From menopause to birth control, women’s health often comes with many questions and myths, and the right answers are not always easy to find. Today, OB-GYN Candice Fraser, MD joins SELF to answer frequently asked women’s health questions and debunk some myths along the way.
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00:00Searching for medical advice on the internet can be confusing and just lead to lots of anxieties.
00:06So I'm here to answer some of the more complex medical questions that you may have.
00:12I'm Dr. Candice Fraser and I'm a board-certified OBGYN.
00:20Does having irregular periods mean I'll have trouble getting pregnant?
00:25Yes and no.
00:26So first of all, what do we mean by irregular?
00:29So something that I realized when I speak to my patients is that it is very important
00:34to know what a regular period is.
00:36When we say when was your last period, we're talking about the first day that you started
00:40to have bleeding.
00:41And then for your cycle, we count from the first day of one period to the first day of
00:46the next period.
00:46And that's how we figure out what your cycle length is or how many days are in between.
00:51In general, a normal cycle length is between 21 and 42 days.
00:56And for an individual person, you want it to be consistent.
01:00So every 28 days, every 38 days, with some variation, plus or minus two or three days,
01:05that's okay.
01:07Now, if you are having periods that vary in cycle length, so one month it's 28 days,
01:13one month it's 21 days, then it's 40 days, or you're skipping complete months, or it's
01:18every few months, that's what we mean by irregular.
01:21So a very common cause would be polycystic ovarian syndrome or PCOS, can be problems
01:27with your thyroid or other hormones such as prolactin.
01:30And sometimes this means that you're not ovulating regularly.
01:34So therefore, you're not having a period regularly.
01:37Does this necessarily mean that you will have trouble getting pregnant?
01:40No.
01:41If you are ovulating at all, you can get pregnant on any cycle that you're ovulating.
01:47However, for some people, it takes multiple months of trying to get pregnant.
01:51So let's take a year.
01:52If you're having a period every month, that's 12 months of ovulation, so 12 opportunities
01:57to get pregnant.
01:58So if you're a person that's going to need 12 months to get pregnant, but in any given
02:02year, you're only ovulating eight times, that means it may take you longer, or it may be
02:07a little bit more difficult, or you may notice difficulty in getting pregnant.
02:11If it is that you're not really ovulating much at all, then yeah, it may be a little
02:15bit more difficult and you may need help.
02:17However, I have lots of patients who have conditions like polycystic ovarian syndrome
02:22or other conditions that cause their periods to be regular and they get pregnant the first
02:27time they try.
02:28So do not use your irregular periods as a reason not to use birth control if you do
02:33not want to get pregnant.
02:34If you're on hormonal birth control, will it affect your ability to get pregnant or
02:39will it take longer to get pregnant after you come off of birth control?
02:43In most cases, the answer is absolutely not.
02:46So for most birth controls that are hormonal, so pills, pads, ring, IUD, implant, once
02:52you stop it or you take it out, you're right back to baseline fertility.
02:56So with Depo-Provera, which you usually get every three months, it may take a little bit
03:01longer for your body to start to ovulate again once you stop that method.
03:06But other than that, all the others, you go right back to baseline fertility right away.
03:11So you don't have to stop birth control a long time in advance prior to trying to get
03:16pregnant.
03:17What are the main things I should know about menopause in my late 30s or early 40s?
03:22I think it's because we're talking about it more.
03:25People are being more open about how they feel and these symptoms and changes that they're
03:30going through.
03:31It's a natural part of life.
03:32It's going to happen.
03:33I think about it kind of like puberty, which is the other big change that we go through.
03:38Some of it we can manage, but some of it our bodies are just going to be different.
03:43And I think understanding that and knowing that and sort of almost welcoming it is very
03:48helpful.
03:49Now, having said that, you're going to welcome it and you know it's going to happen, but
03:54it can be terrible.
03:55It does not have to be, but it can be.
03:57So I think knowing what some of the symptoms can be and anticipating it can be helpful
04:04and being comfortable discussing the symptoms that you're having also is important.
04:08One thing that I always ask my patients when they're like, oh my gosh, am I going through
04:12perimenopause or is this menopause?
04:14I usually ask if they know how old their mother or other people in their family went through
04:21menopause because it kind of tracks in families.
04:24Average age of menopause in the U.S. is 51.
04:27People who go through menopause at a younger age and people who go through menopause at
04:30an older age.
04:32Menopause is 12 months of no period.
04:35That's how we define it and diagnose it.
04:37The time before that is called perimenopause.
04:40So in the years leading up to menopause, when estrogen is slowly creeping down and decreasing,
04:46you can start to notice things like hot flashes, changes in mood, changes in sleep, changes
04:52in the way your body kind of looks or feels.
04:56These things can happen and can be due to perimenopause.
04:59So if you are having symptoms in the perimenopausal period or the menopausal period, there are
05:05medications, there are other more holistic things and lifestyle things that we can speak
05:10about to help you through that transition.
05:13Given that the average age of menopause is 51, usually you become less and less able
05:21to get pregnant spontaneously, probably, you know, in the 10 years or so leading up to
05:28that.
05:29So if you are thinking that you will probably want to possibly get pregnant in your late
05:3630s, early 40s, I always recommend that my patients consider things like egg freezing.
05:43Now, egg freezing is not for everyone.
05:45You may not feel comfortable with it.
05:47It's pretty expensive as well, but it is something that you should consider and understand.
05:52I think the most important thing I tell my patients is understanding that there is a
05:56window, that it is not forever.
05:59There are many stories on the internet of people getting pregnant in their 50s.
06:03Those tend to be the exception and not the rules.
06:06So when you're in your late 30s or early 40s and all your friends are talking about
06:11menopause and perimenopause, I want you to just listen to the conversations, pay attention
06:16to your own body, understand that this is just a transition in life and you can get
06:22through it.
06:23What can I do if I get very painful ovulation pinches?
06:28Some people do report that when they ovulate, which is in the middle of the cycle, usually
06:33two weeks before you have a period, they can feel pain or discomfort in their lower abdomen
06:39or pelvis region on one side or the other.
06:42It may last for a few hours.
06:44It may last for a day or two.
06:45And that's usually because the one follicle that's going to ovulate is getting larger.
06:51The ovary is a little bit more active.
06:53Sometimes when you ovulate, what's left behind kind of bleeds a little bit because, you know,
06:59something just burst out of it.
07:00I think paying attention to that is very important.
07:04Tracking it to see, okay, is this happening around the same time every month, every 28,
07:1030 days, going along with your cycle to make sure that it is in fact related to ovulation?
07:16How severe is it?
07:18If it is that you're doubled over in pain every month, you should 100% get that evaluated
07:25and checked out.
07:26If you're just having mild discomfort, you can use heating pads.
07:29You can use any over-the-counter medication that you will usually use.
07:33It's very important to track this pain because if it is that it's more random and when you
07:40write it down on your calendar and you count the frequency, you realize that it is not,
07:44you know, happening on, you know, with some consistency.
07:47It may be due to other things.
07:49This can be assessed on the ovary.
07:51This could be due to fibroids.
07:53This can be due to an infection.
07:55But we always need to remember that we have doctors and medical providers that can help
08:02us figure things out if we're not sure.
08:04So don't be afraid to bring it up.
08:06Do I really not have to get a pap smear every year anymore?
08:11Yes.
08:11For most people, the answer is yes.
08:14So we have great research and evidence that has allowed us to determine the frequency
08:22with which pap smears should be done.
08:24So first of all, pap smears are screening tests for cervical cancer.
08:28When you get a pap smear, it's a sample of the cells.
08:31And sometimes, depending on your age, it can also include testing for HPV, specifically
08:35if you're older than 30 years old.
08:37So we know that if someone has a negative pap smear and also they test negative for
08:43HPV, their risk of having a high-grade lesion that's precancerous is very, very, very,
08:51very low.
08:52So you don't need to have a pap smear in the next year.
08:55We know that HPV is the primary driver of cervical cancer.
08:59So HPV is a virus, human papillomavirus.
09:02It's pretty common.
09:0380% of us will have at least one strain of HPV in our lifetime.
09:06However, I call HPV the lazy virus.
09:09It moves pretty slowly.
09:11So usually, it takes more than 10 years, even up to 20 years, for an HPV infection to become
09:19cervical cancer if it were going to.
09:22But usually, it clears itself.
09:24Our body is able to fight off the infection in one to two years.
09:27So let's say someone had a pap smear.
09:29It was negative.
09:30And then in the next one to two years, they get an HPV infection.
09:34By the time they get another pap smear in three to five years, that infection is likely
09:39to be gone.
09:40And even if it were not gone, it's not going to be cervical cancer, which is what we're
09:45screening for.
09:46So we've figured out, based on someone's current pap smear results, their old pap smear
09:50results, and altered their age, what their risk is of having a high-grade precancerous
09:56lesion on their cervix now and also within five years.
09:59So based on that information, the experts, many of them, have determined with what frequency
10:06we should have pap smears.
10:07And so if you're younger than 30, it's going to be every three years.
10:10If you're older than 30 and you have a negative pap smear, a negative HPV test, it can be
10:14as infrequent as every five years.
10:17If it is normal, you do not need to have it every year.
10:20If it is abnormal, you need to discuss with your doctor what follow-up testing you need
10:25and with which frequency and for how long you're going to need more frequent pap smears.
10:30I hope you enjoyed this video.
10:32I just want to remind you that everyone is different.
10:34Everyone's body is different.
10:36So always consult with a medical profession when looking for advice that's relevant to
10:41you.