What women ask about, and what their doctors tell them

Answers to questions such as 'When am I most fertile?' and 'Do I have a UTI?'

Smiling Dr. Abrea Roark talks with a patient in an exam room. The patient's back is to the camera.

Every woman has unique, complex health needs. But women often pose similar questions to their doctors throughout their lifetimes. Here are the answers to some common questions women ask, from fertility to menopause, with a lot in between.

1. I’m trying to conceive. When am I most fertile?

A woman with a typical menstrual cycle has five days of fertility, explained Sanford Health OB-GYN Jessica Dickes in Watertown, South Dakota.

For a 28-day cycle, with ovulation on day 14, the five fertile days are three days before ovulation, the day of ovulation and the day after. “That’s because sperm can stay active in the female reproductive tract for up to three days,” she said. But the ovulated egg will die within 24 hours.

The easy, “not really thinking about it” way, Dr. Dickes said, “is sex every other day, day 10 to 20. Most people are going to hit one of their fertile days.”

Of course, many people do not have that average 28-day cycle, so figuring out ovulation — which happens about 14 days before the start of a menstrual cycle — can get a little trickier, especially if cycle length varies from month to month.

Ovulation tests are available over the counter to measure the surge in luteinizing hormone that occurs 12 to 24 hours before ovulation. “We tell people to have sex that day and the next day, and they should hit their fertile day,” Dr. Dickes said.

Women could also chart their daily basal body temperature. A temperature rise occurs after ovulation and might help predict future ovulation dates, she said. Changes in cervical mucus also can indicate ovulation. It becomes stringy and stretchy during the most fertile period.

If women do have irregular cycles and have trouble conceiving, Dr. Dickes urges them to talk with their doctor. A series of testing can help determine the cause of irregular periods, including polycystic ovarian syndrome.

2. Can I do anything to decrease the risk of miscarriage?

Many miscarriages occur because of chromosomal issues, where the fetus develops abnormally. Dr. Dickes reassures patients that they did nothing to cause the loss of the pregnancy.

“Finding somebody that you can talk with … you’re going to find that there’s probably more women that have had a miscarriage than you realize,” she said. The miscarriage rate is about 25% in the normal population, she added.

To reduce the chances for a miscarriage with a healthy fetus, Dr. Dickes outlines some precautions women can take before and during pregnancy.

  • Address any known medical issues before becoming pregnant with preconception care from your doctor. Diabetes, thyroid and uterine abnormalities are among medical issues that can contribute to a miscarriage.
  • Limit exposure to unneeded medications.
  • Limit exposure to chemicals and radiation.
  • Avoid alcohol and drug use.
  • Avoid smoking.
  • Limit caffeine consumption.
  • Take a folic acid supplement.

More: A Q&A about miscarriage

3. How much grief is normal after a pregnancy loss?

Women who have had a miscarriage or other pregnancy loss can be surprised by the amount of grief they go through afterward, said Johnna Nynas, a Sanford Health OB-GYN in Bemidji, Minnesota.

“There’s no right or wrong way to grieve a pregnancy loss,” Dr. Nynas said. “It’s completely normal if women are really devastated and struggle with it for a long time. It’s also normal if women don’t feel particularly affected.”

Women may experience anxiety or depression. They may struggle with their perception of themselves as a woman capable of reproducing.

Most of the time, Dr. Nynas said, the symptoms will get better over time. However, women should talk with their primary care provider or OB-GYN if symptoms persist or get worse. Other red flags that warrant a visit would be if the pregnancy loss affects relationships at home or at work; if it changes sleeping or eating habits, leading to weight gain or loss; or if it diminishes interest or pleasure in once-enjoyable activities.

Anxiety can also show up during a new pregnancy, too, Dr. Nynas said, as a woman may become hypervigilant for any signs of another miscarriage. “It’s those women that I try to provide extra support for and encouragement,” she said.

4. Do I have a UTI or something else?

The three common symptoms of a urinary tract infection (UTI) are increased frequency of urination, feeling of urgency and burning pain during urination, said Sanford Health OB-GYN Peter Klemin, who works in Bismarck, North Dakota.

However, if a woman experiences one or more of these symptoms, they don’t necessarily have a UTI, he said. Pregnancy and menopause can increase frequency and urgency. So can pelvic organ prolapse, or bladder prolapse. An irritation of the urethra from a vaginal infection can produce symptoms similar to a UTI; so can a chlamydia infection. Vaginal atrophy in postmenopausal women or women who have had their ovaries removed can cause symptoms, too.

It’s best to confirm a UTI through a urine sample, Dr. Klemin said. A UTI requires treatment with antibiotics. Other issues may call for other types of treatment, so a course of antibiotics may do nothing for symptoms in those cases.

Dr. Klemin recommends seeking treatment within three to four days of experiencing symptoms of a UTI, although anyone with previous issues involving the kidney or bladder could be at risk for more severe issues and should seek help sooner.

More: A Q&A about UTIs

5. Is this odor normal?

When women ask Dr. Nynas about odor or discharge, she explains that the vagina has populations of healthy bacteria that prefer a balanced environment. Throwing off that balance can result in an infection or changes in odor.

“My rule,” Dr. Nynas said, “is the vagina is a self-cleaning oven. Don’t mess with it.”

She discourages women from using products such as soaps or creams to “treat” an already healthy vagina.

“Women need to know that your vagina shouldn’t smell like a rose garden. It’s not intended to,” Dr. Nynas said.

“All you need to do to take care of your vagina is rinse it with clean, warm water,” she added.

Some circumstances that might cause a noticeably different odor include swimming in the pool and sitting around in a wet swimsuit, or continuing to wear exercise clothing after a workout and retaining sweat.

Also, Dr. Nynas said, thongs, nylon and satin underwear, leggings and tight pantyhose can reduce ventilation and result in odor.

“The vagina’s happiest with just plain cotton underwear,” she said.

Overnight, women with concerns could simply wear loose clothing without underwear.

6. How do I know if I have a yeast infection?

Yeast infections can be irritating and itchy, externally on the vulva or inside the vagina.

The infections typically are accompanied by a thick, white, “cottage cheese” discharge, Dr. Dickes said.

Yeast infections can occur in women of any age. They may be more common with hormonal changes such as the use of birth control or during pregnancy, as well as after the use of antibiotics. Antibiotics can change the flora of the vagina, Dr. Dickes said.

Eating yogurt or taking a probiotic can help some women keep the flora of the vagina in balance, Dr. Dickes said.

Tips for reducing the risk for a yeast infection are similar to those that can address odor: Don’t put anything into the vagina, such as douches or fragrances. Avoid wearing wet or sweaty clothing for long periods, in the hot tub or in the gym. Wear loose-fitting cotton clothing.

Yeast infections are simple to treat. Most women just need to take one pill.

7. What can I do about constipation?

“People bring up, no matter what age group — even a lot of young women — about constipation problems,” Dr. Klemin said.

Common during pregnancy because of a more sluggish intestinal tract, constipation certainly isn’t confined to those patients.

Dr. Klemin attributes a lot of constipation, as well as bloating, to dietary habits that lack fiber, fruits and vegetables. Obesity can decrease intestinal movement as well.

So he spends some time talking with patients about diet choices that could improve chronic constipation, along with stool softeners and fiber supplements.

“If it’s part of a bigger issue, some people require physical therapy or more detailed testing,” he said.

And he has seen patients whose painful abdominal bloating was actually caused by endometriosis instead.

8. Should I take a multivitamin?

Most women eat a pretty varying diet, said Abrea Roark, a Sanford Health OB/GYN in Sioux Falls, South Dakota. “However, almost all of us are lacking in some category.”

So she recommends that women take a once-a-day multivitamin. If they’re of reproductive age, then she recommends a prenatal vitamin, regardless of contraception practices.

“Most vitamins are water soluble, so whatever we don’t need, we would excrete through the kidneys,” Dr. Roark said.

Her best advice for choosing a multivitamin is to find one you can tolerate. “Most of those multivitamins or the prenatal vitamins are really big … so if people are feeling nauseated at all or a little bit more of a gag reflex, sometimes it’s hard to get those down. But there’s so many options now, with gummy options,” she said.

9. How much water should I drink in a day?

Drinking enough water in a day can be a tall order for some women, especially if their work situation prevents them from sipping constantly. But it’s important, Dr. Roark said.

“Generally, most people should do about 64 ounces of water a day,” she said, “which I tell people kind of sounds like a full-time job.”

How do you know if you’re getting enough water? “Urine should be clear,” is Dr. Roark’s rule of thumb. “You can measure your hydration by how often you have to use the restroom.”

Not drinking enough water may result in headaches and eyestrain.

Two groups of patients could use even more water, though. Dr. Roark encourages pregnant women to drink as much as possible. That can help keep vague symptoms like dizziness and lightheadedness away.

And to women who are trying to lose weight, Dr. Roark recommends they drink half of their body weight in ounces of water. Sometimes when people think they’re hungry, they’re actually thirsty and dehydrated, she said.

More: Q&A about water intake

10. How old will I be when menopause starts?

Jean Marie McGowan, an internal medicine physician in Fargo, North Dakota, who is certified in menopause management, hears questions about menopause when women starting wondering if their symptoms could be related to hormones.

While the age of menopause can vary, the average age in the U.S. is about 52, “give or take one or two years,” Dr. McGowan said. It also can be surgically induced at any age, if a woman’s ovaries are removed.

The most common symptoms are hot flashes and vaginal dryness, Dr. McGowan said. Issues can include discomfort during intercourse, urinary urgency and pelvic floor weakness. Other changes may involve weight, hair, skin, mood and sleep.

Symptoms of menopause typically last a couple of years, though it could be longer for 10% of women. “But some women have no symptoms at all, so they’re the lucky ones,” Dr. McGowan said.

To help ease symptoms, “living a healthy lifestyle definitely helps,” she said.

Smoking makes symptoms worse. Weight loss can help make them better. Dr. McGowan also recommends limiting alcohol. Spicy food and hot beverages can worsen hot flashes, while dressing in layers and using cooling sheets and cooling pillows can help.

“When it comes to medication,” Dr. McGowan said, “hormone therapy is really the most effective treatment for hot flashes and vaginal dryness.”

She recommends using hormone therapy in the smallest dose for the shortest time needed, which is usually about five years. In addition to addressing menopause symptoms, hormone therapy may also protect the heart and protect against bone loss.

Dr. McGowan cautions women to be sure to use FDA-regulated hormone therapies, which have gone through extensive testing and contain the dosage they say they do. “Bioidenticals or compounded hormones are not recommended because they’re not FDA-regulated,” she said.

11. What are some health issues that affect women differently?

Dr. Klemin said women are conscious of their breast cancer and cervical cancer risks, and many diligently screen for those. But they may be overlooking their risks related to heart disease and hypertension. So screening and prevention measures targeting those are important, too, along with awareness of symptoms women should watch for, which can differ from those for men.

Sexually transmitted diseases can give women different symptoms than men as well, or no symptoms at all. But whereas bacteria may just affect a man’s urethra and possibly prostate, it can spread through the uterus and Fallopian tubes or even the rest of the pelvic area in a woman, resulting in pelvic inflammatory disease.

“Complications from it can be quite significant,” Dr. Klemin, including hospitalization and possibly surgery, as well as fertility problems and chronic pain.

Bone density testing is key to determining a woman’s risk for osteoporosis. “Women on average will start losing bone density after age 30, and then it can accelerate after menopause,” Dr. Klemin said. So incorporating weight-bearing exercises as well as calcium and vitamin D can help women retain bone density.

12. How can I try to stay healthy throughout my lifetime?

For all age groups, Dr. McGowan considers these elements key to living the best life: eating, sleeping, moving and loving.

“I really do believe we are what we eat,” she said. “Diet is so important.”

Eight hours of sleep is crucial, too. “Otherwise, we can have high sugars, high blood pressures, fatigue, mood disorders, etc.”

Exercise and being active are important.

And then there’s love. “I think loving yourself is one part,” Dr. McGowan said. “And then sexual health is another, too. It’s important to have a healthy sex life at any age, or one that is most satisfying for the person.” She refutes the notion women may hear about sexual desire declining with age and says other factors could play a role.

Dr. McGowan also offers these considerations for women at various stages in life.

  • 20s and 30s: Know your family history. That helps determine if you need to start screening early for breast cancer, colon cancer or ovarian cancer. Cervical cancer screening starts at age 21 and runs every three to five years. The HPV vaccine may be an option for women up to age 45 now. Family planning is another consideration, whether a woman is interested in having a baby and should be taking folic acid, or whether she is not interested in having a baby and wants to discuss birth control. Practicing safe sex and managing weight are two other factors for this age group.
  • 40s and 50s: Breast cancer screening is added at age 40. Colonoscopies are added as well. While this age group may not experience symptoms, heart health and bone health are important. “It’s what they do now that will help them in their 60s and beyond,” Dr. McGowan said.
  • 60s and older: Continue breast cancer, cervical cancer (till age 65) and colon cancer screenings. Bone health and mind health are key to keep in mind. Stay active and engaged, Dr. McGowan recommends.

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Posted In Gynecology, Health Information, Healthy Living, Pregnancy, Women's

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