Women's Health Archive

Dysfunctional Uterine Bleeding

Questions to Discuss with Your Doctor:

• Do you have regular menstrual cycles?
• When was your last period?
• Is your bleeding always heavy or prolonged?
• How old were you when you started menstruating?
• How long ago did you develop abnormal bleeding?
• Are you sexually active?
• How many times have you been pregnant?
• What was the outcome of each pregnancy (live births, miscarriages, cesarean sections)?
• Have you ever had difficulty getting pregnant?
• What medications are you taking (including over-the-counter drugs and herbal remedies such as ginseng)?
• Are you taking hormone replacement therapy or birth control pills?
• Have you ever had medications injected (Depo-Provera or Norplant) for birth control?
• Have you ever taken estrogen or tamoxifen?
• Are you taking warfarin or other blood thinners?
• Have you ever had an abnormal Pap smear?

Your Doctor Might Examine the Following Body Structures or Functions:

• Blood pressure, heart rate, weight
• Abdominal examination
• Pelvic exam

Your Doctor Might Order the Following Lab Tests or Studies:

• Pregnancy test
• Blood tests such as complete blood count, coagulation (clotting) studies, and certain hormone tests (such as thyroid stimulating hormone, cortisol, prolactin, follicle stimulating hormone, testosterone)
• Pelvic ultrasound
• Pap smear
• Endometrial biopsy.

Pregnancy: 1st Trimester

Questions to Discuss with Your Doctor:

• Your age and how it will affect your pregnancy.
• Have you been pregnant before? If so, what was the outcome of each pregnancy. Did you have a full-term pregnancy (your baby was born close to your due date)? Did you give birth via a vaginal delivery or a cesarean section ("C-section") surgery? If you had a C-section, what type of C-section was it? Did any of your pregnancies end in miscarriage, voluntary abortion, or an ectopic (tubal) pregnancy?
• Does this pregnancy come at a good time for you?
• When was the first day of your last menstrual period?
• What is the usual length of your menstrual cycle?
• Do you have any medical problems such as diabetes, high blood pressure, thyroid problems, asthma, tuberculosis, epilepsy, or heart disease?
• Have you ever had any sexually transmitted infections such as gonorrhea, herpes, syphilis, or human papilloma virus (HPV)?
• Do any medical problems tend to run in your family such as sickle cell anemia, cystic fibrosis, Down syndrome, or hemophilia?
• Are you taking any medications (including over-the-counter medications)? If so, what are they?
• Do you smoke? If so, how many packs per day?
• In an average week, how many alcoholic beverages do you consume?
• Do you use any recreational drugs?
• Did you have any problems getting pregnant?
• Do you eat a well-balanced diet? Are you taking any vitamins, including folic acid (folate)?
• Do you exercise regularly?
• What is your home situation like? Who do you live with? Is your partner supportive of this pregnancy? If not, has your partner hit or threatened you?
• Are you having any problems with morning sickness (that is, nausea and vomiting)?
• Are you having any bleeding from your vagina?

Your Doctor Might Examine the Following Body Structures or Functions:

• Temperature, blood pressure, pulse, weight
• Chest exam
• Heart exam
• Abdominal exam
• Pelvic exam with Pap smear and cervical cultures
• Leg exam

Your Doctor Might Order the Following Lab Tests or Studies:

• Confirm pregnancy with blood or urine test
• Complete blood count and blood type
• Blood tests for syphilis, rubella antibodies, hepatitis B, HIV
• Urinalysis
• Portable Doppler instrument or stethoscope to measure fetal heart sounds
• Urine culture
• "Triple screen" (also known as "AFP-3" or "Enhanced AFP"
• Genetic testing

Pregnancy: 3rd Trimester

Questions to Discuss With Your Doctor:

• Do you have adequate support at home from family or friends?
• How do you feel? Have you had any problems since your last visit?
• Have you had any vaginal bleeding or spotting?
• Have you had any pain or uterine cramping?
• Have you had any discharge or leakage of fluid from your vagina?
• Have you noticed swelling of your face or ankles?
• Have you had any problems with your vision?
• Are you getting frequent headaches?
• Have you noticed a change in the frequency or intensity of fetal movement?
• Are you planning to breast-feed or bottle-feed?
• Have you selected a pediatrician for your baby?
• Are you taking classes on labor and delivery?
• Have you added health insurance coverage for your new baby?
• Have you purchased a special car seat to hold your baby when riding in your car?
• Have you decided on whether the baby will have a circumcision, if a boy?
• Have you talked with your doctor about the length of your stay in the hospital?
• Do you know the signs of going into labor so that you can call your doctor when labor begins? (These include uterine contractions and rupture of the membranes).

Your Doctor Might Examine the Following Body Structures or Functions:

• Breasts (to see if your nipples are inverted)
• Abdominal exam, including measurement of the height of your fundus (top of the uterus)

Your Doctor Might Order the Following Lab Tests or Studies:

• Culture of the vagina and rectum for Group B streptococcus bacteria
• Fetal ultrasound

Pregnancy: 2nd Trimester

Questions to Discuss with Your Doctor:

• How do you feel? Have you had any problems since your last visit?
• Have you had any vaginal bleeding or spotting?
• Have you had persistent vomiting?
• Have you had any pain or uterine cramping?
• Have you noticed swelling of your face or fingers?
• Have you had any problems with your vision?
• Are you getting frequent headaches?
• Have you had any vaginal discharge?
• Have you noticed fetal movement?
• Are you planning to breast-feed or bottle-feed?

Your Doctor Might Examine the Following Body Structures or Functions:

• Blood pressure, weight
• Abdominal exam including measurement of the height of your fundus (top of the uterus) and using a portable Doppler instrument or stethoscope to measure fetal heart sounds

Your Doctor Might Order the Following Lab Tests or Studies:

• Consider repeat complete blood count
• Fetal ultrasound
• Glucose tolerance test

Your Doctor Might Order the Following Treatment:

• Rhogam (Rh-Immunoglobulin), if your blood type is Rh negative (see p. 920)

Vaginitis

Questions to Discuss with Your Doctor:

• How long have you had this vaginal discomfort?
• Does it itch or burn?
• Do you have vaginal discharge? Does it have a bad odor? What is the consistency?
• Are you pregnant?
• Are you sexually active?
• Is sexual intercourse painful?
• Do you have pain or burning with urination?
• Are you urinating more frequently?
• Do you have urinary incontinence?
• Are you post-menopausal?
• Do you have vaginal dryness?
• Do you have diabetes?
• Have you recently taken antibiotics or corticosteroids?
• Is your immune system suppressed in any way?
• Do you take birth-control pills?
• Do you wear tight pants or synthetic fabrics (nylon)? (These are all predisposing factors for yeast infections).
• Have you or your partner ever had a sexually transmitted disease?
• Do you have fevers, chills, abdominal pain, joint pain, or a rash?

Your Doctor Might Examine the Following Body Structures or Functions:

• Abdominal examination
• Pelvic examination

Your Doctor Might Order the Following Lab Tests or Studies:

• Sample of the vaginal discharge to examine under a microscope (wet smear)
• Cultures of the vaginal discharge

Irregular Menstrual Periods

Questions to Discuss with Your Doctor:

• Have you been experiencing high levels of stress?
• How much do you exercise?
• Have you ever had an eating disorder?
• Have you lost weight recently?
• Have you been intolerant of heat or cold.
• Have you had rapid heartbeats, dry skin, hair loss, constipation or diarrhea, or a change in weight (these are symptoms of thyroid abnormalities, which can cause irregular periods)?
• Do you have abnormal body hair?
• Have you gained weight?
• Do you have regular menstrual cycles?
• Is your bleeding always heavy or prolonged?
• How old were you when you started menstruating?
• How long ago did you develop irregular periods?
• When you do have your period, is it accompanied by symptoms such as abdominal cramping, mood changes, and bloating?
• Are you sexually active?
• When was your last period?
• How many times have you been pregnant?
• What was the outcome of each pregnancy (live births, miscarriages, cesarean sections)?
• Have you ever had difficulty getting pregnant?

Your Doctor Might Examine the Following Body Structures or Functions:

• Heart rate, blood pressure, and weight
• Heart and lungs
• Pelvic examination

Your Doctor Might Order the Following Lab Tests or Studies:

• Pregnancy test
• Blood tests for certain hormone levels (thyroid stimulating hormone, cortisol, prolactin, follicle stimulating hormone, 17-hydroxyprogesterone, testosterone, DHEA)
• 24-hour urine collection for free cortisol
• Pelvic ultrasound
• Pap smear (see p. 1066)

The devastation left in the wake of recent natural disaster and terror attacks provides graphic evidence of just how destructive they can be. Residents can be forced to evacuate from their homes at a moment's notice in an atmosphere of panic and chaos, and many of them will not be able to return for months. In light of these potential disasters and their aftermath, it has become clear that preparation for the unknown is of the utmost importance.

No matter where you live in the United States, you are vulnerable to some sort of natural disaster such as a blizzard, earthquake, flood, hurricane, or tornado. In addition, terrorist attacks on America are also possible. Both natural disasters and terrorist attacks can disrupt power, communication, and transportation for days or even longer.

The belief that teens should have the right to an abortion without parental knowledge or consent is supported by a group of medical associations, and is based primarily on concerns about safety and the medical consequences of requiring that parents be informed.

Ovarian cancer has long been called a "silent killer," because symptoms are thought to develop only after the disease has reached an advanced stage and is largely incurable. But health experts have identified a set of physical complaints that often occur in women who have ovarian cancer and may be early warning signs. These symptoms are very common, and most women with them do not have ovarian cancer. But for the women who do, the hope is that greater awareness will lead to earlier diagnosis and treatment.

Four symptoms are more likely to occur in women with ovarian cancer than in women in the general population. These symptoms are bloating or increased abdominal size; pelvic or abdominal pain; difficulty eating or feeling full quickly; and urinary frequency or urgency.

Inflamed vaginal tissue may not be something most women want to talk about, but it can be painful and life altering for those who have it. Atrophic vaginitis, the medical term for this condition, occurs as a result of deterioration of the vaginal tissue. It's a common condition in postmenopausal women because as estrogen levels drop, the tissue that lines the vagina becomes thinner and more easily damaged. The top layer of cells is often lost entirely, exposing the layer below, which is more vulnerable to inflammation or infection. Vaginal secretions also decline, which can make intercourse painful. Women with atrophic vaginitis may also experience vaginal itching, burning, frequent urination, or vaginal discharge.

Women can treat this condition topically with estrogen creams, tablets (Vagifem), or an estrogen-releasing ring placed in the vagina (Estring). Oral estrogen, available with a doctor's prescription, will also restore vaginal tissue. Vaginal lubricants offer an alternative for women wary of using estrogen. Moisturizers such as Replens, Astroglide, and Lubrin can reduce symptoms and make sexual intercourse more comfortable. They are available over the counter.