A menstrual flow requiring more than seven pads per day is excessive. If this persists it should be treated by a doctor. Severe menstrual cramps often affect adolescent females. They should not be simply accepted because there are whole families of non-steroidal medications and hormones that can address the problem. Birth control pills provide menstrual predictability and shorten the menstrual cycle. Non-steroidal anti-inflammatory drugs (NSAIDs) can be used to prevent the severe uterine contractions and pain caused by prostaglandins. It is easier to prevent menstrual pain than it is tocontrol it once the uterine contractions begin.

Dr. Wulf-Gutierrez advises everyone between the ages of 15 and 50 (i.e., women of child-bearing age) to take vitamins and folic acid. Folic acid can reduce the incidence of spina bifida, a birth defect involving the nervous system.

She recommends that women have their first Pap smear at 21. Women who begin sexual activity before the age of eighteen need Pap smears at an earlier age.

Because of the importance of using condoms, Dr. Wulf-Gutierrez advises teens not to tell anyone if they are taking the pill. It is a personal matter. Boy friends may take the information as a sign they don’t need to use condoms. Condoms are strongly recommended for anyone who is having premarital sexual relations.

Human Papilloma Virus (HPV) is actually a group of viruses that affect three out of every four sexually active people in the U.S. Most people don’t know they are infected. A majority of infected people develop immunity in a year or so. If there is a visual symptom, it most commonly is a genital wart. It is unclear what the benefits to a woman might be of disclosing to a partner that a Pap smear has revealed an HPV infection. Certain types of “high risk” HPVs are the main risk factor for cervical cancer.

Women who receive regular Pap smears have a dramatically decreased risk of developing invasive cervical cancer. About one quarter of all sexually active adults have genital herpes, although 90% of those infected do not know they have it. She advises patients who do know they have herpes to tell their partner. Genital herpes can affect pregnancy and a child during labor. Hepatitus B and C are other types of STDs. Immunization against Hepatitis B is now recommended for children to prevent the infection during adulthood. Some parents have expressed concern that allowing their children to be immunized might promote their promiscuity. Dr. Wulf-Gutierrez says there is no evidence this is true. Women also are at risk of sexual assault, and immunization would protect against infection from Hepatitis B under these circumstances.

She noted that some STDs such as gonorrhea and Chlamydia can result in tubal infections. Tubal infection, or pelvic inflammatory disease (PID), is a leading cause of tubal infertility which may not be apparent for 10 or 15 years. Some women who get repeated cases of STDs have issues that contribute to poor decision-making. Binge drinking and substance abuse have been associated with repeated STD infections.

Dr. Wulf-Gutierrez noted that teenage years are times for seeking one’s identity, and that includes gender preference. She urged parents to be supportive while teens are going through this search.

She stated that teenage pregnancies have been declining the last ten years but there are still many pregnancies that are not by choice. She urged teens to think of the potential consequences of sexual activity and that teenage parenthood deprives the teen of time he/she needs to mature. Condoms are not 100% effective for birthcontrol but they are the only form of birth control that provides protection against STDs.

Questions and Answers

The Patch. The Patch can be used to reduce menstrual cramps. It can be placed on the abdomen, back, or arms, but not the breast. One must consider the lack of privacy that wearing a patch confers as a woman decides if it is the right contraceptive choice for her.

Initiation of Breast Exams. Starting at the age of 18, women should conduct breast exams since that is the youngest age at which breast cancer has been diagnosed. The exam should be done after the menstrual cycle since breasts are typically enlarged and sensitive just prior to menstruation. Many young breasts are naturally lumpy so women need to know what is normal for them. If a woman detects a pea, marble, or cyst-sized growth for more than one month, she should contact a doctor.

Genetic incidence of bad periods. Heavy periods and endometriosis do run in families. Endometriosis can cause menstrual cramps in teens as well as in adults. The definitive method of diagnosing endometriosis is with a surgical procedure called a diagnostic laparoscopy. This is not necessary for the majority of adolescents who are able to have the pain controlled medically with the use of birth control pills and NSAIDs.

Puberty Weight Gain. It is normal for teens to gain weight when they start menstruation. If they don’t there could be significant negative health impacts later in life.

Effect of Physical Activity on Menstrual Cycles. There is a significant impact of heavy physical activity on menstrual cycles. Athletes like ballerinas who are not having normal periods may need to take estrogen.

Physical Feelings for Boys. There is tremendous variation in when girls start having physical feelings for boys. Often it is peer pressure rather than hormones that cause the first feelings. She noted that lots of people don’t date until college and that lots of people don’t have sex until they are in their 20’s or 30’s or until marriage.

Safety of the Pill. Dr. Wulf-Gutierrez believes birth control pills are safe for the women taking them and there is no reason why women can’t stay on them for years. She noted that women who have been taking birth control pills for at least five years have a lower risk for some forms of cancer.

IUDs. There are two types of IUDs. One lasts for 10 years. The other lasts for five years and contains hormones that stop menstrual cycles. It is good for women in their 40’s with pre-menopausal bleeding. There is very little use of IUDs by teens since there is a risk of infection in the first few weeks after insertion.

Effectiveness of Condoms. Condoms are 85% effective. Some birth control failures are the result of non-use or misuse.

Female condoms. Female condoms are not used very much. Dr. Wulf-Gutierrez has talked with older women who tell her they like them. There are technical issues related to fitting different-size women that need to be overcome before female condoms see increased use.

Oral sex. She remarked that many teens believe oral sex is not sex. However, oral sex can lead to oral herpes or other infections.