WOMEN'S HEALTH

Acknowledgedment: Women's Health Topics in this Section is Prepared
by the Office on Women's Health

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Urinary Tract Infection
Pelvic Inflammatory Disease
Polycystic Ovary Syndrome
Osteoporosis
Premenstrual Syndrome (PMS)
Thyroid Disease
Infertility Facts-sheet
Common STDs in Women		 Vaginal Yeast Infection
Syphilis FactsSheet
Viral Hepatitis
Varicose Veins & Spider Veins
Sexual Assault & Date Rape
Mammograms & Pap Test
Ovarian Cancer
Oral Health

Urinary Tract Infection Fact Sheet

Nancy's story

It was a normal day at work, but I was tired and felt like I had to pass urine the whole day. But when I went to the bathroom, not much came out. When I did pass urine, it burned and smelled bad — and looked cloudy too. These problems lasted a few days. So I called my doctor, and she said it sounded like a urinary tract infection, or UTI. I went to her office, and she asked me to pass urine into a cup. She tested the urine and told me I had a UTI. She called my drug store and ordered pills for me. I took all of the pills she prescribed, and then the UTI and the symptoms were gone.

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What is a urinary (YOOR-uh-nair-ee) tract infection (UTI)?

A UTI is an infection anywhere in the urinary tract. The urinary tract makes and stores urine and removes it from the body. Parts of the urinary tract include:


Image source: The National Kidney and Urologic
Diseases Information Clearinghouse (NKUDIC)

What causes UTIs?

Bacteria (bak-TIHR-ee-uh), a type of germ that gets into your urinary tract, cause a UTI. This can happen in many ways:

 



For the National Cancer Institute © 2013 Terese Winslow LLC, U.S. Govt. has certain rights

What are the signs of a UTI?

If you have an infection, you may have some or all of these signs:

How does a doctor find out if I have a urinary tract infection (UTI)?

To find out if you have a UTI, your doctor will need to test a clean sample of your urine. The doctor or nurse will give you a clean plastic cup and a special wipe. Wash your hands before opening the cup. When you open the cup, don’t touch the inside of the lid or inside of the cup. Put the cup in easy reach. Separate the labia, the outer lips of the vagina, with one hand. With your other hand, clean the genital area with the wipe. Wipe from front to back. Do not touch or wipe the anus. While still holding the labia open, pass a little bit of urine into the toilet. Then, catch the rest in the cup. This is called a “clean-catch” sample. Let the rest of the urine fall into the toilet.

If you are prone to UTIs, your doctor may want to take pictures of your urinary tract with an x-ray or ultrasound. These pictures can show swelling, stones, or blockage. Your doctor also may want to look inside your bladder using a cystoscope (SISS-tuh-skohp). It is a small tube that's put into the urethra to see inside of the urethra and bladder.

How is a UTI treated?

UTIs are treated with antibiotics (an-tuh-beye-OT-iks), medicines that kill the bacteria that cause the infection. Your doctor will tell you how long you need to take the medicine. Make sure you take all of your medicine, even if you feel better! Many women feel better in one or two days.

If you don't take medicine for a UTI, the UTI can hurt other parts of your body. Also, if you're pregnant and have signs of a UTI, see your doctor right away. A UTI could cause problems in your pregnancy, such as having your baby too early or getting high blood pressure. Also, UTIs in pregnant women are more likely to travel to the kidneys.

Will a UTI hurt my kidneys?

If treated right away, a UTI is not likely to damage your kidneys or urinary tract. But UTIs that are not treated can cause serious problems in your kidneys and the rest of your body.

How can I keep from getting UTIs?

These are steps you can take to try to prevent a UTI. But you may follow these steps and still get a UTI. If you have symptoms of a UTI, call your doctor.

I get UTIs a lot. Can my doctor do something to help?

About one in five women who get UTIs will get another one. Some women get three or more UTIs a year. If you are prone to UTIs, ask your doctor about your treatment options. Your doctor may ask you to take a small dose of medicine every day to prevent infection. Or, your doctor might give you a supply of antibiotics to take after sex or at the first sign of infection. “Dipsticks” can help test for UTIs at home. They are useful for some women with repeat UTIs. Ask your doctor if you should use dipsticks at home to test for UTI. Your doctor may also want to do special tests to see what is causing repeat infections. Ask about them.

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More information on urinary tract infection

For more information about urinary tract infection, call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

Urinary tract infection fact sheet was reviewed by:

Magda Barini-García, M.D., M.P.H.
Senior Medical Advisor
Center for Quality
Health Resources and Services Administration
Rockville, MD

Kristene Whitmore, M.D.
Director, Pelvic and Sexual Health Institute
Graduate Hospital
Philadelphia, PA

Source: Office on Women's Health, HHS

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Pelvic Inflammatory Disease

What is pelvic inflammatory disease (PID)?

Female reproductive system

Pelvic inflammatory disease (PID) is an infection of a woman's pelvic organs. The pelvic organs include the uterus (womb), fallopian tubes (fuh-LOH-pee-uhn toobs), ovaries, and cervix.

What causes PID?

A woman can get PID if bacteria (germs) move up from her vagina and infect her pelvic organs. Many different types of bacteria can cause PID. But, most cases of PID are caused by bacteria that cause 2 common sexually transmitted infections (STIs) — gonorrhea (gah-nuh-REE-uh) and chlamydia (kluh-MI-dee-uh). It can take from a few days to a few months for an infection to travel up from the vagina to the pelvic organs.

You can get PID without having an STI. Normal bacteria found in the vagina and on the cervix can sometimes cause PID. No one is sure why this happens.  

How common is PID?

Each year in the United States, more than 1 million women have an episode of PID. More than 100,000 women become infertile each year because of PID. Also, many ectopic pregnancies that occur are due to problems from PID.

Are some women more likely to get PID?

Yes. You’re more likely to get PID if you:

How do I know if I have PID?

Many women don't know they have PID because they don't have any symptoms. For women who have them, symptoms can range from mild to severe. The most common symptom of PID is pain in your lower abdomen (stomach area). Other symptoms include:

PID can come on fast with extreme pain and fever, especially if it’s caused by gonorrhea.

Are there any tests for PID?

If you think that you may have PID, see a doctor right away. If you have pain in your lower abdomen (stomach area), your doctor will perform a physical exam. This will include a pelvic (internal) exam. Your doctor will check for:

Your doctor will also test you for STIs, including HIV and syphilis (SI-fuh-luhs), urinary tract infection, and if needed, pregnancy. If needed, your doctor may do other tests.

These tests will help your doctor find out if you have PID, or if you have a different problem that looks like PID.

How is PID treated?

PID can be cured with antibiotics (drugs that kill bacteria). Most of the time, at least two antibiotics are used that work against a wide range of bacteria. Your doctor will work with you to find the best treatment for you.You must take all your medicine, even if your symptoms go away. This helps to make sure your infection is fully cured. You should see your doctor again 2 to 3 days after starting treatment to make sure the antibiotics are working.

Without treatment, PID can lead to severe problems like infertility, ectopic pregnancy, and chronic pelvic pain.

Any damage done to your pelvic organs before you start treatment likely cannot be undone. Still, don't put off getting treatment. If you do, you may not be able to have children. If you think you may have PID, see a doctor right away.

Your doctor may suggest going into the hospital to treat your PID if you:

If you still have symptoms or if the abscess doesn't go away after treatment, you may need surgery. Problems caused by PID, such as constant pelvic pain and scarring, are often hard to treat. But, sometimes they get better after surgery.

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What if my partner is infected?

Even if your sex partner doesn't have any symptoms, she or he could still be infected with bacteria that can cause PID. Take steps to protect yourself from being infected again.

My friend was told she can't get pregnant because she has PID. Is this true?

The more times you have PID, the more likely it is that you won't be able to get pregnant. When you have PID, bacteria infect the tubes or cause inflammation of the tubes. This turns normal tissue into scar tissue. Scar tissue can block your tubes and make it harder to get pregnant. Even having just a little scar tissue can keep you from getting pregnant without infertility treatment.

How can I keep myself from getting PID?

PID is most often caused by an STI that hasn't been treated. You can keep from getting PID by not getting an STI.

What should I do if I think I have an STI?

If you think you may have an STI, see a doctor right away. You may feel scared or shy about asking for information or help. Keep in mind, the sooner you seek treatment, the less likely the STI will cause you severe harm. And the sooner you tell your sex partner(s) that you have an STI, the less likely they are to infect you again or spread the disease to others.

To learn about STIs or get tested, contact your doctor, local health department, or an STI and family planning clinic. The American Social Health Association (ASHA) keeps lists of clinics and doctors who provide treatment for STIs. Call ASHA at 800-227-8922. You can get information from the phone line without leaving your name.

More information on pelvic inflammatory disease

For more information about pelvic inflammatory disease, call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

Pelvic inflammatory disease fact sheet was reviewed by:

Dr. Songhai Barclift, M.D.
Lieutenant Commander
HIV/AIDS Bureau
Health Resources and Services Administration
U.S. Department of Health and Human Service

Source: Office on Women's Health, HHS

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Polycystic ovary syndrome (PCOS) fact sheet

What is polycystic ovary syndrome (PCOS)?

Polycystic (pah-lee-SIS-tik) ovary syndrome (PCOS) is a health problem that can affect a woman's:

With PCOS, women typically have:

How many women have PCOS?

Between 1 in 10 and 1 in 20 women of childbearing age has PCOS. As many as 5 million women in the United States may be affected. It can occur in girls as young as 11 years old.

What causes PCOS?

The cause of PCOS is unknown. But most experts think that several factors, including genetics, could play a role. Women with PCOS are more likely to have a mother or sister with PCOS.

A main underlying problem with PCOS is a hormonal imbalance. In women with PCOS, the ovaries make more androgens than normal. Androgens are male hormones that females also make. High levels of these hormones affect the development and release of eggs during ovulation.

Researchers also think insulin may be linked to PCOS. Insulin is a hormone that controls the change of sugar, starches, and other food into energy for the body to use or store. Many women with PCOS have too much insulin in their bodies because they have problems using it. Excess insulin appears to increase production of androgen. High androgen levels can lead to:

What are the symptoms of PCOS?

The symptoms of PCOS can vary from woman to woman. Some of the symptoms of PCOS include:

Why do women with PCOS have trouble with their menstrual cycle and fertility?

The ovaries, where a woman’s eggs are produced, have tiny fluid-filled sacs called follicles or cysts. As the egg grows, the follicle builds up fluid. When the egg matures, the follicle breaks open, the egg is released, and the egg travels through the fallopian tube to the uterus (womb) for fertilization. This is called ovulation.

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In women with PCOS, the ovary doesn't make all of the hormones it needs for an egg to fully mature. The follicles may start to grow and build up fluid but ovulation does not occur. Instead, some follicles may remain as cysts. For these reasons, ovulation does not occur and the hormone progesterone is not made. Without progesterone, a woman's menstrual cycle is irregular or absent. Plus, the ovaries make male hormones, which also prevent ovulation.

Normal ovary and polycystic ovary

Does PCOS change at menopause?

Yes and no. PCOS affects many systems in the body. So, many symptoms may persist even though ovarian function and hormone levels change as a woman nears menopause. For instance, excessive hair growth continues, and male-pattern baldness or thinning hair gets worse after menopause. Also, the risks of complications (health problems) from PCOS, such as heart attack, stroke, and diabetes, increase as a woman gets older.

How do I know if I have PCOS?

There is no single test to diagnose PCOS. Your doctor will take the following steps to find out if you have PCOS or if something else is causing your symptoms.

Medical history. Your doctor will ask about your menstrual periods, weight changes, and other symptoms.

Physical exam. Your doctor will want to measure your blood pressure, body mass index (BMI), and waist size. He or she also will check the areas of increased hair growth. You should try to allow the natural hair to grow for a few days before the visit.

Pelvic exam. Your doctor might want to check to see if your ovaries are enlarged or swollen by the increased number of small cysts.

Blood tests. Your doctor may check the androgen hormone and glucose (sugar) levels in your blood.

Vaginal ultrasound (sonogram). Your doctor may perform a test that uses sound waves to take pictures of the pelvic area. It might be used to examine your ovaries for cysts and check the endometrium (en-do-MEE-tree-uhm) (lining of the womb). This lining may become thicker if your periods are not regular.

How is PCOS treated?

Because there is no cure for PCOS, it needs to be managed to prevent problems. Treatment goals are based on your symptoms, whether or not you want to become pregnant, and lowering your chances of getting heart disease and diabetes. Many women will need a combination of treatments to meet these goals. Some treatments for PCOS include:

Lifestyle modification. Many women with PCOS are overweight or obese, which can cause health problems. You can help manage your PCOS by eating healthy and exercising to keep your weight at a healthy level. Healthy eating tips include:

This helps to lower blood glucose (sugar) levels, improve the body's use of insulin, and normalize hormone levels in your body. Even a 10 percent loss in body weight can restore a normal period and make your cycle more regular.

Birth control pills. For women who don't want to get pregnant, birth control pills can:

Keep in mind that the menstrual cycle will become abnormal again if the pill is stopped. Women may also think about taking a pill that only has progesterone (proh-JES-tuh-rohn), like Provera, to control the menstrual cycle and reduce the risk of endometrial cancer (See Does PCOS put women at risk for other health problems?). But, progesterone alone does not help reduce acne and hair growth.

Diabetes medications. The medicine metformin (Glucophage) is used to treat type 2 diabetes. It has also been found to help with PCOS symptoms, though it isn’t approved by the U.S Food and Drug Administration (FDA) for this use. Metformin affects the way insulin controls blood glucose (sugar) and lowers testosterone production. It slows the growth of abnormal hair and, after a few months of use, may help ovulation to return. Recent research has shown metformin to have other positive effects, such as decreased body mass and improved cholesterol levels. Metformin will not cause a person to become diabetic.

Fertility medications. Lack of ovulation is usually the reason for fertility problems in women with PCOS. Several medications that stimulate ovulation can help women with PCOS become pregnant. Even so, other reasons for infertility in both the woman and man should be ruled out before fertility medications are used. Also, some fertility medications increase the risk for multiple births (twins, triplets). Treatment options include:

Another option is in vitro fertilization (IVF). IVF offers the best chance of becoming pregnant in any given cycle. It also gives doctors better control over the chance of multiple births. But, IVF is very costly.

Surgery. "Ovarian drilling" is a surgery that may increase the chance of ovulation. It’s sometimes used when a woman does not respond to fertility medicines. The doctor makes a very small cut above or below the navel (belly button) and inserts a small tool that acts like a telescope into the abdomen (stomach). This is called laparoscopy (lap-uh-RAHS-kuh-pee). The doctor then punctures the ovary with a small needle carrying an electric current to destroy a small portion of the ovary. This procedure carries a risk of developing scar tissue on the ovary. This surgery can lower male hormone levels and help with ovulation. But, these effects may only last a few months. This treatment doesn't help with loss of scalp hair or increased hair growth on other parts of the body.

Medicine for increased hair growth or extra male hormones. Medicines called anti-androgens may reduce hair growth and clear acne. Spironolactone (speer-on-oh-LAK-tone) (Aldactone), first used to treat high blood pressure, has been shown to reduce the impact of male hormones on hair growth in women. Finasteride (fin-AST-uhr-yd) (Propecia), a medicine taken by men for hair loss, has the same effect. Anti-androgens are often combined with birth control pills.  These medications should not be taken if you are trying to become pregnant.

Before taking Aldactone, tell your doctor if you are pregnant or plan to become pregnant. Do not breastfeed while taking this medicine. Women who may become pregnant should not handle Propecia.

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Other options include:

Other treatments. Some research has shown that bariatric (weight loss) surgery may be effective in resolving PCOS in morbidly obese women. Morbid obesity means having a BMI of more than 40, or a BMI of 35 to 40 with an obesity-related disease. The drug troglitazone (troh-GLIT-uh-zohn) was shown to help women with PCOS. But, it was taken off the market because it caused liver problems. Similar drugs without the same side effect are being tested in small trials.

Researchers continue to search for new ways to treat PCOS. To learn more about current PCOS treatment studies, visit ClinicalTrials.gov. Talk to your doctor about whether taking part in a clinical trial might be right for you.

How does PCOS affect a woman while pregnant?

Women with PCOS appear to have higher rates of:

Babies born to women with PCOS have a higher risk of spending time in a neonatal intensive care unit or of dying before, during, or shortly after birth. Most of the time, these problems occur in multiple-birth babies (twins, triplets).

Researchers are studying whether the diabetes medicine metformin can prevent or reduce the chances of having problems while pregnant. Metformin also lowers male hormone levels and limits weight gain in women who are obese when they get pregnant.

Metformin is an FDA pregnancy category B drug. It does not appear to cause major birth defects or other problems in pregnant women. But, there have only been a few studies of metformin use in pregnant women to confirm its safety. Talk to your doctor about taking metformin if you are pregnant or are trying to become pregnant. Also, metformin is passed through breastmilk. Talk with your doctor about metformin use if you are a nursing mother.

Does PCOS put women at risk for other health problems?

Women with PCOS have greater chances of developing several serious health conditions, including life-threatening diseases. Recent studies found that:

Women with PCOS may also develop anxiety and depression. It is important to talk to your doctor about treatment for these mental health conditions.

Women with PCOS are also at risk for endometrial cancer. Irregular menstrual periods and the lack of ovulation cause women to produce the hormone estrogen, but not the hormone progesterone. Progesterone causes the endometrium (lining of the womb) to shed each month as a menstrual period. Without progesterone, the endometrium becomes thick, which can cause heavy or irregular bleeding. Over time, this can lead to endometrial hyperplasia, when the lining grows too much, and cancer.

I have PCOS. What can I do to prevent complications?

If you have PCOS, get your symptoms under control at an earlier age to help reduce your chances of having complications like diabetes and heart disease. Talk to your doctor about treating all your symptoms, rather than focusing on just one aspect of your PCOS, such as problems getting pregnant. Also, talk to your doctor about getting tested for diabetes regularly. Other steps you can take to lower your chances of health problems include:

How can I cope with the emotional effects of PCOS?

Having PCOS can be difficult. You may feel:

Getting treatment for PCOS can help with these concerns and help boost your self-esteem. You may also want to look for support groups in your area or online to help you deal with the emotional effects of PCOS. You are not alone and there are resources available for women with PCOS.

More information on polycystic ovary syndrome (PCOS)

For more information about polycystic ovary syndrome (PCOS), call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

Polycystic ovary syndrome (PCOS) fact sheet was reviewed by:

Esther Eisenberg, M.D., M.P.H.
Professor of Obstetrics and Gynecology, Vanderbilt University
Medical Officer, Reproductive Sciences Branch
The Eunice Kennedy Shriver National Institute of Child Health and Human Development
National Institutes of Health

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Osteoporosis fact sheet

Anna's story

I used to think that women don't need to worry about frail bones until they get older. I was wrong! I recently learned that women of all ages need to take steps to help keep their bones strong. Millions of women already have or are at risk of osteoporosis. So, I do what I can to keep my bones as strong as they can be. I make sure to get enough calcium and vitamin D, I don't smoke or drink too much alcohol, and I try to walk with my neighbor in the mornings. I also talked to my doctor about taking medicine to help build bone mass and asked my doctor about a bone density test. Strong bones will lower my risk of breaking a bone and keep me healthy as I age.

What is osteoporosis?

Osteoporosis (OS-tee-oh-poh-ROH-sis) is a disease of the bones. People with osteoporosis have bones that are weak and break easily.

A broken bone can really affect your life. It can cause severe pain and disability. It can make it harder to do daily tasks on your own, such as walking.

What bones does osteoporosis affect?

Osteoporosis affects all bones in the body. However, breaks are most common in the hip, wrist, and spine, also called vertebrae (VUR-tuh-bray). Vertebrae support your body, helping you to stand and sit up. See the picture below.

Osteoporosis in the vertebrae can cause serious problems for women. A fracture in this area occurs from day-to-day activities like climbing stairs, lifting objects, or bending forward. Signs of osteoporosis:

What increases my chances of getting osteoporosis?

There are several risk factors that raise your chances of developing osteoporosis. Some of these factors are things you can control, while some you can’t control.

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Factors that you can’t control:

Factors that you can control:

You may also develop symptoms that are warning signs for osteoporosis. If you develop the following, you should talk to your doctor about any tests or treatment you many need:

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How can I find out if I have weak bones?

There are tests you can get to find out your bone density. This is related to how strong or fragile your bones are. One test is called dual-energy X-ray absorptiometry (DXA or dexa). A DXA scan takes X-rays of your bones. Screening tools also can be used to predict the risk of having low bone density or breaking a bone. Talk with your doctor or nurse about this test or tools to assess risk.

When should I get a bone density test?

If you are age 65 or older, you should get a bone density test to screen for osteoporosis. If you are younger than 65 and have risk factors for osteoporosis, ask your doctor or nurse if you need a bone density test before age 65. Bone density testing is recommended for older women whose risk of breaking a bone is the same or greater than that of a 65?year?old white woman with no risk factors other than age. To find out your fracture risk and whether you need early bone density testing, your doctor will consider factors such as:

How can I prevent weak bones?

The best way to prevent weak bones is to work on building strong ones. No matter how old you are, it is never too late to start. Building strong bones during childhood and the teen years is one of the best ways to keep from getting osteoporosis later. As you get older, your bones don’t make new bone fast enough to keep up with the bone loss. And after menopause, bone loss happens more quickly. But there are steps you can take to slow the natural bone loss with aging and to prevent your bones from becoming weak and brittle.

1. Get enough calcium each day.

Bones contain a lot of calcium. It is important to get enough calcium in your diet. You can get calcium through foods and/or calcium pills, which you can get at the grocery store or drug store. Getting calcium through food is definitely better since the food provides other nutrients that keep you healthy. Talk with your doctor or nurse before taking calcium pills to see which kind is best for you. Taking more calcium pills than recommended doesn't improve your bone health. So, try to reach these goals through a combination of food and supplements.

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Here’s how much calcium you need each day.

Daily calcium requirements

Ages

Milligrams(mg) per day

9-18

1,300

19-50

1,000

51 and older

1,200

Pregnant or nursing women need the same amount of calcium as other women of the same age.

Here are some foods to help you get the calcium you need. Check the food labels for more information.

Foods containing calcium

Food

Portion

Milligrams

Plain, fat free yogurt

1 cup

452

Milk (fat-free)

1 cup

306

Milk (1 percent low-fat)

1 cup

290

Tofu with added calcium

1/2 cup

253

Spinach, frozen

1/2 cup

146

White beans, canned

1/2 cup

106

The calcium amounts of these foods are taken from the United States Department of Agriculture’s Dietary Guidelines for Americans. 

2. Get enough vitamin D each day.

It is also important to get enough vitamin D, which helps your body absorb calcium from the food you eat. Vitamin D is produced in your skin when it is exposed to sunlight. You need 10 to 15 minutes of sunlight to the hands, arms, and face, two to three times a week to make enough vitamin D. The amount of time depends on how sensitive your skin is to light. It also depends on your use of sunscreen, your skin color, and the amount of pollution in the air. You can also get vitamin D by eating foods, such as milk, or by taking vitamin pills. Vitamin D taken in the diet by food or pills is measured in international units (IU). Look at the pill bottle or food label for the IU amount.

Here’s how much vitamin D you need each day: 

Daily vitamin D requirements

Ages

IU per day

19-70

600

71+

800

Although it’s difficult to get enough vitamin D through food, here are some foods that can help. Check the food labels for more information.

Foods containing vitamin D

Food

Portion

IU

Salmon, cooked

3 1/2 oz

360

Milk, vitamin D fortified

1 cup

98

Egg (vitamin D is in the yolk)

1 whole

20

These foods and IU counts are from the National Institutes of Health Office on Dietary Supplements.

White milk is a good source of vitamin D, most yogurts are not.

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3. Eat a healthy diet.

Other nutrients (like vitamin K, vitamin C, magnesium, and zinc, as well as protein) help build strong bones too. Milk has many of these nutrients. So do foods like lean meat, fish, green leafy vegetables, and oranges.  

4. Get moving.

Being active helps your bones by:

Do weight-bearing physical activity, which is any activity in which your body works against gravity. There are many things you can do:

5. Don’t smoke.

Smoking raises your chances of getting osteoporosis. It harms your bones and lowers the amount of estrogen in your body. Estrogen is a hormone made by your body that can help slow bone loss.

6. Drink alcohol moderately.

If you drink, don’t drink more than one alcoholic drink per day. Alcohol can make it harder for your body to use the calcium you take in. And, importantly, too much at one time can affect your balance and lead to falls.

7. Make your home safe.

Reduce your chances of falling by making your home safer. Use a rubber bath mat in the shower or tub. Keep your floors free from clutter. Remove throw rugs that may cause you to trip. Make sure you have grab bars in the bath or shower.

8. Think about taking medicines to prevent or treat bone loss.

Talk with your doctor or nurse about the risks and benefits of medicines for bone loss.

How can I help my daughter have strong bones?

Act now to help her build strong bones to last a lifetime. Girls ages 9-18 are in their critical bone-building years. Best Bones Forever!® is a national education effort to encourage girls ages 9-14 to eat more foods with calcium and vitamin D and get more physical activity. There is also a website for the parents. This site gives parents the tools and information they need to help their daughters build strong bones during the critical window of bone growth — ages 9-18.

What if dairy foods make me sick or I don't like to eat them? How can I get enough calcium?

If you’re lactose intolerant, it can be hard to get enough calcium. Lactose is the sugar that is found in dairy products like milk. Lactose intolerance means your body has a hard time digesting foods that contain lactose. You may have symptoms like gas, bloating, stomach cramps, diarrhea, and nausea. Lactose intolerance can start at any age but often starts when you get older.

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Lactose-reduced and lactose-free products are sold in food stores. There’s a great variety, including milk, cheese, and ice cream. You can also take pills or liquids before eating dairy foods to help you digest them. You can buy these pills at the grocery store or drug store. Please note: If you have symptoms of lactose intolerance, see your doctor or nurse. These symptoms could also be from a different, more serious illness.

People who are lactose intolerant or who are vegans (eat only plant-based foods) can choose from other food sources of calcium, including canned salmon with bones, sardines, Chinese cabbage, bok choy, kale, collard greens, turnip greens, mustard greens, broccoli, and calcium-fortified orange juice. Some cereals also have calcium added. You can also take calcium pills. Talk to your doctor or nurse first to see which one is best for you.

Do men get osteoporosis?

Yes. In the U.S., over two million men have osteoporosis. Men over age 50 are at greater risk. So, keep an eye on the men in your life, especially if they are over 70 or have broken any bones.

How will pregnancy affect my bones?

To grow strong bones, a baby needs a lot of calcium. The baby gets his or her calcium from what you eat (or the supplements you take). In some cases, if a pregnant woman isn’t getting enough calcium, she may lose a little from her bones, making them less strong. So, pregnant women should make sure they are getting the recommended amounts of calcium and vitamin D. Talk to your doctor about how much you should be getting.

Will I suffer bone loss during breastfeeding?

Although bone density can be lost during breastfeeding, this loss tends to be temporary. Several studies have shown that when women have bone loss during breastfeeding, they recover full bone density within six months after weaning.

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How is osteoporosis treated?

If you have osteoporosis, you may need to make some lifestyle changes and also take medicine to prevent future fractures. A calcium-rich diet, daily exercise, and drug therapy are all treatment options.

These different types of drugs are approved for the treatment or prevention of osteoporosis:

Your doctor can tell you what treatments might work best for you.

More information on osteoporosis

For more information about osteoporosis, call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

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The information on our website is provided by the U.S. federal government and is in the public domain. This public information is not copyrighted and may be reproduced without permission, though citation of each source is appreciated.

Osteoporosis fact sheet was reviewed by:

Dr. Joan A. McGowan, Ph.D.
Director, Division of Musculoskeletal Diseases
National Institute of Arthritis and Musculoskeletal and Skin Diseases
National Institutes of Health

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Premenstrual syndrome (PMS) fact sheet

What is premenstrual syndrome (PMS)?

Premenstrual (pree-MEN-struhl) syndrome (PMS) is a group of symptoms linked to the menstrual cycle. PMS symptoms occur 1 to 2 weeks before your period (menstruation or monthly bleeding) starts. The symptoms usually go away after you start bleeding. PMS can affect menstruating women of any age and the effect is different for each woman. For some people, PMS is just a monthly bother. For others, it may be so severe that it makes it hard to even get through the day. PMS goes away when your monthly periods stop, such as when you get pregnant or go through menopause.

What causes PMS?

The causes of PMS are not clear, but several factors may be involved. Changes in hormones during the menstrual cycle seem to be an important cause. These changing hormone levels may affect some women more than others. Chemical changes in the brain may also be involved. Stress and emotional problems, such as depression, do not seem to cause PMS, but they may make it worse. Some other possible causes include:

What are the symptoms of PMS?

PMS often includes both physical and emotional symptoms, such as:

Symptoms vary from woman to woman.

How do I know if I have PMS?

Your doctor may diagnose PMS based on which symptoms you have, when they occur, and how much they affect your life. If you think you have PMS, keep track of which symptoms you have and how severe they are for a few months. Record your symptoms each day on a calendar or PMS symptom tracker (PDF, 66 KB). Take this form with you when you see your doctor about your PMS.

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Your doctor will also want to make sure you don’t have one of the following conditions that shares symptoms with PMS:

How common is PMS?

There’s a wide range of estimates of how many women suffer from PMS. The American College of Obstetricians and Gynecologists estimates that at least 85 percent of menstruating women have at least 1 PMS symptom as part of their monthly cycle. Most of these women have fairly mild symptoms that don’t need treatment. Others (about 3 to 8 percent) have a more severe form of PMS, called premenstrual dysphoric (dis-FOHR-ik) disorder (PMDD). See "What is premenstrual dysphoric disorder (PMDD)?" below to learn more.

PMS occurs more often in women who:

What is the treatment for PMS?

Many things have been tried to ease the symptoms of PMS. No treatment works for every woman. You may need to try different ones to see what works for you. Some treatment options include:

Lifestyle changes

If your PMS isn’t so bad that you need to see a doctor, some lifestyle changes may help you feel better. Below are some steps you can take that may help ease your symptoms.

Medications

Over-the-counter pain relievers may help ease physical symptoms, such as cramps, headaches, backaches, and breast tenderness. These include:

In more severe cases of PMS, prescription medicines may be used to ease symptoms. One approach has been to use drugs that stop ovulation, such as birth control pills. Women on the pill report fewer PMS symptoms, such as cramps and headaches, as well as lighter periods.

Researchers continue to search for new ways to treat PMS. To learn more about current PMS treatment studies, visit the clinicaltrials.gov website. Talk to your doctor about whether taking part in a clinical trial might be right for you.

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Alternative therapies

Certain vitamins and minerals have been found to help relieve some PMS symptoms. These include:

Amounts of calcium you need each day

Ages

Milligrams per day

9-18

1300

19-50

1000

51 and older

1200

Pregnant or nursing women need the same amount of calcium as other women of the same age.

Some women find their PMS symptoms relieved by taking supplements such as:

Talk with your doctor before taking any of these products. Many have not been proven to work and they may interact with other medicines you are taking.

What is Premenstrual Dysphoric Disorder (PMDD)?

A brain chemical called serotonin (ser-uh-TOH-nuhn) may play a role in Premenstrual Dysphoric Disorder (PMDD), a severe form of PMS. The main symptoms, which can be disabling, include:

You must have 5 or more of these symptoms to be diagnosed with PMDD. Symptoms occur during the week before your period and go away after bleeding starts.

Making some lifestyle changes may help ease PMDD symptoms. See “What is the treatment for PMS?” above to learn more.

Antidepressants called selective serotonin reuptake inhibitors (SSRIs) have also been shown to help some women with PMDD. These drugs change serotonin levels in the brain. The Food and Drug Administration (FDA) has approved 3 SSRIs for the treatment of PMDD:

Yaz (drospirenone (droh-SPIR-uh-nohn) and ethinyl (ETH-uh-nil) estradiol (es-truh-DEYE-ohl)) is the only birth control pill approved by the FDA to treat PMDD. Individual counseling, group counseling, and stress management may also help relieve symptoms.

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More information on premenstrual syndrome (PMS)

For more information about premenstrual syndrome (PMS), call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

Songhai Barclift, M.D.
Lieutenant Commander
HIV/AIDS Bureau
Health Resources and Services Administration
U.S. Department of Health and Human Services

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Thyroid disease fact sheet

Thyroid gland

For the National Cancer Institute © 2012 Terese Winslow LLC, U.S. Govt. has certain rights.

Thyroid disease

Your thyroid is a small gland at the base of your neck that makes thyroid hormone. Thyroid hormone controls many activities in your body, including how fast you burn calories and how fast your heart beats. Diseases of the thyroid cause it to make either too much or too little of the hormone. Depending on how much or how little hormone your thyroid makes, you may often feel restless or tired, or you may lose or gain weight. Women are more likely than men to have thyroid diseases, especially right after pregnancy and after menopause.

What is the thyroid?

Your thyroid is a small butterfly-shaped gland found at the base of your neck, just below your Adam's apple. This gland makes thyroid hormone that travels in your blood to all parts of your body. The thyroid hormone controls your body's metabolism in many ways, including how fast you burn calories and how fast your heart beats.

How do thyroid problems affect women?

Women are more likely than men to have thyroid disease. One in eight women will develop thyroid problems during her lifetime.1 In women, thyroid diseases can cause:

Sometimes, symptoms of thyroid problems are mistaken for menopause symptoms. Thyroid disease, especially hypothyroidism, is more likely to develop after menopause.

Are some women more at risk for thyroid disease?

Yes. You may want to talk to your doctor about getting tested if you:

Screening for thyroid disease is not recommended for most women.

What kinds of thyroid disease affect women?

These thyroid diseases affect more women than men:

What is hypothyroidism?

Hypothyroidism is when your thyroid does not make enough thyroid hormones. It is also called underactive thyroid. This slows down many of your body's functions, like your metabolism.

The most common cause of hypothyroidism in the United States is Hashimoto's disease. In people with Hashimoto's disease, the immune system mistakenly attacks the thyroid. This attack damages the thyroid so that it does not make enough hormones.

Hypothyroidism also can be caused by:

What are the signs and symptoms of hypothyroidism?

Symptoms of hypothyroidism develop slowly, often over several years. At first, you may feel tired and sluggish. Later, you may develop other signs and symptoms of a slowed-down metabolism, including:

You also may have high LDL or "bad" cholesterol, which can raise your risk for heart disease.

How is hypothyroidism treated?

Hypothyroidism is treated with medicine that gives your body the thyroid hormone it needs to work normally. The most common medicines are man-made forms of the hormone that your thyroid makes. You will likely need to take thyroid hormone pills for the rest of your life. When you take the pills as your doctor tells you to, the pills are very safe.

What is hyperthyroidism?

Hyperthyroidism , or overactive thyroid, causes your thyroid to make more thyroid hormone than your body needs. This speeds up many of your body's functions, like your metabolism and heart rate.

The most common cause of hyperthyroidism is Graves' disease. Graves' disease is a problem with the immune system.

What are the signs and symptoms of hyperthyroidism?

At first, you might not notice the signs or symptoms of hyperthyroidism. Symptoms usually begin slowly. But, over time, a faster metabolism can cause symptoms such as:

Hyperthyroidism raises your risk for osteoporosis, a condition that causes weak bones that break easily. In fact, hyperthyroidism might affect your bones before you have any of the other symptoms of the condition. This is especially true of women who have gone through menopause or who are already at high risk of osteoporosis.

How is hyperthyroidism treated?

Your doctor's choice of treatment will depend on your symptoms and the cause of your hyperthyroidism. Treatments include:

What is thyroiditis?

Thyroiditis is inflammation of the thyroid. It happens when the body's immune system makes antibodies that attack the thyroid.

Causes of thyroiditis include:

Two common types of thyroiditis are Hashimoto's disease and postpartum thyroiditis.

What is postpartum thyroiditis?

Postpartum thyroiditis, or inflammation of the thyroid after giving birth, affects 10% of women.3 It often goes undiagnosed because symptoms are much like the "baby blues" that may follow delivery. Women with postpartum thyroiditis may feel very tired and moody.

Postpartum thyroiditis typically happens in two phases, though not everyone with the condition goes through both phases:

Who is at risk for postpartum thyroiditis?

Your immune system may cause postpartum thyroiditis. If you have an autoimmune disease, like type 1 diabetes, your risk is higher.

Your risk is also higher if:

How is postpartum thyroiditis treated?

Treatment for postpartum thyroiditis depends on the phase of the disease and what symptoms you have. For example, if you get symptoms of hyperthyroidism in the first phase, your treatment may include medicines to slow down the heart rate.

In most women who have postpartum thyroiditis, the thyroid returns to normal within 12 to 18 months after symptoms start. But if you have a history of postpartum thyroiditis, your risk is higher for developing permanent hypothyroidism within 5 to 10 years.

What is a goiter?

A goiter is an unusually enlarged thyroid gland. It may happen only for a short time and may go away on its own without treatment. Or it could be a symptom of another thyroid disease that requires treatment. Goiter is more common in women than in men and especially in women before menopause.

Some common causes of goiter include:

Usually, the only symptom of a goiter is a swelling in your neck. It may be large enough that you can see it or feel the lump with your hand. A very large goiter can also cause a tight feeling in your throat, coughing, or problems swallowing or breathing.

Your doctor will do tests to see if it is caused by another thyroid disease.

How is goiter treated?

You may not need treatment if your thyroid works normally and the symptoms do not bother you.

If you do need treatment, medicine should make the thyroid shrink back to near normal size. You may need surgery to take out part or most of the thyroid.

What are thyroid nodules?

A thyroid nodule is a swelling in one section of the thyroid gland. The nodule may be solid or filled with fluid or blood. You may have just one thyroid nodule or many.

Thyroid nodules are common and affect four times as many women as men.7Researchers do not know why nodules form in otherwise normal thyroids.

What are the signs and symptoms of thyroid nodules?

Most thyroid nodules do not cause symptoms and are not cancerous.8 Some thyroid nodules make too much thyroid hormone, causing hyperthyroidism. Sometimes, nodules grow so big that they cause problems with swallowing or breathing. About one-third of nodules are found by the patient, another third by the doctor, and the other third through an imaging test of the neck.

You can sometimes see or feel a thyroid nodule yourself. Stand in front of a mirror and raise your chin slightly. Look for a bump on either side of your windpipe below your Adam's apple. If the bump moves up and down when you swallow, it may be a thyroid nodule. Ask your doctor to look at it.

How are thyroid nodules treated?

Treatment depends on the type of nodule or nodules that you have. Treatments include:

What is thyroid cancer?

Thyroid cancer happens when cancer cells form from the tissues of the thyroid gland.

Most people with thyroid cancer have a thyroid nodule that does not cause any symptoms. If you do have symptoms, you may have swelling or a lump in your neck. The lump may cause problems swallowing. Some people get a hoarse voice.

To tell if the lump or nodule is cancerous, your doctor will order certain tests. Most thyroid nodules are not cancerous.

For more information about thyroid cancer, visit the National Cancer Institute's thyroid cancer page.

Who is at risk for thyroid cancer?

About three times as many women get thyroid cancer as men. The number of women with thyroid cancer is also going up. By 2020, the number of women with thyroid cancer is expected to double, from 34,000 women to more than 70,000 women.

Thyroid cancer is more common in women who:

How is thyroid cancer treated?

The main treatment for thyroid cancer is surgery to take out the whole thyroid gland or as much of it as can be safely removed. Surgery alone can cure thyroid cancer if the cancer is small and has not yet spread to lymph nodes.

Your doctor may also use radioiodine therapy after surgery. Radioiodine therapy destroys any thyroid cancer cells that were not removed during surgery or that have spread to other parts of the body.

Your doctor may also talk with you about other treatments for thyroid cancer. Learn more about thyroid cancer treatments at the National Cancer Institute.

How are thyroid diseases diagnosed?

It can be hard to tell if you have a thyroid disease. The symptoms are the same as many other health problems. Your doctor may start by asking about your health history and if any of your family members has had thyroid disease. Your doctor may also give you a physical exam and check your neck for thyroid nodules.

Depending on your symptoms, your doctor may also do other tests, such as:

High levels of radioiodine mean that your thyroid makes too much of the thyroid hormone. Low levels mean that your thyroid does not make enough thyroid hormone.

Ultrasound may also be helpful in finding thyroid cancer, although by itself it cannot be used to diagnose thyroid cancer.

Can thyroid disease cause problems getting pregnant?

Both hyperthyroidism and hypothyroidism can make it harder for you to get pregnant. This is because problems with the thyroid hormone can upset the balance of the hormones that cause ovulation. Hypothyroidism can also cause your body to make more prolactin, the hormone that tells your body to make breastmilk. Too much prolactin can prevent ovulation.

Thyroid problems can also affect the menstrual cycle. Your periods may be heavier or irregular, or you may not have any periods at all for several months or longer (called amenorrhea).

How does thyroid disease affect pregnancy?

Pregnancy-related hormones raise the level of thyroid hormones in the blood. Thyroid hormones are necessary for the baby's brain development while in the womb.

It can be harder to diagnose thyroid problems during pregnancy because of the change in hormone levels that normally happen during pregnancy. But it is especially important to check for problems before getting pregnant and during pregnancy. Uncontrolled hyperthyroidism and hypothyroidism can cause problems for both mother and baby.

Hyperthyroidism that is not treated with medicine during pregnancy can cause:

Hypothyroidism that is not treated with medicine during pregnancy can cause:

More information about thyroid diseases

For more information about thyroid diseases, call the OWH Helpline at 800-994-9662 or contact the following organizations:

This fact sheet was reviewed by:

Monica C. Skarulis, M.D., Chief Clinical Endocrine Section, Director Inter-Institute Endocrine Training Program, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Brendan C. Stack, Jr., M.D., FACS, FACE, Thyroid and Parathyroid Surgery, Professor, Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences

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 Infertility fact sheet

What is infertility?

Infertility means not being able to get pregnant after one year of trying (or six months if a woman is 35 or older). Women who can get pregnant but are unable to stay pregnant may also be infertile.

Pregnancy is the result of a process that has many steps. To get pregnant:

Infertility can happen if there are problems with any of these steps.

Is infertility a common problem?

Yes. About 10 percent of women (6.1 million) in the United States ages 15-44 have difficulty getting pregnant or staying pregnant, according to the Centers for Disease Control and Prevention (CDC).

Is infertility just a woman's problem?

No, infertility is not always a woman's problem. Both women and men can have problems that cause infertility. About one-third of infertility cases are caused by women's problems. Another one third of fertility problems are due to the man. The other cases are caused by a mixture of male and female problems or by unknown problems.

What causes infertility in men?

Infertility in men is most often caused by:

Sometimes a man is born with the problems that affect his sperm. Other times problems start later in life due to illness or injury. For example, cystic fibrosis often causes infertility in men.

What increases a man's risk of infertility?

A man's sperm can be changed by his overall health and lifestyle. Some things that may reduce the health or number of sperm include:

What causes infertility in women?

Most cases of female infertility are caused by problems with ovulation. Without ovulation, there are no eggs to be fertilized. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods.

Ovulation problems are often caused by polycystic ovarian syndrome (PCOS). PCOS is a hormone imbalance problem which can interfere with normal ovulation. PCOS is the most common cause of female infertility. Primary ovarian insufficiency (POI) is another cause of ovulation problems. POI occurs when a woman's ovaries stop working normally before she is 40. POI is not the same as early menopause.

Less common causes of fertility problems in women include:

What things increase a woman's risk of infertility?

Many things can change a woman's ability to have a baby. These include:

How does age affect a woman's ability to have children?

Many women are waiting until their 30s and 40s to have children. In fact, about 20 percent of women in the United States now have their first child after age 35. So age is a growing cause of fertility problems. About one-third of couples in which the woman is over 35 have fertility problems.

Aging decreases a woman's chances of having a baby in the following ways:

How long should women try to get pregnant before calling their doctors?

Most experts suggest at least one year. Women 35 or older should see their doctors after six months of trying. A woman's chances of having a baby decrease rapidly every year after the age of 30.

Some health problems also increase the risk of infertility. So, women should talk to their doctors if they have:

It is a good idea for any woman to talk to a doctor before trying to get pregnant. Doctors can help you get your body ready for a healthy baby. They can also answer questions on fertility and give tips on conceiving.

How will doctors find out if a woman and her partner have fertility problems?

Doctors will do an infertility checkup. This involves a physical exam. The doctor will also ask for both partners' health and sexual histories. Sometimes this can find the problem. However, most of the time, the doctor will need to do more tests.

In men, doctors usually begin by testing the semen. They look at the number, shape, and movement of the sperm. Sometimes doctors also suggest testing the level of a man's hormones.

In women, the first step is to find out if she is ovulating each month. There are a few ways to do this. A woman can track her ovulation at home by:

Doctors can also check ovulation with blood tests. Or they can do an ultrasound of the ovaries. If ovulation is normal, there are other fertility tests available.

Some common tests of fertility in women include:

Finding the cause of infertility can be a long and emotional process. It may take time to complete all the needed tests. So don't worry if the problem is not found right away.

How do doctors treat infertility?

Infertility can be treated with medicine, surgery, artificial insemination, or assisted reproductive technology. Many times these treatments are combined. In most cases infertility is treated with drugs or surgery.

Doctors recommend specific treatments for infertility based on:

Doctors often treat infertility in men in the following ways:

In women, some physical problems can also be corrected with surgery.

A number of fertility medicines are used to treat women with ovulation problems. It is important to talk with your doctor about the pros and cons of these medicines. You should understand the possible dangers, benefits, and side effects.

What medicines are used to treat infertility in women?

Some common medicines used to treat infertility in women include:

Many fertility drugs increase a woman's chance of having twins, triplets, or other multiples. Women who are pregnant with multiple fetuses have more problems during pregnancy. Multiple fetuses have a high risk of being born too early (prematurely). Premature babies are at a higher risk of health and developmental problems.

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What is intrauterine insemination (IUI)?

Intrauterine insemination (IUI) is an infertility treatment that is often called artificial insemination. In this procedure, the woman is injected with specially prepared sperm. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI.

IUI is often used to treat:

What is assisted reproductive technology (ART)?

Assisted reproductive technology (ART) is a group of different methods used to help infertile couples. ART works by removing eggs from a woman's body. The eggs are then mixed with sperm to make embryos. The embryos are then put back in the woman's body.

How often is assisted reproductive technology (ART) successful?

Success rates vary and depend on many factors. Some things that affect the success rate of ART include:

The U.S. Centers for Disease Control and Prevention (CDC) collects success rates on ART for some fertility clinics. According to a 2006 CDC report on ART, the average percentage of ART cycles that led to a live birth were:

ART can be expensive and time-consuming. But it has allowed many couples to have children that otherwise would not have been conceived. The most common complication of ART is multiple fetuses. But this is a problem that can be prevented or minimized in several different ways.

What are the different types of assisted reproductive technology (ART)?

Common methods of ART include:

ART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who can not produce eggs. Also, donor eggs or donor sperm is sometimes used when the woman or man has a genetic disease that can be passed on to the baby. An infertile woman or couple may also use donor embryos. These are embryos that were either created by couples in infertility treatment or were created from donor sperm and donor eggs. The donated embryo is transferred to the uterus. The child will not be genetically related to either parent.

Surrogacy

Women with no eggs or unhealthy eggs might also want to consider surrogacy. A surrogate is a woman who agrees to become pregnant using the man's sperm and her own egg. The child will be genetically related to the surrogate and the male partner. After birth, the surrogate will give up the baby for adoption by the parents.

Gestational carrier

Women with ovaries but no uterus may be able to use a gestational carrier. This may also be an option for women who shouldn't become pregnant because of a serious health problem. In this case, a woman uses her own egg. It is fertilized by the man's sperm and the embryo is placed inside the carrier's uterus. The carrier will not be related to the baby and gives him or her to the parents at birth.

Recent research by the Centers for Disease Control and Prevention showed that ART babies are two to four times more likely to have certain kinds of birth defects. These may include heart and digestive system problems, and cleft (divided into two pieces) lips or palate. Researchers don’t know why this happens. The birth defects may not be due to the technology. Other factors, like the age of the parents, may be involved. More research is needed. The risk is relatively low, but parents should consider this when making the decision to use ART.

More information on infertility

For more information about infertility, call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

Share this information!

The information on our website is provided by the U.S. federal government and is in the public domain. This public information is not copyrighted and may be reproduced without permission, though citation of each source is appreciated.

Infertility fact sheet was reviewed by:

Esther Eisenberg, M.D., M.P.H.
Reproductive Sciences Branch
Eunice Kennedy Shriver
National Institute of Child Health and Human Development
Bethesda, MD

Kelly Brumbaugh, M.P.H., C.H.E.S.
Renee Brown-Bryant, M.S.
Lee Warner, Ph.D.
Division of Reproductive Health
Centers for Disease Control and Prevention
Atlanta, GA

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Common STDs in Women:STD Facts Sheet (STI)

What is a sexually transmitted infection (STI)?

It is an infection passed from person to person through intimate sexual contact. STIs are also called sexually transmitted diseases, or STDs.

How many people have STIs and who is infected?

In the United States about 19 million new infections are thought to occur each year. These infections affect men and women of all backgrounds and economic levels. But almost half of new infections are among young people ages 15 to 24. Women are also severely affected by STIs. They have more frequent and more serious health problems from STIs than men. African-American women have especially high rates of infection.

How do you get an STI?

You can get an STI by having intimate sexual contact with someone who already has the infection. You can’t tell if a person is infected because many STIs have no symptoms. But STIs can still be passed from person to person even if there are no symptoms. STIs are spread during vaginal, anal, or oral sex or during genital touching. So it’s possible to get some STIs without having intercourse. Not all STIs are spread the same way.

Can STIs cause health problems?

Yes. Each STI causes different health problems. But overall, untreated STIs can cause cancer, pelvic inflammatory disease, infertility, pregnancy problems, widespread infection to other parts of the body, organ damage, and even death.

Having an STI also can put you at greater risk of getting HIV. For one, not stopping risky sexual behavior can lead to infection with other STIs, including HIV. Also, infection with some STIs makes it easier for you to get HIV if you are exposed.

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What are the symptoms of STIs?

Many STIs have only mild or no symptoms at all. When symptoms do develop, they often are mistaken for something else, such as urinary tract infection or yeast infection. This is why screening for STIs is so important. The STIs listed here are among the most common or harmful to women.

Symptoms of sexually transmitted infections

STI Symptoms of sexually transmitted infections
Bacterial vaginosis (BV)

Most women have no symptoms. Women with symptoms may have:

  • Vaginal itching

  • Pain when urinating

  • Discharge with a fishy odor
Chlamydia

Most women have no symptoms. Women with symptoms may have:

  • Abnormal vaginal discharge

  • Burning when urinating

  • Bleeding between periods

Infections that are not treated, even if there are no symptoms, can lead to:

  • Lower abdominal pain

  • Low back pain

  • Nausea

  • Fever

  • Pain during sex
Genital herpes

Some people may have no symptoms. During an “outbreak,” the symptoms are clear:

  • Small red bumps, blisters, or open sores where the virus entered the body, such as on the penis, vagina, or mouth

  • Vaginal discharge

  • Fever

  • Headache

  • Muscle aches

  • Pain when urinating

  • Itching, burning, or swollen glands in genital area

  • Pain in legs, buttocks, or genital area

Symptoms may go away and then come back. Sores heal after 2 to 4 weeks.
Gonorrhea

Symptoms are often mild, but most women have no symptoms. If symptoms are present, they most often appear within 10 days of becoming infected. Symptoms are:

  • Pain or burning when urinating

  • Yellowish and sometimes bloody vaginal discharge

  • Bleeding between periods

  • Pain during sex

  • Heavy bleeding during periods

Infection that occurs in the throat, eye, or anus also might have symptoms in these parts of the body.
Hepatatis B

Some women have no symptoms. Women with symptoms may have:

  • Low-grade fever

  • Headache and muscle aches

  • Tiredness

  • Loss of appetite

  • Upset stomach or vomiting

  • Diarrhea

  • Dark-colored urine and pale bowel movements

  • Stomach pain

  • Skin and whites of eyes turning yellow
HIV/AIDS

Some women may have no symptoms for 10 years or more. About half of people with HIV get flu-like symptoms about 3 to 6 weeks after becoming infected. Symptoms people can have for months or even years before the onset of AIDS include:

  • Fevers and night sweats

  • Feeling very tired

  • Quick weight loss

  • Headache

  • Enlarged lymph nodes

  • Diarrhea, vomiting, and upset stomach

  • Mouth, genital, or anal sores

  • Dry cough

  • Rash or flaky skin

  • Short-term memory loss

Women also might have these signs of HIV:

  • Vaginal yeast infections and other vaginal infections, including STIs

  • Pelvic inflammatory disease (PID) that does not get better with treatment

  • Menstrual cycle changes
Human papillomavirus (HPV)

Some women have no symptoms. Women with symptoms may have:

  • Visible warts in the genital area, including the thighs. Warts can be raised or flat, alone or in groups, small or large, and sometimes they are cauliflower-shaped.

  • Growths on the cervix and vagina that are often invisible.
Pubic lice
(sometimes called "crabs")

Symptoms include:

  • Itching in the genital area

  • Finding lice or lice eggs
Syphilis

Syphilis progresses in stages. Symptoms of the primary stage are:

  • A single, painless sore appearing 10 to 90 days after infection. It can appear in the genital area, mouth, or other parts of the body. The sore goes away on its own.

If the infection is not treated, it moves to the secondary stage. This stage starts 3 to 6 weeks after the sore appears. Symptoms of the secondary stage are:

  • Skin rash with rough, red or reddish-brown spots on the hands and feet that usually does not itch and clears on its own

  • Fever

  • Sore throat and swollen glands

  • Patchy hair loss

  • Headaches and muscle aches

  • Weight loss

  • Tiredness

In the latent stage, symptoms go away, but can come back. Without treatment, the infection may or may not move to the late stage. In the late stage, symptoms are related to damage to internal organs, such as the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Some people may die.
Trichomoniasis
(sometimes called "trich")

Many women do not have symptoms. Symptoms usually appear 5 to 28 days after exposure and can include:

  • Yellow, green, or gray vaginal discharge (often foamy) with a strong odor

  • Discomfort during sex and when urinating

  • Itching or discomfort in the genital area

  • Lower abdominal pain (rarely)

How do you get tested for STIs?

Tests for reproductive health

Bring our Tests for Reproductive Health (PDF, 306 KB) to your next checkup.

There is no one test for all STIs. Ask your doctor about getting tested for STIs. She or he can tell you what test(s) you might need and how it is done. Testing for STIs is also called STI screening. Testing (or screening) for STIs can involve:

Sexually transmitted infections testing site

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Find an STI testing site near you.

These methods are used for many kinds of tests. So if you have a pelvic exam and Pap test, for example, don’t assume that you have been tested for STIs. Pap testing is mainly used to look for cell changes that could be cancer or precancer. Although a Pap test sample also can be used to perform tests for HPV, doing so isn’t routine. And a Pap test does not test for other STIs. If you want to be tested for STIs, including HPV, you must ask.

You can get tested for STIs at your doctor’s office or a clinic. But not all doctors offer the same tests. So it’s important to discuss your sexual health history to find out what tests you need and where you can go to get tested.

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Who needs to get tested for STIs?

Screening tests

If you are sexually active, talk to your doctor about STI screening. Which tests you might need and how often depend mainly on your sexual history and your partner’s. Talking to your doctor about your sex life might seem too personal to share. But being open and honest is the only way your doctor can help take care of you. Also, don’t assume you don’t need to be tested for STIs if you have sex only with women. Talk to your doctor to find out what tests make sense for you.

How are STIs treated?

The treatment depends on the type of STI. For some STIs, treatment may involve taking medicine or getting a shot. For other STIs that can’t be cured, like herpes, treatment can help to relieve the symptoms.

Only use medicines prescribed or suggested by your doctor. There are products sold over the Internet that falsely claim to prevent or treat STIs, such as herpes, chlamydia, human papillomavirus, and HIV. Some of these drugs claim to work better than the drugs your doctor will give you. But this is not true, and the safety of these products is not known.

What can I do to keep from getting an STI?

You can lower your risk of getting an STI with the following steps. The steps work best when used together. No single strategy can protect you from every single type of STI.

How do STIs affect pregnant women and their babies?

STIs can cause many of the same health problems in pregnant women as women who are not pregnant. But having an STI also can threaten the pregnancy and unborn baby's health. Having an STI during pregnancy can cause early labor, a woman's water to break early, and infection in the uterus after the birth.

Some STIs can be passed from a pregnant woman to the baby before and during the baby’s birth. Some STIs, like syphilis, cross the placenta and infect the baby while it is in the uterus. Other STIs, like gonorrhea, chlamydia, hepatitis B, and genital herpes, can be passed from the mother to the baby during delivery as the baby passes through the birth canal. HIV can cross the placenta during pregnancy and infect the baby during the birth process.

The harmful effects to babies may include:

Some of these problems can be prevented if the mother receives routine prenatal care, which includes screening tests for STIs starting early in pregnancy and repeated close to delivery, if needed. Other problems can be treated if the infection is found at birth.

What can pregnant women do to prevent problems from STIs?

Pregnant women should be screened at their first prenatal visit for STIs, including:

In addition, some experts recommend that women who have had a premature delivery in the past be screened and treated for bacterial vaginosis (BV) at the first prenatal visit. Even if a woman has been tested for STIs in the past, she should be tested again when she becomes pregnant.

Chlamydia, gonorrhea, syphilis, trichomoniasis, and BV can be treated and cured with antibiotics during pregnancy. Viral STIs, such as genital herpes and HIV, have no cure. But antiviral medication may be appropriate for some pregnant woman with herpes to reduce symptoms. For women who have active genital herpes lesions at the onset of labor, a cesarean delivery (C-section) can lower the risk of passing the infection to the newborn. For women who are HIV positive, taking antiviral medicines during pregnancy can lower the risk of giving HIV to the newborn to less than 2 percent. C-section is also an option for some women with HIV. Women who test negative for hepatitis B may receive the hepatitis B vaccine during pregnancy.

Pregnant women also can take steps to lower their risk of getting an STI during pregnancy.

Do STIs affect breastfeeding?

Did you know?

If you have HIV, do not breastfeed. You can pass the virus to your baby.

Talk with your doctor, nurse, or a lactation consultant about the risk of passing the STI to your baby while breastfeeding. If you have chlamydia or gonorrhea, you can keep breastfeeding. If you have syphilis or herpes, you can keep breastfeeding as long as the sores are covered. Syphilis and herpes are spread through contact with sores and can be dangerous to your newborn. If you have sores on your nipple or areola, stop breastfeeding on that breast. Pump or hand express your milk from that breast until the sore clears. Pumping will help keep up your milk supply and prevent your breast from getting engorged or overly full. You can store your milk to give to your baby in a bottle for another feeding. But if parts of your breast pump that contact the milk also touch the sore(s) while pumping, you should throw the milk away.

If you are being treated for an STI, ask your doctor about the possible effects of the drug on your breastfeeding baby. Most treatments for STIs are safe to use while breastfeeding.

Is there any research being done on STIs?

Yes. Research on STIs is a public health priority. Research is focused on prevention, diagnosis, and treatment.

With prevention, researchers are looking at strategies such as vaccines and topical microbicides (meye-KROH-buh-syds). One large study is testing a herpes vaccine for women. Topical microbicides could play a big role in protecting women from getting STIs. But so far, they have been difficult to design. They are gels or creams that would be put into the vagina to kill or stop the STI before it could infect someone. Researchers are also looking at the reasons some people are at higher risk of STIs, and ways to lower these risks.

Early and fast diagnosis of STIs means treatment can start right away. Early treatment helps to limit the effects of an STI and keep it from spreading to others. Researchers are looking at quick, easy, and better ways to test for STIs, including vaginal swabs women can use to collect a sample for testing. They also are studying the reasons why many STIs have no symptoms, which can delay diagnosis.

Research also is underway to develop new ways to treat STIs. For instance, more and more people are becoming infected with types of gonorrhea that do not respond well to drugs. So scientists are working to develop new antibiotics to treat these drug-resistant types. An example of treatment research success is the life-prolonging effects of new drugs used to treat HIV.

More information on sexually transmitted infections (STI)

For more information about sexually transmitted infections (STI), call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

Share this information!

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The information on our website is provided by the U.S. federal government and is in the public domain. This public information is not copyrighted and may be reproduced without permission, though citation of each source is appreciated.

Content last updated: July 16, 2012.

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Vaginal Yeast Infection

Most women will get a vaginal yeast infection at some point in their life. Symptoms of vaginal yeast infections include burning, itching, and thick, white discharge. Yeast infections are easy to treat, but it is important to see your doctor or nurse if you think you have an infection. Yeast infection symptoms are similar to other vaginal infections and sexually transmitted infections (STIs). If you have a more serious infection, and not a yeast infection, it can lead to major health problems.

What is a vaginal yeast infection?

A vaginal yeast infection is an infection of the vagina that causes itching and burning of the vulva, the area around the vagina. Vaginal yeast infections are caused by an overgrowth of the fungus Candida.

Vaginal Yeast Infection

Who gets vaginal yeast infections?

Women and girls of all ages can get vaginal yeast infections. Three out of four women will have a yeast infection at some point in their life. Almost half of women have two or more infections.

Vaginal yeast infections are rare before puberty and after menopause.

Are some women more at risk for yeast infections?

Yes. Your risk for yeast infections is higher if:

What are the signs and symptoms of a vaginal yeast infection?

The most common symptom of a vaginal yeast infection is extreme itchiness in and around the vagina.

Other signs and symptoms include:

You may have only a few of these symptoms. They may be mild or severe.

What causes yeast infections?

Yeast infections are caused by overgrowth of the microscopic fungus Candida.

Your vagina may have small amounts of yeast at any given time without causing any symptoms. But when too much yeast grows, you can get an infection.

Can I get a yeast infection from having sex?

Yes. A yeast infection is not considered an STI, because you can get a yeast infection without having sex. But you can get a yeast infection from your sexual partner. Condoms and dental dams may help prevent getting or passing yeast infections through vaginal, oral, or anal sex.

Should I call my doctor or nurse if I think I have a yeast infection?

Yes. Seeing your doctor or nurse is the only way to know for sure if you have a yeast infection and not a more serious type of infection.

The signs and symptoms of a yeast infection are a lot like symptoms of other more serious infections, such as STIs and bacterial vaginosis (BV). If left untreated, STIs and BV raise your risk of getting other STIs, including HIV, and can lead to problems getting pregnant. BV can also lead to problems during pregnancy, such as premature delivery.

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How is a yeast infection diagnosed?

Your doctor will do a pelvic exam to look for swelling and discharge. Your doctor may also use a cotton swab to take a sample of the discharge from your vagina. A lab technician will look at the sample under a microscope to see whether there is an overgrowth of the fungus Candida that causes a yeast infection.

How is a yeast infection treated?

Yeast infections are usually treated with antifungal medicine. See your doctor or nurse to make sure that you have a vaginal yeast infection and not another type of infection.

You can then buy antifungal medicine for yeast infections at a store, without a prescription. Antifungal medicines come in the form of creams, tablets, ointments, or suppositories that you insert into your vagina. You can apply treatment in one dose or daily for up to seven days, depending on the brand you choose.

Your doctor or nurse can also give you a single dose of antifungal medicine taken by mouth, such as fluconazole . If you get more than four vaginal yeast infections a year, or if your yeast infection doesn't go away after using over-the-counter treatment, you may need to take regular doses of antifungal medicine for up to six months.

Is it safe to use over-the-counter medicines for yeast infections?

Yes, but always talk with your doctor or nurse before treating yourself for a vaginal yeast infection. This is because:

You may be trying to treat an infection that is not a yeast infection. Studies show that two out of three women who buy yeast infection medicine don't really have a yeast infection. Instead, they may have an STI or bacterial vaginosis (BV). STIs and BV require different treatments than yeast infections and, if left untreated, can cause serious health problems.

How do I treat a yeast infection if I'm pregnant?

During pregnancy, it's safe to treat a yeast infection with vaginal creams or suppositories that contain miconazole or clotrimazole.

Do not take the oral fluconazole tablet to treat a yeast infection during pregnancy. It may cause birth defects.

Can I get a yeast infection from breastfeeding?

Yes. Yeast infections can happen on your nipples or in your breast (commonly called "thrush") from breastfeeding. Yeast thrive on milk and moisture. A yeast infection you get while breastfeeding is different from a vaginal yeast infection. However, it is caused by an overgrowth of the same fungus.

Symptoms of thrush during breastfeeding include:

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If you have any of these signs or symptoms or think your baby might have thrush in his or her mouth, call your doctor. Learn more about thrush in our Breastfeeding section.

If I have a yeast infection, does my sexual partner need to be treated?

Maybe. Yeast infections are not STIs. But it is possible to pass yeast infections to your partner during vaginal, oral, or anal sex.

How can I prevent a yeast infection?

You can take steps to lower your risk of getting yeast infections:

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Does yogurt prevent or treat yeast infections?

Maybe. Studies suggest that eating eight ounces of yogurt with "live cultures" daily or taking Lactobacillus acidophilus capsules can help prevent infection.

But, more research still needs to be done to say for sure if yogurt with Lactobacillus or other probiotics can prevent or treat vaginal yeast infections. If you think you have a yeast infection, see your doctor or nurse to make sure before taking any over-the-counter medicine.

What should I do if I get repeat yeast infections?

If you get four or more yeast infections in a year, talk to your doctor or nurse.

About 5% of women get four or more vaginal yeast infections in one year. This is called recurrent vulvovaginal candidiasis (RVVC). RVVC is more common in women with diabetes or weak immune systems, such as with HIV, but it can also happen in otherwise healthy women.

Doctors most often treat RVVC with antifungal medicine for up to six months. Researchers also are studying the effects of a vaccine to help prevent RVVC.

More information about vaginal yeast infections

For more information on vaginal yeast infections, call the OWH Helpline at 800-994-9662 or contact the following organizations:

This fact sheet was reviewed by:

Michail S. Lionakis, M.D., Sc.D., Clinical Investigator, Chief, Fungal Pathogenesis Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy & Infectious Diseases (NIAID), NIH

Lance Edwards, MD., FACOG, Suffolk Obstetrics, Port Jefferson, New York

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Syphilis Factsheet

What is syphilis?

Syphilis (SIF-uh-luhss) is a sexually transmitted infection (STI) caused by bacteria (germ). It progresses in stages. Syphilis is easy to cure in its early stages. But without treatment, it can hurt your body's organs, leading to severe illness and even death.

How is syphilis spread?

Syphilis is spread through direct contact with a syphilis sore or rash during vaginal, anal, or oral sex. The bacteria can enter the body through the penis, anus, vagina, mouth, or through broken skin. An infected pregnant woman can also pass the disease to her unborn child. Syphilis is not spread by contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.

What are the symptoms of syphilis?

Each stage of syphilis has different symptoms. A person infected with syphilis can pass it to others during the first two stages.

Primary stage
A single sore, called a chancre (SHANG-kuhr), appears in the first, or primary stage. Sometimes, more than one sore appears. The time between infection with syphilis and the start of the chancre can range between 10 to 90 days (21 days average). The chancre is usually firm, round, small, and painless. It appears at the spot where the infection entered the body, such as the vulva, vagina, cervix, tongue, lips, or other parts of the body. In this stage, syphilis can be passed to others through contact with the chancre during vaginal, anal, or oral sex. The chancre lasts 3 to 6 weeks and heals with or without treatment. If the infection is not treated, it moves to the secondary stage.

Secondary stage
The secondary stage can start as the chancre is healing or a few weeks after it has healed. It typically starts with a rash on 1 or more areas of the body. Some or all of these symptoms can appear:

In this stage, the infection can be passed to others through contact with open sores or rash during vaginal, anal, or oral sex. Rash and other symptoms will go away with or without treatment. But without treatment, the infection will move to the latent and possibly late stages of disease.

Latent stage
The latent, or hidden, stage starts when symptoms from the first and second stages go away. The latent stage can last for many, many years. During this stage, the infection lives in the body even though there are no signs or symptoms. The infection cannot be passed to others during the latent stage. Sometimes, symptoms from the secondary phase come back. If this happens, the infection can be passed to others until the symptoms go away again. Without treatment, the infection will advance to the late stage in some people.

Late stage
About 15 percent of people with untreated syphilis will advance to the late stage. This can happen within a few years or as many as 20 years or more after first becoming infected. In the late stage, the disease can hurt your organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. This damage can lead to nerve problems, paralysis, blindness, dementia, and other health problems. Some people may die from the disease. You will only reach the late stage if you do not receive treatment earlier. If you have syphilis, get treated as soon as possible to avoid these problems.

How do I found out if I have syphilis?

A doctor can tell if you have syphilis. The most common ways include:

How is syphilis treated?

Penicillin (an antibiotic) is the preferred drug to treat syphilis at all stages. The dose and length of treatment depends on the stage of syphilis and symptoms of the disease. For people who are allergic to penicillin, other drugs might work during the first and second stages. But they cannot be used by pregnant women. In late syphilis, treatment will prevent further harm, but damage already done to body organs cannot be reversed. Treatment does not protect you from getting syphilis again. You can get syphilis again after being cured if you are exposed to it.

What happens if syphilis isn't treated?

Without treatment, syphilis can lead to severe illness and even death. Having syphilis also increases your risk of getting or giving HIV, the disease that causes AIDS. The open sores caused by syphilis make it easier for HIV to spread through sexual contact. If you have syphilis, you are thought to be 2 to 5 times more likely to get HIV if exposed. Untreated syphilis also can cause problems during pregnancy.

Can syphilis cause problems during pregnancy?

Yes. Pregnant women can pass syphilis to their babies during pregnancy and childbirth. It can cause miscarriage, stillbirth, or death soon after birth. An infected baby may be born without signs of disease. However, if not treated right away, the baby may have serious problems within a few weeks. Babies born with syphilis may develop skin sores, rashes, fever, jaundice, anemia, or a swollen liver and spleen. Untreated babies may become developmentally delayed, have seizures, or die.

All pregnant women should be tested for syphilis. Pregnant women with syphilis are treated right away with penicillin. For women who are allergic to penicillin, no other drugs are available for treatment. So, doctors try to help women with this allergy become less sensitive to the penicillin so it can be used. Penicillin will prevent passing syphilis to the baby. But women who are treated during the second half of pregnancy still are at risk of premature labor and problems with the unborn baby.

How can I keep from getting syphilis?

There are steps you can take to lower your risk of getting syphilis:

Who should get tested for syphilis?

Ask your doctor about getting tested for syphilis if:

I just found out I have syphilis. What should I do?

More information on syphilis

For more information about syphilis, call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

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 Viral Hepatitis Factsheet

ARE YOU AT RISK? Millions of Americans have VIRAL HEPATITIS. Take this online assessment to see if you're at risk.

What is hepatitis?

Hepatitis (he-puh-TEYE-tuhs) means inflammation (swelling) of the liver. Hepatitis can be caused by:

Hepatitis is most often caused by one of several viruses, which is why it is often called viral hepatitis. The most common types of viral hepatitis in the United States are hepatitis A, hepatitis B, and hepatitis C.

This fact sheet focuses on viral hepatitis. You can learn more about other kinds of hepatitis from the National Library of Medicine.

What are the signs of viral hepatitis?

Some people with viral hepatitis have no signs of the infection. Symptoms, if they do appear, can include:

How do you get viral hepatitis?

You can get hepatitis A by eating food or drinking water contaminated with feces (stool) from a person infected with the virus or by anal-oral contact. Some ways you can get this type of hepatitis include:

You can get hepatitis B if you come into contact with an infected person's:

The virus can also be passed from an infected mother to her baby during childbirth.

Hepatitis C is also spread through contact with the blood of an infected person. This usually happens when people use contaminated needles to inject drugs.

Do I need to be tested for hepatitis?

This depends on your risk factors. Ask your doctor about testing if:

You can live with hepatitis C for a long time without knowing it, so it is important to discuss your risk with your doctor.

How is viral hepatitis diagnosed?

If you think you might have viral hepatitis, see your doctor. To diagnose your illness, your doctor will:

Hepatitis infections are diagnosed with blood tests that look for parts of the virus or antibodies your body makes in response to the virus.

What's the difference between acute viral hepatitis and chronic viral hepatitis?

Acute viral hepatitis is a short-term, viral infection. It happens when you first get infected with the virus and can be mild or severe. In some cases, acute infection leads to chronic infection. Chronic viral hepatitis is a long-lasting infection that can last a lifetime.

Hepatitis A only causes acute infection. Hepatitis viruses B and C can cause both acute and chronic infections. Chronic hepatitis B and C are serious health problems. They can lead to:

How is viral hepatitis treated?

Viral hepatitis will often get better on its own after several weeks to several months. However, when hepatitis becomes a chronic or long-term illness, the infection may need to be treated with specific medications calledantivirals.

If you think you have any type of viral hepatitis, talk to your doctor about what treatments may be right for you. 

How common is viral hepatitis?

In the United States in 2007, there were an estimated:

An estimated 800,000 to 1.4 million people have chronic hepatitis B and 3.2 million people have chronic hepatitis C in the United States. Between 75 and 85 percent of people who get infected with the hepatitis C virus develop a chronic infection.

How can I prevent viral hepatitis infection?

Below are the best methods for preventing the hepatitis viruses most commonly seen in the United States.

Hepatitis A prevention

Hepatitis B prevention

Hepatitis C prevention

If you are a health care or public safety worker, always follow routine barrier precautions and safely handle needles and other sharp objects.

If you are pregnant, your doctor will test your blood for hepatitis B. If you are an infected mother, your baby should be given hepatitis B immune globulin (H-BIG) and the hepatitis B vaccine within 12 hours after birth. If you have chronic hepatitis B, make sure your babies get all of their hepatitis B shots in the first six months of lif

Who should get viral hepatitis vaccines?

The hepatitis A vaccine is given in two doses, six to 18 months apart. The vaccine is recommended for:

The hepatitis B vaccine is usually given in three doses over six months. The vaccine is recommended for:

How long do the hepatitis A and B vaccines protect you?

Only one series of the hepatitis A vaccine (two shots) and hepatitis B vaccine (three shots) is needed during a person's lifetime. Most people don't need a booster dose of either vaccine. But, if you have had hemodialysis (hee-moh-dy-AL-uh-suhs) (medical procedure to purify blood) or have a weakened immune system, your doctor might recommend a booster dose of the hepatitis B vaccine.

Is it safe to visit someone with hepatitis?

It is safe to visit someone with viral hepatitis. You cannot get hepatitis through casual contact. It is fine to shake hands with, hug, or kiss someone who is infected with any type of viral hepatitis.

How does a pregnant woman pass hepatitis B virus to her baby?

During birth, blood from the mother gets inside the baby's body. If the mother has hepatitis B virus in her blood, her baby will likely become infected. But this can be prevented by having the baby receive all of the shots in the hepatitis B vaccine series. A very small number of babies get infected before birth.

If I have hepatitis B, what does my baby need so that she doesn't get the virus?

Make sure your baby gets the hepatitis B vaccine and hepatitis B immune globulin (H-BIG) within 12 hours of birth. Your baby will need two or three more shots of vaccine over the next one to 15 months to help prevent hepatitis B. The timing and total number of shots will depend on the type of vaccine and baby's age and weight.

The vaccine is very important. More than 90 percent of babies who are exposed to the virus, but don't get the vaccine, develop chronic hepatitis B. Your baby should be tested after the last vaccine shot to make sure he or she is protected from the disease.

Can I breastfeed my baby if I have hepatitis B?

Yes, you can breastfeed your baby if you have hepatitis B. Make sure your baby gets the hepatitis B vaccine and hepatitis B immune globulin (H-BIG). Take good care of your nipples to prevent cracking and bleeding. If your nipples are cracking or bleeding, avoid nursing your baby on that breast until the sores heal. Until they heal, you can pump your milk to keep up your milk supply. But, you should throw away this pumped milk. Do not feed it to your baby.

More information on viral hepatitis

For more information about viral hepatitis, call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

Share this information!

The information on our website is provided by the U.S. federal government and is in the public domain. This public information is not copyrighted and may be reproduced without permission, though citation of each source is appreciated.

Viral hepatitis fact sheet was reviewed by:

Dr. Cynthia Jorgensen, Ph.D.
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention

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Varicose veins and spider veins fact sheet

What are varicose veins and spider veins?

Varicose (VAR-i-kos) veins are enlarged veins that can be blue, red, or flesh-colored. They often look like cords and appear twisted and bulging. They can be swollen and raised above the surface of the skin. Varicose veins are often found on the thighs, backs of the calves, or the inside of the leg. During pregnancy, varicose veins can form around the vagina and buttocks.

Spider veins are like varicose veins but smaller. They also are closer to the surface of the skin than varicose veins. Often, they are red or blue. They can look like tree branches or spiderwebs with their short, jagged lines. They can be found on the legs and face and can cover either a very small or very large area of skin.

What causes varicose veins and spider veins?

Varicose veins can be caused by weak or damaged valves in the veins. The heart pumps blood filled with oxygen and nutrients to the whole body through the arteries. Veins then carry the blood from the body back to the heart. As your leg muscles squeeze, they push blood back to the heart from your lower body against the flow of gravity. Veins have valves that act as one-way flaps to prevent blood from flowing backwards as it moves up your legs. If the valves become weak, blood can leak back into the veins and collect there. (This problem is called venous insufficiency.) When backed-up blood makes the veins bigger, they can become varicose.

Spider veins can be caused by the backup of blood. They can also be caused by hormone changes, exposure to the sun, and injuries.

How common are abnormal leg veins?

About 50 to 55 percent of women and 40 to 45 percent of men in the United States suffer from some type of vein problem. Varicose veins affect half of people 50 years and older.

What factors increase my risk of varicose veins and spider veins?

Many factors increase a person's chances of developing varicose or spider veins. These include:

Why do varicose veins and spider veins usually appear in the legs?

Most varicose and spider veins appear in the legs due to the pressure of body weight, force of gravity, and task of carrying blood from the bottom of the body up to the heart.

Compared with other veins in the body, leg veins have the toughest job of carrying blood back to the heart. They endure the most pressure. This pressure can be stronger than the one-way valves in the veins.

What are the signs of varicose veins?

Varicose veins can often be seen on the skin. Some other common symptoms of varicose veins in the legs include:

Are varicose veins and spider veins dangerous?

Spider veins rarely are a serious health problem, but they can cause uncomfortable feelings in the legs. If there are symptoms from spider veins, most often they will be itching or burning. Less often, spider veins can be a sign of blood backup deeper inside that you can’t see on the skin. If so, you could have the same symptoms you would have with varicose veins.

Varicose veins may not cause any problems, or they may cause aching pain, throbbing, and discomfort. In some cases, varicose veins can lead to more serious health problems. These include:

Should I see a doctor about varicose veins?

You should see a doctor about varicose veins if:

If you’re having pain, even if it’s just a dull ache, don’t hesitate to get help. Also, even if you don’t need to see a doctor about your varicose veins, you should take steps to keep them from getting worse (see How can I prevent varicose veins and spider veins? ).

How are varicose veins diagnosed?

Your doctor may diagnose your varicose veins based on a physical exam. Your doctor will look at your legs while you’re standing or sitting with your legs dangling. He or she may ask you about your symptoms, including any pain you’re having. Sometimes, you may have other tests to find out the extent of the problem and to rule out other disorders.

You might have an ultrasound, which is used to see the veins’ structure, check the blood flow in your veins, and look for blood clots. This test uses sound waves to create pictures of structures in your body.

Although less likely, you might have a venogram. This test can be used to get a more detailed look at blood flow through your veins.

If you seek help for your varicose veins, there are several types of doctors you can see, including:

Each of these specialists do some or all of the procedures for treating varicose veins. You might start out by asking your regular doctor which specialist he or she recommends. You also might check with your insurance plan to see if it would pay for a particular provider or procedure.

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How are varicose and spider veins treated?

Varicose veins are treated with lifestyle changes and medical treatments. These can:

Your doctor may recommend lifestyle changes if your varicose veins don’t cause many symptoms. If symptoms are more severe, your doctor may recommend medical treatments. Some treatment options include:

Compression stockings

Compression stockings put helpful pressure on your veins. There are 3 kinds of compression stockings:

Sclerotherapy
Sclerotherapy (SKLER-o-ther-a-pee) is the most common treatment for both spider veins and varicose veins. The doctor uses a needle to inject a liquid chemical into the vein. The chemical causes the vein walls to swell, stick together, and seal shut. This stops the flow of blood, and the vein turns into scar tissue. In a few weeks, the vein should fade. This treatment does not require anesthesia and can be done in your doctor's office. You can return to normal activity right after treatment.

The same vein may need to be treated more than once. Treatments are usually done every 4 to 6 weeks. You may be asked to wear gradient compression stockings after sclerotherapy to help with healing and decrease swelling. This treatment is very effective when done correctly.

Possible side effects include:

There is a type of sclerotherapy called ultrasound-guided sclerotherapy (or echo-sclerotherapy). This type of sclerotherapy uses ultrasound imaging to guide the needle. It can be useful in treating veins that cannot be seen on the skin’s surface. It may be used after surgery or endovenous techniques if the varicose veins return. This procedure can be done in a doctor’s office. Possible side effects include skin sores, swelling, injection into an artery by mistake, or deep vein thrombosis (a potentially dangerous blood clot).

Surface laser treatments

In some cases, laser treatments can effectively treat spider veins and smaller varicose veins. This technique sends very strong bursts of light through the skin onto the vein. This makes the vein slowly fade and disappear. Not all skin types and colors can be safely treated with lasers.

No needles or incisions are used, but the heat from the laser can be quite painful. Cooling helps reduce the pain. Laser treatments last for 15 to 20 minutes. Generally, 2 to 5 treatments are needed to remove spider veins in the legs. Laser therapy usually isn’t effective for varicose veins larger than 3 mm (about a tenth of an inch). You can return to normal activity right after treatment.

Possible side effects of lasers include:

Endovenous techniques (radiofrequency and laser)

These methods for treating the deeper veins of the legs, called the saphenous (SAF-uh-nuhs) veins, have replaced surgery for most patients with severe varicose veins. These techniques can be done in a doctor’s office.

The doctor puts a very small tube, called a catheter, into the vein. A small probe is placed through the tube. A device at the tip of the probe heats up the inside of the vein and closes it off. The device can use radiofrequency or laser energy to seal the vein. The procedure can be done using just local anesthesia. You might have slight bruising after treatment.

Healthy veins around the closed vein take over the normal flow of blood. The symptoms from the varicose vein improve. Usually, veins on the surface of the skin that are connected to the treated varicose vein will also shrink after treatment. If they don’t, these connected veins can be treated with sclerotherapy or other techniques.

Surgery

Surgery is used mostly to treat very large varicose veins. Types of surgery for varicose veins include:

How can I prevent varicose veins and spider veins?

Not all varicose and spider veins can be prevented. But, there are some steps you can take to reduce your chances of getting new varicose and spider veins. These same things can help ease discomfort from the ones you already have:

Can varicose and spider veins return even after treatment?

Current treatments for varicose veins and spider veins have very high success rates compared to traditional surgical treatments. Over a period of years, however, more abnormal veins can develop because there is no cure for weak vein valves. Ultrasound can be used to keep track of how badly the valves are leaking (venous insufficiency). Ongoing treatment can help keep this problem under control.

The single most important thing you can do to slow down the development of new varicose veins is to wear gradient compression support stockings as much as possible during the day.

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More information on varicose veins and spider veins

For more information about varicose veins and spider veins, call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

Varicose veins and spider veins fact sheet was reviewed by:

Robert J. Min, M.D.
Chairman of Radiology
Weill Cornell Medical College

Melvin Rosenblatt, M.D.
Chairman, Public Education Committee
American College of Phlebology

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 Sexual Assault Factsheet

What is sexual assault?

Sexual assault and abuse is any type of sexual activity that you do not agree to, including:

Sexual assault can be verbal, visual, or anything that forces a person to join in unwanted sexual contact or attention. Examples of this are voyeurism (when someone watches private sexual acts), exhibitionism (when someone exposes him/herself in public), incest (sexual contact between family members), and sexual harassment. It can happen in different situations:  in the home by someone you know, on a date, or by a stranger in an isolated place.

Rape is a common form of sexual assault. It is committed in many situations — on a date, by a friend or an acquaintance, or when you think you are alone. Educate yourself on “date rape” drugs. They can be slipped into a drink when a victim is not looking. Never leave your drink unattended — no matter where you are. Attackers use date rape drugs to make a person unable to resist assault. These drugs can also cause memory loss so the victim doesn’t know what happened.

Rape and sexual assault are never the victim’s fault — no matter where or how it happens.

What do I do if I've been sexually assaulted?

These are important steps to take right away after an assault:

While at the hospital:

Where else can I go for help?

If you are sexually assaulted, it is not your fault. Don’t be afraid to ask for help or support. Help is available. You can call these organizations:

There are many organizations and hotlines in every state and territory. These crisis centers and agencies work hard to stop assaults and help victims. Find contact information for these organizations. You also can obtain the numbers of shelters, counseling services, and legal assistance in your phone book or online.

How can I lower my risk of sexual assault?

There are things you can do to reduce your chances of being sexually assaulted. Follow these tips from the National Crime Prevention Council.

How can I help someone who has been sexually assaulted?

You can help someone who is abused or who has been assaulted by listening and offering comfort. Go with her or him to the police, the hospital, or to counseling. Reinforce the message that she or he is not at fault and that it is natural to feel angry and ashamed.

More information on sexual assault

For more information about sexual assault, call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

Share this information!

The information on our website is provided by the U.S. federal government and is in the public domain. This public information is not copyrighted and may be reproduced without permission, though citation of each source is appreciated.

Sexual assault fact sheet was reviewed by:

Joyce Lukima
National Sexual Violence Resource Center
Pennsylvania Coalition Against Rape

Date rape drugs fact sheet

What are date rape drugs?

These are drugs that are sometimes used to assist a sexual assault. Sexual assault is any type of sexual activity that a person does not agree to. It can include touching that is not okay; putting something into the vagina; sexual intercourse; rape; and attempted rape. These drugs are powerful and dangerous. They can be slipped into your drink when you are not looking. The drugs often have no color, smell, or taste, so you can't tell if you are being drugged. The drugs can make you become weak and confused — or even pass out — so that you are unable to refuse sex or defend yourself. If you are drugged, you might not remember what happened while you were drugged. Date rape drugs are used on both females and males.

The three most common date rape drugs are:

These drugs also are known as "club drugs" because they tend to be used at dance clubs, concerts, and "raves."

The term "date rape" is widely used. But most experts prefer the term "drug-facilitated sexual assault." These drugs also are used to help people commit other crimes, like robbery and physical assault. They are used on both men and women. The term "date rape" also can be misleading because the person who commits the crime might not be dating the victim. Rather, it could be an acquaintance or stranger.

What do the drugs look like?

What effects do these drugs have on the body?

These drugs are very powerful. They can affect you very quickly and without your knowing. The length of time that the effects last varies. It depends on how much of the drug is taken and if the drug is mixed with other drugs or alcohol. Alcohol makes the drugs even stronger and can cause serious health problems — even death.

Rohypnol

The effects of Rohypnol can be felt within 30 minutes of being drugged and can last for several hours. If you are drugged, you might look and act like someone who is drunk. You might have trouble standing. Your speech might be slurred. Or you might pass out. Rohypnol can cause these problems:

GHB

GHB takes effect in about 15 minutes and can last 3 or 4 hours. It is very potent: A very small amount can have a big effect. So it's easy to overdose on GHB. Most GHB is made by people in home or street "labs." So, you don't know what's in it or how it will affect you. GHB can cause these problems:

Ketamine

Ketamine is very fast-acting. You might be aware of what is happening to you, but unable to move. It also causes memory problems. Later, you might not be able to remember what happened while you were drugged. Ketamine can cause these problems:

Are these drugs legal in the United States?

Some of these drugs are legal when lawfully used for medical purposes. But that doesn't mean they are safe. These drugs are powerful and can hurt you. They should only be used under a doctor's care and order.

Is alcohol a date rape drug? What about other drugs?

Any drug that can affect judgment and behavior can put a person at risk for unwanted or risky sexual activity. Alcohol is one such drug. In fact, alcohol is the drug most commonly used to help commit sexual assault. When a person drinks too much alcohol:

The club drug "ecstasy" (MDMA) has been used to commit sexual assault. It can be slipped into someone's drink without the person's knowledge. Also, a person who willingly takes ecstasy is at greater risk of sexual assault. Ecstasy can make a person feel "lovey-dovey" towards others. It also can lower a person's ability to give reasoned consent. Once under the drug's influence, a person is less able to sense danger or to resist a sexual assault.

Even if a victim of sexual assault drank alcohol or willingly took drugs, the victim is not at fault for being assaulted. You cannot "ask for it" or cause it to happen.

How can I protect myself from being a victim?

Are there ways to tell if I might have been drugged and raped?

It is often hard to tell. Most victims don't remember being drugged or assaulted. The victim might not be aware of the attack until 8 or 12 hours after it occurred. These drugs also leave the body very quickly. Once a victim gets help, there might be no proof that drugs were involved in the attack. But there are some signs that you might have been drugged:

What should I do if I think I've been drugged and raped?

More information on date rape drugs

For more information about date rape drugs, call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

Share this information!

The information on our website is provided by the U.S. federal government and is in the public domain. This public information is not copyrighted and may be reproduced without permission, though citation of each source is appreciated.

Date rape drugs fact sheet was reviewed by:

Susan Weiss
Chief, Science Policy Branch
National Institute on Drug Abuse

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 Mammograms fact sheet

What is a mammogram?

A mammogram is a low-dose x-ray exam of the breasts to look for changes that are not normal. The results are recorded on x-ray film or directly into a computer for a doctor called a radiologist to examine.

A mammogram allows the doctor to have a closer look for changes in breast tissue that cannot be felt during a breast exam. It is used for women who have no breast complaints and for women who have breast symptoms, such as a change in the shape or size of a breast, a lump, nipple discharge, or pain. Breast changes occur in almost all women. In fact, most of these changes are not cancer and are called “benign,” but only a doctor can know for sure. Breast changes can also happen monthly, due to your menstrual period.

What is the best method of detecting breast cancer as early as possible?

A high-quality mammogram plus a clinical breast exam, an exam done by your doctor, is the most effective way to detect breast cancer early. Finding breast cancer early greatly improves a woman's chances for successful treatment.

Like any test, mammograms have both benefits and limitations. For example, some cancers can't be found by a mammogram, but they may be found in a clinical breast exam.

Checking your own breasts for lumps or other changes is called a breast self-exam (BSE). Studies so far have not shown that BSE alone helps reduce the number of deaths from breast cancer. BSE should not take the place of routine clinical breast exams and mammograms.

If you choose to do BSE, remember that breast changes can occur because of pregnancy, aging, menopause, menstrual cycles, or from taking birth control pills or other hormones. It is normal for breasts to feel a little lumpy and uneven. Also, it is common for breasts to be swollen and tender right before or during a menstrual period. If you notice any unusual changes in your breasts, contact your doctor.

How is a mammogram done?

You stand in front of a special x-ray machine. The person who takes the x-rays, called a radiologic technician, places your breasts, one at a time, between an x-ray plate and a plastic plate. These plates are attached to the x-ray machine and compress the breasts to flatten them. This spreads the breast tissue out to obtain a clearer picture. You will feel pressure on your breast for a few seconds. It may cause you some discomfort; you might feel squeezed or pinched. This feeling only lasts for a few seconds, and the flatter your breast, the better the picture. Most often, two pictures are taken of each breast — one from the side and one from above. A screening mammogram takes about 20 minutes from start to finish.

Are there different types of mammograms?

A digital mammogram also uses x-rays to produce an image of the breast, but instead of storing the image directly on film, the image is stored directly on a computer. This allows the recorded image to be magnified for the doctor to take a closer look. Current research has not shown that digital images are better at showing cancer than x-ray film images in general. But, women with dense breasts who are pre- or perimenopausal, or who are younger than age 50, may benefit from having a digital rather than a film mammogram. Digital mammography may offer these benefits:

How often should I get a mammogram?

The United States Preventive Services Task Force (USPSTF) recommends:

What can mammograms show?

The radiologist will look at your x-rays for breast changes that do not look normal and for differences in each breast. He or she will compare your past mammograms with your most recent one to check for changes. The doctor will also look for lumps and calcifications.

If calcifications are grouped together in a certain way, it may be a sign of cancer. Depending on how many calcium specks you have, how big they are, and what they look like, your doctor may suggest that you have other tests. Calcium in the diet does not create calcium deposits, or calcifications, in the breast.

What if my screening mammogram shows a problem?

If you have a screening test result that suggests cancer, your doctor must find out whether it is due to cancer or to some other cause. Your doctor may ask about your personal and family medical history. You may have a physical exam. Your doctor also may order some of these tests:

Where can I get a high-quality mammogram?

Women can get high-quality mammograms in breast clinics, hospital radiology departments, mobile vans, private radiology offices, and doctors’ offices. The Food and Drug Administration (FDA) certifies mammography facilities that meet strict quality standards for their x-ray machines and staff and are inspected every year. You can ask your doctor or the staff at the mammography center about FDA certification before making your appointment. A list of FDA-certified facilities can be found on the Internet.

Your doctor, local medical clinic, or local or state health department can tell you where to get no-cost or low-cost mammograms. You can also call the National Cancer Institute's Cancer Information Service toll free at 800-422-6237.

What if I have breast implants?

Women with breast implants should also have mammograms. A woman who had an implant after breast cancer surgery in which the entire breast was removed (mastectomy) should ask her doctor whether she needs a mammogram of the reconstructed breast.

If you have breast implants, be sure to tell your mammography facility that you have them when you make your appointment. The technician and radiologist must be experienced in x-raying patients with breast implants. Implants can hide some breast tissue, making it harder for the radiologist to see a problem when looking at your mammogram. To see as much breast tissue as possible, the x-ray technician will gently lift the breast tissue slightly away from the implant and take extra pictures of the breasts.

How do I get ready for my mammogram?

First, check with the place you are having the mammogram for any special instructions you may need to follow before you go. Here are some general guidelines to follow:

Are there any problems with mammograms?

Although they are not perfect, mammograms are the best method to find breast changes that cannot be felt. If your mammogram shows a breast change, sometimes other tests are needed to better understand it. Even if the doctor sees something on the mammogram, it does not mean it is cancer.

As with any medical test, mammograms have limits. These limits include:

More information on mammograms

Mammograms fact sheet was reviewed by:

Worta McCaskill-Stevens, M.D.
Community Oncology and Prevention Trials Research Group
Division of Cancer Prevention
National Cancer Institute, National Institutes of Health
 

Richard E. Manrow, Ph.D.
Associate Director, Office of Cancer Content Management
Office of Communications and Education
National Cancer Institute, National Institutes of Health.

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Pap test

The Pap test (or Pap smear) looks for cancers and precancers in the cervix (the lower part of the uterus that opens into the vagina). Precancers are cell changes that might become cancer if they are not treated the right way. Most health insurance plans must cover Pap tests or cervical cancer screening at no cost to you.

What is a Pap test?

A Pap test checks the cervix for abnormal cell changes. The cervix is the lower part of the uterus (womb), which opens into the vagina. Cell changes can develop on the cervix that, if not found and treated, can lead to cervical cancer. Cervical cancer can almost always be prevented, and having regular Pap tests is the key.

Why do I need a Pap test?

A Pap test can save your life. It can find early signs of cervical cancer. If caught early, the chance of successful treatment of cervical cancer is very high. Pap tests can also find abnormal cervical cells before they turn into cancer cells. Treating these abnormal cells can help prevent most cases of cervical cancer from developing. Getting a Pap test is one of the best things you can do to prevent cervical cancer.

Do all women need Pap tests?

Most women ages 21 to 65 should get Pap tests as part of routine health care. Even if you are not currently sexually active, you should still have a Pap test. Women who have gone through menopause (when a woman’s periods stop) and are younger than 65 still need regular Pap tests.

Women who do not have a cervix (usually because of a hysterectomy), and who also do not have a history of cervical cancer or abnormal Pap results, do not need Pap tests. Women ages 65 and older who have had three normal Pap tests in a row and no abnormal test results in the last 10 years do not need Pap tests.

Who does not need a regular Pap test?

The only women who do not need regular Pap tests are:

All women should speak to a doctor before stopping regular Pap tests.

I had a hysterectomy. Do I still need Pap tests?

It depends on the type of hysterectomy (surgery to remove the uterus) you had and your health history. Women who have had a hysterectomy should talk with their doctor about whether they need routine Pap tests.

How often do I need to get a Pap test?

It depends on your age and health history. Talk with your doctor about what is best for you. Most women can follow these guidelines:

Some women may need more frequent Pap tests. You should talk to your doctor about getting a Pap test more often if:

How can I prepare for a Pap test?

Some things can cause incorrect Pap test results.

For two days before the test do not:

Should I get a Pap test when I have my period?

No. Doctors suggest you schedule a Pap test when you do not have your period. The best time to be tested is 10 to 20 days after the first day of your period.

How is a Pap test done?

Your doctor can do a Pap test during a pelvic exam. It is a simple and quick test. You will lie down on an exam table. Your doctor will put an instrument called a speculum into your vagina and will open it to see your cervix. He or she will then use a special stick or brush to take a few cells from the surface of and inside the cervix. The cells are placed on a glass slide and sent to a lab for testing. A Pap test may be mildly uncomfortable but should not be painful. You may have some spotting afterwards.

When will I get the results of my Pap test?

Usually it takes one to three weeks to get Pap test results. Most of the time, test results are normal. If the test shows that something might be wrong, your doctor will contact you to schedule more tests. There are many reasons for abnormal Pap test results. Abnormal Pap test results do not always mean you have cancer.

My Pap test was “abnormal.” What happens now?

It can be scary to hear that your Pap test results are “abnormal.” But abnormal Pap test results usually do not mean you have cancer. Most often there is a small problem with the cervix. If results of the Pap test are unclear or show a small change in the cells of the cervix, your doctor may repeat the Pap test immediately, in 6 months, or a year, or he or she may run more tests.

Some abnormal cells will turn into cancer. Treating abnormal cells that don’t go away on their own can prevent almost all cases of cervical cancer. If you have abnormal results, talk with your doctor about what they mean. Your doctor should answer any questions you have and explain anything you don’t understand. Treatment for abnormal cells is often done in a doctor’s office during a routine appointment.

If the test finds more serious changes in the cells of the cervix, the doctor will suggest more tests. Results of these tests will help your doctor decide on the best treatment.

My Pap test result was a “false positive.” What does this mean?

Pap tests are not always perfect. False positive and false negative results can happen. This can be upsetting and confusing.

How can I reduce my chances of getting cervical cancer?

You can reduce your chances of getting cervical cancer in several ways:

How can I get a free or low-cost Pap test?

Pap tests are covered under the Affordable Care Act, the health care law passed in 2010. Most insurance plans now cover Pap tests at no cost to you.

For information about other services covered by the Affordable Care Act, visit HealthCare.gov.

For more information…

For more information on Pap tests, call the OWH Helpline at 800-994-9662 or contact the following organizations:

Pamela Marcus, PhD, Epidemiologist National Cancer Institute, Division of Cancer Control and Population Sciences

Paul Doria-Rose, PhD, DVM, Epidemiologist National Cancer Institute, Division of Cancer Control and Population Sciences

 Ovarian Cancer fact sheet

Ovarian cancer is cancer that begins in the ovaries. The ovaries make female hormones and produce a woman's eggs. Ovarian cancer is a serious cancer that is more common in older women. Treatment is most effective when the cancer is found early.

What is ovarian cancer?

Ovarian cancer forms in tissues of the ovary. (An ovary is one of a pair of female reproductive glands in which the ova, or eggs, are formed.)

Tumors in the ovaries can be benign, which means they are not cancer, or they can be malignant, which means they are cancer.

Cancers that start in the ovaries can spread to other parts of the body. This is called metastasis. Cancer that starts in the ovaries and spreads to other parts of the body is still called ovarian cancer.

Who gets ovarian cancer?

Around one in every 60 women in the United States will develop ovarian cancer. Most ovarian cancers are diagnosed in women over 60, but this disease can also affect younger women. Among women in the United States, ovarian cancer is the eighth most common cancer and the fifth leading cause of cancer death.

Are some women more at risk for ovarian cancer?

Women with a high risk of ovarian cancer are those with a harmful mutation on the BRCA1 or BRCA2 genes. These mutations can be found with a blood test. Women with a family or personal history of breast or ovarian cancer also have a higher risk of ovarian cancer.

If you have family members in multiple generations with breast cancer or ovarian cancer, see your doctor to learn more about your risk of ovarian cancer. Research shows that certain steps, such as surgery to remove the ovaries and the fallopian tubes, may help prevent ovarian cancer in women who are at high risk. The sooner ovarian cancer is found and treated, the better your chance for recovery. But ovarian cancer is hard to detect early because its symptoms are also the symptoms of many other illnesses.

What are the symptoms of ovarian cancer?

The following may be symptoms of ovarian cancer if they continue or get worse over time:

If you have any of these symptoms, talk to your doctor. He or she can determine if the cause is cancer or something else. Your doctor also may ask you to visit a gynecologic oncologist. This is a doctor who focuses on cancers of the female pelvis.

Should I be screened for ovarian cancer?

The U.S. Preventive Services Task Force (USPSTF) recommends against screening women who are not at high risk for ovarian cancer. The USPSTF found that testing for ovarian cancer may do more harm than good. Current testing methods, like pelvic exams, ultrasound, and blood tests, can lead to "false-positives" (results that say a woman has ovarian cancer when she really does not have ovarian cancer). These incorrect results can lead to surgeries that are not needed and that can be risky.

Some women, like those who are at high risk, can talk to their doctor about their risk and what they can do to help prevent ovarian cancer.

For more information...

For more information about ovarian cancer, call the OWH Helpline at 800-994-9662 or contact the following organizations:

This content was reviewed by:

Elise C. Kohn, M.D., Head, Molecular Signaling Section, Head, Women's Cancers Clinic, Medical Oncology Branch and Affiliates, National Cancer Institute

Ovarian cysts

Ovarian cysts are fluid-filled sacs in the ovary. They are common and usually form during ovulation. Ovulation happens when the ovary releases an egg each month. Many women with ovarian cysts don’t have symptoms. The cysts are usually harmless.

What are ovarian cysts?

A cyst is a fluid-filled sac. It can form in many places in the body. Ovarian cysts form in or on the ovaries.

What are the different types of ovarian cysts?

The most common types of ovarian cysts (called functional cysts) form during the menstrual cycle. They are usually benign (not cancerous).

The two most common types of cysts are:

Other types of benign ovarian cysts are less common:

In some women, the ovaries make many small cysts. This is called polycystic ovary syndrome (PCOS). PCOS can cause problems with the ovaries and with getting pregnant.

Malignant (cancerous) cysts are rare. They are more common in older women. Cancerous cysts are ovarian cancer. For this reason, ovarian cysts should be checked by your doctor. Most ovarian cysts are not cancerous.

Who gets ovarian cysts?

Ovarian cysts are common in women with regular periods. In fact, most women make at least one follicle or corpus luteum cyst every month. You may not be aware that you have a cyst unless there is a problem that causes the cyst to grow or if multiple cysts form. About 8% of premenopausal women develop large cysts that need treatment.1

Ovarian cysts are less common after menopause. Postmenopausal women with ovarian cysts are at higher risk for ovarian cancer.

At any age, see your doctor if you think you have a cyst. See your doctor also if you have symptoms such as bloating, needing to urinate more often, pelvic pressure or pain, or abnormal (unusual) vaginal bleeding. These can be signs of a cyst or other serious problem.

What causes ovarian cysts?

The most common causes of ovarian cysts include:

What are the signs and symptoms of ovarian cysts?

Most ovarian cysts are small and don’t cause symptoms.

If a cyst does cause symptoms, you may have pressure, bloating, swelling, or pain in the lower abdomen on the side of the cyst. This pain may be sharp or dull and may come and go.

If a cyst ruptures, it can cause sudden, severe pain.

If a cyst causes twisting of an ovary, you may have pain along with nausea and vomiting.

Less common symptoms include:

How are ovarian cysts found?

If you have symptoms of ovarian cysts, talk to your doctor. Your doctor may do a pelvic exam to feel for swelling of a cyst on your ovary.

If a cyst is found, your doctor will either watch and wait or order tests to help plan treatment. Tests include:

Are ovarian cysts ever an emergency?

Yes, sometimes. If your doctor told you that you have an ovarian cyst and you have any of the following symptoms, get medical help right away:

These symptoms could mean that your cyst has broken open, or ruptured. Sometimes, large, ruptured cysts can cause heavy bleeding.

Will my ovarian cyst require surgery?

Maybe. The National Institutes of Health estimates that 5% to 10% of women have surgery to remove an ovarian cyst. Only 13% to 21% of these cysts are cancerous.

Your cyst may require surgery if you are past menopause or if your cyst:

If your cyst does not require surgery, your doctor may:

What types of surgeries remove ovarian cysts?

If your cyst requires surgery, your doctor will either remove just the cyst or the entire ovary.

Surgery can be done in two different ways:

Can ovarian cysts lead to cancer?

Yes, some ovarian cysts can become cancerous. But most ovarian cysts are not cancerous.

The risk for ovarian cancer increases as you get older. Women who are past menopause with ovarian cysts have a higher risk for ovarian cancer. Talk to your doctor about your risk for ovarian cancer. Screening for ovarian cancer is not recommended for most women.3 This is because testing can lead to “false positives.”  A false positive is a test result that says a woman has ovarian cancer when she does not.

Can ovarian cysts make it harder to get pregnant?

Typically, no. Most ovarian cysts do not affect your chances of getting pregnant. Sometimes, though, the illness causing the cyst can make it harder to get pregnant. Two conditions that cause ovarian cysts and affect fertility are:

How do ovarian cysts affect pregnancy?

Ovarian cysts are common during pregnancy. Typically, these cysts are benign (not cancerous) and harmless.4 Ovarian cysts that continue to grow during pregnancy can rupture or twist or cause problems during childbirth. Your doctor will monitor any ovarian cyst found during pregnancy.

Can I prevent ovarian cysts?

No, you cannot prevent functional ovarian cysts if you are ovulating. If you get ovarian cysts often, your doctor may prescribe hormonal birth control to stop you from ovulating. This will help lower your risk of getting new cysts.

More information about ovarian cysts

For more information on ovarian cysts, call the OWH Helpline at 800-994-9662 or contact the following organizations:

Sources

  1. Ross, E.K. (2013). Incidental Ovarian Cysts: When to Reassure, When to Reassess, When to Refer. Cleveland Clinic Journal of Medicine; 80(8): 503–514. Retrieved from 2013 article.

  2. NIH consensus conference (1995). Ovarian cancer: screening, treatment, and follow-up. NIH Consensus Development Panel on Ovarian Cancer. JAMA; 273: 491–497. Retrieved from 2013 article.

  3. U.S. Preventive Services Task Force (2012). Screening for Ovarian Cancer.

  4. Horowitz, N.S. (2011). Management of adnexal masses in pregnancy.Clinical Obstetrics & Gynecology; 54: 519–527.

This fact sheet was reviewed by:

Cheryl B. Iglesia, M.D., FACOG, Professor, Department of Obstetrics and Gynecology, Georgetown University School of Medicine; Director, Female Pelvic Medicine and Reconstructive Surgery, MedStar Washington Hospital Center; Food and Drug Administration Advisory Committee

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Oral health fact sheet

Celia's Story

I started having pain in my mouth about 10 months ago. At first I just ignored it. I hoped it would go away on its own. But it didn't. I told my daughter about it and she said, "Mom, you need to see a dentist." But I didn't make an appointment. I was afraid. I waited several more months and the pain got worse and worse. Then, my gums started bleeding when I brushed my teeth. Now I was really nervous to see the dentist. I was afraid and thought the treatment would hurt worse than the pain I was already having. Also, I felt embarrassed that I had waited so long to make an appointment. So my daughter made the appointment for me. She even went with me to the dentist. And do you know what? It wasn't bad at all! Dental treatments have gotten so much better! I explained to my dentist that I was very anxious, and she made sure that I was comfortable through my whole visit. Now I plan to schedule regular cleanings to keep myself healthy!

What is oral health?

The word "oral" refers to the mouth, which includes your teeth, gums, jawbone, and supporting tissues. Taking good care of your oral health can prevent disease in your mouth. Oral health can affect the health of your entire body. Good oral health does not just mean you have pretty teeth. Your whole mouth needs care to be in good health.

What are the most common oral health problems?

The most common oral health problems are cavities and gum disease.

Cavities
We are all at risk of tooth decay, or cavities. (Cavities look like chalky white and/or brown holes on your teeth). Bacteria (germs) that naturally live in our mouths use sugar in food to make acids. Over time, the acids destroy the outside layer of your teeth. Then cavities and other tooth harm occur.

Gum diseases
Gum diseases are infections caused by bacteria, along with mucus and other particles that form a sticky plaque on your teeth. Plaque that is left on teeth hardens and forms tartar. Gingivitis (jin-juh-VEYE-tuhss) is a mild form of gum disease. It causes red, swollen gums. It can also make the gums bleed easily. Gingivitis can be caused by plaque buildup. And the longer plaque and tartar stay on teeth, the more harm they do. Most gingivitis can be treated with daily brushing and flossing and regular cleanings at the dentist's office. This form of gum disease does not lead to loss of bone or tissue around the teeth. But if it is not treated, it can advance to periodontitis (pair-ee-oh-don-TEYE-tuhss). Then the gums pull away from the teeth and form infected "pockets." You may also lose supporting bone. If you have periodontitis, see your dentist for treatment. Otherwise your teeth may loosen over time and need to be removed.

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Your risk of gum disease is higher if you:

Plaque left on teeth hardens into tartar. As plaque and tartar build up, the gums pull away from the teeth and pockets form between the teeth and gums. Bone supporting the teeth may get infected and start to weaken.

The gums recede further, destroying more bone and the ligament around the tooth. Teeth may become loose and need to be removed.

Normal, healthy gums
Healthy gums and bone anchor teeth firmly in place.

Periodontitis
Plaque left on teeth hardens into tartar. As plaque and tartar build up, the gums pull away from the teeth and pockets form between the teeth and gums. Bone supporting the teeth may get infected and start to weaken.

Advanced periodontitis
The gums recede further, destroying more bone and the ligament around the tooth. Teeth may become loose and need to be removed.

What are some other problems I might have with my mouth?

Bad breath. Bad breath is also called halitosis (hal-lih-TOH-suhss). Bad-smelling breath can be caused by several things, including:

Practicing good oral hygiene and avoiding tobacco and some foods often helps people with bad-smelling breath. You may want to try using a tongue scraper to clean food from your tongue. You could also just brush your tongue with your toothbrush. But if doing so doesn't seem to help or if you always need mouthwash to hide bad breath, talk to your dentist.

Burning mouth. People with this condition describe a burning feeling in the mouth or tongue. It is most common in postmenopausal women. The cause is unknown, but might be linked to:

Talk to your doctor or dentist if you have burning mouth. Treatment depends on the cause — if it can be determined — and might include adjusting your dentures, vitamin supplements, or pain or other medicines.

Canker sores. These sores are small ulcers inside the mouth. They have a white or gray base and a red border. Women are more likely than men to have canker sores that recur. The cause of canker sores is unknown. Risk factors include:

Canker sores most often heal on their own in one to three weeks. See your dentist if you get a large sore (larger than a half inch, or about the size of a dime). You may need medicine to treat it.

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To help with pain:

No proven way exists to prevent canker sores. If you get them often, talk with your dentist.

Cold sores. These small, painful sores are caused by herpes simplex virus type 1. Once you are exposed to the virus, it can hide in your body for years. Things that trigger the virus and lead to cold sores include:

Cold sores can spread from person to person. They most often form on the lips and sometimes under the nose or chin. The sores heal in about 7 to 10 days without scarring. You can buy over-the-counter drugs to put on cold sores to help relieve pain. If you get cold sores a lot, talk with your doctor or dentist about a prescription for an antiviral drug. These drugs can help reduce healing time and the number of new sores.

Dry mouth. Dry mouth is also called xerostomia (ZEER-oh-STOM-mee-uh). This problem happens when you don't have enough saliva, or spit, in your mouth. Some reasons why people get dry mouth include:

Source: Prepared by the Office on Women's Health, HHS..

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