of endometrial cancer.

Are treatments available for women with PCOS?
A variety of treatments are available to address the problems of PCOS. Treatment is tailored to each woman according to symptoms, other health problems, and whether she wants to become pregnant.

How can combination birth control pills be used to treat women with PCOS?
Combination birth control pills can be used for long-term treatment in women with PCOS who do not wish to become pregnant. Combination pills contain both estrogen and progestin. Birth control pills regulate the menstrual cycle and reduce hirsutism and acne by decreasing androgen levels. They also decrease the risk of endometrial cancer.

What effect can weight loss have on women with PCOS?
For overweight women, weight loss alone often regulates the menstrual cycle. Even a small weight loss of 10–15 pounds can be helpful in making menstrual periods more regular. Weight loss also has been found to improve cholesterol and insulin levels and relieve symptoms such as excess hair growth and acne.

How can insulin-sensitizing drugs help treat women with PCOS?
Insulin-sensitizing drugs used to treat diabetes frequently are used in the treatment of PCOS. These drugs help the body respond to insulin. In women with PCOS, they can help decrease androgen levels and improve ovulation. Restoring ovulation helps make menstrual periods regular and more predictable.

What can be done to increase the chances of pregnancy for women with PCOS?
Successful ovulation is the first step toward pregnancy. For overweight women, weight loss often accomplishes this goal. Medications also may be used to cause ovulation. Surgery on the ovaries has been used when other treatments do not work. However, the long-term effects of these procedures are not clear.

Glossary

Acanthosis Nigricans: Patches of thickened, velvety, darkened skin that is sometimes associated with insulin resistance.

Androgens: Steroid hormones produced by the adrenal glands or by the ovaries that promote male characteristics, such as a beard and deepening voice.

Cardiovascular Disease: Disease of the heart and blood vessels.

Cells: The smallest units of a structure in the body; the building blocks for all parts of the body.

Cholesterol: A natural substance that serves as a building block for cells and hormones and helps to carry fat through the blood vessels for use or storage in other parts of the body.

Cysts: Sacs or pouches filled with fluid or other material.

Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.

Endometrial Hyperplasia: A condition in which the lining of the uterus grows too thick; if left untreated for a long time, it may lead to cancer.

Endometrium: The lining of the uterus.

Estrogen: A female hormone produced in the ovaries.

Glucose: A sugar that is present in the blood and is the body’s main source of fuel.

Hirsutism: Excessive hair on the face, abdomen, and chest.

Hormones: Substances produced by the body to control the functions of various organs.

Infertility: A condition in which a couple has been unable to get pregnant after 12 months without the use of any form of birth control.

Insulin: A hormone that lowers the levels of glucose (sugar) in the blood.

Metabolic Syndrome: Combination of factors that contribute to both diabetes and heart disease.

Ovaries: Two glands, located on either side of the uterus, that contain the eggs released at ovulation and that produce hormones.

Ovulation: The release of an egg from one of the ovaries.

Progestin: A synthetic form of progesterone that is similar to the hormone produced naturally by the body.

What is vulvodynia?
Vulvodynia is chronic (long-lasting) pain and discomfort of the vulva that is not caused by an infection, skin disease, or cancer. It is likely that many factors, including those related to the body’s nerves, hormones, or immune system, are involved.

What are the different types of vulvodynia?
Two types of vulvodynia are recognized: generalized vulvodynia and localized vulvodynia. In generalized vulvodynia, the pain is felt over the entire vulvar area. In localized vulvodynia, the pain is felt on a specific area of the vulva.

What is vulvar vestibulitis syndrome (VVS)?
Vulvar vestibulitis syndrome (VVS) is a specific form of localized vulvodynia. In VVS, the pain is felt only in the vestibule (the area around the opening of the vagina), usually in response to touch or pressure.

What does the pain of vulvodynia feel like?
The three most common ways that the pain is described are burning, stinging, and rawness. Additional ways that vulvodynia can be described include itching, aching, soreness, throbbing, and swelling.

When do symptoms of vulvodynia occur?
Symptoms can start and stop without warning or they may occur only when the area is touched, such as while inserting a tampon, having sex, or wearing snug underwear. Some women report symptoms when doing certain activities, such as during exercise, after urinating, or while sitting or resting. The pain also may have no relationship to touch or pressure and may be constant.

What causes vulvodynia?
Vulvodynia is a complex pain disorder. Many factors acting together are believed to be involved. Some of these factors include the following:

  • Damage or irritation of the nerves of the vulva
  • Increased number of nerve endings in the vestibule
  • Increased production of chemicals by cells in the vulva that lead to inflammation
  • Long-term reactions to certain infections
  • Changes in responses to hormones
  • Weakening of the muscles of the pelvic floor

How is vulvodynia diagnosed?
Your health care provider will try to rule out other known causes of pain first. Your health care provider most likely will perform a physical exam and may order specific tests. You may be asked questions about your symptoms and medical history, such as when symptoms occur, what treatments you have tried, and whether you have any chronic infections or skin problems.

What is involved in the physical exam?
Your health care provider will examine the vulva and vagina carefully. If any skin changes are found, tests may be done. A swab test may be done to find out whether the pain is generalized or localized. In this test, the health care provider uses a cotton swab to touch areas of the vulva and vestibule. The goal is to find where the pain is and whether it is mild, moderate, or severe.

What is the first step I can take that may lessen the pain of vulvodynia?
The first step in vulvodynia treatment usually involves avoiding products, clothing, and other items that come in contact with the vulva and that may be irritating, such as soaps and products containing deodorants, perfumes, and dyes. Wear cotton underwear and switch to cotton menstrual products if regular ones are irritating. Pay close attention to what makes your symptoms worse, and avoid the things that provoke your pain. While you are experiencing pain, applying cool gel packs may bring relief.

Can changing my diet help with vulvodynia?
For some women, certain foods make symptoms worse, while other foods help relieve symptoms. An elimination diet may help you identify these foods. In this kind of diet, you cut out one type of food at a time and note whether this makes your symptoms better or worse. Foods that commonly are associated with triggering symptoms include caffeine, foods high in sugar, acidic foods, and processed foods.

What medications are used in the treatment of vulvodynia?
The following medications have been found to be helpful in treating vulvodynia:

  • Local anesthetics—These medications are applied to the skin for short-term pain relief, or they can be used for extended periods.
  • Antidepressants and anti-seizure drugs—Drugs used to treat depression and to prevent seizures also may help reduce the signs and symptoms of vulvodynia.
  • Hormone creams—Estrogen is a hormone that is produced by the ovaries. Estrogen cream applied to the vulva may help relieve vulvodynia in some cases. Another hormone, called testosterone, also is used as a topical treatment for vulvodynia.

How may physical therapy help treat vulvodynia?
Physical therapy can relax tissues in the pelvic floor and release tension in muscles and joints. Biofeedback is a form of physical therapy that trains you to strengthen the pelvic floor muscles. Strengthening these muscles may help to lessen your pain.

What is trigger point therapy?
Trigger point therapy is a form of massage therapy. A trigger point is a small area of tightly contracted muscle. Pain from a trigger point travels to nearby areas. Trigger point therapy involves soft tissue massage to break up the trigger point and relax muscles. An anesthetic drug also can be injected into the trigger point to provide relief.

What is a nerve block and how can it help relieve pain?
A nerve block is a type of anesthesia in which an anesthetic drug is injected into the nerves that carry pain signals from the vulva to the spinal cord. This treatment interrupts the pain signals and can provide short-term and sometimes long-term pain relief.

Can psychotherapy, or talk therapy, help in the treatment of vulvodynia?
A counselor can help you learn to cope with chronic pain. This may help reduce stress and help you feel more in control of your symptoms. Sexual counseling can provide support and education about this condition for both you and your partner.

When is surgery an option for vulvodynia?
Vestibulectomy, the removal of the painful tissue from the vestibule, can be used for women who have VVS for whom other treatments have not worked. The procedure may help relieve pain and make sex more comfortable. It is not recommended for women with generalized vulvodynia.

Glossary

Anesthesia: Relief of pain by loss of sensation.

Anesthetics: Drugs used to relieve pain.

Antidepressants: Medications that are used to treat depression.

Depression: Feelings of sadness for periods of at least 2 weeks.

Estrogen: A female hormone produced in the ovaries.

Hormones: Substances made in the body by cells or organs that control the function of cells or organs. An example is estrogen, which controls the function of female reproductive organs.

Immune System: The body’s natural defense system against foreign substances and invading organisms, such as bacteria that cause disease.

Inflammation: Pain, swelling, redness, and irritation of tissues in the body.

Ovaries: Two glands, located on either side of the uterus, that contain the eggs released at ovulation and produce hormones.

Pelvic Floor: A muscular area at the base of the abdomen attached to the pelvis.

Testosterone: A hormone produced by the testes in men and in smaller amounts by the ovaries and other tissues in women that is responsible for male sex characteristics such as hair growth, muscle development, and a lower voice.

Vestibule: The space within the labia minora into which the vagina and urethra open.

Vestibulectomy: Surgical removal of painful tissue of the vaginal vestibule.

Vulva: The external female genital area.

Vulvar Vestibulitis Syndrome (VVS): Inflammation of an area near the opening of the vagina, the vestibule.

Vulvodynia: Long-lasting pain of the vulva that is not caused by an infection or skin disease.

What is an infertility evaluation?
During an infertility evaluation, exams and tests are done to try to find the cause of infertility. If a cause is found, treatment may be possible. Infertility often can be successfully treated even if no cause is found.

When should I consider having an infertility evaluation?
You should consider having an infertility evaluation if any of the following apply to you:

  • You have not become pregnant after 1 year of having regular sexual intercourse without the use of birth control.
  • You are older than 35 years and have not become pregnant after 6 months of having regular sexual intercourse without the use of birth control.
  • Your menstrual cycle is not regular.
  • You or your partner have a known fertility problem.

What causes infertility?
Infertility can be caused by a number of factors. Both male and female factors can contribute to infertility. Female factors may involve problems with ovulation, the reproductive organs, or hormones. Male factors often involve problems with the amount or health of sperm.

Does age affect fertility?
Yes. A woman begins life with a fixed number of eggs. This number decreases as she grows older. For healthy, young couples, the chance that a woman will become pregnant is about 20% in any single menstrual cycle. This percentage starts to decline in a woman’s early 30s. It declines more rapidly after age 37 years. A man’s fertility also declines with age, but not as predictably.

Can lifestyle affect fertility?
Lifestyle factors can play a role in infertility. For women, being underweight, being overweight, or excessive exercise may be associated with infertility. Drinking alcohol at moderate or heavy levels and smoking may make it difficult for a woman to get pregnant. For men, smoking, heavy drinking, marijuana use, and anabolic steroid use can reduce sperm count and movement. Smoking also can lead to erectile dysfunction.

How long does an infertility evaluation take?
The infertility evaluation can be finished within a few menstrual cycles in most cases.

What should I expect during my first visit for infertility?
The first visit usually involves a detailed medical history and a physical exam. During the medical history, you will be asked questions about your menstrual period, abnormal vaginal bleeding or discharge, pelvic pain, and disorders that can affect reproduction, such as thyroid disease. If you have a male partner, both of you will be asked about the following health issues:

  • Medications (both prescription and over-the-counter) and herbal remedies
  • Illnesses, including sexually transmitted diseases, and past surgery
  • Birth defects in your family
  • Past pregnancies and their outcomes
  • Use of tobacco, alcohol, and illegal drugs
  • Occupation

You and your partner also will be asked questions about your sexual history:

  • Methods of birth control
  • How long you have been trying to become pregnant
  • How often you have sex and whether or not you have difficulties
  • If you use lubricants during sex
  • Prior sexual relationships

What tests are done for infertility?
Tests for infertility include laboratory tests, imaging tests, and certain procedures.

What does the basic testing for a woman consist of?
Laboratory tests include tracking basal body temperature, a urine test, a progesterone test, thyroid function tests, prolactin level test, and tests of ovarian reserve. Imaging tests and procedures include an ultrasound exam, hysterosalpingography, sonohysterography, hysteroscopy, and laparoscopy. You may not have all of these tests and procedures. Some are done based on results of previous tests and procedures.

What is the purpose of tracking basal body temperature?
Tracking basal body temperature is a way to tell whether ovulation has occurred. After a woman ovulates, her body temperature increases slightly.

How do I track my basal body temperature?
To perform this test, you will need to take your temperature by mouth every morning before you get out of bed. You record it on a chart for two or three menstrual cycles.

What do results from a urine test determine?
Urine test results determine when and if you ovulate. The test detects luteinizing hormone (LH) in the urine. LH triggers the release of an egg.

How is a progesterone test done?
A sample of blood is taken on a given day in the menstrual cycle. The level of the hormone progesterone is measured. An increased level shows that you have ovulated.

When would a thyroid function test be done?
Thyroid function problems can affect fertility. If a problem is suspected with your thyroid gland, levels of hormones that control the thyroid gland are measured to see if it is working normally.

What is a prolactin level test?
This blood test measures the level of the hormone prolactin. High prolactin levels can disrupt ovulation.

What are tests of ovarian reserve?
These tests measure the levels of certain hormones in the blood that are involved in ovulation. They may be recommended if you are older than 35 years or if you have known fertility problems. Results of these tests can give an idea of the number of eggs the ovaries have and whether they are still healthy.

Why are imaging tests and procedures done?
Different imaging tests and procedures are used to look at your reproductive organs. They check whether your fallopian tubes are healthy and whether there are problems in your uterus. The procedures used depend on your symptoms as well as the results of other tests and procedures.

What does the basic testing for a man consist of?
The testing for a man often involves a semen analysis (sperm count). If the result of the semen analysis is abnormal or areas of concern are found in the man’s history, other tests may be considered. For example, an ultrasound exam may be done to find problems in the ducts and tubes that the semen moves through. Ultrasound also may be used to find problems in the scrotum that may be causing infertility.

Glossary

Basal Body Temperature: The temperature of the body at rest.

Erectile Dysfunction: The inability in a man to achieve an erection or to sustain it until ejaculation or until intercourse takes place.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

Hormones: Substances produced by the body to control the functions of various organs.

Hysterosalpingography: A special X-ray procedure in which a small amount of fluid is placed into the uterus and fallopian tubes to detect abnormal changes in their size and shape or to determine whether the tubes are blocked.

Hysteroscopy: A procedure in which a slender device, the hysteroscope, is inserted into the uterus through the cervix to view the inside of the uterus or perform surgery.

Laparoscopy: A surgical procedure in which an instrument called a laparoscope is inserted into the pelvic cavity through a small incision. The laparoscope is used to view the pelvic organs. Other instruments can be used with it to perform surgery.

Luteinizing Hormone (LH): A hormone produced by the pituitary gland that helps an egg to mature and be released.

Ovulation: The release of an egg from one of the ovaries.

Progesterone: A female hormone that is produced in the ovaries and that prepares the lining of the uterus for pregnancy.

Scrotum: The external genital sac in the male that contains the testes.

Semen: The fluid made by male sex glands that contains sperm.

Sexual Intercourse: The act of the penis of the male entering the vagina of the female (also called “having sex” or “making love”).

Sexually Transmitted Diseases: Diseases that are spread by sexual contact, including chlamydia, gonorrhea, genital warts, herpes, syphilis, and infection with human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Sonohysterography: A procedure in which sterile fluid is injected into the uterus through the cervix while ultrasound images are taken of the inside of the uterus.

Ultrasound: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

What is infertility?
Infertility is defined as not having become pregnant after 1 year of having regular sexual intercourse without the use of birth control (see the FAQ Evaluating Infertility). Infertility can be caused by a number of factors. Both male and female factors can contribute to infertility.

What treatment options are available for infertility?
Treatment options depend on the cause of your infertility. Lifestyle changes, medication, surgery, or assisted reproductive technology (ART) may be recommended. Several different treatments may be combined to improve results. Infertility often can be successfully treated even if no cause is found.

What lifestyle changes may help improve my chances for pregnancy?
If lifestyle factors are identified, you may need to lose or gain weight or do more or less exercise. You or your male partner may need to reduce your intake of alcohol, quit smoking, or stop using illegal drugs.

How is surgery used to treat infertility in women?
In women, surgery may be able to repair blocked or damaged fallopian tubes. Surgery is used to treat endometriosis, which is commonly associated with infertility (see the FAQ Endometriosis).

How is surgery used to treat infertility in men?
In men, surgery can be used to treat some infertility problems. A common problem that leads to male infertility, varicocele, sometimes can be treated with surgery.

How are hormonal problems treated in women?
Abnormal levels of hormones can cause irregular ovulation or lack of ovulation. For example, polycystic ovary syndrome is a condition in which the levels of certain hormones are abnormal and menstrual periods are irregular or absent. It is a common cause of infertility. This condition often is treated with lifestyle changes or medication. Progesterone may be used to treat some ovulation problems. Other hormonal conditions that affect fertility in women, such as thyroid disease, should be ruled out.

What is ovulation induction?
Ovulation induction is the use of drugs to induce a woman’s ovaries to release an egg. This treatment is used when ovulation is irregular or does not occur at all and other causes have been ruled out.

How is ovulation induction done?
The drug most commonly used for ovulation induction is clomiphene citrate. About 40% of women achieve pregnancy with the use of this drug within six menstrual cycles. Side effects usually are mild and include hot flashes, breast tenderness, nausea, and mood swings.

What drugs other than clomiphene citrate are used for ovulation induction?
If clomiphene citrate is not successful, drugs called gonadotropins may be tried to induce ovulation. Gonadotropins also are used when many eggs are needed for ART or other infertility treatments. This is called super ovulation.

How are gonadotropins used?
Gonadotropins are given in a series of shots early in the menstrual cycle. Blood tests and ultrasound exams are used to track the maturation of the follicles (small sacs in which eggs develop). When test results show that the follicles have reached a certain size, another drug called human chorionic gonadotropin (hCG) may be given. This drug triggers ovulation.

What risks are associated with ovulation induction?
Twins occur in about 10% of women treated with clomiphene citrate. Triplets or more are rare. The risk of multiple pregnancy is higher when gonadotropins are used. Up to 30% of pregnancies conceived with gonadotropins are multiple. About two thirds of these pregnancies are twins and one third are triplets or more.

Ovulation induction can lead to ovarian hyperstimulation syndrome. Most cases of this condition are mild. In severe cases, hospitalization may be needed.

What is intrauterine insemination?
In intrauterine insemination, a large amount of healthy sperm is placed in the uterus as close to the time of ovulation as possible. It often is used with ovulation induction or super ovulation. The woman’s partner or a donor may provide the sperm. Sperm that has been retrieved earlier and frozen also can be used.

What are the risks of intrauterine insemination?
If ovulation drugs are used with intrauterine insemination, multiple pregnancy can occur. If too many eggs are developing at the time of insemination, the insemination may be canceled.

What is assisted reproductive technology (ART)?
ART includes all fertility treatments in which both eggs and sperm are handled. ART usually involves in vitro fertilization (IVF). In IVF, sperm is combined with the egg in a lab, and the embryo is transferred to the uterus. IVF is done for the following causes of infertility:

  • Damaged or blocked fallopian tubes that cannot be treated with surgery
  • Some male infertility factors
  • Severe endometriosis
  • Premature ovarian failure
  • Unexplained infertility

How can I find out ART success rates?
The Centers for Disease Control and Prevention reports this information on its web site (www.cdc.gov/reproductivehealth/ index.htm). Success rates also are listed on the web site of the Society for Assisted Reproductive Technology (SART) (www.sart.org).

How is in vitro fertilization (IVF) done?
IVF is done in cycles. It can take more than one cycle to succeed. The sperm may come from your partner or from a donor. Sperm can be retrieved and then frozen for later use in IVF. Ovulation usually is induced with gonadotropins so that many eggs are produced. The egg also may come from a donor. Eggs that have been previously frozen can be used.

Eggs are removed from the ovaries when they are mature. Healthy sperm then are added to the eggs in the lab. The eggs are checked the following day to see if they have been fertilized. A few days later, one or more embryos are placed in your uterus. The embryo may come from a donor. Healthy embryos that are not transferred can be frozen and stored for later use.

What is intracytoplasmic sperm injection (ICSI)?
Sometimes, a single sperm may be injected into each egg. This is called ICSI. ICSI may be recommended if there is a problem with your partner’s sperm. In ICSI, only a single healthy sperm is needed for each egg. A few days later, one or more embryos are placed in the uterus through the vagina.

What are the risks associated with IVF?
There is an increased risk of multiple pregnancy with IVF. IVF also has been linked to an increased risk of birth defects. These defects include cleft palate, heart problems, and problems with the digestive tract. Overall, however, the increase in risk of birth defects is small.

What steps can be taken to help prevent multiple pregnancy with IVF?
Several things can be done to help prevent multiple pregnancy. If test results suggest that too many eggs are developing, the hCG shot that triggers ovulation may be delayed or not given. Your doctor also may limit the number of embryos transferred to your uterus.

Glossary

Assisted Reproductive Technology (ART): A group of infertility treatments in which an egg is fertilized with a sperm outside the body; the fertilized egg then is transferred to the uterus.

Egg: The female reproductive cell produced in and released from the ovaries; also called the ovum.

Embryo: The developing organism from the time it implants in the uterus up to 8 completed weeks of pregnancy.

Endometriosis: A condition in which tissue similar to that normally lining the uterus is found outside of the uterus, usually on the ovaries, fallopian tubes, and other pelvic structures.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

Follicles: The sac-like structures in which eggs develop inside the ovary.

Hormones: Substances produced by the body to control the functions of various organs.

Human Chorionic Gonadotropin (hCG): A hormone produced during pregnancy; its detection is the basis for most pregnancy tests.

In Vitro Fertilization (IVF): A procedure in which an egg is removed from a woman’s ovary, fertilized in a dish in a lab with the man’s sperm, and then reintroduced into the woman’s uterus to achieve a pregnancy.

Multiple Pregnancy: A pregnancy in which there are two or more fetuses.

Ovarian Hyperstimulation Syndrome: A condition caused by overstimulation of the ovaries that may cause painful
swelling of the ovaries and fluid in the abdomen and lungs.

Ovaries: Two glands, located on either side of the uterus, that contain the eggs released at ovulation and that produce hormones.

Ovulation: The release of an egg from one of the ovaries.

Polycystic Ovary Syndrome: A condition characterized by two of the following three features: the presence of growths called cysts on the ovaries, irregular menstrual periods, and an increase in the levels of certain hormones.

Premature Ovarian Failure: A condition in which ovulation and the menstrual cycle stop before age 35 years.

Progesterone: A female hormone that is produced in the ovaries and that prepares the lining of the uterus for pregnancy.

Sexual Intercourse: The act of the penis of the male entering the vagina of the female (also called “having sex” or “making love”).

Sperm: A male cell that is produced in the testes and can fertilize a female egg.

Ultrasound: A test in which sound waves are used to examine internal structures.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Varicocele: Varicose veins in the scrotum.

What is endometrial hyperplasia?

Endometrial hyperplasia occurs when the endometrium, the lining of the uterus, becomes too thick. It is not cancer, but in some cases, it can lead to cancer of the uterus.

How does the endometrium normally change throughout the menstrual cycle?

The endometrium changes throughout the menstrual cycle in response to hormones. During the first part of the cycle, the hormone estrogen is made by the ovaries. Estrogen causes the lining to grow and thicken to prepare the uterus for pregnancy. In the middle of the cycle, an egg is released from one of the ovaries (ovulation). Following ovulation, levels of another hormone called progesterone begin to increase. Progesterone prepares the endometrium to receive and nourish a fertilized egg. If pregnancy does not occur, estrogen and progesterone levels decrease. The decrease in progesterone triggers menstruation, or shedding of the lining. Once the lining is completely shed, a new menstrual cycle begins.

What causes endometrial hyperplasia?

Endometrial hyperplasia most often is caused by excess estrogen without progesterone. If ovulation does not occur, progesterone is not made, and the lining is not shed. The endometrium may continue to grow in response to estrogen. Thecells that make up the lining may crowd together and may become abnormal. This condition, called hyperplasia, may lead to cancer in some women.

When does endometrial hyperplasia occur?

Endometrial hyperplasia usually occurs after menopause, when ovulation stops and progesterone is no longer made. It also can occur during perimenopause, when ovulation may not occur regularly. Listed as follows are other situations in which women may have high levels of estrogen and not enough progesterone:

  • Use of medications that act like estrogen
  • Long-term use of high doses of estrogen after menopause (in women who have not had a hysterectomy)
  • Irregular menstrual periods, especially associated with polycystic ovary syndrome or infertility
  • Obesity

What risk factors are associated with endometrial hyperplasia?

Endometrial hyperplasia is more likely to occur in women with the following risk factors:

  • Age older than 35 years
  • White race
  • Never having been pregnant
  • Older age at menopause
  • Early age when menstruation started
  • Personal history of certain conditions, such as diabetes mellitus, polycystic ovary syndrome, gallbladder disease, or thyroid disease
  • Obesity
  • Cigarette smoking
  • Family history of ovarian, colon, or uterine cancer

What are the types of endometrial hyperplasia?

Endometrial hyperplasia is classified as simple or complex. It also is classified by whether certain cell changes are present or absent. If abnormal changes are present, it is called atypical. The terms are combined to describe the exact kind of hyperplasia:

  • Simple hyperplasia
  • Complex hyperplasia
  • Simple atypical hyperplasia
  • Complex atypical hyperplasia

What are signs and symptoms of endometrial hyperplasia?

The most common sign of hyperplasia is abnormal uterine bleeding. If you have any of the following, you should see your health care provider:

  • Bleeding during the menstrual period that is heavier or lasts longer than usual
  • Menstrual cycles that are shorter than 21 days (counting from the first day of the menstrual period to the first day of the next menstrual period)
  • Any bleeding after menopause

How is endometrial hyperplasia diagnosed?

There are many causes of abnormal uterine bleeding. If you have abnormal bleeding and you are 35 years or older, or if you are younger than 35 years and your abnormal bleeding has not been helped by medication, your health care provider may perform diagnostic tests for endometrial hyperplasia and cancer.

Transvaginal ultrasound may be done to measure the thickness of the endometrium. For this test, a small device is placed in your vagina. Sound waves from the device are converted into images of the pelvic organs. If the endometrium is thick, it may mean that endometrial hyperplasia is present.

The only way to tell for certain that cancer is present is to take a small sample of tissue from the endometrium and study it under a microscope. This can be done with an endometrial biopsydilation and curettage, or hysteroscopy.

What treatments are available for endometrial hyperplasia?

In many cases, endometrial hyperplasia can be treated with progestin. Progestin is given orally, in a shot, in an intrauterine device, or as a vaginal cream. How much and how long you take it depends on your age and the type of hyperplasia. Treatment with progestin may cause vaginal bleeding like a menstrual period.

If you have atypical hyperplasia, especially complex atypical hyperplasia, the risk of cancer is increased. Hysterectomy usually is the best treatment option if you do not want to have any more children.

What can I do to help prevent endometrial hyperplasia?

You can take the following steps to reduce the risk of endometrial hyperplasia:

  • If you take estrogen after menopause, you also need to take progestin or progesterone.
  • If your menstrual periods are irregular, birth control pills (oral contraceptives) may be recommended. They contain estrogen along with progestin. Other forms of progestin also may be taken.
  • If you are overweight, losing weight may help. The risk of endometrial cancer increases with the degree of obesity.

Glossary

Cells: The smallest units of a structure in the body; the building blocks for all parts of the body.

Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.

Dilation and Curettage: A procedure in which the cervix is opened and tissue is gently scraped or suctioned from the inside of the uterus.

Endometrial Biopsy: A test in which a small amount of the tissue lining the uterus is removed and examined under a microscope.

Endometrium: The lining of the uterus.

Estrogen: A female hormone produced in the ovaries that stimulates the growth of the lining of the uterus.

Hormones: Substances produced by the body to control the function of various organs.

Hysterectomy: Removal of the uterus.

Hysteroscopy: A procedure in which a slender, light-transmitting device, the hysteroscope, is inserted into the uterus through the cervix to view the inside of the uterus or perform surgery.

Intrauterine Device: A small device that is inserted and left inside the uterus to prevent pregnancy.

Menopause: The time in a woman’s life when the ovaries have stopped functioning, defined as the absence of menstrual periods for 1 year.

Menstruation: The monthly discharge of blood and tissue from the uterus that occurs in the absence of pregnancy.

Ovulation: The release of an egg from one of the ovaries.

Perimenopause: The period preceding menopause that usually extends from age 45 years to 55 years.

Polycystic Ovary Syndrome: A condition in which levels of certain hormones are abnormal and small growths called cysts may be present on the ovaries. It is associated with infertility and may increase the risk of diabetes mellitus and heart disease.

Progesterone: A female hormone that is produced in the ovaries and that prepares the lining of the uterus for pregnancy.

Progestin: A synthetic form of progesterone that is similar to the hormone produced naturally by the body.

Transvaginal Ultrasound: A type of ultrasound in which a transducer specially designed to be placed in the vagina is used.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

 

What are menopause and perimenopause?

Menopause is defined as the absence of menstrual periods for 1 year. The average age of menopause is 51 years, but the normal range is 45 years to 55 years.

The years leading up to this point are called perimenopause. This term means "around menopause." This phase can last for up to 10 years. During perimenopause, shifts in hormone levels can affect ovulation and cause changes in the menstrual cycle.

What are some of the common changes that occur in the menstrual cycle during perimenopause?

During a normal menstrual cycle, the levels of the hormones estrogen and progesterone increase and decrease in a regular pattern. Ovulation occurs in the middle of the cycle, and menstruation occurs about 2 weeks later. During perimenopause, hormone levels may not follow this regular pattern. As a result, you may have irregular bleeding or spotting. Some months, your period may be longer and heavier. Other months, it may be shorter and lighter. The number of days between periods may increase or decrease. You may begin to skip periods.

How can I tell if bleeding is abnormal?

Any bleeding after menopause is abnormal and should be reported to your health care provider. Although the menstrual period may become irregular during perimenopause, you should be alert for abnormal bleeding, which can signal a problem not related to perimenopause. A good rule to follow is to tell your health care provider if you notice any of the following changes in your monthly cycle:

  • Very heavy bleeding
  • Bleeding that lasts longer than normal
  • Bleeding that occurs more often than every 3 weeks
  • Bleeding that occurs after sex or between periods

What are some of the common causes of abnormal bleeding?

  • Polyps—Polyps are usually noncancerous growths that develop from tissue similar to the endometrium, the tissue that lines the inside of the uterus. They either attach to the uterine wall or develop on the endometrial surface. They may cause irregular or heavy bleeding. Polyps also can grow on the cervixor inside the cervical canal. These polyps may cause bleeding after sex.
  • Endometrial atrophy—After menopause, the endometrium may become too thin as a result of low estrogen levels. This condition is called endometrial atrophy. As the lining thins, you may have abnormal bleeding.
  • Endometrial hyperplasia—In this condition, the lining of the uterus thickens. It can cause irregular or heavy bleeding. Endometrial hyperplasia most often is caused by excess estrogen without enough progesterone. In some cases, the cells of the lining become abnormal. This condition, called atypical hyperplasia, can lead to cancer of the uterus. When endometrial hyperplasia is diagnosed and treated early, endometrial cancer often can be prevented. Bleeding is the most common sign of endometrial cancer in women after menopause (see the FAQ Endometrial Hyperplasia).

How is abnormal bleeding diagnosed?

To diagnose the cause of abnormal perimenopausal bleeding or bleeding after menopause, your health care provider will review your personal and family health history. You will have a physical exam. You also may have one or more of the following tests:

  • Endometrial biopsy—Using a thin tube, a small amount of tissue is taken from the lining of the uterus. The sample is sent to a lab where it is looked at under a microscope.
  • Transvaginal ultrasound—Sound waves are used to create a picture of the pelvic organs with a device placed in the vagina.
  • Sonohysterography—Fluid is injected into the uterus through a tube, called a catheter, while ultrasound images are made of the uterus.
  • Hysteroscopy—A thin, lighted tube with a camera at the end, called a hysteroscope, is inserted through the vagina and the opening of the cervix. The hysteroscope allows the inside of the uterus to be seen.
  • Dilation and curettage (D&C)—The opening of the cervix is enlarged. Tissue is scraped or suctioned from the lining of the uterus. The tissue is sent to a lab, where it is examined under a microscope.

Some of these tests can be done in your health care provider’s office. Others may be done at a hospital or surgical center.

What treatment is available for abnormal bleeding?

Treatment for abnormal perimenopausal bleeding or bleeding after menopause depends on its cause. If there are growths (such as polyps) that are causing the bleeding, surgery may be needed to remove them. Endometrial atrophy can be treated with medications. Endometrial hyperplasia can be treated with progestin therapy, which causes the endometrium to shed. Thickened areas of the endometrium may be removed using hysteroscopy or D&C.

Women with endometrial hyperplasia are at increased risk of endometrial cancer. They need regular endometrial biopsies to make sure that the hyperplasia has been treated and does not return.

Endometrial cancer is treated with surgery (usually hysterectomy with removal of nearby lymph nodes) in most cases. Discuss your options with your health care provider.

Glossary

Cervix: The lower, narrow end of the uterus, which protrudes into the vagina.

Estrogen: A female hormone produced in the ovaries.

Hysterectomy: Removal of the uterus.

Lymph Nodes: Small glands that filter the flow of lymph (a nearly colorless fluid that bathes body cells) through the body.

Ovulation: The release of an egg from one of the ovaries.

Progesterone: A female hormone that is produced in the ovaries and prepares the lining of the uterus for pregnancy.

Progestin: A synthetic form of progesterone that is similar to the hormone produced naturally by the body.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

 

What is cervical cancer screening?

Cervical cancer screening is used to find abnormal changes in the cells of the cervix that could lead to cancer. Screening includes the Pap test and, for some women, testing for a virus called human papillomavirus (HPV) .

What causes abnormal cervical cancer screening test results?

The main cause of cervical cancer is infection with HPV. There are many types of HPV. Some types have been linked to cancer of the cervix, vulva, vagina, anus, and penis. Some also can cause cancer of the head and neck. These types of HPV are known as “high-risk” types. Most cases of cervical cancer are caused by just two high-risk types of HPV—type 16 and type 18. Cells that are infected with HPV appear different from normal cells under a microscope. Abnormal changes can be mild, or they can be more serious. The more serious changes can lead to cancer if not treated.

What is the difference between the terms cervical intraepithelial lesion and squamous intraepithelial lesion?

These terms are used to describe changes in the cervix, but they are used in different situations. Squamous intraepithelial lesion (SIL) is used to describe Pap test results. “Squamous” refers to the type of cells that make up the tissue that covers the cervix. SIL is not a diagnosis of precancer or cancer. The Pap test is a screening test. It cannot tell exactly how severe the changes are in cervical cells. A cervical biopsy is needed to find out whether precancer or cancer actually is present.

Cervical intraepithelial lesion (CIN) is used to report cervical biopsy results. CIN describes the actual changes in cervical cells. CIN is graded as 1, 2, or 3. CIN 1 is used for mild (low-grade) changes in the cells that usually go away on their own without treatment. CIN 2 is used for moderate changes. CIN 3 is used for more severe (high-grade) changes. Moderate and high-grade changes can progress to cancer. For this reason, they may be described as “precancer.”

What are the different types of abnormal Pap test results?

  • Atypical squamous cells of undetermined significance (ASC-US)—ASC-US means that changes in the cervical cells have been found. The changes are almost always a sign of an HPV infection. ASC-US is the most common abnormal Pap test result.
  • Low-grade squamous intraepithelial lesion (LSIL)—LSIL means that the cervical cells show changes that are mildly abnormal. LSIL usually is caused by an HPV infection that often goes away on its own.
  • High-grade squamous intraepithelial lesion (HSIL)—HSIL suggests more serious changes in the cervix than LSIL. It is more likely than LSIL to be associated with precancer and cancer.
  • Atypical squamous cells, cannot exclude HSIL (ASC-H)—ASC-H means that changes in the cervical cells have been found that raise concern for the presence of HSIL.
  • Atypical glandular cells (AGC)—Glandular cells are another type of cell that make up the thin layer of tissue that covers the inner canal of the cervix. Glandular cells also are present inside the uterus. An AGC result means that changes have been found in glandular cells that raise concern for the presence of precancer or cancer.

What testing is needed after an abnormal cervical cancer screening test result?

If you have an abnormal cervical cancer screening test result, you may need further testing. The following tests may be done depending on your age and your initial Pap test result.

  • Repeat Pap test or co-test—A repeat Pap test or a repeat co-test (Pap test and a test for high-risk types of HPV) is recommended as a follow-up to some abnormal test results. These repeat tests may be done in 1 year or in 3 years depending on your initial test result, your age, and the results of previous tests.
  • HPV test—An HPV test looks for the presence of the HPV types that have been linked to cervical cancer. An HPV test can be done on the same cells used for the initial Pap test. This is called reflex HPV testing. There is another kind of HPV test that looks specifically for HPV type 16 and HPV type 18. These two types cause the most cases of cervical cancer. This kind of HPV test is called HPV typing.
  • Colposcopy, biopsy, and endocervical sampling—Colposcopy is an exam of the cervix with a magnifying device. If an area of abnormal cells is seen, your health care provider may decide that a cervical biopsy is needed. For a biopsy, the health care provider removes a small sample of tissue and sends it to a lab for testing. The lab tests can determine whether CIN is present and, if so, what grade it is. Endocervical sampling also may be done. A small brush or other instrument is used to take a tissue sample from the cervical canal.
  • Endometrial sampling—A sample of the endometrium (the lining of the uterus) is collected for study. Some women with an AGC result need to have this follow-up test.

How are abnormal cervical cells treated?

In general, there are two ways to treat abnormal cervical cells: 1) “excisional” treatment and 2) “ablative” treatment. With excisional treatments, tissue is removed from the cervix and is sent to a laboratory to be studied. Results can tell whether CIN actually is present and, if so, how severe it is. With ablative treatment, abnormal cervical tissue is destroyed, and there is no tissue to send to a laboratory for study.

What types of excisional treatments are there?

Excisional treatments include the following:

  • Loop electrosurgical excision procedure (LEEP)—A thin wire loop that carries an electric current is used to remove abnormal areas of the cervix.
  • Conization—A cone-shaped piece of the cervix that contains the abnormal cells is removed.

What types of ablative treatments are there?

  • Cryotherapy—An instrument is used to freeze abnormal cervical tissue, which then sloughs off.
  • Laser therapy—A focused beam of light is used to destroy abnormal cervical tissue.

Glossary

Cells: The smallest units of a structure in the body; the building blocks for all parts of the body.

Cervical Biopsy: A minor surgical procedure to remove a small piece of cervical tissue that is then examined under a microscope in a laboratory.

Cervical Intraepithelial Neoplasia (CIN): A term used to describe abnormal changes in the cells of the cervix that are caused by infection with human papillomavirus. CIN is graded as 1 (low-grade), 2 (moderate), or 3 (high-grade).

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Colposcopy: Viewing of the cervix, vulva, or vagina under magnification with an instrument called a colposcope.

Conization: A procedure in which a cone-shaped piece of tissue is removed from the cervix.

Cryotherapy: A freezing technique used to destroy diseased tissue; also known as “cold cautery.”

Human Papillomavirus (HPV): The name for a group of related viruses, some of which cause genital warts and some of which can cause cancer of the cervix, vulva, vagina, penis, anus, and throat.

Loop Electrosurgical Excision Procedure (LEEP): The removal of abnormal tissue from the cervix using a thin wire loop and electric energy.

Pap Test: A test in which cells are taken from the cervix and vagina and examined under a microscope.

Squamous Intraepithelial Lesion (SIL): A term used to describe abnormal cervical cells detected by the Pap test.

 
       
         
         
         
         
         
         
   
 

 

What is cancer of the cervix?

A woman’s cervix (the opening of the uterus at the top of the vagina) is covered by a thin layer of tissue made up of cells. Healthy cells grow, divide, and are replaced as needed. Cancer of the cervix occurs when these cells change. Cancer cells divide more rapidly. They may grow into deeper cell layers or spread to other organs. The cancer cells eventually form a mass of tissue called a tumor.

How long does it take for cervical cancer to develop?

It often takes several years for cervical cancer to develop. During this time, the cells on or around the cervix become abnormal. The cell changes that occur before cancer is present are called dysplasia or cervical intraepithelial neoplasia (CIN).

What is the main cause of cervical cancer?

The main cause of cervical cancer is human papillomavirus (HPV) infection. There are many types of HPV. Some types of HPV, called "high-risk types," can cause cancer of the anus, cervix, vulva, vagina, and penis. They also can cause cancer of the head and neck. Other types have been linked to genital warts.

Who is at risk of cervical cancer?

The most important risk factor for cervical cancer is infection with the types of HPV linked to cancer. The following factors increase your risk of becoming infected with HPV:

  • Multiple sexual partners
  • Having a male sexual partner who has had multiple sexual partners
  • Early age at which you first had sex (younger than 18 years)

Other risk factors include the following:

  • A personal history of dysplasia of the cervix, vagina, or vulva
  • A family history of cervical cancer
  • Smoking
  • Certain sexually transmitted diseases, such as chlamydia
  • Problems with the immune system
  • Having a mother who took a drug called diethylstilbestrol (DES) during pregnancy

Is there a screening test for cervical cancer?

Yes. The Pap test checks for abnormal cell changes of the cervix (see the FAQ Cervical Cancer Screening). This allows early treatment of the abnormal cells so that they do not become cancer. An HPV test also is available. It is used along with the Pap test to screen for cervical cancer in some women and as a follow-up test when a woman has an abnormal Pap test result.

What are some of the symptoms of cervical cancer?

The first signs may be abnormal bleeding, spotting, or watery discharge from the vagina. Menstrual bleeding may be heavier than usual, and bleeding may occur after sex. Signs of advanced cancer can include pelvic pain, problems urinating, and swollen legs. If the cancer has spread to nearby organs or the lymph nodes, the tumors can affect how those organs work. For instance, a tumor might press on your bladder or block blood flow in a vein.

How is cervical cancer diagnosed?

If your health care provider suspects that you have cancer of the cervix, a biopsy may be done. For certain abnormal Pap test results that require treatment, the abnormal cervical tissue may be removed and sent to a lab to be studied.

If cervical cancer is diagnosed, your health care provider will assess the size of the cancer and the extent (if any) to which the disease has spread. This process may include the following tests:

  • A pelvic exam (which may include a rectal exam)—An examination in which your health care provider checks the uterus, ovaries, and other organs near the cervix
  • Cystoscopy—A test in which the inside of the urethra and bladder are studied with a lighted device
  • Colonoscopy—A test in which the entire colon is examined with a slender, lighted instrument called a colonoscope

What is staging?

"Staging" is the process of finding out how much the cancer has spread. Most types of cancer have stages from I to IV. The lower the number, the less the cancer has spread.

Some types of cancer, including cervical cancer, have a Stage 0. Stage 0 also is called noninvasive cervical cancer or carcinoma in situ. In Stage 0, cancer cells are present on the top layer of the cervix only. They have not gone into deeper layers of the cervical tissue or other organs. The remaining stages are called invasive cancer. In these stages, the cancer has invaded into deeper layers of the cervix.

What are the types of treatment?

Invasive cancer of the cervix is treated with surgery (hysterectomy), radiation therapy, and chemotherapy (the use of cancer-killing drugs). The type of treatment chosen depends on the cancer stage. You may receive more than one type of treatment.

Is special follow-up required after treatment?

Your health care provider may suggest more frequent cervical cancer screening for the first few years after treatment to make sure that all the cancer cells were removed. Even if your cervix has been removed to treat your cancer, you still need cervical cancer screening. Cells are taken from the upper vagina instead of the cervix.

Glossary

Biopsy: A minor surgical procedure to remove a small piece of tissue that is then examined under a microscope in a laboratory.

Bladder: A muscular organ in which urine is stored.

Cells: The smallest units of a structure in the body; the building blocks for all parts of the body.

Cervical Intraepithelial Neoplasia (CIN): Another term for dysplasia; a noncancerous condition that occurs when normal cells on the surface of the cervix are replaced by a layer of abnormal cells. CIN is graded as 1 (mild dysplasia), 2 (moderate dysplasia), or 3 (severe dysplasia or carcinoma in situ).

Cervix: The opening of the uterus at the top of the vagina.

Dysplasia: A noncancerous condition that occurs when normal cells are replaced by a layer of abnormal cells.

Human Papillomavirus (HPV): The common name for a group of related viruses, some of which are linked to cervical changes and cervical cancer.

Hysterectomy: Removal of the uterus.

Immune System: The body’s natural defense system against foreign substances and invading organisms, such as bacteria that cause disease.

Lymph Nodes: Small glands that filter the flow of lymph (a nearly colorless fluid that bathes body cells) through the body.

Pap Test: A test in which cells are taken from the cervix and examined under a microscope.

Sexually Transmitted Diseases: Diseases that are spread by sexual contact, including chlamydia, gonorrhea, human papillomavirus infection, herpes, syphilis, and infection with human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Urethra: A tube-like structure through which urine flows from the bladder to the outside of the body.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

 

What is human papillomavirus (HPV)?

 Human papillomavirus (HPV) is a virus that can be passed from person to person through skin-to-skin contact. More than 100 types of HPV have been found. About 30 of these types infect the genital areas of men and women.

How is HPV spread?

HPV is primarily spread through vaginal, anal, or oral sex, but sexual intercourse is not required for infection to occur. HPV is spread by skin-to-skin contact. Sexual contact with an infected partner, regardless of the sex of the partner, is the most common way the virus is spread.

What diseases does HPV cause?

Approximately 12 types of HPV cause genital warts. Two types, type 6 and type 11, cause most cases of genital warts. Genital warts are growths that may appear on the outside or inside of the vagina or on the penis and can spread to nearby skin. They also can grow around the anus, on the vulva, or on the cervix. They can be treated with medication that is applied to the area or by surgical removal. The type of treatment depends on where the warts are located.

About 15 types of HPV cause cancer of the cervix. They also cause cancer of the vulva, vagina, anus, penis, and the head and neck. Most cases of cervical cancer are caused by just two types of HPV—type 16 and type 18.

How does HPV cause cancer of the cervix?

The cervix is covered by a thin layer of tissue made up of cells. If one of the cancer-causing types of HPV is present, it may enter these cells. Infected cells may become abnormal or damaged and begin to grow differently. It usually takes several years for cervical cancer to develop. Cervical cancer screening can detect early signs of abnormal changes of the cervix and allows early treatment so that they do not become cancer.

What HPV vaccines are available?

Two vaccines are currently available that protect against some types of HPV:

  • One vaccine protects against type 6 and type 11, which cause the most cases of genital warts, and against type 16 and type 18, which cause the most cases of cervical cancer.
  • One vaccine protects against type 16 and type 18.

How effective are the vaccines in preventing HPV infection?

The four-type vaccine is almost 100% effective in preventing cervical precancer and genital warts caused by four types of HPV. The two-type vaccine also is almost 100% effective in preventing cervical precancer caused by two types of HPV.

The vaccines are most effective if they are given before a woman is sexually active and exposed to HPV. If a woman is already infected with one type of HPV, the vaccines will not protect against disease caused by that type. However, the vaccines can protect against the other types of HPV included in the vaccines.

Who should get the HPV vaccine?

Both vaccines are recommended for girls and women aged 9 years through 26 years and are given in three doses over a 6-month period. The vaccines are not recommended for pregnant women but are safe for women who are breastfeeding. Boys and men can get the four-type vaccine beginning at age 9 years and up to age 26 years.

If I get the vaccine, do I still need to have regular cervical cancer screening?

The vaccines do not protect against all types of HPV and do not give complete protection against cervical cancer or genital warts. Therefore, women who are vaccinated should still have regular cervical cancer screening as recommended by their health care providers.

What side effects may be caused by the vaccines?

The most common side effect of the HPV vaccine is soreness in the arm where the shot is given. On very rare occasions, persons who received the shot experienced headache, fatigue, nausea, dizziness, fainting, or pain in the arm. These symptoms are mild and usually go away quickly.

Glossary

Cells: The smallest units of a structure in the body; the building blocks for all parts of the body.

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Sexual Intercourse: The act of the penis of the male entering the vagina of the female (also called "having sex" or "making love").

Vulva: The external female genital area.

 

What is a screening test?

screening test is used to find diseases, such as cancer, in people who do not have signs or symptoms. This allows early treatment. The earlier cancer is treated, the greater the chance of survival.

What screening tests are used to screen for breast problems?

Screening for breast problems includes mammography, clinical breast exams, and breast self-awareness.

What is mammography?

Mammography is an X-ray technique used to study the breasts. No dyes have to be injected or swallowed, and no instruments will be put in your body.

Why is mammography done?

Mammography is done for two reasons: 1) as a screening test to regularly check for breast cancer in women who do not have signs or symptoms of the disease, and 2) as a diagnostic test to check lumps or other symptoms that you have found yourself or that have been found by a health care provider.

When should I start having annual mammograms?

Age 40 years is recommended as the starting point in order to find cancer at an early and more treatable stage.

What if the result of my mammography reveals a lump?

Mammography by itself cannot tell whether a lump or other finding is benign (not cancer) or malignant (cancer). If a mammography finding is suspicious for cancer, a biopsy is needed to confirm that cancer is present. In a biopsy, the lump or a small sample of cells from the lump is removed and looked at under a microscope.

How do I prepare for a mammogram?

The day you have a mammogram, do not wear powders, lotions, or deodorants. Most of these products have substances that can be seen on the X-ray and make it hard to read.

What happens during mammography?

To get ready for the test, you will need to completely undress from the waist up and put on a gown. You will be asked to stand or sit in front of the X-ray machine. One of your breasts will be placed between two smooth, flat plastic or glass plates. You will briefly feel firm pressure on your breast. The plates will flatten your breast as much as possible so that the most tissue can be viewed with the least amount of radiation. After the first X-ray, the plates may be removed so that another X-ray can be obtained from one or more other positions. The test then is done on the other breast.

What are the risks of mammography?

You may be concerned about the risk of cancer from the radiation used in mammography. Mammography uses a low level of radiation. The risk of harm from the level of radiation used in mammography is low. Having a yearly screening mammogram does not increase cancer risk.

What is digital mammography?

Digital mammography is a type of mammography technique. It differs from standard mammography only in the way the image is stored. Instead of using film, the image in digital mammography is stored as a digital file on a computer. A computer program allows the image to be enlarged or enhanced or specific areas to be magnified. Digital mammography may be better at detecting cancer in some groups of women, such as those with dense breast tissue, women younger than 50 years, and women who have not gone through menopause.

What is a clinical breast exam?

Your health care provider will examine your breasts during routine checkups. This is called a clinical breast exam. Women aged 29–39 years should have a clinical breast exam every 1–3 years. Women aged 40 years and older should have one every year.

How is a clinical breast exam done?

The exam may be done while you are lying down, sitting up, or both. You may be asked to raise your arms over your head. The breasts are first checked for any changes in size or shape. Your health care provider also looks for puckers, dimples, or redness of the skin. He or she then feels for changes in each breast and under each arm. The nipple may be gently squeezed to check for discharge.

What is breast self-awareness?

Breast self-awareness is an understanding of how your breasts normally look and feel.

How is breast self-awareness different from the traditional breast self-exam?

In the traditional breast self-exam, you use a precise method to examine your breasts on a regular basis, such as once a month. Breast self-awareness does not require you to examine your breasts once a month or with a precise method. Instead, it focuses on having a sense of what is normal for your breasts so that you can tell if there are changes—even small changes—and report them to your health care provider.

Glossary

Benign: Not cancer.

Biopsy: A minor surgical procedure to remove a small piece of tissue that is then examined under a microscope in a laboratory.

Cells: The smallest units of a structure in the body; the building blocks for all parts of the body.

Malignant: A term used to describe cells or tumors that are able to invade tissue and spread to other parts of the body.

Mammography: A procedure that uses X-rays to detect and study breast cancer and other problems of the breast.

Menopause: The time in a woman’s life when the ovaries have stopped functioning; defined as the absence of menstrual periods for 1 year.

Screening Test: A test that looks for possible signs of disease in people who do not have symptoms.

 

 What is menopause?

Menopause is the time in a woman’s life when she stops having menstrual periods. The years leading up to this point are called perimenopause, or "around menopause." Menopause marks the end of the reproductive years that began in puberty.

What happens as menopause nears?

As menopause nears, the ovaries make less estrogen. One of the earliest and most common signs that menopause may be approaching is a change in your menstrual periods.

Even though menstrual periods tend to be irregular around the time of menopause, you should be aware of bleeding that is not normal for you. This could be a sign of a problem (see the FAQ Abnormal Uterine Bleeding).

At some point, the ovaries stop making enough estrogen to thicken the lining of the uterus. This is when menstrual periods stop. You are not completely free of the risk of pregnancy until 1 year after your menstrual last period.

What else can trigger menopause besides age?

Menopause also can occur when a woman’s ovaries are surgically removed. This may trigger severe symptoms because the hormone levels decrease all at once.

Although the removal of the uterus (a hysterectomy) ends menstrual periods, it will not cause menopause unless the ovaries also are removed.

What is the most common symptom of menopause?

The most common symptom of menopause is hot flashes. As many as 75% of menopausal women in the United States will have them. A hot flash is a sudden feeling of heat that rushes to the upper body and face. The skin may redden like a blush. You also may break out in a sweat. A hot flash may last from a few seconds to several minutes or longer.

Hot flashes can cause a lack of sleep by often waking a woman from a deep sleep. A lack of sleep may be one of the biggest problems you face as you approach menopause.

What vaginal and urinary tract changes occur during menopause?

Loss of estrogen causes changes in the vagina. Its lining may become thin and dry. These changes can cause pain during sexual intercourse. They also can make the vagina more prone to infection, which can cause burning and itching.

The urinary tract also changes with age. The urethra (the tube that carries urine from the bladder) can become dry, inflamed, or irritated. Some women may need to urinate more often. Women may have an increased risk of bladder infection after menopause.

How does menopause affect bone loss?

At menopause, the rate of bone loss increases. Osteoporosis, which can result from this bone loss, increases the risk of bone fracture in older women. The bones of the hip, wrist, and spine are affected most often.

How do decreased estrogen levels affect a woman’s risk of heart attacks and stroke?
The estrogen produced by women’s ovaries before menopause protects them from heart attacks and stroke. When less estrogen is made after menopause, women lose much of this protection. The risk of heart attack and stroke then increases.

What causes emotional changes during menopause?

The change in hormone levels may make you feel nervous, irritable, or very tired. These feelings may be linked to other symptoms of menopause, such as lack of sleep.

How may menopause affect my sex life?

Some women find that they have less interest in sex around and after menopause. Lower hormone levels may decrease the sex drive. It may affect your ability to have an orgasm, or it may take longer for you to reach orgasm.

Are there treatments that relieve the symptoms of menopause?

Hormone therapy can help relieve the symptoms of menopause. In some cases, you may begin hormone therapy before menopause. If you are taking birth control pills, they will be stopped when you begin treatment.

For women with a uterus, estrogen usually is given along with progestin—a synthetic version of the hormone progesterone. This helps reduce the risk of cancer of the lining of the uterus that occurs when estrogen is used alone.

What are the benefits of hormone therapy?

Estrogen is used to treat the main symptom of menopause—hot flashes. It also relieves vaginal dryness and can help to relieve some changes that can cause problems in the urinary tract. Estrogen protects against bone loss. Hormone therapy slows bone loss after menopause and helps prevent osteoporosis. Estrogen also can help reduce the risk of colon cancer.

What are the risks of hormone therapy?

Like any treatment, hormone therapy is not free of risk. In women with a uterus, using estrogen alone can increase the risk of endometrial cancer because estrogen causes the lining of the uterus to grow. Taking a progestin along with estrogen will help reduce the risk of uterine problems. The drawback of using a progestin is that it seems to increase the risk of breast cancer. Also, menopausal women may start bleeding again, although bleeding may occur only for a short time.

What other therapies are available for menopause?

If a woman does not take hormone therapy, there are some other options for preventing bone loss, such as bisphosphonates or selective estrogen receptor modulators (SERMs). A medication called calcitonin slows bone loss. It can be given by injection or nasal spray. Bisphosphonates are used to increase bone density and reduce the risk of fractures. Parathyroid hormone also is used for this purpose.

Glossary

Estrogen: A female hormone produced in the ovary that stimulates the growth of the lining of the uterus.

Hormone Therapy: Treatment in which estrogen, and often progestin, is taken to relieve the symptoms caused by the low levels of hormones produced by the body.

Osteoporosis: A condition in which the bones become so fragile that they break more easily.

Progestin: A synthetic form of progesterone that is similar to the hormone produced naturally by the body.

 

Menopause is defined as the absence of menstrual periods for 1 year. The average age of menopause is 51 years, but the normal range is 45 years to 55 years.

The years leading up to this point are called perimenopause. This term means "around menopause." This phase can last for up to 10 years. During perimenopause, shifts in hormone levels can affect ovulation and cause changes in the menstrual cycle.

What are some of the common changes that occur in the menstrual cycle during perimenopause?

During a normal menstrual cycle, the levels of the hormones estrogen and progesterone increase and decrease in a regular pattern. Ovulation occurs in the middle of the cycle, and menstruation occurs about 2 weeks later. During perimenopause, hormone levels may not follow this regular pattern. As a result, you may have irregular bleeding or spotting. Some months, your period may be longer and heavier. Other months, it may be shorter and lighter. The number of days between periods may increase or decrease. You may begin to skip periods.

How can I tell if bleeding is abnormal?

Any bleeding after menopause is abnormal and should be reported to your health care provider. Although the menstrual period may become irregular during perimenopause, you should be alert for abnormal bleeding, which can signal a problem not related to perimenopause. A good rule to follow is to tell your health care provider if you notice any of the following changes in your monthly cycle:

  • Very heavy bleeding

  • Bleeding that lasts longer than normal

  • Bleeding that occurs more often than every 3 weeks

  • Bleeding that occurs after sex or between periods

What are some of the common causes of abnormal bleeding?

  • Polyps—Polyps are usually noncancerous growths that develop from tissue similar to the endometrium, the tissue that lines the inside of the uterus. They either attach to the uterine wall or develop on the endometrial surface. They may cause irregular or heavy bleeding. Polyps also can grow on the cervix or inside the cervical canal. These polyps may cause bleeding after sex.

  • Endometrial atrophy—After menopause, the endometrium may become too thin as a result of low estrogen levels. This condition is called endometrial atrophy. As the lining thins, you may have abnormal bleeding.

  • Endometrial hyperplasia—In this condition, the lining of the uterus thickens. It can cause irregular or heavy bleeding. Endometrial hyperplasia most often is caused by excess estrogen without enough progesterone. In some cases, the cells of the lining become abnormal. This condition, called atypical hyperplasia, can lead to cancer of the uterus. When endometrial hyperplasia is diagnosed and treated early, endometrial cancer often can be prevented. Bleeding is the most common sign of endometrial cancer in women after menopause (see the FAQ Endometrial Hyperplasia).

How is abnormal bleeding diagnosed?

To diagnose the cause of abnormal perimenopausal bleeding or bleeding after menopause, your health care provider will review your personal and family health history. You will have a physical exam. You also may have one or more of the following tests:

  • Endometrial biopsy—Using a thin tube, a small amount of tissue is taken from the lining of the uterus. The sample is sent to a lab where it is looked at under a microscope.

  • Transvaginal ultrasound—Sound waves are used to create a picture of the pelvic organs with a device placed in the vagina.

  • Sonohysterography—Fluid is injected into the uterus through a tube, called a catheter, while ultrasound images are made of the uterus.

  • Hysteroscopy—A thin, lighted tube with a camera at the end, called a hysteroscope, is inserted through the vagina and the opening of the cervix. The hysteroscope allows the inside of the uterus to be seen.

  • Dilation and curettage (D&C)—The opening of the cervix is enlarged. Tissue is scraped or suctioned from the lining of the uterus. The tissue is sent to a lab, where it is examined under a microscope.

Some of these tests can be done in your health care provider’s office. Others may be done at a hospital or surgical center.

What treatment is available for abnormal bleeding?

Treatment for abnormal perimenopausal bleeding or bleeding after menopause depends on its cause. If there are growths (such as polyps) that are causing the bleeding, surgery may be needed to remove them. Endometrial atrophy can be treated with medications. Endometrial hyperplasia can be treated with progestin therapy, which causes the endometrium to shed. Thickened areas of the endometrium may be removed using hysteroscopy or D&C.

Women with endometrial hyperplasia are at increased risk of endometrial cancer. They need regular endometrial biopsies to make sure that the hyperplasia has been treated and does not return.

Endometrial cancer is treated with surgery (usually hysterectomy with removal of nearby lymph nodes) in most cases. Discuss your options with your health care provider.

Glossary

Cervix: The lower, narrow end of the uterus, which protrudes into the vagina.

Estrogen: A female hormone produced in the ovaries.

Hysterectomy: Removal of the uterus.

Lymph Nodes: Small glands that filter the flow of lymph (a nearly colorless fluid that bathes body cells) through the body.

Ovulation: The release of an egg from one of the ovaries.

Progesterone: A female hormone that is produced in the ovaries and prepares the lining of the uterus for pregnancy.

Progestin: A synthetic form of progesterone that is similar to the hormone produced naturally by the body.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

 

What is sterilization?

Sterilization is a permanent method of birth control. Sterilization procedures for women are called tubal occlusion. The procedure for men is called vasectomy.

How does tubal occlusion work to prevent pregnancy?

Tubal occlusion closes off the fallopian tubes. This prevents the egg from moving down the fallopian tube to the uterus and keeps the sperm from reaching the egg.

How effective is female sterilization?

Sterilization is a highly effective way to prevent pregnancy. Fewer than 1 out of 100 women will become pregnant within 1 year of having the procedure. After 10 years, pregnancy rates range from fewer than 1 to fewer than 4 women out of 100, depending on the type of sterilization method used.

Does female sterilization protect against sexually transmitted infections (STIs)?

Female sterilization does not protect against sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). A male or female condom should be used to protect against these infections if you are at risk of getting an STI.

Are there risks associated with female sterilization?

A risk common to all female sterilization methods is that if pregnancy does occur, there is an increased chance that it will be an ectopic pregnancy. However, the risk of ectopic pregnancy occurring in women after tubal sterilization is lower than in women who do not use any birth control. Other risks are specific to the type of procedure.

How is female sterilization performed?

There are three ways that sterilization for women can be performed:

  • Minilaparotomy—A small incision is made in the abdomen. The fallopian tubes are brought up through the incision. Then they are blocked with clips or, more commonly, a small section of each tube is removed. This approach frequently is used for postpartum sterilization.
  • Laparoscopy—This is a type of surgical procedure that uses a device called a laparoscope to view the pelvic organs (see the FAQ Sterilization by Laparoscopy). The fallopian tubes are closed off using instruments passed through the laparoscope or with another instrument inserted through a second small incision.
  • HysteroscopyHysteroscopic sterilization does not require incisions in the skin. It can be done with local anesthesia in a health care provider’s office. Small devices are placed into the openings of the fallopian tubes. The devices cause scar tissue to form that blocks the fallopian tubes. After having the procedure, it takes 3 months for the scar tissue to form. During this time, you must use another form of birth control to prevent pregnancy. A test called hysterosalpingography must be done to ensure that the tubes are blocked before you can use it as your only method of birth control.

How does a vasectomy work to prevent pregnancy?

The vas deferens is one of two tubes that carry sperm from the testes. In a vasectomy, these tubes are tied, cut, clipped, or sealed to prevent the release of sperm. This prevents a woman’s egg from being fertilized with the man’s sperm.

How effective is a vasectomy?

The effectiveness of vasectomy in preventing pregnancy after 1 year is slightly higher than that of female sterilization. As with female sterilization, vasectomy does not protect against STIs.

How is a vasectomy done?

One or two small openings are made in the skin of the scrotum. Each vas deferens is pulled through the opening until it forms a loop. A small section is cut out of the loop and removed. The two ends are tied and may be sealed with heat. This causes scar tissue to grow and block the tubes. Each vas deferens then is placed back into the scrotum. There also is a “no-scalpel” technique that does not require incisions in the skin. It can be done with local anesthesia in a health care provider’s office.

How long does it take for a vasectomy to work?

It takes about 2–4 months for the semen to become totally free of sperm. A couple must use another method of birth control or avoid sexual intercourse until a sperm count confirms that no sperm are present. In this test, the number of sperm in a semen sample is counted.

What are the benefits and risks of vasectomy?

Vasectomy generally is considered to be safer than female sterilization and requires only local anesthesia. Also, there is no increased risk of ectopic pregnancy if the vasectomy fails. Risks of vasectomy include minor bleeding and infection. Major complications are rare.

Can sterilization be reversed?

Sterilization is permanent birth control and is not meant to be reversible. Before having the procedure, you (and your partner, if appropriate) must be certain that you do not want children in the future. If you have a sterilization procedure and you change your mind after the operation, you can have surgery to try to reverse it, or assisted reproductive technology can be used to attempt pregnancy. These procedures are expensive and may not be covered by insurance. There also is no guarantee that you will be able to become pregnant afterward.

Glossary

Ectopic Pregnancy: A pregnancy in which the fertilized egg begins to grow in a place other than inside the uterus, usually in one of the fallopian tubes.

Egg: The female reproductive cell produced in and released from the ovaries; also called the ovum.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body’s immune system and causes acquired immunodeficiency syndrome (AIDS).

Hysterosalpingography: A special X-ray procedure in which a small amount of fluid is placed into the uterus and fallopian tubes to detect abnormal changes in their size and shape or to determine whether the tubes are blocked.

Hysteroscopic Sterilization: A sterilization procedure in which the opening of each fallopian tube is blocked with scar tissue formed by the insertion of small implants, preventing sperm from entering the fallopian tubes to fertilize an egg.

Hysteroscopy: A procedure in which a device called a hysteroscope is inserted into the uterus through the cervix to view the inside of the uterus or perform surgery.

Laparoscope: An instrument that is inserted into the abdominal cavity through a small incision to view internal organs or to perform surgery.

Laparoscopy: A surgical procedure in which an instrument called a laparoscope is inserted into the pelvic cavity through a small incision. The laparoscope is used to view the pelvic organs. Other instruments can be used with it to perform surgery.

Local Anesthesia: The use of drugs that prevent pain in a part of the body.

Minilaparotomy: A small abdominal incision used for a sterilization procedure in which the fallopian tubes are closed off.

Postpartum Sterilization: A permanent procedure that prevents a woman from becoming pregnant, performed soon after the birth of a child.

Scrotum: The external genital sac in the male that contains the testes.Semen: The fluid made by male sex glands that contains sperm.

Sexually Transmitted Infections (STIs): Infections that are spread by sexual contact, including chlamydia, gonorrhea, human papillomavirus infection, herpes, syphilis, and infection with human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Sperm: A cell produced in the male testes that can fertilize a female egg.

Sterilization: A permanent method of birth control.

Testes: Two male organs that produce sperm and the male sex hormone testosterone.

Tubal Occlusion: Blockage of the fallopian tubes.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Vas Deferens: One of two small tubes that carries sperm from each male testis to the prostate gland.

Vasectomy: A method of male sterilization in which a portion of the vas deferens is removed.

 

What are barrier methods?

Barrier methods of birth control are physical or chemical barriers that prevent sperm from passing through the woman’s cervix into the uterus and fallopian tubes to fertilize an egg. Some methods also protect against sexually transmitted disease (STDs).

What are the types of barrier methods and how effective are they in preventing pregnancy?

The following table lists the barrier methods and their effectiveness in preventing pregnancy:

Method

Number of women out of 100 who will become pregnant during the first year of typical use (when a method is used by the average person who does not always use the method correctly or consistently*

Diaphragm

12

Sponge
   Women who have not given birth
   Women who have given birth

 
12
24

Cervical cap
   Women who have not given birth
   Women who have given birth

 
13
23

Male condom

18

Female condom

21

Spermicide

28

What are spermicides and how are they used?

A spermicide is a foam, cream, jelly, suppository (an insert that melts after it is inserted in the vagina), or film (thin sheets). Spermicide can be used with all other barrier methods except the sponge, which already contains a spermicide.

A spermicide should be inserted into the vagina close to the cervix no more than 30 minutes before intercourse. It should remain in place for 6–8 hours after sex. A spermicide should be reapplied with each act of sex.

What are the benefits, risks, and side effects of using spermicides?

Benefits:

— Spermicides are easy to use.

— They do not cost very much and can be bought over-the-counter.

— They have no effect on a woman’s natural hormones.

— They can be used while breastfeeding.

Risks:

— When used alone, spermicides do not protect against STDs, including infection with human immunodeficiency virus (HIV).

— Frequent use of spermicides can increase the risk of getting HIV from an infected partner. Spermicides should only be used if you are at low risk of HIV infection. Possible side effects: allergic reaction to the spermicide and vaginitis.

What are condoms and how are they used?

Two types of condoms are available: male and female. The male condom is a thin sheath made of latex (rubber), polyurethane (plastic), or natural (animal) membrane that is worn by the man over his erect penis. Latex and polyurethane condoms provide the best available protection against many STDs, including HIV.

The female condom is a thin plastic pouch that lines the vagina. It is held in place by a closed inner ring at the cervix and an outer ring at the opening of the vagina. It can be inserted up to 8 hours before sex and provides some protection against STDs.

Both types of condoms should be used with a lubricant to prevent the condom from tearing or breaking and to reduce irritation. Latex condoms should only be used with water-based or silicone lubricants. Oil-based lubricants can weaken the latex and increase the risk that the condom will break.

What are the benefits, risks, and side effects of using condoms?

Benefits:

— Condoms do not cost very much and can be bought over-the-counter.

— They can be carried in a pocket or purse.

— They have no effect on a woman’s natural hormones.

— They can be used while breastfeeding.

— Latex and polyurethane condoms provide the best available protection against STDs.

— The female condom can be inserted up to 8 hours before sex.

Risks: none  Possible side effects: allergic reaction to latex or polyurethane

 What is the sponge and how is it used?

The sponge is a doughnut-shaped device made of soft foam coated with spermicide. It is inserted into the vagina to cover the cervix. It is available without a prescription. The sponge does not protect against STDs, including HIV. A male or female condom should be used with the sponge to provide STD protection if you are at risk of getting an STD.

What are the benefits, risks, and side effects of using the sponge?

Benefits:

— It can be bought over-the-counter.

— It can be carried in a purse or pocket.

— It has no effect on a woman’s natural hormones.

— Each sponge contains enough spermicide for repeated acts of intercourse during a 24-hour period.

— It can be used while breastfeeding beginning 6 weeks after childbirth.

Risks:

— Cases of toxic shock syndrome have occurred in a few women using the sponge.

— The sponge should only be used if you are at low risk of HIV infection. Frequent use of spermicides can increase the risk of getting HIV from an infected partner.

Possible side effects: vaginal irritation and allergic reactions to polyurethane, spermicides, or sulfites (all of which are found in the sponge)

What is the diaphragm and how is it used?

The diaphragm is a small dome-shaped device that fits inside the vagina and covers the cervix. It is used with spermicide. Diaphragms are made of latex or silicone. They require a prescription and need to be fitted by a health care provider. Use water-based lubricants only if you use a latex diaphragm.

The diaphragm does not protect against STDs, including HIV. A male or female condom should be used with the diaphragm to provide STD protection if you are at risk of getting an STD.

What are the benefits, risks, and side effects of using the diaphragm?

Benefits:

— It has no effect on a woman’s natural hormones.

— It can be used while breastfeeding beginning 6 weeks after childbirth.

— It can be inserted up to 2 hours before sex. If it is inserted more than 2 hours beforehand, the spermicide must be reapplied.

Risks:

— Birth control methods that need spermicides to be effective should only be used if you are at low risk of HIV infection. Frequent use of spermicides can increase the risk of getting HIV from an infected partner.

—There is an increased risk of toxic shock syndrome if the diaphragm is left in for more than 24 hours.

—Use of a diaphragm and spermicide may increase the risk of urinary tract infection.

Possible side effects: allergic reaction to latex or to the spermicide

What is the cervical cap and how is it used?

The cervical cap is a small plastic dome that fits tightly over the cervix and stays in place by suction. The cervical cap is used with a spermicide. It has a strap over the dome that is used for removal. A cervical cap must be fitted and prescribed by a health care provider.

The cervical cap does not protect against STDs, including HIV. A male or female condom should be used with the cervical cap to provide STD protection if you are at risk of getting an STD.

What are the benefits, risks, and side effects of using the cervical cap?

Benefits:

— It has no effect on a woman’s natural hormones.

— It can be used while breastfeeding beginning 6 weeks after childbirth.

— It can be inserted up to 6 hours before sex.

Risks:

— Birth control methods that need spermicides to be effective should only be used if you are at low risk of HIV infection. Frequent use of spermicides can increase the risk of getting HIV from an infected partner.

— To avoid an increased risk of infection, including toxic shock syndrome, the cervical cap should not be used during your menstrual period.

— Use of a cervical cap and spermicide may increase the risk of urinary tract infection.

Possible side effects: allergic reaction to the spermicide and vaginal irritation or odor

Glossary

Cervix: The opening of the uterus at the top of the vagina.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body’s immune system and causes acquired immunodeficiency syndrome (AIDS).

Penis: An external male sex organ.

Sexually Transmitted Disease (STD): A disease that is spread by sexual contact, including chlamydia, gonorrhea, genital warts, herpes, syphilis, and infection with human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Toxic Shock Syndrome: A severe illness caused by a bacterial infection.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.

Vaginitis: Infection or inflammation of the vagina.

 

What is natural family planning?

Natural family planning is a form of birth control that is based on the timing of sex during a woman’s menstrual cycle. It is not a single method but a variety of methods.

What factors influence the success or failure of natural family planning methods?

The success or failure of any of these methods will depend on your ability to

  • recognize the signs that ovulation (the release of an egg from the woman’s ovary) is about to occur
  • not have sex during the fertile period or use another method, such as condoms, during the fertile period

How effective is it in preventing pregnancy?

Natural family planning is not as effective as most other methods of birth control. One in four women who use this method become pregnant. The method is not suited for the following women:

  • Women who should not get pregnant because of medical reasons
  • Women with irregular menstrual periods who may not be able to tell when they are fertile
  • Women with abnormal bleeding, vaginitis, or cervicitis (these make the cervical mucus method unreliable)
  • Women who use certain medications (for instance, antibiotics, thyroid medications, and antihistamines) that may change the nature of vaginal secretions, making mucus signs impossible to read
  • Women with certain problems unrelated to fertility (for instance, fever) that can cause changes in basal body temperature

When is ovulation likely to occur?

For most women, an egg is released almost 2 weeks before her next expected menstrual period. The egg remains able to be fertilized for about 24 hours after it is released. Sperm can live in a woman’s body for 3 days or more.

What are the types of natural family planning?

There are five methods of natural family planning:

  1. Basal body temperature method
  2. Ovulation/cervical mucus method
  3. Symptothermal method
  4. Calendar method
  5. Lactational amenorrhea

What is the basal body temperature method?

The temperature method of natural family planning is based on the fact that most women have a slight increase in their normal body temperature just after ovulation. A woman using this method takes her temperature every morning before getting out of bed. She then records it on a graph. In this way, she is able to detect the increase in body temperature that signals ovulation has occurred. For this method to work, a woman must take her temperature every day. Temperature readings may be affected by fever, restless sleep, or varying work schedules. A couple using this method does not have sex from the end of the menstrual period until 3 days after the increase in temperature.

What is the ovulation/cervical mucus method?

The ovulation method involves changes in how much mucus is produced by the cervix and how it feels. Women who use this method learn to recognize the changes that occur around the time of ovulation. To do this, a woman checks regularly for mucus at the opening of the vagina and looks for such changes.

For most women the vagina is dry for a time just after menstruation. A sticky mucus then appears. Just before ovulation the mucus becomes wet and slippery. The last day of wetness, called the "peak" day, often occurs at the same time as ovulation. Just after the peak day, the mucus becomes thick again or may even go away, and the feeling of dryness comes back.

The safe period is the 10 or 11 days at the end of the cycle and the dry days, if any, that occur just after menstruation. The fertile period (during which the couple should not have sex) starts with the first signs of mucus and continues until 4 days after the peak day.

What is the symptothermal method?

The symptothermal method combines the temperature and ovulation methods. In addition to taking her temperature and checking for mucus changes every day, the woman checks for other signs of ovulation:

  • Abdominal pain or cramps
  • Spotting
  • Changes in the position and firmness of the cervix

This method requires that you abstain from sex from the day you first notice signs of fertility (mucus or wet feeling) until the third day after the increase in temperature or the fourth day after the peak day of mucus production.

What is the calendar method?

The calendar method also is called the rhythm method. To use this method, a woman records every day of her menstrual cycle for 6 months. She then can calculate her fertile period by looking at the calendar.

A menstrual cycle is counted from the first day of menstrual bleeding (day 1 of the menstrual cycle) to the first day of the next menstrual period. A normal menstrual cycle is about 28 days, but can range from 23 days to 35 days. The first day of the fertile phase is found by subtracting 18 days from the length of the shortest cycle. To find the last day of the fertile phase, subtract 11 days from the longest cycle. To avoid pregnancy, a couple should not have sex from the first day of the fertile phase until the last day of the fertile phase.

What is lactational amenorrhea?

Lactational amenorrhea means a woman does not have her menstrual period because of a change in hormones caused by breastfeeding. Ovulation and menstruation usually are postponed in breastfeeding women. This is because levels of a certain hormone, prolactin (which causes lactation), are increased. If a woman does not ovulate, she cannot become pregnant.

How can lactational amenorrhea be used as a method of birth control?

For this method to work, a woman must be feeding her baby nothing but milk from her breast. The time between feedings should not be longer than 4 hours during the day or 6 hours at night. The baby should always be fed on demand. The more the baby feeds and the longer the suckling per feeding, the less likely it is ovulation will return. Although feeding with formula on occasion may be fine, this may reduce the hormonal response in the woman and make ovulation more likely to return. A woman may begin ovulating before she has a menstrual period and knows that she can become pregnant again.

How long is lactational amenorrhea effective?

This method is most effective during the first 6 months of exclusive breastfeeding.

Glossary

Cervicitis: Inflammation of the cervix.

Cervix: The lower, narrow end of the uterus, which protrudes into the vagina.

Fertile: Capable of reproduction.

Hormones: Substances produced by the body to control the functions of various organs.

Ovary: One of two glands, located on either side of the uterus, that contains the eggs released at ovulation and that produces hormones.

Vaginitis: Inflammation of the vagina.

 

What is sterilization?

Sterilization is a permanent method of birth control. It is the most popular form of birth control worldwide.

What is the sterilization procedure for women?

Tubal sterilization is sterilization for women. In tubal sterilization, the fallopian tubes are cut and tied with special thread, closed shut with bands or clips, sealed with an electric current, or blocked with scar tissue formed by small implants. Tubal sterilization prevents the sperm from reaching the egg.

How is tubal sterilization done?

Tubal sterilization can be performed in three different ways:

1) with a minilaparotomy

2) with laparoscopy

3) with hysteroscopy

How effective is laparoscopic sterilization in preventing pregnancy?

Laparoscopic sterilization is highly effective. Depending on how the fallopian tubes are closed, pregnancy rates within 10 years of having the procedure range from 18 out of 1,000 women to 37 out of 1,000 women.

Does tubal sterilization protect against sexually transmitted diseases?

Tubal sterilization does not protect against sexually transmitted diseases, including human immunodeficiency virus (HIV). Women at risk of sexually transmitted diseases should use a male or female condom to protect against these infections.

How is laparoscopic sterilization performed?

In laparoscopy, an instrument called a laparoscope is inserted through a small incision made in or near the navel. Another small incision may be made for an instrument used to close the fallopian tubes. The fallopian tubes are closed off by bands or clips. They also can be cut and closed with special thread or sealed with an electric current. The laparoscope then is withdrawn. The incisions are closed with stitches or special tape.

What are the risks associated with laparoscopic sterilization?

Sterilization by laparoscopy has a low risk of complications. The most common complications are those related to general anesthesia. There is a risk of injury to the bowel, bladder, or a major blood vessel. If an electric current is used to seal the fallopian tubes, there is a risk of burn injury to the skin or bowel. Other risks include bleeding from the incisions made in the skin and infection.

Pregnancy is rare after sterilization. If pregnancy does occur, the risk of an ectopic pregnancy is higher than in women who did not have sterilization.

What are the benefits of laparoscopic sterilization?

Laparoscopy has some benefits over minilaparotomy. Recovery usually is quicker. There are fewer complications. It usually is performed as outpatient surgery, meaning that you can go home the same day. It has some benefits over hysteroscopic sterilization as well. Unlike hysteroscopic sterilization, laparoscopic sterilization is effective right away.

What should I expect after having laparoscopic sterilization?

After surgery, you will be observed for a short time to be sure that there are no problems. Most women can go home 2–4 hours after the procedure. You will need someone to take you home. You may feel some discomfort or have other symptoms that last a few days:

  • Dizziness
  • Nausea
  • Shoulder pain
  • Abdominal cramps
  • Gassy or bloated feeling
  • Sore throat (from the breathing tube if general anesthesia was used)

Most women return to their normal routines within 1 week of surgery.

What should I consider when choosing a sterilization method?

Deciding on a method of sterilization involves considering the following factors:

  • Personal choice
  • Physical factors, such as weight
  • Medical history

Sometimes previous surgery, obesity, or other conditions may affect which method can be used.

When should sterilization be avoided?

You should avoid making this choice during times of stress (such as during a divorce or after losing a pregnancy). You also should not make this choice under pressure from a partner or others. Research shows that women younger than 30 years are more likely than older women to regret having the procedure.

What if I decide I want to become pregnant after I have laparoscopic sterilization?

If you choose to have sterilization and you change your mind after the operation, attempts to reverse it may not work. After tubal sterilization is reversed, many women still are not able to get pregnant. Also, the risk of problems, such as ectopic pregnancy, is increased.

Glossary

Ectopic Pregnancy: A pregnancy in which the fertilized egg begins to grow in a place other than inside the uterus, usually in one of the fallopian tubes.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

General Anesthesia: The use of drugs that produce a sleep-like state to prevent pain during surgery.

Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body’s immune system and causes acquired immunodeficiency syndrome (AIDS).

Hysteroscopic Sterilization: A sterilization procedure in which the opening of each fallopian tube is blocked with scar tissue formed by the insertion of small implants, preventing sperm from entering the fallopian tubes to fertilize an egg.

Hysteroscopy: A procedure in which a device called a hysteroscope is inserted through the cervix and vagina into the uterus. The hysteroscope is used to view the inside of the uterus or perform surgery.

Laparoscopy: A surgical procedure in which a slender, light-transmitting instrument, the laparoscope, is inserted into the pelvic cavity through small incisions. The laparoscope is used to view the pelvic organs. Other instruments can be used to perform surgery.

Minilaparotomy: A small abdominal incision used for a sterilization procedure in which the fallopian tubes are closed off.

Sexually Transmitted Diseases: Diseases that are spread by sexual contact, including chlamydia, gonorrhea, human papillomavirus infection, herpes, syphilis, and infection with human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Tubal Sterilization: A method of female sterilization in which the fallopian tubes are tied, banded, clipped, sealed with lectric current, or blocked by scar tissue formed by the insertion of small implants.

 

What is sterilization?

Sterilization is a permanent method of birth control. Sterilization for women is called tubal sterilization. In tubal sterilization, the fallopian tubes are closed off. Tubal sterilization prevents the egg from moving down the fallopian tube to the uterus and keeps the sperm from reaching the egg.

What is postpartum sterilization?

Postpartum sterilization is sterilization performed after the birth of a baby.

What is the most common method of postpartum sterilization?

The method used most often for postpartum sterilization is called tubal ligation. For women who have had a vaginal delivery, a small incision is made in the abdomen (a procedure called minilaparotomy). For women who have had a cesarean delivery, postpartum tubal ligation can be done through the same abdominal incision that was made for delivery

When is postpartum sterilization performed?

After a woman gives birth, the fallopian tubes and the still-enlarged uterus are located just under the abdominal wall below the navel. Postpartum tubal ligation ideally is done before the uterus returns to its normal location, usually within a few hours or days following delivery. For women who have had a cesarean delivery, it is done right after the baby is born.

How is postpartum sterilization performed?

Postpartum sterilization is performed with regional anesthesiageneral anesthesia, or local anesthesia. A small incision is made below the navel. If you had a cesarean delivery, tubal ligation is done through the incision that has already been made. The fallopian tubes are brought up through the incision. Usually, the tubes then are cut and closed with special thread. After the tubes are closed off, the incision below the navel is closed with stitches and a bandage.

How long does postpartum sterilization take?

The operation takes about 30 minutes. Having it done soon after childbirth usually does not make your hospital stay any longer.

Are there risks associated with postpartum sterilization?

In general, tubal sterilization is a safe form of birth control. It has a low risk of death and complications. The most common complications are those that are related to general anesthesia. Other risks include bleeding and infection.

What are the side effects of postpartum sterilization?

Side effects after surgery vary and may depend on the type of anesthesia used and the way the surgery is performed. You likely will have some pain in your abdomen and feel tired. The following side effects also can occur but are not as common:

  • Dizziness
  • Nausea
  • Shoulder pain
  • Abdominal cramps
  • Gassy or bloated feeling
  • Sore throat (from the breathing tube if general anesthesia was used)

If you have abdominal pain that does not go away after a few days, if pain is severe, or if you have a fever, contact your health care provider right away.

What should I consider when choosing a sterilization method?

Deciding on a method of sterilization involves considering the following factors:

  • Personal choice
  • Physical factors, such as weight
  • Medical history

Sometimes previous surgery, obesity, or other conditions may affect which method can be used. You should be fully aware of the risks, benefits, and other options before making a choice.

Glossary

Cesarean Delivery: Delivery of a baby through incisions made in the mother’s abdomen and uterus.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

General Anesthesia: The use of drugs that produce a sleep-like state to prevent pain during surgery.

Local Anesthesia: The use of drugs that prevent pain in a part of the body.

Minilaparotomy: A small abdominal incision used for a sterilization procedure, in which the fallopian tubes are closed off.

Postpartum Sterilization: A permanent procedure that prevents a woman from becoming pregnant, performed soon after the birth of a child.

Regional Anesthesia: The use of drugs to block sensation in certain areas of the body.

 

What is emergency contraception?

Emergency contraception is the use of certain methods to prevent pregnancy after a woman has had sex without birth control, if her current method fails, or if she is raped.

What types of emergency contraception are available?

There are two forms of emergency contraception available in the United States: 1) emergency contraceptive pills and 2) the copper intrauterine device (IUD).

What are the types of emergency contraceptive pills?

There are three types of emergency contraceptive pills: 1) progestin-only pills, 2) combination pills, and 3) ulipristal.

How are progestin-only emergency contraception pills taken?

Progestin-only emergency contraception pills are available as a single pill or two pills that are taken 12–24 hours apart. The pills should be started as soon as possible after having unprotected sex. Progestin-only pills can be used more than once, even within the same menstrual cycle.

How effective are progestin-only emergency contraception pills?

Progestin-only pills are thought to prevent pregnancy mainly by preventing ovulation. They will not work if you are already pregnant and will not affect a pregnancy that has started. They are about 75% effective in preventing pregnancy. Their effectiveness decreases with time. They are most effective when taken within 72 hours (3 days) of unprotected sex. They are moderately effective when taken within 120 hours (5 days).

What are combination pills?

Birth control pills that contain estrogen and progestin are called combination pills.

How are combination pills used for emergency contraception?

Taken in higher-than-usual amounts, combination birth control pills can be used for emergency contraception. They are taken in two doses. The number of pills needed for emergency contraception is different for each brand of pill. Combination emergency contraceptive pills need to be taken as soon as possible up to 120 hours, or 5 days, after unprotected intercourse. They are thought to work by preventing ovulation.

How effective are combination emergency contraceptive pills?

Combination emergency contraceptive pills are not as effective in preventing pregnancy as progestin-only pills. For this reason and because of the higher risk of nausea and vomiting, progestin-only methods are preferred over combination emergency contraceptive pills.

Where can I find out how many combination pills to take for emergency contraception?

A health care provider or pharmacist can tell you how many pills you should take for the type of birth control pills that you have. This information also is available at the web site http://www.not-2-late.com.

How is ulipristal taken?

Ulipristal can be taken up to 120 hours (5 days) after unprotected intercourse with no decrease in effectiveness. Ulipristal is available by prescription only. Research suggests that it may prevent more pregnancies than progestin-only pills when taken as directed.

How often can ulipristal be taken?

Because the effects of repeated use of ulipristal are not yet known, it should be taken only once during a menstrual cycle. It also may decrease the effectiveness of hormonal birth control methods. For this reason, a nonhormonal method, such as a condom, should be used after taking ulipristal until your next menstrual period starts.

How can I get emergency contraception pills?

Ulipristal and combination birth control pills are available only by prescription. Plan B One-Step is a progestin-only pill that can be bought at a pharmacy without a prescription. Next Choice One Dose is a progestin-only pill that can be bought at a pharmacy without a prescription if you are 17 years or older and show proof of age and by prescription only if you are younger than 17 years. You can go to http://eclocator.not-2-late.com or call the Emergency Contraception Hotline (888-NOT- 2-LATE) to find a health care provider who can provide a prescription. Also, many health care providers will give an advance prescription for emergency contraception.

What are the side effects of emergency contraception pills?

Nausea and vomiting may occur after taking the progestin-only and combination pills. Your next menstrual period may not occur at the expected time. You may have bleeding or spotting in the week or month after the treatment. Other possible side effects include the following:

  • Abdominal pain and cramps
  • Breast tenderness
  • Headache
  • Dizziness
  • Fatigue

These side effects usually go away within a few days.

Possible ulipristal side effects include headache, nausea, and abdominal pain. Your menstrual period may occur earlier or later than expected. Spotting may occur.

How safe are emergency contraception pills?

The progestin-only pills and the combination birth control pills are safe even for women who normally are cautioned against using hormonal birth control methods. Emergency contraception is used for a much shorter period of time than regular use of a hormonal birth control method. However, these pills should not be used as long-term birth control because frequent use of emergency contraception results in more side effects.

Do I need to see a health care provider after using emergency contraception pills?

No other tests or procedures are needed after taking emergency contraception. However, you should see your health care provider for a pregnancy test if you have not had a period within a week of when you expect it. Progestin-only pills and combination pills do not harm a pregnancy or the health of the baby if you are already pregnant. Currently, there is little information about whether ulipristal can harm a pregnancy if you are already pregnant.

Can I get pregnant later in my menstrual cycle after I have used emergency contraception pills?

It is possible to become pregnant later in the same menstrual cycle if you have used emergency contraception pills. To prevent pregnancy, you should use a barrier contraception method, such as a condom, until your next menstrual period occurs. You also can start birth control pills, the patch, or the vaginal ring immediately after taking emergency contraception, but you also need to use a barrier method until your next menstrual period starts.

How is the copper intrauterine device (IUD) used as emergency contraception?

The copper IUD must be inserted within 5 days of having unprotected sex. It is about 99% effective in preventing pregnancy. A benefit is that the IUD then can be used for long-term birth control. A drawback is that it does not protect against STDs. If you are at risk of STDs, a male or female condom should be used in addition to the IUD for STD protection. Also, some women with certain medical conditions cannot use an IUD.

Glossary

Estrogen: A female hormone produced in the ovaries.

Intrauterine Device (IUD): A small device that is inserted and left inside the uterus to prevent pregnancy.

Ovulation: The release of an egg from one of the ovaries.

Progestin: A synthetic form of progesterone that is similar to the hormone produced naturally by the body.

 

What is sterilization?

Sterilization is a permanent form of birth control.

What is tubal sterilization?

Sterilization procedures for women are called tubal sterilization. Tubal sterilization involves closing off the fallopian tubes.Tubal sterilization prevents the egg from moving down the fallopian tube to the uterus and prevents the sperm from reaching the egg.

Does tubal sterilization protect against sexually transmitted diseases?

Sterilization does not protect against sexually transmitted diseases, including human immunodeficiency virus (HIV).

What is hysteroscopic sterilization?

Hysteroscopic sterilization is a type of tubal sterilization procedure that uses the body’s natural openings to place small implants into the fallopian tubes. These implants cause tissue growth that blocks the tubes. No surgical incision is needed.

How effective is hysteroscopic sterilization in preventing pregnancy?

Less than 1 woman out of 1,000 will become pregnant within 5 years of having the procedure.

How is hysteroscopic sterilization performed?

Hysteroscopic sterilization involves inserting a tiny device into each fallopian tube with a hysteroscope. The hysteroscope is an instrument that is inserted through the vagina and cervix and then into the uterus. It allows the inside of the uterus and the tubal openings to be seen. Once the devices are in place, scar tissue forms around them.

Is hysteroscopic sterilization effective right away?

No. It takes about 3 months after the procedure for the tubes to become completely blocked by the scar tissue. While the scar tissue is forming, it is possible to become pregnant. After 3 months, an X-ray procedure called hysterosalpingography (HSG) is done to make sure that the fallopian tubes are blocked. A backup birth control method should be used until an HSG test result confirms that the fallopian tubes are blocked.

Where is hysteroscopic sterilization performed?

This type of sterilization often can be performed in your health care provider’s office with local anesthesia. A drug to make you drowsy may be given as well. It also can be done in an operating room with general anesthesia.

What are the benefits of hysteroscopic sterilization?

Hysteroscopic sterilization uses your body’s natural openings and does not require incisions in your skin. It can be done with local anesthesia. For these reasons, recovery from hysteroscopic sterilization usually is quicker than from other types of sterilization.

What are the risks of hysteroscopic sterilization?

Hysteroscopic sterilization has the following risks:

  • It may not be possible to place the devices in one or both fallopian tubes. Even when the devices are placed in both tubes, there is a risk that one or both tubes will not become completely blocked. In either case, the procedure cannot be relied on for birth control.
  • There is a risk of injury to the uterus or fallopian tubes injury during the procedure. If this happens, the device can move out of place and embed itself in the abdomen. Surgery may be needed to remove the device.
  • Pregnancy is uncommon after any type of sterilization procedure. However, if it does occur, there is a higher risk that it will be an ectopic pregnancy. Ectopic pregnancy can be a medical emergency.
  • In rare cases, women report pain that does not go away after having hysteroscopic sterilization. If this happens, the devices can be removed using hysteroscopy or laparoscopy.

What can I expect after hysteroscopic sterilization?

Most women are able to resume normal activities within 24 hours. Some women do have discomfort during the procedure or for up to 1 week afterward. Side effects may include the following:

  • Pain (similar to that of menstrual cramps)
  • Nausea and vomiting
  • Dizziness and light-headedness
  • Bleeding and spotting

Glossary

Cervix: The opening of the uterus at the top of the vagina.

Ectopic Pregnancy: A pregnancy in which the fertilized egg begins to grow in a place other than inside the uterus, usually in one of the fallopian tubes.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

General Anesthesia: The use of drugs that produce a sleep-like state to prevent pain during surgery.

Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body’s immune system and causes acquired immunodeficiency syndrome (AIDS).

Hysterosalpingography (HSG): A special X-ray procedure in which a small amount of fluid is placed into the uterus and fallopian tubes to detect abnormal changes in their size and shape or to determine whether the tubes are blocked.

Hysteroscope: A device that is used to look inside the uterus and to do procedures.

Hysteroscopic Sterilization: A sterilization procedure in which the opening of each fallopian tube is blocked by scar tissue formed by the insertion of small implants, which prevents sperm from entering the fallopian tubes to fertilize an egg.

Local Anesthesia: The use of drugs that prevent pain in a part of the body.

Sexually Transmitted Diseases: Diseases that are spread by sexual contact.

Tubal Sterilization: A method of female sterilization in which the fallopian tubes are tied, banded, clipped, sealed with electric current, or blocked by scar tissue formed by the insertion of small implants.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.

 

What are long-acting reversible contraception (LARC) methods?

Long-acting reversible contraception (LARC) methods include the intrauterine device (IUD) and the birth control implant.Both methods are highly effective in preventing pregnancy, last for several years, and are easy to use. Both are reversible—if you want to become pregnant or if you want to stop using them, you can have them removed at any time.

How effective are LARC methods?

The IUD and the implant are the most effective forms of reversible birth control available. During the first year of typical use, fewer than 1 in 100 women using an IUD or an implant will become pregnant. This rate is in the same range as that forsterilization.

How do LARC methods compare with other methods of contraception?

Over the long term, LARC methods are 20 times more effective than birth control pills, the patch, or the ring.

What is the intrauterine device (IUD)?

The IUD is a small, T-shaped, plastic device that is inserted into and left inside the uterus. There are two types of IUDs:

  1. The hormonal IUD releases progestin. One hormonal IUD is approved for use for up to 5 years. Another is approved for use for up to 3 years.
  2. The copper IUD does not contain hormones. It is approved for use for up to 10 years.

How does the IUD work?

Both types of IUDs work mainly by preventing fertilization of the egg by the sperm. The hormonal IUD also thickens cervical mucus, which makes it harder for sperm to enter the uterus and fertilize the egg, and keeps the lining of the uterus thin, which makes it less likely that a fertilized egg will attach to it.

What are the benefits of the IUD?

The IUD has the following benefits:

  • Once it is in place, you do not have to do anything else to prevent pregnancy.
  • No one can tell that you are using birth control.
  • It does not interfere with sex or daily activities.
  • It can be inserted immediately after an abortion, a miscarriage, or childbirth and while breastfeeding.
  • Almost all women are able to use an IUD.
  • If you wish to become pregnant or if you want to stop using it, you can simply have the IUD removed.
  • The hormonal IUD helps decrease menstrual pain and heavy menstrual bleeding.
  • The copper IUD also is the most effective form of emergency contraception.

How is the IUD inserted?

A health care provider must insert and remove the IUD. He or she will review your medical history and will perform a pelvic exam. To insert the IUD, the health care provider puts the IUD in a slender plastic tube. He or she places the tube into thevagina and guides it through the cervix into the uterus. The tube is withdrawn, leaving the IUD in place.

Will I feel anything when the IUD is inserted?

Insertion of the IUD may cause some discomfort. Taking over-the-counter pain relief medication before the procedure may help. The IUD has a string made of thin plastic threads. After insertion, the strings are trimmed so that 1–2 inches extend past the cervix into your vagina. The strings should not bother you.

What are possible side effects of use of the IUD?

With the copper IUD, menstrual pain and bleeding may increase. Bleeding between periods may occur. Both effects are common in the first few months of use. Pain and heavy bleeding usually decrease within 1 year of use. Both hormonal IUDs may cause spotting and irregular bleeding in the first 3–6 months of use. The amount of menstrual bleeding and the length of the menstrual period usually decrease over time. Menstrual pain also usually decreases. A few women also may have side effects related to the hormones in these IUDs. These side effects may include headaches, nausea, depression, and breast tenderness.

What are possible risks of use of the IUD?

Serious complications from use of an IUD are rare. However, some women do have problems. These problems usually happen during or soon after insertion:

  • The IUD may come out of the uterus. This happens in about 5% of users in the first year of using the IUD.
  • The IUD can perforate (or pierce) the wall of the uterus during insertion. It is rare and occurs in only about 1 out of every 1,000 insertions.
  • Pelvic inflammatory disease (PID) is an infection of the uterus and fallopian tubes. PID may cause scarring in the reproductive organs, which may make it harder to become pregnant later. The risk of PID is only slightly increased in the first 20 days after insertion of an IUD, but the overall risk still is low (fewer than 1 in 100 women).
  • Rarely, pregnancy may occur while a woman is using an IUD.
  • In the rare case that a pregnancy occurs with the IUD in place, there is a higher chance that it will be an ectopic pregnancy.

What is the birth control implant?

The birth control implant is a single flexible rod about the size of a matchstick that is inserted under the skin in the upper arm. It releases progestin into the body. It protects against pregnancy for up to 3 years.

How does the birth control implant work?

The progestin in the implant prevents pregnancy mainly by stopping ovulation. In addition, the progestin in the implant thickens cervical mucus, which makes it harder for sperm to enter the uterus and fertilize the egg. Progestin also keeps the lining of the uterus thin, making it less likely that a fertilized egg will attach to it.

What are the benefits of the birth control implant?

The implant has the following benefits:

  • Once it is in place, you do not have to do anything else to prevent pregnancy.
  • No one can tell that you are using birth control.
  • It can be inserted immediately after an abortion, a miscarriage, or childbirth and while breastfeeding.
  • It does not interfere with sex or daily activities.
  • Almost all women are able to use the implant.
  • If you wish to become pregnant or if you want to stop using it, you can simply have the implant removed.

How is the birth control implant inserted?

The implant is inserted into your arm by a health care provider. A small area on your upper arm is numbed with a local anesthetic. No incision is made. Your health care provider places the implant under the skin with a special inserter. The procedure takes only a few minutes.

How is the birth control implant removed?

To remove the implant, your health care provider again numbs the area. One small incision is made. The implant then is removed.

What are possible side effects of use of the birth control implant?

The most common side effect of the implant is unpredictable bleeding. For some women, these bleeding patterns improve over time. Some women have less menstrual pain while using the implant. In some women, bleeding stops completely. Other common side effects include mood changes, headaches, acne, and depression. Some women have reported weight gain while using the implant, but it is not clear whether it is related to the implant.

What are possible risks of use of the birth control implant?

Possible risks include problems with insertion or removal of the implant. These problems occur in less than 2% of women. Although rare, if a woman becomes pregnant while the implant is inserted, there is a slightly increased risk that it will be an ectopic pregnancy.

Glossary

Birth Control Implant: A small, single rod that is inserted under the skin in the upper arm by a health care provider. It releases a hormone and protects against pregnancy for up to 3 years.

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Ectopic Pregnancy: A pregnancy in which the fertilized egg begins to grow in a place other than inside the uterus, usually in one of the fallopian tubes.

Egg: The female reproductive cell produced in and released from the ovaries; also called the ovum.

Emergency Contraception: Methods that are used to prevent pregnancy after a woman has had sex without birth control,

Fertilization: Joining of the egg and sperm.

Intrauterine Device (IUD): A small device that is inserted and left inside the uterus to prevent pregnancy.

Ovulation: The release of an egg from one of the ovaries.

Pelvic Exam: A physical examination of a woman’s reproductive organs.

Pelvic Inflammatory Disease (PID): An infection of the uterus, fallopian tubes, and nearby pelvic structures.

Progestin: A synthetic form of progesterone that is similar to the hormone produced naturally by the body.

Sperm: A cell produced in the male testes that can fertilize a female egg.

Sterilization: A permanent method of birth control.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.

 

What are combined hormonal birth control methods?

Birth control pills, the birth control patch, and the vaginal birth control ring are combined hormonal birth control methods. They contain two hormonesestrogen and progestin.

How do combined hormonal methods prevent pregnancy?

Combined hormonal birth control methods release estrogen and progestin into the whole body. These hormones prevent pregnancy mainly by stopping ovulation (the release of an egg from one of the ovaries). They also cause other changes in the body that help prevent pregnancy. The mucus in the cervix thickens, making it hard for sperm to enter the uterus. The lining of the uterus thins, making it less likely that a fertilized egg can attach to it.

How effective are combined hormonal birth control methods?

With typical use—meaning that the method may not always be used consistently or correctly—9 women out of 100 (9%) will become pregnant during the first year of using these methods. With perfect use—meaning that the method is used consistently and correctly each time—fewer than 1 woman out of 100 will become pregnant during the first year.

What are the benefits of combined hormonal methods?

Combined hormonal methods have several benefits in addition to protecting against pregnancy:

  • They may make your period more regular, lighter, and shorter.
  • They help reduce menstrual cramps.
  • They decrease the risk of cancer of the uterus, ovary, and colon.
  • They may improve acne and reduce unwanted hair growth.
  • They can be used to treat certain disorders that cause heavy bleeding and menstrual pain, such as fibroids and
  • Used continuously, they can reduce the frequency of migraines associated with menstruation (although they should not be used if you have migraines with aura). They also can be used to treat heavy bleeding and pain by stopping the menstrual period.

What are possible risks of combined hormonal methods?

Combined hormonal methods are safe for most women, but they are associated with a small increased risk of deep vein thrombosis (DVT), heart attack, and stroke. The risk is higher in some women, including women older than 35 years whosmoke more than 15 cigarettes a day or women who have multiple risk factors for cardiovascular disease, such as high cholesterol, high blood pressure, and diabetes; a history of stroke, heart attack, or DVT; or a history of migraine headaches with aura.

You should not use combined hormonal methods during the first 3 weeks after delivery because the risk of DVT is higher in the weeks after childbirth. If you have additional risk factors for DVT, you should wait to use combined hormonal methods until after the first 4–6 weeks following delivery.

The risk of DVT also may be slightly higher in women taking pills containing a progestin called drospirenone and in women using the patch. However, the risk of DVT is higher during pregnancy and in the weeks after childbirth than when taking drospirenone-containing pills or using the patch.

Can I use combined hormonal birth control methods while I am breastfeeding?

If you are breastfeeding, estrogen may affect your milk supply. It is recommended that you wait until the fifth week after delivery to start using these methods, when breastfeeding has been well established.

How can I get combined hormonal pills?

In the United States, birth control pills are available by prescription only.

What are the different types of combined hormonal pills and how are they taken?

  • 21-day pills—Take one pill at the same time each day for 21 days. Wait 7 days before starting a new pack. During the week you are not taking the pill, you will have your period.
  • 28-day pills—Take one pill at the same time each day for 28 days. Depending on the brand, the first 21 pills or the first 24 pills contain estrogen and progestin. The remaining pills may be estrogen-only pills; pills that contain a dietary supplement, such as iron, but no hormones; or inactive pills (containing no hormones or supplements). During the days you are taking the hormone-free pills, you will have your period.
  • 90-day pills—Take one pill at the same time each day for 84 days. Depending on the brand, the last seven pills either contain no hormones or contain estrogen only. With both brands, you will have your period on the last 7 days every 3 months.
  • 365-day pills—Take one pill at the same time each day for a year. In time, your bleeding may become lighter and may even stop.

What are possible side effects of using the combined hormonal birth control pill?

Possible side effects include the following:

  • Headache
  • Nausea
  • Breast tenderness
  • Breakthrough bleeding

Breakthrough bleeding usually is a temporary side effect as the body adjusts to a change in hormone levels. It may last longer than a few months with continuous-dose pills.

What is the vaginal ring?

The vaginal ring is a flexible, plastic ring that is placed in the upper vagina. It releases estrogen and progestin that are absorbed through the vaginal tissues into the body.

How can I get the vaginal ring?

A health care provider must prescribe the vaginal ring, but you insert it yourself.

How do I use the vaginal ring?

You fold the ring and insert it into the vagina. It stays there for 21 days. You then remove it and wait 7 days before inserting a new ring. During the week the ring is not used, you will have your period. To use the ring as a continuous-dose form of birth control, insert a new ring every 21 days with no ring-free week in between.

What are possible side effects of using the vaginal ring?

Possible side effects include the following:

  • Headache
  • Nausea
  • Breast tenderness
  • Vaginal discharge
  • Vaginal irritation
  • Breakthrough bleeding

What is the contraceptive skin patch?

The contraceptive skin patch is a small (1.75 square inch) adhesive patch that is worn on the skin to prevent pregnancy. The patch releases estrogen and progestin, which are absorbed through the skin into the body.

How can I get the contraceptive skin patch?

A health care provider must prescribe the patch, but you do not need to visit a health care provider to apply or remove the patch. The patch is less effective in women who weigh more than 198 pounds.

How do I use the contraceptive skin patch?

The patch can be worn on the buttocks, chest (except the breasts), upper back or arm, or abdomen. You wear a patch for a week at a time for a total of 3 weeks in a row. During the fourth week, a patch is not worn, and you will have your period. After week 4, a new patch is applied and the cycle is repeated. You apply the patch on the same day of the week even if you still are bleeding. To use the patch as a continuous-dose form of birth control, apply a new patch every week on the same day without skipping a week.

What are possible side effects of using the contraceptive skin patch?

Most side effects are minor and often go away after a few months of use. Possible side effects include the following:

  • Skin irritation
  • Breast tenderness
  • Headache
  • Breakthrough bleeding

Glossary

Aura: A sensation or feeling, such as flashing lights, a particular smell, dizziness, or seeing spots, experienced just before the onset of certain disorders like migraine attacks or epileptic seizures.

Breakthrough Bleeding: Vaginal bleeding at a time other than the menstrual period.

Cardiovascular Disease: Disease of the heart and blood vessels.

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Deep Vein Thrombosis (DVT): A condition in which a blood clot forms in veins in the leg or other areas of the body.

Endometriosis: A condition in which tissue that lines the uterus is found outside of the uterus, usually on the ovaries, fallopian tubes, and other pelvic structures.

Estrogen: A female hormone produced in the ovaries.

Fibroids: Benign growths that form in the muscle of the uterus.

Hormones: Substances made in the body by cells or organs that control the function of cells or organs. An example is estrogen, which controls the function of female reproductive organs.

Ovaries: Two glands, located on either side of the uterus, that contain the eggs released at ovulation and produce hormones.

Ovulation: The release of an egg from one of the ovaries.

Progestin: A synthetic form of progesterone that is similar to the hormone produced naturally by the body.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

 

What is progestin?

Progestin is a form of progesterone, a hormone that plays a role in the menstrual cycle and pregnancy. Progestin is used in combination with another hormone called estrogen in combined hormonal birth control pills, the vaginal ring, and the skin patch. It also can be used by itself in progestin-only pills and the birth control injection. The birth control implant and the hormonal intrauterine device also are progestin-only forms of birth control.

How effective are progestin-only pills and the birth control injection in preventing pregnancy?

Progestin-only pills and the injection have about the same effectiveness as combination estrogen and progestin pills, rings, and patches.

What are progestin-only pills?

Progestin-only pills contain progestin. They are available by prescription only.

How do progestin-only pills work?

Progestin-only birth control pills, sometimes called “mini-pills,” have several effects in the body that help prevent pregnancy:

  • The mucus in the cervix thickens, making it difficult for sperm to enter the uterus and fertilize an egg.
  • They stop ovulation, but they do not do so consistently. About 40% of women who use progestin-only pills will continue to ovulate.
  • They thin the lining of the uterus, making it less likely that a fertilized egg can attach to it.

What are the benefits of progestin-only pills?

  • They do not interfere with sex.
  • They may reduce menstrual bleeding or stop your period altogether.
  • They are not associated with an increased risk of high blood pressure or cardiovascular disease and can be taken even if you have certain health conditions that prevent you from taking combination pills, such as a history of  deep vein thrombosisor uncontrolled high blood pressure.
  • They can be used immediately after childbirth, even if you are breastfeeding.

What are possible risks of progestin-only pills?

Progestin-only pills may not be a good choice for women who have certain medical conditions, such as some forms of lupus.Women who have breast cancer or who have a history of breast cancer should not take progestin-only pills.

How do I take progestin-only pills?

The progestin-only pill comes in packs of 28 pills. All the pills in the pack contain progestin. Take one pill at the same time each day for 28 days. It is important to take the progestin-only pill at the exact same time each day for maximum effectiveness. Do not skip pills for any reason—even if you bleed between periods or feel sick.

What if I forget to take a pill?

If a pill is missed by more than 3 hours, you should take a pill as soon as possible and use a backup method of contraception (such as condoms) for the next 2 days. If vomiting or severe diarrhea occurs within 3 hours after taking a pill, the progestin may not be absorbed completely by your body. Keep taking your pills, but use a backup method until 2 days after your vomiting or diarrhea stops.

What are possible side effects of progestin-only pills?

Bleeding may be unpredictable. You may have short cycles of bleeding, spotting, or heavy bleeding or no bleeding at all. Other side effects include headaches, nausea, and breast tenderness.

What is the birth control injection?

The birth control injection is an injection of the hormone depot medroxyprogesterone acetate. It provides protection against pregnancy for 3 months.

How does the injection work?

The injection has several effects that work together to prevent pregnancy:

  • It stops ovulation.
  • It thickens and decreases the amount of cervical mucus. This makes it difficult for sperm to enter the uterus and fertilize an egg.
  • It thins the lining of the uterus, making it less likely that a fertilized egg can attach to it.

How is the injection given?

A health care provider must give the injection. The first shot can be given at any time during your menstrual cycle as long as you and your health care provider are reasonably sure you are not pregnant.

How often do I need injections?

You must return to your health care provider every 13 weeks for repeated injections. The repeat injection can be given up to 2 weeks late (15 weeks from the last injection). If it is given more than 2 weeks late, you will need to avoid sexual intercourse or use a backup method of birth control, such as condoms, for the next 7 days.

What are the benefits of the injection?

  • The injection does not need to be taken daily.
  • It does not interfere with sex or daily activities.
  • No one can tell you are using birth control.
  • It has several health benefits not related to birth control:

— Reduced risk of cancer of the uterus if used long term

— Possible protection against pelvic inflammatory disease

— Reduced pelvic pain caused by endometriosis

— Possible absence of periods

— Possible relief of certain symptoms of sickle cell disease and seizure disorders

— Possible decrease in bleeding associated with uterine fibroids

What are possible risks of the injection?

Bone loss may occur while using the birth control injection. When the injections are stopped, at least some and sometimes all of the bone that is lost is gained back. Women who have multiple risk factors for cardiovascular disease may be at increased risk of cardiovascular disease while using the injection. This increased risk may last for some time after the method is stopped. Women with a history of stroke, vascular disease, or poorly controlled high blood pressure also may be at increased risk of cardiovascular disease while using this method.

What are possible side effects of the injection?

The injection may cause irregular bleeding. Some women report weight gain while using progestin-only birth control methods. Among women who gained weight, the average amount of weight gained was less than 5 pounds. It takes an average of 10 months for pregnancy to occur after stopping the injection.

Glossary

Bone Loss: The gradual loss of calcium and protein from bone, making it brittle and more likely to fracture.

Cardiovascular Disease: Disease of the heart and blood vessels.

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Deep Vein Thrombosis: A condition in which a blood clot forms in veins in the leg or other areas of the body.

Egg: The female reproductive cell produced in and released from the ovaries; also called the ovum.

Endometriosis: A condition in which tissue that lines the uterus is found outside of the uterus, usually on the ovaries, fallopian tubes, and other pelvic structures.

Estrogen: A female hormone produced in the ovaries.

Fibroids: Benign growths that form in the muscle of the uterus.

Hormone: A substance made in the body by cells or organs that controls the function of cells or organs. An example is estrogen, which controls the function of female reproductive organs.

Intrauterine Device: A small device that is inserted and left inside the uterus to prevent pregnancy.

Lupus: An autoimmune disorder that causes changes in the joints, skin, kidneys, lungs, heart, or brain.

Ovulation: The release of an egg from one of the ovaries.

Progesterone: A female hormone that is produced in the ovaries and that prepares the lining of the uterus for pregnancy.

Progestin: A synthetic form of progesterone that is similar to the hormone produced naturally by the body.

Sperm: A cell produced in the male testes that can fertilize a female egg.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

 

This is a nonsurgical procedure that makes a woman sterile (unable to have children). The Essure Procedure can be performed in a doctor’s office without general anesthesia.

How Does Essure Work?

With Essure, there is no cutting into the body. Instead, an Essure-trained doctor inserts spring-like coils, called micro-inserts, through the body’s natural pathways (vagina, cervix, and uterus) and into the fallopian tubes. During the 3 months following the procedure, the body and the micro-inserts work together to form a tissue barrier. This prevents the egg from passing into the uterus, and sperm from reaching the egg. Therefore, fertilization cannot take place.

During the Essure® Procedure, the procedure takes about 5 minutes. You are given medication to take 1 to 2 hours before the procedure. This helps keep the fallopian tubes open and reduces cramping. During the procedure:

The doctor inserts a narrow telescope-like instrument called a hysteroscope through the vagina and cervix and into the uterus. The hysteroscope is attached to a video camera that sends pictures to a monitor. This lets the doctor see inside the uterus. Fluid (called normal saline or saltwater) flows through the hysteroscope and into the uterus. The fluid expands the uterus to let the doctor see the openings to the fallopian tubes clearly. The spring-like micro-inserts are placed into each fallopian tube using a small, flexible tube (delivery catheter) that is passed through the hysteroscope.

Is NovaSure Endometrial Ablation right for me?

If you are absolutely sure that you never want to have any children in the future, and would like to stop your heavy period and restart your life, the NovaSure® endometrial ablation procedure may be right for you.

If you know you don't want children right now, but think you could change your mind in the future, then do not choose a one-time treatment option. Try a temporary treatment option to help lighten or stop your periods instead.

GYNECARE THERMACHOICE® Uterine Balloon Therapy System is a soft, flexible balloon that a doctor inserts in the uterus (womb) to treat the endometrium, the lining of the uterus. GYNECARE THERMACHOICE® is an effective, nonhormonal treatment for heavy periods. It involves a minimally invasive, 8-minute procedure that can be performed in your doctor's office or in a hospital.

How does GYNECARE THERMACHOICE® work?
GYNECARE THERMACHOICE® uses a method called global endometrial ablation (GEA) to remove the endometrium, the lining of the uterus.

Here’s how it works:

1. A small soft, flexible balloon attached to a thin catheter (tube) is first passed through the vagina and cervix, and then placed into the uterus. No incision is required. The balloon is made of silicone material, eliminating the risk of allergy for latex-sensitive women.

2. The balloon is then filled with fluid so that it inflates to the unique contours of the uterus.

3. The fluid is heated and circulated in the uterus for 8 minutes while the lining of the uterus is treated.

4. When the treatment is completed, all the fluid is withdrawn from the balloon, and the catheter is removed. Nothing remains in the uterus. The treated uterine lining will shed, like during a period, over the next 7-10 days.

In most cases, patients can resume normal activities the next day.

Clinically proven safe and effective. Twelve month clinical study results showed:

• 81% of women treated with GYNECARE THERMACHOICE® returned to normal levels of menstrual bleeding or lower

• 89% of patients in a study had a reduction of menstrual pain and cramping

• 96% of patients reported satisfaction with GYNECARE THERMACHOICE®

With over a million women treated worldwide GYNECARE THERMACHOICE® is clinically proven safe and effective.

Who’s a candidate for GYNECARE THERMACHOICE®?

You may be a candidate for GYNECARE THERMACHOICE® if you meet the following criteria:

• You are a premenopausal woman who is finished having children but wish to retain your uterus.

• Your heavy periods are the result of hormonal imbalance or associated with certain fibroids.

• You have normal Pap smears and biopsy (tissue samples from inside the uterus) and no abnormal uterine conditions, including uterine cancer or precancerous conditions.

• You prefer not to take hormone therapy, or if treatment with birth control pills has failed to reduce your heavy periods.

Women using an intrauterine device (IUD) for birth control must have the device removed before treatment.

You may not be a candidate for GYNECARE THERMACHOICE® if you are pregnant or plan on becoming pregnant, if you’ve had a prior classical Caesarean section, or if you’ve had malignant (cancerous) tissue in this area of the body before. Again, a doctor can help you make the best treatment choice for you.

What to Expect:
Under local anesthesia, the doctor inserts a small silicone balloon into your uterus. The balloon is filled with fluid and then heated to treat the lining of your uterus. No incision is required. You may feel a slight warmth or pressure during the treatment time, which is 8 minutes; the entire appointment usually lasts approximately 30 minutes.

In most cases, patients can resume their normal activities the next day.

What happens after the procedure?
The first postoperative check-up usually occurs within 7 to 10 days after the procedure, and your doctor may determine that sexual activity can resume after that check-up. Your first few periods after the procedure may continue to be heavy, with improvement thereafter. Some women experience a pinkish watery discharge that usually lasts about 2 weeks, but may last up to one month.

What are the risks with GYNECARE THERMACHOICE®?
All medical procedures present risks, so talk to a doctor about whether GYNECARE THERMACHOICE® is right for you..

As with all procedures of its type, GYNECARE THERMACHOICE® poses a risk of injury to the uterus and surrounding tissues. Most common side effects include discharge, cramping, nausea, and vomiting.

Global endometrial ablation procedures, including GYNECARE THERMACHOICE® Uterine Balloon Therapy System, are intended for pre-menopausal women with heavy bleeding due to benign causes who do not wish to become pregnant in the future. It is not appropriate for a patient who is pregnant or wants to become pregnant in the future. Becoming pregnant after this procedure can be dangerous for both the mother and the fetus.

Pregnancy after ablation is unlikely. However, pregnancies following ablation can be dangerous for both the mother and fetus. Therefore, after treatment you will need to continue to use a birth control method that is appropriate for you. There are several options available for birth control. You should discuss these options with your doctor.