Health Risks

Breast Cancer

General Information About Breast Cancer Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.

The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes, which have many smaller sections called lobules. Lobules end in dozens of tiny bulbs that can produce milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts.

Each breast also has blood vessels and lymph vessels. The lymph vessels carry an almost colorless fluid called lymph. Lymph vessels lead to organs called lymph nodes. Lymph nodes are small bean-shaped structures that are found throughout the body. They filter substances in a fluid called lymph and help fight infection and disease. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest.

The most common type of breast cancer is ductal carcinoma, which begins in the cells of the ducts. Cancer that begins in the lobes or lobules is called lobular carcinoma and is more often found in both breasts than are other types of breast cancer. Inflammatory breast cancer is an uncommon type of breast cancer in which the breast is warm, red, and swollen.

Age and health history can affect the risk of developing breast cancer.

Anything that increases your chance of getting a disease is called a risk factor. Risk factors for breast cancer include the following: Older age. Menstruating at an early age. Older age at first birth or never having given birth. A personal history of breast cancer or benign (noncancer) breast disease. A mother or sister with breast cancer. Treatment with radiation therapy to the breast/chest. Breast tissue that is dense on a mammogram. Taking hormones such as estrogen and progesterone. Drinking alcoholic beverages. Being white. Breast cancer is sometimes caused by inherited gene mutations (changes). The genes in cells carry the hereditary information that is received from a person’s parents. Hereditary breast cancer makes up approximately 5% to 10% of all breast cancer. Some altered genes related to breast cancer are more common in certain ethnic groups.

Women who have an altered gene related to breast cancer and who have had breast cancer in one breast have an increased risk of developing breast cancer in the other breast. These women also have an increased risk of developing ovarian cancer, and may have an increased risk of developing other cancers. Men who have an altered gene related to breast cancer also have an increased risk of developing this disease. (For more information, refer to the PDQ summary on Male Breast Cancer Treatment.)

Tests have been developed that can detect altered genes. These genetic tests are sometimes done for members of families with a high risk of cancer. (Refer to the PDQ summaries on Screening for Breast Cancer, Prevention of Breast Cancer, and Genetics of Breast and Ovarian Cancer for more information.)

Tests that examine the breasts are used to detect (find) and diagnose breast cancer.

A doctor should be seen if changes in the breast are noticed. The following tests and procedures may be used: Mammogram: An x-ray of the breast. Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If a lump in the breast is found, the doctor may need to cut out a small piece of the lump. Four types of biopsies are as follows: Excisional biopsy: The removal of an entire lump or suspicious tissue.

Incisional biopsy: The removal of part of a lump or suspicious tissue.

Core biopsy: The removal of part of a lump or suspicious tissue using a wide needle.

Needle biopsy: The removal of part of a lump, suspicious tissue, or fluid, using a thin needle. This procedure is also called a fine-needle biopsy.

Estrogen and progesterone receptor test: A test to measure the amount of estrogen and progesterone (hormones) receptors in cancer tissue. If cancer is found in the breast, tissue from the tumor is checked in the laboratory to find out whether estrogen and progesterone could affect the way cancer grows. The test results show whether hormone therapy may stop the cancer from growing. Certain factors affect prognosis (chance of recovery) and treatment options.The prognosis (chance of recovery) and treatment options depend on the following: The stage of the cancer (whether it is in the breast only or has spread to lymph nodes or other places in the body). The type of breast cancer. Estrogen-receptor and progesterone-receptor levels in the tumor tissue. A woman’s age, general health, and menopausal status (whether a woman is still having menstrual periods). Whether the cancer has just been diagnosed or has recurred (come back).

Stages of Breast Cancer After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body.

The process used to find out whether the cancer has spread within the breast or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.

The following stages are used for breast cancer: Stage 0 (carcinoma in situ)There are 2 types of breast carcinoma in situ: Ductal carcinoma in situ (DCIS) is a noninvasive, precancerous condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast. In some cases, DCIS may become invasive cancer and spread to other tissues, although it is not known at this time how to predict which lesions will become invasive. Lobular carcinoma in situ (LCIS) is a condition in which abnormal cells are found in the lobules of the breast. This condition seldom becomes invasive cancer; however, having lobular carcinoma in situ in one breast increases the risk of developing breast cancer in either breast. Stage I In stage I, the tumor is 2 centimeters or smaller and has not spread outside the breast. Stage IIAIn stage IIA: no tumor is found in the breast, but cancer is found in the axillary lymph nodes (the lymph nodes under the arm); or the tumor is 2 centimeters or smaller and has spread to the axillary lymph nodes; or the tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to the axillary lymph nodes. Stage IIBIn stage IIB, the tumor is either: larger than 2 centimeters but not larger than 5 centimeters and has spread to the axillary lymph nodes; or larger than 5 centimeters but has not spread to the axillary lymph nodes. Stage IIIAIn stage IIIA: no tumor is found in the breast, but cancer is found in axillary lymph nodes that are attached to each other or to other structures; or the tumor is 5 centimeters or smaller and has spread to axillary lymph nodes that are attached to each other or to other structures; or the tumor is larger than 5 centimeters and has spread to axillary lymph nodes that may be attached to each other or to other structures. Stage IIIBIn stage IIIB, the cancer may be any size and: has spread to tissues near the breast (the skin or chest wall, including the ribs and muscles in the chest); and may have spread to lymph nodes within the breast or under the arm. Stage IIICIn stage IIIC, the cancer: has spread to lymph nodes beneath the collarbone and near the neck; and may have spread to lymph nodes within the breast or under the arm and to tissues near the breast. Stage IIIC breast cancer is divided into operable and inoperable stage IIIC.

In operablestage IIIC, the cancer: is found in 10 or more of the lymph nodes under the arm; or is found in the lymph nodes beneath the collarbone and near the neck on the same side of the body as the breast with cancer; or is found in lymph nodes within the breast itself and in lymph nodes under the arm. In inoperablestage IIIC breast cancer, the cancer has spread to the lymph nodes above the collarbone and near the neck on the same side of the body as the breast with cancer. Stage IVIn stage IV, the cancer has spread to other organs of the body, most often the bones, lungs, liver, or brain.

Tumor Size Increase (Stage by Stage).

Inflammatory Breast Cancer In inflammatory breast cancer, the breast looks red and swollen and feels warm. The redness and warmth occur because the cancer cells block the lymph vessels in the skin. The skin of the breast may also show the pitted appearance called peau d’orange (like the skin of an orange). Inflammatory breast cancer may be stage IIIB, stage IIIC, or stage IV.

Recurrent Breast Cancer Recurrent breast cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the breast, in the chest wall, or in other parts of the body.

Treatment There are different types of treatment for patients with breast cancer.

Different types of treatment are available for patients with breast cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Four types of standard treatment are used: SurgeryMost patients with breast cancer have surgery to remove the cancer from the breast. Some of the lymph nodes under the arm are usually taken out and looked at under a microscope to see if they contain cancer cells. Breast-conserving surgery, an operation to remove the cancer but not the breast itself, includes the following:

Lumpectomy: Surgery to remove a tumor (lump) and a small amount of normal tissue around it. Partial mastectomy: Surgery to remove the part of the breast that has cancer and some normal tissue around it. This procedure is also called a segmental mastectomy. Patients who are treated with breast-conserving surgery may also have some of the lymph nodes under the arm removed for biopsy. This procedure is called lymph node dissection. It may be done at the same time as the breast-conserving surgery or after. Lymph node dissection is done through a separate incision.

Other types of surgery include the following: Total mastectomy: Surgery to remove the whole breast that has cancer. This procedure is also called a simple mastectomy. Some of the lymph nodes under the arm may be removed for biopsy at the same time as the breast surgery or after. This is done through a separate incision. Modified radical mastectomy: Surgery to remove the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles. Radical mastectomy: Surgery to remove the breast that has cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm. This procedure is sometimes called a Halsted radical mastectomy. Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy, chemotherapy, or hormone therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.

If a patient is going to have a mastectomy, breast reconstruction (surgery to rebuild a breast’s shape after a mastectomy) may be considered. Breast reconstruction may be done at the time of the mastectomy or at a future time. The reconstructed breast may be made with the patient’s own (nonbreast) tissue or by using implants filled with saline or silicone gel. The Food and Drug Administration (FDA) has decided that breast implants filled with silicone gel may be used only in clinical trials.

Radiation therapy Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated. Hormone therapy

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working.

Hormone therapy with tamoxifen is often given to patients with early stages of breast cancer and those with metastatic breast cancer (cancer that has spread to other parts of the body). Hormone therapy with tamoxifen or estrogens can act on cells all over the body and may increase the chance of developing endometrial cancer. Women taking tamoxifen should have a pelvic exam every year to look for any signs of cancer. Any vaginal bleeding, other than menstrual bleeding, should be reported to a doctor as soon as possible.

Hormone therapy with an aromatase inhibitor is given to some postmenopausal women who have hormone-dependent breast cancer. Hormone-dependent breast cancer needs the hormone estrogen to grow. Aromatase inhibitors decrease the body’s estrogen by blocking an enzyme called aromatase from turning androgen into estrogen. Aromatase inhibitors are also being tested in clinical trials to compare them to hormone therapy with tamoxifen for the treatment of metastatic breast cancer.

New types of treatment are being tested in clinical trials. These include the following: Sentinel lymph node biopsy followed by surgery Sentinel lymph node biopsy is the removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. It is the first lymph node the cancer is likely to spread to from the tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes. After the sentinel lymph node biopsy, the surgeon removes the tumor (breast-conserving surgery or mastectomy). High-dose chemotherapy with stem cell transplant

High-dose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body’s blood cells.

Studies have shown that high-dose chemotherapy followed by stem cell transplant does not work better than standard chemotherapy in the treatment of breast cancer. Doctors have decided that, for now, high-dose chemotherapy should be tested only in clinical trials. Before taking part in such a trial, women should talk with their doctors about the serious side effects, including death, that may be caused by high-dose chemotherapy.

Monoclonal antibodies as adjuvant therapy Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Monoclonal antibodies are also used in combination with chemotherapy as adjuvant therapy.

Trastuzumab (Herceptin) is a monoclonal antibody that blocks the effects of the growth factor protein HER2, which transmits growth signals to breast cancer cells. About one-fourth of patients with breast cancer have tumors that may be treated with trastuzumab combined with chemotherapy.


Osteoporosis is a disease of bone in which the bone mineral density (BMD) is reduced, bone micro architecture is disrupted, and the amount and variety of non-collagenous proteins in bone is altered. Osteoporotic bones are more at risk of fracture. Osteoporosis is defined by the World Health Organization (WHO) in women as a bone mineral density 2.5 standard deviations below peak bone mass (20-year-old sex-matched healthy person average); the term “established osteoporosis” includes the presence of a fragility fracture. While treatment modalities are becoming available (such as the bisphosphonates), prevention is still considered the most important way to reduce fracture. Due to its hormonal component, more women, particularly after menopause, suffer from osteoporosis than men. In addition it may be caused by various hormonal conditions, smoking and medications (specifically glucocorticoids) as well as many chronic diseases.

Clinical Picture

Osteoporotic fractures are those that occur under slight amount of stresses that would not normally lead to fractures in nonosteoporotic people. Typical fractures occur in the vertebral column, hip and wrist. Collapse of a vertebra (“compression fracture”) can cause one or a combination of the following: acute onset of back pain; a hunched forward or bent stature; loss of height; limited mobility and possibly disability.

Fractures of the long bones acutely impair mobility and may require surgery. Hip fracture, in particular, usually requires prompt surgery, as there are serious risks associated with a hip fracture, such as deep vein thrombosis and a pulmonary embolism.

While osteoporosis occurs in men, especially elderly men, and pre-menopausal women, the problem is overwhelmingly prevalent in postmenopausal women.

Risk Factors
Risk factors for osteoporotic fracture can be split between modifiable and non-modifiable:

Nonmodifiable: history of fracture as an adult, family history of fracture, female sex, advanced age, European or Asian ancestry, and dementia
Potentially modifiable: prolonged intake of the prescription drug prednisone or any other glucocortioid, tobacco smoking, low body mass index, estrogen defic iency, early menopause (<45 years) or bilateral oophorectomy, premature ovaria n failure, prolonged premenopausal amenorrhea (>1 year), low calcium and vitam in D intake, alcoholism, impaired eyesight despite adequate correction, high risk of falls or recurrent falls, inappropriate physical activity (i.e. too little or also if done in excess), poor health/frailty. Coeliac disease can l ead those with an otherwise adequate calcium intake to develop osteoporosis due to the inability to absorb calcium. Osteoporotic fracture may indeed be the event that leads to diagnosis that coeliac disease (which affects around one in a hundred people in the West) has affected the patient for many years. The effects of soft drinks (containing phosphoric acid) are debatable; soft drinks may merely displace calcium-containing drinks from the diet.
A strong association between cadmium, lead and bone disease has also been established. Low level exposure to cadmium is associated with an increased loss of bone mineral density readily in both genders, leading to pain and increased risk of fractures, especially in elderly and in females. Higher cadmium exposure results in osteomalacia (softening of the bone).

Disease Burden
It is estimated that 1 in 3 women and 1 in 12 men over the age of 50 worldwide have osteoporosis. It is responsible for millions of fractures annually, mostly involving the lumbar vertebrae, hip, and wrist.

Risk factors for osteoporosis:

Menopause before age 48
Surgery to remove ovaries before menopause
Not getting enough calcium
Not getting enough exercise
Osteoporosis in your family
Alcohol abuse
Thin body and small bone frame
Fair skin (Caucasian or Asian race)
Long-term use of oral steroids

Tips to keep Bones Strong

Eat a well-balanced diet with at least 1,000 mg of calcium a day.
Quit smoking. Smoking makes osteoporosis worse.
Talk to your doctor about HRT or other medicines to prevent or treat osteoporosis.


Dual energy X-ray absorptiometry (DXA, formerly DEXA) is considered the gold standard for diagnosis of osteoporosis. Diagnosis is made when the bone mineral density is less than or equal to 2.5 standard deviations below that of a young adult reference population. This is translated as a T-score. The World Health Organization has established diagnostic guidelines as T-score -1.0 or greater is “normal”, T-score between -1.0 and -2.5 is “low bone mass” (or “osteopenia”) and -2.5 or below as osteoporosis. When there has also been a low trauma or osteoporotic fracture, defined as one that occurs as a result of a fall from a standing height, the term “severe or established” osteoporosis is used. This is very important, because a person who has already had a fracture is at least 4 times as likely to have another fracture as another person of the same age and bone density. The absolute risk of fracture depends strongly on age as well as bone density and factors which affect strength and falling.

The rate of bone turnover can be measured with urine NTx, a byproduct of bone cartilage breakdown. Urine NTx greater than 40 may indicate osteoporosis.

In order to differentiate between “primary” (post-menopausal, regardless of age, or senile – related to age) and “secondary” osteoporosis, blood tests and X-rays are usually done to rule out cancer with metastasis to the bone, multiple myeloma, Cushing’s disease and other causes mentioned above.

The U.S. Preventive Services Task Force (USPSTF) recommends that all women 65 years of age or older should be screened with bone densitometry (PMID 12230355). The Task Force recommends screening women 60 to 64 years of age who are at increased risk. The best risk factor for indicating increased risk is lower body weight (weight < 70 kg). Treatment Patients at risk for osteoporosis (e.g. steroid use) are generally treated with vitamin D and calcium supplements. In renal disease, more active forms of Vitamin D such as paracalcitol or (1,25-dihydroxycholecalciferol or calcitriol which is the main biologically active form of vitamin D) is used, as the kidney cannot adequately generate calcitriol from calcidiol (25-hydroxycholecalciferol) which is the storage form of vitamin D. In osteoporosis (or a very high risk), bisphosphonate drugs are prescribed. The most often prescribed bisphosphonates are presently sodium alendronate (Fosamax) 10 mg a day or 70 mg once a week, risedronate (Actonel) 5mg a day or 35mg once a week or and ibandronate (Boniva once a month). Other medicines prescribed for prevention of osteoporosis include raloxifene (Evista), a selective estrogen receptor modulator (SERM). Estrogen replacement remains a good treatment for prevention of osteoporosis but, at this time, is not recommended unless there are other indications for its use as well. There is uncertainty and controversy about whether estrogen should be recommended in women in the first decade after the menopause; hopefully new research will provide guidance. Recently, teriparatide (Forteo, recombinant parathyroid hormone 1-34) has been shown to be effective in osteoporosis. It is used mostly for patients who have already fractured, have particularly low BMD or several risk factors for fracture or cannot tolerate the oral bisphosphonates. It is given as a daily injection with the use of a pen-type injection device. Teriparatide is only licensed for treatment if bisphosphonates have failed or are contraindicated (however, this differs by country and is not required by the FDA in the USA. However, patients with previous radiation therapy, or Paget's disease, or young patients should avoid this medication). Oral Strontium ranelate (Protelos - Servier) is the first in a new class of drugs called a Dual Action Bone Agents (DABA's), and has proven efficacy in the prevention of vertebral and non-vertebral fractures (including hip fracture). Strontium Ranelate works by stimulating the proliferation of osteoblast (bone building) cells (there is some debate about this), and inhibiting the proliferation of osteoclast (bone absorbing) cells. This means that strontium Ranelate increases BMD by forming new bone, rather than just preserving existing bone. In comparison to bisphosphonates which only act on one aspect of bone remodeling, strontium ranelate also preserves bone turnover, allowing the microarchitecture of the bone to be continuously repaired as it would in healthy bone. Strontium ranelate is taken as a 2g oral suspension daily, and is licensed for the treatment of osteoporosis to prevent vertebral and hip fracture. Strontium ranelate has show significant efficacy at reducing both vertebral, and non-vertebral fractures in patients over the age of 80, who are the most at risk where osteoporosis is concerned. Strontium ranelate has side effect benefits over the bisphosphonates, as it does not cause any form of upper GI side effect, which is the most common cause for medication withdrawal in osteoporosis. Changes to lifestyle factors and diet are also recommended; the "at-risk" patient should include 1200 to 1500mg of calcium daily either via dietary means (for instance, an 8 oz glass of milk contains approximately 300 mg of calcium) or via supplementation. The body will absorb only about 500 mg of calcium at one time and so intake should be spread throughout the day. However, the benefit of supplementation of calcium alone remains, to a degree, controversial since several nations with high calcium intakes through milk-products (e.g. the USA, Sweden) have some of the highest rates of osteoporosis worldwide. A few studies even suggested an adverse effect of calcium excess on bone density and blamed the milk industry for misleading customers. Some nutrionists assert that excess consumption of dairy products causes acification, which leeches calcium from the system, and argue that vegetables and nuts are a better source of calcium and that in fact milk products should be avoided. This theory has no proof from scientific clinical studies. Similarly, nutritionists believe that excess caffeine consumption can also contribute to leaching calcium from the bones. In any case, thirty minutes of weight-bearing exercise such as walking or jogging, three times a week, has been shown to increase bone mineral density, and reduce the risk of falls by strengthening the major muscle groups in the legs and back. In a recent study that examined the relationship between calcium supplementation and clinical fracture risk in an elderly population, there was a significant decrease in fracture risk in patients that received calcium supplements versus those that received placebo. However, this benefit only applied to patients who were compliant to their treatment regimen. The very large Women's Health Initiative study did not find a fracture benefit from calcium and vitamin D supplementation, but these women were already taking (on average) 1200mg/day of calcium. Increasing vitamin D intake has been shown to reduce fractures up to twenty-five percent in older people, according to recent studies. There is some evidence to suggest bone density benefits from taking the following supplements (in addition to calcium and vitamin D): boron, magnesium, zinc, copper, manganese, silicon, strontium, folic acid, and vitamins B6, C, and K. This is weak evidence and quite controversial. Exercise is of great importance for people suffering from the osteoporosis syndrome. Regular load bearing exercises can help both to delay the onset of the condition, and to relieve pain; this is because regular movement can help to keep joints supple. It is important to be shown how to do exercises for osteoporosis by a professional physiotherapist; this will ensure that the sufferer gains full benefits and does not cause further damage. Sufferers of osteoporosis must learn to judge their own pain thresholds and exercise accordingly. Source: American Academy of Family Physicians [/learn_more] [learn_more caption="Menstrual Periods - A Sign of Health" ] Menstrual Periods Women shouldn't "curse" their periods, they should celebrate them! Why? Because they are a positive sign of health - and not just gynecological health but of general health. Getting your period is a minor miracle of biology. It means that your pituitary gland (in the brain) must send chemical messengers to your ovaries at the right time, and when your ovaries get the message they must produce their hormones on schedule. In order to make and store the hormones, you must have a critical level of cholesterol and of body fat. So, if you get a period, you know that some important things are right with your body. Periods are not only a sign of gynecological health; they tell you that you are producing adequate amounts of the very important hormone, estrogen. Hundreds of cellular functions throughout the body are affected by estrogen. When estrogen levels are too low, women may get menopause-like symptoms: hot flashes, urinary frequency, and vaginal dryness. More importantly, young women, who are in the bone building phase of their lives, need estrogen and other elements for this to occur. If estrogen levels stay too low for months or years, you may begin to LOSE bone, particularly in your hips and spine. Estrogen also has many protective effects in arteries and skin and there is growing evidence of benefits to the brain. Periods also tell you that you are probably producing enough androgens, including testosterone (which is often thought of as a male hormone but is normally produced in females too). Too little testosterone can negatively affect bone, muscle strength, and sex drive and response. Irregular Cycles: When you first start menstruating you may have an irregular menstrual pattern. This is normal. It may take as long as two years before it regulates. You may wonder why a woman, who already has a regular cycle, might experience menstrual irregularity, or why she might stop menstruating altogether. The most common reason for cessation of periods is pregnancy. But if this is not the situation, there are many other conditions that may be to blame. Some common causes are anorexia or even prolonged, intense dieting and/or very intense exercising. As mentioned above, women need a certain amount of body fat for adequate hormone levels; being ultra lean can create medical problems for women. Other causes of lack of periods, such as thyroid or pituitary irregularities, require investigation by a doctor. We don't want to alarm women whose periods are irregular or who skip a period altogether now and then. You should probably consult a doctor if you normally menstruate every month and find that you have missed two periods in a row. Most likely you will be told that everything is okay. It may turn out that you are having a cycle in which no egg was released and your doctor may suggest taking progesterone (another female hormone) for 12 days to induce a flow. If no progesterone is taken, your next period could be very heavy. Last but not least, remember that your period is one aspect of being a female, something we hope you can celebrate even more often than once a month. How can you be ready for your period if you don't know when it's coming? It's like carrying an umbrella in case it might rain -- just carry a tampon or pad with you. For extra insurance, wear a pantiliner for the days leading up to your period. Since tampons are small, they'll also fit easily in your purse. If you're caught off guard, don't be shy - ask a friend if she has any pads or tampons with her. The school nurse, secretary, or a physical education or health teacher might be able to help, too. What happens if you start your period and you don't have protection? As a short-term solution, fold some toilet tissue and put it in your underwear to absorb the flow. Your period usually starts with just a few drops of blood, so you have time to get the right protection. What do you do if you start menstruating in school? If your period comes unexpectedly, no matter where you are, don't panic. At school, your teachers and school nurse know all about what's happening and usually can provide you with "emergency" menstrual protection. How Long Will My Period/Cycle Last? When you first start menstruating, the length of your period won't be regular -- it could last one day or 10 days. The average length of a period is 5-7 days. When you first start to menstruate, the cycle could be very irregular; starting, stopping and starting again. For example, you could have one period and then wait as long as six months for the next one! This isn't unusual. Until your body adjusts to your cycle, your period may be unpredictable. But after that, your menstrual cycle should be fairly regular during most of your menstruating years. If your period continues to be very irregular, you should see your doctor. The length of time between periods can be anywhere from 21-35 days. Pads or Tampons--What's Right for You? Pads Because pads are easy to use, most girls use pads when they first start their periods. Pads are the right choice for girls who want external protection. There are lots of features that may influence what kind of pad is right for you. Some girls like the ultra options that are available while others prefer the feeling of a thicker pad. Girls with smaller bodies might choose a slender pad. And heavy sleepers might like overnight pads for extra security. Tampons Many girls like the discretion and convenience of tampons, which are also easy to use. They choose tampons because they don't show through clothes and you can do things like swimming while wearing them. Tampax Tampons also have features for personal protection. For women with heavy flow there are extra absorbency tampons. For smaller girls there are slender options. Some girls are scared to try tampons. If you're ready to try tampons, relax. If the first try doesn't work you'll have plenty of time to get used to them. Pantiliners Many girls use Pantiliners through out the month. They like the freshness of daily protection. Other girls find that they're the right back-up for a tampon or for light flow days. Selecting a feminine protection product is a personal decision. It may take some trial runs to figure out what products suit you best. Source [/learn_more] [learn_more caption="Menstrual Abnormalities " ] Menorrhagia: Heavy Flow Menorrhagia is an abnormally heavy and prolonged menstrual period. Causes may be due to abnormal blood clotting, disruption of normal hormonal regulation of periods or disorders of the endometrial lining of the womb. Depending upon the cause, it may be associated with abnormally painful periods (dysmenorrhoea). Signs and symptoms: Normal ovulation The signs and symptoms of menorrhagia may include: Menstrual flow that soaks through one or more sanitary pads or tampons every hour for several consecutive hours The need to use double sanitary protection to control your menstrual flow The need to change sanitary protection during the night Menstrual period that lasts longer than seven days Menstrual flow that includes large blood clots Heavy menstrual flow that interferes with your regular lifestyle Constant pain in your lower abdomen during menstrual period Irregular menstrual periods Tiredness, fatigue or shortness of breath (symptoms of anemia). Causes: In some cases the cause of heavy menstrual bleeding is unknown, but a number of conditions may cause menorrhagia. Common causes include: Hormonal imbalance. In a normal menstrual cycle, a balance between the hormones estrogen and progesterone regulates the buildup of the lining of the uterus (endometrium), which you shed during menstruation. If a hormonal imbalance occurs, the endometrium develops in excess and eventually sheds by way of heavy menstrual bleeding. Hormonal imbalance occurs most often in adolescent girls experiencing their menstrual periods for the first time and in women approaching menopause. Menorrhagia caused by certain conditions involving hormonal imbalance, such as thyroid disease, often can be controlled with hormone medications. However, improper use of hormone medications can also be a direct cause of menorrhagia. Uterine fibroids. These noncancerous (benign) tumors of the uterus appear during your childbearing years. Uterine fibroids may cause heavier than normal or prolonged menstrual bleeding. Together, hormonal imbalance and uterine fibroids account for about 80 percent of all cases of menorrhagia. Other causes may include: Polyps. The development of small benign growths on the uterine wall (uterine polyps) may cause heavy or prolonged menstrual bleeding. Polyps of the uterus most commonly occur in women of reproductive age as the result of excessive hormone production or consumption and can lead to bleeding not associated with menstruation (spotting). Ovarian cysts. These fluid-filled sacs or pockets occur within or on the ovary. Ovarian cysts are often benign and rarely cause menstrual irregularities, including menorrhagia. Dysfunction of the ovaries. Failure of the ovaries to produce, mature or release eggs (anovulation) may cause hormonal imbalance and result in menorrhagia. Adenomyosis. This condition occurs when glands from the endometrium become embedded in the uterine muscle, often causing heavy bleeding and pain. Adenomyosis is most likely to develop if you're a middle-aged woman who has had many children. Intrauterine device (IUD). Menorrhagia is a well-known side effect of using an intrauterine device for birth control. When an IUD is the cause of excessive menstrual bleeding, you'll often need to remove it. Light spotting is normal with the use of an IUD and, with no other symptoms present, is most likely insignificant. Pregnancy complications. A single heavy period that's late may be due to a miscarriage. If bleeding occurs at the usual time of menstruation, however, miscarriage is less likely to be the cause. An ectopic pregnancy, implantation of a fertilized egg within the fallopian tube instead of the uterus, also may cause menorrhagia. Cancer. Rarely, certain female reproductive cancers may cause menorrhagia. Uterine cancer, ovarian cancer and cervical cancer can cause excessive vaginal bleeding. Medications. Certain drugs, including those that prevent blood clotting (anticoagulants) and anti-inflammatory medications, can contribute to heavy or prolonged menstrual bleeding. Other medical conditions. A number of other medical conditions may cause or increase your risk of menorrhagia. Pelvic inflammatory disease (PID), thyroid problems, endometriosis, lupus, liver or kidney disease, some uncommon blood disorders, certain cancers and chemotherapy may cause menorrhagia. Risk Factors: Obesity Anovulation Estrogen administration (without progestogens) Prior treatment with progestational agents or oral contraceptives increases the risk of endometrial atroph y, but decreases the risk of endometrial hyperplasia or neoplasia Treatment: Specific treatment for menorrhagia is based on a number of factors, including: Your overall health and medical history The extent of the condition The cause of the condition Your tolerance for specific medications, procedures or therapies Your doctor's expectations for how the condition will progress Effects of the condition on your lifestyle Your opinion or personal preference Drug therapy for menorrhagia may include: Iron supplements. If the condition is accompanied by anemia, your doctor may recommend that you take iron supplements regularly. If your iron levels are low but you're not yet anemic, you may be started on iron supplements rather than waiting until you become anemic. Prostaglandin inhibitors. These include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin, others) to help reduce cramping and blood flow. Oral contraceptives. Aside from providing effective birth control, oral contraceptives can help regulate ovulation and reduce episodes of excessive or prolonged menstrual bleeding. Progesterone. The hormone progesterone can help correct hormonal imbalance and reduce menorrhagia. If you have drug-induced menorrhagia from taking hormone medication, you and your doctor may be able to treat the condition by changing or stopping your medication. You may need surgical treatment for menorrhagia if drug therapy is unsuccessful. Treatment options include: Dilation and curettage (D and C). In this procedure, your doctor opens (dilates) your cervix and then scrapes or suctions tissue from the lining of your uterus to reduce menstrual bleeding. Although this procedure is common and often treats menorrhagia successfully, you may need the procedure repeated if menorrhagia recurs. Operative hysteroscopy. This procedure uses a tiny tube with a light (hysteroscope) to view your uterine cavity and can aid in the surgical removal of a polyp that may be causing increased menstrual bleeding. Endometrial ablation. Using ultrasonic energy, your doctor permanently destroys the entire lining of your uterus (endometrium). After endometrial ablation, most women have normal menstrual flow. However, some women have little or no menstrual flow after the procedure. Endometrial ablation negatively affects your ability to become pregnant. Endometrial resection. This surgical procedure uses an electrosurgical wire loop to remove the lining of the uterus. Both endometrial ablation and endometrial resection benefit women who have very heavy menstrual bleeding but don't have other underlying uterine problems such as large fibroids, polyps or cancer. Like endometrial ablation, this procedure negatively affects your ability to become pregnant. Hysterectomy. This surgical removal of the uterus and cervix is a permanent procedure that causes sterility and cessation of menstrual periods. You'll need general anesthesia and hospitalization. Additional removal of the ovaries (total hysterectomy) may cause premature menopause in younger women. Because hysterectomy is permanent, be sure you want this treatment before going ahead with surgery. Except for hysterectomy, these surgical procedures are usually done on an outpatient basis. Although you'll usually need a general anesthetic, it's likely that you can go home the same day. Self-care Consider these tips for successful self-care of menorrhagia: Get your rest. Your doctor may recommend rest if bleeding is excessive and disruptive to your normal schedule or lifestyle. Keep a record. Record the number of pads and tampons you use so that your doctor can determine the amount of bleeding. Change tampons regularly, at least every four to six hours. Avoid aspirin. Because aspirin may promote bleeding, avoid it. Ibuprofen (Advil, Motrin, others) often is more effective than aspirin in relieving menstrual discomforts. Source: Dysmenorrhea: Painful Cramps Dysmenorrhea (or dysmenorrhoea), cramps or painful menstruation, involves menstrual periods that are accompanied by either sharp, intermittent pain or dull, aching pain, usually in the pelvis or lower abdomen. Painful menstruation affects approximately 50% of menstruating women, and 10% are incapacitated for up to 3 days. Painful menstruation is the leading cause of lost time from school and work among women of childbearing age. This pain may precede menstruation by several days or may accompany it, and it usually subsides as menstruation tapers off. Although some pain during menstruation is normal, excessive pain is not. Dysmenorrhea refers to menstrual pain severe enough to limit normal activities or require medication. It may coexist with excessively heavy blood loss (menorrhagia). Primary dysmenorrhoea This term is used to describe normal period pain experienced by many women around the time of their period. There is no underlying medical problem. It most commonly affects teenagers and young women. This is the type of period pain discussed in this factsheet. Secondary dysmenorrhoea This term is used to describe pain around the time of the period that's caused by an underlying problem. It is less common than primary dysmenorrhoea, and tends to affect women later in their reproductive lives. Incidence The incidence of menstrual pain is greatest in women in their late teens and 20s, then declines with age. Some women experience increased menstrual pain in their late 30s and 40s as their endocrine systems prepare for menopause by decreasing hormone levels and thus fertility. It does not appear to be affected by childbearing. An estimated 10 percent to 15 percent of women experience monthly menstrual pain severe enough to prevent normal daily function at school, work, or home. What causes period pain? Pains may start with the first-ever period. However, they are more likely to begin 6-12 months later, once cycles where an egg is released are established. It's these cycles that appear to cause more pain. The cause of period pain is not certain. Once an egg has been released from one of the ovaries, natural chemicals produced by the body called prostaglandins are made in the lining of the uterus (womb). Some prostaglandins cause the walls of the uterus to contract. Some women produce higher levels of prostaglandins, which may cause increased contractions of the uterus. These cramps may be more painful because there is reduced blood (and therefore oxygen) supply to the myometrium (muscle wall of the uterus) during the contractions. Symptoms of painful periods Cramping lower abdominal pains are the most common symptom. Pain can also spread to the lower back and the thighs. When severe, the pain can be accompanied by nausea or vomiting, diarrhoea, constipation or feeling faint. Some women may also get headaches. Pain usually lasts two to three days and tends to happen in the first few days of the period, coinciding with the time of heaviest blood flow. Period pains do not cause any damage to the uterus and a pelvic examination or "internal" would show that the uterus and ovaries are normal. Up to 15% of women have period pains severe enough to interfere with their daily activities. This can lead to missing days at school or work or decreased participation in social or sporting activities. Period pains are often worse in adolescence and tend to improve as women get older. Many women notice that their periods are less painful after they have had a baby. Treatment Self-help Over the counter painkillers such as ibuprofen, naproxin and paracetamol often help. There are also painkilling tablets available that contain the drug, hyoscine (eg Feminax), that may help prevent the muscle contractions. Moderate physical exercise can also be helpful for relieving pain, and may help prevent period pain. Many women find a hot water bottle held to the abdomen or back is comforting. Self-heating patches or heat packs that can be warmed in a microwave are a convenient alternative. Prescribed medicines If these measures do not provide enough relief, or if period pains are interfering with daily life, then it's best to see a doctor. A doctor can usually diagnose period pains easily and several treatment options may be discussed. Anti-inflammatory drugs These work by decreasing the levels of prostaglandins. Examples include ibuprofen, naproxen and mefenamic acid. They relieve pain and can also decrease the amount of bleeding. They work best when taken regularly from the time when either pain or bleeding starts or the day before a period is due. These drugs are not suitable for everyone - for example, people with asthma or indigestion problems may not be able to take them. Oral contraceptive pill The combined oral contraceptive pill, which is the most widely used type of pill, prevents ovulation (the release of an egg). This may help to decrease period pains because the lining of the uterus remains thin and fewer prostaglandins build up. It is particularly useful if a woman also wants contraception. Mirena intra-uterine system Mirena is the brand name of a new type of intra-uterine contraceptive device (IUCD), or coil. It differs from other coils because it releases a form of the hormone progesterone (called levonorgestrel) into the uterus. This prevents the thickening of the lining of the uterus. In addition to providing contraception, some women find that their periods become much lighter within three to six months of having the coil fitted. In a few cases the periods stop altogether. As a result of this, many women find that they also experience less period pain. Sometimes the non-hormone releasing coils can cause or increase period pains. Other treatments There is some evidence that taking thiamine (vitamin B1) or magnesium supplements can help reduce period pains. Transcutaneous electrical nerve stimulation (TENS) is another alternative. This involves a small electrical device, which is taped to the lower back. It releases tiny electrical pulses that aim to "distract" the brain from experiencing pain from the nerves supplying the uterus. It's most commonly used for labour pains. TENS machines are usually supplied by physiotherapists, but it's also possible to buy or hire them from local health centres, high street chemists, hospital pain clinics or branches of the National Childbirth Trust (NCT). Some people find that acupuncture relieves certain kinds of pain, including period pain, but there is little definite scientific evidence to prove this. Could there be another problem? As mentioned, period pains can sometimes be the result of an underlying gynaecological condition (secondary dysmenorrhoea). A doctor should be consulted if period pains are particularly severe, or new, or are associated with any of the following symptoms: bleeding between periods bleeding after intercourse pain during or after intercourse unusually heavy periods. A doctor will carry out a pelvic examination and may then arrange further investigations or a referral to a gynaecologist. Tests might include, for example, an ultrasound scan of the pelvis to look at the uterus and ovaries. Other tests may take place in a hospital. Hysteroscopy - a thin telescope is passed through the neck of the womb (cervix) to enable the inside of the uterus to be viewed. Laparoscopy - where a small telescope is passed through a small cut in the wall of the abdomen allowing the pelvic organs to be viewed. Problems such as endometriosis can be diagnosed in this way (see the separate BUPA factsheet Endometriosis). Further treatment depends on the specific diagnosis Source Amenorrhea: the absence of menstruation This can happen during puberty or later in life. Primary amenorrhea describes a condition in which you haven't had any menstrual periods by age 16. Secondary amenorrhea occurs when you were previously menstruating but then stopped having periods. Pregnancy may be your first thought if you miss a period, but there are many reasons why you might not be menstruating regularly. A symptom, not a disease, amenorrhea seldom results from a serious condition. However, not knowing why menstruation has stopped can be stressful, and waiting for it to recur may feel like a lifetime. But don't hit the panic button. With a little investigation into your medical history and an accurate description of what you're experiencing, you and your doctor can get to the root of the problem. Treating the underlying problem can resolve amenorrhea. Signs and symptoms The main indication that you might have amenorrhea is that you don't have menstrual periods. Here's what to look for in primary and secondary amenorrhea: Primary amenorrhea. You have no menstrual period by age 16. Secondary amenorrhea. You have no periods for three to six months or longer. Depending on the cause of amenorrhea, you might experience other signs or symptoms along with the absence of periods, such as milky nipple discharge, headache, vision changes, hair loss or excess facial hair Causes: Primary amenorrhea affects approximately 1 in 1,000 adolescent girls in the United States. The most common causes of primary amenorrhea include: Chromosomal abnormalities. Certain chromosomal abnormalities can cause a premature depletion of the eggs and follicles involved in ovulation and menstruation. Problems with the hypothalamus. Functional hypothalamic amenorrhea is a disorder of the hypothalamus - an area at the base of your brain that acts as a control center for your body and regulates your menstrual cycle. Excessive exercise, eating disorders such as anorexia, and physical or psychological stress can all contribute to a disruption in the normal function of the hypothalamus. Less commonly, a tumor may prevent your hypothalamus from functioning normally. Pituitary disease. The pituitary is another gland in the brain that's involved in regulating the menstrual cycle. A tumor or other invasive growth may disrupt the pituitary gland's ability to perform this function. Lack of reproductive organs. Sometimes problems arise during fetal development that lead to a baby girl being born without some major part of her reproductive system, such as her uterus, cervix or vagina. Because her reproductive system didn't develop normally, she won't have menstrual cycles. Structural abnormality of the vagina. An obstruction of the vagina may prevent menstrual periods from occurring. A membrane or wall may be present in the vagina that blocks the outflow of blood from the uterus and cervix. Secondary amenorrheais much more common than primary amenorrhea. Many possible causes of secondary amenorrhea exist: Pregnancy. In women of reproductive age, pregnancy is the most common cause of amenorrhea. When a fertilized egg is implanted in the lining of your uterus, the lining remains to nourish the fetus and isn't shed by menstruation. Contraceptives. Some women who take birth control pills may not have periods. When oral contraceptives are stopped, it may take three to six months to resume regular ovulation and menstruation. Contraceptives that are injected or implanted, such as Depo-Provera, also may cause amenorrhea, as can progesterone-containing intrauterine devices, such as Mirena. Breast-feeding. Mothers who breast-feed often experience amenorrhea. Although ovulation may occur, menstruation may not. Pregnancy can result despite the lack of menstruation. Stress. Mental stress can temporarily alter the functioning of your hypothalamus - an area of your brain that controls the hormones that regulate your menstrual cycle. Ovulation and menstruation may stop as a result. Regular menstrual periods usually resume after your stress decreases. Medication. Certain medications can cause menstrual periods to stop. For example, antidepressants, antipsychotics, some chemotherapy drugs, and oral corticosteroids can cause amenorrhea. Illness. Chronic illness may postpone menstrual periods. As you recover, menstruation typically resumes. Hormonal imbalance. A common cause of amenorrhea or irregular periods is polycystic ovary syndrome (PCOS). This condition causes relatively high and sustained levels of estrogen and androgen, a male hormone, rather than the fluctuating condition seen in the normal menstrual cycle. This results in a decrease in the pituitary hormones that lead to ovulation and menstruation. PCOS is associated with obesity; amenorrhea or abnormal, often heavy uterine bleeding; acne and sometimes excess facial hair. Low body weight. Excessively low body weight interrupts many hormonal functions in your body, potentially halting ovulation. Women who have an eating disorder, such as anorexia or bulimia, often stop having periods because of these abnormal hormonal changes. Excessive exercise. Women who participate in sports that require rigorous training, such as ballet, long-distance running or gymnastics, may find their menstrual cycle interrupted. Several factors combine to contribute to the loss of periods in athletes, including low body fat, stress and high energy expenditure. Thyroid malfunction. An underactive thyroid gland (hypothyroidism) commonly causes menstrual irregularities, including amenorrhea. Thyroid disorders can also cause an increase or decrease in the production of prolactin - a reproductive hormone generated by your pituitary gland. An altered prolactin level can affect your hypothalamus and disrupt your menstrual cycle. Pituitary tumor. A noncancerous (benign) tumor in your pituitary gland (adenoma or prolactinoma) can cause an overproduction of prolactin. Excess prolactin can interfere with the regulation of menstruation. This type of tumor is treatable with medication, but it sometimes requires surgery. Uterine scarring. Asherman's syndrome, a condition in which scar tissue builds up in the lining of the uterus, can sometimes occur after uterine procedures, such as a dilation and curettage (D and C), Caesarean section or treatment for uterine fibroids. Uterine scarring prevents the normal buildup and shedding of the uterine lining, which can result in very light menstrual bleeding or no periods at all. Premature menopause. Menopause occurs at an average age of 51. If you experience menopause before age 40, it's considered premature. The lack of ovarian function associated with menopause decreases the amount of circulating estrogen in your body, which in turn thins your uterine lining (endometrium) and brings an end to your menstrual periods. Premature menopause may result from genetic factors or autoimmune disease, but often no cause can be found. Treatment What type of treatment you need - if any - depends on what's causing the amenorrhea. Your doctor may suggest that you make changes to your lifestyle depending on your weight, physical activity or stress level. If you have PCOS or athletic amenorrhea, your doctor may prescribe oral contraceptives to treat the problem. Amenorrhea caused by thyroid or pituitary disorders may be treated with medications. Self-care The best way to avoid an interruption in your menstrual cycle is to maintain a healthy lifestyle: Make changes in your diet and exercise activity to achieve a healthy weight. Strive for a healthy balance in work, recreation and rest. Assess areas of stress and conflict in your life. If you can't decrease stress on your own, ask for help from family, friends or your doctor. Be aware of changes in your menstrual cycle and check with your doctor if you have concerns. Keep a record of when your periods occur. Note the date your period starts, how long it lasts and any troublesome symptoms you might experience. Talk to your mother, sister or other close female relatives. Has anyone else in your family had a similar problem? Gathering this information can help your doctor determine what's causing your amenorrhea. Amenorrhea may cause anxiety, but by working with your doctor, you can determine the cause and find ways to regulate your cycle. Source: [/learn_more] [learn_more caption="Vaginal Yeast Infections " ] Yeast Infections All women secrete moisture and mucus from the membranes that line the vagina and cervix. This discharge is clear or slightly milky and may be somewhat slippery or clumpy. When dry, it may be yellowish. When a woman is sexually aroused, under stress, or at midcycle, this secretion increases. It normally causes no irritation or inflammation of the vagina or vulva. If you want to examine your own discharge, collect a sample from inside your vagina--with a washed finger--and smear it on clear glass (such as a glass slide). Many bacteria normally grow in the vagina of a healthy woman. Some of them, especially lactobacilli, help to keep the vagina healthy, maintaining an acid pH and controlling overgrowth of potentially bad bacteria. When infections occur, you may have an abnormal discharge, mild or severe itching and burning of the vulva, chafing of the thighs, and (in some cases) frequent urination. (Chronic vaginal symptoms sometimes result from skin conditions of the vulva and vagina, such as eczema or psoriasis.) Vaginal infections may be due to lowered resistance (from stress, lack of sleep, poor diet, other infections in our bodies); douching or use of "feminine hygiene" sprays; pregnancy; taking birth control pills, other hormones, or antibiotics; diabetes or a pre-diabetic condition; cuts, abrasions, and other irritations in the vagina (from childbirth, intercourse without enough lubrication, tampons, or using an instrument in the vagina medically). Chronic vaginal infections may be a sign of serious medical problems such as HIV infection and diabetes. Signs and Symptoms; How do I know if I have a yeast infection? Yeast infections can be very uncomfortable, but are usually not serious. Symptoms include the following: Itching and burning in the vagina and around the vulva (the skin that surrounds your vagina) A white vaginal discharge that may look like cottage cheese Pain during sexual intercourse Swelling of the vulva Yeast infections are so common that 3/4 of women will have one at some time in their lives. Half of all women have more than one infection in their lives. If you have symptoms of a yeast infection, your doctor will probably want to talk to you about your symptoms and examine you to make sure a yeast infection is the cause. How are these infections treated? Yeast infections are usually treated with medicine that you put into your vagina. This medicine may be a cream that you insert in your vagina with a special applicator, or it may be a suppository that you put into your vagina and allow to dissolve on its own. Medicine in a cream form can also be put on your vulva to help relieve itching. Medicine in a pill form that you take by mouth is also available. Should I see my doctor every time I have a yeast infection? Be sure to see your doctor the first time you have symptoms of a yeast infection. It's very important to make sure you have a yeast infection before you start taking medicine. The symptoms of a yeast infection are also the symptoms of other infections, such as some STDs. Treating yourself for a yeast infection when you actually have another type of infection may make the problem much worse. If you have often been diagnosed with yeast infections, talk to your doctor about using a medicine you can buy without a prescription. How can I avoid getting another infection? Here are some things you can do to help prevent another yeast infection: Gently wash your vulva and anus regularly. Pure, unscented mineral oil cleans well and does not dry out the tissues as soap can. Pat your vulva dry after bathing, and try to keep it dry. Also, don't use other people's towels or washcloths. Avoid irritating sprays and soaps (use special cleansers for sensitive skin). Avoid talcum powder, since some studies have linked it to ovarian cancer. Avoid nylon underwear and panty hose--they retain moisture and heat, which help harmful bacteria to grow faster. Wear clean underpants, preferably all cotton. Launder all underwear in hot, soapy water. Be sure to rinse thoroughly. Avoid pants that are tight in the crotch and thighs. Always wipe your genital and anal area from front to back, so that bacteria from the anus won't get into the vagina or urethra. Make sure your sex partners are clean. A man should wash his penis daily and especially before making love. Using a condom can provide added protection. If you or your male partner is being treated for a genital infection, make sure he wears a condom during intercourse. Better yet, avoid intercourse until the infection has cleared up. Use a sterile, water-soluble jelly if you need lubrication (K-Y jelly or Astroglide, not Vaseline). Spermicidal gels and creams, which usually contain nonoxynol-9, may cause irritation and are no longer recommended for preventing infections. Avoid any kind of vaginal penetration that is painful or abrasive. Cut down on coffee, alcohol, sugar, and refined carbohydrates. Diets high in sugars can increase sugar in the vagina, which feeds bacteria. Avoid douching of any kind unless specifically recommended by your health care provider. Although you may feel cleaner, douching can destroy the "good" bacteria in your vagina. Avoid inserting yogurt to relieve mild symptoms of vaginal infections, other than yeast infections, because this can prevent proper diagnosis and may even contribute to chronic vaginal problems. Eat well and get enough rest! Not taking care of yourself makes you more susceptible to infection. Avoid using tampons, especially if you have a history of frequent vaginal infections. Source: American Academy of Family Physicians Source: Boston Women's Health Book Collective, Inc.; [/learn_more]