OB-GYN Responds to Women’s Health Questions About Menopause, Periods & More

Searching for medical advice on the internet

can be confusing and just lead to lots of anxiety.

So I'm here to answer

some of the more complex medical questions

that you may have.

I am Dr. Candice Fraser, and I'm a board-certified OB/GYN.

Does having irregular periods

mean I'll have trouble getting pregnant?

Yes and no.

So first of all, what do we mean by irregular?

So something that I realize when I speak to my patients

is that it is very important

to know what a regular period is.

When we say, When was your last period?,

we're talking about the first day

that you started to have bleeding.

And then for your cycle,

we count from the first day of one period

to the first day of the next period.

And that's how we figure out what your cycle length is

or how many days are in between.

In general, a normal cycle length is between 21 and 42 days.

And for an individual person, you want it to be consistent,

so every 28 days, every 38 days, with some variation,

plus or minus two or three days, that's okay.

Now, if you are having periods that vary in cycle length,

so one month it's 28 days, one month it's 21 days,

then it's 40 days,

or you're skipping complete months or it's every few months,

that's what we mean by irregular.

So a very common cause

would be polycystic ovarian syndrome, or PCOS.

It can be problems with your thyroid

or other hormones such as prolactin.

And sometimes this means

that you're not ovulating regularly,

so therefore you're not having a period regularly.

Does this necessarily mean

that you will have trouble getting pregnant?

No.

If you are ovulating at all,

you can get pregnant on any cycle that you're ovulating.

However, for some people

it takes multiple months of trying to get pregnant.

So let's take a year.

If you're having a period every month,

that's 12 months of ovulation.

So 12 opportunities to get pregnant.

So if you're a person

that's gonna need 12 months to get pregnant,

but in any given year you're only ovulating eight times,

that means it may take you longer

or it may be a little bit more difficult,

or you may notice difficulty in getting pregnant.

If it is that you're not really ovulating much at all,

then yeah, it may be a little bit more difficult

and you may need help.

However, I have lots of patients

who have conditions like polycystic ovarian syndrome

or other conditions that cause their periods to be irregular

and they get pregnant the first time they try.

So do not use your irregular periods

as a reason not to use birth control

if you do not wanna get pregnant.

If you are on hormonal birth control,

will it affect your ability to get pregnant

or will it take longer to get pregnant

after you come off of birth control?

In most cases, the answer is absolutely not.

So for most birth controls that are hormonal,

so pills, patch, ring, IUD, implant,

once you stop it or you take it out,

you're right back to baseline fertility.

So with Depo-Provera,

which you usually get every three months,

it may take a little bit longer for your body

to start to ovulate again once you stop that method.

But other than that, all the others,

you go right back to baseline fertility right away,

so you don't have to stop birth control

a long time in advance prior to trying to get pregnant.

What are the main things I should know about menopause

in my late thirties or early forties?

I think it's because we're talking about it more,

people are being more open about how they feel

and these symptoms and changes that they're going through.

It's a natural part of life. It's gonna happen.

I think about it kind of like puberty,

which is the other big change that we go through.

Some of it we can manage,

but some of it our bodies are just going to be different.

And I think understanding that and knowing that

and sort of almost welcoming it is very helpful.

Now having said that, you're gonna welcome it

and you know it's gonna happen, but it can be terrible.

It does not have to be, but it can be.

So I think knowing what some of the symptoms can be

and anticipating it can be helpful

and being comfortable discussing the symptoms

that you're having also is important.

One thing that I always ask my patients when they're like,

Oh my gosh, am I going through perimenopause

or is this menopause?,

I usually ask if they know how old their mother

or other people in their family went through menopause,

because it kind of tracks in families.

Average age of menopause in the US is 51.

People who go through menopause at a younger age

and people who go through menopause at an older age.

Menopause is 12 months of no period.

That's how we define it and diagnose it.

The time before that is called perimenopause.

So in the years leading up to menopause,

when estrogen is slowly creeping down and decreasing,

you can start to notice things like hot flashes,

changes in mood, changes in sleep,

changes in the way your body kind of looks or feels.

These things can happen and can be due to perimenopause.

So if you are having symptoms

in the perimenopausal period or the menopausal period,

there are medications,

there are other more holistic things

and lifestyle things that we can speak about

to help you through that transition.

Given that the average age of menopause is 51,

usually you become less and less able

to get pregnant spontaneously,

probably, you know, in the 10 years or so

leading up to that.

So if you are thinking that you will probably

want to possibly get pregnant

in your late thirties, early forties,

I always recommend

that my patients consider things like egg freezing.

Now, egg freezing is not for everyone.

You may not feel comfortable with it.

It's pretty expensive as well,

but it is something that you should consider and understand.

I think the most important thing I tell my patients

is understanding that there is a window,

that it is not forever.

There are many stories on the internet

of people getting pregnant in their fifties.

Those tend to be the exception and not the rule.

So when you're in your late thirties or early forties

and all your friends

are talking about menopause and perimenopause,

I want you to just listen to the conversations,

pay attention to your own body,

understand that this is just a transition in life

and you can get through it.

What can I do if I get very painful ovulation pinches?

Some people do report that when they ovulate,

which is in the middle of the cycle,

usually two weeks before you have a period,

they can feel pain or discomfort

in their lower abdomen or pelvis region

on one side or the other.

It may last for a few hours, it may last for a day or two,

and that's usually because the one follicle

that's going to ovulate is getting larger.

The ovary is a little bit more active.

Sometimes when you ovulate,

what's left behind kind of bleeds a little bit

because, you know, something just burst out of it.

I think paying attention to that is very important.

Tracking it to see, okay,

is this happening around the same time every month,

every 28, 30 days, going along with your cycle

to make sure that it is in fact related to ovulation.

How severe is it?

If it is that you're doubled over in pain every month,

you should 100% get that evaluated and checked out.

If you're just having mild discomfort,

you can use heating pads,

you can use any over-the-counter medication

that you will usually use.

It's very important to track this pain

because if it is that it's more random

and when you write it down on your calendar

and you count the frequency,

you realize that it is not,

you know, happening with some consistency,

it may be due to other things.

This can be a cyst on the ovary.

This could be due to fibroids.

This can be due to an infection.

But we always need to remember

that we have doctors and medical providers

that can help us figure things out if we're not sure.

So don't be afraid to bring it up.

Do I really not have to get a Pap smear every year anymore?

Yes, for most people, the answer is yes.

So we have great research and evidence

that has allowed us to determine

the frequency with which Pap smears should be done.

So first of all, Pap smears are screening tests

for cervical cancer.

When you get a Pap smear, it's a sample of the cells,

and sometimes depending on your age,

it can also include testing for HPV,

specifically if you're older than 30 years old.

So we know that if someone has a negative Pap smear

and also they test negative for HPV,

their risk of having a high-grade lesion that's precancerous

is very, very, very, very low.

So you don't need to have a Pap smear in the next year.

We know that HPV is the primary driver of cervical cancer.

So HPV is a virus, human papilloma virus.

It's pretty common.

80% of us will have

at least one strain of HPV in our lifetime.

However, I call HPV the lazy virus. It moves pretty slowly.

So usually it takes more than 10 years, even up to 20 years,

for an HPV infection

to become cervical cancer if it were going to.

But usually it clears itself.

Our body is able to fight off the infection

in one to two years.

So let's say someone have a Pap smear who is negative

and then in the next one to two years

they get an HPV infection.

By the time they get another Pap smear

in three to five years,

that infection is likely to be gone.

And even if it were not gone,

it's not gonna be cervical cancer,

which is what we're screening for.

So we figured out,

based on someone's current Pap smear results,

their old Pap smear results, and also their age,

what their risk is of having

a high-grade precancerous lesion on their cervix

now and also within five years.

So based on that information, the experts, many of them,

have determined with what frequency

we should have Pap smears.

And so if you're younger than 30,

it's gonna be every three years.

If you're older than 30 and you have a negative Pap smear

or a negative HPV test,

it can be as infrequent as every five years.

If it is normal, you do not need to have it every year.

If it is abnormal, you need to discuss with your doctor

what follow-up testing you need and with which frequency

and for how long you're gonna need more frequent Pap smears.

I hope you enjoyed this video.

I just wanna remind you that everyone is different.

Everyone's body is different,

so always consult with a medical professional

when looking for advice that's relevant to you.

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