womenshealth.gov

1-800-994-9662

TDD: 1-888-220-5446

U.S. Department of Health 

and Human Services, 

Office on Women’s Health

Brought to you by the National Women’s

Health Information Center

It’s Your

Time!

12 Months to a

Healthier You

2007 Women’s

Health Daybook
A Message from Secretary Mike Leavitt

I

t is my great pleasure to present the 2007 Women’s Health 

Daybook. Use this Daybook as the fi rst step in taking an 

active role in your health. It provides information on simple 

ways you can reduce your risk for many serious health problems. It will help you learn how to prevent or manage diseases, 

including heart disease, stroke, cancer, and diabetes, and protect your mental health.

Besides the important information in this Daybook, 

womenshealth.gov, a project of the Offi ce on Women’s 

Health, provides reliable women’s health information. Free 

health information is available toll-free via 1-800-994-9662 

and TDD: 1-888-220-5446 for those without Internet access. 

Other valuable resources found in this Daybook by the 

Department range from childhood immunization schedules to 

information on how to prepare your family for emergencies or 

sudden disasters to prescription drug coverage under Medicare.

I encourage you to read all the information in this Daybook

to learn how to live a longer, healthier, and happier life. Best 

wishes for a healthier 2007! 

U.S. Department of Health and Human Services
Visit the National Women’s Health Information Center web site www.womenshealth.gov 1

It’s Your Time: 12 Months to a Healthier You

It’s Your Time

12 Months to a Healthier You

“Let’s dare to be ourselves, 

for we do that better than anyone else can.”

Shirley Briggs, in Sue Patton Th oele’s Th e Courage to Be Yourself (1988)

On an average day, so many 

things seem more urgent than taking care 

of your health. Your 

job, your family, your 

relationships. Shopping for groceries, 

paying bills, attending school recitals, 

running errands, 

staying in touch with friends and relatives, 

doing chores, taking care of pets. Th e list can 

seem endless. Th e same is true for women 

in every profession, in every part of the 

country, of every race and ethnicity, of every 

faith, in every family structure. 

All of those activities are important. But so 

are you! Beyond all your responsibilities to 

others is your responsibility to yourself. You 

must take an active role in your health. You 

are important. You matter. You are worthy 

of your own care. 

If you haven’t yet taken that fi rst step to 

better health, or are uncertain where to 

start, why not begin 

your journey now? 

Th is 2007 Women’s 

Health Daybook is 

a resource guide for 

women of all ages. 

Use it to help you 

learn more about 

common health problems, how to prevent 

some diseases, and ideas for managing these 

conditions. You’ll fi nd charts that describe 

the screenings and immunizations that 

you and your loved ones should get. You’ll 

fi nd tips on how to get a second opinion 

from a doctor, how to read a drug label, and 

more. You’ll be referred to the government’s 

National Women’s Health Information 

Center (NWHIC), with its toll-free telephone 

numbers and two web sites. NWHIC serves 

as your link to credible, pre-screened organizations; government hotlines; other trustworthy web sites; and publications. 

Read this guide, share it with friends, write 

notes in it. Make it yours.
2 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Table of Contensts

Table of Contents

It’s Your Time! .......................................................................................................................... 1

About Us ................................................................................................................................... 4

Know Yourself, Know Your Health

Know Your Body ....................................................................................................................... 6

Pay Attention: Symptoms of Serious Health Conditions ..................................................... 10

Feel Great: Quit Smoking ...................................................................................................... 13

How to Talk to Your Doctor or Nurse ................................................................................... 14

How to Get a Second Opinion ............................................................................................... 16

How to Read Drug Labels ...................................................................................................... 18

How to Be Prepared for Emergencies .................................................................................... 20

Understanding Avian and Pandemic Flu .............................................................................. 22

Screenings and Immunizations 

Common Screening and Diagnostic Tests Explained ........................................................... 24

Taking Charge of Your Health ............................................................................................... 27

General Screenings and Immunizations for Women ........................................................... 28

Recommended Screenings, Tests, and Immunizations 

for Women with High-Risk Factors ....................................................................................... 30

When Do Children and Teens Need Vaccinations? .............................................................. 34

Your Body: From Your Head to Your Toes

Eating Healthy and Being Active ........................................................................................... 36

Getting Strong Bones: From Youth to Old Age .................................................................... 42

Loving Your Heart and Understanding Stroke ..................................................................... 48

Knowing Your Breasts and Common Breast Conditions ..................................................... 54

Maintaining a Healthy Digestive System .............................................................................. 58

Having a Healthy Pregnancy ................................................................................................. 66

Protecting Your Reproductive System .................................................................................. 74

Recognizing Problems in Your Uterus .................................................................................. 88

Treating Urinary Incontinence .............................................................................................. 96

Living with Autoimmune Diseases ..................................................................................... 102

Taking Care of Your Smile .................................................................................................... 110
Visit the National Women’s Health Information Center web site www.womenshealth.gov 3

Table of Contents

Coping with Stress ............................................................................................................... 120

Protecting Yourself from Violence and Abuse .................................................................... 124

Understanding Menopause and Its Challenges .................................................................. 132

2007 Calendars

January ................................................................................................................................. 140

February ............................................................................................................................... 146

March .................................................................................................................................... 152

April ...................................................................................................................................... 158

May ....................................................................................................................................... 164

June ...................................................................................................................................... 170

July ....................................................................................................................................... 176

August ................................................................................................................................... 182

September ............................................................................................................................. 188

October ................................................................................................................................. 194

November ............................................................................................................................. 200

December .............................................................................................................................. 206

2007 and 2008 Calendars

Two Years At-a-Glance Calendars ........................................................................................ 212

More Resources

Health Resources for Men ................................................................................................... 214

Health Resources for Children ............................................................................................ 216

Resources for Health Insurance .......................................................................................... 219

Regional Women’s Health Coordinators ............................................................................. 223

Quick Health Data Online ................................................................................................... 224

NWHIC’s Web Site on Girls Health ..................................................................................... 225

More For You

Addresses and Telephone Numbers .................................................................................... 226

Acknowledgments ................................................................................................................ 228

Your Opinion Matters ..........................................................................................................229

Citations ............................................................................................................................... 231
4 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

About Us

About Us

What is the U.S. Department of 

Health and Human Services?

Th e U.S. Department of Health and Human 

Services (HHS) is the federal agency responsible for protecting the health of all Americans. Its headquarters are based in Washington, DC. HHS is the publisher of the 2007 

Women’s Health Daybook. 

What is the Offi ce on Women’s 

Health?

Th e Offi ce on Women’s Health (OWH) was 

established in 1991 as a division of the 

Offi ce of Public Health and Science within 

HHS. Our mission is to improve the health 

and well-being of all U.S. women and girls. 

OWH leads and coordinates the eff orts of 

all the HHS agencies and offi ces involved in 

women’s health. We create and sponsor innovative programs that focus on the health 

of women and girls. We educate health 

professionals, such as physicians, dentists, 

researchers, therapists, and nurses. Our 

publications, web sites, and special events 

reach out to you, the public. We work to educate and motivate people to live healthier 

lives by giving them trustworthy, accurate 

health information. As part of our work, we 

produced this resource guide. 

What is the National Women’s 

Health Information Center?

Th e National Women’s Health Information 

Center (NWHIC) is a free service of the U.S. 

Department of Health and Human Services. 

NWHIC provides reliable, accurate, commercial-free information on the health of women and girls. It covers more than 800 topics, 

on issues ranging from adolescent health to 

reproductive health to older women’s health. 

You can access the resources of NWHIC 

in two ways: through a toll-free telephone 

call or through the Internet. NWHIC has 

an information referral center with trained 

Information Specialists answering your calls 

in either English or Spanish. Call 1-800-994-

9662. For individuals who are hearing impaired, call TDD at 1-888-220-5446. NWHIC 

also has two comprehensive web sites that 

focus on women’s and girls’ health. Visit 

them online at www.womenshealth.gov and 

www.girlshealth.gov. 
Visit the National Women’s Health Information Center web site www.womenshealth.gov 5

About Us

Whichever way you use NWHIC’s services, 

you’ll get 

✦ clear answers to frequently asked questions

✦ links to thousands of health publications 

✦ statistics on women’s health

✦ online journals and dictionaries

✦ daily news on women’s health

✦ a calendar of events 

✦ a National Breastfeeding Helpline with 

trained peer counselors

✦ health information in Spanish 

How is NWHIC diff erent from 

other web sites on women’s 

health? 

NWHIC is sponsored by the federal government with your tax dollars. We don’t represent any special commercial interests. We 

don’t allow advertisements on our site. We 

don’t try to sell you products, magazines, or 

anything else. We screen all health information for accuracy before it ever appears on 

our web sites or in our publications. Our 

Information Specialists are trained to help 

you, whether it’s referring you to the right 

organization, mailing you free information, or even coaching new moms on how to 

breastfeed their infants. 

NWHIC exists to help you and your loved 

ones get the reliable and accurate health 

information you need to get, or stay, 

healthy. 

www.womenshealth.gov/breastfeeding
Know Your Body

Brain

Esophagus

Spinal Cord

Lung

Stomach

Large Intestine

Small Intestine

Bladder

Vagina

Liver

Kidney

Ovary

Uterus

Cervix

Heart

Trachea

Women’s Body Systems

Dashed line indicates 

that organ is behind 

other main organs.

Appendix

Pancreas

Thyroid

Cardiovascular and Circulatory—heart, 

lungs, arteries, veins

Digestive (gastrointestinal)—esophagus, 

liver, stomach, pancreas, large intestine (colon), 

small intestine, appendix, rectum, anus

Endocrine—thyroid, ovaries, pancreas

Nervous (neurological) and Skeletal—

brain, nerves, spinal cord, bones, joints

Reproductive—ovaries, fallopian tubes, 

uterus, cervix, vagina, breasts

Respiratory—lungs, nose, trachea (windpipe)

Urinary—urinary tract, bladder, kidneys

6 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Know Your Body
Know Your Body

Cardiovascular and Circulatory System

Jugular Vein

Superior Vena Cava (vein)

Lung

Carotid Artery

Aorta (artery)

Left Pulmonary Artery

Heart

Digestive System

Liver

Gallbladder

Pancreas

Large Intestine (colon)

Appendix

Esophagus (food pipe)

Stomach

Small Intestine

Rectum

Anus

Visit the National Women’s Health Information Center web site www.womenshealth.gov 7

Know Your Body
Know Your Body

Reproductive System

Ovary

Uterus (womb)

Breast

Fallopian Tube

Cervix

Vagina

Respiratory System

Esophagus

Trachea

Right Lung

Nasal Cavity

Mouth

Left Lung

Ribs

Diaphragm

8 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Know Your Body
Know Your Body

Skeletal and Nervous System

Brain

Jaw

Urinary System

Ureter

Sphincter

Kidneys

Bladder

Urethra

Neck

Spinal Cord

*Shoulder

*Elbow

*Wrist

Femoral Nerve

Sciatic Nerve

*Knee

*Ankle

Skull

Clavicle (collar bone)

Ribs

Humerus

Ulna

Radius

Pelvis (hip)*

Femur (thigh)

Patella (knee cap)

Fibula (shin)

Tibia (shin)

*Major joints where arthritis or joint disease can occur.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 9

Know Your Body
Pay Attention: Symptoms of Serious 

Health Conditions

This chapter shows some symptoms that could be signs of serious health conditions, which 

should be checked by a doctor or nurse. It is important to note that you might feel symptoms in one part of your body that could actually mean a problem in another part. Even if the 

symptoms don’t seem related, they could be. Keep track of your symptoms. If you have any of 

these symptoms, make an appointment to see your doctor. Listen to what your body is telling 

you, and be sure to describe every symptom in detail to your provider. 

Note: A chart of diagnostic tests that your provider might order are found later in this guide.

Signs of a heart attack

Some symptoms of a heart attack can happen a month or so 

before the heart attack. Before

a heart attack, women may have 

had one or more of these symptoms:

✦ unusual tiredness

✦ trouble sleeping

✦ problems breathing

✦ indigestion

✦ anxiety

During a heart attack, women may have one 

or more of these symptoms:

✦ pain or discomfort in the center of the chest

✦ pain or discomfort in other areas of the 

upper body, including the arms, back, neck, 

jaw, or stomach

✦ other symptoms, such as shortness of 

breath, breaking out in a cold sweat, nausea, or light-headedness

If you have any of these symptoms, go to 

an emergency room right away or call 911.

Signs of a stroke

Signs of a stroke happen suddenly and are diff erent from 

signs of a heart attack:

✦ sudden or developing problems with speaking or understanding

✦ sudden or developing problems with sight

✦ sudden or developing problems with balance, coordination, walking, and dizziness

✦ sudden numbness or weakness in the face, 

arms, or legs

✦ sudden severe headache with no known cause

If you have any of these symptoms, go to 

an emergency room right away or call 911.

Symptoms of reproductive 

health problems

✦ bleeding or spotting between 

periods

✦ itching, burning, or irritation (including 

bumps, blisters, or sores) of the vagina or 

genital area

10 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Symtoms of Serious Health Conditions
✦ pain or discomfort during sex

✦ severe or painful bleeding with periods

✦ moderate to severe pelvic pain

✦ unusual (for you) vaginal discharge of any 

type or color or with strong odor

Symptoms of breast 

problems

✦ nipple discharge

✦ unusual breast tenderness or 

pain

✦ breast or nipple skin changes: ridges, dimpling, pitting, swelling, redness, or scaling

✦ lump or thickening in or near breast or in 

underarm area, or tenderness

Symptoms of lung 

problems

✦ coughing up blood

✦ persistent cough that gets 

worse over time

✦ repeated bouts of bronchitis or 

pneumonia

✦ shortness of breath

✦ wheezing

Symptoms of stomach or 

digestive problems

✦ bleeding from the rectum

✦ blood or mucus in the stool 

(including diarrhea) or black stools

✦ change in bowel habits or not being able 

to control bowels

✦ constipation, diarrhea, or both

✦ heartburn or acid refl ux (feels like burning in throat or mouth)

✦ pain or feeling of fullness in stomach

✦ unusual abdominal swelling, bloating, or 

general discomfort

✦ vomiting blood

Symptoms of bladder 

problems 

✦ diffi cult or painful urination

✦ frequent urination or loss of 

bladder control

✦ blood in urine

✦ feeling the urge to urinate when bladder is 

empty

Symptoms of skin 

problems

✦ changes in the skin, such as 

changes in existing moles or 

new growths 

✦ moles that are no longer round or have 

irregular borders

✦ moles that change colors or change in size 

(usually get bigger) 

✦ frequent fl ushing (a sudden feeling of heat)

✦ jaundice (when the skin and whites of the 

eyes turn yellow)

✦ painful, crusting, scaling, or oozing sores 

that don’t heal

✦ sensitivity to sun 

Visit the National Women’s Health Information Center web site www.womenshealth.gov 11

Symptoms of Serious Health Conditions
Symptoms of muscle or 

joint problems

✦ muscle pains and body aches 

that are persistent, or that 

come and go often

✦ numbness, tingling (pins and needles 

sensation), or discomfort in hands, feet, 

or limbs

✦ pain, stiff ness, swelling, or redness in or 

around joints

Symptoms of emotional 

problems

Note: Th ese symptoms can have 

a physical cause and are usually 

treatable.

✦ anxiety and constant worry

✦ depression: feeling empty, sad all the 

time, or worthless

✦ extreme fatigue, even when rested

✦ extreme tension that can’t be explained

✦ fl ashbacks and nightmares about traumatic events

✦ no interest in getting out of bed or doing 

regular activities, including eating or sex

✦ thoughts about suicide and death

✦ seeing or hearing things that aren’t there 

(hallucinations)

✦ seeing things diff erently from what they 

are (delusions)

✦ “baby blues” that haven’t gone away two 

weeks after giving birth and seem to get 

worse over time

✦ thoughts about harming yourself or your 

baby after giving birth

Symptoms of headache 

problems

✦ headaches between the eyes

✦ headaches that come on 

suddenly

✦ headaches that last longer than a couple 

of days

✦ seeing fl ashing lights or zigzag lines and 

temporary vision loss before a headache 

starts

✦ spreading pain in face that starts in one 

eye

✦ severe pain on one or both sides of head 

with upset stomach, nausea, or vision 

problems

Symptoms of eating or 

weight problems

✦ extreme thirst or hunger

✦ losing weight without trying

✦ desire to binge on food excessively

✦ desire to vomit on purpose

✦ desire to starve (not eat at all)

12 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Symptoms of Serious Health Conditions
Feel Great: Quit Smoking

20 minutes after quitting

✦ Your blood pressure drops. 

✦ Th e temperature in your hands and feet rises.

8 hours after quitting

✦ Th e carbon monoxide (a gas 

that can be toxic) in your 

blood drops to normal.

24 hours after quitting

✦ Your chance of having a 

heart attack goes down.

2 days after quitting

✦ You can taste and 

smell things better.

2 weeks to 3 months after 

quitting

✦ You have better circulation.

✦ Your lungs are working better.

1 to 9 months after quitting

✦ Coughing, sinus congestion, fatigue, and shortness of breath decrease.

✦ Your lungs start to function better, lowering your risk of lung infections.

1 year after quitting

✦ Your risk of heart disease is 

half that of a smoker’s. 

5 years after quitting

✦ Your risk of having a stroke 

is the same as someone who 

doesn’t smoke.

10 years after quitting

✦ Your risk of dying from lung cancer is half that of a smoker’s.

✦ Your risk of cancer of the mouth, 

throat, esophagus, bladder, kidney, and pancreas also decreases.

15 years after quitting

✦ Your risk of heart disease is now the 

same as someone who doesn’t smoke.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 13

Feel Great: Quit Smoking

New information shows that smoking causes diseases in nearly every organ of the body. Smoking is linked to diseases such as leukemia, cataracts, pneumonia, and cancers of 

the cervix, lung, kidney, pancreas, and stomach. Lung cancer alone claims the lives of more 

women than any other cancer. Stop smoking to lower your chances of getting these diseases!
HOW TO

Talk to Your Doctor or Nurse

Waiting in your doctor’s offi ce can make you feel nervous, impatient, or even 

scared. You might worry about what’s wrong 

with you. You might feel annoyed because 

you’re not getting other things done. Th en 

when you see your doctor or nurse, the visit 

seems to be so short. You might have only a 

few minutes to explain your symptoms and 

concerns. Later that day, you might remember something you forgot to ask. You wonder if your question and its answer matters. 

Knowing how to talk to your doctor, nurse, 

or other members of your health care team 

will help you get the information you need. 

Tips: What To Do

✦ List your questions and concerns.

Before your appointment, make a list of 

what you want to ask. When you’re in the 

waiting room, review your list and organize your thoughts. You can share the list 

with your doctor or nurse. 

✦ Describe your symptoms. Say when 

these problems started. Say how they 

make you feel. If you know, say what 

sets them off or triggers them. Say what 

you’ve done to feel better. 

✦ Give your doctor a list of your medications. Tell what prescription drugs and 

over-the-counter medicines, vitamins, 

herbal products, 

and other supplements you’re taking.

✦ Be honest about 

your diet, physical activity, 

smoking, alcohol 

or drug use, and 

sexual history.

Not sharing information with your 

doctor or nurse 

can be harmful! 

✦ Describe any allergies to drugs, 

foods, pollen, 

or other things.

Don’t forget to mention if you are being 

treated by other doctors, including mental 

health professionals. 

✦ Talk about sensitive topics. Your doctor or nurse has probably heard it before! 

Don’t leave something out because you’re 

worried about taking up too much time. 

Be sure to talk about all of your concerns 

before you leave. If you don’t understand 

the answers your doctor gives you, ask 

again.

14 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

How to Talk to Your Doctor or Nurse
✦ Ask questions about any tests and 

your test results. Get instructions on 

what you need to do to get ready for the 

test(s). Ask if there are any dangers or 

side eff ects. Ask how you can learn the 

test results. Ask how long it will take to 

get the results. 

✦ Ask questions about your condition or 

illness. If you are diagnosed with a condition, ask your doctor how you can learn 

more about it. What caused it? Is it permanent? What can you do to help yourself 

feel better? How can it be treated?

✦ Tell your doctor or nurse if you are 

pregnant or intend to become pregnant. Some medicines may not be suitable for you. Other medicines should be 

used with caution if you are pregnant or 

about to become pregnant. 

✦ Ask your doctor about any treatments 

he or she recommends. Be sure to ask 

about all of your options for treatment. 

Ask how long the treatment will last. Ask 

if it has any side eff ects. Ask how much 

it will cost. Ask if it is covered by your 

health insurance.

✦ Ask your doctor about any medicines 

he or she prescribes for you. Make 

sure you understand how to take your 

medicine. What should you do if you miss 

a dose? Are there any foods, drugs, or activities you should avoid when taking the 

medicine? Is there a generic brand of the 

drug you can use? You can also ask your 

pharmacist if a generic drug is available 

for your medication.

✦ Ask more questions if you don’t 

understand something. If you’re not 

clear about what your doctor or nurse is 

asking you to do or why, ask to have it 

explained again. 

✦ Bring a family member or trusted 

friend with you. Th at person can take 

notes, off er moral support, and help you 

remember what was discussed. You can 

have that person ask questions, too!

✦ Call before your visit to tell them if 

you have special needs. If you don’t 

speak or understand English well, the offi ce may need to fi nd an interpreter. If you 

have a disability, ask if they can accommodate you. 

Visit the National Women’s Health Information Center web site www.womenshealth.gov 15

How to Talk to Your Doctor or Nurse
HOW TO

Get a Second Opinion

Even though doctors may get similar medical training, they can have their 

own opinions and thoughts about how to 

practice medicine. Th ey can have diff erent ideas about how to diagnose and treat 

conditions or diseases. Some doctors take a 

more conservative, or traditional, approach 

to treating their patients. Other doctors are 

more aggressive and use the newest tests 

and therapies. It seems like we learn about 

new advances in medicine almost every day. 

Many doctors specialize in one area of 

medicine, such as cardiology or obstetrics or 

psychiatry. Not every doctor can be skilled 

in using all the latest technology. Getting 

a second opinion from a diff erent doctor 

might give you a fresh perspective and new 

information. It could provide you with new 

options for treating your condition.Th en you 

can make more informed choices. If you get 

similar opinions from two doctors, you can 

also talk with a third doctor. 

Tips: What To Do

✦ Ask your doctor for a recommendation. Ask for the name of another doctor or specialist, so you can get a second 

opinion. Don’t worry about hurting your 

doctor’s feelings. Most doctors welcome a 

second opinion, especially when surgery 

or long-term treatment is involved. 

✦ Ask someone you trust for a recommendation. If you don’t feel comfortable 

asking your doctor for a referral, then call 

another doctor you trust. You can also call 

university teaching hospitals and medical societies in your area for the names of 

doctors. Some of this information is also 

available on the Internet. 

16 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

How to Get a Second Opinion
✦ Check with your 

health insurance 

provider. Call your 

insurance company 

before you get a 

second opinion. 

Ask if they will pay 

for this offi ce visit. 

Many health insurance providers do. 

Ask if there are any 

special procedures 

you or your primary 

care doctor need to 

follow.

✦ Ask to have medical records sent 

to the second doctor. Ask your primary 

care doctor to send your medical records 

to the new doctor. You need to give written permission to your current doctor 

to send any records or test results to a 

new doctor. You can also ask for a copy of 

your own medical records for your fi les. 

Your new doctor can then examine these 

records before your offi ce visit.

✦ Learn as much as you can. Ask your 

doctor for information you can read. Go 

to a local library. Search the Internet. 

Find a teaching hospital or university that 

has medical libraries open to the public. 

Th e information you fi nd can be hard to 

understand, or just confusing. Make a list 

of your questions, and bring it with you 

when you see your new doctor. 

✦ Do not rely on the Internet or a telephone conversation. When you get a 

second opinion, you need to be seen by a 

doctor. Th at doctor will perform a physical 

examination and perhaps other tests. Th e 

doctor will also thoroughly review your 

medical records, ask you questions, and 

address your concerns. 

Visit the National Women’s Health Information Center web site www.womenshealth.gov 17

How to Get a Second Opinion
HOW TO 

Read Drug Labels

Prescription Drug Label

Pharmacy name

and address

Drug store phone

number

Today’s date

Doctor’s name

Number used by

the drug store to

identify this drug

for your refills

Person who gets

this drug

Number of refills

Name of drug and

strength of drug

Instructions

about how often

and when to take

Don’t use this drug past this date

18 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

How to Read Drug Labels

Medicines, or drugs, come as either prescription or over the counter. Prescription drugs 

are used under a doctor’s care. Over-the-counter drugs can be bought and used without a doctor’s prescription, and you buy them at a drug store or grocery store. When using 

any kind of drug, it’s really important to read the drug label for instructions. Not following 

the instructions can hurt your health. Read the label each time you use a drug, just in case 

there have been changes to it since the last time you used it. See the drug label below and 

on the next page to know what to look for. If you read the label and still have questions, call 

your doctor, nurse, or pharmacist for help.
Over-the-Counter (OTC) Medicine Label

Product type

Symptoms or 

diseases the drug 

treats

Therapeutic

substance in drug

When not to use

this drug, when to

stop taking it,

when to see a

doctor, and

possible side

effects

Read carefully: 

how much to take, 

how to take it, and 

how long to take it

More information

on how to store

the drug Other things in the 

drug, such as 

colors or flavorings

Visit the National Women’s Health Information Center web site www.womenshealth.gov 19

How to Read Drug Labels
HOW TO

Be Prepared for Emergencies

When disaster strikes, you may not have much time to act. To help protect 

loved ones, take simple steps now to prepare 

your family for sudden emergencies or other 

disasters.

Th ree Basic Steps for Disaster 

or Emergency Preparedness

1. KNOW what natural or other disasters 

could occur in your area and how to prepare for them. Learn about local evacuation routes, so that you know how to leave 

an area quickly. Th e Federal Emergency 

Management Agency off ers information on 

preparedness at www.fema.gov.

2. PLAN out on paper the steps you should 

take during an emergency and give family members a copy. Talk about potential 

disasters or emergencies and how to 

respond to each. Choose a meeting place, 

other than your home, for family members 

to gather in case you can’t go home. Make 

sure you choose an “emergency check-in” 

contact person and teach your children the 

phone number for this person. 

3. PACK emergency supplies in your home 

to meet your needs for three days. Always 

keep all of your important documentation 

together, in one place, in case you have to 

“grab and go” during an evacuation. 

Need to Evacuate? Have a Kit 

Ready that Includes

✦ identifi cation for yourself and your children, such as birth certifi cates and social 

security cards

✦ important personal papers, such as health 

insurance identifi cation cards, immigration papers, and children’s school records

✦ funds in the form of cash, traveler’s 

checks, credit cards, and checkbook 

✦ keys to the house, car, and safety deposit 

box or post offi ce box

✦ ways to communicate, including a calling 

card, cell phone and extra battery, and the 

emergency check-in number for family 

members to call

✦ prescription medications, including 

written prescription orders, and supplies 

20 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

How to Be Prepared for Emergencies
such as contact lens cleaner and feminine 

hygiene products

Essential Items for Disaster 

Preparedness

Relief workers will most likely be on the 

scene after a disaster, but they cannot reach 

everyone immediately. Gather the supplies 

below in case you have to stay where you are. 

Water. Keep at least a 3-day supply of water 

for each person, stored in plastic containers. 

Each person needs 1 gallon of water each 

day. 

Food. Store at least a 3-day supply of nonperishable food such as canned meat, beans, 

vegetables, fruit and juices; peanut butter or 

other high-energy food; and unsalted crackers. Keep a non-electric can opener handy. If 

you have pets, stock up on canned pet food.

Infant care. Store baby formula and water 

to prepare it if a child is not breastfed. If 

you need to evacuate quickly, bring towels 

or sheets to carry a baby instead of a bulky 

stroller.

Other supplies. Make sure you have large 

plastic bags that seal for waterproofi ng important papers, a battery-powered fl ashlight 

and radio with extra batteries, and a fi rst aid 

kit. 

Breastfeeding During an 

Emergency

When an emergency occurs, breastfeeding 

saves lives.

✦ Breastfeeding protects babies from the 

risks of a contaminated water supply. 

✦ Breastfeeding helps protect against respiratory illnesses and diarrhea — diseases 

that can be fatal in populations displaced 

by disaster. 

Th e basics of breastfeeding during an emergency are much the same as they are in 

normal times. Continuing to breastfeed 

whenever the baby seems hungry maintains 

a mother’s milk supply and is calming to both 

mother and baby. Visit www.lalecheleague.org 

for information on how to breastfeed in an 

emergency, even if you have been giving your 

baby formula.

Food and Water Safety During 

an Emergency

Food may not be safe to eat during and 

after an emergency. Water may not be safe 

to drink, clean with, or bathe in after an 

emergency such as a hurricane or fl ood 

because it can become contaminated with 

bacteria, sewage, agricultural or industrial 

waste, chemicals, and other substances that 

can cause illness or death. Th e Centers for 

Disease Control and Prevention has information about keeping your food and water 

safe at www.cdc.gov. 

Staying Safe from Violence 

During an Emergency

After disasters, women are at greater risk of 

sexual assault or other violence. Visit www.

womenshealth.gov for safety tips.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 21

How to Be Prepared for Emergencies
Understanding Avian and Pandemic Flu

over to infect people. Th e H5N1 virus is very 

powerful, having caused the deaths of more 

than half of the people infected. Experts 

think most of these cases have been caused 

by contact with infected birds. To date, there 

has been very limited spread of the virus 

from person to person. Th e concern is that 

H5N1 will change into a virus that can pass 

from person to person more easily and more 

quickly. An increasing number of human 

cases have been found in Asian, European, 

and African countries. Health offi cials are 

watching the situation very closely to prepare for the possibility that the virus may 

spread to other parts of the world. 

Q: Will getting a seasonal fl u 

shot prevent me from getting 

avian fl u?

A: No. Th e fl u shot can only help protect you 

from seasonal fl u. No vaccine is available 

to protect against the H5N1 virus that has 

Avian infl uenza (fl u) is not the same as 

pandemic fl u. A fl u pandemic is a global 

outbreak of a fl u. A pandemic can happen 

when a new virus appears that people have 

little or no immunity against and for which 

there is no vaccine. (Having an immunity 

means you are resistant to, or protected 

against, a disease.) A new virus can spread 

quickly from person to person around the 

world, causing severe illness and even death. 

Although it is hard to know when the next 

fl u pandemic will happen or how dangerous it will be, you can be informed and take 

steps to prepare your family. Avian fl u has 

received a lot of attention in recent years, 

raising many questions about the dangers of 

a fl u pandemic. 

Q: What is avian infl uenza (fl u)?

A: Avian or “bird fl u” is caused by infl uenza 

viruses that naturally aff ect birds. Wild birds 

carry these highly contagious viruses, but 

they generally do not become sick. Domesticated birds, though, are at great risk. Avian 

fl u can cause very serious illness and death 

for infected chickens, ducks, and turkeys.

Q: Why are health offi cials 

concerned about avian fl u for 

humans?

A: Although people are not usually at risk of 

getting avian fl u viruses, a virus called H5N1 

is one of the few strains that has crossed 

22 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Understanding Avian and Pandemic Flu
been found in people, but researchers are 

working on making one.

Q: What are the symptoms of 

avian fl u?

A: Symptoms can include regular fl u symptoms such as fever, cough, sore throat, and 

muscle aches. Other symptoms may include 

eye infections, pneumonia, and severe respiratory problems. Th ere may be other symptoms that we do not yet know about.

Q: Are there treatments 

available for avian fl u?

A: Th e H5N1 virus is resistant to two medicines used to treat the fl u: amantadine and 

rimantadine. Two other fl u medicines called 

oseltamavir and zanamavir may work to 

treat the fl u caused by H5N1. More research 

is needed to test these medicines. Health researchers are also working on improving fl u 

testing, to better detect which fl u strain you 

have and where it came from. Th is will help 

government offi cials track dangerous fl u 

viruses and help keep the public informed.

Q: What can I do to help keep 

my family healthy?

A: You and members of your family can take 

steps to help limit the spread of germs. 

✦ Wash your hands with soap and warm 

water often.

✦ Use an alcohol-based hand cleanser if you 

don’t have soap handy.

✦ When coughing or sneezing, cover your 

mouth and nose with a tissue (or your 

upper sleeve if you don’t have a tissue), 

throw used tissue away, and wash your 

hands afterward.

✦ If you are sick, stay home.

It is also important to eat a balanced diet, 

drink plenty of water, exercise regularly, and 

get enough rest. 

Q: What should I do to help 

my family prepare for a fl u 

pandemic?

A: Visit www.pandemicfl u.gov to learn how 

to prepare your family. Th is web site provides preparation checklists for families and 

businesses, information for people who deal 

with poultry, and the latest information 

on how avian fl u is aff ecting people around 

the world. If H5N1 does cause a pandemic 

fl u, this web site will off er important safety 

information. You can also call the Centers 

for Disease Control and Prevention Hotline 

at 1-800-CDC-INFO (1-800-232-4636) or 

1-888-232-6348 (TDD) 24 hours a day, 

seven days a week.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 23

Understanding Avian and Pandemic Flu

www.pandemicfl u.gov 

1-800-CDC-INFO or 

1-888-232-6348 (TDD)
Common Screening and Diagnostic Tests Explained

Test Name Defi nition

Angiogram Exam of your blood vessels using x-rays. The doctor inserts a small tube into the blood vessel and 

injects dye to see the vessels on the x-ray.

Barium enema A lubricated enema tube is gently inserted into your rectum. Barium fl ows into your colon. An x-ray is 

taken of the large intestine. 

Biopsy A test that removes cells or tissues for examination by a pathologist to diagnose for disease. The tissue 

is examined under a microscope for cancer or other diseases.

Blood test Blood is taken from a vein in the inside elbow or back of the hand to test for a health problem.

Bone mineral density 

(BMD) test 

Special x-rays of your bones are used to test if you have osteoporosis, or a weakening of the bones.

Bronchoscopy Exam of the lungs. A bronchoscope, or fl exible tube, is put through the nose or mouth and into your 

windpipe (trachea).

Clinical breast exam 

(CBE)

A doctor, nurse, or other health professional uses his or her hands to examine your breasts and underarm areas to fi nd lumps or other problems. 

Chest x-ray An x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm. 

Colonoscopy An examination of the inside of the colon using a colonoscope, inserted into the rectum. A colonoscope 

is a thin, tube-like instrument with a light and lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for disease.

Computed tomographic 

(CT or CAT) scan 

The patient lies on a table and x-rays of the body are taken from diff erent angles. Sometimes, a fl uid is 

used to highlight parts of the body in the scan.

Echocardiogram An instrument (that looks like a microphone) is placed on the chest. It uses sound waves to create a 

moving picture of the heart. A picture appears on a TV moniter, and the heart can be seen in diff erent 

ways. 

Electroencephalogram 

(EEG)

Measures the electrical activity of the brain, using electrodes that are put on the patient’s scalp. 

Sometimes patients sleep during the test.

Electrocardiogram (EKG 

or ECG)

Records the electrical activity of the heart, using electrodes placed on the arms, legs, and chest. 

Exercise stress test Electrodes are placed on the chest, arms, and legs to record the heart’s activity. A blood pressure cuff is 

placed around the arm and is infl ated every few minutes. Heart rate and blood pressure are taken before 

exercise starts. The patient walks on a treadmill or pedals a stationary bicycle. The pace of the treadmill 

is increased. The response of the heart is monitored. The test continues until target heart rate is reached. 

Monitoring continues after exercise for 10 to 15 minutes or until the heart rate returns to normal.

Fecal occult blood test 

(FOBT)

Detects hidden blood in a bowel movement. There are two types: the smear test and fl ushable 

reagent pads. 

24 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Common Screening and Diagnostic Tests
Note: Anesthesia (medicine to block pain or sedate you) is given during some of these tests to keep you comfortable. Be sure to talk 

with your doctor or nurse about what to expect during and after tests, and how to prepare for tests.

Test Name Defi nition

Laparoscopy A small tube with a camera is inserted into the abdomen through a small cut in or just below the belly 

button to see inside the abdomen and pelvis. Other instruments can be inserted in the small cut as 

well. It is used for both diagnosing and treating problems inside the abdomen.

Magnetic resonance 

imaging (MRI) 

A test that uses powerful magnets and radio waves to create a picture of the inside of your body without surgery. The patient lies on a table that slides onto a large tunnel-like tube, which is surrounded by 

a scanner. Small coils may be placed around your head, arm, leg, or other areas. 

Mammogram X-rays of the breast taken by resting one breast at a time on a fl at surface that contains an x-ray plate. 

A device presses fi rmly against the breast. An x-ray is taken to show a picture of the breast. Mammography is used to screen healthy women for signs of breast cancer. It can also be used to evaluate a 

woman who has symptoms of disease. It can, in some cases, detect breast cancers before you can feel 

them with your fi ngers.

Medical history The doctor or nurse talks to the patient about current and past illnesses, surgeries, pregnancies, 

medications, allergies, use of alternative therapies, vitamins and supplements, diet, alcohol and drug 

use, physical activity, and family history of diseases.

Pap test The nurse or doctor uses a small brush to take cells from the cervix (opening of the uterus) to look at 

under a microscope in a lab.

Pelvic exam A doctor or nurse asks about the patient’s health and looks at the vaginal area. The doctor or nurse 

checks the fallopian tubes, ovaries, and uterus by putting two gloved fi ngers inside the vagina. With 

the other hand, the doctor or nurse will feel from the outside for any lumps or tenderness.

Physical exam The doctor or nurse will test for diseases, assess your risk of future medical problems, encourage a 

healthy lifestyle, and update your vaccinations.

Positron emission 

tomography (PET) scan 

The patient is injected with a radioactive substance, such as glucose. A scanner detects any cancerous 

areas in the body. Cancerous tissue absorbs more of the substance and looks brighter in images than 

normal tissue. 

Sigmoidoscopy The sigmoidoscope is a small camera attached to a fl exible tube. This tube, about 20 inches long, is 

gently inserted into the colon. As the tube is slowly removed, the lining of the bowel is examined.

Spirometry The patient breathes into a mouthpiece that is connected to an instrument called a spirometer. The 

spirometer records the amount and the rate of air that is breathed in and out over a specifi ed time. It 

measures how well the lungs exhale.

Ultrasound A clear gel is put onto the skin over the area being examined. An instrument is then moved over that 

area. The machine sends out sound waves, which refl ect off the body. A computer receives these waves 

and uses them to create pictures of the body. 

Common Screening and Diagnostic Tests Explained

Visit the National Women’s Health Information Center web site www.womenshealth.gov 25

Common Screening and Diagnostic Tests
26 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Notes

Notes
Taking Charge of Your Health 

Your role in prevention

Getting regular check ups, preventive 

screening tests, and immunizations are 

among the most important things you can 

do for yourself. Use these charts to fi gure 

out when to see your doctor or nurse based 

on your health profi le. Th en, become a 

partner with your doctor or nurse to choose 

when you need your screenings and immunizations. Share your family history, voice 

your concerns, and always ask questions 

about what you can do to prevent certain 

diseases. For instance, if your doctor or 

nurse asks you to exercise more, ask which 

types of exercises are best for you. If you 

don’t know how to do a monthly breast selfexam, ask how and practice until you feel at 

ease doing it. If you don’t know if you need 

certain screenings, ask your doctor or nurse. 

Understanding risk factors

Th e fi rst chart in this section lists recommended screenings and immunizations for 

women at average risk for most diseases. 

How do you know if your risk is higher than 

average? Check the second set of charts for 

the recommended screenings and immunizations for women with higher than average 

risk factors. Risk factors are things in your 

life that increase your chances of getting a 

condition or disease. Th ey can include things 

like family history, exposures to things in 

the environment, being a certain age or 

sex, being from a certain ethnic group, or 

already having a health condition. If you do 

have high risk factors, your doctor or nurse 

will most likely want you to be screened or 

immunized at a younger age or more often 

than what is recommended. Check with 

your doctor or nurse to fi nd out if you need 

to have certain health screenings and how 

often you will need them.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 27

Taking Charge of Your Health
General Screenings and Immunizations for Women

Screening Tests Ages 18–39 Ages 40–49 Ages 50–64 Ages 65 and Older

General Health:

Full checkup, including 

weight and height

Discuss with your doctor 

or nurse.

Discuss with your doctor 

or nurse.

Discuss with your doctor 

or nurse.

Discuss with your doctor 

or nurse.

Thyroid test (TSH)1 Start at age 35, then every 

5 years

Every 5 years Every 5 years Every 5 years

Heart Health:

Blood pressure test2

At least every 2 years At least every 2 years At least every 2 years At least every 2 years

Cholesterol test3 Start at age 20, discuss 

with your doctor or nurse.

Discuss with your doctor 

or nurse.

Discuss with your doctor 

or nurse.

Discuss with your doctor 

or nurse.

Bone Health:

Bone mineral density test4

Discuss with your doctor 

or nurse.

Discuss with your doctor 

or nurse.

Get a bone mineral density 

test at least once. Talk to 

your doctor or nurse about 

repeat testing.

Diabetes:

Blood glucose test5

Discuss with your doctor 

or nurse.

Start at age 45, then every 

3 years

Every 3 years Every 3 years

Breast Health:

Mammogram (x-ray of 

breast)6

Every 1-2 years. Discuss 

with your doctor or nurse.

Every 1-2 years. Discuss 

with your doctor or nurse.

Every 1-2 years. Discuss 

with your doctor or nurse.

Reproductive Health:

Pap test & pelvic exam7

Every 1-3 years if you have 

been sexually active or are 

older than 21

Every 1-3 years Every 1-3 years Discuss with your doctor 

or nurse.

Chlamydia test8 Yearly until age 25 if sexually active. Older than age 

25, get this test if you have 

new or multiple partners. 

All pregnant women 

should have this test.

Get this test if you have 

new or multiple partners. 

All pregnant women 

should have this test.

Discuss with your doctor 

or nurse.

Discuss with your doctor 

or nurse.

Sexually transmitted 

disease (STD) tests8

Both partners should get 

tested for STDs, including 

HIV, before initiating 

sexual intercourse.

Both partners should get 

tested for STDs, including 

HIV, before initiating 

sexual intercourse.

Both partners should get 

tested for STDs, including 

HIV, before initiating 

sexual intercourse.

Both partners should get 

tested for STDs, including 

HIV, before initiating 

sexual intercourse.

Mental Health 

Screening9

Discuss with your doctor 

or nurse.

Discuss with your doctor 

or nurse.

Discuss with your doctor 

or nurse.

Discuss with your doctor 

or nurse.

These charts are guidelines only. Your doctor will personalize the timing of each test and immunization to meet your health care needs. 

Use the stickers to remind yourself of these exams. Citations are found on pages 231–232.

28 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

General Screenings and Immunizations

Th is chart lists recommended screenings and immunizations for women at average risk for most diseases.
Screening Tests Ages 18–39 Ages 40–49 Ages 50–64 Ages 65 and Older

Colorectal Health:

Fecal occult blood test10,11

Yearly Yearly

Flexible sigmoidoscopy 

(with fecal occult blood 

test is preferred)10,11

Every 5 years (if not having 

a colonoscopy)

Every 5 years (if not having 

a colonoscopy)

Double Contrast Barium 

Enema (DCBE)10,11

Every 5-10 years (if not 

having a colonoscopy or 

sigmoidoscopy)

Every 5-10 years (if not 

having a colonoscopy or 

sigmoidoscopy)

Colonoscopy10,11 Every 10 years Every 10 years

Rectal exam10,11 Discuss with your doctor 

or nurse.

Discuss with your doctor 

or nurse.

Every 5-10 years with each 

screening (sigmoidoscopy, 

colonoscopy, or DCBE)

Every 5-10 years with each 

screening (sigmoidoscopy, 

colonoscopy, or DCBE)

Eye and Ear Health:

Eye exam12

If you have any visual 

problems; at least one exam 

from ages 20-29 and at least 

two exams from ages 30-39.

Every 2-4 years Every 2-4 years Every 1-2 years

Hearing test13 Starting at age 18, then 

every 10 years

Every 10 years Every 3 years Every 3 years

Skin Health:

Mole exam14

Monthly mole self-exam; 

by a doctor every 3 years, 

starting at age 20.

Monthly mole self-exam; 

by a doctor every year.

Monthly mole self-exam; 

by a doctor every year.

Monthly mole self-exam; 

by a doctor every year.

Oral Health:

Dental exam15

One to two times every 

year

One to two times every 

year

One to two times every 

year

One to two times every 

year

Immunizations:

Infl uenza vaccine16

Discuss with your doctor 

or nurse.

Discuss with your doctor 

or nurse.

Yearly Yearly

Pneumococcal vaccine16 One time only

Tetanus-diphtheria booster 

vaccine16

Every 10 years Every 10 years Every 10 years Every 10 years

Human papillomavirus 

vaccine (HPV)17

Discuss with your doctor 

or nurse.

Discuss with your doctor 

or nurse.

Discuss with your doctor 

or nurse.

Meningococcal vacine18 Discuss with your doctor or 

nurse if attending college.

General Screenings and Immunizations for Women

These charts are guidelines only. Your doctor will personalize the timing of each test and immunization to meet your health care needs. 

Use the stickers to remind yourself of these exams. Citations are found on pages 231–232.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 29

General Screenings and Immunizations

Th is chart lists recommended screenings and immunizations for women at average risk for most diseases.
Recommended Screenings, Tests, and Immunizations 

for Women with High-Risk Factors

✔

if it 

applies

Does your family history include? Then ask your doctor or nurse if you need the following screenings, tests, exams, or vaccines more often or 

at a younger age:

High blood pressure Blood pressure test

High cholesterol Cholesterol test

Heart disease, premature heart disease, or heart attack Blood pressure test, cholesterol test, exercise stress test

Diabetes Blood glucose test

Breast cancer Mammogram, ovarian cancer tests

Endometrial cancer Colon screening

Ovarian cancer Pelvic exam, ovarian cancer tests, colon screening, clinical 

breast exam

Osteoporosis, bone fracture in adulthood Bone mineral density test

Thyroid disease or thyroid cancer Thyroid test and/or genetic counseling

Gum (periodontal) disease Oral exam

Hearing problems, deafness Hearing test

Vision problems, eye disease, blindness Vision exam

Infl ammatory bowel disease; colon polyps; colon, ovarian, 

or endometrial cancer

Colonoscopy, sigmoidoscopy, DCBE, rectal exam, fecal occult 

blood test, pap test, pelvic exam, ovarian cancer tests

Cancer, heart disease, or any illness at an unusually young 

age (50 or younger)

Genetic counseling, possible early screening tests

Two relatives with the same kind of cancer Genetic counseling, possible early screening tests

Birth defects or genetic disorder (you or your partner) Genetic counseling, possible early screening tests. If you want 

to become pregnant, genetic counseling for you and your 

partner.

30 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Screenings for Women with High-Risk Factors

This chart lists screenings, tests, or exams you might need more often or earlier because of having 

high-risk factors or things in your life that increase your chances of developing a condition or disease. 
Recommended Screenings, Tests, and Immunizations 

for Women with High-Risk Factors

✔

if it 

applies

Are You? Then ask your doctor or nurse if you need the following screenings, tests, exams, or vaccines more often or at a younger age:

African American Blood pressure test, cholesterol test, blood glucose test, vision exam, 

colonoscopy, genetic counseling for sickle cell anemia

Latina Blood pressure test, cholesterol test, blood glucose test, colonoscopy

Alaska Native or Pacifi c Islander Blood glucose test, pneumococcal vaccine

American Indian Blood glucose test, pneumococcal vaccine

Ashkenazi Jewish descent Genetic counseling for Tay-Sachs disease, if you want to become 

pregnant

Ashkenazi Jewish with family history of breast 

or ovarian cancer

Genetic counseling for possible BRCA1/2 mutation

Asian American Blood glucose test

Age 65 or older Bone mineral density test, fl u vaccine, pneumococcal vaccine

Between the ages of 60 and 64, weigh fewer 

than 154 lbs., and not taking estrogen

Bone mineral density test

College age MMR vaccine, varicella vaccine, human papillomavirus (HPV) vaccine, 

meningococcal vaccine

Postmenopausal Bone mineral density test

Pregnant Blood pressure test, blood glucose test, urine test, HIV test, STD tests, 

MMR vaccine, hepatitis B antigen test

A non-pregnant woman of childbearing age MMR vaccine, varicella vaccine

A smoker Blood pressure test, cholesterol test, bone mineral density test, oral 

exam, vision exam

Overweight Blood pressure test, blood glucose test, weight

Living in prison Tuberculosis (TB) test; HIV test; STD tests; hepatitis A, B vaccines

Living in long-term care TB test, infl uenza vaccine, pneumococcal vaccine

A health care worker TB test, infl uenza vaccine, pneumococcal vaccine, MMR vaccine, varicella 

vaccine, HIV test, hepatitis test, hepatitis B vaccine if exposed to blood

Visit the National Women’s Health Information Center web site www.womenshealth.gov 31

Screenings for Women with High-Risk Factors

This chart lists screenings, tests, or exams you might need more often or earlier because of having 

high-risk factors or things in your life that increase your chances of developing a condition or disease. 
Recommended Screenings, Tests, and Immunizations 

for Women with High-Risk Factors

✔

if it 

applies

Do you have or have you had? Then ask your doctor or nurse if you need the following 

screenings, tests, exams, or vaccines more often or at a 

younger age:

High blood pressure Blood pressure test, cholesterol test, blood glucose test

High cholesterol Blood pressure test, cholesterol test, blood glocose test

Heart disease Blood pressure test, cholesterol test, blood glucose test, infl uenza 

vaccine, pneumococcal vaccine

Diabetes Blood pressure test, cholesterol test, blood glucose test, vision 

exam, urine test

Gestational diabetes (diabetes during pregnancy) Blood glucose test

A baby weighing more than 9 lbs. Blood glucose test

Breast cancer Mammogram, ovarian cancer tests

Dense breast Digital mammogram, clinical breast exam

Cervical, uterine, endometrial, vaginal cancer Pap test, pelvic exam, ovarian cancer tests, colon screening

Ovarian cancer Pelvic exam, ovarian cancer tests, mammogram, 

colon screening

Previous abnormal Pap tests Pap test, pelvic exam, human papillomavirus (HPV) vaccine

Early menopause (natural or surgically induced); absent or infrequent menstrual periods; advanced age; 

a personal history of bone fracture in adulthood; 

lifelong low calcium intake; lifelong inactive lifestyle 

or little physical activity; low body weight (fewer 

than 154 lbs.), or a history of an eating disorder such 

as anorexia nervosa

Bone mineral density test

An autoimmune disease (including lupus, rheumatoid arthritis, scleroderma, multiple sclerosis, 

psoriasis)

Thyroid test, TB test, infl uenza shot, MMR vaccine, pneumococcal 

vaccine, autoimmune screening test, bone mineral density test

32 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Screenings for Women with High-Risk Factors

This chart lists screenings, tests, or exams you might need more often or earlier because of having 

high-risk factors or things in your life that increase your chances of developing a condition or disease. 
Recommended Screenings, Tests, and Immunizations 

for Women with High-Risk Factors

✔

if it 

applies

Do you have or have you had? Then ask your doctor or nurse if you need the following 

screenings, tests, exams, or vaccines more often or at a 

younger age:

Chronic lung disease Infl uenza vaccine, pneumococcal vaccine

Chronic liver disease Hepatitis A, B vaccines

Thyroid disease Thyroid test, infl uenza vaccine, pneumococcal vaccine, bone 

mineral density test (if hyperthyroid)

Gum (periodontal) disease Oral exam

Colon polyps; infl ammatory bowel disease Colonoscopy

Colon cancer Endometrial cancer screening, colon cancer screening tests

A developmental delay Vision exam, hearing test

Eye injury or disease Vision exam

Ear injury or prolonged exposure to loud noise Hearing test

HIV/AIDS Oral exam; vision exam; Pap test; pelvic exam; TB test; thyroid 

test; STD tests; infl uenza vaccine; pneumococcal vaccine; 

hepatitis screening; hepatitis A, B vaccines

A blood transfusion or solid organ transplant before 1992 Hepatitis C test

Received clotting factor concentrates made before 1987 Hepatitis C test

A blood transfusion before 1985 HIV test

Multiple sex partners (or a partner who has or had 

multiple sex partners)

STD tests, HIV test, hepatitis B vaccine, Pap test, pelvic exam, 

human papillomavirus (HPV) vaccine

Alcoholism Pneumococcal vaccine, TB test, psychological screening, liver tests

Injection drug use (IDU) or addiction Hepatitis A, B vaccines; hepatitis C test; TB test; STD tests; HIV 

test; psychological screening

A sexually transmitted disease (STD) STD tests, HIV test, Pap test, pelvic exam, hepatitis B vaccine, 

human papillomavirus (HPV) vaccine

Lived or worked with someone exposed to tuberculosis (TB) TB test

A serious injury (cut or laceration) Tetanus-diphtheria booster vaccine

A baby recently (within the last few weeks or months) Postpartum depression screening

Visit the National Women’s Health Information Center web site www.womenshealth.gov 33

Screenings for Women with High-Risk Factors

This chart lists screenings, tests, or exams you might need more often or earlier because of having 

high-risk factors or things in your life that increase your chances of developing a condition or disease. 
When Do Children and Teens Need Vaccinations?

Vaccinations start at birth and continue throughout life. See page 29 for adult immunizations.

34 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Children and Teen Vaccinations

Birth

1

month

2 

months

4 

months

6 

months

12 

months

15 

months

18 

months

24 

months

4–6

years

11–12

years

13–14

years

15

years

16–18

years

Hepatitis B1 HepB HepB1

Diphtheria,

Tetanus, 

Pertussis2

DTaP DTaP DTaP DTaP Tdap

Haemophilus 

infl uenzae

type b3

Hib Hib Hib3

Inactivated

Poliovirus IPV IPV IPV

Measles, 

Mumps,

Rubella4

MMR

Varicella5

Meningococcal6 MCV4

Pneumococcal7 PCV PCV PCV

Infl uenza8

Hepatitis A9

Human papillomavirus (HPV) HPV

HepB1 HepB HepB Series

DTaP Tdap

Hib

IPV

MMR MMR

Varicella Varicella

PCV

MPSV4 MCV4

MCV4

PCV PPV

Infl uenza (Yearly) Infl uenza (Yearly)

HepA Series

Range of recommended ages Catch-up immunization10 11–12 year old assessment

HPV

1 All newborns should get HepB before leaving the hospital. Infants whose mothers 

are HBsAg-positive should get HepB and hepatitis B immune globulin within 12 

hours of birth (these infants will also need to be checked again after the HepB 

series is fi nished). Depending on the type of vaccine used, your child may not need 

a dose at 4 months of age.

2

 The fourth dose of DTaP can be given as early as 12 months of age, as long as 6 

months have gone by since the third dose. Tdap is a vaccine preparation recommended at 11-12 years old for those who have fi nished DTaP.

3

 Your infant may not need a dose at 6 months of age, depending on the type of 

vaccine your health care provider uses.

4

 The second MMR dose is recommended at 4-6 years old. MMR can be given at any 

visit as long as at least 4 weeks have passed since the fi rst dose and both doses are 

given at or after 12 months of age.

5

 Varicella vaccine is recommended after 12 months of age for children at risk of 

getting chicken pox.

6

 Meningococcal vaccine should be given at the 11-12 year visit and given to unvaccinated adolescents entering high school. All college freshmen living in dormitories 

should be vaccinated, preferably with MCV4, although meningococcal polysaccharide vaccine (MPSV4) is an acceptable alternative. MPSV4 is recommended starting 

at age 2 and above for children and adolescents with certain health problems.

7

 Pneumococcal conjugate vaccine (PCV) is recommended for all children 2-23 

months old and for certain children 2-5 years old. PPV is recommended in addition 

to PVC for certain high risk groups.

8

 Infl uenza vaccine is recommended for infants younger than 6 months old with 

certain risk factors, such as asthma, heart disease, or sickle cell disease. The vaccine 

is recommended for healthy children ages 6-23 months.

9

 HepA is recommended at one year of age, and for older high risk children and 

adolescents.

10 At these ages, children who have not been vaccinated should get catch-up doses.

Source: Adapted from the Centers for Disease Control and Prevention
Visit the National Women’s Health Information Center web site www.womenshealth.gov 35

Notes

Notes
Eating Healthy 

and Being 

Active 

Heart disease, cancer, and stroke are the leading causes of death for women in 

the United States. Did you know that an 

unhealthy diet and physical inactivity can 

increase your chances of getting these and 

other diseases? 

Unhealthy eating habits (your diet) and 

physical inactivity (not being active enough) 

are contributing factors to becoming overweight or obese. Overweight and obesity are 

problems that continue to get worse in the 

United States. Why? Just a few of the reasons are bigger portion sizes, little time to 

exercise or cook healthy meals, and relying 

so much on cars for transportation.

36 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Eating Healthy and Being Active

heart disease type

2 diabetes

high

blood pressure

stroke

breathing problems arthritis

gallbladder disease

osteoarthritis

some

cancers

Poor diet and physical inactivity are main causes of becoming overweight or 

obese. About 64 percent of Americans are overweight or obese. Being overweight 

or obese raises your risk of getting many diseases, including those above. 
Physical Eff ects of Being 

Overweight or Obese

But body weight isn’t just the problem. Th e 

places where you store your body fat also affect your health. Women with a “pear” shape 

tend to store fat in their hips and buttocks. 

Women with an “apple” shape store fat 

around their waists. 

For most women, if they carry extra weight 

around their waists and their waists are 

larger than 35 inches, their risk of certain 

health problems increase. Th ese problems 

include heart disease, diabetes, and some 

cancers. Women who carry extra weight 

around their waists (“apples”) are at higher 

risk than women who carry extra weight 

around their hips (“pears”). Tips for Healthy Eating

✦ Start your day with breakfast. Breakfast fi lls your “empty tank” to get you going after a long night without food. Make 

an easy breakfast, like whole-grain cereal 

with fruit and fat-free or low-fat milk, or 

whole-wheat toast with peanut butter, or 

fat-free or low-fat yogurt with fruit, or 

whole-grain waffl es. Eating breakfast will 

give you better strength, endurance, and 

concentration throughout your day. 

✦ Eat a variety of foods. You don’t have to 

give up foods you enjoy like hamburgers, 

french fries, and ice cream to eat healthy. 

You just have to be smart about how often 

you eat them and how much you eat. Your 

body needs nutrients such as protein, 

Visit the National Women’s Health Information Center web site www.womenshealth.gov 37

Eating Healthy and Being Active

Apple Pear
carbohydrates, fat, and many diff erent vitamins and minerals from diff erent foods. 

Balance your food choices to get important nutrients.

✦ Eat whole grains, fruit, and vegetables. Th ese foods give you energy, plus 

vitamins, minerals, and fi ber. Besides, 

they taste good! Try foods like brown rice 

or whole-wheat bread. Bananas, strawberries, and melons are some great tasting 

fruit. Try vegetables raw, on a sandwich, 

or in a salad. Be sure to pick a variety of 

colors and kinds of fruit and vegetables. 

You can vary the form. Try them fresh, 

frozen, canned, or dried.

✦ Watch your portion control. Eating 

the right amount of food at each meal is 

just as important as eating a variety of 

foods. A “portion” is the amount of food 

you choose to eat for a meal or snack. It 

can big or small. A “serving” is a specifi c 

amount of food or drink, such as one slice 

of bread or 1 cup of milk. For example, 

one cheese sandwich is a portion, probably made up of two servings of bread and 

one serving of cheese. A serving is probably smaller than you think. 

38 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Eating Healthy and Being Active

Serving Sizes

For Grains: 1 serving equals 1 cup of cereal fl akes (the size of your fi st) 

1⁄2 cup of cooked rice, pasta, or potato (the size of 1⁄2 

baseball)

For Vegetables and Fruit: 

1 serving equals

1 cup of salad greens (the size of a baseball)

1 medium fruit (the size of a baseball)

For Dairy and Cheese: 

1 serving equals

1⁄2 cup of ice cream (the size of 1⁄2 baseball)

11⁄2 ounces of cheese (2 cheese slices or 4 cubes the size of dice)

Meat and Alternatives 3 ounces of meat, fi sh, poultry (the size of a deck of cards)

3 ounces of grilled or baked fi sh (the size of a checkbook)
Get Moving!

An active lifestyle can help every woman. 

You don’t have to be as fi t as a professional 

athlete to benefi t from physical activity. 

In fact, 30 minutes of moderate-intensity 

physical activity on most days of the week 

can greatly improve your health. Examples 

include walking, biking, water aerobics, 

weight training, dancing, softball, and yoga. 

Some benefi ts

✦ Reduces your risk of dying from heart 

disease or stroke 

✦ Lowers your risk of getting heart disease, 

stroke, high blood pressure, colon cancer, 

and diabetes

Visit the National Women’s Health Information Center web site www.womenshealth.gov 39

Eating Healthy and Being Active

✦ Helps control blood pressure by lowering 

high blood pressure and helps keep blood 

pressure from rising in the fi rst place 

Small Steps to Improve Your Eating Habits 

If You Usually... Then...

Use whole or 2% milk Use low-fat (1% or less fat) milk or fat-free milk.

Drink regular soda Drink water or other calorie-free drinks.

Have second helpings Put the food away after you serve it. Or put the food in the 

kitchen instead of placing serving bowls on the table.

Eat big portions Eat the appropriate portion sizes off a smaller plate.

Eat a lot of white bread or pasta Eat a variety of whole-grain foods, like whole-wheat bread, 

low-fat popcorn, and brown rice.

Use butter Use butter-fl avored cooking spray.

Eat fast food on the road Pack sandwiches, yogurt, string cheese, and low-fat crackers for 

the trip. Cut up vegetables and fruit for snacks.

Eat meats high in fat Eat lean cuts of beef or pork, skinless chicken or turkey, or fi sh.

Eat snacks high in fat, salt, and 

sugar

Keep graham crackers, peanut butter, light popcorn, dry unsweetened cereals, low-fat cheese, along with fruit and veggies 

readily available.

Skip breakfast Try eating a healthy breakfast each day.

Fry your food Grill, bake, or roast your food instead.
✦ Helps keep your bones, muscles, and 

joints healthy

✦ Can reduce anxiety and depression and 

improve your mood

✦ Helps you handle stress

✦ Helps control your weight

✦ Reduces your risk of falling and breaking 

bones in older adults

✦ May help protect against breast cancer

✦ Helps control joint swelling and pain from 

arthritis

✦ Helps you feel more energetic

✦ Helps you sleep better

Small Steps to Increase Your Physical Activity

If you usually... Then...

Park as close as possible to the store Park farther away and walk.

Let your dog out the back door Take your dog for a walk.

Take the elevator Take the stairs, but make sure the stairwells are well 

lit.

Have lunch delivered Walk to pick up lunch.

Relax while the kids play Get involved in their activity.

40 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Eating Healthy and Being Active

Keep Your Children Healthy

Th e habits and behaviors that kids learn 

when they’re young become more diffi cult 

to change as they get older. Th is is true 

for their eating habits and their levels of 

physical activity. Many children today have 

a poor diet with little physical activity. Th ey 

eat foods high in calories and saturated fat. 

Th ey don’t eat enough fruit and vegetables. 

Th ey watch TV, play video games, or use 

the computer instead of being active. More 

and more kids are becoming overweight or 

obese. And these kids have a higher chance 

of becoming obese adults. Th ey are at higher 

risk of developing diabetes, high blood pressure, and heart disease than children who 

are not overweight or obese. 
Help your child become more active

✦ Set limits on the amount of time the family watches TV, plays video games, and 

uses the computer.

✦ Encourage your children to get at least 

one hour of physical activity every day. 

✦ Find out about activity programs in your 

community.

✦ Ask your children what they like to do 

and what they’d like to try, like playing 

baseball, basketball, soccer, or swimming. 

✦ Create family activities that involve physical activity, like hiking, walking, or playing ball.

✦ Plan vacations where the whole family can 

enjoy being active together.

Help your children eat right

✦ Have your children plan and cook healthy 

meals with you.

✦ Make meal time your family time. Turn 

off the TV, and remove other distractions. 

✦ Give your kids healthy snacks, like fruit, 

whole-grain crackers, and vegetables.

✦ Limit the amount of fast food and takeout 

you and your kids eat. 

✦ Involve the whole family in healthy eating. Don’t single out your children by 

their weight. 

We know children do what they see, not always what they are told. Set a good example 

for your children. Your kids will learn to eat 

right and be active by watching you. Setting 

a good example can mean a lifetime of good 

habits for you and your kids.

Th en and Now

Over the past 20 years, the portions 

of food we’re served and eat have gotten much bigger. It’s hard to fi nd a small 

portion in a restaurant these days. Your 

plate arrives, often with enough food on 

it for two or even three people. Because of 

this “portion distortion,” we often don’t 

recognize what a “normal” portion is. For 

example, two decades ago, a regular soda 

was 6.5 ounces and 65 calories. Today a 

typical, non-diet soda is 20 ounces and has 

250 calories. Cutting back on portion size 

is a great way to help keep calories in check.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 41

Eating Healthy and Being Active
Getting Strong 

Bones: From 

Youth to Old Age

Women don’t have to worry about frail 

bones until they get older, right? 

WRONG!

Preventing bone disease should begin at birth 

and continue throughout your life. By being 

physically active, following a bone-healthy 

diet, and avoiding smoking, women can improve their bone health from youth to old age.

Women of Caucasian and Asian ancestry are 

at the highest risk for developing osteoporosis. African American and Hispanic women 

have a lower risk, but still a signifi cant one. 

All women need to pay attention to getting, 

or keeping, healthy bones.

Women of all ages need to keep their bones 

strong. Unfortunately, millions of women 

already have osteoporosis [oss-tee-oh-puhro-sis]. If they don’t yet have the disease, 

then they may be at risk for it. Osteoporosis 

means that your bones get weak, and you’re 

more likely to break a bone. Because it has 

no symptoms, you might not know your 

bones are getting weaker until you break a 

bone. Th e disease can just get worse until a 

bone breaks.

A broken bone can make your life much 

more diffi cult. It can cause disability, pain, 

or loss of independence. It can make it 

harder for you to do your daily activities 

without help, such as walking. It can make it 

hard to participate in social activities. It can 

also cause severe back pain and deformity.

You can develop osteoporosis in any of your 

bones. It is most common in the hip, wrist, 

and spine (also called vertebrae [ver-tuhbray]). Vertebrae are important because 

these small bones support your body, so you 

can stand and sit upright. See Signs of Osteoporosis in Your Spine on the opposite page.

Building Strong Bones

Building strong bones during childhood 

and adolescence is the best defense against 

getting osteoporosis later. Building strong 

bones at a young age will help you when you 

start to lose bone around the age of 30.

But no matter how old you are, it is never 

too late to start! As you get older, your 

bones don’t make new bone quickly enough 

to keep up with the bone loss. And after 

menopause, bone loss increases faster. Here 

are some steps you can take to stop your 

bones from becoming weak and brittle.

42 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Getting Strong Bones: From Youth to Old Age
Get your bones tested

More than one kind of test is available. 

Th ese tests fi nd out the strength of your 

bones, or your bone density. Talk to your 

doctor or nurse to fi nd out which type of 

test is best for you. One test is a dual-energy 

x-ray absorptiometry (DEXA). A DEXA takes 

special x-rays of your bones. 

✦ If you are 65 years old or older, get a bone 

density test.

✦ If you are between 60 and 64 years old, 

weigh fewer than 154 pounds, and don’t 

take estrogen, get a bone density test. 

Don’t wait until you’re 65. You have a 

higher chance for your bones to break.

Osteoporosis in the vertebrae can cause 

serious problems for women. A fracture in 

this area occurs from day-to-day activities 

like climbing stairs, lifting objects, or 

bending forward.

● Sloping shoulders

● Curve in the back

● Height loss

● Back pain

● Hunched posture

● Protruding abdomen

Signs of Osteoporosis in Your Spine

Healthy spine Osteoporosis

Visit the National Women’s Health Information Center web site www.womenshealth.gov 43

Getting Strong Bones: From Youth to Old Age
Get enough calcium each day

Bones are made of calcium. Th e best way to 

prevent osteoporosis is to get enough calcium in your diet. You need enough calcium 

each day for strong bones throughout life. 

You can get it through foods or calcium pills 

or both. You can get calcium pills at the drug 

store. Talk with your doctor or nurse before 

taking calcium pills to see which kind is best 

for you.

Amounts of Calcium You Need Each Day

Ages Milligrams per day

9-18 1300

19-50 1000

51 and older 1200

Pregnant or nursing women need the same 

amount of calcium as other women of the 

same age.

Get enough vitamin D each day

It is also important to get enough vitamin 

D, which helps your body take in calcium. 

You can get vitamin D through sunlight and 

foods like milk. You need 10 to 15 minutes 

of sunlight to the hands, arms, and face, two 

to three times a week to get enough vitamin 

D. Th e amount of time depends on how sensitive your skin is to light, use of sunscreen, 

skin color, and pollution. You can also get 

vitamin D by eating foods rich in vitamin 

D or in your vitamin pills. It’s measured in 

international units (IU). 

Some Foods with Calcium

Food Portion Milligrams % Daily Value*

Plain, nonfat (or low-fat) yogurt 1 cup 450 45

American cheese 2 ounces 348 35

Milk (fat-free or low-fat) 1 cup 300 30

Orange juice with added calcium 1 cup 300 30

Broccoli, cooked or fresh 1 cup 90 10

Note: Check the food labels for more information.

*Th e % daily value tells you how much of the recommended daily amount of that nutrient is in that portion of food. 

For example, eating 2 ounces of American cheese and 2 cups of milk would be 95% of your daily calcium needs.

44 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Getting Strong Bones: From Youth to Old Age
Amounts of Vitamin D You Need Each Day

Ages IU per day

19-50 200

51-70 400

71 and older 600

Get moving 

Being active really helps your bones by

✦ slowing bone loss

✦ improving muscle strength

✦ helping your balance 

Do weight-bearing physical activity. Any 

activity in which your body works against 

gravity is a weight-bearing activity. It means 

that your feet, legs, or arms are supporting 

or carrying your body’s weight. Jogging, 

walking, stair climbing, dancing, and playing 

soccer are examples of weight-bearing physical activities. Other weight-bearing activities 

are running, working in your garden, doing 

yoga or tai chi, hiking, playing tennis, or lifting weights.

Recommendations for physical activity

✦ Infants, toddlers, pre-schoolers, and older 

children need 60 minutes of physical 

activity each day. Th irty to sixty minutes 

of activity broken into 10 or 15 minutes 

throughout the day can improve their 

health. Because children spend most of 

their time in school, the type and amount 

of physical activity encouraged in schools 

is important.

Some Foods with Vitamin D

Food Portion IU % Daily Value

Milk: fat-free, low-fat, reduced-fat, & 1 cup 98 25

whole, vitamin D-fortifi ed

Egg (vitamin D is in the yolk) 1 whole 25 6

Pudding (made from mix & 1⁄2 cup 50 13

vitamin D-fortifi ed milk)

Note: Check the food labels for more information.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 45

Getting Strong Bones: From Youth to Old Age
✦ Teenagers need to exercise for about 60 

minutes every day. You can mix up your 

activities. Participate in moderate activities like fast walking or riding a bike. Th en 

switch to more intense or vigorous activities such as jogging or fast dancing. Th e 

exercise you get in gym class is probably 

not enough to meet the total amount of 

exercise you need each week. Make physical activity a regular part of your lifestyle. 

✦ Adults 18 and older need 30 minutes of 

physical activity on fi ve or more days a week 

to be healthy. You can improve your health 

by including a moderate amount of physical 

activity. Examples include 30 minutes of 

brisk walking or raking leaves, 15 minutes 

of running, or 45 minutes of playing volleyball. You get more health benefi ts if you 

do more physical activity.

✦ Older adults should also strive for 30 minutes of physical activity on fi ve or more 

days a week. Physical activity is one of the 

most important steps older adults can 

take to improve their physical and mental 

health. Being active can also improve your 

quality of life because it can increase your 

strength, stamina, and fl exibility. Exercise also helps older adults to maintain 

bone mass, improve balance, and increase 

endurance. Walking groups, senior swim 

clubs, and water aerobic classes are examples of good activities. 

Eat a healthy diet

Other nutrients, like vitamin A, vitamin 

C, magnesium, and zinc, as well as protein, 

help build strong bones too. Milk provides 

many of these nutrients. But you can also 

get these nutrients by eating a healthy diet, 

including foods that have these nutrients. 

Some examples are lean meats, fi sh, green 

leafy vegetables, and oranges. 

Don’t smoke

Smoking raises a woman’s risk of getting 

osteoporosis. It damages your bones and 

lowers the amount of estrogen in your body. 

Estrogen is a hormone made by your body 

that can help slow bone loss.

Drink alcohol moderately 

If you drink alcohol, limit it to no more than 

one drink per day. “One drink” is defi ned as 

one 12-ounce bottle of beer or wine cooler, 

one 5-ounce glass of wine, or 1.5 ounces of 

80-proof distilled spirits. Alcohol can make 

it harder for your body to use the calcium 

you take in. 

Make your home safe 

Reduce your chances of falling by making 

your home safer. For example, use a rubber 

bathmat in the shower or tub. Keep a light 

on at night. Keep your fl oors free of clutter. 

Remove throw rugs that cause you to trip. 

Make sure you have grab bars in the bath or 

shower.

Th ink about taking medicines to 

prevent or treat bone loss

Talk with your doctor or nurse about the 

risks and benefi ts of medicines for bone 

loss. 

46 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Getting Strong Bones: From Youth to Old Age
Teach your daughter early

Making good choices for healthy bones 

should start in childhood and become habits 

that last. Help your daughter build healthy 

bones. Powerful Bones. Powerful Girls.TM is 

a national education eff ort to help girls 

increase the calcium in their diets. Th e campaign has a user-friendly web site at www.

cdc.gov/powerfulbones as well as a web site 

for parents at www.cdc.gov/powerfulbones/

parents. Th is site provides parents with the 

information they need to help their daughters build strong bones during the critical 

window of bone growth—ages 9 to 12. 

Get Sick from Dairy?

If you are lactose intolerant, it can be hard 

to get enough calcium. Lactose intolerance 

means the body is not able to easily digest 

foods that contain lactose, or the sugar that 

is found in dairy products like milk. Gas, 

bloating, stomach cramps, diarrhea, and 

nausea are symptoms you might have. It can 

start at any age but often begins as we grow 

older. 

People who are lactose intolerant have different responses to the amounts and types 

of foods they can handle. For example, one 

person may have symptoms after drinking a 

small glass of milk. Another person may be 

able to drink an entire glass of milk but not 

two. Others may be able to eat ice cream 

and aged cheeses, such as cheddar and 

Swiss, but not other dairy products. People 

learn through trial and error about how 

much lactose they can handle. Soy-based 

or rice-based products can be alternative 

sources of calcium.

Lactose-reduced and lactose-free products 

are sold in food stores. Th ey include milk, 

cheese, and ice cream. You also can take special pills or liquids before eating to help you 

digest dairy foods.

You can also eat foods that have calcium 

added (fortifi ed), like some cereals and orange juice. Also think about taking calcium 

pills. Talk to your doctor or nurse fi rst to see 

which one is best for you. Please note: If you 

have symptoms of lactose intolerance, talk 

to your doctor or nurse. Th ese symptoms 

could also be signs of a diff erent, or more 

serious, illness.

Th en and Now

Before the 1990s, we used to think only 

women got osteoporosis. Now we know 

that men also have to worry about weak 

bones. In fact, one in four men older 

than age 50 will have a fracture caused by 

osteoporosis.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 47

Getting Strong Bones: From Youth to Old Age
Loving Your 

Heart and

Understanding 

Stroke

Heart disease is the #1 killer of women. It doesn’t matter how young or old you 

are. Whatever your age, you need to take 

action to protect your heart. Stroke is the #3 

killer of women. Stroke is also a major cause 

of serious, long-term disability for women. 

Th e Basics of Heart Disease

People can have diff erent kinds of heart 

disease. Th e most common kind of heart disease is coronary artery disease (CAD). You 

can get this disease when your heart doesn’t 

get enough blood. If your heart doesn’t get 

enough blood, you can have a heart attack.

Know the Signs of a Heart Attack

Women and men don’t respond to a heart attack in the same ways. Women are less likely 

Dashed line indicates 

that organ is behind 

other main organs.

Brain

anxiety, dizziness, trouble sleeping

Chest

chest pain, chest pressure, fullness 

or squeezing (lasts more than a few

minutes or comes and goes)

Skin

cold sweat

Lungs

trouble breathing

Stomach

upset stomach, urge to throw up

Body

feel tired and weak

Arms, Back, Jaw,

Shoulders, Neck

pain

Signs of a Heart Attack

48 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Loving Your Heart and Understanding Stroke
to believe they’re having a heart attack than 

men. Women are more likely to put off seeking treatment for a heart attack than men.

Women and men can have diff erent symptoms, too, when they’re having a heart 

attack. For women, chest pain may not be 

the fi rst sign that your heart is in trouble. 

Before a heart attack, women have said 

that they have unusual tiredness, trouble 

sleeping, problems breathing, indigestion, 

and anxiety. Th ese symptoms can happen a 

month or so before the heart attack. 

During a heart attack, women often have 

one or more of these symptoms:

✦ pain or discomfort in the center of the 

chest

✦ pain or discomfort in other areas of the 

upper body, including the arms, back, 

neck, jaw, or stomach

✦ other symptoms, such as shortness of 

breath, breaking out in a cold sweat, nausea, or dizziness

Th e Basics of Stroke

A stroke occurs when the blood supply to 

the brain is cut off . When that happens, the 

brain doesn’t get the oxygen and nutrients 

it needs. Th en certain brain cells are injured 

Face, Arm, or Leg

numbness or 

weakness (mainly on 

one side of the body)

Brain

confusion, trouble talking or 

understanding speech, dizziness, 

loss of balance, bad headache

Eyes

trouble seeing in one or both eyes

Stomach

throwing up (or urge to)

Body

feel tired

Legs

trouble walking

Dashed line indicates 

that organ is behind 

other main organs.

Signs of a Stroke

Visit the National Women’s Health Information Center web site www.womenshealth.gov 49

Loving Your Heart and Understanding Stroke
or die. People can suff er from two primary 

types of stroke. One type, the ischemic 

stroke, is caused by clots that block the fl ow 

of blood to the brain. Th e other type, the 

hemorrhagic stroke, is caused by bleeding in 

or around the brain.

People can also suff er from a “mini-stroke,” 

or a transient ischemic attack (TIA). It is 

considered to be a stroke, and it is serious. 

For a short time, the brain doesn’t get the 

blood it needs. Th e symptoms of a TIA are 

the same as a full stroke, but typically they 

don’t last as long. However, it is an important sign that a major stroke could occur. 

Many people don’t even know when they are 

having a stroke. It is important for bystanders to learn to recognize the symptoms of a 

stroke. When you see someone showing the 

signs of a stroke, it’s a medical emergency. 

Seek immediate medical treatment. You 

could save a life and reduce that person’s 

risk of having a long-term disability.

Know the Signs of a Stroke

Th e signs of a stroke happen suddenly. Th e 

signs of a stroke are diff erent from the signs 

of a heart attack. You should look for 

✦ weakness or numbness on one side of 

your body

✦ dizziness

✦ loss of balance

✦ confusion

✦ trouble talking or understanding speech

✦ headache

✦ nausea

✦ trouble walking or seeing. 

Many of the same health conditions and 

lifestyle habits that can increase your risk of 

heart disease are the same as the ones that 

can increase your risk of a stroke.

Steps to a Healthy Heart 

✦ Don’t smoke. Smoking hurts your entire 

body, including your heart, lungs, blood, 

stomach, and cervix. If you smoke, try to 

quit. Try until you’re successful!

✦ Get your cholesterol tested. If it’s high 

(above 200), talk to your doctor or nurse 

about losing weight, if you’re overweight. 

Talk to them about how you can get more 

active. Ask if there’s medicine that can 

help. Look at the chart on page 28 to fi nd out 

when you should be tested.

Get help right away

If you have signs of a heart attack or stroke, 

call 911. Call right away—in 5 minutes or 

less.

50 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Loving Your Heart and Understanding Stroke
✦ Know your blood pressure. Your heart 

moves blood through your body. If it’s 

diffi cult for your heart to do this, your 

heart works harder. Th en your blood pressure will rise. Have it checked to make 

sure you’re on track! If it is high, talk to 

your doctor or nurse about how to lower 

it. Look at the chart on page 28 to fi nd out 

when you should be tested.

✦ Get tested for diabetes. Diabetes 

can raise your chances of getting heart 

disease. If you have diabetes, keep your 

blood glucose levels in check! Th is is the 

BEST way for you to take care of yourself 

and your heart. Look at the chart on page 

28 to fi nd out when you should be tested.

✦ Eat heart-healthy foods. Eat wholegrain foods, vegetables, and fruit. Choose 

lean meats and low-fat cheese and dairy 

products. Limit foods that have lots of 

saturated fat, like butter, whole milk, 

baked goods, ice cream, fatty meats, and 

cheese.

✦ Keep a healthy weight. Being overweight or obese raises your risk for heart 

disease and stroke.

✦ Eat less salt. Choose 

foods with less salt. 

Use spices, herbs, lemon, and lime instead of 

salt. Making this small 

change is really important if you have high 

blood pressure.

✦ If you drink alcohol, don’t have more 

than one drink per day. Too much 

alcohol raises blood pressure and can raise 

your risk for stroke and other problems.

✦ Get moving! Get at least 30 minutes of 

physical activity on most days, if not all 

days, of the week.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 51

Loving Your Heart and Understanding Stroke
✦ Take your medicine. If your doctor has 

prescribed medicine to lower your blood 

pressure or cholesterol, take it exactly as 

you have been told to. 

✦ Take steps to treat your sleep problems. If you snore loudly, have been told 

you stop breathing at times when you 

sleep, and are very sleepy during the day, 

you may have sleep apnea. If you don’t 

treat it, it raises your chances of having a 

heart attack or stroke. Talk with your doctor or nurse about treating this problem. 

✦ Find healthy ways to cope with stress.

Sometimes, people cope with stress by 

eating, drinking too much alcohol, or 

smoking. All these ways of coping can 

hurt your heart. Lower your stress: talk 

to friends, be physically active, meditate, 

and try not to take on more than you can 

handle.

Physical Activity Is for All Ages

When you hear “physical activity,” do you 

think of exercise? Exercise is just one type of 

physical activity. You can do many things to 

be active, at any age. But remember: check 

with your doctor or nurse fi rst before starting vigorous activities. Here are some ways 

to get moving:

✦ walking

✦ swimming

✦ biking

✦ water aerobics

✦ playing with children

✦ housework

✦ running

✦ gardening

✦ dancing

✦ hiking

✦ climbing steps

✦ carrying laundry or groceries

52 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Loving Your Heart and Understanding Stroke
✦ working in the yard

✦ washing the car

✦ yoga

✦ tai chi

✦ lifting weights or cans

✦ walking the dog

Balerma’s Story

So many of my female 

relatives had diabetes 

when I was growing 

up that I didn’t know 

how dangerous it is. 

My wake-up call came 

when my mother had 

a massive heart attack 

at a young age. I looked 

around and realized how many of my 

female relatives with diabetes died of 

heart problems. Diabetes is high among 

American Indians, but my sisters and I just 

weren’t taught about what could happen 

if we had it, or that it could be prevented.

I found out I had diabetes three years ago. 

This was only six months after my mother 

died from a second heart attack. A lot of 

Comanche women don’t talk about their 

health, but I’m trying to be open with my 

kids about diabetes. I teach them how 

to eat better and get more exercise. I 

tell them they’re doing these things for 

me, but more importantly for their own 

health and their own kids’ lives as well. I 

know that if I don’t change things in my 

life, I might not live to see my grandchildren. Every day, I talk myself into doing 

things for my health, like taking the 

stairs instead of the elevator and eating 

more fruits and vegetables. These things 

haven’t become habits for me yet, but I’m 

working on it.

From Stories from the Heart, The Heart Truth Campaign, National Heart, Lung, and Blood Institute.

Th e Red Dress Is a Red Alert

Th e Red Dress is the national symbol 

for women and heart disease awareness. 

Th e symbol was introduced by the National Heart, Lung, and Blood Institute 

as the centerpiece of Th e Heart Truth 

campaign. It serves as a red alert for 

women. Heart disease doesn’t care what 

you wear—it’s the #1 killer of women. 

Visit www.hearttruth.gov to learn more 

about Th e Heart Truth and get your Red 

Dress pin.

Th en and Now

We used to think of heart disease as 

a man’s problem. Now, we know it is 

the #1 killer of women. Stroke is also a 

major killer of women and can cause 

serious disabilities.

Balerma, 52

Visit the National Women’s Health Information Center web site www.womenshealth.gov 53

Loving Your Heart and Understanding Stroke
Knowing Your 

Breasts and 

Common Breast 

Conditions 

During a woman’s life, she has diff erent 

changes in her breasts. She might have 

more lumpiness during her period or may 

have breast problems, like mastitis, while 

breastfeeding. (Mastitis is explained later in 

this chapter.) Several breast conditions can 

aff ect women. Learning more about these 

breast conditions can help you fi nd problems early and have them treated right away.

Conditions in the Breast

General breast lumpiness (fi brocystic 

changes). Th is lumpiness happens around 

the nipple and areola and in the upper-outer 

part of the breast. Your breast may feel rubbery, fi rm, or hard to the touch. Changes 

or infection could cause your breasts to feel 

painful or full and lumpy. Some women can 

feel these lumps before and during their 

periods. Th e lumps usually go away by the 

end of their periods. During pregnancy, the 

milk-producing glands become swollen, and 

Lobe

(each mammary gland forms a lobe of the 

breast, which consists of a single major 

branch of alveoli and milk ducts that end 

at the nipple pore)

Milk duct

(tube through which milk travels)

Nipple

Areola

(the dark area around the nipple)

Alveoli cells

(grape-like clusters of tissue that 

secrete milk)

Anatomy of the Breast

54 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Knowing Your Breasts and Common Conditions
the breasts may feel lumpier than usual. 

Your breasts also can feel very painful or feel 

lumpy when you’re breastfeeding. You may 

feel lumpiness in your breasts more as you 

approach middle age, and the milk-producing tissue of your breasts turns into soft, 

fatty tissue. Unless you are taking hormone 

therapy, this type of lumpiness generally 

goes away after menopause. 

Cyst or “fl uid-fi lled lump.” A cyst is a 

sac or capsule in your breast that is fi lled 

with fl uid. It can get larger right before your 

period. If it gets large enough, it feels like a 

lump, moves around when you touch it, and 

may be painful. Cysts may go away on their 

own, or your doctor can drain the fl uid. Th ey 

are usually not cancer. 

Fibroadenoma. Th ese breast tumors are 

not cancerous. Th ey are round masses that 

can be small or large. You may feel them as 

a moveable, painless, fi rm, or rubbery lump. 

Th ey may get bigger during pregnancy and 

smaller after menopause. Sometimes, they 

stop growing or shrink on their own. Th ey 

can also be removed by surgery. 

Intraductal papilloma. Th ese growths 

usually occur in the milk ducts near the 

nipple. Th e growths cause bleeding from the 

nipple. Th ey may also cause pain and breast 

enlargement. Sometimes, you can feel the 

lump. It is treated by taking out the growth 

and the part of the duct where it has grown.

Mastitis. Th is breast infection causes soreness or a lump in the breast. It can happen 

when you are breastfeeding or if you get a 

crack in the skin around the nipple. It causes 

a fever and fl u-like symptoms, such as feeling run down or very achy. Some women 

also have nausea and vomiting. It can cause 

yellowish discharge from the nipple. Your 

breasts may feel warm or hot to the touch. 

You also can have redness and swelling on 

the skin of your breast over the area that is 

infected. It usually occurs only in one breast. 

Mastitis is treated with self-care (such as 

applying warm compresses, getting plenty of 

rest and fl uids) and antibiotics.

Duct ectasia. Th is condition happens to 

women nearing menopause. Th e ducts under 

the nipple become infl amed and clogged. 

Symptoms are a thick, green or black, sticky 

Ask your doctor or nurse 

to explain any changes in 

your breasts.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 55

Knowing Your Breasts and Common Conditions
discharge; pain; or a hard lump. Th is problem can go away on its own, or you may be 

treated with warm compresses, antibiotics, 

or surgery.

Abscess. Severe infections in the breast, like 

mastitis, can lead to an abscess. An abscess 

is a build-up of pus. Th e breast may be tender and swollen in that area. Th e abscess can 

be drained and treated with antibiotics.

Fat necrosis. When the breast is hurt from 

an injury, scar tissue can form and cause a 

lump. Th e lump may or may not be painful, 

depending on how long ago you were injured. Th e skin may be red, bruised, or look 

dimpled. Th e lump may go away on its own 

or may be removed by surgery. 

Breast Cancer

Many women are aff ected by breast cancer 

at some point in their lives, whether you’ve 

had it or had a family member or friend 

who’s battled it. Other than skin cancer, 

breast cancer is the most common cancer in 

American women. It is also the disease that 

many women fear the most. But we need 

to remember that if breast cancer is found 

early, it can often be treated successfully. 

Many women have overcome breast cancer 

and are living their lives cancer free! 

Early breast cancer is usually not painful. 

However, when the cancer grows, it can 

cause changes in your breasts. Look for 

them: 

✦ a hard lump, thickening, or hard knot in 

or near the breast or in your underarm 

✦ a change in the size or shape of the breast

✦ nipple discharge, clear or especially if 

bloody or blood-tinged that leaks out on 

its own without the nipple being squeezed 

✦ dimpling or puckering of the skin on the 

breast

✦ itchy, scaly sore or rash on the nipple

Lump Skin dimpling

Change in skin color 

or texture

Change in how the 

nipple looks, like 

pulling in of the 

nipple

Clear or bloody fl uid that 

leaks out of the nipple

Signs of Breast Cancer

56 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Knowing Your Breasts and Common Conditions
✦ ridges or pitting of the breast (when your 

skin looks like the peel of an orange) 

✦ unusual swelling, warmth, or redness that 

doesn’t go away

Diff erent Ways to Find Breast 

Changes

✦ Get a mammogram. It is the best way 

to fi nd out if you have breast cancer. A 

mammogram is an x-ray of the breast. It 

can fi nd breast cancer that is too small 

for you or your doctor to feel. All women 

starting at age 40 should get a mammogram every one to two years. Discuss how often you need a mammogram 

with your doctor. If your mother or sister 

had breast cancer, be especially proactive 

about getting a mammogram. 

✦ Have the mammogram done right 

after your period because it might 

be less painful. It will also be more accurate at that time than when you have 

your period. If you change mammography 

facilities or need a second opinion, be sure 

to get your original mammograms—not 

copies. Your doctor will need to compare 

past mammograms with current ones to 

see if there are any changes.

• Get a clinical breast exam. Th is breast 

exam is done by your doctor or nurse. He 

or she will check your breasts and underarms for any lumps, nipple discharge, or 

other changes. Th e breast exam should be 

part of a routine checkup. 

 A breast self-exam and a clinical breast 

exam are not substitutes for mammograms.

✦ Get to know your breasts. Some women check their own breasts for changes. 

If you fi nd a change, it’s important to call 

your doctor or nurse for an appointment 

to see him or her. Make sure to watch the 

change you have found until you see your 

doctor or nurse.

Treatment Options

Diff erent types of treatment are available for 

patients who have breast cancer. New types 

of treatments are also being tested in clinical trials, which are research studies. Some 

treatments may not be appropriate for all 

patients, however. Talk to your doctor about 

what may work best for you. Visit the web 

site of the National Women’s Health Information Center at www.womenshealth.gov to 

fi nd information on breast cancer and links 

to reliable resources, or call us at 1-800-994-

9662 or TDD 1-888-220-5440.

Th en and Now

Detecting breast cancer has come a long 

way. Mammography was invented in 

1969. Since then, this technology has 

advanced. Mammography is now the best 

way to detect breast cancer. 

Visit the National Women’s Health Information Center web site www.womenshealth.gov 57

Knowing Your Breasts and Common Conditions
Maintaining 

a Healthy 

Digestive 

System

Heartburn, gas, bloating, diarrhea, and constipation. We don’t like to tell others we’re having these problems! We tend to 

suff er in silence, hoping that our discomfort 

will end soon. Although these symptoms 

could be caused by a stomach “bug,” or 

something we ate, they also could be signs of 

serious health problems. Some problems in 

our digestive system have no known cause, 

but they can usually be treated.

Stomach (STUH-muk) 

The organ where digestion of 

protein begins.

Anus (AY-nus) 

The opening at the end of the 

digestive tract where bowel 

movements leave the body.

Appendix (uh-PEN-diks) 

A pouch attached to the first 

part of the large intestine. No 

one knows its function. 

Esophagus (eh-SAW-fuh-gus) 

Carries food from the mouth to 

the stomach.

Gallbladder (GAWL-blah-dur) 

Stores the bile made in the 

liver, then empties it to help 

digest fats. 

Large intestine (LARJ in-TES-tin) 

Also called the colon. It absorbs 

water and sodium from stool.

Liver (LIH-vur) 

The largest organ inside the 

body. Makes bile (fluid that 

helps break down fats and gets 

rid of wastes in the body); 

changes food into energy; and 

cleans alcohol, some medicines, 

and poisons from the blood. 

Pancreas (PAN-kree-ahs) 

A gland that makes enzymes for 

digestion and the hormone insulin 

(which helps the body turn food 

into energy). 

Rectum (REK-tum) 

The lower end of the large intestine, 

leading to the anus.

Small intestine

The organ where most digestion 

occurs.

Your Digestive System

58 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Maintaining a Healthy Digestive System
Common Digestive Diseases 

and Syndromes

Infl ammatory [in-FLAM-uh-toh-ree] 

bowel disease (IBD). IBD is a long-term 

disease that causes a swollen small intestine and colon. When these tissues become 

infl amed or swollen, sores (ulcers) form and 

bleed. No one knows for sure what causes 

IBD, but researchers suspect it may be a 

bacterium (germ) or virus. A genetic component may also play a role. It most often 

occurs in young people before age 40. 

Common symptoms of IBD are 

✦ diarrhea that can be bloody

✦ bleeding from your rectum

✦ mucus (a clear liquid) in your stool

✦ nausea (the feeling of wanting to throw 

up) and vomiting (throwing up) 

✦ fever

✦ weight loss without a certain reason

✦ pain and tenderness in the lower right 

side of your abdomen 

✦ slowed growth and delayed sexual development (in children)

Two of the Most Common Forms of IBD 

✦ Ulcerative [UL-sur-ay-tuv] colitis [koh-LYtis]. It causes infl ammation and ulcers in 

the lining of the large intestine (colon) or 

rectum. 

✦ Crohn’s [krohnz] disease. It causes irritation deeper within the intestinal wall. It 

usually occurs in the small intestine. It 

can also occur in the mouth, esophagus, 

stomach, duodenum, large intestine, appendix, and anus.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 59

Maintaining a Healthy Digestive System
Irritable bowel syndrome (IBS). IBS 

is not a disease. It describes discomfort 

and other symptoms in the digestive tract, 

mainly aff ecting the colon (large intestine). 

It is a problem in which the colon does not 

work as it should. IBS does not hurt the intestines and does not lead to colon cancer. It 

is not related to Crohn’s disease or ulcerative 

colitis. IBS doesn’t cause damage to the digestive tract. Th e cause of IBS is not known, 

and as yet there is no cure.

Common symptoms of IBS are

✦ gas

✦ bloating (feeling of fullness in your 

abdomen)

✦ burping

✦ abdominal (stomach) pain

✦ diarrhea (frequent loose stools)

✦ constipation (infrequent stools that may 

be hard, dry, and painful to pass)

✦ alternating constipation and diarrhea

✦ feeling like you don’t have complete bowel 

movements

✦ feeling a crampy urge to move the bowels 

but cannot do so 

✦ mucus (a clear liquid) in the stool

Gastroesophageal [gastro-eh-saw-fuhJEE-ul ] refl ux disease (GERD). Th is 

disease occurs when the muscle between 

the esophagus (food pipe) and the stomach relaxes. Th is muscle acts like a door to 

the stomach. Th e door opens for food from 

the esophagus. Th e door should close after 

the food goes into the stomach. When the 

“door” muscle doesn’t work correctly, stomach contents splash back into the esophagus. Th is action is called refl ux. 

Heartburn, which feels like a burning deep 

in the throat or near the mouth, is the most 

common symptom of GERD. Mild heartburn 

can often be controlled through diet by not 

eating certain types of foods or not drinking 

alcohol. It can often be controlled by eating 

smaller and more frequent meals throughout the day. 

Common symptoms of GERD are

✦ heartburn

✦ needing to clear your throat a lot more 

than usual

60 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Maintaining a Healthy Digestive System
✦ problems swallowing

✦ feeling that food is stuck in your throat

✦ a burning feeling in your mouth

✦ pain in the chest

Long-term heartburn can wear away the 

lining of the esophagus. If you have this 

condition, get examined by your doctor or 

nurse. Anyone who has heartburn twice a 

week or more may have GERD. But you can 

have GERD without having heartburn. Having GERD increases your risk of esophageal 

cancer.

In infants and children, GERD may cause 

repeated vomiting, coughing, and other 

respiratory problems. Most babies grow 

out of GERD by their fi rst birthday. Still, 

you should talk to your child’s doctor if his 

or her symptoms occur regularly and cause 

discomfort.

Symptoms That May Be Signs of More 

Serious Health Problems

Call your doctor right away if you 

have any of these symptoms.

• Sharp and sudden stomach pain 

• Stomach pain that doesn’t go away

• Bloody stools (that can be either bright 

red or very black)

• Bleeding from your rectum or pain in 

your rectum

• Bloody vomit that looks like coff ee 

grounds

• Unexplained weight loss

• Constant and extreme fatigue

• A change in your normal bowel movements that lasts longer than 10 to 14 

days or that does not get back to normal 

with over-the-counter medicines

Visit the National Women’s Health Information Center web site www.womenshealth.gov 61

Maintaining a Healthy Digestive System
Tests and Treatments

Step 1

A physical exam is the fi rst step in fi nding out 

if you have a digestive disease. Your doctor 

will ask you about your symptoms: when they 

started, when and how often they occur, how 

long they last. You will also be asked about 

your bowel habits, diet, and medications you 

might be taking. Th e history and tests may 

rule out other health problems to make sure 

they aren’t the cause of your symptoms. 

Step 2

In many cases, your doctor will treat your 

symptoms and then ask you to make lifestyle 

changes. 

What changes might I be asked to make? ✦ Change your diet. You may be asked to not 

eat certain types of foods or to not drink 

alcohol. You may be advised to eat smaller, 

more frequent meals throughout the day.

✦ Quit smoking. ✦ Reduce stress. ✦ Get regular physical activity.

Step 3

If your symptoms do not improve, you may 

need one or more tests, depending on your 

symptoms. Once your doctor fi gures out 

what your health problem is, treatment can 

begin. Medicines are usually the fi rst treatments. Your doctor might suggest surgery if 

you have a more severe problem that is not 

helped by medicines.

62 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Maintaining a Healthy Digestive System
Disease/

Syndrome Tests Treatment

Infl ammatory 

Bowel Disease 

(IBD)

• Blood and stool samples: Look for blood or 

infection.

• Barium [BAIR-ee-um] enema [EN-uh-muh] 

x-ray: Looks for problems in the colon. A 

doctor puts barium into your colon though 

the anus. Th en x-rays are taken. 

• Colonoscopy [koh-luh-NAW-skuh-pee] or 

sigmoidoscopy [SIG-moy-DAW-skuh-pee]: 

Looks for problems in the lining of the 

colon. A thin, fl exible tube is put into the 

colon through the anus. 

• Upper gastrointestinal [GAH-stroh-in-TEStuh-nul] (GI) series: Looks for problems in 

the small intestine. You drink a liquid, and 

then x-rays are taken.

• Medicines to control infl ammation 

and relieve symptoms

• Surgery to remove 

the colon or diseased parts of the 

intestines

Irritable Bowel 

Syndrome (IBS)

• Blood and stool samples: Look for blood or 

infection.

• Barium enema x-ray: Looks for problems in 

the colon. A doctor puts barium into your 

colon through the anus. Th en x-rays are 

taken.

• Colonoscopy or sigmoidoscopy: Looks for 

problems in the lining of the colon. A thin, 

fl exible tube is put into the colon through 

the anus. 

Th ese tests are performed to help rule out 

diseases that have symptoms similar to IBS.

• Medicines to relieve symptoms

Visit the National Women’s Health Information Center web site www.womenshealth.gov 63

Maintaining a Healthy Digestive System
Steps You Can Take for a 

Healthy Digestive System

In addition to working with your doctor and 

taking medicines to control your symptoms, 

here are other steps you can take.

✦ Try to limit the foods you eat that cause 

your symptoms to fl are up. Before you 

change your diet, however, keep a journal 

noting the foods that seem to cause you 

distress. Th en discuss your fi ndings with 

your doctor. You may also want to consult 

a registered dietitian (RD), who can help 

you make changes to your diet. For example, if dairy products cause your symptoms to fl are up, try eating less of those 

foods. Dairy products are an important 

source of calcium and other nutrients, 

though. If you need to avoid them, be sure 

to get enough calcium and nutrients in 

other foods.

✦ Eat smaller, more frequent meals. Large 

meals can cause cramping and diarrhea in 

people with irritable bowel syndrome.

✦ Eat a diet low in saturated fat.

✦ Eat a diet high in fi ber. In many cases, 

fi ber helps lessen constipation. But fi ber 

may not help diarrhea or pain. Wholegrain breads and cereals, fruit, and vegetables are good sources of fi ber. High-fi ber 

diets may cause gas and bloating at fi rst, 

but these symptoms often go away within 

a few weeks as your body adjusts.

✦ Try to drink six to eight glasses of plain 

water each day, especially if you have diarrhea. Carbonated drinks, such as sodas, 

may cause gas and stomach discomfort. 

Chewing gum and eating too quickly can 

lead to swallowing air, which again leads 

to gas.

Disease/

Syndrome Tests Treatment

Gastroesophageal 

Refl ux Disease 

(GERD)

• Barium swallow radiograph: Looks for 

problems with how the esophagus is working. You drink a liquid, and then x-rays are 

taken.

• Upper endoscopy: Looks for problems 

and infl ammation of the esophagus. Your 

throat is numbed. A thin tube that has a 

tiny camera is then put down your throat. 

• pH-monitoring exam: Looks at what goes 

on when stomach acid comes up into your 

esophagus. A tiny tube is placed into the 

esophagus for 24 hours. 

• Medicines to control your body from 

making too much 

acid and to relieve 

symptoms

• Medicines to make 

the stomach empty 

faster

• In severe cases, surgery to strengthen 

and repair stomach 

muscles

64 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Maintaining a Healthy Digestive System
✦ Ask your doctor if you should take vitamins or supplements.

✦ Try to stay at a healthy weight. Talk with 

your doctor about what a healthy weight 

is for you.

✦ If you drink alcohol, do not have more 

than one drink per day, or stop drinking 

altogether.

✦ If you smoke, quit.

✦ Get regular physical activity. At least 30 

minutes on most days of the week can 

greatly improve your health!

✦ Control your stress. Many people think 

stress alone can cause digestive problems, 

but that’s not true. But sometimes stress 

and emotions can trigger some symptoms 

and also make them feel worse. See the 

Coping with Stress chapter, starting on page 

120, for more information.

✦ Get regular screening tests for colorectal cancer, which is cancer in either the 

colon or rectum. Colorectal cancer is easy 

to treat and often curable when found 

early. Th e best tool against this disease 

is screening. Many women fear that the 

screening tests are embarrassing or painful. But they’re not as bad as you might 

think. See the Common Screening Tests and 

Diagnostic Tests Explained on pages 24–25.

✦ If you have GERD, avoid lying down for 

three hours after a meal. You might also 

try raising the head of your bed six to 

eight inches by putting blocks of wood 

under the bedposts. Just using extra pillows will not help.

Th en and Now

In 2000, the U.S. Food and Drug Administration (FDA) approved two new 

treatments for chronic (long-term) heartburn. One treatment puts stitches in the 

muscle between the esophagus and the 

stomach to help strengthen the muscle, 

so it does not allow the contents of your 

stomach to go back up into the esophagus. Th e other treatment creates tiny cuts 

on that muscle. When the cuts heal, the 

scar tissue helps toughen the muscle. Th e 

long-term eff ects of these two new treatments are unknown, but they give hope 

to people who have severe problems with 

heartburn.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 65

Maintaining a Healthy Digestive System
Having a Healthy 

Pregnancy

Pregnancy can be a thrilling and special part of your life. But it can also be a 

little scary. If this is your fi rst baby, you 

might have questions about what to do and 

what not to do. What do I need to eat? Will 

I be tired all the time? Will I have stretch 

marks? Th ese questions are normal. But try 

to enjoy this journey one step at a time! You 

can do simple things to keep both you and 

your baby happy and healthy. 

One half of all pregnancies 

are not planned!

It’s important for you to be as healthy as 

you can be, all the time. Many women don’t 

know they are pregnant during the fi rst few 

weeks of their pregnancy. Take action now 

to manage any of your current health problems. Then you can help reduce any health 

risks to you and your baby.

by other types of doctors, including for 

mental health issues.

✦ Ask your doctor about the new national 

preconception guidelines. You and your 

doctor can talk about how you can get, or 

stay healthy, before you get pregnant or 

early in your pregnancy. By understanding how your health and behavior before 

pregnancy can aff ect you and your baby’s 

health DURING and AFTER pregnancy, 

you can help prevent future problems for 

you and your baby. You and your doctor 

should talk about healthy behaviors such 

as appropriate weight, nutrition, exercise, 

oral health, and avoiding alcohol, tobacco, 

and other toxic substances. Your doctor could also help you and your partner 

understand genetic risks, mental health 

issues (such as depression), and intimate 

partner domestic violence.

✦ Ask your partner to stay healthy too! Ask 

your partner to limit how much alcohol 

he consumes. If your partner uses illegal 

drugs or smokes, encourage him to quit. 

Studies show that men who drink a lot, 

Before Pregnancy

If you are thinking about getting pregnant, 

or you are able to get pregnant, you have 

many ways to take care of your health. 

✦ Are you planning a baby? Th en plan a 

visit with your doctor! At this visit, you 

can discuss any health concerns you have. 

Ask for advice on all the steps listed here! 

Tell your doctor if you are being treated 

66 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Having a Healthy Pregnancy
Why Is Taking Folic 

Acid So Important?

Before 1991 we didn’t know that taking folic 

acid before getting pregnant and in the fi rst 

three months of pregnancy helps prevent 

certain kinds of birth defects. Now we know 

that getting 400 micrograms (or 0.4 mg) of 

folic acid daily in a vitamin or in a folic acid 

pill is best for ALL women who might get 

pregnant. And it helps to eat a healthy diet 

that has lots of fruit and vegetables and 

foods that have folic acid added to them.

smoke, or use drugs can have problems 

with their sperm. Th eir health issues 

might cause you to have problems getting 

pregnant.

✦ Get 400 micrograms (or 0.4 

mg) of folic acid daily from 

foods fortifi ed with folic 

acid or by taking a vitamin 

or folic acid pill. Do this BEFORE you get pregnant and 

for at least the fi rst three 

months of pregnancy. Folic 

acid (or folate) can help keep your baby 

from having birth defects. If you don’t get 

enough folic acid, your baby’s spine may 

not form right. Th is condition is called 

spina bifi da [spy-nuh bif-uh-duh]. If you 

don’t get enough folic acid, your baby’s 

brain may not form or may only partly 

form. Th is condition is called anencephaly 

[an-en-seff elee]. 

✦ Many doctors will prescribe a vitamin for 

you that has folic acid. But you also can 

buy vitamins or folic acid pills at the drug 

store or grocery store. Taking folic acid in 

a pill is the best way to know you are getting enough. You could get your folic acid 

though food alone, but it is hard to know 

if you’re getting enough. A healthy diet is 

important for you and your baby. Some 

foods with folate are leafy green vegetables, kidney beans, orange juice and other 

citrus fruit, peanuts, broccoli, asparagus, 

peas, lentils, and whole-grain products. 

Folic acid is also added to some foods like 

enriched breads, pastas, rice, and cereals.

✦ Start watching what you eat. Eat fruit, 

vegetables, and whole grains, like wholewheat breads or crackers. Eat plenty of 

calcium-rich foods, such as non-fat milk 

or yogurt, low-fat milk or yogurt, and 

broccoli, that you and your baby need for 

strong bones and teeth. If you live in areas 

where fruit and vegetables aren’t in season, frozen vegetables are a good option. 

Avoid eating a lot of fatty foods, such as 

Visit the National Women’s Health Information Center web site www.womenshealth.gov 67

Having a Healthy Pregnancy
butter and fatty meats, and salt. Choose 

leaner foods, such as chicken and turkey 

without the skin and fi sh.

✦ Tell your doctor if you smoke or use alcohol or drugs. Quitting is hard, but you can 

do it. Ask your doctor for help. It’s one of 

the best things you can do for your baby.

✦ Get enough sleep. Try to get seven to nine 

hours every night.

✦ If you can, control the stress in your life. 

When it comes to work and family, fi gure 

out what you can really do. Set limits with 

yourself and others. Don’t be afraid to say 

NO to requests for your time and energy.

✦ Move your body. It is best to start exercise 

programs before pregnancy. Start now. 

With your doctor’s guidance, continue an 

exercise program when you are pregnant.

✦ Get any health problems under control. 

Talk to your doctor about how your health 

problems might aff ect you and your baby. 

If you have diabetes, monitor your blood 

glucose levels. If you have high blood pressure, monitor your blood pressure. If you 

are overweight, talk to your doctor about 

what a healthy weight is for you. You and 

your doctor can work together to help you 

have a safe pregnancy and a healthy baby.

✦ Ask your mother, aunts, grandmother, 

and sisters about their pregnancies. Did 

they have morning sickness? Problems 

with labor? How did they cope with them?

✦ Find out what health problems run in 

your family. Tell your doctor about these 

issues. You can get tested before getting 

pregnant for some health problems that 

run in families, which is called genetic 

testing. 

✦ Make sure you have had all of your 

immunizations (shots), especially for 

rubella (German measles). If you haven’t 

had chickenpox or rubella, get the shots 

at least three months before getting 

pregnant. 

✦ Get checked for 

 • hepatitis [hep-uh-tie-tus] B

 • hepatitis C

 • sexually transmitted diseases (STDs)

 • HIV

 Th ese diseases can harm both you and 

your baby. Tell your doctor if you or your 

sex partners have ever had an STD or HIV.

✦ Talk with your doctor about all of the 

medicines you take, whether they are 

prescription medicines, over-the-counter 

medicines you buy without prescriptions, 

and herbal supplements. Ask your doctor 

if they are safe to take while you are trying to get pregnant or are pregnant. 

68 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Having a Healthy Pregnancy
During Pregnancy

If you know you are pregnant, or think you 

might be, call your doctor and set up a visit. 

You will need to visit your doctor many 

times during your pregnancy. Follow your 

doctor’s schedule for visits and don’t miss 

them! 

You will notice your body is changing in 

many ways. Th ese changes may be strange at 

fi rst, but they are all normal. Try to stay as 

healthy as you can—for you and your new 

baby! You can take these actions:

✦ Learn about the benefi ts of breastfeeding 

your baby. Read the box on breastfeeding on page 73 of this chapter, so you can 

learn more about how it helps you and 

your baby. 

✦ Stop smoking, drinking alcohol, and 

doing drugs! Th ese behaviors can cause 

long-term damage to your baby. Ask your 

doctor for help. You also can talk with 

someone you trust, such as a member of 

your faith community, a counselor, or a 

friend.

✦ Keep eating a healthy diet. Eat lots of 

fruit, vegetables, whole grains, and 

calcium-rich foods. You need 1000 milligrams (mg) of calcium per day. If you 

are 18 or younger, you need 1300 mg of 

calcium each day. Your body is giving a 

Stages of Pregnancy

Pregnancy lasts about 40 weeks, counting from the fi rst day of your last menstrual period. The 

weeks are grouped into three “trimesters.” Your doctor will refer to your pregnancy by the age 

of your baby in weeks.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 69

Having a Healthy Pregnancy

First trimester Second trimester Th ird trimester

Week 1 to Week 12 Week 13 to Week 26 Week 27 to end of pregnancy
lot of its calcium to your baby’s growing 

bones. Drinking at least eight glasses of 

water a day can help keep you and your 

baby healthy. Avoid eating a lot of fatty 

foods such as butter, fatty meats, mayonnaise, and high-fat snack foods. Choose 

foods lower in fat such as fat-free milk or 

yogurt, low-fat milk or yogurt, chicken 

and turkey without the skin, and fi sh.

✦ Don’t eat uncooked or undercooked meats 

or fi sh. Th ey can make you sick.

✦ Limit caff eine from coff ee, tea, sodas, 

medicines, and chocolates.

✦ Take at least 400 micrograms of folic acid 

daily to help prevent certain types of birth 

defects. Your doctor may prescribe a daily 

vitamin that has folic acid. You can also 

buy folic acid pills at the drug store or grocery store. Keep eating foods high in folic 

acid like orange juice, other citrus fruit 

and juices, leafy green vegetables, beans, 

peanuts, peas, and whole-grain products.

Limit your fi sh! 

Follow these guidelines.

Some fi sh have mercury, which, in high 

doses, can hurt your baby’s growing brain 

and nervous system. There are some fi sh 

you should avoid eating if you are pregnant. 

• Try not to eat shark, swordfi sh, king 

mackerel, and tilefi sh (also called golden 

or white snapper). These fi sh have high 

levels of mercury. 

• Many of us enjoy tuna. But, to be safe, 

don’t eat more than six ounces of “white” 

or “albacore” tuna or tuna steak each 

week.

• If you can, buy “light” tuna. But don’t eat 

more than 12 ounces of light tuna or 

other cooked fi sh each week. 

• Other fi sh that are low in mercury 

are shrimp, salmon, pollock, and 

catfi sh.

Foods with Calcium

Read the food labels to learn more.

Food Portion Calcium (milligrams)

Plain, nonfat yogurt 1 cup 450

Grilled cheese sandwich 1 sandwich 371

American cheese 2 ounces 348

Ricotta cheese, part skim 1⁄2 cup 337

Fruit yogurt 1 cup 315

70 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Having a Healthy Pregnancy
✦ Talk to your doctor about all the medicines you take, whether they are prescription medicines, over-the-counter products, and herbal supplements. Ask if they 

are safe to take while you are pregnant. 

Most of the time, the medicine a pregnant 

woman is taking does not aff ect her baby. 

But sometimes it can, causing damage or 

birth defects. Talk with your doctor about 

which drugs are safe.

✦ Stay active. Being physically active during pregnancy helps you in many ways. 

It prevents a lot of extra weight gain. It 

helps you have good posture, which will 

help you feel better later in your pregnancy. It can help you sleep better and have 

a shorter, easier labor. If you were physically active before getting pregnant, you 

should stay active. Continue your low-impact aerobic dance, swimming, or walking. 

✦ If you were not physically active before 

getting pregnant, you still can become 

active. Start slowly. Try walking at fi rst, 

then build up to more. Talk to your doctor 

about which activities are good for you. 

✦ Avoid toxic chemicals such as paint, paint 

thinners, cleaning products, products 

used to kill bugs, or products that contain 

lead or mercury. Read the product label to 

see if it has a pregnancy warning.

✦ Avoid hot tubs, saunas, and x-rays.

✦ Avoid changing cat litter. It can cause an 

infection that can cause birth defects. 

Wear gloves when gardening in areas that 

cats may have visited.

✦ Get enough sleep. Try to get seven to nine 

hours every night.

✦ If you can, control the stress in your life. 

Remember, this is YOUR time. Don’t be 

afraid to say NO to requests for your time 

and energy.

✦ Learn all you can about pregnancy, childbirth, breastfeeding, and the early years 

of childhood. Read books, watch videos, 

go to a childbirth class, and talk with 

other moms. 

You have choices! 

Diff erent types of professionals can 

help you have your baby.

• OB or OB/GYN (obstetrician/gynecologist): A medical doctor who is an expert 

in prenatal care, labor, and in delivering 

babies. 

• Certifi ed nurse-midwife (CNM): An expert in prenatal care, labor, and delivery. 

CNMs can deliver your baby. 

• Doula: An expert support person who 

helps give you physical support during 

labor and birth. A doula off ers advice on 

how to breathe, relax, move, and position 

yourself. She also gives emotional support and comfort. Doulas and midwives 

often work together during a woman’s 

labor. 

Visit the National Women’s Health Information Center web site www.womenshealth.gov 71

Having a Healthy Pregnancy
After Your Baby Is Born

After your baby is born, you really need to 

keep doing all you can to stay strong and 

healthy. It takes a lot of energy to care for 

your precious new child!

✦ Be patient with yourself! You’re going to 

do a great job!

✦ Rest as much as you can. One way is to 

sleep when your baby sleeps. Spend time 

getting to know your baby. Let others help 

you with chores. Don’t be afraid to ask for 

help.

✦ Try drinking eight glasses of water a day 

to help you recover from labor and to relieve constipation (when it’s hard to make 

a bowel movement).

✦ Keep eating plenty of calcium-rich foods, 

such as fat-free milk or yogurt, low-fat 

milk and yogurt, low-fat cheese, and broccoli. You still need 1000 mg of calcium per 

day for strong, healthy bones.

Th en and Now

Preconception care takes place before conception or before a woman even knows she’s 

pregnant. It could improve the health of both mother and baby. Talk with your doctor 

about the new preconception guidelines. You can fi nd information about them on the 

Internet at www.cdc.gov/ncbddd/preconception/QandA.htm and www.cdc.gov/mmwr/

preview/mmwrhtml/rr5506a1.htm .

Call Your Doctor NOW If You Have Any 

of These Symptoms

• Very heavy vaginal bleeding (more than 

a heavy period)

• A fever of 101° or higher

• Severe pain in your lower stomach

• Severe headaches or problems seeing 

that do not go away

• Frequent or burning urination

• Very sad or empty feelings or strange or 

unusual thoughts that do not go away

72 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Having a Healthy Pregnancy
✦ Keep taking your daily vitamin. Th ese 

extra vitamins can keep your body strong. 

Breastfeeding moms need 500 micrograms of folic acid daily.

✦ Get support. Talk to family members, 

other new moms, and friends about what 

you are going through. Share stories 

about your baby. 

✦ Talk with your doctor about what kinds of 

activities you can do after giving birth.

✦ Ask your doctor about birth control. You 

can get pregnant at this time, even if you 

haven’t had a period since giving birth, 

and even if you are breastfeeding.

✦ See your doctor four to six weeks after the 

birth. 

Breast Milk Is One of the Best Gifts Only You Can Give Your Baby!

Why breastfeed? 

• Breast milk is free, clean and saves you time.

• If you breastfeed for at least six months, 

your baby won’t be sick as often.

• Breast milk has the perfect amount of fat, 

sugar, water, and protein to help your baby 

grow just right.

• Most babies fi nd breast milk easier to digest 

than formula.

What do I need to know? 

• Give your baby breast milk only—no 

formula—for the fi rst six months of life. It is 

even better for your baby to breastfeed for 

12 months or longer. You can also give solid 

foods when your baby is six months old, 

while you keep breastfeeding. 

• Be patient with yourself! What works for 

one mom might not work for you. Relax 

and try to fi nd a routine and positions 

that work for you and your baby. It will get 

easier with time. 

• If you are having a hard time, don’t give 

up! The National Women’s Health Information Center off ers a National Breastfeeding 

Helpline. Our specially trained breastfeeding peer counselors can help with your basic breastfeeding questions and concerns. 

Call us toll-free at 1-800-994-9662 or TDD at 

1-888-220-5446. Or visit us online at www.

womenshealth.gov/breastfeeding.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 73

Having a Healthy Pregnancy
Protecting Your 

Reproductive 

System 

Did you know that your reproductive system is one of the most fragile systems 

of your body? It can easily get infected or 

injured. If it does, you might have long-term 

health problems. Taking simple steps to 

prevent getting or spreading HIV/AIDS and 

other sexually transmitted diseases (STDs) 

will help protect you and your loved ones. 

An STD is an infection or disease that you 

get by having vaginal, anal, or oral sex with 

someone who already has an STD. STD defi -

nitions and symptoms start on page 81.

Some STDs can be “silent,” which means you 

do not show any signs of infection, illness, 

or disease. Others can have mild to severe 

symptoms. Get regular checkups for STDs, 

even if you do not have any symptoms.

Protecting your reproductive system also 

means having control over if and when you 

become pregnant. But choosing which type 

of birth control to use is not easy. Learn 

what types of birth control are available. 

Talk with your doctor or nurse to help you 

choose among the options.

Learn More About Birth Control

Only one method of birth control prevents 

pregnancy all the time. Abstinence. Abstinence means not having vaginal, anal, or 

oral sex at any time. NO other method of 

birth control prevents pregnancy all the 

time. But other methods are very eff ective 

at preventing pregnancy.

When choosing your birth control method, 

consider

✦ your overall health

✦ how often you have sex

✦ the number of sexual partners you have

✦ if you want to have children

✦ how well it prevents pregnancy

✦ potential side eff ects

✦ your comfort level with using the method

Learning how to use some forms of birth 

control can take time and practice.

Know that many forms of birth control do 

NOT protect you from getting infected with 

HIV or other STDS, such as gonorrhea, the 

human papillomavirus (HPV), herpes, and 

chlamydia. Th e best way to protect yourself 

is to be totally abstinent, 100 percent of the 

time. But using a latex male condom or a female condom correctly every time you have 

sex helps lower your chances of getting HIV 

or other STDs. Th ey do not eliminate ALL 

risk, however.

Types of Birth Control 

No single method of birth control is the 

“best” one. Each has its own advantages and 

disadvantages. (See pages 75–78 to read about 

these options.) 

74 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Protecting Your Reproductive System
Barrier methods (act as a physical 

block between you and your sexual 

partner)

✦ Male condom. Worn by 

the man, a male condom 

keeps sperm from getting 

into a woman’s body. 

Latex condoms help prevent pregnancy and HIV and other STDs. 

“Natural” or “lambskin” condoms also 

help prevent pregnancy, but they do not 

protect against STDs, including HIV. Male 

condoms are 85 to 98 percent eff ective at 

preventing pregnancy. Condoms can only 

be used once. You can buy condoms, KY 

jelly, or water-based lubricants at a drug 

store. Do not use oil-based lubricants such 

as massage oils, baby oil, lotions, or petroleum jelly. Th ey will weaken the condom, 

causing it to tear or break. 

✦ Female condom. Worn by 

the woman, this method 

keeps sperm from getting 

into her body. It is packaged with a lubricant and is 

available at drug stores. It 

helps reduce your chances 

of getting HIV and other 

STDs. It can be inserted up 

to eight hours before sexual intercourse. 

Female condoms are 79 to 95 percent effective at preventing pregnancy. Only one 

kind of female condom is available in this 

country, and its brand name is Reality.

✦ Diaphragm or cervical cap. Each of 

these barrier methods are placed inside 

the vagina to cover the 

cervix to block sperm. 

Th e diaphragm is shaped 

like a shallow cup. Th e 

cervical cap is a thimbleshaped cup. Before 

sexual intercourse, you 

insert them with spermicide to block or 

kill sperm. Th e diaphragm is 84 to 94 

percent eff ective at preventing pregnancy. 

Visit your doctor for a proper fi tting because diaphragms and cervical caps come 

in diff erent sizes. Using diaphragm or 

cervical caps does not protect you against 

STDs.

Intrauterine devices (IUDs)

✦ Copper T IUD. An IUD 

is a small device that is 

shaped in the form of a 

“T.” Your doctor places 

it inside the uterus to 

prevent pregnancy. It 

can stay in your uterus for up to 10 years. 

It does not protect you from HIV or other 

STDs. Th is IUD is 99 percent eff ective at 

preventing pregnancy.

✦ Mirena intrauterine system (IUS).

Th e IUS is a small T-shaped device like 

the IUD. It is placed inside the uterus by 

a doctor. It releases a small amount of 

a hormone each day to keep you from 

getting pregnant. Th e IUS stays in your 

uterus for up to fi ve years. It does not 

protect you from HIV or other STDs. Th e 

IUS is 99 percent eff ective at preventing 

pregnancy.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 75

Protecting Your Reproductive System
Hormonal methods

✦ Oral contraceptives. Also 

called “the pill,” it contains 

the hormones estrogen and 

progestin. It is prescribed 

by a doctor. A pill is taken 

at the same time each day. 

It does not protect against 

HIV or other STDs. If you are older than 

35 and smoke, or have a history of blood 

clots, breast cancer, or endometrial cancer, your doctor may advise you not to 

take the pill. Th e pill is 92 to 99 percent 

eff ective at preventing pregnancy.

✦ Mini-pill. Unlike the pill, the mini-pill 

only has one hormone, progestin, instead 

of both estrogen and progestin. It is prescribed by a doctor. It is taken at the same 

time each day. Mothers who breastfeed 

can use the mini-pill because it will not 

aff ect their milk supply. It is a good option 

for women who can’t take estrogen or for 

women who have a risk of blood clots. Th e 

mini-pill does not protect against HIV or 

other STDs. Th ey are 92 to 99.9 percent 

eff ective at preventing pregnancy.

✦ Patch (Ortho Evra). Th is skin patch is 

worn on the lower abdomen, buttocks, 

or upper body. Th is method 

is prescribed by a doctor. 

It releases the hormones 

progestin and estrogen into 

the bloodstream. You put 

on a new patch once a week 

for three weeks. During the 

fourth week, you do not 

wear a patch, so you can have a menstrual 

period. Th e patch is 92 to 99 percent 

eff ective at preventing pregnancy. But it 

appears to be less eff ective in women who 

weigh more than 198 pounds. It does not 

protect against HIV or other STDs.

✦ Hormonal vaginal contraceptive ring 

(NuvaRing). Th e NuvaRing releases the 

hormones progestin and estrogen. Your 

doctor places the ring inside your vagina 

to go around your cervix (the opening to 

your womb). You wear the ring for three 

weeks, take it out for the week that you 

have your period, and then put in a new 

ring. It is 92 to 99 percent eff ective at 

preventing pregnancy. Th is method does 

not protect you from HIV or other STDs.

✦ Depo-Provera. Women get shots of the 

hormone progestin in the buttocks or arm 

every three months from their doctor. It 

does not protect you from HIV or other 

STDs. It is 97 to 99 percent eff ective at 

preventing pregnancy.

✦ Emergency contraception. Emergency 

contraception is NOT a regular method of 

birth control. It should never be used as 

one. Emergency contraception should only 

be used after no birth control was used 

during sex, or if the birth control method 

failed, such as if a condom broke. Neither 

of the two methods described here protects you from HIV or other STDs.

 One type of emergency contraception 

requires you to take two doses of hormonal 

pills 12 hours apart. You have to take the 

76 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Protecting Your Reproductive System
pills starting within three days (72 hours) 

after having unprotected sex. Th ey are 

sometimes referred to as “morning after” 

pills, even though they can be used up 

to three days later. Th e pills are 75 to 89 

percent eff ective at inhibiting ovulation, 

fertilization, or implantation of a fertilized 

egg in the uterine wall, or all three. Plan B 

is available over the counter for women age 

18 and older. Plan B is available by prescription for women age 17 and under. (Plan B 

is the brand name of one product approved 

by the Food and Drug Administration for 

use as emergency contraception.)

 Another type of emergency contraception 

is having your doctor insert the Copper T 

IUD into your uterus within seven days 

of unprotected sex. Th is method is 99.9 

percent eff ective at inhibiting ovulation, 

fertilization, or implantation of a fertilized egg in the uterine wall, or all three. 

Surgical options

✦ Surgical sterilization. Th ese surgical 

methods are meant for people who want 

a permanent method of birth control. In 

other words, they never want to have a 

child, or they do not want more children. 

Both methods listed here are 99 to 99.5 

percent eff ective at preventing pregnancy. 

Th ese surgical options do not protect you 

from HIV or other STDs. 

✦ Tubal ligation or “tying tubes.” A 

woman can have her fallopian tubes tied 

(or closed) to stop eggs from going down 

to her uterus where they can be fertilized. 

Visit the National Women’s Health Information Center web site www.womenshealth.gov 77

Protecting Your Reproductive System

Th e procedure can be done in a hospital or 

in an outpatient surgical center. You can 

go home the same day of the surgery and 

resume your normal activities within a 

few days. Th is method is eff ective immediately. In the fi rst year after the surgery, 

your chance of getting pregnant is less 

than 1 percent. Over time, the ends of 

your fallopian tubes could fuse back together, and it may be possible to get pregnant. Failure rates have been reported in 

women who had their tubes tied earlier 

in their lives. But these failure rates are 

lower in women who are older when they 

have tubal ligation. 

✦ Vasectomy [va-sec-toe-me]. Th is operation is done to keep a man’s sperm from 

going to his penis, so his ejaculate never 

has any sperm in it that can fertilize an 

egg. Th is operation is simpler than tying a 

woman’s tubes. Th e procedure is done at 

an outpatient surgical center. Th e man can 

go home the same day. Recovery time is 

less than one week. After the operation, a 

man visits his doctor for tests to count his 

sperm and to make sure the sperm count 

has dropped to zero. It may take a few 

weeks for that to happen. Another form 

of birth control should be used until the 

man’s sperm count has dropped to zero. 

Other methods

✦ Continuous abstinence. Th is method 

means not having vaginal, anal, or oral 

sex at any time. It is the only 100-percent 

eff ective way to prevent pregnancy, HIV, 

and other STDs.
78 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Protecting Your Reproductive System

✦ Non-surgical sterilization (Essure 

Permanent Birth Control System). It 

is the fi rst non-surgical method of sterilizing women. A thin tube is used to thread 

a tiny device into each fallopian tube. It 

irritates the fallopian tubes and causes 

scar tissue to grow and permanently plug 

the tubes. It can take about three months 

for the scar tissue to grow, so use another 

form of birth control during this time.

Return to your doctor for a test to see if 

scar tissue has fully blocked your fallopian 

tubes. With blocked tubes, you can’t get 

pregnant. Research studies followed more 

than 600 women for one year. None had 

any pregnancies when the devices were 

implanted correctly. It does not protect 

you from HIV or other STDs.

✦ Natural family planning or fertility 

awareness. Understanding your monthly 

fertility pattern can help you plan to get 

pregnant or to avoid getting pregnant. 

Your fertility pattern is the number of 

days in the month when you are fertile 

(able to get pregnant), days when you are 

infertile, and days when fertility is unlikely, but possible. If you have a regular 

menstrual cycle, you have about nine or 

more fertile days each month. If you do 

not want to get pregnant, you do not have 

sex on the days you are fertile, or you use 

a form of birth control on those days. To 

learn more about your monthly fertility 

pattern, go to www.womenshealth.gov 

Th ese methods are 75 to 99 percent eff ective at preventing pregnancy. Th ey do not 

protect you from HIV or other STDs.

✦ Spermicides. Th ese products work by 

killing sperm and come in several forms—

foam, gel, cream, fi lm, suppository, or tablet. Th ey are placed in the vagina no more 

than one hour before intercourse. You 

leave them in place at least six to eight 

hours after intercourse. You can use a 

spermicide in addition to a male condom, 

diaphragm, or cervical cap. Spermicides 

alone are about 71 to 82 percent eff ective 

at preventing pregnancy. Th ey can be purchased in drug stores. Vaginal spermicide 

with Nonoxynol-9 will not protect you 

from HIV or other STDs, such as gonorrhea or chlamydia. 

Learn More About STDs 

STDs can be a real threat to your health, 

especially if they are not treated. STDs 

can result in life-long problems, including 

blindness, bone deformities, mental retardation, and death for infants infected by 

their mothers during pregnancy or birth. In 

women, STDs can lead to pelvic infl ammatory disease (PID), infertility, ectopic pregnancies (pregnancies that occur in the fallopian 

tubes instead of the uterus), and cancer of 

the reproductive system.

Early treatment of STDs is important. Th e 

quicker you seek treatment, the less likely the 

STD will cause you severe harm. Th e sooner 

you tell your sexual partner(s) that you have 

an STD, the sooner they can get treated. If 

you are treated for an STD, and your partner 

is not treated, and you have unprotected sex, 

then you can get the STD again. Get regular 

follow-up visits with your doctor.
Sometimes a person may be too scared or 

embarrassed to ask for information about 

STDs or to ask for help. Keep in mind that 

some STDs are curable, such as chlamydia, 

gonorrhea, syphilis, and trichomoniasis. 

Other STDS can only be treated, not cured. 

Th ese STDs, such as herpes, can be spread 

to another person, even if they are under 

control and managed with medicines. A vaccine is available that protects people against 

the human papillomavirus (HPV) and the 

hepatitis B virus (HBV).

Visit the National Women’s Health Information Center web site www.womenshealth.gov 79

Protecting Your Reproductive System

Th e organs of your reproductive system that can be hurt by HIV and other STDs.

Fallopian tube

connects the ovary to the uterus

Ovaries 

two small glands next to the uterus that make 

hormones, such as estrogen, which spark the 

start of your menstrual cycle, and release one 

egg about once a month until menopause

Uterus (womb)

an inside area or pocket where a baby grows

Cervix

the narrow entryway between the vagina 

and uterus

Vagina

a hollow canal or tube made of muscle that 

can grow wider to deliver a baby that has 

finished growing inside the uterus

Th e HPV vaccine protects against four HPV 

types, which together cause 70 percent of cervical cancers and 90 percent of genital warts. 

Th e HPV vaccine is recommended for 11- to 

12-year-old girls as well as 13- to 26-year-old 

girls and women. It can be given to girls as 

young as 9. Ideally, females should get the 

vaccine before they are sexually active. Girls 

and women who have not been infected with 

any of those four HPV types will get the full 

benefi ts of the vaccine. Females who are sexually active may also benefi t from the vaccine. 

It does not treat existing HPV infections, 

genital warts, precancers, or cancers.
Once an individual has HPV, the symptoms 

can be treated but not cured.

When you visit your doctor, tell him or her if 

you are allergic to any medications. Take all 

medicines exactly as prescribed. Do not skip 

taking your medications. Do not share your 

medications. Ask about any possible side effects of the medicine or dietary supplements 

BEFORE you take them, especially if you 

are pregnant or nursing. After treatment, 

visit your doctor again to make sure you are 

cured. A few STDs are resistant to certain 

medicines, so your doctor may need to prescribe a diff erent medicine for you.

HIV is an STD that can be spread through 

having sex (vaginal, anal, or oral) with a 

person who has HIV. HIV (the human immunodefi ciency virus) causes AIDS, the 

acquired immunodefi ciency syndrome. HIV 

attacks the body’s immune system, which is 

its natural defense system against disease.

80 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Protecting Your Reproductive System

Know the ABCs of STDs

Th e best way to protect your body is to know the “ABCs” of STDs. You can feel proud 

knowing you are doing your best to keep both you and your partner safe and healthy for 

life. Remember, if you choose not to follow A, B, or C, you could get a sexually transmitted disease (STD), including HIV, the virus that causes AIDS.

A= Abstinence. Not having sex of any kind (vaginal, anal, or oral sex) is the only  100% eff ective way to avoid getting STDs.

B= Be faithful. Being in a sexual relationship with only one partner who is free of an 

 STD and who is also faithful to you limits the chance of infections. 

C= Condoms. If you fail to follow A or B, use a latex condom. Latex condoms have been proven to reduce the risk of getting infected with HIV and many other STDS, 

if used correctly and consistently every time you have sex. 

Th e virus destroys one type of blood cells 

(CD4 cells) that helps the body fi ght off and 

destroy germs. 

HIV can also be passed from one person to 

another person in other ways, besides having 

sex. A person can get infected with HIV by 

sharing needles with a drug user who has HIV 

or AIDS. Th e virus can also be passed from 

a mother who has HIV or AIDS to her baby 

during pregnancy. AIDS has no cure, but it 

can be treated to reduce its symptoms and 

to prolong life. Get tested. Ask your partner 

to get tested. Know your HIV/AIDS status. 

Know your partner’s HIV/AIDS status. Knowing helps prevent getting HIV or passing it on 

to someone else. Treatment is most eff ective 

when started early. For detailed information 

on HIV/AIDS, visit www.womenshealth.gov/

HIV and www.cdc.gov/std.

Th e good news is that STDs can be prevented. Remember ABC.
Visit the National Women’s Health Information Center web site www.womenshealth.gov 81

Protecting Your Reproductive System

Sexually Transmitted Diseases (STDs)

Questions Answers

What are STDs? An infection or disease that you get by having vaginal, anal, or oral 

sex with someone who already has an STD. STD symptoms start on 

page 83.

How could I get 

STDs?

You can get HIV, gonorrhea, chlamydia, and trichomoniasis if infected semen or vaginal fl uids contact your vagina, the tip of the penis, 

an oral cavity, or the rectum. Condoms do not always protect you 

from STDs. For genital herpes, syphilis, and human papillomavirus 

(HPV), skin-to-skin contact with sores or infected skin that looks 

normal can transfer the disease from person to person. (HPV causes 

genital warts and cervical cancer.) Condoms are eff ective in reducing 

the likelihood of getting any STD. But even if you use a condom, 

you can get genital herpes, syphilis, and HPV through contact 

with infected genital areas that aren’t covered by a condom.

How do STDs hurt 

women?

STDs can

• increase your chances for getting HIV and other STDs

• cause pelvic infl ammatory disease (PID), which may lead to longlasting abdominal pain

• cause infertility (not being able to have a baby) or ectopic pregnancy, which is a pregnancy in your fallopian tube instead of your 

womb

• increase your chances of getting cervical cancer (Certain types of a 

sexually transmitted virus, HPV, are the major cause of this cancer.)

What if I am 

pregnant?

You should be screened for STDs, so treatment can begin right away. 

Having an untreated STD when you are pregnant can

• cause you to go into labor early, cause your water to break early, 

and cause infection in your womb after the birth

• hurt your baby by causing him or her to have problems like a low 

birth weight, eye infection, pneumonia, infection in the blood 

stream, birth defects, liver disease, or dying in your womb
Questions Answers

What if I am 

breastfeeding?

Talk with your doctor, nurse, or a lactation consultant about the risk 

of passing STDs onto your baby while breastfeeding. If you are being 

treated for an STD, ask your doctor about the possible eff ects of the 

drug on your breastfeeding baby. Most treatments for STDs are safe 

to use while breastfeeding.

• If you have HIV, you should not breastfeed because you can pass 

the virus to your baby. 

What if I am 

breastfeeding? 

(continued)

• If you are positive for hepatitis B or hepatitis C, you can breastfeed.

• If you have either chlamydia or gonorrhea, you can keep breastfeeding.

• If you have syphilis or herpes, you can keep breastfeeding as long 

as the sores are covered. Syphilis and herpes are spread through 

contact with sores and can be dangerous to your newborn. If you 

have sores on your nipple or areola (the darker skin around the 

nipple), you should stop breastfeeding on that breast until the 

sores clear. In the meantime, to keep this breast from getting 

overly full or engorged, you can pump or hand express your milk 

from this side. Pumping will also help keep up your milk supply. If 

parts of your breast pump touch the sore(s), these parts and the 

milk might become contaminated. Do not give this milk to your 

infant. Do not store it in a bottle. Th row that milk away, and sterilize or throw away the contaminated breast pump parts.

How can I get 

tested for STDs?

Talk with your doctor or nurse about getting tested for STDs, especially if you have more than one sex partner. Talk with your doctor 

or nurse if you have not been using condoms all the time or have had 

condoms break or come off during vaginal, oral, or anal sex. Also see 

the screening charts on pages 28–29. See your doctor right away if you 

have any symptoms of STDs. (See the symptoms chart on pages 83–86.)

If you are pregnant, or think you might be, ask your doctor about 

getting tested for STDs. Not all doctors will routinely do these tests 

without being asked by you. Be proactive and ask! Even if you have 

been tested in the past for STDs, get re-tested when you get pregnant. Your doctor will examine you and might take some tests that 

are usually quick and not painful.

82 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Protecting Your Reproductive System
STD Symptoms

Some of the most common STDs and their 

symptoms are shown in this chart. You can 

get and pass many of these diseases through 

diff erent forms of sex (vaginal, anal, and 

oral). It can take some time between getting 

infected and having symptoms, depending 

Visit the National Women’s Health Information Center web site www.womenshealth.gov 83

Protecting Your Reproductive System

on the STD. Sometimes you can get infected 

but not show symptoms. Even if you have 

NO symptoms, you can still pass the disease on to another person if you have been 

infected. Seek medical help right away if you 

think you have an STD, or if someone you 

have been with has an STD. 

Common STDs Symptoms

Chlamydia Most people have no symptoms. Women with symptoms may have

• abnormal vaginal discharge

• burning when urinating

Infections that are not treated, even if there are no symptoms, can lead to

• lower abdominal pain

• low back pain

• nausea

• fever

• pain during sex

• bleeding between periods

Note: If not treated, chlamydia can lead to serious, long-term problems 

such as pelvic infl ammatory disease (PID) and infertility.

Genital herpes Many people who have herpes are not aware they have it. But if you are 

having an “outbreak,” the symptoms are clear. After exposure, the fi rst 

outbreak is often within two weeks. 

Symptoms are

• small red bumps, blisters, or open sores on the penis, vagina, or on 

areas close by

• vaginal discharge

• fever

• headache

• muscle aches

• pain when urinating
Common STDs Symptoms

Genital herpes 

(continued)

• itching, burning, or swollen glands in the genital area

• pain in legs, buttocks, or genital area

Symptoms may go away and then come back. Sores heal after two to 

four weeks. 

Note: Some people may have no symptoms. Most people with this type 

of herpes infection may never have sores. Sometimes, only very mild 

sores appear, but they are mistaken for an insect bite or other skin 

problems.

Gonorrhea Symptoms are often mild. But most women have no symptoms. Even 

when women do have symptoms, they can sometimes be mistaken for 

a bladder infection or other vaginal infection. 

• pain or burning when urinating

• yellowish and sometimes bloody vaginal discharge

• bleeding between menstrual periods

Note: If not treated, gonorrhea can lead to serious, long-term problems. 

Hepatitis B

(also spread 

through blood)

Some people have no symptoms. Women with symptoms may have

• mild fever

• headache and muscle aches

• tiredness

• loss of appetite

• nausea or vomiting

• diarrhea

• dark-colored urine and pale bowel movements

• stomach pain

• skin and whites of eyes turning yellow

84 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Protecting Your Reproductive System
Common STDs Symptoms

Hepatitis C

(mostly spread 

through blood, 

but some cases 

are spread by 

sex) 

Most people have no symptoms. Women with symptoms may have

• skin and whites of eyes turning yellow

• tiredness

• dark urine

• abdominal pain

• loss of appetite

• nausea

Note: People at risk for hepatitis C infection might also be at risk for 

infection with hepatitis B or HIV.

HIV/AIDS Symptoms are

• extreme fatigue

• rapid weight loss

• frequent low-grade fevers and night sweats

• frequent yeast infections (in the mouth) or vaginal yeast infections 

and other STDs

• pelvic infl ammatory disease (PID)

• menstrual cycle changes

• red, brown, or purplish blotches on or under the skin or inside the 

mouth, nose, or eyelids

Note: Some people may have no symptoms for 10 years or more.

Human papillomavirus (HPV)Many people with HPV, which causes genital warts, don’t know they 

are infected because they may not have symptoms. After sexual contact with an infected person, genital warts may appear within weeks or 

months, or not at all. Women may get visible warts in the genital area, 

including the thighs. Warts can be raised or fl at, alone or in groups, 

small or large. Sometimes, the warts are caulifl ower-shaped. Th ey 

might also be hard to see and painless. Or women may have lesions on 

the cervix and in the vagina. 

Note: Some types of HPV can cause cervical cancer, so it’s important to 

get regular Pap tests if you’re sexually active.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 85

Protecting Your Reproductive System
Common STDs Symptoms

Syphilis Symptoms in the fi rst, or primary stage, occur about 10 days to 90 

days after exposure. (Th e most common timeframe for symptoms to 

occur after exposure is 21 days.) 

Symptoms in the fi rst, or primary stage, are 

• a single, painless sore appears, usually in the genital areas but may 

appear in the mouth 

• sometimes you have more than one sore

• sores heal on their own

Note: If the infection is not treated, it moves to the next stage.

Symptoms in the next, or secondary, stage are 

• skin rash on the hands and feet that usually does not itch and clears 

on its own

• fever

• swollen lymph glands

• sore throat

• patchy hair loss

• headaches

• weight loss

• muscle aches

• tiredness

In the last stage, which is called the latent, or hidden, stage, the symptoms listed above disappear. But the infection remains in the body, 

where it can damage the brain, nerves, eyes, heart, blood vessels, liver, 

bones, and joints.

Trichomoniasis Symptoms usually appear 5 to 28 days after exposure and can include

• yellow, green, or gray vaginal discharge (often foamy) with a strong 

odor

• discomfort during sex and when urinating

• irritation and itching of the genital area

• lower abdominal pain in rare cases

86 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Protecting Your Reproductive System
Th en and Now

Th e birth control pill was fi rst introduced in the United States in 1960. It was not available for use until then. Today, women are able to use a number of forms of birth control, 

including the pill, to space children and to prevent pregnancy.

What You Should Know to Protect Yourself

• Know that some methods of birth control, 

such as birth control pills, shots, implants, 

or diaphragms, will not protect you from 

HIV or other STDs. If you use one of these 

methods, be sure to also use a latex 

condom or dental dam (used for oral sex) 

correctly every time you have sex. 

• Don’t share needles or IV (intravenous) 

drug equipment for illegal drugs such as 

heroin and cocaine, or for legal drugs such 

as insulin. If you get a tattoo or body piercing, make sure the needles are sterile.

• Talk with your sex partner(s) about STDs, 

HIV, and using condoms. It’s up to you to 

make sure you are protected. Remember, 

it’s YOUR body! For more information, call 

the National STD hotline at 1-800-227-

8922.

• Talk frankly with your doctor or nurse and 

your sex partner(s) about any STDs you or 

your partner have or have had. Talk about 

any sores or discharge in the genital area. 

Try not to be embarrassed. Being honest 

could save your life. If you are living with 

HIV, be sure to tell your partner and your 

doctor.

• Have regular pelvic exams. Talk with your 

doctor about how often you need them. 

Many tests for STDs can be done during an 

exam. Ask your doctor to test you for STDs. 

The sooner an STD is found, the easier it is 

to treat. See the screening charts on pages 

28–29 to see how often you need a Pap test or 

tests for HPV, HIV, and other STDs.

• If you are pregnant, get screened for chlamydia, gonorrhea, hepatitis B and C, HIV, 

and syphilis. Get screened as soon as you 

think you may be pregnant. The longer you 

wait, the more harm you may be doing to 

your baby. 

• If you have HIV and are pregnant, you can 

lower the chances of giving HIV to your 

baby by taking medicine. Talk with your 

doctor about your options. 

• Don’t douche. Douching removes some 

of the normal bacteria in the vagina that 

protects you from infection. It can raise your 

risk of getting HIV and some other STDs.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 87

Protecting Your Reproductive System
Recognizing 

Problems in 

Your Uterus

The uterus is the hollow, pear-shaped organ in a woman’s body where a baby 

grows. Menstruation—getting your period—also begins here 

each month. Th e lower 

end of the uterus, or 

cervix, extends into the 

vagina. Th e upper part is 

the “body” of the uterus. 

Th e body of the uterus has 

two layers: an inner and 

an outer layer. Th e endometrium is the inner layer. 

During the menstrual 

cycle, or “period,” this 

layer builds up extra blood 

and tissue to get ready for 

pregnancy. If a pregnancy 

doesn’t happen, the extra 

blood and tissue leave the 

body through the vagina. 

You then have a period. 

Th e myometrium is the 

outer layer of the body of 

the uterus. Th is layer has 

the muscle that pushes the 

baby out during delivery.

You may have had times in your life when 

you’ve had pain in your lower abdomen or 

bleeding that was diff erent from your normal period. Th ese symptoms can make you 

nervous and wonder if something is wrong. 

Knowing about the diff erent health problems that can aff ect your uterus and knowing their symptoms can help you fi gure out 

when you should see your doctor. Be sure 

to see your doctor if you think you have any 

problems.

Vagina

Fallopian tube

Ovaries 

Uterus

(womb)

Cervix

 Reproductive System

88 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Recognizing Problems in Your Uterus
Fast Facts on Fibroids

What they are Benign (non-cancerous) 

growths within the wall 

of the uterus (or womb). 

Th ey are also called 

uterine leiomyomas.

What they look 

like

Fibroids can grow as a single growth or in groups. Th eir size can vary 

from small, like an apple seed, to even larger than a grapefruit.

Cause No one knows exactly what causes fi broids. Fibroids often run in 

families.

Symptoms Most fi broids do not cause any symptoms. If they do cause symptoms, they are

• heavy bleeding or painful periods

• spotting or bleeding between periods

• feeling of fullness in the pelvic area (lower abdomen)

• urinating often 

• pain during sex

• lower back pain

• reproductive problems like not being able to get pregnant, having 

more than one miscarriage, or having early onset of labor during 

pregnancy

Uterine Fibroids

Fibroids

Visit the National Women’s Health Information Center web site www.womenshealth.gov 89

Recognizing Problems in Your Uterus
Fast Facts on Fibroids

Tests • Regular pelvic exam

• Tests that create a “picture” of the inside of your body to see if you 

have fi broids (ultrasound)

• Laparoscopy—surgery when your doctor places a small tube with a 

light inside your abdomen to see any fi broids 

• Hysteroscopy—surgery when your doctor inserts a long tube with 

a camera into the vagina and directly into the uterus to see any 

fi broids

Treatment • Pain medicine

• Drugs that decrease the size of the fi broids or that stop or slow the 

growth of fi broids 

• Surgery 

• Shrinking the fi broids by placing a freezing agent on them 

• Cutting off the blood supply to the uterus and the fi broids so they 

shrink (uterine artery embolization)

Are they cancer 

or could they become cancerous?

Although fi broids are sometimes called tumors, they are benign and 

do not cause cancer. 

Fast Facts on Endometriosis

What it is Each month, the endometrial tissue normally builds up in the uterus. 

Th is tissue and blood is shed as your monthly period. Endometriosis 

occurs when this tissue grows outside of the uterus.

What it looks 

like

Bumps, scars, or fl uid-fi lled sacs called cysts.

Cause No one knows exactly what causes endometriosis.

(continued)

90 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Recognizing Problems in Your Uterus
Fast Facts on Endometriosis

Where it grows It mostly grows in the abdomen, lower back, and pelvic areas: on or 

under the ovaries, on the bowels or bladder, behind the uterus, on 

the tissues that hold the uterus in place. When endometrial tissue 

is outside your uterus, this tissue is still shed monthly. But because 

this tissue is not where it is supposed to be, it can’t leave a woman’s 

body the way a woman’s period normally does. Th ese areas may hurt 

nearby tissues and can damage your organs.

Symptoms • Very painful cramps or periods

• Heavy periods

• Chronic pelvic pain

• Spotting or bleeding between periods

• Lower back pain

• Intestinal pain

• Pain during or after sex

• Can’t get pregnant

• Painful bowel movements (BM) or pain passing urine during your 

period

• Tiredness

• Stomach problems

uterus

abdomen

lower back

ovary

bowels bladder 

(continued)

Visit the National Women’s Health Information Center web site www.womenshealth.gov 91

Recognizing Problems in Your Uterus
Fast Facts on Endometriosis

Tests • Medical history

• Pelvic exam

• Physical exam

• Tests that create a “picture” of the inside of your body (ultrasound) 

• Laparoscopy—surgery when your doctor places a small tube with a 

light inside your abdomen to see if you have endometriosis

Treatment • Pain medicine

• Hormone therapy

• Surgery

Fast Facts on Uterine Prolapse

What it is Th e uterus slips from its 

normal position into the 

vaginal canal.

Causes Th e tissues and muscles that hold up the uterus weaken. 

It can happen

• after one or more vaginal births 

• after delivery of a large baby (more than 9 pounds) 

• after hard labor and delivery 

• with normal aging 

• with reduction in estrogen 

Obesity and chronic coughing or straining can also weaken the 

muscles and raise a woman’s chances of having this condition.

Vagina

Uterus

(continued)

92 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Recognizing Problems in Your Uterus
Fast Facts on Uterine Prolapse

Symptoms • A feeling of heaviness or pulling in the pelvis

• A feeling like you’re sitting on a small ball

• Painful sex

• Low back pain

• Feeling an urgent need to urinate

• Leaking urine

• Painful bowel movements (BM)

• Constipation

Test • Pelvic exam

Treatment • Inserting an object into the vagina to hold the uterus in place

• Surgery

• Kegel exercises (squeezing your pelvic muscles as if you’re trying to 

stop the fl ow of urine)

• Estrogen therapy

Fast Facts on Cancer of the Uterus

What it is Th ere are two kinds of cancer of the uterus: endometrial cancer (cancer that begins in the lining of the uterus) and uterine sarcoma (a rare 

cancer that begins in the muscle or other tissues of the uterus). 

Risk Factors We don’t know what causes endometrial cancer. Women have a 

higher chance of getting it if they

• have been treated with tamoxifen for breast cancer

• started their periods before age 12

• start menopause after age 50

• have heavy bleeding during perimenopause, the time leading up to 

menopause

• are obese

Visit the National Women’s Health Information Center web site www.womenshealth.gov 93

Recognizing Problems in Your Uterus

(continued)
Fast Facts on Cancer of the Uterus

Risk Factors 

(continued)

• have a family history of colon cancer

• have never been pregnant

• have taken estrogen, without progestin, for menopausal symptoms

• have polycystic ovarian syndrome (PCOS)

• have a high-fat diet

• have diabetes

• are age 40 or older

• had breast cancer or ovarian cancer

• had prior radiation therapy to the pelvic area 

Symptoms for 

endometrial 

cancer

• Abnormal bleeding or discharge not related to your periods

• Diffi culty or pain passing urine

• Pain during sex

• Pain in your pelvis

• Weight loss

Tests for 

endometrial 

cancer

• Medical history

• Physical exam

• Pelvic exam

• Biopsy—removal of tissue from the endometrium 

(the inner lining of the uterus)

• D&C (dilation and curettage) or removal of tissue 

• X-ray

• Tests that create a “picture” of the inside of your body (ultrasound)

• Blood tests

Treatment for 

endometrial 

cancer

• Surgery

• Chemotherapy

• Radiation therapy

• Hormone therapy

94 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Recognizing Problems in Your Uterus

(continued)
Hysterectomy

A hysterectomy is a surgical procedure to 

remove a woman’s uterus. Sometimes, other 

organs are removed, too. A hysterectomy 

will stop a woman’s periods if she hasn’t 

reached menopause yet. If the ovaries are removed before a woman reaches menopause, 

she will suddenly enter menopause. 

Th e diff erent types of hysterectomies are 

listed below. 

✦ A complete or total hysterectomy removes 

the cervix and uterus. It is the most common type of hysterectomy. 

✦ A partial or subtotal hysterectomy removes 

the upper part of the uterus but leaves the 

cervix. 

✦ A radical hysterectomy removes the uterus, 

cervix, upper part of the vagina, and supporting tissues. 

✦ A bilateral salpingo-oophorectomy removes 

both ovaries and fallopian tubes during a 

hysterectomy. 

Do What You Can to Prevent 

Problems in Your Uterus

✦ Prevent sexually transmitted diseases 

(STDs), including HIV, by practicing 

safer sex. See the Protecting Your Reproductive System chapter, starting on page 74, for 

more information about STDs and safer sex.

✦ See your doctor if you have abnormal 

bleeding or discharge, pain during sex, 

pain in your pelvic area, or pain during 

urination.

Th en and Now

Uterine fi broids are one of the most common medical conditions for women of 

childbearing age. Th ese benign tumors 

can cause prolonged, heavy bleeding. In 

the past, doctors often recommended 

a hysterectomy, a major surgery that 

removed the uterus and made the woman 

unable to have children. Now, women 

have other options that might be right 

for them and that preserve their fertility. If you have uterine fi broids, but don’t 

have any other problems, you may not 

need any treatment. If you have many 

symptoms or often feel pain, you may 

benefi t from medical therapy, which 

means using certain medications rather 

than having surgery. If you have moderate to severe symptoms of fi broids, 

surgery may be the best form of treatment. Surgery can be a major or minor 

procedure. Talk to your doctor about the 

diff erent types of treatments for uterine 

fi broids. Also talk about the possible risks 

and the side eff ects of the treatments. 

Researchers continue to look for other 

methods of treating uterine fi broids.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 95

Recognizing Problems in Your Uterus
Treating Urinary 

Incontinence 

Urinary [YOOR-in-air-ee] incontinence 

[in-KAHN-tih-nens] is when urine leaks 

out before you can get to a bathroom. If 

you have urinary incontinence, you’re not 

alone. Millions of women have this problem. 

More than 13 million Americans—men and 

women, young and old— have incontinence. 

Women are more likely to leak urine than 

men. 

Older women have more bladder control 

problems than younger women. It does not 

have to be a normal part of aging. Many 

medical conditions can cause incontinence 

problems. Loss of bladder control is a symptom of an underlying disorder, a sign that 

something is wrong. Th e worst thing you can 

do is to ignore it. Th e best thing you can do 

is to talk to your doctor. Acknowledge the 

problem. Tell your doctor. Get treatment. 

Learn how to manage incontinence. Most 

cases of poor bladder control can be improved greatly, and some even cured. 

Some Causes of Urinary 

Incontinence

Many possible reasons cause women to leak 

urine. Sometimes it’s caused by an illness, 

and bladder control returns when the illness 

goes away. For example, bladder infections 

and infections in the vagina can cause 

incontinence for a short time. Being unable 

to have a bowel movement or taking certain 

medicines also may make it hard to control 

your bladder. 

Sometimes, women fi nd urinary incontinence to be an ongoing problem. In this 

case, the reason may be that 

✦ the bladder cannot empty completely 

✦ the muscles that help to hold or release 

urine are weakened 

✦ a urinary passage is blocked 

✦ the nerves that control the bladder are 

damaged 

Leaking can also result from some medical conditions, including neurologic injury, 

birth defects, strokes, multiple sclerosis, and 

physical problems associated with aging.

Sometimes, diseases such as arthritis and 

Alzheimer’s disease can make it hard to get 

to the bathroom in time. Th ey can make it 

even harder to control urine leakage. 

urine

urethra

pelvic floor

muscles

bladder

muscle

sphincter

muscles

96 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Treating Urinary Incontinence

Bladder Control System
Pregnancy, Delivery, and 

Urinary Incontinence

Being pregnant can cause urine leakage, 

but don’t panic! Unborn babies push down 

on the bladder, urethra (the tube that you 

urinate from), and the pelvic muscles. If 

you lose bladder control after having a baby, 

the problem often goes away by itself. Your 

muscles may just need time to recover. 

Being pregnant can also cause leakage due to 

✦ the extra pressure of the baby on the 

bladder and pelvic muscles

✦ a vaginal delivery

✦ an episiotomy, where the doctor makes a 

cut in the muscle that makes it easier for 

the baby to come out

✦ damage to the nerves that control the 

bladder

If you still have bladder problems six weeks 

after having your baby, talk to your doctor. 

Without treatment, the loss of bladder control can become a long-term problem. 

Sometimes bladder control problems show 

up years after you’ve had your baby. Some 

women do not have problems until later, 

often in their 40s. 

Menopause, Aging, and 

Incontinence

Some women do have bladder control problems after they stop having periods, which is 

called menopause or the change of life. After 

your periods end, your body stops making 

the female hormone estrogen [ES-truh-jun]. 

Some experts think this loss of estrogen 

weakens the vaginal tissue. 

Incontinence is more common among adults 

60 years of age or older. It is one of the most 

common reasons for adults to be admitted 

to a nursing home. Urinary incontinence is 

NOT a normal part of the aging process. It 

doesn’t HAVE to happen in later life. You do 

not have to live with it in silence or shame. 

It is almost always treatable, and sometimes 

it can be cured. strong bladder

control muscles

weak bladder

control muscles

urine

muscle wall

of bladder

backbone

vagina

bowel

urethra

pelvic floor

muscle

bladder

uterus

Visit the National Women’s Health Information Center web site www.womenshealth.gov 97

Treating Urinary Incontinence
Diff erent Types of Urinary 

Incontinence 

✦ Stress Incontinence. Leakage happens 

when you cough, sneeze, exercise, laugh, 

lift heavy things, and perform other 

movements that put pressure on the bladder. It is the most common type of incontinence. It can be treated and sometimes 

cured.

✦ Urge incontinence. Th is type of incontinence is sometimes called “overactive 

bladder.” Leakage usually happens after 

a strong, sudden urge to urinate. Th is 

sudden urge may occur when you don’t 

expect it, such as during sleep, after 

drinking water, or when you hear or touch 

running water.

✦ Functional incontinence. Leaking 

occurs because you can’t get to a toilet 

in time. People with this type of incontinence may have problems thinking, 

moving, or speaking that keep them from 

reaching a toilet. For example, a person 

with Alzheimer’s disease may not plan a 

trip to the bathroom in time to urinate. A 

person in a wheelchair may be unable to 

get to a toilet in time.

✦ Overfl ow incontinence. Urine leaks 

because the bladder doesn’t empty completely. Overfl ow incontinence is less common in women.

✦ Mixed incontinence. Some women have 

two or more types of incontinence together, most often stress and urge incontinence.

✦ Transient incontinence. Urine leaks 

because of an illness such as a bladder 

infection. Th e urine leakage stops when 

the illness is treated.

How to Talk to Your Doctor

Most people don’t want to talk to their doctor about such a personal topic. But keep in 

mind that urinary incontinence is a common 

medical problem. Millions of women have 

the same problem, so your doctor has probably heard many stories like yours. 

Even if you feel shy, you have to be the one 

to take that fi rst step. Some doctors don’t 

treat bladder control problems, so they may 

not think to ask about it. Others might 

expect you to bring up the subject. If your 

doctor doesn’t treat bladder problems, ask 

for help fi nding a doctor who does. 

It may help you to write down when you leak 

urine. Be sure to note what you were doing 

at the time. Were you sneezing, coughing, 

laughing, or sleeping? Take this log with you 

when you visit your doctor. 

Some Questions You Should 

Ask Your Doctor

✦ Could what I eat or drink cause bladder 

problems? 

✦ Could my medicines (prescription or 

over-the-counter) cause bladder control 

problems?

✦ Could other medical conditions cause loss 

of bladder control?

98 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Treating Urinary Incontinence
✦ What are the treatments to regain bladder 

control? Which one is best for me?

✦ What can I do about the odor and rash 

caused by urine?

Tests for Urinary Incontinence 

Step 1

See your doctor. Again, if your primary 

doctor doesn’t treat bladder problems, get a 

referral for someone who does.

Step 2 

Your doctor will do a physical exam of you 

to look for signs of health problems that can 

cause incontinence. He or she will ask you 

the following questions:

✦ What are your symptoms?

✦ What is your medical history?

✦ How often do you empty your bladder?

✦ How and when do you leak urine?

✦ How much urine do you leak? 

Step 3

Your doctor will perform tests. One test is 

done to fi gure out how well your bladder 

works and how much urine it can hold. For 

this test, you will drink water and urinate 

into a measuring pan. Th en your doctor will 

measure any urine still remaining in your 

bladder. 

One or more of the these tests might be 

ordered: 

✦ Stress test. While you cough or bear 

down, the doctor watches for loss of 

urine.

✦ Urinanlysis. You give a urine sample to 

your doctor or nurse. Th e sample is then 

tested for signs of infection and other 

causes of incontinence.

✦ Blood test. You give a blood sample, 

which is sent to a lab where it is tested for 

signs of other causes of incontinence.

✦ Ultrasound. Sound waves are used to 

take a picture of the kidneys, bladder, 

and urethra. Your doctor will look to see 

if any problems in these areas could cause 

incontinence.

✦ Cystoscopy. A thin tube with a tiny 

camera is placed in the urethra to view the 

inside of the urethra and bladder.

✦ Urodynamics. A thin tube is placed into 

your bladder, and your bladder is fi lled 

with water. Your doctor measures the 

pressure in the bladder.

Your doctor may ask you to write down 

when you empty your bladder and how 

much urine you produce for a day or a week.

One Way to Help Prevent 

Urinary Incontinence

Not all types of urinary incontinence can be 

prevented. But exercising your pelvic fl oor 

muscles regularly can help prevent some 

bladder problems. Th ese exercises are called 

Kegels. Th ey are also used as a treatment for 

urinary incontinence.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 99

Treating Urinary Incontinence
Treatments for Urinary 

Incontinence

Many treatments are available to you. Your 

doctor will work with you to fi nd the best 

treatment for you. Treatments may include 

✦ Pelvic Muscle Exercises (Kegel exercises). Th ese easy exercises help make 

your pelvic muscles stronger. Doing these 

exercises every day can help reduce or 

cure stress leakage.

✦ Electrical Stimulation. Electrodes are 

placed in the vagina or rectum for a short 

time to stimulate nearby muscles and 

make them stronger. Th is treatment can 

reduce both stress incontinence and urge 

incontinence.

✦ Biofeedback. Biofeedback helps you 

learn how your body works. A therapist 

puts an electrical patch over your bladder 

and urethral muscles. A wire connected 

to the patch is linked to a TV screen. You 

and your therapist watch the screen to 

see when these muscles contract, so you 

can learn to control these muscles. Biofeedback can be used with pelvic muscle 

exercises and electrical stimulation to 

help control stress incontinence and urge 

incontinence. 

✦ Timed Voiding or Bladder Retraining.

In timed voiding, you urinate at set times 

instead of waiting for a strong urge. To 

do bladder retraining, you slowly increase 

the time between your scheduled voiding 

times to train your bladder to hold urine 

better. Th ese treatments can reduce urge 

incontinence and overfl ow incontinence. 

A doctor can tell you if they may help you.

✦ Weight Loss. Extra weight puts more 

pressure on your bladder and nearby 

muscles, which can cause bladder control 

How To Do Kegel Exercises

1. It may be easier to begin practicing these 

exercises while lying down.

2. Squeeze the muscles in your genital 

areas as if you were trying to stop from 

passing gas. Try not to squeeze the 

muscles in your belly or legs at the same 

time. 

3. Relax. Squeeze the muscles again and 

hold for 3 seconds. Then relax for 3 seconds. Do this 8 more times. Work up to 5 

sets of 10.

4. When your muscles get stronger, do your 

exercises sitting or standing. You can do 

these exercises any time, while sitting at 

your desk, in the car, waiting in line, doing the dishes, etc.

Be patient. It may take 3 to 6 weeks before 

you see results. 

If you’re not sure you’re doing Kegel exercises right, ask your doctor or nurse to 

check you while you try to do them. If you 

aren’t squeezing the right muscles, your 

doctor or nurse can teach you the right way 

to do the exercises. A pelvic fl oor physical 

therapist may be available in your area to 

help teach you how to strengthen these 

muscles or help you with other treatments 

listed below.

100 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Treating Urinary Incontinence
problems. If you’re overweight, work with 

your doctor to plan a diet and exercise 

program that works for you.

✦ Dietary Changes. Certain foods and 

drinks can cause incontinence, such as 

alcohol and caff eine, which is found in coffee, some sodas, chocolate, and tea. Limiting these foods and drinks can reduce 

incontinence.

✦ Medications. Medications can reduce 

some types of leakage. Certain drugs can 

tighten or strengthen urethral and pelvic 

fl oor muscles. Other medicines can calm 

overactive bladder muscles and nerves. 

Talk to your doctor to see if medication is 

right for you.

✦ Pessary. A pessary is a small device that 

fi ts in your vagina and helps hold it up. 

A pessary can help reduce leakage. Your 

doctor or nurse will decide which type and 

size of pessary are right for you. He or she 

will check the pessary regularly.

✦ Implants. Your doctor may suggest 

injecting a material into the space around 

the urethra with a needle. Th is material 

thickens the area around the urethra, so 

you can control your urine fl ow better.

✦ Surgery. Surgery can fi x problems such 

as blocked areas. It can also support the 

bladder or the urethra to prevent loss 

of urine. A surgeon can also put a small 

device in the body that acts on nerves to 

control bladder activity.

✦ Urethral Inserts. A urethral insert is a 

thin tube that you place inside the urethra 

that blocks urine from coming out. You 

take the tube out when you need to urinate, and then put it back in again until 

you need to urinate again.

✦ External Urethral Barrier. Th is device 

is a small foam or gel disposable pad that 

you place over the opening of the urethra. 

Th e pad seals itself against your body, 

keeping you from leaking. When you go 

to the bathroom, you take it off . After 

urinating, you place a new pad over the 

urethra.

✦ Catheters. If nothing else helps, your 

doctor may suggest catheters, which are 

thin tubes placed in the bladder by a doctor or by you. A catheter drains the bladder for you, sometimes into an attached 

bag.

Th en and Now

Women who lose control of their bladder often restrict their outings, avoid 

their friends, and drop out of some social 

activities. Even going to the grocery store 

might have to be planned around how to 

get to a bathroom quickly enough. Many 

of these women do not seek professional help. Others deny that they have a 

problem. But treatment for incontinence 

is now highly successful. Tell your doctor. 

Restore your quality of life. 

Visit the National Women’s Health Information Center web site www.womenshealth.gov 101

Treating Urinary Incontinence
Living with 

Autoimmune 

Diseases 

Our bodies have an immune system that protects us from disease and infection. 

But if you have an autoimmune disease, your 

immune system attacks itself by mistake, 

and you can get sick. Autoimmune diseases 

can aff ect connective tissue in your body. 

(Connective tissue binds together body tissues and organs.) Autoimmune disease can 

aff ect many parts of your body, such as your 

kidneys, nerves, muscles, endocrine system, 

and digestive system. (Your endocrine system directs your body’s hormones and other 

chemicals.)

Most autoimmune diseases occur in women, 

and most often during their childbearing 

years. Some of these diseases occur more 

in African American, American Indian, and 

Latina women than in White women. Some 

common autoimmune diseases are Hashimoto’s thyroiditis, Graves’ disease, lupus, 

multiple sclerosis, and rheumatoid arthritis.

Th ese diseases tend to run in families. Your 

genes, along with the way your immune system responds to certain triggers or things in 

the environment, aff ect your chances of getting one of these diseases. If you think you 

may have an autoimmune disease, ask your 

family members if they have had symptoms 

like yours. Although we don’t have a cure 

for autoimmune diseases, you can treat your 

symptoms and feel better. 

102 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Living with Autoimmune Diseases
Disease Symptoms Tests for Diagnosing

Hashimoto’s 

Th yroiditis 

(underactive thyroid)

• Tiredness

• Depression

• Sensitivity to cold

• Weight gain

• Muscle weakness and cramps

• Dry hair

• Tough skin

• Constipation

You may have no symptoms.

• Blood test for thyroidstimulating hormone 

(TSH)

Graves’ Disease 

(overactive thyroid)

• Insomnia (not able to sleep)

• Irritability

• Weight loss without dieting

• Heat sensitivity

• Sweating

• Fine brittle hair

• Weakness in your muscles

• Light menstrual periods

• Bulging eyes

• Shaky hands

You may have no symptoms.

• Blood test for thyroidstimulating hormone 

(TSH)

Common Autoimmune Diseases

Common Autoimmune Diseases

More than 80 types of autoimmune diseases have been recognized. If you learn the 

symptoms of some of the more common 

ones, you can help yourself recognize the 

signs. But some autoimmune diseases share 

similar symptoms. Th ese similarities make 

diagnosing this group of diseases diffi cult, 

even for doctors. Th e delay in naming your 

problem can make your visits to doctors 

long and stressful. But if you are having 

symptoms that bother you, you need to talk 

with your doctor or nurse to learn how you 

can get some relief. 

Visit the National Women’s Health Information Center web site www.womenshealth.gov 103

Living with Autoimmune Diseases
Disease Symptoms Tests for Diagnosing

Lupus • Swelling and damage to the 

joints, skin, kidneys, heart, lungs, 

blood vessels, and brain

• “Butterfl y” rash across the nose 

and cheeks

• Rashes on other parts of the body

• Painful and swollen joints

• Sensitivity to the sun

• An exam of your body

• Lab tests (antinuclear antibody [ANA] test, blood 

tests, and urine tests)

Multiple Sclerosis 

(MS)

• Weakness and trouble with coordination, balance, speaking, and 

walking

• Paralysis

• Tremors

• Numbness and a tingling feeling 

in arms, legs, hands, and feet

• An exam of your body

• An exam of your brain, 

spinal cord, and nerves 

(a neurologic exam)

• X-ray tests (magnetic 

resonance imaging [MRI] 

and magnetic resonance 

spectroscopy [MRS]) 

• Other tests on the brain 

and spinal cord fl uid 

Rheumatoid Arthritis • Infl ammation begins in the tissue that lines your joints. It then 

spreads to the whole joint. Hand 

joints are the most common site, 

but the disease can aff ect most 

joints in the body. 

• Muscle pain

• Deformed joints

• Weakness

• Fatigue

• Loss of appetite

• Weight loss

• In severe cases, becoming confi ned to bed

• Blood tests may show 

that you have anemia, 

which is when your body 

does not have enough 

red blood cells. Th e tests 

may also show that you 

have an antibody called 

rheumatoid factor (RF). 

However, some people 

with RF never get this 

disease. Other people 

who do have the disease 

never have this antibody. 

104 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Living with Autoimmune Diseases
Living with an Autoimmune 

Disease

You can learn to treat your symptoms and 

manage your disease. Women with autoimmune diseases lead full, active lives. Your 

life goals should not have to change. Seeing 

a doctor who specializes in these types of 

diseases is important. 

Symptoms can come and go, be better or 

worse on diff erent days, or they can all go 

away for a while. (Your symptoms can be 

in remission). Flare-ups, or the sudden and 

severe onset of symptoms, can also happen. 

Work closely and often with your doctor and 

other members of your health care team to 

manage your illness. If you do have a fl areup, fi rst call your doctor. Don’t try a “cure” 

you heard about from a friend or relative. 

Your doctor(s) will talk to you about which 

medicines might work best for you. Th e 

type of medicine you take depends on which 

disease you have and what your symptoms 

are. Some people can take over-the-counter 

drugs, such as aspirin and ibuprofen for 

pain. Others with more severe symptoms 

may have to take certain prescription drugs 

to help with pain, swelling, depression, anxiety, sleep problems, fatigue, or rashes. You 

might also be able to take medicine to help 

slow the progress of your disease. New treatments for autoimmune diseases are being 

studied all the time.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 105

Living with Autoimmune Diseases
What You Can Do to Feel Better

✦ Eat a healthy diet. Keep your immune 

system as healthy as it can be! Th e list of 

nutrients you need for a healthy immune 

system is long. But don’t try to overload 

on vitamins because that could be worse 

for your health. Eat balanced meals with 

foods from all of the food groups. Include 

yummy fruit and vegetables and whole 

grains. Also eat calcium-rich foods, such 

as fat-free milk, low-fat milk, fat-free yogurt, or low-fat yogurt. Avoid fatty foods. 

✦ Get regular exercise. (But be careful not 

to overdo it.) Th irty minutes of physical 

activity most days of the week is best. 

But fi rst talk with your doctor about what 

types of exercise you can do. A gradual 

You have some power to lessen 

your pain! Try using imagery for 

15 minutes, two or three times 

each day.

1. Put on your favorite calming music.

2. Lie back on your favorite chair or sofa. Or 

if you are at work, sit back and relax in 

your chair.

3. Close your eyes.

4. Imagine your pain or discomfort.

5. Imagine something that confronts this 

pain and watch it “destroy” the pain.

and gentle exercise program often works 

well for people with long-lasting muscle 

and joint pain. Some types of yoga or tai 

chi exercises may be helpful.

106 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Living with Autoimmune Diseases
✦ Get enough rest. Rest allows your body 

tissues and joints the time they need to 

repair. Sleeping is a great way you can 

help your body and your mind. If you 

don’t get enough sleep, your stress level 

and symptoms could get worse. You also 

can’t fi ght off sickness as well when you 

sleep poorly. With enough sleep, you can 

tackle your problems better, and you can 

lower your risk for illness. Try to get at 

least seven hours of sleep every night.

✦ Reduce stress and try to “self” manage your pain. See the Stress chapter 

starting on page 120 for helpful hints on 

reducing stress in your life. You might be 

able to lessen your pain or muscle spasms 

if you try meditation or self-hypnosis. 

Th ey may also help you deal with other 

aspects of living with your disease. You 

can learn about these practices by reading 

self-help books, listening to audiotapes, or 

working with an instructor. You also can 

use imagery, which is using the power of 

your thoughts to “destroy” your pain. You 

can also distract yourself from your pain 

by doing a hobby or something else you 

enjoy.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 107

Living with Autoimmune Diseases
A Health Care Team Can Help

Juggling your health care needs among different doctors and other types of health care 

providers can be hard. But visiting other 

types of health care workers, along with 

your main doctor, may help you manage 

some symptoms of your disease. If you are 

visiting many types of health care workers, 

make sure you have a supportive main doctor to help you. Your family doctor may help 

coordinate your care. 

What kind of health care team might help 

me? 

✦ Nephrologist. A doctor who will look at 

how well your kidneys are working. Kidneys are organs that clean the blood and 

produce urine. See page 6 to see where your 

kidneys are located.

✦ Rheumatologist. A doctor who specializes in arthritis and other diseases. 

✦ Endocrinologist. A doctor who specializes in diseases that aff ect your glands, 

which are organs in your body that make 

hormones. Glands help control the body’s 

reproduction, energy levels, weight, food 

and waste production, and growth and 

development.

✦ Physical therapist. A health care worker 

who can help you with stiff ness, weakness, and restricted body movement. 

He or she will work with you to fi nd the 

proper level of exercise for your body.

✦ Occupational therapist. A health care 

worker who can help improve your ability 

to perform day-to-day activities, despite 

your pain and other health problems. 

Th ey can recommend special equipment 

and devices that can help you adapt better 

to your environment. He or she may also 

make changes in your home or workplace. 

✦ Speech therapist. A health care worker 

who can help people with multiple sclerosis (MS) and other illnesses who have 

speech problems.

108 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Living with Autoimmune Diseases
Th en and Now

Multiple sclerosis (MS) develops when 

the body’s immune cells mistakenly attack the nerves in the brain and spinal 

cord. In the past, MS was thought to 

occur just in adults. Now researchers 

in the United States and Canada report 

seeing more children with the disease. 

Why is this number rising? Researchers 

think that more doctors now recognize 

the symptoms of MS and diagnose them 

correctly.

Chronic Fatigue Syndrome and Fibromyalgia

Chronic fatigue syndrome (CFS) and fi bromyalgia (FM) are not autoimmune diseases. But they 

often have symptoms similar to some autoimmune diseases and other illnesses. Just two of 

these symptoms are being tired all the time and being in pain. 

• Chronic fatigue syndrome is a complex disorder that can cause you to be very tired, have 

trouble concentrating, feel weak, and have muscle pain. Symptoms of CFS can come and go. 

We don’t know what causes CFS. 

• Fibromyalgia is a disorder that has symptoms of widespread muscle pain, fatigue (feeling 

tired and having low energy), and multiple tender points. Tender points are located in the 

neck, spine, shoulders, hips, and knees. These areas are painful when pressure is applied to 

them. FM occurs mostly in women of childbearing age. But children, the elderly, and men are 

sometimes diagnosed with FM. We don’t know what causes FM.

✦ Vocational therapist. A health care 

worker who off ers job training for people 

who cannot do their current jobs because 

of their illness or other health problems. You can fi nd a vocational therapist 

through both public and private agencies.

✦ Counselor for emotional support. A 

health care worker who is specially trained 

to help you to fi nd ways to cope with your 

illness. You can work through your feelings of anger, fear, denial, and frustration 

in a safe environment.

✦ Support groups. Some women fi nd support and kinship by talking with others 

who have the same health problems. It 

can help them fi nd new ways of coping 

with their illness. 

✦ Chiropractor. A type of doctor who may 

help relieve some of your symptoms, such 

as muscle spasms and backaches. If you 

are thinking of seeing a chiropractor, talk 

with your main doctor fi rst. Don’t visit a 

chiropractor instead of your regular autoimmune disease doctor.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 109

Living with Autoimmune Diseases
Taking Care of 

Your Smile

Having a healthy smile means so much more than having healthy teeth. It 

means living free of oral problems and diseases. Th e word “oral” refers to the mouth, 

which includes the teeth, gums, and supporting tissues. It is easy to take your oral 

health for granted. But good oral health 

is key to living comfortably each day. Th e 

tissues in your mouth allow you to speak, 

smile, sigh, kiss, smell, taste, chew, and 

swallow. Th ey also let you show a world of 

feelings through your expressions. Taking 

good care of these tissues can prevent disease in them and throughout your body.

Oral Health and Your Body

How are the tissues in your mouth 

linked to health problems in other 

places in your body? 

✦ Did you ever hear the phrase, “the mouth 

is a mirror?” Th e health of your mouth can 

be a sign of your overall health. Many serious diseases, such as diabetes, HIV, and 

some eating disorders, show their fi rst 

symptoms in the mouth. For that reason 

and others, it is very important for you to 

get complete, regular oral exams. 

✦ Most of us think of problems with the 

mouth in terms of cavities, toothaches, 

and crooked or stained teeth. Not having 

healthy teeth and gums can infl uence how 

we look, but it also aff ects the health of our 

bodies. For example: 

 • If you have gum disease, you may be 

more likely to get heart disease. 

 • If you having missing teeth, you may not 

feel as good about yourself as you could. 

 • If you have diabetes, you may be more 

likely to get gum disease. 

 • Studies show that if you have both 

diabetes and gum disease, you can have 

more problems controlling your blood 

glucose levels. 

Th e Most Common Oral Health 

Problems: Cavities and Gum 

Disease

Dental cavities

Everyone is at risk of getting cavities 

throughout their lives. By the time most 

110 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Taking Care of Your Smile
people are adults, 85 percent of people will 

have had a cavity! 

How do we get cavities? 

✦ You naturally have bacteria (germs) in 

your mouth. 

✦ Th e bacteria mix with your saliva and bits 

of food in your mouth to form a coating 

(dental plaque) that sticks to your teeth. 

✦ Acids in the plaque wear away the teeth. 

✦ Th ese acids can get inside the teeth and 

create holes, or cavities.

Gum diseases

Gum diseases become more common as 

we age. Most people show signs of them 

by their mid-30s. Gum disease is caused by 

infection or plaque around your teeth. Th ey 

are the most common reason we lose our 

teeth after the age of 35. 

Gingivitis [jin-ji-vie-tus] is the most common type of gum disease. In its fi rst stage, 

gingivitis irritates the gums and causes 

them to bleed and swell. Periodontitis [pearee-o-don-tie-tus] is a more serious type of 

gum disease. If it is not treated, periodontitis gets worse because pockets of infection 

form between the teeth and gums. Th en the 

gums grow away from teeth and lose supporting bone. If your teeth can’t be supported, they could fall out. 

Th is disease is caused by bacteria in your 

mouth. You may be more likely to be infected with these bacteria if

✦ someone else in your family has 

periodontitis

✦ you smoke

✦ you have a disease such as diabetes 

or HIV

Normal, healthy gums Periodontitis Advanced periodontitis

teeth

gums

Unremoved plaque hardens.

As it keeps building up, the

gums begin to pull away

from the teeth, and pockets

form between the teeth

and gums. 

The gums pull away farther, 

destroying more bone and 

tissue. Teeth may become

loose and need to be

removed. 

Healthy gums and bone

anchor teeth firmly in place. 

Visit the National Women’s Health Information Center web site www.womenshealth.gov 111

Taking Care of Your Smile
Some other problems of the mouth include

Cold sores (herpes simplex virus type 1 

[HSV-1] infections)

If you’ve ever had a cold sore, you’re not 

alone. A half million people get one every 

year. Once you’re exposed to this virus, it 

can hide in the body for years. The virus can 

cause tiredness, muscle aches, a sore throat, 

enlarged and tender lymph nodes, and cold 

sores. These sores or blisters are very contagious. They usually form on the lips. Sometimes the sores appear under the nose or 

under the chin. The sores heal in about 7 to 10 

days without scarring. 

What can trigger the virus? 

• Getting too much sun

• Having mild fevers when you get a cold

• Being under stress

What can help you feel better?

• You can buy medicines at the drug store or 

grocery store to put on the cold sore. They 

will help to numb the area and relieve the 

pain. 

• If cold sores are a problem for you, talk with 

your doctor or dentist about getting a prescription for an antiviral drug. It could help 

lower your chances of getting these kinds 

of viral infections.

Canker sores

These common, but mostly harmless, sores 

appear inside your mouth as ulcers. They have 

a white or gray base and a red border. Canker 

sores tend to be tiny. They usually heal by 

themselves in one to three weeks. 

They occur in women more often than men, 

usually during women’s periods. We don’t 

know why they appear. But some experts 

believe that problems with the immune 

system—the system in our bodies that fi ghts 

disease—may be involved. Bacteria or viruses 

could also be involved. 

What can increase your chances of getting 

canker sores? 

• Feeling tired

• Feeling stressed

• Having allergies

• Having a cut inside your cheek or on your 

tongue 

What can help you feel better?

• If you get a large sore (about 1⁄2 inch in 

size), you may need to be treated with 

medicine. 

• Stay away from hot and spicy foods.

• Use mild mouthwashes or salt water rinses.

• Dab the sore with a mixture of hydrogen 

peroxide and water, or milk of magnesia. 

We don’t know how to prevent canker sores. 

But if you get them often, tell your doctor, 

nurse, or dentist what might be irritating 

your mouth. 

Oral fungal or yeast infections 

(candidiasis [can-di-die-uh-sis])

These infections appear as red or white 

lesions, fl at or slightly raised, in the mouth. 

They are common among denture wearers. 

They occur most often in people who are 

112 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Taking Care of Your Smile
very young, elderly, or who have a problem 

with their immune system (the system in our 

bodies that fi ghts disease). People who have 

dry mouth syndrome are also very likely to 

get oral yeast infections. 

What can prevent these infections?

• These infections can be prevented with 

good oral hygiene. 

• If you wear dentures, clean them and 

remove them at bedtime.

Talk with your doctor or dentist 

about medicines that may be helpful if you 

have a problem with these infections.

Dry mouth syndrome

This condition is common in many adults, 

especially as they age. It may make it hard 

to eat, swallow, taste, and speak. It happens 

when your salivary glands don’t work right, 

often as a side eff ect from medicines or from 

other health problems. If left untreated, this 

lack of salivia can lead to cavities. It is saliva 

that helps get rid of bits of food in your 

mouth. Salivia also helps stop acid from forming plaque on your teeth. 

Oral cancer 

This cancer usually develops in people who 

are older than 40. It is often found when the 

cancer is in its late stages, when it is harder to 

treat. Oral cancer is not usually painful, so you 

may not know you have it. And many people 

do not visit their dentists often enough to fi nd 

the cancer early. 

Oral cancer often starts as a tiny, unnoticed 

white or red spot or sore anywhere in the 

mouth. The most common places it develops 

are on the tongue, the lips, and the fl oor of 

the mouth. Using tobacco, especially with 

drinking alcohol, is the main cause of oral 

cancer.

What are the signs of oral cancer? 

• A sore that bleeds easily or does not heal

• A change in color of the tissues in your 

mouth 

• A lump, thickening, rough spot, crust, or 

small eroded area 

• Pain, tenderness, or numbness anywhere in 

the mouth or on the lips 

• Problems chewing, swallowing, speaking, 

or moving the jaw or tongue 

• A change in the way your teeth fi t together

Oral problems from cancer therapies.

Treatments such as chemotherapy or radiation to the head and neck can cause dry 

mouth, tooth decay, painful mouth sores, and 

cracked, peeling lips.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 113

Taking Care of Your Smile

Oral Health and Women

You need to have good oral hygiene at 

all stages of your life. As a woman, your 

changing hormone levels during puberty, 

menstruation (your monthly period), and 

menopause cause changes in your mouth. 

Hormone changes can cause

✦ frequent cold sores and canker sores 

✦ gingivitis during puberty 

✦ dry mouth (often also linked to using 

certain medicines)
need should be done before the pregnancy 

or between the fourth and sixth month of 

pregnancy. You can get treatment for an 

urgent problem during pregnancy, but it 

can present risks to your baby. Treatments 

are most dangerous during the fi rst three 

months of a pregnancy. If you are in the last 

three months of pregnancy, you may get 

dental treatment. You may fi nd the dental 

chair uncomfortable, though.

Some pregnant women get gum disease, 

a problem called pregnancy gingivitis. It 

increases their chances for getting more 

serious gum disease. Th is condition can be 

caused by poor oral hygiene and increased 

hormone levels during pregnancy. It may 

make you less likely to brush your teeth and 

fl oss the right way or as much as you should. 

Pregnant women with gum diseases are 

much more likely to have premature babies 

of low birth weight.

To control your risk for infl ammation of 

your gums and oral disease,

✦ Start practicing good oral hygiene, if you 

haven’t already.

✦ Eat a healthy diet. 

✦ Be thorough when brushing your teeth 

daily.

✦ Floss your teeth and gums daily.

Oral Health and New Mothers

What should you know? 

✦ Don’t put your baby’s toys, spoons, pacifi ers, and other items in your mouth. Th e 

114 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Taking Care of Your Smile

✦ changes in sensation or taste

✦ increased risk of gum disease

✦ bone weakness before, during, and after 

menopause

Oral Health and Pregnancy

If you are pregnant, you have special oral 

health needs. 

Try to have a complete oral exam done 

before you become pregnant or very early 

in your pregnancy. All dental work that you 
same germs that cause tooth decay in 

your mouth can be passed onto your baby.

✦ Wipe your baby’s teeth and gums with 

a soft cloth or a baby’s toothbrush after 

each nursing and feeding. Th at quick action can help remove the sugars found in 

milk, which can cause tooth decay. 

✦ If you bottle-feed your baby, stop by age one. 

✦ Never put your baby to bed with a bottle 

of milk or juice. 

✦ Never place a pacifi er covered with honey 

or sugar in your baby’s mouth when he or 

she sleeps. 

✦ Sucking on a bottle when lying down can 

destroy your baby’s teeth. It can cause 

years of tooth pain and problems with 

eating.

Pediatricians and pediatric dentists suggest 

that all babies have an oral exam between 

one and two years old. Th is exam checks 

your baby for any problems in the mouth 

and with the way you might be feeding him 

or her. You also can learn how to properly 

care for your child’s teeth and mouth. 

Toothpastes and Mouthwashes

You can choose from so many types of 

toothpastes these days. Some say they’re 

made for whitening your teeth. Others say 

they reduce gingivitis and plaque. Others 

suggest they’re made just for people with 

sensitive teeth. 

What should you know? 

✦ As long as the toothpaste contains fl uoride 

and its box shows 

the American Dental 

Association’s (ADA) 

seal of acceptance, the 

toothpaste is good for 

your oral health. If your toothpaste meets 

those two conditions, then it’s just a personal choice which brand and type to use. 

✦ Mouthwashes claim to freshen your 

breath. But they really only mask bad 

odors in your mouth for a few hours. If 

you use a breath freshener regularly to 

hide bad mouth odor, see your dentist. 

✦ If you need extra help controlling plaque, 

your dentist might suggest using an antiseptic mouth rinse. Many of these products are accepted by the ADA because they 

Visit the National Women’s Health Information Center web site www.womenshealth.gov 115

Taking Care of Your Smile
reduce plaque and gum disease. Th ey also 

help kill the germs that cause bad breath. 

✦ You also may want to use a fl uoride 

mouth rinse, along with brushing and 

fl ossing, to help prevent tooth decay. 

Tooth Whitening or Bleaching

You might want to whiten your teeth more 

than is possible through regular brushing, 

fl ossing, and dental checkups. You have several options. Th ey vary in price and in how 

well they work.

What should you know? 

✦ Chairside bleaching or “power bleaching.” In your dentist’s offi ce, he or she 

applies a gel or a rubber shield to protect 

your gums and oral tissues. Th en a bleach 

is put on your teeth. Ask your dentist if 

the bleaching agents have the ADA seal of 

acceptance. A special light or a laser may 

be used to help the bleach work better. 

But no products that use lasers are accepted right now by the ADA. If you and your 

dentist use this method, you may have to 

visit your dentist more than once. You will 

see results right away, usually your teeth 

will be about fi ve shades brighter. It works 

well on diff erent types of stains on your 

teeth. 

✦ Professionally dispensed bleaching 

solutions. You get these products from 

your dentist, but you use them at home. 

Th ey contain peroxide(s), which actually 

bleach the tooth enamel. Most of these 

solutions are in gel form. Th e solution is 

then placed in a mouth guard or tray that 

fi ts inside your mouth around your teeth. 

How long you use them depends on what 

results you’re looking for and if you are 

sensitive to the bleach. Some products are 

made to be used about twice a day for two 

weeks. Others are used overnight for one 

to two weeks. Th ey work well on many 

types of stains on your teeth. You can get 

your teeth about six shades brighter with 

long-lasting results.

116 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Taking Care of Your Smile
✦ Over-the-counter, TV, and Internet 

products. You can buy these products 

through many diff erent sources and use 

them at home. Th ey include whitening 

strips, paint-on products, and gels and 

trays. Th ey have a low amount of peroxide. You wear some of these products 

during the day. With other products, 

you apply them at night before bedtime. 

Th ey have limited results if you use them 

before you have a professional remove the 

stains. But they can help prolong the results you get from this earlier treatment. 

Th ey can help with stains that result from 

age and certain foods. You can get about 

two shades brighter for up to six months. 

None of these gels and trays are accepted 

by the ADA.

✦ Whitening toothpastes. All toothpastes 

help remove surface staining of your teeth 

through their mild abrasives. “Whitening” toothpastes with the ADA seal have 

special polishing agents that remove 

even more stains. Unlike bleaches, these 

products do not change the actual color of 

your teeth. Th ey help with slight surface 

stains only. You get temporary results of 

perhaps one to two shades brighter.

Keep Smiling! Steps You Can 

Take to Keep Your Mouth 

Healthy

1. Brush your teeth at least twice 

each day, fi rst thing in the morning 

and before going to bed. Once a day, 

use fl oss or an interdental cleaner to 

clean between teeth to remove food 

that your toothbrush missed. 

✦ Drink fl uoridated water and use fl uoride toothpaste. Fluoride protects teeth 

against dental decay at any age. You also 

may want to use a fl uoride mouth rinse, 

along with brushing and fl ossing, to help 

prevent tooth decay. 

Talk with your dentist before you use any 

whitening products. Your dentist can help 

you decide which method is best for the 

type of stains on your teeth. Not all products will work on all people. The options 

off ered by your dentist can be expensive. 

Be certain to ask what results you can really expect. Remember: whitening your 

teeth alone does not make your mouth any 

healthier.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 117

Taking Care of Your Smile
✦ Gently brush all sides of your teeth with a 

soft-bristled brush and a fl uoride toothpaste. Use circular and short back-andforth strokes. 

✦ Take time to brush along the gum line. 

Lightly brush your tongue to help remove 

plaque and food debris. 

✦ Ask your dentist to show you the best way 

to fl oss your teeth. 

✦ Change your toothbrush at least every 

three months or earlier if the toothbrush 

looks worn. A new toothbrush can remove 

more plaque than a toothbrush that’s 

more than three months old.

✦ If you wear dentures, be sure to remove 

them at night. Clean them before putting 

them back in your mouth the next morning.

2. Have a healthy lifestyle.

✦ Eat healthy meals. Brush your teeth, 

gums, and tongue after meals to lessen 

your chances of tooth decay. Don’t snack 

on sugary or starchy foods between meals.

✦ Don’t smoke. Smoking raises your risk 

of getting gum disease, oral and throat 

cancers, and oral fungal infections. 

✦ If you drink alcohol, only drink it in moderation. For women, that means no more 

than one drink per day. For men, that 

means no more than two drinks per day. 

Heavy alcohol use increases your risk of 

getting oral and throat cancers. When alcohol and tobacco are used together, your 

risk of oral cancer is even greater than if 

you only drank or only smoked.

3. Get regular checkups.

✦ Have an oral exam twice a year, so your 

dentist can fi nd any signs of problems early. During regular checkups, dentists and 

other types of dental providers can fi nd 

signs of nutritional defi ciencies, diseases, 

infections, immune disorders, injuries, 

and some cancers. 

✦ Make an appointment right away if you 

have any of these problems:

 • Your gums bleed often.

 • You see any red or white patches on the 

gums or tongue.

118 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Taking Care of Your Smile
 • You have pain in your mouth or jaw 

pain that won’t go away.

 • You have sores in your mouth that do 

not heal within two weeks.

 • You have problems swallowing or 

chewing.

4. Follow your dentist’s advice.

Your dentist may suggest more ways that 

you can keep your mouth healthy. He or she 

can teach you how to properly fl oss or brush, 

and how often. He or she might suggest 

preventive steps or treatments to keep your 

mouth healthy.

5. If you have another health problem, it may aff ect your oral health.

✦ If you take medicines that give you a dry 

mouth, ask your doctor or nurse if there’s 

another medication you can use instead. 

Consider using a saliva substitute. 

✦ Have an oral exam before beginning 

cancer treatment to help prevent or limit 

other oral problems or tissue damage.

✦ If you have diabetes, practice good oral 

hygiene to prevent gum disease. Ask your 

dentist about the best way to brush and 

fl oss. Tell your dentist about your condition. Try to schedule your dental appointments for the mornings, when your blood 

glucose levels are likely to be the most 

stable. On the morning of your offi ce 

visit, eat a light, healthy breakfast.

Th en and Now

In 1945, fl uoride was introduced into 

community water systems in the United 

States. Today, most Americans are exposed to fl uoride from diff erent sources, 

such as water, toothpaste, mouth rinses, 

and some foods. For years now, water fl uoridation has reduced pain and suff ering related to tooth decay. It has reduced tooth 

loss. It has reduced time lost from school 

and work to care for teeth problems. It has 

also reduced the amount of money that 

Americans spend on dental care. Fluoridation has been a major reason why tooth 

decay has been declining in this country.

Other Types of Dental Providers 

• Dental hygienists. They work as part 

of your dentist’s staff . They clean 

patient’s gums and teeth. They instruct 

patients on the ways they can prevent 

oral disease and maintain their oral 

health.

• Periodontists. These dentists treat 

gum disease and place dental 

implants, or artifi cial teeth, to replace 

lost teeth. 

• Oral surgeons. These dentists can 

perform biopsies, which means taking 

a sample of tissue from your mouth so 

they can look at it under a microscope. 

They can also perform surgery on your 

mouth and supporting tissues if you 

have a serious problem.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 119

Taking Care of Your Smile
Coping with 

Stress

Feeling stressed out? It’s hard to stay calm and relaxed in our hectic lives. Our 

day-to-day tasks can feel overwhelming. 

On top of that, many of us are coping with 

serious illnesses in our families and dealing 

with other problems. As women, we have 

many roles: spouse, partner, mother, caregiver, friend, employee, boss. With all we 

have going on in our lives, it seems almost 

impossible to fi nd ways to de-stress. But it’s 

important to fi nd those ways. Your health 

depends on it. 

How Women React to Stress

We all deal with stressful things like traffi c, 

arguments with spouses, and problems on 

the job. Some researchers think that women 

handle stress in a unique way: we tend and 

befriend. 

✦ Tend: Women protect and care for their 

children.

✦ Befriend: Women seek out and get social 

support.

Women’s bodies make chemicals that are 

believed to contribute to these responses 

to stress. One of these chemicals is oxytocin [ahk-see-toe-sin], which has a calming 

eff ect during stress. Th is same chemical is 

released during childbirth. It is also found 

at higher levels in breastfeeding mothers, 

who are believed to be calmer than women 

who don’t breastfeed. Women also have the 

hormone estrogen, which boosts the eff ects 

of oxytocin. Men, however, have high levels 

of testosterone during stress. Th is hormone 

blocks the calming eff ects of oxytocin and 

causes hostility, withdrawal, and anger. 

Stress Aff ects Your Entire Body

Everyone experiences stressful events at 

times. We have short-term stress, such as 

getting lost while driving or missing the 

bus. Even everyday events, such as planning 

a meal or making time for errands, can be 

stressful. Th is kind of stress can make us feel 

worried or anxious. 

Other times, we face long-term stress, such 

as a life-threatening illness, chronic disease, 

disability, divorce, or the death of a loved 

one. Women often have to deal with all 

120 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Coping with Stress
aspects of a loved one passing away, especially if it is a parent or child. Th ese stressful 

events also aff ect your health on many levels. Long-term stress can increase your risk 

for some health problems, like depression. 

Both short-term and long-term stress can 

have negative eff ects on your body. Research is starting to identify how our bodies 

respond to stress. Stress triggers changes in 

our bodies and makes us more likely to get 

sick. It can also worsen some of the health 

problems we already have.

Don’t Let Stress Make You Sick

As women, we tend to carry a higher burden 

of stress than we should. Many times we’re 

not even aware of our stress levels. Listen 

to your body, so you know when stress is affecting your health. 

Common Eff ects of Stress on Your Health

• Trouble sleeping

• Headaches

• Constipation

• Diarrhea

• Irritability

• Lack of energy

• Lack of concentration

• Eating too much or not at 

all

• Anger

• Sadness

• Higher risk of asthma and 

arthritis fl are-ups 

• Tension

• Stomach cramping

• Stomach bloating

• Skin problems, like hives

• Depression

• Anxiety

• Weight gain or loss

• Heart problems 

• High blood pressure

• Irritable bowel syndrome

• Diabetes 

• Neck pain, back pain, or 

both 

• Less sexual desire

• Harder to get pregnant

Tips: How To Lessen Your Stress

✦ Relax. It’s important to unwind. Every 

person has her own way to relax. Some 

ways include deep breathing, yoga, meditation, and massage therapy. You can also 

take a few minutes to sit, listen to soothing music, or read a book.

✦ Make time for yourself. It’s important 

to care for yourself. Remember, you matter. You are worthy of your own care. No 

matter how busy you are, try to set aside 

at least 15 to 30 minutes each day to take 

a walk, work in your garden, play with your 

children. Maybe taking a bubble bath or 

calling a friend is your way to fi ght stress.

✦ Sleep. Sleeping is a great way to help both 

your body and mind. Your stress could get 

worse if you don’t get enough sleep. You 

also can’t fi ght off sickness as well when 

Visit the National Women’s Health Information Center web site www.womenshealth.gov 121

Coping with Stress
you sleep poorly. When you get enough 

sleep, you can tackle your problems better, and you lower your risk of illness. Try 

to get seven to nine hours of sleep every 

night.

✦ Eat healthy. Fuel up with fruit, vegetables, and whole-grain foods, such as 

whole-grain crackers and breads. Don’t be 

fooled by the jolt you get from caff eine or 

sugar. Th at boost of energy you may feel 

will wear off . 

✦ Get moving. Believe it or not, getting 

physical activity helps relieve your tense 

muscles. Moving also improves your 

mood, too! Your body makes certain 

chemicals, called endorphins, after you’re 

active. Th ese chemicals help relieve stress 

and improve your mood. See the Eating 

Healthy and Being Active chapter starting on 

page 36.

✦ Talk to friends. Talk to your friends 

to help you work through your stress. 

Friends are good listeners. Finding someone who will let you talk freely about your 

problems and feelings without judging 

you does a world of good. It also helps to 

hear a diff erent point of view. Friends will 

remind you that you’re not alone.

✦ Get help from a professional if you 

need it. Talk to a therapist. A therapist 

can help you work through stressful 

times. He or she can help you fi nd better 

ways to deal with your problems.

✦ Compromise. Sometimes, it’s not always 

worth the stress to argue. Give in once in 

awhile.

✦ Write down your thoughts. Have you 

ever typed an e-mail to a friend about 

your lousy day and felt better afterward? 

Most Stressful Life Events

Any change in our lives can be stressful. 

Even some of our happiest times can produce stress, such as having a baby or getting a new job. Here are some of the most 

stressful events in our lives. 

• Death of a spouse

• Divorce

• Marital separation

• Spending time in jail 

• Death of a close family member

• Personal illness or injury

• Marriage

• Pregnancy

• Retirement

Mental Health: A Report of the Surgeon General (1999)

122 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Coping with Stress
Why not grab a pen and paper and write 

down what’s going on in your life. Or 

type your thoughts. Keeping a journal of 

any kind can be a great way to get things 

off your mind and work through issues. 

Later, you can go back and read through 

your journal and see how you’ve made 

progress!

✦ Help others. Helping someone else can 

help you. Help your neighbor, or volunteer in your community. 

✦ Get a hobby. Find something you enjoy 

doing. Be sure to give yourself time to explore your interests. Is it reading? Painting? Swimming? 

✦ Set limits. When it comes to work and 

family, fi gure out what you can reasonably do. You only have so many hours 

in a single day. Set limits with yourself 

Deep Breathing: A Guide

Deep breathing is a good way to relax. Try it 

a few times every day. 

1. Lie down or sit in a chair.

2. Rest your hands on your abdomen.

3. Slowly count to four and inhale through 

your nose. Feel your abdomen rise. Hold 

it for a second.

4. Slowly count to four while you exhale 

through your mouth. To control how fast 

you exhale, purse your lips like you’re going to whistle. Your abdomen will slowly 

fall.

5. Repeat 5 to 10 times.

and others. Don’t be afraid to say NO to 

requests for your time and energy.

✦ Plan your time. Th ink ahead about how 

you’re going to spend your time. Write 

a to-do list. Figure out what’s the most 

important task to get done that day. 

✦ Don’t deal with your stress in unhealthy ways. Don’t drink too much alcohol. Don’t use illicit drugs. Don’t smoke. 

Don’t overeat. 

Th en and Now

Among this group, who is the most likely 

to get an ulcer?

a. High school teacher

b. Police offi cer

c. Medical resident

d. Stockbroker

e. Reporter

f. Waiter

g. Mother

Th ey all have the same chance of getting an ulcer! Doctors used to think that 

ulcers were caused by stress and spicy 

foods. Now we know that stress doesn’t 

cause ulcers—it just irritates them. Ulcers are actually caused by a germ called 

Helicobacter pylori. Researchers don’t 

know for sure how people get this germ. 

It might be through food or water. Ulcers 

are treated with a combination of antibiotics and other drugs.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 123

Coping with Stress
Protecting 

Yourself from 

Violence and 

Abuse

Violence and abuse aff ect all kinds of people every day. It doesn’t matter what 

race or culture you come from, how much 

money you have, or if you have a disability. 

It is most common among women between 

ages 15 and 54, but it can happen at any 

age. Learn more about how to recognize the 

signs of violence and abuse. Learn how to 

stay safe. If you are being abused or have 

a loved one who is abused, or think there 

is abuse, get help as soon as you can. Remember, abuse can be physical, mental, and 

emotional.

Th e Most Common Forms of 

Violence

Domestic violence and abuse. It is also 

called intimate partner violence, partner 

abuse, spouse abuse, or battering. It occurs when one person uses force to infl ict 

injury — either emotional or physical — on 

another person they have, or had, a relationship with. It occurs between spouses and 

partners, parents and children, children 

and grandparents, and brothers and sisters. 

Victims can be any age, race, or gender.

Often, the violent person is a husband, 

former husband, boyfriend, or ex-boyfriend. 

But sometimes the abuser is female. Domestic violence and abuse are common and must 

be taken very seriously.

Forms of domestic violence and abuse 

include

✦ physical abuse 

✦ psychological or emotional abuse

✦ sexual assault

✦ isolation 

✦ controlling all of the victim’s money, 

shelter, time, food, etc. 

Sexual assault and abuse. It is any type of 

sexual activity that you do not agree to. Sexual assault can be verbal, visual, or anything 

that forces a person to join in unwanted 

sexual contact or attention. Rape is a common form of sexual assault. It is committed 

in many situations—on a date, by a friend 

or an acquaintance, or by a stranger.

124 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Protecting Yourself from Violence and Abuse
Examples of sexual assault and abuse 

include

✦ inappropriate touching 

✦ vaginal, anal, or oral penetration

✦ sexual intercourse that you say “NO” to 

✦ rape 

✦ attempted rape

✦ child molestation

✦ voyeurism, when someone watches private sexual acts

✦ exhibitionism, when someone exposes 

himself or herself in public

✦ incest, which is sexual contact between 

family members

✦ sexual harassment, whether it occurs by a 

stranger, in the workplace, on a date, or in 

the home by someone you know

Educate yourself on “date rape” drugs. Th ey 

can be slipped into a drink when you’re not 

looking. Never leave your drink unattendSigns You Are Being Abused

If someone you love, live with, or had a 

relationship with does any of these things 

to you, it’s time to get help.

• Monitors what you’re doing all the time.

• Criticizes you for little things.

• Constantly accuses you of being unfaithful.

• Prevents or discourages you from seeing 

friends or family, or going to work or 

school.

• Gets angry when he or she is drinking 

alcohol or using drugs.

• Controls how you spend your money.

• Controls your use of medicines you need.

• Humiliates you in front of others.

• Destroys your property or things that you 

care about.

• Threatens to hurt you, the children, or 

pets.

• Causes harm by hitting, beating, pushing, 

shoving, punching, slapping, kicking, or 

biting.

• Uses or threatens to use a weapon 

against you.

• Forces you to have sex against your will.

• Blames you for his or her violent outbursts.

ed—no matter where you are. Always be 

aware of your surroundings. Date rape drugs 

make a person unable to resist assault and 

have memory loss of the event.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 125

Protecting Yourself from Violence and Abuse
Elder abuse. Th is abuse occurs when a caregiver, family member, or others use power 

and control to infl ict physical, sexual, emotional, or fi nancial injury or harm on vulnerable adults in their care. Many victims are 

people who are older and frail and depend 

on others to meet their needs. It can happen to women and men. It can aff ect people 

of all ethnic backgrounds and social status. 

Family members of the victim are responsible for most cases of elder abuse.

Types of elder abuse are 

✦ physical abuse

✦ emotional abuse

✦ sexual abuse

✦ exploitation 

✦ neglect

✦ abandonment

Signs of Elder Abuse

Type of Elder 

Abuse

Signs and Symptoms Include, But Are Not Limited To, the 

Following:

Physical abuse:

Infl icting, or threatening to infl ict, physical pain or injury on 

a vulnerable elder, or 

depriving them of a 

basic need

• Bruises, black eyes, welts, lacerations, and rope marks from being restrained

• Bone fractures, broken bones, and skull fractures

• Open wounds, cuts, punctures, and untreated injuries

• Sprains, dislocations, internal injuries, and internal bleeding 

• Broken eyeglasses or frames, or physical signs of being subjected to punishment

• Laboratory fi ndings of medication overdose or the under-use of 

prescribed medications

• An elder’s report of being hit, slapped, kicked, or mistreated

• An elder’s sudden change in behavior

• An elder who does not want to be alone with caregiver

• Th e caregiver’s refusal to allow visitors to see an elder alone

• Changes in speaking, breathing, or swallowing that may be the 

result of strangulation

126 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Protecting Yourself from Violence and Abuse
Type of Elder 

Abuse

Signs and Symptoms Include, But Are Not Limited To, the 

Following:

Sexual abuse:

Any sexual contact 

that is not agreed to 

by the elder, like unwanted touching and 

all types of sexual 

assault

• Bruises around the breasts or genital area

• Unexplained sexually transmitted diseases (STDs) or genital 

infections

• Unexplained vaginal or anal bleeding

• Torn, stained, or bloody underclothing

• An elder’s report of being sexually assaulted or raped

Emotional abuse: 

Infl icting mental 

pain, anguish, or distress on an elder person through verbal or 

nonverbal acts

• Being emotionally upset or agitated

• Being extremely withdrawn and non-communicative or non-responsive

• Unusual behavior, usually thought to be caused by dementia 

(for example, sucking, biting, rocking)

• An elder’s report of being verbally or emotionally mistreated

• Isolation: Family members and friends may be cut off from the 

victim because the abuser refuses to allow contact with the elder 

or relay information to the elder. 

• Psychological abuse is a strong indicator that other forms of 

abuse are also occurring. 

Exploitation:

Illegal taking, misuse, 

or concealment of 

funds, property, or 

assets of a vulnerable 

elder

• Sudden changes in bank account or banking practice

• Unexplained withdrawal of large sums of money by a person accompanying the elder

• Including additional names on an elder’s bank signature card

• Abrupt changes in a will or other fi nancial documents

• Unexplained disappearance of funds or valuable possessions

• Substandard care being provided or bills unpaid despite adequate fi nancial resources

• Discovery of an elder’s signature being forged 

• An elder’s report of fi nancial exploitation 

Visit the National Women’s Health Information Center web site www.womenshealth.gov 127

Protecting Yourself from Violence and Abuse
Type of Elder 

Abuse

Signs and Symptoms Include, But Are Not Limited To, the 

Following:

Neglect:

Refusal or failure by 

those responsible to 

provide food, shelter, 

health care, fi nancial 

care, or protection for 

a vulnerable elder

• Dehydration, malnutrition, untreated bed sores, and poor personal hygiene

• Unattended or untreated health problems

• Hazardous or unsafe living conditions: improper wiring, no 

heat, or no running water

• Unsanitary and unclean living conditions: dirt, fl eas or lice on 

the person, soiled bedding, fecal and urine smells, inadequate 

clothing

• An elder’s report of being mistreated

Abandonment:

Th e desertion of 

a vulnerable elder 

by anyone who has 

assumed the responsibility for care 

or custody of that 

person

• Th e desertion of an elder at a hospital, a nursing facility, a 

shopping center, or other public place

• An elder’s own report of being abandoned 

Steps to Get Help for Elder 

Abuse

Each one of us has a responsibility to keep 

vulnerable elders safe from harm. Every case 

of elder abuse should be reported. 

Legislators in all 50 states have passed some 

form of laws on the issue of elder abuse. 

Th ese laws vary greatly from state to state. 

But all states have set up reporting systems. 

Adult Protective Services (APS) agencies 

receive and investigate reports of suspected 

elder abuse. Th ey screen calls for potential 

seriousness. It keeps all information confi -

dential. If the agency decides the situation 

might be violating the state’s laws, it assigns 

a caseworker to conduct an investigation 

(in cases of an emergency, usually within 24 

hours). If the victim needs crisis intervention, services are available. 

✦ Call the police or 911 immediately if 

someone you know is in immediate, lifethreatening danger!

✦ If the danger is not immediate, but you 

suspect that abuse has occurred or is 

occurring, report your suspicions to the 

local APS agency. 

128 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Protecting Yourself from Violence and Abuse
✦ If you cannot fi nd the telephone number 

for your state’s Adult Protective Services 

hotline, call the Eldercare Locator 

helpline at 1-800-677-1116. Specially 

trained operators will refer you to a local 

agency that can help you. Th e helpline is 

open Mondays–Fridays, 9 a.m.–8 p.m., 

Eastern Standard Time. 

✦ To report elder abuse, call Adult Protective Services through your state’s hotline. 

For a state-by-state listing of statewide 

toll-free telephone numbers, go to the 

web site of the National Center on Elder 

Abuse at www.elderabusecenter.org/

default.cfm?p=statehotlines.cfm. 

✦ If the suspected incident of elder abuse 

involves an older person living in an institutional setting, call the offi ce of the local 

long-term care (LTC) ombudsman. Go to 

the web site of the National Center on 

Elder Abuse at www.elderabusecenter.org/

default.cfm?p=nursinghomeabuse.cfm. 

You’ll fi nd a directory of state hotlines 

for reporting abuse in nursing homes, 

assisted living, or board and care homes. 

You’ll also fi nd many other resources 

there to help you report suspected abuse. 

Steps to Get Help for Domestic 

Violence and Abuse

You’re not alone. Many women are victims 

of domestic abuse.

✦ If you are abused or have a loved one who 

is abused, get help. 

✦ Call a crisis hotline or the National 

Domestic Violence Hotline at 1-800-

799-SAFE (7233) or TDD 1-800-787-

3224. Th is hotline is available 24 hours 

a day, 365 days a year, in English, Spanish, and other languages. It can give you 

the phone numbers of local hotlines and 

other resources. 

✦ Call the police or leave if you or your children are in danger! 

✦ Don’t ignore it. Th e abuse won’t go away. 

Learn how to lower your risk of being a 

victim before you fi nd yourself in an uncomfortable or threatening situation.

✦ Don’t keep it to yourself. Talk with someone you trust: a family member, friend, 

colleague, or faith counselor. 

Visit the National Women’s Health Information Center web site www.womenshealth.gov 129

Protecting Yourself from Violence and Abuse
✦ If you’ve been hurt, get medical attention. 

Go to a doctor or an emergency room and 

report what happened to you. Ask that 

they document your visit.

✦ Call the police. Abuse is a crime and you 

have rights. 

✦ Find out about local battered women’s 

shelters before you have to use them during a crisis. A crisis hotline or the police 

can help you fi nd one.

✦ Plan for how you and your children will 

escape if you’re attacked again. Identify a 

safe place for them, like a friend’s house, 

where they can go for help.

✦ Put aside emergency money as you can. 

Or ask friends or family members to hold 

money for you.

✦ If you decide to leave, you’ll be prepared. 

Put important papers—marriage license, 

birth certifi cates, regularly needed medications, credit cards, checkbooks, insurance information, and other papers—in a 

place where you can get them quickly.

✦ Contact your family court for information 

about getting a civil protection order. Call 

a domestic violence court, if one is off ered 

by your state. 

✦ To fi nd a state-by state list of places to get 

help, go to www.womenshealth.gov/

violence/state. 

Steps to Get Help for Sexual 

Assault

Take action right away if you’ve been 

sexually assaulted.

✦ Get away from the attacker to a safe place 

as fast as you can. Th en call 911 or the 

police. 

✦ Call a crisis center or a hotline to talk 

with a counselor. One hotline is the 

National Sexual Assault Hotline at 

1-800-656-HOPE (4673).

✦ Feelings of shame, guilt, fear, and shock 

are normal. Get counseling from a trusted 

professional.

✦ Call a friend or family member you trust. 

If you are that trusted someone, you can 

help by listening and off ering comfort. Go 

130 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Protecting Yourself from Violence and Abuse
with her or him to the police, the hospital, 

or to counseling. Reinforce the message 

that she or he is not at fault and that it is 

natural to feel angry and ashamed. 

✦ Do not wash, comb, or clean any part of 

your body. Do not change clothes if possible, so the hospital staff can collect evidence. Do not touch or change anything 

at the scene of the assault.

✦ Go to your nearest hospital emergency 

room as soon as possible. You need to be 

examined, treated for any injuries, and 

screened for possible sexually transmitted 

diseases (STDs) or pregnancy. Th e doctor 

will collect evidence using a rape kit for 

fi bers, hairs, saliva, semen, or clothing 

that the attacker may have left behind.

✦ You or the hospital staff can call the police 

from the emergency room to fi le a report.

✦ Ask the hospital staff about possible support groups you can attend right away.

Steps to Get Help for Elder 

Abuse

✦ When an elder is in immediate danger, 

call 911 or the local police.

✦ For help with locating elder care services, 

call toll-free to the Eldercare Locator at 

1-800-677-1116.

✦ Protect your loved ones from abuse. Make 

sure they get the care and services they 

need. 

✦ Every case of elder abuse should be reported to the local authority in your area. 

✦ Reporting procedures diff er in each 

state. Look in your area phone book for 

numbers of the Adult Protective Services 

(APS) agency, or a Department on Aging, 

an Agency on Aging, or the Department 

of Social Services. 

✦ Many states have 24-hour toll-free numbers that take calls for reporting elder 

abuse. You can get more information on 

elder abuse from the National Center on 

Elder Abuse at www.elderabusecenter.org. 

Th en and Now

In the past, employers didn’t get involved 

if an employee suff ered from violence at 

home. In the 1990s, people began to realize that the abuse would happen at work 

as well. Abusive partners would harrass 

the victims at work. Some employers and 

state governments have started to take 

steps to address this growing problem.

To get immediate help and support,

• Call the National Domestic Violence 

Hotline at 1-800-799-SAFE (7233) or TDD 

1-800-787-3224.

• Call the National Sexual Assault Hotline 

at 1-800-656-4673.

• Call the Eldercare Locator at 1-800-677-

1116 for help with locating elder care 

services.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 131

Protecting Yourself from Violence and Abuse
Understanding 

Menopause and 

Its Challenges

Menopause

Menopause is a normal change in your life 

that usually happens when you are in your 

late 40s to mid-50s and your period stops. 

Th at’s why some people call menopause “the 

change of life.” During perimenopause, your 

body begins making less of the hormones 

estrogen and progesterone. (Perimenopause 

is the years leading up to menopause and 

one year after your fi nal menstrual period.) 

You have reached menopause when you have 

not had a period for 12 months in a row 

(and you are not pregnant or breastfeeding 

and you have no other disease-related causes 

for this change). As you near menopause, 

you may have symptoms from the hormone 

changes in your body. Many women wonder 

if these changes are normal. Many women 

are confused about how to treat their symptoms. It may help you feel better to learn all 

you can about menopause and to talk with 

your doctor about your health and your 

symptoms. If you want to treat your symptoms, your doctor or nurse can teach you 

more about your options and help you make 

the best treatment choices. 

Symptoms of Perimenopause 

Some women may not have any symptoms 

around the time of menopause. Other 

women may have these symptoms: 

✦ Changes in your period: Th e time between 

periods and the fl ow from month to 

month may be diff erent.

✦ Abnormal bleeding or “spotting”: Common as you near menopause. But if your 

periods have stopped for 12 months in 

a row and you still have “spotting,” you 

should report this symptom to your doctor to rule out serious causes, such as 

cancer. 

✦ Hot fl ashes (“hot fl ushes”): Getting warm 

and possibly sweaty in the face, neck, and 

chest.

✦ Night sweats and sleeping problems: 

Th ese symptoms may lead to feeling tired, 

stressed, or tense.

132 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Understanding Menopause and Its Challenges
✦ Vaginal changes: Th e vagina may become 

dry and thin, and sex and vaginal exams 

may be painful. You also might get more 

vaginal infections.

✦ Weakening of your bones: Th is may increase your chances of bone breaks (osteoporosis) and loss of height. See the Getting 

Strong Bones chapter, starting on page 42, 

for information on osteoporosis.

Th ese changes may also happen around the 

time of menopause, but are not necessarily 

caused by hormone changes:

✦ mood changes, such as mood swings, 

depression, and irritability

✦ urinary problems, such as leaking urine 

when sneezing, coughing, or laughing; or 

burning or pain when urinating

✦ problems with concentration or memory

✦ less interest in sex and changes in sexual 

response

✦ weight gain or increase in body fat around 

your waist

✦ hair thinning or loss

Treatment for Menopause

Should you seek treatment for the symptoms of menopause? Many of your menopause symptoms will go away over time 

without treatment. Some women will choose 

treatment for their symptoms or to prevent 

bone loss that can happen around the time 

of menopause. Treatments may include 

prescription drugs that contain types of 

hormones that your ovaries stop making 

around the time of menopause. Menopausal 

hormone therapy can contain the hormone 

estrogen alone, for a woman who does not 

have a uterus or womb, as a result of a hysterectomy or surgical removal. Menopausal 

hormone therapy can also contain estrogen with the hormone progesterone, for a 

woman who still has her uterus. Estrogen 

therapy usually is taken by pill or skin patch, 

Who Should NOT Take Hormone 

Therapy for Menopause? 

Women who

• think they are pregnant

• have had certain kinds of cancers (such 

as breast cancer and uterine cancer)

• have had a stroke or heart attack

• have had blood clots

• have liver disease

Visit the National Women’s Health Information Center web site www.womenshealth.gov 133

Understanding Menopause and Its Challenges
as a cream or gel, or using a vaginal ring or 

tablet. How estrogen is taken can depend on 

its purpose. For instance, a vaginal ring or 

cream can ease vaginal dryness, but it may 

not relieve hot fl ashes. If you only want to 

prevent bone loss, you also should talk with 

your doctor about medicines other than 

menopausal hormone therapy that can help 

your bones.

Risks and Benefi ts of 

Menopausal Hormone Th erapy 

Benefi ts. Menopausal hormone therapy can 

help with menopause by

✦ reducing hot fl ashes

✦ treating vaginal dryness

✦ slowing bone loss

DO NOT use hormone therapy to prevent 

heart attacks, strokes, memory loss, or Alzheimer’s disease. And remember, there are 

other medicines that can help your bones. 

Talk with your doctor to identify what will 

work best for you. 

Risks. For some women, menopausal hormone therapy may increase their chance of 

getting

✦ blood clots

✦ heart attacks

✦ strokes

✦ breast cancer

✦ gallbladder disease

What Have We Learned 

About Taking Menopausal 

Hormone Therapy? 

We know that menopausal hormone 

therapy may be an eff ective way to help 

with symptoms of menopause. Hormones 

do NOT help prevent heart disease, stroke, 

memory loss, or Alzheimer’s disease. If you 

decide to use hormones, use them at the 

lowest dose that helps and for the shortest time needed. Check with your doctor 

regularly to see if you still need them.

Because both benefi ts and risks are linked 

to taking them, every woman should think 

about these in regard to her own health. 

She should also discuss these issues with 

her doctor. We are still trying to learn more 

about the long- and short-term eff ects of 

hormone therapies on women’s health. 

134 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Understanding Menopause and Its Challenges
For a woman with a uterus, taking estrogen 

alone, without progesterone, increases her 

chance of getting endometrial cancer (cancer 

of the lining of the uterus). Adding progesterone to the estrogen therapy lowers this 

risk. 

Menopausal hormone therapy also may 

cause these side eff ects:

✦ vaginal bleeding (like having a period)

✦ bloating

✦ breast enlargement or tenderness

✦ headaches

✦ mood changes

✦ nausea

Natural Treatments

Some women decide to take herbal, natural, 

or plant-based products to help their symptoms. Some of the most common products 

include the following.

✦ Soy. Soy contains phytoestrogens (estrogen-like substances from a plant). 

But there is no proof that soy—or other 

sources of phytoestrogens—really do 

relieve hot fl ashes. Any risks of taking soy, 

Visit the National Women’s Health Information Center web site www.womenshealth.gov 135

Understanding Menopause and Its Challenges

If you decide to use 

hormones, use them at 

the lowest dose that helps 

and for the shortest time 

needed. Check with your 

doctor regularly to see if 

you still need them. 
especially the pills and powders, are not 

known. You can get soy from foods, too. 

Soy food products include tofu, tempeh, 

soy milk, and soy nuts. 

✦ Bioidentical hormone therapy. Some 

women are interested in menopausal 

symptom therapies marketed as “bioidentical hormone therapy.” Every product 

is custom compounded, so the mixture 

of hormones and other substances can 

vary from patient to patient, from bottle 

to bottle. Although some products are 

labeled as “natural” and containing plant 

products, they are not necessarily safer or 

more eff ective than prescription hormone 

products. Before using these therapies, 

you should discuss them with your doctor. 

You should also tell your doctor about all 

the medications you are taking, both prescription drugs and the over-the-counter 

products, including herbal products. Some 

herbal products can interact with drugs. 

Other Ways to Help Your 

Symptoms 

✦ Hot fl ashes. A 

hot environment; 

eating or drinking hot or spicy 

foods, alcohol, 

or caff eine; and 

stress can bring 

on hot fl ashes. 

Try to avoid these 

triggers. Dress 

in layers and keep a fan in your home or 

workplace. Regular exercise might also 

bring relief from hot fl ashes and other 

symptoms. Ask your doctor about taking an antidepressant medicine. Th ere is 

proof that these medicines can be helpful 

for some women.

✦ Vaginal dryness. Use an over-the-counter, water-based vaginal lubricant. Your 

doctor might also give you prescription 

estrogen creams or tablets. If you have 

spotting or bleeding while using estrogen 

creams, tell your doctor. 

✦ 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 avoid a lot 

of exercise close to bedtime. Also avoid 

alcohol, caff eine, large meals, and napping near bedtime. You might want to 

drink something warm, such as herb tea 

136 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Understanding Menopause and Its Challenges
or warm milk, before you go to bed. Try 

to keep your bedroom at a comfortable 

temperature. Try to go to bed and get up 

at the same times every day.

✦ Memory problems. Keep an active mind. 

Read, work crossword or other puzzles, or 

learn something new. Try to get enough 

sleep and be physically active.

✦ Mood swings. Try to get enough sleep 

and be physically active. Th ink about going to a support group for women who are 

going through the same thing as you are. 

Or think about getting counseling to talk 

through your problems and fears. Antidepressant medicines may also help in some 

cases. Ask your doctor whether these 

medicines are right for you. 

Improve Your Health Whether 

You Use Hormones or Not 

You have many ways to stay healthy during 

this time in your life. 

✦ Be active and get plenty of exercise. Try to 

get at least 30 minutes of physical activity 

on most days of the week. Try weightbearing exercises, like walking, running, 

or dancing.

✦ If you smoke, quit. Ask your doctor for 

help.

✦ Eat healthy. 

 • Eat lots of whole-grain products, vegetables, and fruit. 

 • Choose foods low in fat and cholesterol. 

Visit the National Women’s Health Information Center web site www.womenshealth.gov 137

Understanding Menopause and Its Challenges
 • Get enough calcium and vitamin D to 

keep your bones strong. Women older 

than 50 need 1200 mg of calcium per 

day. You also need 400 IU of vitamin D 

from ages 51 to 70. You need 600 IU of 

vitamin D after age 70.

✦ If you drink alcohol, limit it to no more 

than one drink per day. “One drink” is 

defi ned as one 12-ounce bottle of beer or 

wine cooler, one 5-ounce glass of wine, or 

1.5 ounces of 80-proof distilled spirits. 

✦ Control your weight. Ask your doctor 

what a healthy weight is for you.

✦ Talk with your doctor and get regular 

checkups.

✦ Discuss bone 

health. Ask if 

you’re getting 

enough calcium 

and vitamin D. 

Get a bone density test if you’re 

older than 65, or 

if your doctor says 

you have a high 

chance of getting 

osteoporosis. Ask 

about taking medicine to help preserve 

bone and slow down bone loss.

✦ Have your blood pressure, cholesterol, and 

blood glucose checked regularly. 

✦ Have regular breast exams, breast x-rays 

(a mammogram), and Pap tests.

Th en and Now

Researchers used to think that thin women have worse menopausal symptoms. 

But researchers are now fi nding that the 

opposite is true. Th e heavier the woman, 

the worse some menopausal symptoms, 

such as hot fl ashes or night sweats, 

actually are. Our knowledge about the 

symptoms of menopause is growing. New 

information continues to emerge.

138 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Understanding Menopause and Its Challenges
Use this chart to keep track of menopausal symptoms that bother you. Take it with you 

when you visit your doctor, so you both can fi gure out the best way to handle them.

Date Symptoms Things I’ve tried to help them Questions to ask my doctor New things to try

Visit the National Women’s Health Information Center web site www.womenshealth.gov 139

Understanding Menopause and Its Challenges
Birthday

Appointment

Vacation

Special

Event

Special

Event

Special

Event

Special

Event

Special

Event

Special

Event

Don’t

Forget!

Don’t

Forget!

Don’t

Forget!

Don’t

Forget!

Don’t

Forget!

Don’t

Forget!

Don’t

Forget!

Don’t

Forget!

Don’t

Forget!

Don’t

Forget!

Birthday Birthday Birthday Birthday Birthday Wedding Wedding Wedding

Anniversary Anniversary Anniversary

Call Call Call Call Call Call Call

Appointment

Appointment

Appointment

Appointment

Appointment

Appointment

Appointment

Vacation Vacation

Play Play Play Play Play

Shopping Shopping Shopping

Graduation Graduation Shopping Shopping

Back to

School

Back to

School

Dinner

Party

Pay Day

Pay Day Pay Day Pay Day Pay Day Pay Day Pay Day Pay Day Pay Day Pay Day Pay Day Pay Day

Period

Period Period Period Period Period Period Period Period Period Period Period

Pay Day Pay Day Pay Day Pay Day Pay Day Pay Day Pay Day Pay Day Pay Day Pay Day Pay Day

Hair

Appointment

Hair

Appointment

Hair

Appointment

Exercise

class begins

Exercise

class begins

Exercise

class begins

Dinner

Party

Quiet Time Quiet Time Quiet Time

Quiet Time Quiet Time Quiet Time

Immunizations

blood

pressure

test

Get a Pap

Test

Dental

Exam

Dental

Exam

Bone

Density

Test

Colonoscopy Due Date

Doctor’s

Appointment

Doctor’s

Appointment

Eye Exam Mole/Skin

Test Checkup Mammogram

Doctor’s

Appointment

Doctor’s

Appointment

Doctor’s

Appointment

Doctor’s

Appointment

Doctor’s

Appointment

Flu Shot Cholesterol

Test

Blood

Glucose Test

Hair

Appointment

Dinner

Party

Dinner

Party

Special

Event

Special

Anniversary Event

Wedding Wedding

Birthday Birthday Birthday

Call
140 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

January

January 2007

Sunday Monday Tuesday Wednesday Th ursday Friday Saturday

1 2 3 4 5 6

7 8 9 10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30 31

New Year’s Day

Martin Luther 

King Jr. Day
January 2007

Visit the National Women’s Health Information Center web site www.womenshealth.gov 141

January

1

Monday

2

Tuesday

3

Wednesday

4

Th ursday

5

Friday

6

Saturday

New Year’s Day

Featured health observance: National Cervical Health Awareness 

Month

✦ A new vaccine called Gardasil can prevent cervical cancer, precancerous genital lesions, and 

genital warts caused by human papillomavirus (HPV). Ask your doctor or nurse about Gardasil!

✦ Make sure to get a Pap test to screen for cervical cancer every 1 to 3 years. 

✦ Ask your doctor or nurse if you should get screened for this cancer more often.
142 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

January

January 2007

7

Sunday

8

Monday

9

Tuesday

10

Wednesday

11

Th ursday

12

Friday

13

Saturday
Visit the National Women’s Health Information Center web site www.womenshealth.gov 143

January

14

Sunday

15

Monday

16

Tuesday

17

Wednesday

18

Th ursday

19

Friday

20

Saturday

S M T W T F S

 1 2 3 4 5 6

7 8 9 10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30 31

Martin Luther King Jr. Day
144 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

January

January 2007

21

Sunday

22

Monday

23

Tuesday

24

Wednesday

25

Th ursday

26

Friday

27

Saturday
Visit the National Women’s Health Information Center web site www.womenshealth.gov 145

January

28

Sunday

29

Monday

30

Tuesday

31

Wednesday

S M T W T F S

 1 2 3 4 5 6

7 8 9 10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30 31

Notes
146 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

February

February 2007

Sunday Monday Tuesday Wednesday Th ursday Friday Saturday

1 2 3

4 5 6 7 8 9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28

Valentine’s Day

President’s Day Ash Wednesday 

Groundhog Day
Visit the National Women’s Health Information Center web site www.womenshealth.gov 147

February

1

Th ursday

2

Friday

3

Saturday

Featured health observance: Heart Month

Know the signs of a heart attack. During a heart attack, women often have one or more of 

these symptoms:

✦ pain, discomfort, or pressure in the center of the chest

✦ pain or discomfort in other areas of the upper body, including the arms, back, neck, jaw, 

or stomach

✦ shortness of breath (trouble breathing)

✦ breaking out in a cold sweat

✦ nausea or an upset stomach

✦ dizziness 

February 2007

Groundhog Day
148 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

February

February 2007

4

Sunday

5

Monday

6

Tuesday

7

Wednesday

8

Th ursday

9

Friday

10

Saturday
Visit the National Women’s Health Information Center web site www.womenshealth.gov 149

February

11

Sunday

12

Monday

13

Tuesday

14

Wednesday

15

Th ursday

16

Friday

17

Saturday

S M T W T F S

 1 2 3

4 5 6 7 8 9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 

Valentine’s Day
150 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

February

February 2007

18

Sunday

19

Monday

20

Tuesday

21

Wednesday

22

Th ursday

23

Friday

24

Saturday

President’s Day

Ash Wednesday 
Visit the National Women’s Health Information Center web site www.womenshealth.gov 151

February

25

Sunday

26

Monday

27

Tuesday

28

Wednesday

S M T W T F S

 1 2 3

4 5 6 7 8 9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 

Notes
152 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

March

March 2007

Sunday Monday Tuesday Wednesday Th ursday Friday Saturday

1 2 3

4 5 6 7 8 9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

Daylight Saving 

Time starts St. Patrick’s Day

Spring begins

National Women 

and Girls HIV/AIDS 

Awareness Day
Visit the National Women’s Health Information Center web site www.womenshealth.gov 153

March

1 

Th ursday

2

Friday

3

Saturday

Featured health observance: National Colorectal Cancer 

Awareness Month

Cancer of the colon or rectum is often called colorectal cancer. Th e colon and rectum are part 

of the large intestine, which is part of the digestive system. 

✦ Your risk of getting colorectal cancer may increase if you aren’t physically active, especially if your diet is high in fat. Another great reason to get moving! 

✦ If you are 50 years of age or older, get a colonoscopy every 10 years. 

✦ Ask your doctor or nurse if you should get screened for this cancer more often or at a 

younger age.

March 2007
154 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

March

March 2007

4

Sunday

5

Monday

6

Tuesday

7

Wednesday

8

Th ursday

9

Friday

10

Saturday National Women and Girls HIV/AIDS Awareness Day
Visit the National Women’s Health Information Center web site www.womenshealth.gov 155

March

11

Sunday

12

Monday

13

Tuesday

14

Wednesday

15

Th ursday

16

Friday

17

Saturday

S M T W T F S

 1 2 3

4 5 6 7 8 9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24 

25 26 27 28 29 30 31

Daylight Saving Time starts

St. Patrick’s Day
156 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

March

March 2007

18

Sunday

19

Monday

20

Tuesday

21

Wednesday

22

Th ursday

23

Friday

24

Saturday

Spring begins
Visit the National Women’s Health Information Center web site www.womenshealth.gov 157

March

25

Sunday

26

Monday

27

Tuesday

28

Wednesday

29

Th ursday

30

Friday

31

Saturday

S M T W T F S

 1 2 3

4 5 6 7 8 9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24 

25 26 27 28 29 30 31
158 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

April

April 2007

Sunday Monday Tuesday Wednesday Th ursday Friday Saturday

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30

Palm Sunday 

First day of 

Passover Good Friday 

Easter

Last day of 

Passover 
Visit the National Women’s Health Information Center web site www.womenshealth.gov 159

April

1

Sunday

2

Monday

3

Tuesday

4

Wednesday

5

Th ursday

6

Friday

7

Saturday

Palm Sunday 

First day of Passover 

Good Friday 

Featured health observance: Sexual Assault Awareness Month

✦ Find a safe environment, anywhere away from your attacker. Th en call 911 or the police. 

✦ Talk with a counselor at the National Sexual Assault Hotline at 1-800-656-HOPE (4673).

April 2007
160 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

April

April 2007

8

Sunday

9

Monday

10

Tuesday

11

Wednesday

12

Th ursday

13

Friday

14

Saturday

Easter

Last day of Passover 
Visit the National Women’s Health Information Center web site www.womenshealth.gov 161

April

15

Sunday

16

Monday

17

Tuesday

18

Wednesday

19

Th ursday

20

Friday

21

Saturday

S M T W T F S

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30
162 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

April

April 2007

22

Sunday

23

Monday

24

Tuesday

25

Wednesday

26

Th ursday

27

Friday

28

Saturday
Visit the National Women’s Health Information Center web site www.womenshealth.gov 163

April

29

Sunday

30

Monday

S M T W T F S

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30

Notes
164 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

May

May 2007

Sunday Monday Tuesday Wednesday Th ursday Friday Saturday

1 2 3 4 5

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

Cinco de Mayo

Mother’s Day

Memorial Day

Celebrate National Women’s Health Week (May 13-19). Get a checkup!
Visit the National Women’s Health Information Center web site www.womenshealth.gov 165

May

1

Tuesday

2

Wednesday

3

Th ursday

4

Friday

5

Saturday Cinco de Mayo

Featured health observance: National Osteoporosis Awareness 

and Prevention Month

Osteoporosis means that your bones get weak and brittle. Th en you’re more likely to break a bone. 

✦ If you are 65 years old or older, get a bone density test. 

✦ Get a bone density test before age 65 if you are between the ages of 60 and 64, weigh 

fewer than 154 pounds, and don’t take estrogen. 

✦ Quit smoking today! Smoking raises your risk of getting osteoporosis by damaging bones 

and lowering the amount of estrogen in the body, a hormone that slows the loss of bone. 

May 2007
166 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

May

May 2007

6

Sunday

7

Monday

8

Tuesday

9

Wednesday

10

Th ursday

11

Friday

12

Saturday
Visit the National Women’s Health Information Center web site www.womenshealth.gov 167

May

13

Sunday

14

Monday

15

Tuesday

16

Wednesday

17

Th ursday

18

Friday

19

Saturday

S M T W T F S

 1 2 3 4 5

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

Mother’s Day
168 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

May

May 2007

20

Sunday

21

Monday

22

Tuesday

23

Wednesday

24

Th ursday

25

Friday

26

Saturday
Visit the National Women’s Health Information Center web site www.womenshealth.gov 169

May

27

Sunday

28

Monday

29

Tuesday

30

Wednesday

31

Th ursday

S M T W T F S

 1 2 3 4 5

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

Memorial Day
170 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

June

June 2007

Sunday Monday Tuesday Wednesday Th ursday Friday Saturday

1 2

3 4 5 6 7 8 9

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29 30

Father’s Day Summer begins
Visit the National Women’s Health Information Center web site www.womenshealth.gov 171

June

1

Friday

2

Saturday

Featured health observance: Home Safety Month

You can take some simple steps to create a safer home environment. Th e most common 

causes of accidents in the home are falls, fi res and burns, and poisonings.

✦ Post the National Poison Control Hotline phone number next to every phone in your 

home. You can call them at 1-800-222-1222.

✦ Make a fi rst-aid kit. Store it where family members can get to it. 

✦ Make sure everyone in your home knows to “Stop, Drop, and Roll” if their clothes catch 

fi re.

✦ Prepare a basic disaster supplies kit that is easy to carry in case you have to evacuate your 

home.

June 2007
172 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

June

June 2007

3

Sunday

4

Monday

5

Tuesday

6

Wednesday

7

Th ursday

8

Friday

9

Saturday
Visit the National Women’s Health Information Center web site www.womenshealth.gov 173

June

10

Sunday

11

Monday

12

Tuesday

13

Wednesday

14

Th ursday

15

Friday

16

Saturday

S M T W T F S

 1 2

3 4 5 6 7 8 9

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29 30
174 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

June

June 2007

17

Sunday

18

Monday

19

Tuesday

20

Wednesday

21

Th ursday

22

Friday

23

Saturday

Father’s Day

Summer begins
Visit the National Women’s Health Information Center web site www.womenshealth.gov 175

June

24

Sunday

25

Monday

26

Tuesday

27

Wednesday

28

Th ursday

29

Friday

30

Saturday

S M T W T F S

 1 2

3 4 5 6 7 8 9

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29 30
176 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

July

July 2007

Sunday Monday Tuesday Wednesday Th ursday Friday Saturday

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30 31

Independence 

Day
Visit the National Women’s Health Information Center web site www.womenshealth.gov 177

July

1

Sunday

2

Monday

3

Tuesday

4

Wednesday

5

Th ursday

6

Friday

7

Saturday

Independence Day

Featured health observance: UV (ultraviolet) Safety Month

✦ Sunglasses protect your eyes from too much exposure to ultraviolet (UV) rays, an invisible 

form of radiation that can damage your eyes.

✦ UV rays are strongest between 10 a.m. and 4 p.m., so sunglasses are especially important 

during those hours. Buy sunglasses that block 99 to 100 percent of UV rays. 

July 2007
178 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

July

July 2007

8

Sunday

9

Monday

10

Tuesday

11

Wednesday

12

Th ursday

13

Friday

14

Saturday
Visit the National Women’s Health Information Center web site www.womenshealth.gov 179

July

15

Sunday

16

Monday

17

Tuesday

18

Wednesday

19

Th ursday

20

Friday

21

Saturday

S M T W T F S

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30 31 
180 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

July

July 2007

22

Sunday

23

Monday

24

Tuesday

25

Wednesday

26

Th ursday

27

Friday

28

Saturday
Visit the National Women’s Health Information Center web site www.womenshealth.gov 181

July

29

Sunday

30

Monday

31

Tuesday

S M T W T F S

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30 31 

Notes
182 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

August

August 2007

Sunday Monday Tuesday Wednesday Th ursday Friday Saturday

1 2 3 4

5 6 7 8 9 10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

Women’s 

Equality Day
Visit the National Women’s Health Information Center web site www.womenshealth.gov 183

August

1

Wednesday

2

Th ursday

3

Friday

4

Saturday

Featured health observance: World Breastfeeding Week 

(August 1–7)

✦ Are you a breastfeeding mom with questions? Call the breastfeeding helpline at the National Women’s Health Information Center at 1-800-994-9662 or TDD 1-888-220-5446.

✦ Are you looking for more help with breastfeeding? Consider calling on a lactation consultant. Th ey are specialized health care professionals dedicated to helping you with all 

aspects of breastfeeding your baby. To fi nd a certifi ed lactation consultant in your area, 

visit http://gotwww.net/ilca. 

August 2007
184 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

August

August 2007

5

Sunday

6

Monday

7

Tuesday

8

Wednesday

9

Th ursday

10

Friday

11

Saturday
Visit the National Women’s Health Information Center web site www.womenshealth.gov 185

August

12

Sunday

13

Monday

14

Tuesday

15

Wednesday

16

Th ursday

17

Friday

18

Saturday

S M T W T F S

 1 2 3 4

5 6 7 8 9 10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31
186 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

August

August 2007

19

Sunday

20

Monday

21

Tuesday

22

Wednesday

23

Th ursday

24

Friday

25

Saturday
Visit the National Women’s Health Information Center web site www.womenshealth.gov 187

August

26

Sunday

27

Monday

28

Tuesday

29

Wednesday

30

Th ursday

31

Friday

S M T W T F S

 1 2 3 4

5 6 7 8 9 10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

Women’s Equality Day
188 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

September

September 2007

Sunday Monday Tuesday Wednesday Th ursday Friday Saturday

1

2 3 4 5 6 7 8

9 10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

30

Labor Day

Ramandan begins

Rosh Hashana

Yom Kippur

Patriot Day

Autumn begins
Visit the National Women’s Health Information Center web site www.womenshealth.gov 189

September

1

Saturday

Featured health observance: National Cholesterol Education 

Month

Cholesterol is a waxy, fat-like substance found in all cells of the body. Your body makes all 

the cholesterol it needs. Too much cholesterol in the blood, or high blood cholesterol, can be 

serious.

✦ Everyone age 20 and older should have their blood cholesterol measured at least once 

every 5 years. 

✦ If family members have high cholesterol (above 200), ask your doctor or nurse if you 

should get your cholesterol checked at a younger age or more often.

✦ If your cholesterol is high, learn what you can change in your lifestyle to lower your risk.

September 2007

Notes
190 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

September

September 2007

2

Sunday

3

Monday

4

Tuesday

5

Wednesday

6

Th ursday

7

Friday

8

Saturday

Labor Day
Visit the National Women’s Health Information Center web site www.womenshealth.gov 191

September

9

Sunday

10

Monday

11

Tuesday

12

Wednesday

13

Th ursday

14

Friday

15

Saturday

S M T W T F S

 1

2 3 4 5 6 7 8

9 10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

30

Ramandan begins, Rosh Hashana

Patriot Day
192 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

September

September 2007

16

Sunday

17

Monday

18

Tuesday

19

Wednesday

20

Th ursday

21

Friday

22

Saturday Yom Kippur
Visit the National Women’s Health Information Center web site www.womenshealth.gov 193

September

23

Sunday

24

Monday

25

Tuesday

26

Wednesday

27

Th ursday

28

Friday

29

Saturday

S M T W T F S

 1

2 3 4 5 6 7 8

9 10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

30

30

Sunday

Autumn begins
194 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

October

October 2007

Sunday Monday Tuesday Wednesday Th ursday Friday Saturday

1 2 3 4 5 6

7 8 9 10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30 31

Columbus Day

Halloween
Visit the National Women’s Health Information Center web site www.womenshealth.gov 195

October

1

Monday

2

Tuesday

3

Wednesday

4

Th ursday

5

Friday

6

Saturday

Featured health observance: National Mammography Day 

(October 19) 

✦ Starting at age 40, every woman should get a mammogram every 1 to 2 years. 

✦ Make an appointment with your doctor. Remind friends and family members to do the same.

✦ If you have a family history of breast cancer, ask your doctor if you need to start yearly 

mammograms at a younger age or more often.

October 2007
196 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

October

October 2007

7

Sunday

8

Monday

9

Tuesday

10

Wednesday

11

Th ursday

12

Friday

13

Saturday

Columbus Day
Visit the National Women’s Health Information Center web site www.womenshealth.gov 197

October

14

Sunday

15

Monday

16

Tuesday

17

Wednesday

18

Th ursday

19

Friday

20

Saturday

S M T W T F S

 1 2 3 4 5 6

7 8 9 10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30 31
198 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

October

October 2007

21

Sunday

22

Monday

23

Tuesday

24

Wednesday

25

Th ursday

26

Friday

27

Saturday
Visit the National Women’s Health Information Center web site www.womenshealth.gov 199

October

28

Sunday

29

Monday

30

Tuesday

31

Wednesday

S M T W T F S

 1 2 3 4 5 6

7 8 9 10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30 31

Halloween

Notes
200 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

November

November 2007

Sunday Monday Tuesday Wednesday Th ursday Friday Saturday

1 2 3

4 5 6 7 8 9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30

Daylight Saving 

Time ends

Veterans Day

Th anksgiving

Day

Great American 

Smokeout
Visit the National Women’s Health Information Center web site www.womenshealth.gov 201

November

1

Th ursday

2

Friday

3

Saturday

Featured health observance: Lung Cancer Awareness Month

You can help lower your risk of lung cancer, the leading cause of cancer deaths among 

women.

✦ If you smoke, quit today. 

✦ If you are a non-smoker, learn how to protect yourself and your family from secondhand 

smoke.

✦ Test your home for radon, a cancer-causing gas that can get into the air you breathe. You 

can’t see it, smell it, or taste it!

✦ If you are exposed to dust and fumes where you work, ask your employer how you can be 

protected. 

November 2007
202 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

November

November 2007

4

Sunday

5

Monday

6

Tuesday

7

Wednesday

8

Th ursday

9

Friday

10

Saturday

Daylight Saving Time ends
Visit the National Women’s Health Information Center web site www.womenshealth.gov 203

November

11

Sunday

12

Monday

13

Tuesday

14

Wednesday

15

Th ursday

16

Friday

17

Saturday

S M T W T F S

 1 2 3

4 5 6 7 8 9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30

Veterans Day

Great American Smokeout
204 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

November

November 2007

18

Sunday

19

Monday

20

Tuesday

21

Wednesday

22

Th ursday

23

Friday

24

Saturday

Th anksgiving Day
Visit the National Women’s Health Information Center web site www.womenshealth.gov 205

November

25

Sunday

26

Monday

27

Tuesday

28

Wednesday

29

Th ursday

30

Friday

S M T W T F S

 1 2 3

4 5 6 7 8 9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30
206 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

December

December 2007

Sunday Monday Tuesday Wednesday Th ursday Friday Saturday

1

2 3 4 5 6 7 8

9 10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

30 31

First day of 

Chanukah

Last day of 

Chanukah

New Year’s Eve Christmas Day Kwanzaa

Winter begins
Visit the National Women’s Health Information Center web site www.womenshealth.gov 207

December

1

Saturday

Featured health observance: World AIDS Day (December 1)

Th e best way to protect your body is to know the “ABCs” of STDs. If you choose not to follow 

A, B, or C, you could get a sexually transmitted disease (STD), including HIV, the virus that 

causes AIDS.

A= Abstinence. Not having sex of any kind (vaginal, anal, or oral sex) is the only 100%  eff ective way to avoid getting STDs. 

B= Be faithful. Being in a sexual relationship with only one partner who is free of an STD and who is also faithful to you limits the chance of infections. 

C= Condoms. If you fail to follow “A” or “B,” use a latex condom. Latex condoms have  been proven to reduce the risk of HIV infection and infection by many STDs, if used 

correctly and consistently every time you have sex.

December 2007

Notes
208 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

December

December 2007

2

Sunday

3

Monday

4

Tuesday

5

Wednesday

6

Th ursday

7

Friday

8

Saturday

First day of Chanukah
Visit the National Women’s Health Information Center web site www.womenshealth.gov 209

December

9

Sunday

10

Monday

11

Tuesday

12

Wednesday

13

Th ursday

14

Friday

15

Saturday

S M T W T F S

 1

2 3 4 5 6 7 8

9 10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

30 31

Last day of Chanukah
210 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

December

December 2007

16

Sunday

17

Monday

18

Tuesday

19

Wednesday

20

Th ursday

21

Friday

22

Saturday Winter begins
Visit the National Women’s Health Information Center web site www.womenshealth.gov 211

December

23

Sunday

24

Monday

25

Tuesday

26

Wednesday

27

Th ursday

28

Friday

29

Saturday

S M T W T F S

 1

2 3 4 5 6 7 8

9 10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

30 31

30

Sunday

31

Monday

Christmas Day

Kwanzaa

New Year’s Eve
January 2007

SMTWT F S

123456

7 8 9 10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30 31

2007 Calendar

212 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

2007 at-a-glance

April 2007

SMTWT F S

1234567

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30

July 2007

SMTWT F S

1234567

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30 31

October 2007

SMTWT F S

123456

7 8 9 10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30 31

February 2007

SMTWT F S

123

4 5 6 7 8 9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28

March 2007

SMTWT F S

123

4 5 6 7 8 9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

May 2007

SMTWT F S

12345

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

June 2007

SMTWT F S

1 2

3456789

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29 30

August 2007

SMTWT F S

1234

5 6 7 8 9 10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

September 2007

SMTWT F S

1

2345678

9 10 11 12 13 14 15

16 17 18 19 20 21 22

24 25 26 27 28 29

November 2007

SMTWT F S

123

4 5 6 7 8 9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30

December 2007

SMTWT F S

1

2345678

9 10 11 12 13 14 15

16 17 18 19 20 21 22

25 26 27 28 29

23/30

23/30 24/31

2007 At-a-Glance
Visit the National Women’s Health Information Center web site www.womenshealth.gov 213

2008 at-a-glance

January 2008

SMTWT F S

12345

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

2008 Calendar

April 2008

SMTWT F S

12345

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

July 2008

SMTWT F S

12345

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

October 2008

SMTWT F S

1234

5 6 7 8 9 10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

February 2008

SMTWT F S

1 2

3456789

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29

March 2008

SMTWT F S

1

2345678

9 10 11 12 13 14 15

16 17 18 19 20 21 22

25 26 27 28 29

May 2008

SMTWT F S

123

4 5 6 7 8 9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

June 2008

SMTWT F S

1234567

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30

August 2008

SMTWT F S

1 2

3456789

10 11 12 13 14 15 16

17 18 19 20 21 22 23

25 26 27 28 29 30

September 2008

SMTWT F S

123456

7 8 9 10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30

November 2007

SMTWT F S

1

2345678

9 10 11 12 13 14 15

16 17 18 19 20 21 22

24 25 26 27 28 29

December 2007

SMTWT F S

123456

7 8 9 10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30 31

23/30 24/31

24/31

23/30

2008 At-a-Glance
Health Resources for Men

General Health

National Women’s Health Information 

Center (NWHIC)

What About Men’s Health?

Phone: 1-800-994-9662; TDD 1-888-220-5446

Internet: www.womenshealth.gov/mens

U.S. Department of Health and Human 

Services (HHS)

Internet: www.hhs.gov/specifi cpopulations

Healthfi nder®

Internet: www.healthfi nder.gov/justforyou

U.S. National Library of Medicine

National Institutes of Health

MedlinePlus

Internet: www.nlm.nih.gov/medlineplus/

healthtopics.html

Men Shoot for 9

National Cancer Institute

Internet: www.5aday.gov/9aday

Fatherhood Initiative

U.S. Department of Health and Human 

Services

Internet: http://fatherhood.hhs.gov/

index.shtml

Centers for Disease Control and 

Prevention (CDC) 

Men’s Health

Phone: 1-800-311-3435

Internet: www.cdc.gov/men

Centers for Disease Control and 

Prevention (CDC)

HIV/AIDS

Phone: 1-800-CDC-INFO

Internet: www.cdc.gov/hiv

Agency for Healthcare Research and 

Quality (AHRQ)

Internet: www.ahrq.gov/path/menpath.htm 

Heart Health

National Heart, Lung, and Blood Institute (NHLBI)

Internet: www.nhlbi.nih.gov

American Heart Association

Phone: 1-800-AHA-USA-1 

Internet: www.americanheart.org

Cancer 

National Cancer Institute

Phone: 1-800-4-CANCER

Internet: www.cancer.gov

American Cancer Society

Phone: 1-800-ACS-2345 

Internet: www.cancer.org

Mental Health

National Institute of Mental Health 

(NIMH)

Phone: 1-866-615-6464 

Internet: www.nimh.nih.gov

214 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Health Resources for Men
Substance Abuse and Mental Health 

Services Administration (SAMHSA)

Mental Health Information Center

Phone: 1-800-789-2647; 

TDD 1-866-889-2647

Internet: 

www.mentalhealth.samhsa.gov

Substance Abuse and Mental Health 

Services Administration (SAMHSA)

National Clearinghouse for Alcohol and 

Drug Information

Phone: 1-800-729-6686; 

TDD 1-800-487-4889; 

En Español: 1-877-767-8432

Internet: http://ncadi.samhsa.gov

Urologic and Reproductive 

Health

National Kidney and Urologic Diseases

Information Clearinghouse

Phone: 1-800-891-5390

Internet: http://kidney.niddk.nih.gov

American Foundation for Urologic 

Diseases

Phone: 1-866-RING-AUA

Internet: www.afud.org

Visit the National Women’s Health Information Center web site www.womenshealth.gov 215

Health Resources for Men
Health Resources for Children 

General Health

National Women’s Health Information 

Center (NWHIC)

Girls Health

Phone: 1-800-994-9662; TDD 1-888-220-5446

Internet: www.girlshealth.gov

U.S. Department of Health and Human 

Services (HHS)

Internet: www.hhs.gov/specifi cpopulations

U.S. National Library of Medicine

National Institutes of Health

MedlinePlus

Internet: www.nlm.nih.gov/medlineplus/

healthtopics.html

Food and Drug Administration (FDA)

FDA Kid’s Page

Phone: 1-800-216-7331

Internet: www.fda.gov/oc/opacom/kids/

default.htm

Centers for Disease Control and Prevention (CDC)

VERBTM It’s What You Do

Phone: 1-800-CDC-INFO 

Internet: www.cdc.gov/youthcampaign

Internet: www.verbnow.com

Centers for Disease Control and 

Prevention (CDC)

Raising Safe and Healthy Kids

Internet: www.cdc.gov/women/owh/kids

National Institute on Deafness and 

Other Communication Disorders (NIDCD)

WISE EARS!® Hearing Matters

Phone: 1-800-241-1044; 

TTY 1-800-241-1055

Internet: www.nidcd.nih.gov/health/wise

American Academy of Pediatrics

Internet: www.aap.org

Substance Abuse and Mental Health 

Services Administration (SAMHSA)

Building Blocks for a Healthy Future

Phone: 1-800-273-8255; 

TTY 1-800-779-4889

Internet: www.bblocks.samhsa.gov

Internet: www.samhsa.gov

Substance Abuse and Mental Health 

Services Administration (SAMHSA)

Family Guide to Keeping Youth Mentally 

Healthy and Drug-free

Phone: 1-800-273-8255; 

TTY 1-800-779-4889

Internet: www.family.samhsa.gov

Internet: www.samhsa.gov

Kidshealth.org

Internet: www.kidshealth.org

Kids Growth

Internet: http://kidsgrowth.com

Agency for Healthcare Research and 

Quality (AHRQ)

Internet: www.ahrq.gov/child

216 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Health Resources for Children
Girl Power! Campaign

Internet: www.girlpower.gov

Health Resources and Services 

Administration (HRSA)

My Bright Future: Physical Activity and 

Healthy Eating Tools for Young Women

Internet: www.hrsa.gov/womenshealth/

mybrightfuture/menu.html

Child Abuse

Prevent Child Abuse America

Phone: (312) 663-3520

Internet: www.preventchildabuse.org

Cancer

National Cancer Institute

Phone: 1-800-4-CANCER

Internet: www.cancer.gov

Childhood Asthma

American Lung Association

Phone: 1-800-LUNGUSA

Internet: www.lungusa.org

Childhood Diabetes

National Diabetes Information 

Clearinghouse

Phone: 1-800-860-8747

Internet: http://diabetes.niddk.nih.gov

American Diabetes Association

Phone: 1-800-DIABETES

Internet: www.diabetes.org

Immunizations

Centers for Disease Control and 

Prevention (CDC)

National Immunization Program

Phone: 1-800-CDC-INFO; 

TTY 1-888-232-6348

Internet: www.cdc.gov/nip

American Academy of Pediatrics

Immunizations Initiatives

Internet: www.cispimmunize.org

Immunization Action Coalition

Internet: www.immunize.org

Child Nutrition

Powerful Bones. Powerful Girls.

Th e National Bone Health Campaign

Internet: www.cdc.gov/powerfulbones

U.S. Department of Agriculture

Food and Nutrition Service

Child Nutrition Division

Internet: www.fns.usda.gov/cnd

Safety and Injury Prevention

Health Resources and Services Administration (HRSA)

Maternal and Child Health Bureau

Stop Bullying Now Campaign

Internet: http://stopbullyingnow.hrsa.gov

Centers for Disease Control and Prevention (CDC)

National Center for Injury Prevention 

and Control

Phone: 1-800-CDC-INFO

Internet: www.cdc.gov/ncipc

Visit the National Women’s Health Information Center web site www.womenshealth.gov 217

Health Resources for Children
National SAFE KIDS Campaign

Phone: (202) 662-0600

Internet: www.safekids.org

National Highway Traffi c Safety Administration

Car Seat Safety and Installation

Phone: 1-888-327-4236

Internet: www.nhtsa.dot.gov

Consumer Product Safety Commission

Keep Your Child’s Playground Safe

Phone: 1-800-638-2772; 

TTY 1-800-638-8270

Internet: www.cpsc.gov/cpscpub/pubs/

playpubs.html

American Heart Association

CPR and Basic Life Support Skills for 

Children

Phone: 1-800-AHA-USA-1

Internet: www.americanheart.org

National Child Identifi cation Program

Internet: www.childidprogram.com

U.S. Pharmacopeia

Children and Medicines

Phone: 1-800-227-8772

Internet: www.usp.org/druginformation/

children

Visit healthfi nder® for information just for you

www.healthfi nder.gov/justforyou

218 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Health Resources for Children
Resources for Health Insurance

Each year, more American families fi nd 

themselves without health insurance. 

In 2004, more than 45 million Americans 

didn’t have health insurance. Sixteen million 

of them were women. Th ese programs and 

resources may be able to help you and your 

family.

Government Resources Th at 

Can Help

Th e Centers for Medicare and Medicaid Services (CMS), a federal government agency, 

administers health insurance programs such 

as Medicare, Medicaid, and the State Children’s Health Insurance Program. 

Medicare

Medicare is a health insurance program 

funded by the U.S. government. To qualify 

for these benefi ts, you must be 65 years old 

or older, or younger than 65 with certain 

disabilities, or a person of any age who has 

end-stage renal disease. (A person who has 

end-stage renal disease has permanent kidney failure that requires dialysis or a kidney 

transplant.)

Medicare has several parts. Your coverage 

depends on which parts of Medicare you 

have. Medicare Part A typically pays for your 

inpatient hospital expenses. Medicare Part B 

typically pays for your outpatient healthcare 

expenses, including doctor fees. You usually have to pay a monthly premium to be 

covered by Medicare Part B. 

Beginning January 1, 2006, everyone who 

has Medicare is now eligible for prescription 

drug coverage through the new Medicare 

Part D. Th is coverage is available regardless 

of your income and resources, your health 

status, or how much your prescriptions 

cost. It covers both brand-name and generic 

prescription drugs at participating pharmacies in your area. Medicare prescription drug 

coverage provides protection for people who 

have very high drug costs. 

For general information, 24 hours a day, 7 

days a week, 

✦ Call toll-free at 1-800-MEDICARE (1-800-

633-4227) or TTY 1-877-486-2048.

✦ Internet: www.cms.hhs.gov/home/

medicare.asp

Visit the National Women’s Health Information Center web site www.womenshealth.gov 219

Resources for Health Insurance
✦ Internet: Th e Offi cial U.S. Government 

Site for People with Medicare: 

www.medicare.gov 

If you have a limited income and resources, 

you may be eligible for extra help with your 

prescription drug costs. Almost 1 in 3 people 

with Medicare qualify for having almost all 

of their prescription drug costs paid for by 

the program. To fi nd out if you are eligible 

for extra help, contact the Social Security 

Administration.

✦ Call the U.S. Social Security Administration toll-free at 1-800-772-1213 (TTY 

1-800-325-0778).

✦ Internet: www.socialsecurity.gov

Medicaid 

Medicaid is a health insurance program 

jointly funded by states, counties, and the 

U.S. government. Medicaid provides medical benefi ts to groups of low-income people 

that meet certain age, income, and resource 

requirements. People who have certain 

medical conditions such as blindness or who 

are pregnant may also qualify. Whether a 

person is eligible for Medicaid depends on 

the state where he or she lives.

In general, you should apply for Medicaid if 

your income is low and you or someone in 

your family needs health care. A qualifi ed 

caseworker in your state can give you guidance about your situation. Your child may be 

eligible for coverage, even if you are not. 

To fi nd out more about Medicaid in your 

state,

✦ Call the toll-free number for your state. 

A list of toll-free numbers can be reached 

through the CMS web site at www.cms.

hhs.gov/medicaid/consumer.asp.

State Children’s Health Insurance 

Program (SCHIP) 

Like Medicaid, the State Children’s Health 

Insurance Program (SCHIP) is a partnership between the federal government and 

the states. SCHIP is designed to provide 

health insurance coverage to specifi c groups 

of low-income children. Families who earn 

too much money to be eligible for Medicaid 

but not enough money to purchase private 

health insurance may be eligible to get 

health insurance for their children. 

Each state determines how its program is 

designed, who is eligible, what the benefi ts 

are, how costs are shared, and other features. For little or no cost, this insurance 

pays for children’s doctor visits, immunizations, hospitalizations, and emergency room 

visits.

For more information about SCHIP, go to 

their website at www.cms.hhs.gov/home/

schip.asp.

To learn whom you should contact in your 

state or to read specifi c information about 

eligibility in your state, go to Insure Kids 

Now at www.insurekidsnow.gov.

220 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Resources for Health Insurance
Other Government Programs and 

Benefi ts

To learn about the government benefi ts you 

may be entitled to,

✦ Call toll-free at 1-800-FED-INFO (1-800-

333-4636). Calls are answered Monday 

through Friday, 8 a.m. to 8 p.m., Eastern 

Standard Time.

✦ Internet: www.govbenefi ts.gov

Other Public Government and 

Private Resources Th at Can 

Help

For women who make too much money to 

qualify for these federal and state programs 

but who can’t aff ord to pay for health insurance or costly health services, the choices 

are limited and diffi cult. Public and private 

resources may be able to help.

✦ “Safety-net” facilities. Community 

health centers, public hospitals, schoolbased centers, public housing primary 

care, and special need facilities. Contact 

your local or state health department 

for more information or go to 

http://ask.hrsa.gov/pc.

✦ Free clinics. Free clinics provide healthcare services for the uninsured. To fi nd 

a free clinic, go on the Internet to 

www.freeclinic.net or call (540) 344-8242. 

✦ Prescription drug assistance. Some 

states provide prescription drug assistance to women who cannot get Medicaid. 

Many drug companies will work with your 

doctor to provide free medicines to those 

in need. A list of resources can be 

found on the Internet at 

www.disabilityresources.org/RX.html. 

✦ Women with cancer. Women with 

cancer can fi nd help through a variety of 

government-sponsored and volunteer 

organizations. For accurate, up-to-date 

information on cancer and resources 

for people dealing with cancer, go to the 

web site of the National Cancer Institute 

(www.cancer.gov). You can also visit the 

Cancer Information Service of the National Cancer Institute on the Internet 

(http://cis.nci.nih.gov). To get answers 

to specifi c questions about cancer, call 

them at 1-800-4-CANCER (1-800-422-

6237), Monday through Friday, 9:00 a.m. 

to 4:30 p.m. You can speak with a Cancer 

Information specialist. Deaf and hard of 

hearing callers with TTY equipment can 

call 1-800-332-8615. 

✦ Women with HIV. Th e federal Ryan 

White CARE Act funds healthcare services 

for women with HIV/AIDS who do not 

have health insurance or the fi nancial 

resources to pay for care. To locate a CARE 

provider, contact your local or state health 

department or call 1-800-994-9662.

✦ Group health insurance. Some states 

and localities, labor unions, professional 

clubs, associations, and organizations 

off er low-cost group health insurance 

to its members. Th ese plans usually cost 

less than individual insurance and can be 

worth considering. 

Visit the National Women’s Health Information Center web site www.womenshealth.gov 221

Resources for Health Insurance
✦ Temporary insurance. Some individuals who have been denied health insurance because of a medical condition may 

be able to obtain coverage through their 

state’s “risk pools.” More than 30 states 

provide this temporary insurance assistance. For more information, go to the 

web site of HealthInsurance.org at 

www.healthinsurance.org/

riskpoolinfo.html.

Protect Your Health Insurance 

Coverage

If you have health insurance, you should 

know how to protect that insurance coverage. If you are losing your health insurance 

because you have lost your job, have reduced 

hours at work, have gotten a divorce, or have 

had your spouse die, you have certain rights 

and protections. Th ese rights are described 

in the Health Insurance Portability and Accountability Act of 1996, or HIPAA. 

Tips: What To Do 

✦ Obtain proof that you had previous health 

insurance coverage from your employer. 

✦ Apply for COBRA, which stands for the 

Consolidated Omnibus Budget Reconciliation Act of 1985. COBRA requires most 

employers that have 20 or more employees to allow you to continue your health 

insurance for 18 months, but you must 

pay the full premium cost of the insurance. Ask your employer’s human resources offi ce about when and how you should 

apply for these benefi ts. 

✦ Consider your health insurance situation 

carefully before agreeing to certain terms 

and conditions. It is especially important 

to think about your healthcare needs 

when you are separated from your spouse, 

divorced, or are a retiree with annuities. 

✦ In a legal separation or divorce proceeding, you can get a court order to provide 

your children with health insurance under 

the health plan of the noncustodial parent. Th is act is called a qualifi ed medical 

child support order.

✦ Act quickly to get the right information to 

protect you and your family. File any required forms promptly. Strict time limits 

often apply. 

For more information about HIPAA, 

✦ Call 1-866-627-7748.

✦ Internet: www.cms.hhs.gov/

HIPAAGenInfo

For more information on health insurance 

choices, go to the web site of the Agency 

for Healthcare Research and Quality at 

www.ahrq.gov/consumer.

222 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Resources for Health Insurance
Regional Women’s Health Coordinators

In addition to its offi ce in Washington, DC, the Offi ce on Women’s Health supports the work 

of ten Regional Women’s Health Coordinators (RWHCs). Th ey are based in the ten regions 

of the U.S. Public Health Service, within the U.S. Department of Health and Human Services. Th ey promote the health of women and girls at regional, state, and local levels. Wherever 

you live in this country, you can call, write, or e-mail your nearest Regional Women’s Health 

Coordinator to learn about events, education programs, and resources in your area.

Region I - CT, MA, ME, NH, RI, VT

Laurie Robinson, MTS

Boston, MA

Phone: (617) 565-1071

E-mail: Laurie.Robinson@hhs.gov

Region II - NJ, NY, PR, Virgin Islands

Sandra Estepa, MS, CSW

New York, NY

Phone: (212) 264-4628

E-mail: Sandra.Estepa@hhs.gov

Region III - DC, DE, MD, PA, VA, WV

Rosa F. Myers, ARNP, MSN

Philadelphia, PA

Phone: (215) 861-4637 

E-mail: Rosa.Myers@hhs.gov

Region IV - AL, FL, GA, KY, MS, NC, SC, TN

Annie Brayboy Fair, MPH, MSW

Atlanta, GA

Phone: (404) 562-7904

E-mail: Annie.Fair@hhs.gov 

Region V - IL, IN, MI, MN, OH, WI

Michelle Hoersch, MS

Chicago, IL

Phone: (312) 353-8122

E-mail: Michelle.Hoersch@hhs.gov

Region VI - AR, LA, NM, OK, TX

Charlotte Gish, CNM, MSN

Dallas, TX

Phone: (214) 767-3523

E-mail: Charlotte.Gish@hhs.gov 

Region VII - IA, KS, MO , NE

Joyce Townser, RN, MSA

Kansas City, MO

Phone: (816) 426-2926

E-mail: Joyce.Townser@hhs.gov

Region VIII - CO, MT, ND, SD, UT, WY

Laurie Konsella, MPA

Denver, CO

Phone: (303) 844-7854

E-mail: Laurie.Konsella@hhs.gov 

Region IX - AZ, CA, HI, NV, American 

Samoa, Guam, Marshall Islands, Micronesia, Northern Mariana Islands,Palau

Kay A. Strawder, JD, MSW

San Francisco, CA

Phone: (415) 437-8119

E-mail: Kay.Stawder@hhs.gov

Region X - AK, ID, OR, WA

Marian Mehegan, DDS, MPH

Seattle, WA

Phone: (206) 615-2024

E-mail: Marian.Mehegan@hhs.gov

Visit the National Women’s Health Information Center web site www.womenshealth.gov 223

Regional Women’s Health Coordinators
224 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Quick Health Data Online

Do you need health statistics

for your area?

A project of the U.S. Department 

of Health and Human Services’ 

Office on Women’s Health

What is Quick Health Data Online?

 A national database of key health indicators 

 County, state, national, and territory data 

 Data available by gender, race, and, in some cases, age

 Data available for 2000, 2001, 2002, and when available 2003 and 2004

 Healthy People 2010 targets and associated data

 Counts, rates, age-adjusted rates; single-year and three-year averages

With Quick Health Data Online you can easily:

 Compare your locality with others across the country

 View data by county type (e.g., border county, rural/urban status, frontier)

 Examine data trends over time 

 Map data at the county, state, and national levels

 Create charts and reports

 Export data to other applications 

Data in the system are organized into the following major categories: 

 Codes and Status  Demographics

 Mortality  Access to Care

 Infectious/Chronic Disease  Reproductive Health

 Maternal Health  Mental Health

 Violence and Abuse  Prevention

 Healthy People 2010

Quick Health Data Online contains more than 1,400 unique variables with details available by 

gender, race, and year.

womenshealth.gov

1-800-994-9662

TDD: 1-888-220-5446

Try Quick Health Data Online at: 

www.womenshealth.gov/quickhealthdata

The National Women’s Health Indicators Database, recently 

renamed Quick Health Data Online, provides county, state, 

regional, and national health statistics. This free database

includes comprehensive data for both women and men, from

1998 to 2004 on a variety of health-related topics.

Quick Health Data Online
Visit the National Women’s Health Information Center web site www.womenshealth.gov 225

NWHIC’s Web Site on Girls Health

It’s hard enough getting your kids to talk to you.

What do you say to them once they do?

Turn to girlshealth.gov for information that will help you talk to the young 

women in your life about bullying, drugs, alcohol and smoking, stress, 

relationships, and more.

Our Parents and Caregivers page has tools that can help make the important 

issues easy to talk about. Visit www.girlshealth.gov/parents.

The mission of girlshealth.gov is to promote healthy, positive behaviors in girls 

between the ages of 10 and 16. We have the most up-to-date, non-commercial, 

and reliable girls’ health information around.

A project of the U.S. Department of

Health and Human Services’

Offi ce on Women’s Health

Visit

girlshealth.gov or 

call 1-800-994-9662 today for 

FREE posters, brochures, 

and postcards for 

the girls you 

care about.

NWHIC’s Web Site on Girls Health
226 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Addresses and Telephone Numbers

Addresses and Telephone Numbers
Addresses and Telephone Numbers

Visit the National Women’s Health Information Center web site www.womenshealth.gov 227

Addresses and Telephone Numbers
It’s Your Time: 

12 Months to a Healthier You

is a product of the U.S. Department of Health and Human Services, 

Offi ce on Women’s Health.

Daybook Committee

Barbara Disckind, Adrienne Barnes, Sarah Stone, 

Joyce Cusack, Valerie Scardino, Ann Abercrombie

Special thanks to the Centers for Disease Control and Prevention, the National Institutes of 

Health, the Administration on Aging, the Agency for Healthcare Research and Quality, the 

Substance Abuse and Mental Health Services Administration, the Centers for Medicare & 

Medicaid Services, the Administration for Children and Families, and the Health Resources 

and Services Administration for their medical review.

228 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Acknowledgments

Acknowledgments
Your Opinion Matters 

Please use the space below to share your comments with us (such as what 

topic was most useful, what would you change about the Daybook, did you do 

something diff erent because of what you learned, etc.). Th ank you!

Visit the National Women’s Health Information Center web site www.womenshealth.gov 229

Your Opinion Matters
National Women’s Health Information Center

8270 Willow Oaks Corporate Drive

Fairfax, VA 22031

230 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Place

Stamp

Here

✁ (Please trim edge before mailing)

(fold here)

(fold here)
Citations

1 Ladenson PW, Singer PA, Ain KB, Bagchi N, Bigos 

ST, Levy EG, Smith SA, Daniels GH. American 

Th yroid Association Guidelines for Detection of 

Th yroid Dysfunction. Archives of Internal Medicine. 

2000;160:1573-1575.

2 U.S. Preventive Services Task Force. Screening for 

High Blood Pressure: Recommendations and Rationale. July 2003. Agency for Healthcare Research 

and Quality, Rockville, MD. www.ahrq.gov/clinic/

3rduspstf/highbloodsc/hibloodrr.htm. 

3 Adapted from:

 National Heart, Lung, and Blood Institute of the 

National Institutes of Health. Th ird Report of the 

National Cholesterol Education Program Expert 

Panel on Detection, Evaluation, and Treatment of 

High Blood Cholesterol in Adults (Adult Treatment 

Panel III). 2002. NIH Publication No. 02-5215.

4 U.S. Preventive Services Task Force. Screening for 

Osteoporosis in Postmenopausal Women: Recommendations and Rationale. September 2002. Agency 

for Healthcare Research and Quality, Rockville, MD. 

www.ahrq.gov/clinic/3rduspstf/osteoporosis/

osteorr.htm. 

5 American Diabetes Association. Frequently Asked 

Questions about Pre-Diabetes. Available at: www.

diabetes.org/pre-diabetes/faq.jsp. Accessed October 

25, 2006. 

6 National Cancer Institute. Screening Mammograms: 

Questions and Answers. Available at: www.cancer.

gov/cancertopics/factsheet/Detection/screeningmammograms. Accessed October 23, 2006. 

7 National Cancer Institute. Th e Pap Test: Questions 

and Answers. Available at: www.cancer.gov/

cancertopics/factsheet/Detection/Pap-test. Accessed 

October 23, 2006.

8 Centers for Disease Control and Prevention. Sexually Transmitted Disease Treatment Guidelines, 

2006. MMWR. 2006;55(No. RR-11):38.

9 Adapted from:

 National Institute of Mental Health. Depression: 

What Every Woman Should Know. Available at: 

www.nimh.nih.gov/publicat/depwomenknows.

cfm#ptdep8. Accessed October 25, 2006. 

10 Centers for Disease Control and Prevention. Screening Guidelines (Colorectal Cancer). Available at: 

www.cdc.gov/cancer/colorectal/basic_info/screening/guidelines.htm. Accessed October 24, 2006. 

11 American Cancer Society. American Cancer Society Guidelines for the Early Detection of Cancer. 

Available at: www.cancer.org/docroot/PED/content/

PED_2_3X_ACS_Cancer_Detection_Guidelines_

36.asp. Accessed October 24, 2006. 

12 Th e American Academy of Ophthalmology. Th e 

American Academy of Ophthalmology Sets its Sight 

on Healthy Vision Month. Available at: www.aao.

org/news/release/20050501a.cfm. Accessed October 

25, 2006. 

13 American Speech-Language-Hearing Association. 

Hearing Screening. Available at: www.asha.org/

public/hearing/testing. Accessed October 24, 2006. 

14 American Cancer Society. Monitor your Skin for 

Signs of Skin Cancer. Available at: www.cancer.

org/docroot/NWS/content/NWS_1_1x_Monitor_

Your_Skin_for_Signs_of_Skin_Cancer.asp. Accessed 

October 25, 2006. 

15 Agency for Healthcare Research and Quality. Th e 

Pocket Guide to Good Health for Adults. Available 

at: www.ahrq.gov/ppip/adguide/adguide.pdf. 

Accessed October 24, 2006.

Visit the National Women’s Health Information Center web site www.womenshealth.gov 231

Citations
16 Centers for Disease Control and Prevention. Recommended Adult Immunization Schedule—United 

States, October 2006—September 2007. MMWR 

2006;55:Q1-Q4.

17 Adapted from:

 Centers for Disease Control and Prevention. HPV 

and HPV Vaccine: Information for Health Care 

Providers. Available at: www.cdc.gov/std/HPV/

STDFact-HPV-vaccine-hcp.htm#provhpvrec. 

Accessed October 25, 2006.

18 Centers for Disease Control and Prevention. Meningococcal Disease. Available at: www.cdc.gov/ncidod/

dbmd/diseaseinfo/meningococcal_g.htm. Accessed 

August 23, 2006. 

232 Call for free health information 1-800-994-9662 TDD: 1-888-220-5446

Citations
Name _____________________________________________________________________

Address ___________________________________________________________________

Phone _______________________ E-mail ______________________________________

Emergency Medical Information

Blood Type __________________________

Allergies ___________________________

Hospital Preference __________________

Address _____________________________

Phone _____________________________

My Doctor __________________________

Address _____________________________

Phone _____________________________

Current Medications __________________

___________________________________

Nearest relative or friend to call (listed in 

the order I would like them to be called)

Name _______________________________

Phone _____________________________

Address ____________________________

Name ______________________________

Phone _____________________________

Address ____________________________

I have designated Durable Power of Attorney 

for Health Care (someone who makes health 

care decisions for you if you become unable 

to do it yourself)

My Health Care Agent _________________

Phone _____________________________

Living Will __________________________

I have designated Financial Power of Attorney (someone who controls your fi nances 

and assets if you become physically or mentally unable to do it yourself)

My Attorney ________________________

My Court-Appointed 

Guardian ___________________________

Insurance Information

Primary Insurance ___________________

Contacts ___________________________

Customer Service 

Phone Number ______________________

Identifi cation # ______________________

Secondary Insurance _________________

Contacts ___________________________

Customer Service 

Phone Number ______________________

Identifi cation # ______________________

Medicare Number ____________________

Medicaid Numbers ___________________

Notes ______________________________

___________________________________

___________________________________

___________________________________

___________________________________
womenshealth.gov

1-800-994-9662

TDD: 1-888-220-5446

A Project of the U.S. Department of 

Health and Human Services 

Office on Women’s Health