Puberty and periods

Puberty and Periods from Kidshealth.org

Menstruation (a period) is a major stage of puberty in girls; it's one of the many physical signs that a girl is turning into a woman.

And like a lot of the other changes associated with puberty, menstruation can be confusing. Some girls can't wait to start their periods, whereas others may feel afraid or anxious. Many girls (and guys!) don't have a complete understanding of a woman's reproductive system or what actually happens during the menstrual cycle, making the process seem even more mysterious.



When girls begin to go through puberty (usually starting between the ages of 8 and 13), their bodies and minds change in many ways. The hormones in their bodies stimulate new physical development, such as growth and breast development. About 2 to 2½ years after a girl's breasts begin to develop, she usually gets her first menstrual period.

About 6 months or so before getting her first period, a girl might notice an increased amount of clear vaginal discharge. This discharge is common. There's no need for a girl to worry about discharge unless it has a strong odor or causes itchiness.

The start of periods is known as menarche. Menarche doesn't happen until all the parts of a girl's reproductive system have matured and are working together.

The Female Reproductive System
Baby girls are born with ovaries, fallopian tubes, and a uterus. The two ovaries are oval-shaped and sit on either side of the uterus (womb) in the lowest part of the abdomen called the pelvis. They contain thousands of eggs, or ova. The two fallopian tubes are long and thin. Each fallopian tube stretches from an ovary to the uterus, a pear-shaped organ that sits in the middle of the pelvis. The muscles in a female's uterus are powerful and are able to expand to allow the uterus to accommodate a growing fetus and then help push the baby out during labor.

As a girl matures and enters puberty, the pituitary gland releases hormones that stimulate the ovaries to produce other hormones called estrogen and progesterone. These hormones have many effects on a girl's body, including physical maturation, growth, and emotions.

About once a month, a tiny egg leaves one of the ovaries — a process called ovulation — and travels down one of the fallopian tubes toward the uterus. In the days before ovulation, the hormone estrogen stimulates the uterus to build up its lining with extra blood and tissue, making the walls of the uterus thick and cushioned. This happens to prepare the uterus for pregnancy: If the egg is fertilized by a sperm cell, it travels to the uterus and attaches to the cushiony wall of the uterus, where it slowly develops into a baby.

If the egg isn't fertilized, though — which is the case during most of a woman's monthly cycles — it doesn't attach to the wall of the uterus. When this happens, the uterus sheds the extra tissue lining. The blood, tissue, and unfertilized egg leave the uterus, going through the vagina on the way out of the body. This is a menstrual period.

This cycle happens almost every month for several more decades (except, of course, when a female is pregnant) until a woman reaches menopause and no longer releases eggs from her ovaries.

How Often Does a Girl Get Her Period?
Just as some girls begin puberty earlier or later than others, the same applies to periods. Some girls may start menstruating as early as age 10, but others may not get their first period until they are 15 years old.

The amount of time between a girl's periods is called her menstrual cycle (the cycle is counted from the start of one period to the start of the next). Some girls will find that their menstrual cycle lasts 28 days, whereas others might have a 24-day cycle, a 30-day cycle, or even longer. Following menarche, menstrual cycles last 21-45 days. After a couple of years, cycles shorten to an adult length of 21-34 days.

Irregular periods are common in girls who are just beginning to menstruate. It may take the body a while to sort out all the changes going on, so a girl may have a 28-day cycle for 2 months, then miss a month, for example. Usually, after a year or two, the menstrual cycle will become more regular. Some women continue to have irregular periods into adulthood, though.

As a girl gets older and her periods settle down — or she gets more used to her own unique cycle — she will probably find that she can predict when her period will come. In the meantime, it's a good idea to keep track of your menstrual cycle with a calendar.

How Long and How Much?
The amount of time that a girl has her period also can vary. Some girls have periods that last just 2 or 3 days. Other girls may have periods that last 7 days. The menstrual flow — meaning how much blood comes out of the vagina — can vary widely from girl to girl, too.

Some girls may be concerned that they're losing too much blood. It can be a shock to see all that blood, but it's unlikely that a girl will lose too much, unless she has a medical condition like von Willebrand disease. Though it may look like a lot, the average amount of blood is only about 2 tablespoons (30 milliliters) for an entire period. Most teens will change pads 3 to 6 times a day, with more frequent changes when their period is heaviest, usually at the start of the period.

Especially when menstrual periods are new, you may be worried about your blood flow or whether your period is normal in other ways. Talk to a doctor or nurse if:

*your period lasts longer than a week
*you have to change your pad very often (soaking more than one pad every 1-2 hours)
*you go longer than 3 months between periods
*you have bleeding in between periods
*you have an unusual amount of pain before or during your period
*your periods were regular then became irregular

Cramps
Some girls may notice physical or emotional changes around the time of their periods. Menstrual cramps are pretty common — in fact, more than half of all women who menstruate say they have cramps during the first few days of their periods. Doctors think that cramps are caused by prostaglandin, a chemical that causes the muscles of the uterus to contract.

Depending on the girl, menstrual cramps can be dull and achy or sharp and intense, and they can sometimes be felt in the back as well as the abdomen. These cramps often become less uncomfortable and sometimes even disappear completely as a girl gets older.

Many girls and women find that over-the-counter pain medications (like acetaminophen or ibuprofen) can relieve cramps, as can taking a warm bath or applying a warm heating pad to the lower abdomen. Exercising regularly throughout the monthly cycle may help lessen cramps, too. If these things don't help, ask your doctor for advice.

PMS and Pimples
Some girls and women find that they feel sad or easily irritated during the few days or week before their periods. Others may get angry more quickly than normal or cry more than usual. Some girls crave certain foods. These types of emotional changes may be the result of premenstrual syndrome (PMS).

PMS is related to changes in the body's hormones. As hormone levels rise and fall during a woman's menstrual cycle, they can affect the way she feels, both emotionally and physically. Some girls, in addition to feeling more intense emotions than they usually do, notice physical changes along with their periods — some feel bloated or puffy because of water retention, others notice swollen and sore breasts, and some get headaches.

PMS usually goes away soon after a period begins, but it can come back month after month. Eating right, getting enough sleep, and exercising may help relieve some of the symptoms of PMS. Talk to your doctor if you are concerned about your premenstrual symptoms.

It's also not uncommon for girls to have an acne flare-up during certain times of their cycle; again, this is due to hormones. Fortunately, the pimples associated with periods tend to become less of a problem as girls get older.

Pads, Tampons, and Liners
Once you begin menstruating, you'll need to use something to absorb the blood. Most girls use a pad or a tampon. But some use menstrual cups, which a girl inserts into her vagina to catch and hold the blood (instead of absorbing it, like a tampon).

There are so many products out there that it may take some experimenting before you find the one that works best for you. Some girls use only pads (particularly when they first start menstruating), some use only tampons, and some switch around — tampons during the day and pads at night, for example.

Girls who worry about leakage from a tampon often use a pantiliner, too, and some girls use liners alone on very light days of their periods.

Periods shouldn't get in the way of exercising, having fun, and enjoying life. Girls who are very active, particularly those who enjoy swimming, often find that tampons are the best option during sports.

If you have questions about pads, tampons, or coping with periods, ask a parent, health teacher, school nurse, or older sister.

Reviewed by: Mary L. Gavin, MD
Date reviewed: October 2010

Hot flashes from MedicineNet.com

What are hot flashes?

A hot flash (is a feeling of warmth that spreads over the body that begins, and is most strongly felt, in the head and neck regions. Hot flashes are a common symptom experienced by women prior to, and during the early stages of the menopausal transition. However, not all women approaching the menopause will develop hot flashes.


What causes hot flashes?

The complex hormonal changes that accompany the aging process, in particular the declining levels of estrogen as a woman approaches menopause, are thought to be the underlying cause of hot flashes. A disorder in thermoregulation (methods the body uses to control and regulate body temperature) is responsible for the sensation of heat, but the exact way in which the changing hormone levels affect thermoregulation is not fully understood.

While hot flashes are considered to be a characteristic symptom of the menopausal transition, they can also occur in men, and in circumstances other than the perimenopause in women as a result of certain uncommon medical conditions that affect the process of thermoregulation. For example, the carcinoid syndrome results from a type of endocrine tumor that secretes large amounts of the hormone serotonin and can cause hot flashes. Hot flashes can also develop as a side effect of some medications and can sometimes occur with severe infections or cancers that may be associated with fevers and/or night sweats.


What are the symptoms of hot flashes?

Hot flashes are typically brief, lasting from about 30 seconds to a few minutes.

Redness of the skin, known as flushing, may accompany hot flashes.

Excessive perspiration (sweating) can also occur; when hot flashes occur during sleep they may be accompanied by night sweats.
The timing of the onset of hot flashes in women approaching menopause is variable.

While not all women will experience hot flashes, many normally menstruating women will begin experiencing hot flashes even several years prior to the cessation of menstrual periods.

It is impossible to predict if a woman will experience hot flashes, and if she does, when they will begin.

About 75% of women experience hot flashes at some point in the menopausal transition.

How are hot flashes diagnosed?

Hot flashes are symptom, not a medical condition. Through a thorough medical history, the healthcare practitioner will usually be able to determine whether a woman is having hot flashes. The patient will be asked to describe the hot flashes, including how often and when they occur, and if there are other associated symptoms. A physical examination together with the medical history can help determine the cause of the hot flashes and direct further testing if necessary.

Blood tests may be performed if the diagnosis is unclear, either to measure hormone levels or to look for signs of other conditions (such as infection) that could be responsible for the hot flashes.


What is the treatment for hot flashes?

There are a variety of treatments for hot flashes such as:

hormone therapy,

bioidentical hormone therapy,

other drug treatments,

complementary and alternative treatments,

phytoestrogens,

black cohosh, and

other alternative therapies.
Some of these have not been proven by clinical studies, nor are they approved by the FDA.


Hormone Therapy

Traditionally, hot flashes have been treated with either oral or transdermal (patch) forms of estrogen. Hormone therapy (HT), also referred to as hormone replacement therapy (HRT) or postmenopausal hormone therapy (PHT), consists of estrogens alone or a combination of estrogens and progesterone (progestin). All available prescription estrogen medications, whether oral or transdermal; are effective in reducing the frequency of hot flashes and their severity. Research indicates that these medications decrease the frequency of hot flashes by about 80% to 90%.

However, long-term studies (the NIH-sponsored Women's Health Initiative, or WHI) of women receiving combined hormone therapy with both estrogen and progesterone were halted when it was discovered that these women had an increased risk for heart attack, stroke, and breast cancer when compared with women who did not receive hormone therapy. Later studies of women taking estrogen therapy alone showed that estrogen was associated with an increased risk for stroke, but not for heart attack or breast cancer. Estrogen therapy alone, however, is associated with an increased risk of developing endometrial cancer (cancer of the lining of the uterus) in postmenopausal women who have not had their uterus surgically removed.

More recently, it has been noted that the negative effects associated with hormone therapy were described in older women who were years beyond menopause, and some researchers have suggested that these negative outcomes might be lessened or prevented if hormone therapy was given to younger women (prior to or around the age of menopause) instead of women years beyond menopause.

The decision in regard to starting or continuing hormone therapy, therefore, is an individual one in which the patient and doctor must take into account the inherent risks and benefits of the treatment along with each woman's own medical history. It is currently recommended that if hormone therapy is used, it should be used at the smallest effective dose for the shortest possible time.

Bioidentical hormone therapy

There has been increasing interest in recent years in the use of so-called "bioidentical" hormone therapy for perimenopausal women. Bioidentical hormone preparations are medications that contain hormones that have the same chemical formula as those made naturally in the body. The hormones are created in a laboratory by altering compounds derived from naturally-occurring plant products. Some of these so-called bioidentical hormone preparations are U.S. FDA-approved and manufactured by drug companies, while others are made at special pharmacies called compounding pharmacies, which make the preparations on a case-by-case basis for each patient. These individual preparations are not regulated by the FDA, because compounded products are not standardized.

Advocates of bioidentical hormone therapy argue that the products, applied as creams or gels, are absorbed into the body in their active form without the need for "first pass" metabolism in the liver, and that their use may avoid potentially dangerous side effects of synthetic hormones used in conventional hormone therapy. However, studies to establish the long-term safety and effectiveness of these products have not been carried out.


Other drug treatments

The selective serotonin reuptake inhibitor (SSRI) medications have been shown be effective in reducing menopausal hot flashes. These drugs are generally used in the treatment of depression and anxiety as well as other conditions The SSRI that has been tested most extensively in the treatment of hot flashes is venlafaxine (Effexor), although other SSRI drugs may be effective as well.

Clonidine (Catapres) is an anti-hypertensive drug that can relieve hot flashes in some women. Clonidine is taken either by pill or skin patch and decreases blood pressure. Side effects of clonidine can include dry mouth, constipation, drowsiness, or difficulty sleeping.

Gabapentin (Neurontin), a drug primarily used for the treatment of seizures, has also been effective in treating hot flashes.

Megestrol acetate (Megace) is a progestin that is sometimes prescribed over a short-term to help relieve hot flashes, but this drug is not usually recommended as a first-line treatment for hot flashes. Serious side effects can occur if the medication is abruptly discontinued. Megestrol may have the side effect of weight gain.

Medroxyprogesterone acetate (Depo-Provera) is another progestin drug and is administered by injection to treat hot flashes. It may lead to weight gain as well as bone loss.

Complementary and alternative treatments

Some women report that exercise programs or relaxation methods have helped to control hot flashes, but controlled studies have failed to show a benefit of these practices in relieving the symptoms of hot flashes. Maintaining a cool sleep environment and the use of cotton bedclothes can help ease some of the discomfort associated with hot flashes and associated night sweats.

Many women turn to alternative therapies, including herbal products, vitamins, plant estrogens, and other substances, for the treatment of hot flashes. Doctors can be reluctant to recommend alternative treatments because these nonprescription products are not regulated by the FDA (like prescription medications), and their ingredients and strength can vary from manufacturer to manufacturer. For products that are not regulated by the FDA, testing and proof of safety is not required for marketing of these products. Long-term, scientifically controlled studies for these products are either lacking or have not proved the safely and effectiveness of many of the so-called natural or alternative remedies.

Some alternative treatments, however, have been evaluated in well-designed clinical trials. Alternative treatments that have been scientifically studied with some research include phytoestrogens (plant estrogens, isoflavones), black cohosh, and vitamin E.


Phytoestrogens

Isoflavones are chemical compounds found in soy and other plants (such as chick peas and lentils) that are phytoestrogens, or plant-derived estrogens. They have a chemical structure that is similar to the estrogens naturally produced by the body, but their effectiveness as an estrogen has been determined to be much lower than true estrogens.

Some studies have shown that these compounds may help relieve hot flashes and other symptoms of menopause. In particular, women who have had breast cancer and do not want to take hormone therapy (HT) with estrogen sometimes use soy products for relief of menopausal symptoms. However, some phytoestrogens can actually have anti-estrogenic properties in certain situations, and the overall risks of these preparations have not yet been determined.

There is also a perception among many women that plant estrogens are "natural" and therefore safer than hormone therapy, but this has never been proven scientifically. Further research is needed to fully characterize the safety and potential risks of phytoestrogens.

Black cohosh

Black cohosh is an herbal preparation that is becoming more and more popular in the U.S., and the North American Menopause Society does support the short-term use of black cohosh for treating menopausal symptoms, for a period of up to six months (because of its relatively low incidence of side effects when used over the short-term).

Some studies have shown that black cohosh can reduce hot flashes, but most of the studies have not been considered to be rigorous enough in their design to firmly prove any benefit. There also have not been scientific studies done to establish the long-term benefits and safety of this product. Research is ongoing to further determine the effectiveness and safety of black cohosh.


Other alternative therapies

There are many other supplements and substances that have been used as treatments for symptoms of menopause, including:

vitamin E,

licorice,

evening primrose oil,

dong quai,

chasteberry, and

wild yam.
Scientific studies to prove the safety and effectiveness of these products in relieving hot flashes have not been adequately performed.


Can hot flashes be prevented?

While the development of hot flashes cannot be prevented, the treatment methods as described in the above section may be able to reduce their incidence and severity.


Hot Flashes At A Glance
Hot flashes are feelings or warmth that spread over the body and last from 30 seconds to a few minutes.

Hot flashes are a characteristic symptom of the menopausal transition in women but may occasionally result from other medical conditions.

About 75% of women will experience hot flashes at some point in the menopausal transition.

Hot flashes may be treated by hormone therapy or other medications if necessary.

Some alternative treatments for hot flashes have been proposed and may provide relief for some women; the effectiveness of other alternative treatments has not been adequately scientifically evaluated.
Additional resources from WebMD Boots UK on Hot Flushes

Female Sexual Dysfunction

Female Sexual Dysfunction by WebMD

A sexual problem, or sexual dysfunction, refers to a problem during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity. The sexual response cycle has four phases: excitement, plateau, orgasm, and resolution.

While research suggests that sexual dysfunction is common (43% of women and 31% of men report some degree of difficulty), it is a topic that many people are hesitant to discuss. Fortunately, most cases of sexual dysfunction are treatable, so it is important to share your concerns with your partner and doctor.


What Causes Sexual Dysfunction?

Sexual dysfunction can be a result of a physical or psychological problem.

Physical causes. Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart disease, neurological diseases, hormonal imbalances, menopause, chronic diseases such as kidney disease or liver failure, and alcoholism or drug abuse. In addition, the side effects of certain medications, including some antidepressant drugs, can affect sexual desire and function.

Psychological causes. These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, or the effects of a past sexual trauma.
Who Is Affected by Sexual Dysfunction?

Both men and women are affected by sexual dysfunction. Sexual problems occur in adults of all ages. Among those commonly affected are the elderly, which may be related to a decline in health associated with aging.

How Does Sexual Dysfunction Affect Women?

The most common problems related to sexual dysfunction in women include:

Inhibited sexual desire. This involves a lack of sexual desire or interest in sex. Many factors can contribute to a lack of desire, including hormonal changes, medical conditions and treatments (for example, cancer and chemotherapy), depression, pregnancy, stress, and fatigue. Boredom with regular sexual routines also may contribute to a lack of enthusiasm for sex, as can lifestyle factors, such as careers and the care of children.

Inability to become aroused. For women, the inability to become physically aroused during sexual activity often involves insufficient vaginal lubrication. The inability to become aroused also may be related to anxiety or inadequate stimulation. In addition, researchers are investigating how blood flow problems affecting the vagina and clitoris may contribute to arousal problems.

Lack of orgasm (anorgasmia). This is the absence of sexual climax (orgasm). It can be caused by a woman's sexual inhibition, inexperience, lack of knowledge, and psychological factors such as guilt, anxiety, or a past sexual trauma or abuse. Other factors contributing to anorgasmia include insufficient stimulation, certain medications, and chronic diseases.

Painful intercourse. Pain during intercourse can be caused by a number of problems, including endometriosis, a pelvic mass, ovarian cysts, vaginitis, poor lubrication, the presence of scar tissue from surgery, or a sexually transmitted disease. A condition called vaginismus is a painful, involuntary spasm of the muscles that surround the vaginal entrance. It may occur in women who fear that penetration will be painful and also may stem from a sexual phobia or from a previous traumatic or painful experience.


How Is Female Sexual Dysfunction Diagnosed?

To diagnose female sexual dysfunction, the doctor likely will begin with a physical exam and a thorough evaluation of symptoms. The doctor may perform a pelvic exam to evaluate the health of the reproductive organs and a Pap smear to detect changes in the cells of the cervix (to check for cancer or a pre-cancerous condition). He or she may order other tests to rule out any medical problems that may be contributing to the woman's sexual dysfunction.

An evaluation of your attitudes regarding sex, as well as other possible contributing factors (such as fear, anxiety, past sexual trauma/abuse, relationship problems, or alcohol or drug abuse) will help the doctor understand the underlying cause of the problem and make appropriate recommendations for treatment.

How Is Female Sexual Dysfunction Treated?

The ideal approach to treating female sexual dysfunction involves a team effort between the woman, doctors, and trained therapists. Most types of sexual problems can be corrected by treating the underlying physical or psychological problems. Other treatment strategies focus on the following:

Providing education. Education about human anatomy, sexual function, and the normal changes associated with aging, as well as sexual behaviors and responses, may help a woman overcome her anxieties about sexual function and performance.
Enhancing stimulation. This may include the use of erotic materials (videos or books), masturbation, and changes to sexual routines.
Providing distraction techniques. Erotic or non-erotic fantasies; exercises with intercourse; music, videos, or television can be used to increase relaxation and eliminate anxiety.
Encouraging non-coital behaviors. Non-coital behaviors (physically stimulating activity that does not include intercourse), such as sensual massage, can be used to promote comfort and increase communication between partners.
Minimizing pain. Using sexual positions that allow the woman to control the depth of penetration may help relieve some pain. The use of vaginal lubricants can help reduce pain caused by friction, and a warm bath before intercourse can help increase relaxation.
Can Female Sexual Dysfunction Be Cured?

The success of treatment for female sexual dysfunction depends on the underlying cause of the problem. The outlook is good for dysfunction that is related to a treatable or reversible physical condition. Mild dysfunction that is related to stress, fear, or anxiety often can be successfully treated with counseling, education, and improved communication between partners.

How Do Hormones Affect Female Sexual Dysfunction?

Hormones play an important role in regulating sexual function in women. With the decrease in the female hormone estrogen that is related to aging and menopause, many women experience some changes in sexual function as they age, including poor vaginal lubrication and decreased genital sensation. Further, research suggests that low levels of the male hormone testosterone also contribute to a decline in sexual arousal, genital sensation, and orgasm. Researchers still are investigating the benefits of hormones and other medications, including drugs like Viagra, to treat sexual problems in women.

How Is Female Sexual Dysfunction Diagnosed?

To diagnose female sexual dysfunction, the doctor likely will begin with a physical exam and a thorough evaluation of symptoms. The doctor may perform a pelvic exam to evaluate the health of the reproductive organs and a Pap smear to detect changes in the cells of the cervix (to check for cancer or a pre-cancerous condition). He or she may order other tests to rule out any medical problems that may be contributing to the woman's sexual dysfunction.

An evaluation of your attitudes regarding sex, as well as other possible contributing factors (such as fear, anxiety, past sexual trauma/abuse, relationship problems, or alcohol or drug abuse) will help the doctor understand the underlying cause of the problem and make appropriate recommendations for treatment.

How Is Female Sexual Dysfunction Treated?

The ideal approach to treating female sexual dysfunction involves a team effort between the woman, doctors, and trained therapists. Most types of sexual problems can be corrected by treating the underlying physical or psychological problems. Other treatment strategies focus on the following:

Providing education. Education about human anatomy, sexual function, and the normal changes associated with aging, as well as sexual behaviors and responses, may help a woman overcome her anxieties about sexual function and performance.
Enhancing stimulation. This may include the use of erotic materials (videos or books), masturbation, and changes to sexual routines.
Providing distraction techniques. Erotic or non-erotic fantasies; exercises with intercourse; music, videos, or television can be used to increase relaxation and eliminate anxiety.
Encouraging non-coital behaviors. Non-coital behaviors (physically stimulating activity that does not include intercourse), such as sensual massage, can be used to promote comfort and increase communication between partners.
Minimizing pain. Using sexual positions that allow the woman to control the depth of penetration may help relieve some pain. The use of vaginal lubricants can help reduce pain caused by friction, and a warm bath before intercourse can help increase relaxation.

Can Female Sexual Dysfunction Be Cured?

The success of treatment for female sexual dysfunction depends on the underlying cause of the problem. The outlook is good for dysfunction that is related to a treatable or reversible physical condition. Mild dysfunction that is related to stress, fear, or anxiety often can be successfully treated with counseling, education, and improved communication between partners.

How Do Hormones Affect Female Sexual Dysfunction?

Hormones play an important role in regulating sexual function in women. With the decrease in the female hormone estrogen that is related to aging and menopause, many women experience some changes in sexual function as they age, including poor vaginal lubrication and decreased genital sensation. Further, research suggests that low levels of the male hormone testosterone also contribute to a decline in sexual arousal, genital sensation, and orgasm. Researchers still are investigating the benefits of hormones and other medications, including drugs like Viagra, to treat sexual problems in women.

What Effect Does a Hysterectomy Have on Female Sexual Dysfunction?

Many women experience changes in sexual function after a hysterectomy (surgical removal of the uterus). These changes may include a loss of desire, and decreased vaginal lubrication and genital sensation. These problems may be associated with the hormonal changes that occur with the loss of the uterus. Furthermore, nerves and blood vessels critical to sexual function can be damaged during the surgery.

How Does Menopause Affect a Female Sexual Dysfunction?

The loss of estrogen following menopause can lead to changes in a woman's sexual functioning. Emotional changes that often accompany menopause can add to a woman's loss of interest in sex and/or ability to become aroused. Hormone replacement therapy or vaginal lubricants may improve certain conditions, such as loss of vaginal lubrication and genital sensation, which can create problems with sexual function in women.

It should be noted that some post-menopausal women report an increase in sexual satisfaction. This may be due to decreased anxiety over getting pregnant. In addition, post-menopausal woman often have fewer child-rearing responsibilities, allowing them to relax and enjoy intimacy with their partners.

When Should I Call my Doctor About Sexual Dysfunction?

Many women experience a problem with sexual function from time to time. However, when the problems are persistent, they can cause distress for the women and her partner, and can have a negative impact on their relationship. If you consistently experience these problems, see your doctor for evaluation and treatment.

Women's Health Screening

Disease Prevention in Women

Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR

Disease prevention in women overview

Screening tests are a basic part of prevention medicine. All screening tests are commonly available through your general doctor. Some specialized tests may be available elsewhere. Take an active role and discuss screening tests with your doctor early in life. The following charts are beneficial (generally simple and safe) screening tests that can help detect diseases and conditions before they become harmful.


Osteoporosis

Osteoporosis is a condition with progressive loss of bone density leading to bone fractures. Estrogen is important in maintaining bone density. When estrogen levels drop after menopause, bone loss accelerates. Thus osteoporosis is most common among postmenopausal women.

Screening tests

Measurement of bone density using dual energy X-ray absorptiometry (DEXA) scan

DEXA bone density scanning can:

*detect osteoporosis before fractures occur

*predict the risk of future bone fractures

*Although still controversial, some doctors use bone density to monitor effects of osteoporosis treatments

Who to test and how often

The National Osteoporosis Foundation guidelines state that all postmenopausal women below age 65 who have risk factors for osteoporosis or medical conditions associated with osteoporosis and all women aged 65 and older should consider bone density testing.

High risk factors for osteoporosis include:

*early menopause or surgical absence of ovaries;

*family members with osteoporosis and related bone fractures;

*cigarette smoking and/or heavy alcohol use;

*over-active thyroid gland (hyperthyroidism), previous or current anorexia nervosa or bulimia;

*thin stature, light skin;

*Asian or Northern European descent;

*any condition associated with poor absorption of calcium or vitamin D;

*chronic use of oral corticosteroids (such as cortisone and prednisone [Deltasone, Liquid Prep]), excessive thyroid hormone replacement, and phenytoin (Dilantin) or other anti-seizure medications; and


*problems with missed menstrual periods.

Benefits of early detection

Osteoporosis produces no symptoms until a bone fracture occurs. Bone fracture in osteoporosis can occur with only a minor fall, blow, or even just a twist of the body that ordinarily would not cause an injury.

Prevention and treatment of osteoporosis can decrease the risk of bone fractures.

Prevention measures include:

*quitting smoking and curtailing alcohol intake;

*performing regular weight-bearing exercises, including walking, dancing, gardening and other physical activities, and (supervised) muscle strengthening exercises;

*getting adequate calcium and vitamin D intake;

*medications may be taken to prevent osteoporosis. The most effective medications for osteoporosis that are approved by the FDA are anti-resorptive agents, which prevent bone breakdown. Examples include Others include alendronate (Fosamax), risedronate (Actonel), raloxifene (Evista), ibandronate (Boniva), calcitonin (Calcimar), and zoledronate (Reclast); and

*while hormone therapy containing estrogen has been shown to prevent bone loss, increase bone density, and decrease the risk of fractures, HT has also been associated with health risks. Currently, HT is recommended for women for the treatment of menopausal symptoms only at the lowest effective dose for the short-term.

Breast cancer

Breast cancer is the most common cancer among women in the United States. Approximately one in nine women who live to age 65 will develop breast cancer, although many will not do so until after age 65.

Screening tests for breast cancer

*Breast self-examination/breast awareness:

*breast examination by a doctor, and

*mammography

Who to test and how often

Breast awareness

*In November, 2009, the U.S. Preventive Services Task Force recommended against teaching breast self-examination, stating a lack of benefit for a monthly self-exam. Groups such as the American Cancer Society agree with this conclusion and do not offer guidance on exactly how often a woman should check her breasts, but so state that a woman should be aware of any changes in her breasts.

*Breast examination by a doctor.

*Mammography: In their revised recommendations issued in November, 2009, the U.S. Preventive Services Task Force states that women age 40 to 49 do not require routine mammograms. They recommend biannual screening mammograms for women aged 49-74, and further state that: "The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms."

*However, The American Cancer Society (ACS) disagrees and recommends a baseline mammogram for all women by age 40 and annual mammograms for women 40 and older for as long as they are in good health.

*In women with "lumpy breasts" or breast symptoms, and also in women with a high risk of developing breast cancer, sometimes a baseline mammogram at 35 years of age is recommended. This recommendation is somewhat controversial, and there are other viewpoints.

High-risk factors include:

*previous breast cancer; and

*close relatives (mother, sister, or daughter) with breast cancer. The risk is especially higher if both the mother and sister have had breast cancers, if a relative developed her cancer before age 50, if the relative had breast cancer in both breasts, if there is both ovary and breast cancers in the family, or if a male family member has been diagnosed with breast cancer

Benefits of early detection

Early detection of breast cancer is important to every woman, regardless of risk factors, because the earlier a cancer is found, the smaller it is. Studies have clearly shown that the smaller the size of the breast cancer when detected, the better the chance of a surgical cure and long-term survival. Smaller breast cancers are also less likely to have already spread to lymph nodes and to other organs such as the lungs, liver, bones, and brain.

Mammograms can detect many small breast cancers long before they may be felt by breast examinations, and there is extensive evidence that early detection by mammograms has improved survival in women with this disease.

However, some 10% to15% of breast cancers is not detected by mammograms, but are detected by breast examinations. Therefore a normal mammogram does not completely exclude the possibility of breast cancer, and breast self-examinations and breast examinations by a doctor remain important.

Cancer of the cervix

Cancer of the cervix (the portion of the uterus that extends into the vaginal cavity) is the third most common gynecologic cancer. Cancer of the cervix is caused by infection with the human papillomavirus (HPV). Cervical cancer typically develops over the long term from abnormal precancerous (before-cancer) cells on the surface of the cervix. These abnormal cells transform into cervix cancer over a number of years. After turning cancerous, these cancer cells can invade or spread to other parts of the body.

Screening tests

Pap test also known as Pap smear.

A Pap test is a simple, quick office test in which a sample of cells from a woman's cervix is collected by aspiration or swabbing and spread (smeared) on a microscope slide. The cells are examined under a microscope in order to look for precancerous (before-cancer) or cancer cells.

Who to test and how often

Women should have Pap tests as part of a manual pelvic examination beginning at age 21. Because the risk of cervical cancer increases sharply in the first few years after sexual activity begins, some physicians begin screening women as soon as they become sexually active, but not before. High-risk factors for cancer of the cervix include:

*cigarette smoking;

*previous genital warts or other genital infection with the human papilloma virus (HPV);

*multiple sexual partners or a partner who has multiple sexual partners; and

*onset of sexual activity at a young age.

In 2009, the American College of Obstetricians and Gynecologists (ACOG) revised its recommendations regarding Pap screening. Instead of beginning at age 18 as previously recommended, the new recommendations advise beginning Pap smears at age 21. Further changes to the ACOG guidelines are:

*Women younger than 30 years of age should have a Pap test every 2 years.

*Women aged 30 years of age and older should have a Pap test every 2 years. After three normal Pap test results in a row, a woman in this age group may have Pap tests every 3 years if:

**she does not have a history of moderate or severe dysplasia;

**she is not infected with human immunodeficiency virus (HIV);

**her immune system is not weakened (for example, if she has had an organ transplant); and

**she was not exposed to diethylstilbestrol (DES) before birth.

It is rare to find pre-cancer or cancer of the cervix in women over age 65 who have repeatedly had normal Pap smears, so many doctors stop screening in women over age 65 who have had consistently normal Pap smears. Other doctors decrease the frequency of Pap screening under these circumstances.

Women who have had a hysterectomy (surgery to remove the uterus, including the cervix) no longer require a Pap test, but they should continue with manual pelvic and rectal examinations by their doctors as a part of their periodic medical evaluations for reasons other than cancer of the cervix.

Benefits of early detection

There has been a 70% decrease in the deaths from cancer of the cervix by regular use of the Pap test. Benefits of the Pap test include:

Pap tests can prevent cancer of the cervix by identifying and allowing treatment of abnormal cells before they become cancerous.

Pap tests can identify cancer of the cervix at an early curable stage, before cancer cells spread (metastasize) to other parts of the body.

Prevention

A vaccine (Gardasil) has received U.S. FDA approval for use in women between 9 and 26 years of age and confers immunity against HPV types 6, 11, 16, and 18. Initial trials with the vaccine have shown that the HPV-16/18 vaccine is safe and induces a high degree of protection against HPV-16/18 infection. Gardasil is given in three shots over six-months. The U.S. Centers for Disease Control and Prevention (CDC) recommends that girls 11-12 years of age receive the vaccine. It is also recommended for girls and women age 13 through 26 who have not yet been vaccinated or completed the vaccine series.

A newer vaccine (Cervarix) was approved by the FDA in October, 2009, for use in girls and young women ages 10-25 to help prevent cervical cancer. Cervarix targets two HPV strains, HPV 16 and HPV 18, A comparison of the two vaccines has not been carried out.