Women’s Health

Women are complex creatures. As the bearers of offspring for our species, we got quite a few upgrades from the basic human package, and these come with certain advantages as well as an increased potential for things to go wrong. So it goes with extra features: if your car doesn’t have air conditioning, it can’t develop a freon leak, and if you don’t have ovaries, you’ll never be bothered by ovarian cysts. Our most common concerns about our bodies land all over a continuum spanning “requires medical attention,” “responsive to home remedies,” and “doesn’t even need treatment because it’s completely normal.” Because the mechanics of our insides are pretty mysterious to most of us, we’re sometimes faced with some scary guesswork when deciding whether to take a given symptom to the doctor. The articles in this section are designed to help you tell the difference between the normal and the genuinely concerning, between something you can treat yourself and something that needs to be checked out by a health care provider. What follows is a brief overview of the most common concerns unique to women’s health, with links to more in-depth information. But remember: we aren’t doctors, so if you have any doubt about a symptom you’re experiencing, you need to get in touch with someone who is.

Women’s Health Topics

Breast Health

Be alert for changes in the look or feel of your breasts. In women younger than 55, most breast lumps turn out to be harmless. Fluid-filled cysts and solid fibroadenomas are the most common of a multitude of benign masses that can appear in breast tissue, and they may come and go with the phases of your menstrual cycle. If you do a breast self exam every month at the same point in your cycle, you’ll have a good idea of what’s normal for your own breasts. Breast cancer is typically hard, immovable, and irregularly shaped, but because exceptions happen, you should have a doctor examine any new or changing lump. Cancer can also be signaled by other changes in your breasts, including new and unusual pain or differences in the color, texture, or appearance of the skin.

Sensitive or sore breasts are rarely a cause for concern. Most of the time, breast pain is related to menstrual hormone fluctuations, but because it can also be a symptom of early pregnancy or cancer, any pain that’s not normal for you is worth a visit to the doctor.

Discharge from the nipples can be normal or not, depending on context. If it’s white in color and you’ve stopped breastfeeding a baby within the past year, it’s nothing to worry about. But this type of nipple discharge can also be a side effect of antidepressant or antipsychotic medication, or a symptom of hypothyroidism or a pituitary tumor. If the discharge is clear, colored, or bloody and only coming from one nipple, see a doctor; it may be nothing, but it may be a sign of cancer.

Many women who breastfeed experience some difficulty or discomfort. Most breastfeeding problems are short-lived and relatively mild, and they can often be solved with a change in technique to ensure that the baby’s mouth is forming a tight seal around the nipple and that the breast is being emptied efficiently and completely at each feeding. Sore nipples, engorgement, clogged ducts, and trouble with getting enough milk into the baby may all resolve with adjustments in technique or frequency of feedings. You can relieve breast soreness at home with cold compresses, warm showers, gentle massage, or Tylenol. Rubbing expressed milk, olive oil, or lanolin cream on cracked or bleeding nipples will help them heal, and you can temporarily use silicone nipple shields to protect your nipples when nursing is painful. More serious issues like thrush, mastitis, and ducts that don’t unclog after a few days of home treatment are less common and should be treated by a doctor.

Vaginal Health

“Vaginitis” is an umbrella term for several different types of vaginal inflammation.Their symptoms often overlap, but each type requires unique treatment, so it’s important to see a doctor for a diagnosis before you attempt to treat any vaginal itching, irritation, or unusual discharge with home remedies or over-the-counter medication. Also keep in mind that vaginal discharge or odor is not necessarily a symptom of a problem. Many women have clear, white, or yellowish vaginal discharge on a regular basis, and it’s normal for this to increase and change in appearance and texture around ovulation. Vaginas are typically not entirely odorless, either. You should only be concerned about discharge or vaginal odor if it’s unusual for you—especially if the odor is very unpleasant or reminiscent of fish.

The most familiar form of vaginitis, though actually not the most common, is a yeast infection. Its most recognizable symptom is vaginal itching and burning, which may be worse during urination or sex and is sometimes accompanied by thick, white vaginal discharge. Over-the-counter anti-fungal treatments for yeast infections are widely available and affordable, but they won’t help if what you actually have is some other kind of vaginitis, and it’s very common for women to misdiagnose themselves with yeast infections. Ideally, you should see a doctor before trying to treat yourself, but if you skip that step and still have symptoms after finishing a course of OTC medication, you’ll definitely want to get it checked out.

Bacterial vaginosis is the most widespread type of vaginitis. It’s fairly common for women to not even be aware that they have it, since its symptoms can be nonexistent or subtle, usually involving thin, grayish-white vaginal discharge and a fishy vaginal odor that may be more noticeable after sex. BV clears up on its own a lot of the time, but when it doesn’t, it can only be treated with antibiotics prescribed by a doctor.

Atrophic vaginitis is usually associated with lowered estrogen levels after menopause, which can make the tissue lining the vagina thinner and drier. The most common symptoms are vaginal dryness and burning, especially during sex. Some women also feel like they have to urinate more often and may even get recurrent urinary tract infections. Estrogen therapy can be used to treat atrophic vaginitis, but less intensive treatments include regular use of vaginal lubricants or moisturizers, and sexual activity or use of vaginal dilators. Women who smoke may find that quitting restores their estrogen levels enough to ease some or all of their symptoms.

Trichomoniasis is the only form of vaginitis that’s more or less always transmitted through sex. It’s caused by a flagellated protozoan (trichomonas vaginalis) and can come with no symptoms or pretty intense symptoms, such as thin, pus-like, smelly (and, in some cases, green) vaginal discharge and vaginal itching or burning that may get worse during urination or sex. The microorganism usually finds its way into the urethra as well, and leaving trichomoniasis untreated can lead to more serious infections within the reproductive or urinary tracts. Your doctor can prescribe a course of pills that will kill all of the protozoans in your system. Your sexual partner should also be treated, even if he or she doesn’t have any symptoms.

Vaginal bleeding that isn’t associated with your period may come from the uterus, the cervix, or the vagina itself, and can be caused by any number of things. If it’s only light, occasional bleeding, it’s probably nothing to worry about. Bleeding during or after sex is sometimes a sign of cervical, vaginal, or vulvar cancer, but it can also have several other (far less scary) causes, such as cervical polyps or abrasions inside the vagina. Heavier irregular bleeding that isn’t related to sex is more likely to have originated in the uterus, and could be a side effect of hormonal birth control or a symptom of pregnancy, endometriosis, polycystic ovarian syndrome, uterine cancer, or a multitude of other conditions, so an appointment with a doctor is probably called for.

If you experience pain during sex, don’t be shy about mentioning it to your doctor.You can try using a high-quality lubricant first, and if the pain goes away, it’s probably just a matter of you producing too little arousal fluid. Get your partner to amp up the foreplay, and keep a bottle of lube within arm’s reach of the bed. If lubricant doesn’t ease the pain, it could be a symptom of something wrong—maybe vaginitis or endometriosis. If nothing else, your doctor may prescribe a topical pain reliever that you can apply just before sex.

Uterine Health

Endometriosis affects different women in different ways.It’s a disorder in which endometrium, the type of tissue that normally grows in the uterus, also grows on surrounding tissues like the ovaries, fallopian tubes, and colon. Many women go their whole lives without realizing they have it, while others have very painful periods with heavy bleeding, and some even have trouble getting pregnant. It sometimes leads to endometriomas, or chocolate cysts, which are ovarian cysts that contain endometrial tissue. Endometriosis can only be definitely diagnosed through laparoscopic surgery, and treatment depends on the problem it’s causing. Hormonal birth control or non-steroidal anti-inflammatory medications (NSAIDs) like ibuprofen can reduce pain and menstrual bleeding, and if the endometriosis is contributing to fertility problems, it can usually be removed surgically. Women who have severe endometriosis and no plans to ever get pregnant sometimes choose hysterectomy—the only guaranteed, permanent solution.

Uterine fibroids are extremely common tumors that often don’t cause any symptoms. When that’s the case, there’s no need to treat them, since treatment is usually focused on reducing bothersome symptoms. Heavy or prolonged menstrual bleeding can be treated with birth control pills or other hormonal medications, and abdominal cramping can be dulled with NSAIDs. Uterine fibroids are rarely removed surgically unless they seem to be causing fertility issues or look suspiciously like cancer or precancer.

Ovarian cysts are fluid-filled masses that grow in or on ovaries. They’re pretty common, and often don’t require treatment or even produce symptoms. The main symptom they do cause is abdominal pain or pressure, which is sometimes severe enough that the cyst has to be surgically removed. Most of the time, however, ovarian cysts go away on their own without causing any real problems.

Polycystic ovarian syndrome (PCOS) is ovulation gone chronically wrong. Normal ovulation involves the formation of a small follicle, or cyst, on the surface of the ovary, which eventually grows large enough that it bursts and releases an egg. Because of hormonal irregularities associated with PCOS, these follicles don’t always get big enough to rupture, so the woman doesn’t ovulate every month and the cysts remain on the ovaries. Irregular periods, weight gain, and infertility are common symptoms of PCOS. Some women also experience acne, an increase in facial hair, or thinning hair as a result of higher levels of “male” hormones. Weight loss sometimes normalizes hormone levels enough to resolve these symptoms, or a doctor can prescribe birth control pills to regulate your periods. Ovulation-stimulating drugs are used to treat infertility associated with PCOS.

Menstrual Health

About 30% of women regularly experience premenstrual syndrome (PMS) in some form. The most common symptoms are bloating, fatigue, headaches, sore breasts, changes in mood or responses to stress, increased appetite or specific food cravings, acne, and trouble concentrating. These can appear alone or in any combination, and vary in intensity from one woman to the next. In some cases, they interfere with daily activities or general well-being enough to require treatment. Some symptoms can be relieved with home remedies such as relaxation techniques, exercise, and dietary supplements, while others only respond to doctor-prescribed treatments such as oral contraceptives or antidepressants. Hysterectomy is the extreme treatment option for severe, persistent symptoms.

Menstrual cramps (dysmenorrhea) affect about half of menstruating women, usually starting in the year after they get their first period. Menstrual pain that starts in adulthood is often a symptom of an underlying condition such as endometriosis or uterine fibroids, and usually goes away with surgery or other treatment of the cause. On the other hand, “primary” dysmenorrhea stems from inflammation and muscle contractions caused by high levels of hormone-like substances called prostaglandins, which can also cause nausea, diarrhea or constipation, dizziness, and other symptoms. Hormonal birth control or non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are usually effective in treating cramps. Home remedies such as heat, exercise, and yoga may also help, and most women report a natural decrease in cramps as they get older.

Periods that last for a long time or involve very heavy bleeding may be a sign of an underlying problem. Some women naturally have longer or heavier periods than others, but if your periods last for more than seven days or you’re bleeding more than you used to, it’s worth mentioning to a doctor. You could have uterine fibroids, endometriosis, irregular ovulation due to polycystic ovarian syndrome or menopause, or another disorder. Or, if you use a copper IUD for birth control, this could be a side effect. Even if there isn’t an apparent cause for the excessive bleeding, it can still be treated with hormonal contraceptives or regular doses of a non-steroidal anti-inflammatory drug such as ibuprofen. When left untreated, heavy or prolonged periods have the potential to cause anemia.

Amenorrhea, or lack of menstruation, has a long list of potential causes. Missing one period is usually nothing to worry about (though, if you’ve had sex since your last period, you should take a pregnancy test), but if you miss three in a row, or if you’re 15 or older and have never had a period, see a doctor. After pregnancy, polycystic ovarian syndrome and premature menopause are the most common causes of amenorrhea, but it could also be a sign of a pituitary tumor, excessive weight loss or stress, or another problem. Treatment of amenorrhea or oligomenorrhea (having fewer than six to eight periods in a year) is focused on the underlying condition.

Pregnancy

About 70% of pregnant women have to endure morning sickness. The (relatively) lucky ones experience only occasional mild nausea that goes away after the first trimester; the less fortunate have to be constantly braced for vomit, sometimes for the whole nine months. Home remedies are the first line of defense against morning sickness: avoid smells, foods, and environments that seem to aggravate your nausea; eat first thing in the morning and every hour or two afterward to keep your stomach from emptying completely, but do it slowly to avoid getting overly full; and sip at clear, carbonated or sour beverages before meals. Ginger or peppermint candy or tea may help settle your stomach, and vitamin B6 supplements can sometimes prevent nausea. Supplements that contain iron should be avoided or taken with a snack before bed. Antiemetic medication may be necessary to treat severe morning sickness, but most doctors will only prescribe it as a last resort.

An ectopic pregnancy is when the embryo implants somewhere other than the inner wall of the uterus. The most common place is inside one of the fallopian tubes, where the growth of the embryo can cause the fallopian tube to rupture, which in turn results in severe internal bleeding, shock, and sometimes death. About half of ectopic pregnancies are only discovered when the fallopian tube ruptures, but the other half are signaled by pregnancy symptoms in combination with abdominal pain and/or vaginal bleeding. Some ectopic pregnancies can be treated with a medication that stops the growth of the embryo, but others require surgery. Ruptured fallopian tubes can sometimes be repaired, but it’s often necessary for them to be removed.

Miscarriage is a pretty common phenomenon, especially in the first trimester. Up to 25% of pregnancies end in miscarriage, often before the woman even recognizes that she’s pregnant. Genetic abnormalities in the fetus cause about half of all miscarriages, but there’s a long list of other risk factors. For instance, women who are over 35, have had a previous miscarriage, are under- or overweight, or use substances such as alcohol, tobacco, and caffeine are more likely to suffer miscarriages. If you’re pregnant and experiencing vaginal bleeding and/or abdominal pain, it’s a good idea to check with a doctor, though both of those symptoms can sometimes happen in the course of a normal pregnancy.

The threat of postpartum depression should always be taken seriously. It can be easy to explain it away on the basis that some of its symptoms, such as exhaustion and anxiety, overlap with the normal symptoms of caring for a newborn day in and day out. But if, anytime in the first year after your baby is born, you notice that you spend most days feeling sad, hopeless, apathetic, or moody, talk about it with someone you trust—preferably a doctor, who can recommend a depression treatment.

Infertility is often treatable. That’s why you should see a doctor if you’ve been trying to get pregnant for more than a year, or, if you’re over 35, longer than six months. Common causes of female infertility include absent or irregular ovulation, structural problems in the uterus or fallopian tubes, and endometriosis. Treatment of infertility differs depending on the underlying cause, but can involve hormone treatments, medication to stimulate or regulate ovulation, intrauterine insemination, or in vitro fertilization.

Most women take measures to prevent pregnancy at some point in their lives. There’s a mind-boggling variety of methods for doing so, with varying effectiveness, side effects, and levels of inconvenience. Hormonal birth control is typically very effective, and can be delivered via pill, injection, vaginal ring, IUD, an implant placed under the skin, or two doses of post-intercourse emergency contraception. All the forms of contraception that work by regulating hormones are reversible, and all have the potential to cause physical and emotional side effects ranging from mild to intolerable. Barrier methods of birth control, which work by blocking the passage of sperm into a woman’s reproductive tract, include male and female condoms, diaphragms, cervical caps, and spermicides. An IUD is a coil placed inside the uterus, and while some release hormones that prevent ovulation, others are made of copper and come with a different set of possible side effects than their hormonal counterparts. A hormone-releasing IUD remains effective for up to five years, and a copper IUD can stay in place for up to 10 years. A small percentage of women use fertility awareness as birth control, abstaining from sex or using a barrier method of contraception during the part of each menstrual cycle when they are potentially fertile. If you’re certain that you won’t want to get pregnant at any time in the future, there are a few surgical options for permanent sterilization: men can get vasectomies, and women have the option of either tubal ligation or a newish method called Essure, in which coils are implanted in the fallopian tubes; tissue grows into the coils and completely blocks off the fallopian tubes, usually within three months.

A woman may make the decision to terminate a pregnancy for a variety of reasons.Health problems that increase the danger of carrying a pregnancy to term, defects discovered in the fetus, financial constraints, difficulty in reconciling parenthood with other circumstances or responsibilities, and trouble in a romantic relationship are all common factors in the choice to seek an abortion. A woman who is less than seven weeks pregnant may be able to take advantage of the option of medical abortion, which involves taking two doses, several hours apart, of a pill that induces miscarriage. Medical abortion is 98% effective and may cause abdominal cramping, vaginal bleeding, fever, nausea with or without vomiting, or diarrhea. Surgical abortion, or dilation and curettage (D&C), is an outpatient procedure that generally takes less than 20 minutes. A woman may or may not be fully sedated during a D&C, and she should expect some abdominal pain and vaginal bleeding afterward. Some U.S. states require women to submit to a counseling session and an ultrasound before obtaining an abortion. There may also be a 24-hour waiting period between the ultrasound and the surgery.

Menopause

All women go through menopause, usually between the ages of 45 and 55. During this time, your ovaries will gradually stop producing eggs, and your periods will become fewer and farther between before eventually stopping altogether. This transition is officially called “menopause” when it’s been a full year since your last period, though you may start experiencing symptoms of “perimenopause” years before your body gives up on menstruating. Common symptoms include hot flashes and/or night sweats, mood disturbances that may include depression, difficulty sleeping, and vaginal dryness or atrophic vaginitis. Hormone replacement therapies or vaginal treatments such as moisturizers or dilators are sometimes used to treat bothersome symptoms. If you experience vaginal bleeding after reaching menopause, you should see a doctor, since this can be a sign of endometrial cancer or trouble in the endocrine system.

Supplements for Women

Calcium + Vitamin D. Because a woman’s risk of developing osteoporosis after menopause may partly depend on whether there was enough calcium in her diet throughout her life, it’s important for women of all ages to get 1,000-1,300 mg of it from food or supplements every day, especially in young adulthood and after menopause. Some research suggests that adequate calcium intake may also help prevent heart disease, and women who are pregnant or breastfeeding may need a little extra to meet their body’s needs. Because vitamin D improves the body’s ability to absorb calcium, it should be included in your calcium supplement.

Folic acid. In general, women should get 400 micrograms of folic acid every day. It’s especially important for women who could become pregnant (or who are pregnant) because sufficient folate before and during pregnancy significantly reduces the risk of neural tube defects like spina bifida and anencephaly. Some studies suggest that folic acid may also help keep blood pressure at healthy levels.

Prenatal multivitamin. During pregnancy, a woman should take a daily prenatal vitamin to ensure that she’s getting all of the nutrients she and her developing baby need, including increased levels of iron, folic acid, and calcium. Prenatal vitamins are also often recommended for women who are breastfeeding or trying to conceive.

Charting Your Menstrual Cycle

Some women maintain charts—on paper, online, or on a cell phone app—of their various fertility signs over the course of each individual menstrual cycle. Basal body temperature is slightly higher between ovulation and the first day of a menstrual period, cervical fluid gradually becomes more abundant and slippery in the days leading up to ovulation, and the cervix itself gets higher, softer, and more open just before ovulation occurs. Some women also make note of other physical or emotional changes related to the fluctuation of hormones during their menstrual cycles, such as breast tenderness, headaches, moodiness, abdominal cramps, and fatigue. The most common reason for charting fertility signs is to be able to time sex at the point in any given month when the odds of conception are best, but some women use their charts for the opposite reason, avoiding sex completely or using a barrier method of birth control on days when they observe signs of fertility. Other women chart simply to stay more in tune with their health and the workings of their bodies.