Answers to Your Questions






What is a Pap test?
The Pap test, also called a Pap smear, checks for changes in the cells of your cervix. The cervix is the lower part of the uterus (womb) that opens into the vagina (birth canal). The Pap test can tell if you have an infection, abnormal (unhealthy) cervical cells, or cervical cancer.

A Pap test can save your life. It can find the earliest signs of cervical cancer - a common cancer in women. If caught early, the chance of curing cervical cancer is very high. Pap tests also can find infections and abnormal cervical cells that can turn into cancer cells. Treatment can prevent most cases of cervical cancer from developing.

Getting regular Pap tests is the best thing you can do to prevent cervical cancer. About 13,000 women in America will find out they have cervical cancer this year. And in 2004, 3,500 women died from cervical cancer in the United States.

It is important for all women to have pap tests, along with pelvic exams, as part of their routine health care. You need a Pap test if you are:

  • 21 years or older
  • under 21 years old and have been sexually active for three years or more
There is no age limit for the Pap test. Even women who have gone through menopause (when a woman's periods stop) need regular Pap tests.

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How often do I need to get a Pap test?
It depends on your age and health history. Talk with your doctor about what is best for you. The American College of Obstetricians and Gynecologists recommends the following:

  • If you are younger than 30 years old, you should get a Pap test every year.
  • If you are age 30 or older and have had three normal Pap tests for three years in a row, talk to your doctor about spacing out Pap tests to every two or three years.
  • If you are ages 65 to 70 and have had at least three normal Pap tests and no abnormal Pap tests in the last 10 years, ask your doctor if you can stop having Pap tests.
  • Women who have had a hysterectomy should talk with their doctor about whether they need routine Pap tests.
You should have a Pap test every year no matter how old you are if:
  • You have a weakened immune system because of organ transplant, chemotherapy or steroid use
  • Your mother was exposed to diethylstilbestrol (DES) while pregnant
  • You are HIV-positive
Women who are living with HIV, the virus that causes AIDS, are at a higher risk of cervical cancer and other cervical diseases. The U.S. Centers for Disease Control and Prevention recommends that all HIV positive women get an initial Pap test, and get re-tested 6 months later. If both Pap tests are normal, then these women can get yearly Pap tests in the future.

The only women who do not need regular Pap tests are:
  • Women over age 65 who have had a number of normal Pap tests and have been told by their doctors that they don't need to be tested anymore.
  • Women who do not have a cervix and are at low risk for cervical cancer. These women should speak to their doctor before stopping regular Pap tests.
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How is the pap test done?
Your doctor can do a Pap test during a pelvic exam. It is a simple and quick test. While you lie on an exam table, the doctor puts an instrument called a speculum into your vagina, opening it to see the cervix. She will then use a special stick or brush to take a few cells from inside and around the cervix. The cells are placed on a glass slide and sent to a lab for examination. While usually painless, a Pap test is uncomfortable for some women.

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What do abnormal pap results mean?
It is scary to hear that your Pap test results are "abnormal." But abnormal Pap test results usually do NOT mean you have cancer. Most often there is a small problem with the cervix.

Some abnormal cells will turn into cancer. But most of the time, these unhealthy cells will go away on their own. By treating these unhealthy cells, almost all cases of cervical cancer can be prevented. If you have abnormal results, talk with your doctor about what they mean.

There are many reasons for "abnormal" Pap test results. If results of the Pap test are unclear or show a small change in the cells of the cervix, your doctor will probably repeat the Pap test. If the test finds more serious changes in the cells of the cervix, the doctor will suggest more powerful tests. Results of these tests will help your doctor decide on the best treatment. These include:

  • Colposcopy: The doctor uses a tool called a colposcope to see the cells of the vagina and cervix in detail.
  • Endocervical curettage: The doctor takes a sample of cells from the endocervical canal with a small spoon-shaped tool called a curette.
  • Biopsy: The doctor removes a small sample of cervical tissue. The sample is sent to a lab to be studied under a microscope.
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What should I know about HPV?
HPV is a major cause of cervical cancer. HPV infection is also one of the most common sexually transmitted diseases (STD). A woman boosts her chances of HPV infection if she:

  • Starts having sex before age 18
  • Has many sex partners
  • Has sex partners who have other sex partners
  • Has or has had a sexually transmitted disease (STD)
Human papilloma viruses are a group of more than 100 different viruses. About 40 types of HPV are spread during sex. Some types of HPVs can cause cervical cancer when not treated. HPV infection is one of the most common sexually transmitted diseases. About 75 percent of sexually active people will get HPV sometime in their life. Most women with untreated HPV do NOT get cervical cancer. Some HPVs cause genital warts but these HPVs do not cause cervical cancer.
Since HPV rarely causes symptoms, most people don't know they have the infection.

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How would I know if I had human papilloma virus (HPV)
Most women never know they have HPV. It usually stays hidden and doesn't cause symptoms like warts. When HPV doesn't go away on its own, it can cause changes in the cells of the cervix. Pap tests usually find these changes.

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Why should I do a breast self-exam?
Regular breast self-exam can help you know how your breasts normally feel and look, so you can notice any changes. When you find a change, you should see your health care provider. Most breast changes or lumps are not cancerous, but only a health care provider can tell you for sure. When breast cancer is found early, you have more treatment choices and a better chance of recovery. So, it is important to find breast cancer as early as possible.

Breast self-exam should not take the place of getting regular mammograms. Right now, mammograms are the best way to find breast cancer early and to improve your chances for survival.

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What am I looking for when I do a breast self-exam?
You are looking for a lump or change that stands out as different from the rest of your breast tissue. If you find a lump or other change in your breast, either during breast self-exam or by chance, you should examine the other breast. If both breasts feel the same, the lumpiness is probably normal. As you get to know your breasts better by doing breast self-exams, you should be able to tell the difference between your normal lumpiness and what may be a change. Besides a lump or swelling, other changes in your breast might be

  • skin irritation or dimpling
  • nipple pain or retraction (turning inward)
  • redness or scaliness of the nipple or breast skin
  • a discharge other than breast milk.
If you see any of these changes, you should see your health care provider right away.

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Is there a right way to examine my breasts?
Yes. There are several proper ways to examine your breasts. Ask your health care provider to teach you how to do a breast self-exam to make sure you are doing it correctly and thoroughly. We have provided a document that shows the right way to examine your breasts.

Remember that you should discuss any new lump or change with your health care provider.

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How often should I do a self-exam?
A breast self-exam is recommended every month a few days after your period ends. During this time, your breasts are less tender or swollen. It is important to do your breast self-exam at the same time every month.

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What is a mammogram?
A mammogram is a safe test used to look for any problems with a woman's breasts. The test uses a special, low-dose x-ray machine to take pictures of both breasts. The results are recorded on x-ray film or directly onto a computer for a radiologist to examine.

Mammograms allow the doctor to have a closer look for breast lumps and changes in breast tissue. They can show small lumps or growths that a doctor or woman may not be able to feel when doing a clinical breast exam. "Mammography" is the best screening tool that doctors have for finding breast cancer.

If a lump is found, your doctor may order other tests, such as ultrasound or a biopsy--a test where a small amount of tissue is taken from the lump and area around the lump. The tissue is sent to a lab to look for cancer or changes that may mean cancer is likely to develop. Breast lumps or growths can be benign (not cancer) or malignant (cancer). Finding breast cancer early means that a woman has a better chance of surviving the disease. There are also more choices for treatment when breast cancer is found early.

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Are there different types of mammograms?
Screening mammograms are done for women who have no symptoms of breast cancer. When you reach age 40, you should have a mammogram every one to two years.

Diagnostic mammograms are done when a woman has symptoms of breast cancer or a breast lump. This mammogram takes longer than screening mammograms because more pictures of the breast are taken.

Digital mammograms take an electronic image of the breast and store it directly in a computer. Current research has not shown that digital images are better at finding cancer than x-ray film images.

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How is a mammogram done?
You stand in front of a special x-ray machine. The person who takes the x-rays, called a radiologic technologist, places your breasts (one at a time) between two plastic plates. The plates press your breast to make it flat. You will feel pressure on your breast for a few seconds. It may cause you some discomfort; you might feel squeezed or pinched. But, the flatter your breast, the better the picture. Most often, two pictures are taken of each breast--one from the side and one from above. A screening mammogram takes about 15 minutes from start to finish.

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What if I have breast implants?
If you have breast implants, be sure to tell your mammography facility that you have them when you make your appointment. You will need an x-ray radiologic technologist who is trained in x-raying patients with implants. This is important because breast implants can hide some breast tissue, which could make if difficult for the radiologist to see breast cancer when looking at your mammograms. For this reason, to take a mammogram of a breast with an implant, the x-ray technician might gently lift the breast tissue slightly away from the implant.

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How often should I get a mammogram?
Women 40 years and older should get a mammogram every 1 to 2 years.

Women who have had breast cancer or other breast problems or who have a family history of breast cancer, might need to start getting mammograms before age 40 or they might need to get them more often. Talk to your doctor about when to start and how often you should have a mammogram.

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How do I get ready for my mammogram?
First, check with the place you are having the mammogram for any special instructions you may need to follow before you go. Here are some general guidelines to follow:

  • Make your mammogram appointment for one week after your period. Your breasts hurt less after your period.
  • If you have breast implants, be sure to tell your mammography facility that you have them when you make your appointment.
  • Wear a shirt with shorts, pants, or a skirt. This way, you can undress from the waist up and leave your shorts, pants, or skirt on when you get your mammogram.
  • Don't wear any deodorant, perfume, lotion, or powder under your arms or on your breasts on the day of your mammogram appointment. These things can make shadows show up on your mammogram.
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Are there any problems with mammograms?
As with any medical test, mammograms have limits. These limits include:

  • They are only part of a complete breast exam. Your doctor also should do a clinical breast exam. If your mammogram finds something abnormal, your doctor will order other tests.
  • "False negatives" can happen. This means everything may look normal, but cancer is actually present. False negatives don't happen often. Younger women are more likely to have a false negative mammogram than are older women. This is because the breast tissue is denser, making cancer harder to spot.
  • "False positives" can happen. This is when the mammogram results look like cancer is present, even though it is not. False positives are more common in younger women than older women.
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What is perimenopause?
Perimenopause is the time leading up to menopause when you start to notice menopause-related changes--plus the year after menopause. Perimenopause is what some people call "being in menopause" or "going through menopause." But menopause itself is only one day--the day you haven’t had a period for 12 months in a row. During perimenopause, your ovaries start to shut down, making less of certain hormones (estrogen and progesterone), and you begin to lose the ability to become pregnant. This change is a natural part of aging that signals the ending of your reproductive years.

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When does perimenopause start?
Women normally go through perimenopause between ages 45 and 55, but some women start perimenopause earlier, even in their 30s. When perimenopause starts, and how long it lasts varies from woman to women. You will likely notice menopause-related symptoms, such as changes in periods.

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What are some of the signs and symptoms?
Menopause affects every woman differently. Your only symptom may be your period stopping. You may have other symptoms, too. Many symptoms at this time of life are because of just getting older. But some are due to approaching menopause. Menopause-related symptoms you might have during perimenopause include:
  • Changes in pattern of periods (can be shorter or longer, lighter or heavier, more or less time between periods)
  • Hot flashes (sudden rush of heat in upper body)
  • Night sweats (hot flashes that happen while you sleep), often followed by a chill
  • Trouble sleeping through the night (with or without night sweats)
  • Vaginal dryness
  • Mood changes, feeling crabby (probably because of lack of sleep)
  • Trouble focusing, feeling mixed-up or confused
  • Hair loss or thinning on your head, more hair growth on your face
When you visit your doctor, take along a diary about what’s happening with your period. For a few months before your visit, record when your period starts and stops each day, and indicate whether it is light of heavy. Also note any other symptoms you have.

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Is there any treatment for perimenopause? What can I do?
Some women take oral contraceptives (birth control pills, or "the pill") to ease perimenopausal symptoms--even if they don't need them for birth control. These hormone treatments of combined estrogen and progestin can help keep your periods regular plus ease all the symptoms listed above. Talk with your doctor to see if this option is for you. If you are over 35, you should not take birth control pills if you smoke or have a history of blood clots. You need a prescription to get oral contraceptives.

After a woman reaches menopause, if she still needs treatment for menopause symptoms, she should switch from birth control pills to menopause hormone therapy (HT). HT contains much lower doses of hormones, and thus has less risk for bad side effects.
Making some changes in your life can also help ease your symptoms and keep you healthy.

  • Eat Healthy. A healthy diet is more important now than before because your risks of osteoporosis (extreme bone loss) and heart disease go up at this stage of life. Eat lots of whole-grain foods, vegetables, and fruits. Add calcium-rich foods (milk, cheese, yogurt) or take a calcium supplement to obtain your recommended daily intake. Get adequate vitamin D from sunshine or a supplement. Avoid alcohol or caffeine, which also can trigger hot flashes in some women.
  • Get Moving. Regular exercise helps keep your weight down, helps you sleep better, makes your bones stronger, and boosts your mood. Try to get at least 30 minutes of exercise most days of the week, but let your doctor recommend what’s best for you.
  • Find healthy ways to cope with stress. Try meditation or yoga--both can help you relax, as well as handle your symptoms more easily.
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Can I get pregnant while in perimenopause?
Yes, you can get pregnant until you’ve gone 12 months in a row without a period. Talk to your doctor about your birth control options. Keep in mind that birth control pills, shots, implants, or diaphragms will not protect you from STDs or HIV. If you use one of these methods, be sure also to use a latex condom or dental dam (used for oral sex) correctly every time you have sexual contact. Be aware that condoms don't provide complete protection against STDs and HIV--the only sure protection is abstinence (not having sex of any kind). But making sure to always use--and correctly use--latex condoms and other barrier methods can help protect you from STDs.

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What is menopause?

Menopause is the time in a woman's life when her period stops. It is a normal change in a woman's body. A woman has reached menopause when she has not had a period for 12 months in a row (and there are no other causes, such as pregnancy or illness, for this change). Menopause is sometimes called, "the change of life." Leading up to menopause, a woman’s body slowly makes less and less of the hormones estrogen and progesterone. This change often happens between the ages of 45 and 55 years old.

As you near menopause, you may have symptoms from the changes your body is making. Many women wonder if these changes are normal, and many are confused about how to treat their symptoms. You will feel better by learning all you can about menopause and talking with your doctor about your health and your symptoms. If your symptoms are causing you discomfort or concern, your doctor can teach you about treatment options and help you to make wise treatment choices.

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What are the symptoms of menopause?
Menopause affects every woman differently. Your only symptom may be your period stopping. You may have other symptoms, too. Many symptoms at this time of life are because of you getting older. But some are due to menopause. Common symptoms of menopause include:

  • Change in pattern of periods (can be shorter or longer, lighter or heavier, more or less time between periods)
  • Hot flashes (sometimes called hot flushes), night sweats (sometimes followed by a chill)
  • Trouble sleeping through the night (with or without night sweats)
  • Vaginal dryness
  • Mood swings, feeling crabby, crying spells (probably because of lack of sleep)
  • Trouble focusing, feeling mixed-up or confused
  • Hair loss or thinning on your head, more hair growth on your face.
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Does menopause cause bone loss?
When a woman is young, estrogen helps to keep bone strong. When estrogen levels fall at menopause, bones weaken. When bones weaken a lot, the condition is called osteoporosis. Weak bones can break more easily.

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How do I manage menopause? What are my options?
Eating a healthy diet and exercising at menopause and beyond are important to feeling your best. Most women do not need any special treatment for menopause. But some women may have menopause symptoms that need treatment. Several treatments are available. It's a good idea to talk about the treatments with your doctor so you can choose what’s best for you. There is no one treatment that is good for all women. Sometimes menopause symptoms go away over time without treatment, but there’s no way to know when.

Hormone Therapy (HT) -- If used properly, hormone therapy (once called hormone replacement therapy or HRT) is one way to deal with the more difficult symptoms of menopause. It's the only therapy that is approved by the government for treating more difficult hot flashes and vaginal dryness. Hormone therapy should NOT be used solely to prevent heart or bone disease, stroke, memory loss, or Alzheimer's disease. There are many kinds of hormone therapies so your doctor can suggest what's best for you. As with all treatments, HT has both possible benefits and possible risks; it is important to talk about these issues with your doctor. If you decide to use HT, use the lowest dose that helps and for the shortest time needed. Check with your doctor every 6 months to see if you still need HT. For more information on the benefits and risks of HT visit the NHLBI website.

HT can help with menopause by:

  • Reducing hot flashes
  • Treating vaginal dryness
  • Slowing bone loss
  • Improving sleep (and thus decrease mood swings)
For some women, HT may increase their chance of:

  • Blood clots
  • Heart attack
  • Stroke
  • Breast cancer
  • Gall bladder disease
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Who should NOT take HT for menopause?
Women who...

  • Think they are pregnant
  • Have problems with vaginal bleeding
  • Have had certain kinds of cancers (such as breast and uterine cancer)
  • Have had a stroke or heart attack
  • Have had blood clots
  • Have liver disease
  • Have heart disease
HT can also cause these side effects:

  • Vaginal bleeding
  • Bloating
  • Breast tenderness or swelling
  • Headaches
  • Mood changes
  • Nausea
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What about so-called "natural" treatments for menopause?
Some women decide to take herbal or other plant-based products to help relieve hot flashes. Some of the most common ones are:

  • Soy. Soy contains phytoestrogens (chemicals that are like estrogen). But, there is no proof that soy--or other sources of phytoestrogens--really do make hot flashes better. And the risks of taking soy--mainly soy pills and powders--are not known. The best sources of soy are foods such as tofu, tempeh, soymilk, and soy nuts. These soy products are more likely to work on mild hot flashes.
  • Other sources of phytoestrogens. These include herbs such as black cohosh, wild yam, dong quai, and valerian root. Again, there is no proof that these herbs (or pills or creams containing these herbs) help with hot flashes.
    Products that come from plants may sound like they are safe, but there is no proof they really are. There also is no proof that they are better at helping symptoms of menopause. Make sure to discuss these types of products with your doctor before taking them. You also should tell your doctor about other medicines you are taking, since some plant products can be harmful when combined with other drugs.
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What about "bioidentical" hormone therapy?
This term means different things to different people. It’s really hormones that are just the same as the hormones the body makes. There are several products with hormone like this that are on the market and are well-tested. But some people use this term to mean drugs that are custom-made from a doctor’s order. There is no proof that these custom-made products are better or safer than hormone therapy that’s on the market.

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How much physical activity should I do?
A woman should first talk to her doctor to see what's best for her. The goal is to exercise regularly so you can lower the risk of serious disease (such as heart disease or diabetes), and maintain a healthy weight. This usually takes at least 30 minutes of exercise (such as brisk walking) on most days of the week.

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How else can I help my symptoms?
  • Hot Flashes. Some women report that eating or drinking hot or spicy foods, alcohol, or caffeine, feeling stressed, or being in a hot place can bring on hot flashes. Try to avoid any triggers that bring on your hot flashes. Dress in layers, and keep a fan in your home or workplace. Regular exercise might also ease hot flashes, but sometimes exercise can cause a hot flash. If hot flashes continue and HT is not an option, ask your doctor about taking an antidepressant or epilepsy medicine. There is proof that these can relieve hot flashes for some women.
  • Vaginal Dryness. A water-based, over-the-counter vaginal lubricant (like KY® Jelly) can be helpful if sex is painful. A vaginal moisturizer (also over-the-counter) can provide lubrication and help keep needed moisture in vaginal tissues. Really bad vaginal dryness may need HT. If vaginal dryness is the only reason for considering HT, an estrogen product for the vagina is the best choice. Vaginal estrogen products (creams, tablet, ring) treat only the vagina.
  • Problems Sleeping. One of the best ways to get a good night's sleep is to get at least 30 minutes of physical activity on most days of the week. But, don’t exercise close to bedtime. Also avoid large meals, smoking, and working right before bedtime. Caffeine and alcohol should be avoided after noon. Drinking something warm before bedtime, such as herbal tea (no caffeine) or warm milk, might help you to feel sleepy. Keep your bedroom dark, quiet, and cool, and use your bedroom only for sleeping and sex. Avoid napping during the day, and try to go to bed and get up at the same times every day. If you wake during the night and can't get back to sleep, get up and read until you’re sleepy. Don't just lie there. If hot flashes are the cause of sleep problems, treating the hot flashes will usually improve sleep.
  • Mood swings. Some women report mood swings or "feeling blue" as they reach menopause. Women who had mood swings (PMS) before their periods or post-partum depression after giving birth may have more mood swings around menopause. These are women who are sensitive to hormone changes. Often the mood swings will go away with time. If a woman is using HT for hot flashes or another menopause symptom, sometimes her mood swings will get better, too. Also, getting enough sleep and staying physically active will help you to feel your best. Mood swings are not the same as depression.
  • Memory problems. As people age, their memory is not as good as it once was. Some women say they have "fuzzy thinking" as they reach menopause. This may be caused by changing hormones and can improve over time. Getting enough sleep and keeping physically active can help. If memory problems are really bad, talk to your doctor right away. This is not caused by menopause.
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I'm having a hysterectomy soon. Will this cause me to reach menopause?
Sometimes, younger women need a hysterectomy to treat health problems such as endometriosis or cancer. A hysterectomy is an operation to remove a woman’s uterus (womb). Often one or both ovaries (the female organs that produce eggs and hormones) are removed at the same time the hysterectomy is done. If you haven’t reached menopause, a hysterectomy will stop your period. But, you will reach menopause only if both ovaries are removed, called surgical menopause. Because surgical menopause is instant menopause, it can cause more severe symptoms than natural menopause (menopause that occurs as part of the natural aging process). You should talk with your doctor about how to best manage these symptoms.

Women who have a hysterectomy but have their ovaries left in place will not reach menopause at the time of surgery because their ovaries will continue to make hormones. But, because the uterus is removed, they will no longer have their periods and they cannot become pregnant. Later on, they might reach natural menopause a year or two earlier than expected.

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What is premature menopause?
Menopause is called "premature" if it happens at or before the age of 40--whether it is natural or brought on by medical means (induced). Some women have premature menopause because of:

  • Family history (genes)
  • Medical treatments, such as surgery to remove the ovaries
  • Cancer treatments, such as chemotherapy or radiation to the pelvic area that damage the ovaries-- although menopause does not always occur
Having premature menopause puts a woman at more risk for osteoporosis later in her life. For women who want to have children, premature menopause can be a source of great distress. Women who still want to become pregnant can talk with their doctors about other ways of having children, such as donor egg programs or adoption.

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