On and Off the Birth Control Train

Hi Shawna,

I’ve stopped taking my pills a month ago because I wanted to try a different method but I changed my mind and want to stick to pills. I still have 3 filled packs. Is it safe if I start again tomorrow?

Questions about the Pill

PrintHi,

This is a great question!!

You can definitely restart your pills tomorrow or whenever you’d like! Just remember to use a backup method, like condoms, for the entire first week. In fact, you should always use condoms if you are concerned about STD’s or HIV. Also, your period might be slightly off for the first pill pack, but that is normal and OK. If you don’t get a period in 4 weeks, come in for a pregnancy test.

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Hope this helps answer your question!

In happiness & health,

Shawna

Want more information about the pill, like what to do if you miss a pill, click here!

Reviewed by Kohar Der Simonian, MD

To bleed or not to bleed?? How to control your period using the NuvaRing!

Hi Shawna,

I am going on vacation soon and really don’t want to be on my period. I am using the NuvaRing and my best friend told me that if I kept it in, I would skip my period. Is that true?

-Anonymous

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Hi,

Great question! Your friend is right!

Although I have written about the ring before, I have not written about how to use it to skip periods (which is totally safe). For those who have never heard of the NuvaRing or still a bit confused about it, check out my previous blog post by clicking here.

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It’s actually pretty simple to skip a period using the ring. Instead of taking the ring out after 3 weeks and going ring free for a week, simply leave the ring in for 4 weeks and immediately replace it with a new ring when the 4 weeks is up. This means there will not be a time in which you aren’t wearing a ring. Don’t worry; your ring is still protecting you against pregnancy during the 4th week, just don’t forget to remove it and replace it when the 4th week is up. You can do this just once or continually. And remember, it’s totally safe not to have a period, so using your ring in this way is a great option for people who hate having their periods.

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Let me know if you have any other questions!

In happiness & health,

Shawna

Reviewed by Kohar Der Simonian, MD

Stick It Before You Kick It! The 101 on the Birth Control Patch!

Happy 2014!!

This is the first blog of the year! Yay! It’s also the last Friday of the month! Why is that important? Well, I will now only be posting new blogs on the last Friday of the month! I may sneak additional blogs in from time to time but from here on out, you can expect to see a new post at the end of the month. Don’t worry though; you can still contact me by email anytime you have any questions – askshawna@yahoo.com

The first blog of the year is about the birth control patch. I have gotten several emails lately with questions about the patch and so I’m here to tell you all about it! And as always, feel free to comment or email any additional questions you may have.

What is the birth control patch?

T_BC_the-patchThe birth control patch is a small patch that sticks to your skin to prevent pregnancy. Like other methods of birth control, the patch includes a combination of an estrogen (estradiol) and progestogen (progestin) to prevent pregnancy. If used correctly, the patch is a very effective (meaning it works really well) at preventing pregnancy.

How does the birth control patch work?

The patch works by “telling” the ovaries not to release an egg (called ovulation). If no egg is released, there is nothing for sperm to fertilize (the fertilization of an egg by sperm results in pregnancy). However, if the patch is missed or used incorrectly, the ovaries don’t get the message (and may release an egg) making pregnancy possible if there has been recent unprotected sex (sex without a condom).

How to use the patch:

Patch How ToWear the first patch for 7 days. At the end of the 7 days, take off the first patch and apply a new patch in a different location (see below for acceptable patch locations). At the end of those 7 days, take the second patch off and apply a new one in a different location. After the end of those 7 days, take the patch off and DO NOT apply another one. Instead, leave the patch off for 7 days. That’s, 3 weeks on & 1 week off.

It’s during those 7 days of NOT wearing a patch that most women get their period (however, some women may or may not bleed the entire 7 days). Regardless of whether or not you are still bleeding, start a new patch only when the 7 days are complete. No sooner and no later.

Never go more than 7 days without wearing a patch, if you do, you may get pregnant.

Don’t use lotions or makeup on your skin near where the patch is

Don’t put the patch on the same part of your body for 2 weeks in a row – skin may become irritated. Also, don’t wear the path on your legs or breasts.

Some women experience breast tenderness when they first start using the patch. That generally goes away within a few weeks.

Before applying a new patch, think about the clothes you may wear that week and whether or not the patch may be visible.

Why some people love the birth control patch:

What to do if a patch falls off or I make a mistake?  

Issues and mistakes with the patch happen. Although the patch is designed not to come off the skin, it’s definitely possible. Also, sometimes patch users forget when to take off or put on a new patch (if you forget often, you might want to consider switching birth control methods). Knowing what to do if that happens can help prevent an unplanned pregnancy. Read the following for some general instructions on what to do if a patch mistake happens!

If a Patch edge lifts up:

Press down firmly on the Patch with the palm of your hand for 10 seconds, making sure that the whole Patch adheres to your skin. Run your fingers over the entire surface area to smooth out any “wrinkles” around the edges of the Patch.

  • If your Patch does not stick completely, remove it and apply a replacement Patch (no backup method is needed and your Patch Change Day will stay the same). Ask your healthcare professional for a replacement Patch prescription so you always have an extra Patch available.
  • Do not tape or wrap the Patch to your skin or reapply a Patch that is partially adhered to clothing

If your Patch has been off or partially off:

  • For less than 1 Day, try to reapply it. If the Patch does not adhere completely, apply a new patch immediately. (No backup contraception is needed and your Patch Change Day will stay the same)
  • For more than 1 Day or if you are not sure for how long, you may become pregnant. To reduce this risk, apply a new Patch and start a new 4-week cycle. You will now have a new Patch Change Day and must use non-hormonal backup contraception (such as a condoms) for the first week of your new cycle

How to purchase a REPLACEMENT Patch:

  • You can get a replacement Patch at the pharmacy where you filled your prescription
  • You will need a replacement Patch prescription from your healthcare professional
  • Unfortunately, Family Pact does not pay for the replacement patch. You will need to pay for the replacement Patch when you pick it up at the pharmacy.

From the Ortho Evra website:

http://www.orthoevra.com/how-use-loose-fall.html

In happiness & health,

Shawna

Reviewed by Kohar Der Simonian, MD and Andrea Raider, NP

From Bedsider: Mirena Lawsuit – Fact and Fiction!

If you haven’t noticed by now, we LOVE Bedsider here at New Gen! That’s because Bedsider provides all the information you could ever want to know about birth control in a way that is super easy to understand (go check them out by clicking here). Recently Bedsider addressed a concern that we’ve recently been hearing a lot of at New Gen. And although I couldn’t have addressed this subject any better, don’t hesitate to contact me or New Gen if you still have questions or concerns.

In happiness & health,

Shawna

P.S. The following is written entirely by Bedsider and can be found on their site (which I definitely recommend you check out) by clicking “Those Mirena Lawsuit Ads: Fact and Fiction” below the image.

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Those Mirena Lawsuit Ads: Fact and Fiction

The recent slew of Mirena IUD lawsuit ads are creepy. But are they true? We’re going to fearlessly wade into the scary things these ads claim, because we think the over 2 million U.S. women now using IUDs deserve the real info—without the hype.

What problems are being reported—and how common are they?

Some of the ads say 47,000 women have had problems with the Mirena. But where does that number come from? The Food and Drug Administration (FDA) scrutinizes drugs and devices for safety before they can be sold in the U.S., then continues collecting information about problems people have with drugs and devices after they’re on the market and being used more broadly.

Anyone can report problems to the FDA. Since Mirena came on the market in 2001, the FDA has received about 47,000 reports of problems with it. Many millions of women have used a Mirena over the 12 years it’s been on the market, so this number is actually a small fraction of the total—and it includes common complaints in addition to the rarer, scarier problems the lawsuit ads often focus on.

Here’s how the problems break down (and more about each below):

  • almost half (45%, or about 21,500 women) of the complaints are about IUD expulsion
  • pain during or after the IUD placement makes up 25% of the complaints (or 11,700 women)
  • complaints about more bleeding make up 21% (or 10,100 women)
  • complaints of less bleeding or no period account for 6% (or 2,800 women)
  • complaints of pregnancy with the IUD make up 5% (or 2,200 women)
  • perforation of the uterus accounts for 3% of the complaints (or 1,300 women)

Let’s look at the scientific evidence about how common each problem is and what it means if it happens to you.

Expulsion

It’s not surprising that almost half of the reported problems with Mirena were expulsion—it’s relatively common, occurring in up to 5% of women who get an IUD. Expulsion is a fancy way of saying that an IUD has been pushed out of its ideal location at the top of the uterus. The uterus is one big muscle, so this sometimes happens. In a complete expulsion, the IUD is pushed all the way out of the uterus into the vagina. In a partial expulsion (a.k.a. dislocation), an IUD is pushed only part way out and a woman may not know that her IUD isn’t where it should be.

If a woman doesn’t recognize a partially expelled IUD, it can mean the IUD isn’t working to prevent pregnancy. Signs of a partial expulsion include cramping, pain, and feeling the plastic of the IUD at the top of the strings. This is why doctors often advise checking on the IUD strings. If recognized quickly, a partial expulsion is not a big problem: the IUD needs to be removed, and a woman can decide if she wants to try another IUD or switch to a different method. After expelling one IUD, there may be a higher chance of expelling the next one.

The bottom line: Expulsion can be uncomfortable—and it’s definitely inconvenient—but it does not have lasting effects or cause infertility as some of the Mirena lawsuit ads imply.

Pain and bleeding

During insertion: IUD insertion pain is worse for some women than for others. (Even for women who experience a lot of pain during insertion, they often say it was worth the gain of hassle-free birth control.) After the IUD has been inserted, continuing pain may be a sign of a partial expulsion or another problem, so if the pain doesn’t go away within a few days of insertion, it’s definitely a good idea to check in with a health care provider.

During periods: In the long run, many women using a Mirena experience less period pain than they did before getting the IUD. About one-third of users have frequent or longer bleeding in the first three months, and about two-thirds have some spotting or bleeding between periods. After a year, about three-quarters of women have infrequent or no bleeding at all. On the other hand, some of the problems women report to the FDA are about lighter or nonexistent periods. Some Mirena users see this as a benefit, but if you’re not prepared for these possible changes, they can seem like a problem.

The bottom line: Only you know what’s normal for your body in terms of pain and periods. Learn as much as you can about how your pain and bleeding might be affected by any type of IUD before trying one. If after your IUD is inserted you have pain or bleeding beyond what you expected, talk to your health care provider.

Perforation and migration

For about 1 in 2,000 women, the IUD can get stuck in or puncture the uterus—also known as perforation. (That’s about the same chance as being hit by this satellite falling out of the sky.) Perforation only happens when the IUD is being put in. Highly skilled providers who have inserted many IUDs are less likely to have perforations. Women who are breastfeeding or have given birth within the last month are more likely to experience perforations because the muscle of the uterus is softer at those times.

What does it mean if there is a perforation? If it’s recognized immediately, the health care provider will stop the insertion. It takes about a week for the uterus to heal, and then a woman can have another IUD inserted if she wants. More than half of perforations may go unrecognized at the time of insertion. That may mean that a woman thought she had great birth control when she may not have. If undiagnosed for months, a perforation can make removing the IUD difficult, and can sometimes require surgery. Even in the worst-case scenario of an undiagnosed perforation that requires surgery, it shouldn’t have an impact on the woman’s future fertility.

Many of the lawsuit ads warn of IUDs migrating outside the uterus. Although it is extremely rare, there have been cases when an IUD has gotten past all of the thick layers of muscle of the uterus and entered the body cavity. How rare is this? So rare that even with tens of millions of women using IUDs worldwide, we can’t estimate how often it happens. We just know that there have been case reports in medical journals.

The bottom line: Perforation is rare and, if it’s recognized quickly, it’s not a major health event. Many providers will have you come back 4-6 weeks after an IUD placement to check on the strings and make sure everything is okay. If you’re worried, you can check your own strings. If you can’t find your strings, see your health care provider.

Pregnancy, now and later

Can you get pregnant with an IUD? Unfortunately, method failure is a risk with any and all contraceptives. So, yes—for a very small number of women, the IUD can fail and an accidental pregnancy can result. For the Mirena, this happens for about 2 in 1,000 women. That’s way less common than 90 pregnancies in 1,000 women using the pill—but it’s not zero.

What about getting pregnant after having an IUD? Studies have repeatedly shown that in the year after removing an IUD, over 80% of women who want to have a baby do get pregnant—exactly the same as for women who have never used an IUD. In other words, using an IUD now has no impact on future motherhood.

The bottom line: IUDs fail way less than other kinds of birth control, and they don’t affect your ability to get pregnant in the future.

Serious problems with IUDs are rare—but we understand that’s small comfort if you or someone you care about experiences them. Each person has to weigh the risks and benefits when making any decision, including about birth control, and we hope that this and our other information about IUDs helps create a more complete picture than the lawsuit ads alone.

love your body * have fun * use birth control

Period pain? Birth control can help!

This week we have an awesome article written by New Gen’s very own clinician, Meredith Warden!!! The article was originally published on Bedsider but it’s a concern we hear at NGHC all the time so we thought it was worth sharing!

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Meredith Warden MD, MPH is a Family Planning Clinical Fellow and an Ob/Gyn at the University of California, San Francisco. She lives in San Francisco with her fantastic skateboarding husband and their little mini dachshund named Stretch. She loves being outside doing anything, and reading anywhere, anytime.

 

Hormonal birth control is one of the best ways to manage painful periods.

Having a painful period can mess up your day, or week—or weeks! Every woman’s period is different and the same woman’s periods are often different over time. So how do you know if the pain you have with your period is normal? And what can you do to make your periods  less painful?

For more information on periods, check out some previous blogs!

Aunt Flow’s Monthly Visit

When Aunt Flow DOESN’T Visit

My periods are really painful. Am I normal?

It’s normal for women to have some cramping, bloating, nausea, or diarrhea before their period starts each month. These symptoms can continue for a few days after the period starts, and they can be annoying—but they shouldn’t interfere with going to school or work, or with otherwise living life.

Here’s what’s not normal:

  • Moderate to severe cramps or lower belly pain with every period.
  • Periods so bad that they interfere with work, school, or life in general

crampsSo what’s the problem, exactly?

Periods like this may be dysmenorrhea—a fancy medical term for pain with menstruation. There are several possible causes of severe period pain, some of which have special treatment options.

  • The cells from the lining of the uterus may be growing into the muscles of the uterus (adenomyosis) or on other organs in the body (endometriosis).
  • The muscle of the uterus may be growing fibroids.
  • The uterus may be releasing too much of a substance called prostaglandins, causing its muscles to contract irregularly and leading to big-time pain.

The good news is that you don’t have to put up with this pain! If you’re having abnormally bad periods, talk to your health care provider about what might be causing the pain and how to treat it. There are a few things you can do to make your periods less painful, shorter, or go away altogether.

And what are the solutions?

1. Make your periods less painful. You can buy pain killers like ibuprofen (Advil or Motrin) at the drug store. Start taking them right when you first start feeling symptoms, or if your cycle is really regular, take them just before you expect your period.

3-02-11-ibuprofen2. Make your periods lighter. All types of hormonal birth control are even better at reducing pain than over-the-counter meds. The hormonal IUD, the implant, the shot, the pill, the patch, and the ring will all make periods lighter. This is because these methods of birth control make the lining of the uterus thinner. There’s less tissue in the uterus to shed, so periods are lighter. One special note on the implant and the shot: for some women, these methods cause more days of spotting or bleeding, but periods become lighter and less painful overall.

3. Have fewer periods. The ultimate solution may be to have as few periods as possible. Several methods of birth control can make periods go away for months or even years at a time:

  • One of the best ways to treat painful periods is to get the hormonal IUD Mirena. This IUD makes periods lighter and shorter for nearly all women, and many stop getting periods even after one year of use. The chance that you’ll stop getting your period increases the longer you use it. Periods should be light or nonexistent as long as you use a Mirena—up to 5 years. (Of course you don’t have to use it for all 5 years—you can have it removed anytime you want to. Your ability to get pregnant returns right after it’s removed.)

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  • You can use the pill or the ring continuously. Some brands of the pill are packaged for 3 months of continuous use (e.g. Seasonale or Seasonique). But you don’t need a fancy brand: with a monophasic pill, instead of having a few days of placebo pills when you’d normally get your period, you can just start a new pack of active pills. Here are more details on how to use the pill this way. (However, this may not be an option for those using Family Pact, the little green card we give you at New Gen, to pay for their pills because Family Pact will only give 3 packs of pills every 3 months – ask NGHC for more information about this.) For the ring, instead of having the ring out for a few days when you’d normally get your period, you can just change your ring once a month and skip the week without one. After 3-6 months, you may have break-through bleeding.

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  • You can try the shot, which causes about half of women to stop getting periods after a year of use.

DMPAWhen hormonal birth control stops your period, it’s because the lining of the uterus gets so thin that there’s nothing to shed. It’s totally safe to skip periods this way, so if you suffer from serious period pain, talk to your provider about what you can do about it.

If you have questions or you are experiencing period pain, come see us at New Gen! We would love to help put an end to your period pain!

Thank you for reading,

Meredith Warden, MD

Managing Your Period – Toolbox for Aunt Flow!

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P.S. There is another chance to win $25 to Old Navy at the bottom of this post. Leave your answer by commenting : )

Last but not least of the Menstrual Cycle Series (drum roll please):

Managing your period – Toolbox for Aunt Flow!

Having your period doesn’t have to be messy!  We’re talking about tampons, pads, menstrual cups, and panty liners – there are so many options you can find something you like. If you have the right tools you may even forget you’re even having your period!

First, a few things to know:

  • No method is better than the other for dealing with your period.  It’s a personal choice.  There are also a lot of different brands available for each option.  Again, no brand is better than another.  It’s all about personal choice.
  • When choosing your ‘tool’, you may see things like light, regular, super, or super plus.  It’s referring to the amount of blood your body is releasing.  Light for not so much bleeding.  Regular for normal amount of bleeding.  Super for heavy bleeding. Super Plus for super heavy days. Always choose accordingly.  And most women require various sizes within any one cycle because their flow may be different on different days.
  • Whatever you choose, changing it often is very important.  Usually every 3-4 hours.  For sleeping, be sure to use a method that says it can be worn up to 8 hours.
  • Don’t use anything with fragrance.  There may be a light odor during menstruation but it’s totally normal.  If there is ever a strong or unusual odor and lasts longer than your period, come see us.

 Pads:  A pad of absorbent material worn inside underwear to absorb menstrual flow.  Both disposable and reusable kinds exist.

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Panty Liners:  Super thin pad designed to absorb daily vaginal discharge, light menstrual flow, or “spotting.”  Great backup for tampons (see below) or those super light bleeding days!

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Tampons:  A tampon is a plug of cotton or other absorbent material inserted into the vaginal canal to absorb menstrual flow.  They come in all different sizes and with different applicators so you may want to try a few to see what feels most comfortable.  And NO it does not have any effect on virginity.  I promise.  Oh, and it can be worn while swimming!

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Menstrual Cup:  A menstrual cup is a flexible cup (usually made from medical grade silicone) worn inside the vagina during menstruation to collect menstrual fluid.  Unlike tampons and pads, the cup collects menstrual fluid rather than absorbing it and can be worn for up to 12 hours!  Menstrual cups are more cost-efficient and environmentally friendly than tampons, most are reusable, and can be used for up to 5-10 years.  Like tampons, can also be worn while swimming!

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Other tools for your toolbox:

Ibuprofen:   Ibuprofen (generic or same as Motrin or Advil) can be bought at any drug store or super market for a relatively low price. Great for menstrual cramps and headaches! Make sure to follow directions about how much to take and when!  Another type of medicine that can be good for cramping is Naprosyn (generic Aleve) which is long acting.  Both types of medicines work better if you take them as soon as you start to notice cramping, instead of waiting until you are doubled over in pain.

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Heating Pad:  Also a good tool for menstrual cramps.  There are 3 types: electric, water, or one time use.  All 3 are sold at most pharmacies and super markets.  Also pretty cheap.

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Exercise:  I know.  I know.  Most people do not feel like exercising while on their period but it really does help with cramps.  Moderate exercise can help relax muscles which can reduce cramping, headaches, backaches, and all kinds of body aches and pains.

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And here’s another opportunity to earn $25 to Old Navy!

What ideas or theories are there about why many women crave chocolate during their periods??

Hint: Mineral

In happiness & health,

Shawna

Reviewed by Kohar Der Simonian, MD

When Aunt Flow DOESN’T Visit….P.S. There is a chance to win something in this post!

periods

Why is my period sometimes irregular?

If you miss your period and have had unprotected sex, the first thing to check for is pregnancy.  You can take a pregnancy test at home or come into to New Gen! Why would missing a period be a sign of pregnancy?? Leave a comment with the answer for a chance to win a $25 gift card to Old Navy!!!!

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Different pregnancy tests need different amounts of time after a sexual encounter to show pregnancy.  At our clinic, at least 10 days need to pass after a missed period.

That being said, when a pregnancy test comes back negative, many girls wonder why they would have missed a period or why they only get their period a few times a year without being pregnant.  Almost every woman misses a period at some point in her life, for many reasons:

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Age: For the first few years after a woman starts menstruating (in her teens) and for a few years leading up to her last period (in her 40’s or 50’s), it is common for periods to be irregular.  This has to do with the body’s adjustment to having a menstrual cycle or not having a menstrual cycle and changing hormone levels.  

Birth Control: Many birth control methods  can impact your cycle. Check out the list below to see which methods do what to your period.

  • The pill, patch and ring:  These methods usually cause very regular periods, happening during the fourth week of the method when there are no hormones.  Usually the periods are lighter, and shorter.  Women sometimes have some spotting at other times in the first month or two of starting this method
  • The Depo shot:  Bleeding can be very irregular at first, but will likely get lighter and lighter and possibly disappear entirely.
  • The Implanon:  Tends to make women’s bleeding irregular.  This could be many months of no bleeding, bleeding or spotting at irregular times, or spotting throughout the month.
  • The Mirena IUD (hormonal, 5 year): bleeding can be very irregular at first, but tends to get lighter and usually stops entirely.
  • The Paragard IUD (copper/non-hormonal, 10 year):  Women usually have a period in the same pattern as when using no hormonal birth control method (whether that is every month or not), but it is slightly longer, heavier and crampier than their normal periods.
  • Many women worry if they aren’t getting their periods that their bodies may be “clogging up” — but don’t worry, if you are not having your period because of a birth control method  it means that your body is simply not creating the uterine lining (hormones are what control the uterine lining development).
  • Missing a pill or patch – you can get unexpected bleeding or spotting for days afterward.
  • Stopping the shot – you can have several months of no bleeding or irregular bleeding before your normal period returns.
  • Taking the “morning after pill” can cause a little bleeding a day or two after you take it, and make your next period come a little earlier or later.

Stress/Changes:  If your period is usually regular, stress can cause a delayed period.  Perhaps you are feeling tired, worried, or dealing with a big change in your life.  For whatever reason your body may decide it is not a good time to get pregnant.  Over-exercise, poor nutrition, and sudden weight loss can all be kinds of “stress.”                        

Medical Problems: There are a couple medical problems that can cause skipped periods, including ovarian cysts, polycystic ovarian syndrome or amenorrhea.  If you are not getting your period and are not sure why, check with your doctor or make an appointment at New Gen.

As you can see, this is a complicated issue! Periods can be as different as women’s bodies are, and many, many life factors can have an effect on our cycles. We recommend using a calendar to keep track! There are many free menstrual calendars online as well as many popular phone apps!

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If your cycle ever changes or you simply have questions about your periods, come see us!

Next Week:  Pads and tampons aren’t the only options when it comes to managing your period!!!

-Barbara Haupt, AmeriCorps Member

Reviewed by Debbie Davidson, NP