See your doctor about your period if:

• You have not started menstruation by age of 15.
• You have not started menstruating within 3 years after breast growth began, or if breasts haven't started to grow by age 13.
• Your period suddenly stops for more than 90 days.
• Your periods become very irregular after having had regular, monthly cycles.
• Your period occurs more often than every 21 days or less often than every 35 days.
• You are bleeding for more than 7 days.
• You are bleeding more heavily than usual or using more than 1 pad or tampon every 1 to 2 hours.
• You bleed between periods.
• You have severe pain during your period.
• You suddenly get a fever and feel sick after using tampons.

During your period, you shed the thickened uterine lining and extra blood through vagina. Your period may not be the same every month. It may also be different than other women's periods. Periods can be light, moderate, or heavy in terms of how much blood comes out of the vagina. This is called menstrual flow. The length of the period also varies. Most periods last from 3 to 5 days. But, anywhere from 2 to 7 days is normal.

For the first few years after menstruation begins, longer cycles are common. A woman's cycle tends to shorten and become more regular with age. Most of the time, periods will be in the range of 21 to 35 days apart.

Dysmenorrhea - painful periods, including severe cramps. Menstrual cramps in teens are caused by too much of a chemical called prostaglandin. Most teens with dysmenorrhea do not have a serious disease, even though the cramps can be severe. In older women, the pain is sometimes caused by a disease or condition such as uterine fibroids or endometriosis.

For some women, using a heating pad or taking warm baths helps ease their cramps. Some over-the-counter pain medications can also help with these symptoms. They include:

• Ibuprofen ( for instance, Advil, Motrin, Midol Cramp)
• Naproxen (for instance, Aleve)

If these medications don't relieve your pain or pain interferes with work or school, you should see a doctor. Treatment depends on what's causing the problem and how severe it is.

Abnormal uterine bleeding - vaginal bleeding that's different from normal menstrual periods. It includes:

• Bleeding between periods
• Bleeding after sex
• Spotting anytime in the menstrual cycle
• Bleeding heavier or for more days than normal
• Bleeding after menopause

Abnormal bleeding can have many causes. Your doctor may start by checking for problems that are most common in your age group. Some of them are not serious and are easy to treat. Others can be more serious. Treatment for abnormal bleeding depends on the cause.

In both teens and women nearing menopause, hormonal changes cause long periods along with irregular cycles. Even if the cause is hormonal changes, you may be able to get treatment. You should keep in mind that these changes can occur with other serious health problems, such as uterine fibroids, polyps, or even cancer. See your doctor if you have any abnormal bleeding.

In the United States, the average age for a girl to get her first period is 12. This does not mean that all girls start at the same age. A girl can start her period anytime between ages of 8 and 15. Most of the time, the first period starts about 2 years after breasts first develop. If a girl has not had her first period by age 15, or if it has been more than 2 to 3 years since breast growth started, she should see a doctor.

We maintain our cars, boats, RVs and homes why not your body.

Here is a list of routine health care screenings that are recommended by the US Department of Health and Human Services.

Cervical Cancer - Pap smear every 1 year if you are 21 to 65 years old and have been sexually active. If you are older than 65 and recent Pap smears were normal, you do not need a Pap smear. If you have had a hysterectomy for a reason other than cancer, you do not need a Pap smear.

Breast Cancer - Usually between the age of 40-50 years old you should start annual mammograms. Mammograms at earlier ages may be necessary based on age, family history, overall health, and personal concerns. Discuss with your health care team whether a mammogram is right for you.

Osteoporosis ( Bone Thinning) - Have a screening test at age 65 to make sure your bones are strong. If you are younger than 65, talk to your health care team about whether you should be tested.

Chlamydia and Other sexually Transmitted Diseases - Sexually transmitted diseases can make it hard to get pregnant, may affect your baby, and can cause other health problems.

Have a screening test for Chlamydia if you are 24 or younger and sexually active. If you are older than 24, talk to your health care team about being screened for Chlamydia. Ask your doctor or nurse whether you should be screened for other sexually transmitted diseases.

HIV - Talk to your health care team about HIV screening if any of these apply to you:

• You have had unprotected sex with multiple partners.
• You have injected drugs.
• You exchange sex for money or drugs or have sex partners who do.
• You have or had a sex partner who is HIV-infected, bisexual, or injected drugs
• You are being treated for sexually transmitted disease.
• You had a blood transfusion between 1978 and 1985.
• You have any other concerns.

Immunizations

• Get a flu shot every year.
• If you are 65 or older, get a pneumonia shot.
• Depending on health problems, you may need a pneumonia shot at a younger age or need shots to prevent disease like whooping cough or shingles.
• Tetanus Booster is recommended every 10 years.
• Zostavax recommended starting at greater than 60 years of age.

High Blood Pressure - Blood pressure check at least every 2 years starting at age 18.High Blood Pressure is a reading at 140/90 or higher. High Blood Pressure can cause stroke, heart attack, kidney and eye problems, and heart failure.

Diabetes - Get screened for diabetes if your blood pressure is higher than 135/80 or if you take medications for high blood pressure. Diabetes (high blood sugar) can cause problems with your heart, brain, eyes, feet, kidneys, nerves, and other body parts.

Overweight and Obesity - The best way to learn if you are overweight or obese is to find your body mass index (BMI). You can find your BMI by entering your height and weight into a BMI calculator, such as the one available at: https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm.

A BMI between 18.5 and 25 indicates a normal weight. Persons with a BMI of 30 or higher may be obese. If you are obese, talk to your doctor or nurse about seeking intensive counseling and help with changing your behaviors to lose weight. Overweight and obesity can lead to diabetes and cardiovascular disease.

Colorectal Cancer - Have a screening test for colorectal cancer starting at age 50. If you have a family history of colorectal cancer, you may need to be screened earlier. Several different tests can detect this cancer. Your health care team can help you decide which is best for you.

High Cholesterol - Starting at age 20, have your cholesterol checked regularly if:

• You use tobacco.
• You are obese.
• You have diabetes or high blood pressure.
• You have a personal history of heart disease or blocked arteries.
• A man in your family had a heart attack before age 50 or a woman, before age 60.

The most common symptoms of a UTI (bladder infection) are urinary frequency and painful urination. Typically the woman will complain that she voids small amounts of urine extremely frequently (several times per hour). She usually also complains that it hurts to urinate. Typically the pain is in the bladder and/or the suprapubic region. Sometimes a vaginitis will also give you painful urination, but in that case, the pain is usually locally on the vulva where the urine touches the skin.

If you think you have a UTI, you should call the doctor as the infection can usually be treated fairly easily with antibiotics.

After you’ve reached the point in the pregnancy where you’ve been feeling the baby move regularly (usually around 24 weeks), you should be concerned if you do not feel the baby move for a significant period of time, or if the movement decreases. Sometimes this is simply a matter of being distracted and not paying attention. If you eat or drink something that will raise your blood sugar and lie down and pay attention, most times you will begin to feel the baby move. If you do not, you should call the office (in the daytime) or come to labor and delivery.

The other time to go to the hospital is if you are in labor. If you are pre-term (before 37 weeks) you should come to the hospital if you are having regular contractions, less than 10 minutes apart, for an hour or more, particularly if accompanied by a change in vaginal discharge. Sometimes Braxton-Hicks contractions can seem pretty regular. If you are not sure, you could try drinking 32 oz of fluid and lying down. If the contractions persist, it would be best to come to the hospital for evaluation.

If you are at term (37 weeks or beyond), you should come to the hospital when the contractions are regular, coming at least every 5 minutes, and persistent for at least an hour. If you had a fast labor last time, you might want to discuss with the doctor when to come to the hospital.

Whether term or pre-term, you should come to the hospital if you experience rupture of membranes or have any significant amount of vaginal bleeding, whether or not you think you’re in labor. Back pain in pregnancy is common and is caused by loosening of the joints and support ligaments of the pelvis, combined with the extra weight of the pregnancy and the shifts in the center of gravity caused by the pregnancy protruding from the front of your abdomen. There are several things that will help.

1. Pay attention to your posture. Slumping posture aggravates the tension in your back. Also, the American habit of standing on one leg creates uneven forces on your pelvis, further aggravating the situation. Try to stand and sit straight whenever possible. Try not to stand on one leg or lean to one side when sanding or sitting.
2. Lift with your legs and not you back. Squat to lift rather than bending from the waist.
3. Wear a pregnancy support belt. These belts, widely available in maternity stores, help to support the pregnancy and help to shift your center of gravity back toward your middle. If you have back pain, you should wear one whenever you will be on your feet for any length of time.
4. Back exercises will help to strengthen the muscles in you back. Click here (https://www.spine-health.com/wellness/exercise/strengthening-exercises-back-pain-during-pregnancy) for exercises to strengthen the muscles in your back. Click here (https://www.spine-health.com/wellness/exercise/stretching-exercises-back-pain-during-pregnancy) for stretching exercises which will improve flexibility and help to relax overburdened muscles.

If back pain is severe, or these measures do not help, be sure to discuss the issue with your doctor.

Generally, you should ask your doctor if you have any questions about a specific medication. However, certain medications are generally considered safe for use in pregnancy.

Condition - Medications
Pain: Tylenol (Avoid aspirin. Avoid Ibuprofen or Naproxen in the 1st and 3rd trimesters.)
Cold: Chlor-Trimeton, Sudafed (after the 1st trimester and if no history of high blood pressure), Benedryl, Humabid, Robitussin DM
Allergies: Zyrtec, Claritin, Benedryl, Zyrtec-D, Claritin-D
Diarrhea: Kaopectate, Imodium
Heartburn: Maalox, Mylanta, Tums, Rolaids. If antacids don’t work, Zantac, Pepcid AC
Gas and/or bloating: Simethicone (Mylicon, Mylanta anti-gas)
Vaginitis: Monistat, Lotrimin (be gentle with the applicator!)
Constipation: Fiber (Metamucil, Citracil - be sure to use with enough water!), Docusate (Colace, Ducolax), Miralax
Hemorrhoids: Tucks, Preparation H, Anusol

If the above medications do not resolve the problem, or you experience any adverse reaction, you should call the office to be evaluated for the problem. These medications should always be taken according to package directions. Over dosage can have adverse effects on your fetus, even if you feel fine.

Generally, birth control pills are most effective, and easiest to remember if you take them at the same time each day. Also, associating taking your pill with something else you do each day at about the same time will make it easier to remember.

If however, you forget to take your pill on a given day, take it as soon as you remember. If it’s still the same day that the pill was due, there will be only a minor fluctuation in hormone levels and minimal chance of pregnancy.

If however, it’s the next day before you realize you’ve forgotten your pill, you can take the pill you missed, plus the pill for that day. This, however, will increase the risk of ovulation (and pregnancy) due to fairly dramatic hormonal shifts, and you may wish to use a back up method of birth control (such as condoms) for the rest of that cycle of pills.

The first cycle of birth control pills is less effective than subsequent cycles. You may wish to use a back up method of birth control (such as condoms) for that cycle. As mentioned above, you should use a back up if you mess up taking your pills. The other time to consider back up is anytime something may interfere with absorption of the hormones in the pills. Nausea and vomiting, whether or not you see the pill in the vomit, is one example. A case of diarrhea is another. Anytime you take antibiotics, this can also interfere with the absorption of the hormones due to changes in the bacteria in your gut, and it would be safest to use a back up for that cycle.

These are the theoretical and typical use effectiveness ratings of various contraceptive methods. Use effectiveness means their effectiveness as they are actually used, not their theoretical effectiveness. People don’t always use a method 100% correctly. These numbers are based on 1991-1995 data from the 1995 National Survey of Family Growth.

Method	Pregnancy Rate with Perfect Usage (%)	Pregnancy Rate with Typical Usage (%)
Spermicides	18	29
Contraceptive Sponge (No Childbirth)	9	16
Contraceptive Sponge (With Childbirth)	20	32
Male Condom	2	17.4
Female Condom	5	27
Fertility Awareness Methods	1-9	25.3
Diaphragm	6	16
IUD (Copper-Paraguard)	0.6	1.0
IUD (Hormonal-Mirena)	0.1	0.1
Combination birth control pills	0.3	8.7
Contraceptive skin patch (Ortho Evra)	0.3	8
Contraceptive vaginal ring (Nuvaring)	0.3	8
Depo-provera Injection(DMPA)	0.3	6.7
Implant (Implanon)	0.05	1.0
Female Sterilization	0.5	0.7
Male Sterilization	0.1	0.2
Withdrawal	4.0	18.4
No Method	85	85

If you are interested in a particular form of birth control, you should discuss the risks and benefits of that method in your particular case with your doctor or health care provider.