Womens Health

Breast Examinations

Disorders of the Menstrual Cycle

The Normal Menstrual Cycle

During the menstrual cycle, two hormones, called estrogen and progesterone, are made by the ovaries. Each month, these hormones cause the endometrium to grow in preparation for a possible pregnancy. About 12–14 days before the start of the period, an egg is released from one of the ovaries. This is called ovulation. The egg then moves into one of the fallopian tubes. There it can be fertilized by a sperm. If it is not, pregnancy does not occur. The levels of hormones decrease. This decrease is a signal for the uterus to shed its lining. This shedding is the menstrual period.

The cycle begins with the first day of bleeding of one period and ends with the first day of the next. In most women, this cycle lasts about 28 days. Cycles that are shorter or longer by up to 7 days are normal.

Bleeding in any of the following situations is abnormal:

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

To find the cause, your doctor will ask about your personal and family health history. You may be asked about these issues:

  • Past or present illnesses
  • Use of medications
  • Use of birth control
  • Weight, eating and exercise habits, and level of stress

You will have a physical exam. You also may have blood tests. These tests check your blood count and hormone levels and rule out some diseases of the blood. You also may have a test to see if you are pregnant. Based on your symptoms, other tests may be needed.


Treatment will depend on many factors, including the cause of the bleeding. Your age and whether you want to have children also play a role. Treatment falls into three types. You may be given medications, such as hormones. You may need to have surgery. You may decide with your doctor to “watch and wait” before trying the other two treatments. Most women can be treated with medications.

To judge how well treatment is working, you may need to be tested again. If you think you might be pregnant, let your doctor know before you start any treatment.

  • Excessive Menstrual Flow
  • Severe Menstrual Cramps/Pain

Premenstrual Syndrome (PMS): Premenstrual symptoms are a common part of the menstrual cycle. In fact, at least 85% of women who menstruate have at least one premenstrual symptom.

Women with PMS experience a pattern of symptoms month after month. Sometimes, these symptoms interfere with their daily lives.

Contraception (pills, patch, IUD, diaphragm, vaginal ring, tubal ligation

About one half of all pregnancies in the United States are unplanned. Most women can become pregnant from the time they are in their early teens until they are in their late 40s. Birth control can help couples postpone having a baby until the time is right for them—if ever. Some types of birth control also help protect against sexually transmitted diseases (STDs). Today, there are many choices of birth control for women and men.


An intrauterine device, also known as IUD, is a small, plastic, T-shaped device placed inside the uterus to prevent pregnancy. Placement can be done during an office visit. An IUD stays in your uterus until the doctor removes it. The IUD provides excellent contraception by preventing sperm from joining with an egg. Depending upon your particular IUD device, pregnancy can be prevented for up to 10 years.

Endometrial Biopsy

During an endometrial biopsy, the doctor takes a small sample of the lining of the uterus for microscopic evaluation and to evaluate a verity of symptoms such as abnormal uterine bleeding, postmenopausal bleeding and other menstrual abnormalities.

IUD Placement


NEXPLANON is a small, soft, and flexible birth control implant—it’s just 4 centimeters in length. Your health care provider places it discreetly under the skin on the inside of your upper arm. This means it’s hidden from view. NEXPLANON provides up to 3 years of continuous pregnancy prevention.* That means no more daily, weekly, or monthly dosing routine.

Once inserted, NEXPLANON is over 99% effective, just like the pill. But there’s a difference—with NEXPLANON, you don’t have to remember to take it every day.

*NEXPLANON can be removed at any time. It must be removed by the end of the third year and may be replaced by a new NEXPLANON at the time of removal, if continued contraceptive protection is desired.

Pap Test

The Pap test, sometimes called a Pap smear or cervical cytology screening, is a simple test that can detect abnormal cervical cells. It is not the same as a pelv

ic exam. The Pap test allows early diagnosis and treatment so that the abnormal cells do not become cancer. Routine Pap tests help decrease the chance that abnormal cells are missed. If a Pap test misses abnormal cells this time, they may be found on your next Pap test.