Ask Leah

If you would like to ask a question, please leave a brief comment/question below and I will respond as soon as I am able.

Please be respectful and use appropriate language, otherwise I cannot publicly post your comment or respond.

Thank you for being inquisitive and desiring to learn. Know that advice given here does not replace the importance of a doctor’s office visit.

165 Comments on "Ask Leah"

  1. Lola says:

    Hello Dr. Torres,

    I am an 18 year old female who takes Minastrin 24 Fe to help with the symptoms associated with premenstrual dysphoric disorder. I also have anxiety and depression. Recently I had the flu and a bacterial infection in my lungs, so my doctor prescribed Cefdinir for me to take to help with the bacterial infection. Now I think I may have a yeast infection. I heard that some oral contraceptives can cause yeast infections due to the levels of estrogen in the body, and I know that antibiotics not only wipe out bad bacteria, but also the good that help with the balance of bacteria and yeast in the vagina. So I guess one of my questions is: can this be a yeast infection?

    I’ve had one yeast infection before, but not quite like this experience. I stopped taking the Cefdinir about a week ago (around March 10 or so) and Tuesday morning (the 15th) woke up with discomfort, slight itchiness, and discharge. Thinking back, I did notice some white/ light yellow clumpy discharge during the end of treatment with the antibiotics, but it wasn’t a lot and I didn’t think much of it. Tuesday came and as the day progressed, I felt a burning sensation whenever I would urinate and felt like I had pressure down there. I felt like I had to constantly go to the bathroom, but nothing or little would come out. Tuesday night I started using Monistat about a hour or so before I went to bed and it helped relieve my symptoms almost immediately. The next day, I still had the symptoms (and they intensified throughout the course of the day), but they weren’t as severe as the day before’s felt. I used another dose of Monistat again in the evening and, once again, felt like my symptoms had greatly decreased in intensity.

    It’s my third “day” of treatment (using a third dose tonight), and I feel like my symptoms are still decreasing in severity. I still feel a bit discomfort, but its tolerable. I’m still having discharge, but its kind of hard to tell if its the medicine or the “infection” itself. I don’t know if I waited too long to treat it and that’s why I’m in so much discomfort and pain or what exactly.

    Logic tells me that if it’s not a yeast infection, the medicine would not be working and my symptoms wouldn’t feel like they are decreasing in intensity. But that’s why I’m here. Is there anything else that I can be doing to alleviate any more of the discomfort (besides the Monistat)? I have been eating yogurt and drinking cranberry juice and water. I’ve been avoiding soda and other sugary drinks and foods. I’ve tried to avoid bread and other foods with yeast and a lot of sugar (i’m trying to control the yeast so why should I put more in my body?). Would probiotics help? I was taking them with the Cefdinir and stopped when my treatment was complete. Are there any other symptoms of a yeast infection?

    • Leah Torres says:

      Hello Lola,
      You should be symptom-free in a couple of days, but if not I would go back to your doctor for an exam if one wasn’t done already to confirm that you do indeed have a yeast infection. Also, if the outside of your vagina (known as the vulva) is irritated, some nystatin cream may help. Also, if you’re have pain with urination and going a lot, it’s possible you have a UTI, or “bladder infection.” It seems it would be best to at least call and speak to your doctor. I hope you feel better soon!
      -Leah

  2. Kati Denney says:

    Hello, I’m not positive this is still an active site. I’ve been searching online trying to find a website to ask my question. So I’ll ask and see if you respond. Anyway, I have had my mirena IUD for five and a half years, I know it’s only effective for five, but my insurance hasn’t started yet and from researching online I’ve read that it could be kept in for as long as I want but only to be used to stop my period not for pregnancy prevention. For the first few months I had a heavy period but it stopped and I haven’t had one since, four days ago I got very painful cramps and then yesterday I started my period. It isn’t heavy but enough to stain my pants since I forgot to bring tampons to work this morning. The cramps are intense. Is this normal for the hormones wearing off or is there an issue with it now that it’s been so long? I still check my strings but know that it can implant and other issues. I’m just worried. Thank you in advance.

    • Leah Torres says:

      Hi Kati,
      The hormone may have worn off and I think the best thing to do would be to 1) use condoms and 2) see about having it replaced (if you’d like to continue with it) when your insurance kicks in. Your symptoms don’t necessarily mean it’s “embedded” or that anything is wrong, but I think the hormones are wearing off. Ibuprofen should help with the cramps. Feel better and I hope your insurance comes in soon.
      -Leah

  3. Alex says:

    Do you hate children or secretly resent the concept of motherhood? I’m pro choice but, it’s difficult for me to not give some credence to the critique you’re publicizing yourself out of feminist rage when you’re constantly making affirmations to you’re “childfree” status.

    • Leah Torres says:

      Hi Alex,
      I’m not sure what any of that has to do with my desire to not give birth to children. Thank you for your input and I think you may want to speak to a counselor about your own resentment and possible anger issues. It seems you may be exhibiting what we know in medicine to be “projection.” Be well and take care.
      -Leah

  4. Krystal says:

    Hello,

    Almost four months ago, I gave birth to my second baby – healthy, no delivery complications. I don’t know if this is of importance to my question: I was diagnosed with polyhydramnios at 26 weeks when I gave birth at 37.6 weeks, I measured at 42 weeks (~25cm of fluid). It also took longer for the placenta to detach and needed coaxing from the doctor but it had finally released and I bled normally on and off after (twice I passed golfball size clots) up until the day I had my IUD placed. At 7 weeks 3 days, I had the Mirena IUD placed, I had it before with no problems and still menstruated regularly every month. This time around, I didn’t have the cramping or bleeding after placement like I did the first time. I was told to come back in one month to check placement. When I went for the ultrasound they told me that I had some thickened endometrial lining and wanted to put me on 1 month of Minastrin to “make me have a good bleed,” then I was to come back in a month for a repeat U/S. I am now 3 days into the brown pills and besides light spotting occasionally through the month (maybe only a handful of time), sometimes brown other times red but never more than maybe a tablespoon and nothing a thin panty liner couldn’t handle, I have not had that “bad bleed” they said I should have. I called my OBGYN and the nurse said wait 2-3 days into the brown pills that I could still bleed. I am starting to freak out and worry that this thickened lining could be more than just the blood clot the doctor thinks it is. Could it be because I have the mirena in place, I’m lactating and also on these birth control pills that my body is so hormonally out of whack it doesn’t know what to do?! I’m terrified they’ll tell me it’s cancer! Please advice. Thank you.

    • Leah Torres says:

      Hi Krystal,
      It sounds to me that there is nothing to worry about. When you have the Mirena IUD and add birth control pills on top of that, and considering you’re breastfeeding, I’m not terribly surprised you have some unpredictable spotting. The thickened lining is most likely nothing, and in fact I would question if it’s actually “thickened.” Seems to me it might be best to just expect some irregular spotting and bleeding the first few months of the Mirena as that is very typical. I had irregular bleeding for over 6 months when I had my Mirena placed. πŸ™‚ I’m not of the school of thought that “you must bleed every month” and it is not standard of care to check the thickness of the lining after placing the Mirena. All in all, don’t worry, stop the Minastrin as long as it’s OK with your OBGyn and just see what the bleeding does, knowing that irregularity should be expected. Hope this helps to ease your mind, I really don’t think there is anything to be concerned about. Thank you for reading and posting this question, it’s a good one! πŸ™‚
      -Leah

  5. Sam says:

    Hi Leah. I just wanted to thank you so much for what you do. It’s so important to have people like you who advocate and help others about inclusive sexual health. I recently heard someone say that people with vaginas are less likely to become pregnant from a rape. I know this is false information created by republicans to try to stop abortions and that the opposite is actually true from what I have seen. I was wondering why rape does make someone more likely to become pregnant? Thanks for your help.

    • Leah Torres says:

      TW – sexual assault
      Hi Sam,
      Being sexually assaulted does not increase or decrease someone’s risk of an unplanned pregnancy. The assault itself has no influence on pregnancy. Just like with anyone, pregnancy will depend on timing, presence of sperm and egg, use of contraception by either person, etc. The political spin makes this unclear, but, again: sexual assault does not increase or decrease the possibility of pregnancy. Thank you for reading and posting this question!
      -Leah

  6. Kris says:

    On October 15th, I did a “quick start” of Minastrin 24 Fe, meaning that I didn’t do a Day 1 start or Sunday start, but began the day I got my prescription, in the middle of my cycle. 3 days ago (day 11 of birth control) I had sex. We didn’t use a condom at first, but then put one on, and he pulled out before ejaculation. I have heard that on a quick start birth control is effective after a month, but have also heard after a week. Is it effective now (day 14) or after a month? Should I be worried about being pregnant?

    • Leah Torres says:

      Hi Kris,
      Sorry for the delay. I recommend using condoms for the first month when starting a birth control pill. That said, it sounds like you are at low risk of having an unplanned pregnancy. If you find that you are forgetting to take a pill, also use condoms as back-up for that month. The methods that are effective after one week are the hormonal IUD and implant. Thank you so much for reading and posting. I wish you well!
      -Leah

  7. Dan says:

    Leah,

    If someone is on yaz and is late by 1, 2 sometimes 3 or (at most) 4 hours off her regular schedule during a week of travel, is yaz still effective? Can you share your thoughts.

    Thank you for your time

    • Leah Torres says:

      Hello Dan,
      It should not matter so much. It’s when whole days are forgotten that I would recommend using a condom as back-up. With birth control pills that have both estrogen and progesterone, as Yaz does, it’s a bit more forgiving regarding time of day. (For habit, nearly same time of day is helpful so as not to forget!) The progesterone-only pills, however, are cleared from the body in 24 hours, so they are very important to take at the same time every day.
      Thanks for your question and thanks for posting!
      -Leah

    • Ashlund says:

      Leah,
      I am currently taking Minastrin 24 fe and doing suppressive therapy (not taking the 4 brown sugar pills). I’ve been taking it this way for a little less than a year and not had a period. I get ovarian cysts that prohibit me from doing anything, even walking can be excruciating. I’ve had surgery to have ovarian cysts removed in the past. So no period = no ovulation which = hardly no cysts and pain. My question: last month I lost my pack and insurance wouldn’t cover it to replace it so I missed 2 weeks worth. Which as far as birth control and preventing pregnancy is concerned, I’ve had a tubal, so very very little to no chance will pregnancy be an issue. Like I said, The sole purpose is to avoid period/ovulation. Anyways, I missed 2 weeks, got it refilled and had taken 2 days worth when I ended up in Dr office with strep throat. So I was given antibiotics. Now, about 2 weeks later, I’ve been bleeding HEAVILY for 2 days. How do I make it stop? I’m not cramping, or anything else besides grouchy. I just want it to stop. Please tell me you have an answer.
      Thanks
      ASHLUND

      • Leah Torres says:

        Hi Ashlund,
        This sounds like you had some break-through bleeding and sometimes doubling up on pills can help the bleeding stop. That said, you would run out of your pack faster and if you are having trouble with refills and your insurance, that may not be helpful. I would ask your prescribing provider to ensure that you have access in situations like these. He/she can call your insurance to clear things up. I hope by now the bleeding has slowed if not gone away. Be well and thank you for posting.
        -Leah

  8. Blake says:

    I just want to say what convinced me to support abortion rights.

    I grew up as a very conservative christian. I began having anxiety and depression attacks in my teens. By the end of my first year of grad school (when I was 21) I entered full depression. I spent almost a decade struggling with it before my study of neurobiology freed me from religion.

    But even after rejecting religion, I questioned the ethics of abortion. I wondered when a ‘fetus’ becomes a ‘person,’ and how to measure their neural capacity, etc. Then I thought of the following scenario, and it made me reconsider the whole thing.

    What if I, a male, woke up one day to find another person attached to me, using me as a life-support system? What if they had, without my permission, comandeered my body this way? Wouldn’t I object? Wouldn’t I say ‘Whether I support this person with my body or not, that is my choice, and shouldn’t be imposed on my from without?’ By the same token, wouldn’t these same conservatives who want to make women act as incubators for babies against their wills cry foul and havoc against anyone who wanted to, say, make a small blood donation mandatory?

    So for me, the question is not at all about whether or not foetuses are human, or persons, or anything like that. The question is: does one person have the right to attach themselves to a second person without that second person’s permission, and use that second person as a life support system? And to that, I have to answer no. That is why I support abortion rights and I applaud your work.

  9. Lorian says:

    Hi,

    I am 49 yrs old, getting my period regularly, starting to experience some Peri-menopause symptoms – especially moodiness and fatigue.

    My Dr. prescribed me Minastrin 24 fe – I am healthy and active, and did not take birth control pills because of side effects in my youth.

    I am very conflicted about taking the pills because of side effect on one,hand, but also want to take care of my moodiness and fatigue.
    I am small in size 5.3 and weigh 101 pounds.

    I would like to start by taking only half a pill for the first month and see how that affects me – can I do that?…

    Thank you,

    Lorian

    • Leah Torres says:

      Hi Lorain,
      Taking half a pill will not harm you, though you may be risking an unplanned pregnancy (very low chance but not impossible) if you’re still having periods. I would highly recommend using condoms if you plan to halve your pills. Another option might be the vaginal ring, which has the same contraception effect as the pill but fewer side effects. It would also deliver similar relief of peri-menopausal symptoms but with, again, fewer side effects. I hope that helps and thank you for posting!
      -Leah

  10. Arabella says:

    So this is my first time on any birth control..I’ve been on lo loestrin fe for about a month and a half, didn’t get my period at the end of my first pack I am now onto the third week of my second pack but haven’t taken the pills the last two days. I had unprotected sex three days ago, what are the chances of me being pregnant? Please help !

    • Leah Torres says:

      Hi Arabella,
      The chances of you being pregnant are small, but not zero. If you’re concerned, I think it’s completely reasonable to take a pregnancy test. If you can, you should take your pills as soon as you remember them and use a back-up method such as condoms (which also protect against sexually transmitted infections) for that month. If you find you are missing pills at least every month, you may want to consider a different method of contraception (see bedsider.org). It has been past 5 days since you had unprotected sex but you may want to consider having either an IUD or an implant placed to be super effective against unplanned pregnancies. Also, not a bad idea to have emergency contraception (ella or Plan B) in your possession should something like this happen again. I apologize for the delay in getting back to you! Please see bedsider.org for awesome info on different birth control methods if you find the pill is difficult for you to take consistently. (Personally, even I find it difficult to take a pill every day.) Be well!
      -Leah

  11. Sakena says:

    Hello,
    I realized yesterday that I hadn’t taken Tuesday’s pill so I took both Tuesday and wednesdays pill yesterday. Today I woke up with brownish spotting.is this bevause i doubled up? And will it go away once I take my regular pill today on time? I am goin away next week and I am not due for my period for another 2 weeks, help..

    • Leah Torres says:

      Hi Sakena,
      Yes, missing pills and then taking them when remembered can cause irregular bleeding or spotting. Please don’t be alarmed. I would encourage you to use a back-up method such as condoms to prevent pregnancy this month, however. The spotting should clear up, not to worry. If you prefer not to have a period, you may skip the “sugar pill” week and start the new pack such that you are taking a pill with medicine in it every day. There is no reason to have a “withdrawal bleed” while taking a birth control pill. I hope this is helpful!
      -Leah

  12. Samantha says:

    Hi,

    I’ve had some trouble with minastrin fe. After 2 yearsof using it, it made my face break out in very painful cysts then it started making sex very painful. I waited about a month until I decided to stop taking them. The acne went away but the vaginal dryness/irritation did not. My Gyno put me on dasetta and now I’m waiting to see if my body adjusts. It’s been a week and I’m so anxious to know if this one will take the irritation go away. is it too soon to expect results? I know waiting 3 months is what i should be doing, but I am so uncomfortable and I don’t want it to cause any friction in my relationship.

    Thanks

    • Leah Torres says:

      Hi Samantha,
      I wonder if regular life changes are happening and not a change in the pill regarding your symptoms. Either way, 1 week is not long enough to notice a difference but in a month it should be different. If you are having vaginal dryness, I urge you to try using lubrication during intercourse. Something like “KY” or other water-based lubrications should suffice. Many people use this whether they have dryness or not and it is a good accessory to have at the ready. It sounds as though this is causing you some distress, this may also be causing distress during intercourse, which could itself lead to vaginal dryness and a vicious cycle. Please give yourself some time, be patient, use lubrication in the meanwhile, and I imagine sooner rather than later you will find all is well again. I hope this helps but please be sure to have an open conversation with your physician regarding these concerns. Take care and be well.
      -Leah

  13. sally says:

    when I had my period with minastrin 24 fe birth control, I took the white pills not the brown. It is my first month on this pill & the package is on the last row, where the brown pills are. I am not expected my period till three weeks, do I still take the brown pills when it comes up to that day, or should I just start on my next packet & disregard the brown pills this time but take them next period I have?

    • Leah Torres says:

      Hi Sally,
      I apologize for the delay in my response. You do not have to take the non-medicine (non-hormonal, aka sugar pills) if you do not want to. You may start the new pack straight away and skip that week entirely. You may do this as often as you would like, never having to have a bleed if you do not want one. Either way you choose is safe. You may have irregular bleeding with the first month or two of pills, that is normal. Hope that helps! Thank you for posting!
      -Leah

  14. frances says:

    Hello. Last May, after being on oral contraceptives for 17 years, I had a Paraguard inserted. After several months, I had noticed during ovulation i would get very constipated and it would last until menstruation. I had gone for colonoscopy and endoscopy. Everything was normal. The gastro recommended i speak to my gyn about going on low dose birth control, as my constipation seemed hormonal in origin. In january if thos year ai was put on Lo loestrin 24 with the Paragard still in place. I had horrible staining and 2 week long periods. Digestion was much better though. My gyn put me on Minsatrin which is double the estrogen. But now, i am starting a period 11 days into the pack. I never once had irregular flow on the pill. Can this be due to having the IUD in place still, which i know makes the uterine lining very thick and therefore, the pill isnt as effective at controlling blood flow with the IUD in place? I plan to have it removed in a week. Will i once again have normal, every 4 week periods once it is out? Thank you.

    • Leah Torres says:

      Hello Frances,
      I am wondering if I have reached you too late… I apologize if so. I would not imagine the non-hormonal IUD having an effect on your digestion, though birth control pills certainly can. I would recommend not having it removed and instead seeing if a variety of changes in diet might help. If you are taking other medications they also may be a factor. With a copper IUD, you hormone balance is your own without medical influence (i.e. you cycle as you normally would and have bleeding as you normally would though it may be a bit heavier and crampier. This does not generally create constipation, however.) I hope your Gyn was able to provide insight and help you obtain the best method and advice that you were seeking. I hope you are well! (I would be curious for follow-up if anything has changed!)
      -Leah

  15. Kat says:

    Hello there,
    On Dec 30 I started BC I just had a baby in November, I chose to get the Depo shot, I hated it during the 3 months I was just spotting so much so I went about 2weeks earlier before my next shot to change my birth control. I started Menastrin 24 a few days later I had the option to because I was still on the depo., Its only been a week my doctor said I would still be covered from the depo still but on Saturday I was about 25 minutes late taking my birth control I had been taking it on time the whole week, should I be conferned at all or I still covered from both depo and the pill?

    • Leah Torres says:

      Hi Kat,
      You will be fine. I apologize for this being a bit late. Combined birth control pills (those that have both progesterone and estrogen) are a bit more forgiving on timing, but as long as you take it every day (preferably within a few hours of the same time that day) you will be fine. If you find you are consistently missing taking them, though, I would recommend considering a different method and using condoms as back-up. I direct people to bedsider.org (no financial conflict of interest) because I personally know them and know they do a good job of providing birth control information. Hope that helps!
      -Leah

  16. melissa camacho says:

    Hi there
    This question is regarding my birth control pills.I started a new pack on Saturday and I realized that I didn’t have my pills with me to take at my normally regular schedule time. So I wanted to ask you if I am about 2 and a half hours late but I still take it today
    What happens ?

    • Leah Torres says:

      Hi Melissa,
      I apologize for being quite late on this one. Being a few hours off taking your pill should be fine. Just be sure to always take it as soon as you remember it. If you miss a day, take 2 the next day, and then back to your regular one a day. Should you miss one, I would use condoms as back-up (if you’re not already using them for STI protection) that month. If you miss more than one day, I might consider a different method (and use condoms!) as the pill may not be ideal for you. I know it’s not ideal for me. I hope that helps! Take care.
      -Leah

  17. K says:

    Almost 3 months ago, I began taking Minastrin 24 to treat perimenopausal menorrhagia. Skipping the iron pills to prevent periods, I have about a week left of the third pack. I have bled every single day until yesterday. That’s three months or so of bleeding (not heavy, but still….)

    Since beginning the Minsatrin, I have gained 6 lbs on a small frame and my breasts are hot and so swollen I need to wear a sport bra to bed. I have spillage out of my size 30DDD bra. None of my clothes fit. Nothing in the store fits my thick and distorted shape.

    Last week I had migraines so bad I thought I might need to call 911. I put my phone on my bedside with the numbers already punched in so I could just hit the call button.

    Further, I am having frightening mood swings. Right now, I would really like to smash out every window in the house and a few of the neighbors’ cars. I’d like to throttle the researchers who say the pill does not cause weight gain. Blankety blanks. My partner is avoiding me.

    I have doctors pushing ablation so hard that I have to believe it is for their best interests not my own (It was the first thing my last doctor said to me and I was not even in the office for bleeding at that time–bizarre. And all the doctors have posters and ads and fancy handouts). My concern is that this will not help with mid cycle pain and bloating, and the debilitating cramps (now including shooting pains like I am being impaled) I was experiencing. I have heard that if there is endometriosis, this procedure can make it worse. I saw a new doctor yesterday and he also pushed for this. The choices he presented were: this, ablation, or hysterectomy.

    I have tried the Mirena, the patch, lo-e and no e pills in the past. Mirena gave me similar symptoms as this pill, which is why that was ruled out by new doc. So did the patch. I am 50 and looking forward to menopause, but I need some help getting there without ruining my life. Nothing in the past has caused THIS level of emotional disturbance and irritability.

    Do you have any recommendations?

    • Leah Torres says:

      Greetings, [full disclosure: I have no financial conflicts of interest]
      Your situation is certainly not an easy one to tackle, but I shall do my best to help you. If you were my patient, I would say that ablation will not help with your other symptoms, just with the bleeding. It seems that your other symptoms, however, are the most concerning. Given your mood swings I would recommend a birth control pill with drospirenone in it (typically “Yaz”). The progesterone component of pills are the ones that cause side effects like mood swings and weight gain, and it seems like this type of progesterone would suit you best. That said, if you are having bleeding issues as well, the slightly higher dose of estrogen in this pill should help with that as well. I would recommend you take this pill continuously, skipping the “iron pills” which should also help with mood and bleeding. Keep in mind, the changes of menopause themselves, which you are probably experiencing, I imagine are contributing to all of these concerns as well so this is a tough spot to be in.
      Along with switching your pill, I also recommend a medication that can help with other menopausal symptoms such as hot flushes (why you may have breasts that are hot and swollen). It is known for its anti-depressant use, but it is also used to treat menopausal symptoms. This may also be an added benefit to help your mood, too. It is “Effexor.” Ask your doctor about that as it may help in more ways than one.
      Your situation is truly remarkable but I think an ablation is not the entire answer. The bleeding can be stopped without much ado, but, again, it seems your other symptoms are concerning you the most. I do hope you find these suggestions helpful and I hope you find relief to your symptoms soon. Be well.
      -Leah

  18. Alex says:

    Hi,

    Ive been taking the new minastrin for a few months including the brown pills. However, this is the first time that the withdrawal bleeding will conflict with a vacation ill be taking in two weeks. If this is the first time ill be going straight from white pill to white pill “continuously”, what are the chances of me still having withdrawal bleeding during my vacation? and is it safe to go back to how i was taking it before after.

    • Leah Torres says:

      Hi Alex,
      Great questions! You do not ever have to have withdrawal bleeds if you do not want to have them, so feel free to only take the active medicine pills. Switching back to taking the inactive pills will, of course, start a withdrawal bleed, but it is safe to either have a withdrawal bleed or not have a withdrawal bleed. Switching each month to having one or not is also safe. As long as you are taking an active pill every day and not forgetting any, you should not have bleeding. Taking the pill continuously should work if you do not experience bleeding while taking the active pills. This is very safe. I hope that helps! Be well!
      -Leah

  19. Nicole says:

    Hello!

    I have been on Minastrin for about 2 years now. First, i was on Loestrin. Since i suffer from migraines my new doctor told me to skip my inactive period pills every other month (so i am continuously taking the pills 2 months in a row-then getting my period the next month). This month, i have started my new pack and about a week into my new pack I have started spotting. It is nothing that is coming onto underwear but it is there when I whipe. Any idea why this may be happening? Its more of a frustration than anything.

    Also, I started dieting and working out tin the past 2 months and lost 10 pounds so far. I am thinking this could be it as well? Any suggestions or help would be appreciated.

    • Leah Torres says:

      Hi Nicole,
      This is not unusual with weight loss or other changes in health and is usually remedied with a change in dosage of your pill. First, you do not ever need to have a withdrawal bleed but I will leave that between you and your physician. (Meaning you may take your pills continuously, skipping the inactive pills with each pack.) Second, increasing the dose slightly on the estrogen component of your birth control pill should help stop intermittent spotting. I understand what you mean by “frustration” and hopefully a simple adjustment of dose will help alleviate this problem. I hope that helps and I wish you well!
      -Leah

  20. Meg says:

    Hi Leah,
    I’ve been paranoid about pregnancy even though I’ve never had sex. It started because I was grind dancing on a guy and now I can’t shake the feeling that I’m pregnant. I got my period 4 days after this , then it came late the next month and then I started birth control (im assuming my doctor wouldn’t have given me the pill if I was pregnant?) and I get my withdrawel bleeds. Would you say this is just an anxiety thing and I’m completely safe from pregnancy??

    • Leah Torres says:

      Hi Meg,
      I apologize for the delay and I hope that in the mean time you have reached out to sources you trust regarding this issue. You cannot become pregnant by grinding while fully clothed. Sounds like you are on a birth control method, which is a good thing. Please check out scarleteen.com or bedsider.org as these are great resources for sex education and birth control methods, respectively. You are very safe from pregnancy if the clothes stay on, but it sounds like some more education may help alleviate some anxiety around exploring your sexuality so I encourage you to seek it out! Check out Scarleteen, it’s pretty good. I wish you well and be safe!
      -Leah

  21. Tenasja says:

    Hello. I had an abortion at 11 weeks 6 days on a saturday and I went to the gyn for a follow up exam from the abortion that following wednesday. I been having spotting or light bleeding from that saturday to wednesday. Well on the Wednesday visit she said everything looks good and she put me on birth control (Minastrin 24 Fe). I started it that day and ever since my bleeding has been heavier and the cramping has started. It is now Saturday (a week after the procedure) and nothing has changed. I thought the bleeding would stop by now but do you think that the birth control pills is what’s causing it? Should I have waited until the bleeding had ceased completely? The dr said I could start it that day but I don’t know if it is affecting my bleeding and cramping.

    • Leah Torres says:

      Greetings,
      If you are having heavier bleeding and cramping, it is unlikely the birth control pill and I suggest you return to your doctor for evaluation. After any pregnancy, (abortion, miscarriage, or even birth), bleeding afterward can be difficult to diagnose. If your gyn was not the one who performed the abortion, I would return to the person who did and let them know what is going on. If you were my patient, I would want you to contact me, for example. It is most likely nothing but those are my recommendations. Take care and I hope this is resolved soon for you.
      -Leah

  22. Amy Clark says:

    Dr Torres, I’m a fond follower on Twitter who is now in the second year of training in a family medicine residency program. I would like to incorporate early surgical and medical abortion into my practice. However, my program does not teach abortion care. How do you recommend I rectify that situation? Because I transferred, I’m out of electives. πŸ™

    • Leah Torres says:

      Hi Amy,
      Yes, I recognize your avatar! Thank you for the question, it’s super important to get this information out there. There is a Family Medicine Family Planning training program called RHEDI and you should look into it: http://www.rhedi.org. Considering you’re almost done with residency, however, you have a few options. 1) You could work with and train with an OB/Gyn who provides them and can teach you how to do them, 2) You could ensure moonlighting at a Planned Parenthood or other clinic that provides abortions and, again, get trained by those who provide them there, 3) apply for a fellowship in family planning (www.familyplanningfellowship.info) which is what I did after residency because I didn’t feel trained well enough. Ultimately, just because you graduate residency doesn’t mean you can’t train further and develop more skills.

      As a side note, because I was so vocal during my residency about not being trained well enough in abortion care, my former program has started a Ryan Program (RHEDI is the FM version of this OB/Gyn residency program) to train its residents in abortion and contraception provision. I am so proud of them for this and perhaps one day your program could start a RHEDI.

      I hope this helps! Just know that you always have allies in the family planning community and I don’t know of anyone who wouldn’t take on a dedicated physician to train them in abortion care.
      -Leah

      • Amy Clark says:

        Thanks for the resources! I look forward to delving in and seeing what comes forth. I’m pleased to have an ally like you.

  23. Diane says:

    Dr. Torres,
    I am a woman in her late 40’s taking Minastrin for help with heavy and painful periods. It has definitely helped. I am not sexually active and I do not take the pill to prevent pregnancy. Is there any reason for me to take the 4 iron pills? I would rather not have my period at all, but I am not sure if there is a medical reason to have a monthly period.
    Thank you for your time,
    Diane

    • Leah Torres says:

      Hi Diane,
      Very common question! There is no reason to have a “period” when you’re on the pill. You may safely skip the iron pills and start the new pack, skipping the withdrawal bleed. I believe there are more details regarding this in previous questions, though I cannot link directly to them. Thank you for posting, questions help others, too! Take care.
      -Leah

  24. kaylyn says:

    I am due for my period tomorrow buy I don’t have the usual cramps or anything with it. I have had unprotected sex and could be pregnant I don’t know what to do. am I?

    • Leah Torres says:

      Kaylyn,
      If you have not had your period and are concerned about an unplanned pregnancy, I encourage you to please go to your doctor or to a health clinic for emergency contraception, preferably the copper IUD. This may be placed within 5 days of unprotected intercourse as long as your pregnancy test is negative. The next best thing would be to take ella, and last but not least Plan B. In any case, I would make contact with a health care provider today. I hope this reaches you in time and I hope you have access to OB/Gyns, family medicine docs, or a Planned Parenthood, where you live.
      -Leah

  25. Lauren says:

    Hi Dr. Torres,

    I had a surgical abortion at 7 weeks 5 days one week ago and am happy with my choice. I am already significantly nearsighted and noticed my vision worsen during my pregnancy. My doctor told me not to get an eye exam during pregnancy because my prescription would change. How long should I wait after the termination should I wait to get my vision checked? I can only find information stating to wait 3 months after giving birth but nothing about pregnancies that ended as early as mine. I should probably also mention that the vision changes aren’t large enough to present a significant impedance to daily activities, just some headaches from squinting so the timing isn’t imperative.

    -Lauren

    • Leah Torres says:

      Hi Lauren,
      You may have your vision checked at any time and I honestly don’t know of ever needing to have your prescription changed during any length of pregnancy. Vision doesn’t change during pregnancy, though if your physician knows something I do not I would greatly appreciate learning. Take care!
      -Leah

  26. Em says:

    Hi Dr. Torres,

    First of all, thank you for taking the time to write all these thoughtful and informative responses. I was looking through some of them and saw some mentions of “continuous” birth control where you skip the week of sugar pills. I am currently on birth control (Junel) and I think of the sugar-pill withdrawal bleed as a somewhat inconvenient although generally useful indicator that I did everything right that month and am not pregnant. But is this necessarily true? Since a withdrawal bleed is a bit different from a regular period, can you still possibly have a withdrawal bleed if you are pregnant? Is there any reason at all, either medical or practical, to take the week of sugar pills rather than using continuous birth control?

    • Leah Torres says:

      What a great question! No, there is no physiologic or health reason to have a withdrawal bleed. Birth control pills are safe to take continuously. Your thinking is spot-on: your menstruation is being hormonally regulated and the bleeding is simply your body not having that hormonal therapy. This design was so women felt “normal” (I assume), and advances in medical knowledge haven’t gone far past the custom of having that bleed. I counsel my patients that they make take the pill continuously, or not and have a withdrawal bleed, as they prefer. There are some who have other menstrual symptoms associated with these hormonal fluctuations and for them I prescribe continuous pill taking. Regarding the question about pregnancy, if the pill fails, for example, you could have a withdrawal bleed depending on the timing of pill failure and pregnancy. There are people (on or not on the pill) who also have bleeding in early pregnancy that resemble their normal periods, even though they are in fact pregnant, delaying their realization of the fact that they are pregnant. If you have that bleed you should feel reassured that you are not pregnant. That said, nothing in this world is 100%. The generality is, however, that by taking the pill regularly, even when having a withdrawal bleed, one should avoid becoming pregnant in the first place.

      Hope that helps and be well!
      -Leah

  27. Patty says:

    Hi Dr. Torres

    I started using vaginal cups in lieu of tampons a few years ago. I appreciate the convenience. But one thing I have noticed is while it it is inserted my urine stream seams constricted. Is this okay? Just don’t want to make a UTI more “likely.” What should ppl who use these devices be concerned about, if anything?

    TY for all that you do for people.
    Love and peace
    Patty

    • Leah Torres says:

      Hi Patty,
      I wonder if you’re using “InStead”… The Diva cup seems that it would not infringe on the urethra but I can see how the ring of InStead may put pressure on the “top” of the vagina, above which the urethra is located. I would make sure that the cup is pushed as far back into the vagina as possible, specifically the “front” or “top” of the cup that would be closest to the urethra. The back of the vagina is a pouch where the cervix “comes through,” essentially, and if the cup is around the cervix, tucked in the back of the vagina, it shouldn’t put pressure on the urethra.

      By the way, you may want to go into your gynecologist’s office and ask for help as needed. I would rather someone come see me and ask me this before causing themselves discomfort. Finally, these devices are very safe when used with common sense hygiene in mind. I hope this provided some guidance and I wish you well! I appreciate your kind words and your support, thank you.
      -Leah

      • Patty says:

        TY Leah! It is hard to insert the cup up to my cervix on my first day of menstruation. My vagina just says NOPE! My vagina will figure it out by the end of day 2 of menstruation. Just was concerned if the constriction may lead to a UTI using a cup (note haven’t got one yet; just noting my urine stream when placed) and thought I would ask. Thank you again for all that you do for people. And thank you for answering my questions.

        love and peace
        Patty

  28. Hannah says:

    Hi Dr. Leah!
    I last night I was with my boyfriend, I didn’t give him a handjob, but there was pre cum present. I don’t remember if I touched it or not. Then about 5-10 minutes later I used hand sanitizer when I got into the car to go home(it was about 3 degrees last night) when I got home about 15 minutes after the hand sanitizer I accidentally touched my vulva because I had an itch, I totally forgot that I could’ve touched the precum. I don’t know if this matters but I am on minastrin 24 Fe and I am on my period right now. Could I get pregnant from this or would have the hand sanitizer killed it? Also being on Minastrin, is it okay to take the pill at most 2 hours late? I take it at 9pm daily but I sometimes forget and the latest I would take it would be 11pm I have read that if you take it less than 24 hrs and don’t miss it that you are protected, is that true? Thanks!!

    • Leah Torres says:

      Hi Hannah,
      Good questions and I am very glad you asked. I am going to throw out a lot of information and please forgive me if you already know most of it, I just want to be thorough as well as clear. It is extremely unlikely for you to become pregnant in this way. To begin, you are currently having a “withdrawal bleed” from your pill, which means you are at the end of your cycle and should have not had an ovulation if you’ve been using your pills consistently and correctly. (Of note, being a few hours off generally isn’t going to make a difference in the combined pill that has both estrogen and progesterone like Minastrin does.) Sperm may be present in pre-cum, but they would need to survive. This requires a moist environment (the outside of the vulva tends to dry quickly) and not a lot of time to pass before they are safely in a moist environment (so surviving a trip from a dry outside to a moist inside of the vagina is unlikely.) The hand sanitizer is always nice to have around, but I honestly doubt there were any viable sperm present for it to have an effect on.

      Most importantly, it seems that you may want to consider having emergency contraception handy (a pill like “ella” is slightly more effective than Plan B, but a copper IUD is the best method of emergency contraception, hands down.) If you find you are nervous about how well the pill is working, or if you’re taking it correctly, you may also want to consider using methods that are easier and/or more effective than the pill. I refer people to bedsider.org to figure this out. They have great information that is easy to follow. (Full disclosure: I have no financial investment in any of the methods or resources I’ve mentioned.) I recommend considering a different method of contraception as it seems there may be some scares that are possibly avoidable and unnecessary.

      I hope this has been somewhat helpful and thank you for the questions!
      -Leah

  29. Chelsea says:

    Hi, I got my tubes tied about 7 months ago, after that I have bleed every 2 weeks. I went back to the doctor and he said it would take a little time to get regular. Well, it continued and I called them back they put me on a birth control. And I was still bleeding, so he ordered a ultrasound everything looked good. But, now after I have sex I start bleeding and it usually last about a week. please tell me what I should do. I’m tired of all the bleeding and not knowing what’s wrong.

    • Leah Torres says:

      Greetings,
      Gosh, this is a tough one. I can say that occasionally after having your tubes tied there can be changes to menstruation which is thought to be because of the difference in blood supply to the ovaries. (Blood comes from arteries that run along the tubes, which become “cut off” after a tubal ligation, but the major blood supply of the ovaries is from another vessel that remains untouched after a tubal.) Thus, the ovaries may have changed the way they “behave” due to their blood supply. However, know that I was not able to find a lot of research on this and one paper claims that there is no effect of tubal ligation on ovarian function. That said, if pills aren’t working perhaps an IUD may be the answer. Clearly you already have an effective form of contraception, but the Mirena IUD can also help with irregular bleeding. Another possible reason for the bleeding could be something inside the uterus that isn’t always visible on ultrasound (a polyp or a fibroid, both of which are benign but can cause bleeding problems). A hysteroscopy or special ultrasound using saline infusion helps diagnose these possibilities. If the birth control pill has a high enough estrogen dose but you’re still bleeding, you may want to investigate further with one of those tests. I wish I could be more helpful but I think it would be worth your doctor looking into further. It certainly isn’t something you should have to live with. Good luck and be well.
      -Leah

  30. Lauren says:

    Hi Dr. Torres,

    I am something like 7-9 weeks pregnant and don’t wish to be: I have an appointment for an abortion tomorrow morning. My family doctor and I unsure about gestational age because my periods were irregular and we suspect I ovulated late. I was told by the receptionist at the abortion clinic that when they do the ultrasound to age the embryo it may be young enough for medication abortion to be available to me. I am unsure whether medication or surgical abortion would be best for me. I am primarily interested in the quickest alleviation of my pregnancy symptoms – morning sickness, fatigue, depression, and a general ‘brain fog’ – that are disrupting my professional and personal life. Provided I am presented with the option tomorrow, which choice would yield faster resolution of my symptoms? And how long can I expect to wait before I’m at “normal” functioning again?

    -Lauren

    • Leah Torres says:

      Hi Lauren,
      I imagine this may be reaching you late and I apologize if this is the case, but to answer your question the quickest alleviation of pregnancy symptoms is a surgical abortion. This is not always the best option for everyone and people who are eligible for either a medication abortion or a surgical abortion often have a variety of reasons for choosing the option they choose. Given the surgical abortion is over in minutes and thus your body will become non-pregnant faster than with medical abortion (which mimics a miscarriage), that is what I might recommend for you. You should feel “normal” again in the next few days though if you took a pregnancy test it might be “positive” for 1-2 weeks after the procedure. I hope this helps and I am glad you will be able to achieve your life goals and plan if and when to have a family.
      -Leah

      • Lauren says:

        Thank you. I did end up having the surgical abortion and I am happy with my choice. My most debilitating pregnancy symptoms were relieved immediately. I am now doing housework I was too sick and depressed to.do before and I can focus on my work. I plan to get an IUD to prevent pregnancy in the future. I made sure to thank my doctor and all the staff for their work and I extend that to you: thank you for your commitment to reproductive health and choice despite dangers it may pose to you. This experience has solidified my position as an activist for choice and I am inspired by your seemingly tireless education and engagement with the public on these issues. Your work is a perfect marriage between personalized medicine for your patients and political engagement on behalf of all female-bodied persons.

        • Leah Torres says:

          Lauren,
          My cup runneth over. Thank you for your support and I am so excited that you are once again in control of your life. Tell your story as you feel comfortable–I know you are aware of how powerful voices can be. All my best.
          -Leah

  31. Carlie says:

    Hi Leah! I have certainly enjoyed reading your very useful insight!
    I have a question…. I had been on the Minastrin pill for 4 months and was taken off in November of last year due to side effects. I had my period a week after that. I had my next period about 4 1/2 weeks after that. Well last month my period didn’t come and it’s about 2 weeks late. I’ve had some very early pregnancy symptoms such as nausea, headaches, frequent urination, and dull cramps. I’ve taken 4 pregnancy tests and they are all negative. Could the birth control have actually thrown my cycles off? Or is there a chance I may actually be pregnant?

    • Leah Torres says:

      Hi Carlie,
      I would trust the pregnancy tests and know that you are not pregnant. Yes, sometimes oral hormonal birth control can alter your menstrual cycles, but also keep in mind that our cycles will change and have different characteristics throughout our lives. The cycles we have as teens are not the same as the ones we have later in life, for example. Though if you are sexually active with male partners and wanting to avoid pregnancy, I would use another form of birth control in addition to condoms. Just as there is an adjustment when starting a hormonal method of birth control, there may also be an adjustment when it is stopped, as in the case of oral birth control pills. I imagine these symptoms are temporary but you may wish to consider another method of contraception. Hope that helps!
      -Leah

  32. Anne says:

    Hi Leah! Two months ago I started taking the birth control Minastrin 24. Ever since then it has been very hard for me to have an orgasm. I would have thought nothing of it except the same thing has recently happened to a friend of mine who has also just recently started the same birth control. I know it takes about 3 months for your body to become accustomed to a birth control, and I was wondering if, in your opinion, this side effect might go away with time.

    And if you are unsure of if this side effect would go away, how long would you suggest that I should continue to wait for it to change? And if it does not change and I want to take another type of birth control, are there any that do not have this as a side effect?

    Thanks so much!

    • Leah Torres says:

      Hello Anne,
      Everyone reacts differently to hormonal birth control and everyone also has different adjustment periods. I cannot be certain that there has been a direct effect on libido from the pill, but your evidence is fairly convincing. (For example, I’ve had patients switch to non-hormonal methods with no improvement in their low libidos, which is why I say that.) I would say 3 months is a reasonable time to wait for an adjustment and if there is no change, consider a different form of birth control pill (that contains a different progesterone hormone than what Minastrin has). You may also want to consider a different, more effective method entirely (an IUD or an implant). I have no financial ties nor do I have conflicts of interest, but an IUD or implant are the most effective reversible methods and do not affect libido. I also refer people to Bedsider (bedsider.org) to check out which kind of contraceptive method might be best for them. I hope this helps and that this is a temporary situation.
      -Leah

  33. Allie says:

    I am a passionate RJ supporter and advocate, but just realized that I don’t know something and need some insight from a practitioner.

    This is about waiting periods for abortions. I dislike legislatively-mandated waiting periods due to their paternalistic origins and the economic burden it can place on those seeking procedures, but I’m wondering if there would still be waiting periods even without the statutes. For example, with other medical procedures, like, say, getting your teeth pulled, you’re first told that you probably need your teeth removed, and then you have to schedule another appointment to get them removed. If there were no mandated waiting periods, when a person went to a clinic and got a firm diagnosis that they were pregnant, wouldn’t there still be a period of time that person would have to wait, just because of availability of appointments/practitioners/time?

    Basically, from a medical perspective, wouldn’t there always be a ‘waiting period,’ even if there were not legislatively-mandated periods? Or am I getting the timing of when the latter begin wrong?

    Sorry this was so convoluted — I hope you understand what I mean.

    • Leah Torres says:

      Hello Allie,
      What an excellent question, I’m so glad you asked! It’s also a very important question and while I don’t have the single-best answer, I hope to at least provide insight. No, waiting periods are not necessary and they are very antiquated and paternalistic. That said, like with your example of tooth extraction, it is unusual for many specialties to offer procedures the same day they are requested. However, this depends on the procedure. A hysterectomy, for example, unless done for a life-saving reason, is not done the same day it is requested. There are usually scheduling logistics and possible blood work to navigate first. There is no “mandatory” waiting period for this procedure, however, and there should not be. That’s an example of a major surgery, so let’s talk about an outpatient procedure similar to, but not, an abortion: IUD placement. I feel it is a travesty if an IUD cannot be placed the same day it is requested, and only under very specific circumstances is this medically contraindicated. What do I mean? IUDs can and should be placed the same day they are requested and they can and should be placed in the office (again, only under rare circumstances can they not be). The same reasoning applies to abortion because it is a safe outpatient procedure, however because so many regulations have been imposed for political, not medical, reasons it is almost unheard of that they are done the same day. Because every medical condition and every patient is different, the timing of any procedure should be individualized. For example, if I feel someone isn’t entirely sure they want an IUD, I recommend they go home and do some research and return for another appointment if they decide that’s what they want. I do the same for abortion procedures, though I live in a state with a mandatory 72-hr waiting period that hurts more than it helps. (To be fair, I’ve known some who were grateful for the waiting period, but I’ve also known some that were significantly harmed by it.) All in all, with the right counseling and education the decision of what procedure & when should be up to the patient with guidance from their health care provider. No where should a politician intervene. The unique thing about pregnancy is this: it’s time-sensitive, therefore any delays should be avoided at all costs and certainly none should be imposed. Cancer treatment is also time-sensitive, as are treatments for infections or appendicitis. Delays in treating these conditions can lead to undesired health consequences. (As a counter-example, a hysterectomy, colonoscopy, mammogram, may or may not be time-sensitive.) First trimester abortions can be done in an outpatient/office setting safely despite what ill-informed politicians/laws say and, just like with treating a miscarriage, should be done as soon as possible in order to preserve the well-being of the pregnant patient.

      On a last note, I have turned patients away to take more time to think about it if I was concerned that they were not certain about having an abortion. I know my colleagues do the same thing. We support our patients’ decisions and want to ensure that they are not coerced or uncertain.

      What do “mandatory” waiting periods do? They delay care –> pregnancy grows –> abortion procedure can have increased risks the farther along in pregnancy –> the procedure can cost more –> increased costs can be prohibitive, forcing people to travel to other states, incurring even more expenses, or not have the procedure at all and be forced to undergo the health risks of pregnancy and birth, possibly unplanned parenting.

      Thank you for your question! I encourage you to read the many blog posts (RHRealitycheck.org) on this topic as well.
      -Leah

  34. Maddie says:

    Hi Dr. Torres-
    First of all, I wanted to thank you for the bold, patient work you do every day- your responses to ignorance on Twitter are always inspiring to me.
    I just had a question about birth control in general- I saw a New York Times article about how certain methods of birth control become less effective over time- especially taking the same type of pill. I’ve been taking the same pill for almost two years now- is this something that I should be worried about? Would you recommend just switching to a different kind of pill, or thinking about another form of birth control like an IUD or hormonal implant? I’m wondering what would be the most effective- not planning in getting pregnant for at least 5 more years!
    Thank you!
    Maddie

    • Leah Torres says:

      Hi Maddie,
      Thank you for your kind words regarding Twitter and for supporting the efforts to protect reproductive health for everyone. To answer your question, I believe what may not have been communicated well in the article is this: over time, using the pill may lead to increased opportunity for failure. The pill does not lose efficacy, as in the drug doesn’t change how it works with your body. However, because it isn’t perfect, the longer it is used the more opportunity there is for it to fail you. The same can be said with tubal ligation: the earlier it is done, the longer the body has to heal itself and possibly reform a connection in the tubes, thus creating a potential for failure. So, it doesn’t have to do with the drug or hormones themselves, it has to do with likelihood of failure over the passing of time. The more time that passes, the more “chances” there are for the pill to fulfill its 15% failure rate. I hope that makes sense, I know it can be confusing at times. The most effective methods are the IUD and implant and those are the ones I recommend first, especially if there are no plans for pregnancy in the next year. Also, they have no effect on fertility: when they are removed, you go back to being as fertile as you ever were. I also refer people to check out bedsider.org to inform themselves of various methods because it’s medically accurate while being easy to understand. Hope that helps!
      -Leah

  35. Jenna says:

    What would you recommend for someone who thinks they may have endometriosis? I got no real answer from my doctor, and the pain is to the point of being unbearable. I have always had terrible cramping and back pain with my periods, and even now on minastrin (which I take continuously) and being 30 years old, I still have bad cramping and bleeding. The only thing that helps is aleve, and the onset is random. Any suggestions are more than welcome!

    • Leah Torres says:

      Hi Jenna,
      I have had success treating patients with endometriosis by placing a Mirena IUD. There’s some evidence that attests to its efficacy, though we’re not really sure how. I’d recommend placing the IUD and giving it some time to treat the endometriosis. After a few weeks, it may be reasonable to do a laparoscopic surgery (going inside the belly with a small camera) to take out any of the remaining endometriosis lesions. You may wish to have this done by an OB/Gyn skilled in treating endometriosis. Unfortunately it takes time to treat this and nothing is necessarily curative, though various interventions may help. If you are able to see someone who specializes in treating endometriosis, so much the better (some OB/Gyns have this area of interest and thus more experience). I wish you well and please have patience, I know this is not easy to live with or find relief for.
      -Leah

  36. goma says:

    I want to adjust my period schedule because of an event in March. I started taking birth control pills Minastrin 24 FE 2 weeks ago. I am 41 years old and this is the first time I am taking birth control pills. Now I feel terrible, and would like to stop. How will this affect my periods? My periods are usually regular , coming in once every 26-29 days.
    Is there a better way to reschedule my periods?

    • Leah Torres says:

      Hello G, [full disclosure: I have no financial conflicts of interest regarding the following advice]
      There may be several reasons for this but I would say that the most likely is the type of progesterone (norethindrone) that is in the pill you’re taking. It may be a simple matter of switching your pill to one that contains a different type of progesterone. Switching or stopping the pill won’t have an effect on your period, except to say that you may have a withdrawal bleed. With any birth control pill, you have the option of taking it continuously, that is skipping the “sugar pill” week and instead beginning a new pack. This way, you will always be taking a pill that has medicine in it and you will not have a withdrawal bleed (what most people see as their ‘period’ while on the pill). Have you considered something like NuvaRing? That is another nice option that you may use for 4 weeks straight, then take out the old ring and put in a new one, avoiding a withdrawal bleed but also having continuous contraception. There are many different options available to you and it may just be that you should switch the kind of pill you’re on and take a different one, but continuously, without having to worry about timing issues. I hope that was helpful and wish you well!
      -Leah

  37. Mar says:

    Hi,
    I am experiencing break through bleeding on ministrin 24 FE. This is my 5th pack. I am wondering if this is messing with my ovaries/causing them harm? I also have two ovarian cysts on my left ovaries. Both small and cause dull pain usually around mid cycle. Is there ever a chance of these going away? I worry that the combo of cysts/ being on birth control will take away my ability to conceive. I see that you said you do not prescribe minstrin. I would like to know why. I am 26 and have s few years before I would like to conceive. I want to make sure I am doing all the right things to make that a possibility down the line. My Gyno just replies “we can’t predict whether you will or will not be fertile” I am looking for a second opinion.

    • Leah Torres says:

      Hi Mar,
      Thank you for your questions, they are important! Just to clarify, I have nothing against Minastrin 24Fe, it’s just not something I typically prescribe. Any pill with both estrogen and progesterone works to inhibit your ovaries from making follicles because that is how eggs are made. Large follicles are often known as “cysts,” though there are other types of cysts that can cause pain. I’m not sure which kind yours is, but pills should help, if anything. Regarding fertility– once you stop the pill there is an unpredictable length of time before you return to being as fertile as you ever were. There has not been shown to be an affect on fertility from pill use, though people who have never been pregnant, who have taken the pill, then have difficulty conceiving tend to think the pill was to blame. This is not the case and there are many other things that can contribute to difficulty conceiving (including sperm factors). What I generally tell my patients is this: once you stop the pill, after a few months you will go back to being as fertile as you ever were. If you are experiencing breakthrough bleeding, that means the dose of the estrogen in the pill should be adjusted. In your case, I believe it should be increased– for example, Junel or Loestrin with estrogen dose of 30 might be beneficial. I hope this helps and I wish you well!
      -Leah

  38. Jen says:

    I went for my yearly physical/pap and my doctor noticed my cervix was very red and inflamed and it bled easily when she swabbed it. She said it was probably bacterial vaginosis and prescribed me antibiotics for 10 days. I went back to the doctor after the 10 days because she wanted to see if it cleared up, and she said it looked better and wasn’t red anymore (she didn’t do another pap).

    I finally got a call saying my pap results came back abnormal. I’ve never had an abnormal one before. The results said this: “EPITHELIAL CELL ABNORMALITY. LOW-GRADE SQUAMOUS INTRAEPITHELIAL LESION (LGSIL); MILD DYSPLASIA IS PRESENT. Suggest follow up as clinically appropriate. Endocervical and/or squamous metaplastic cells (endocervical component) are present.”

    I always go to my general doctor for my yearly paps, so she told me to schedule an appointment with a gynecologist to get a colposcopy. Do you think a colposcopy is appropriate or should I get a repeat pap in a few months before getting a colpo, since I’ve only had one abnormal pap? Also, would a bacterial infection or an infection of some sort have caused an abnormal pap like the one I had?

    Thanks so much for your time and help.

    • Leah Torres says:

      Hi Jen,
      First of all, having a red and “inflamed” cervix is not a reason to treat any infection and is not part of diagnosing BV. That said, being treated for BV isn’t harmful. Your cervix was what many docs might call “friable” and that’s just dependent on how the cervical cells are oriented. (Medical mumbo jumbo, really, and nothing to worry about.) Also, the only thing that can cause an abnormal Pap smear is Human Papilloma Virus (HPV). This is not a cause for alarm as long as you have regular Pap smears, like the one you just had. The Pap smear is abnormal, but only slightly abnormal (in this case, there are degrees of abnormalities.) All in all, you should have a gynecologist perform a colposcopy. Most likely you will have a repeat Pap smear in 1 year’s time. Your diagnosis is very common and I hope you do not experience anxiety over this. I often refer people to http://arhp.org/publications-and-resources/patient-resources as they have great info on HPV, Pap smears and follow-up. Be well!
      -Leah

  39. Amy says:

    Hi Leah,

    I went on holiday at the beginning of September and I took Utovlan/norethisterone to make sure my period wouldn’t make an unwelcome appearance during that time. It worked, maybe a little too well… My period didn’t start until the last week of October. It’s now been over three weeks and my period hasn’t stopped. I’m not sure whether this is worth a visit to the doctor or not, as there’s no pain or unusual discomfort. I have a Nexplanon implant and this can sometimes make my periods irregular (though not ‘ 3 weeks of bleeding’ irregular), and I wonder whether this is a contributing factor. I’m also fairly stressed/anxious at the moment as I’m in the process of leaving a job I love and moving up north with my husband, far away from friends and family. I’ve heard stress can affect the menstrual cycle too. Based on this info, do you think I should see a doctor?

    Many thanks!

    • Leah Torres says:

      Hi Amy,
      Yes, stress can adversely affect your periods though I’m not sure if what is happening isn’t being caused by something else. In cases like yours, I prefer to do an ultrasound and make sure there isn’t anything like a fibroid or a polyp causing this bleeding. Of course, it’s also reasonable to wait things out and see what happens to your bleeding pattern. Thyroid issues can also cause irregular bleeding, but I’m more inclined to think this may be a fluke thing after starting and stopping the pill. Without knowing more about your history, it’s difficult to say. If you think you’d like to be checked out, I’d recommend seeing your most recent health care provider if you haven’t moved yet, and that might be most helpful. You could also “wait and see” as long as the bleeding isn’t too heavy and causing you to be tired or unable to go about your daily routines. I wish I could be more helpful. Be well and I hope this, too, passes soon.
      -Leah

      • Amy says:

        You’ve been very helpful, thanks very much! I hadn’t considered the possibility of a polyp or something similar, but as the bleeding isn’t much more than a nuisance at the moment I think I will wait till the end of the week and see if the bleeding has slowed/stopped by then. If not, I’ll make a doctor’s appointment for next week. Thanks and best wishes.

  40. Lili says:

    Dear Dr. Torres,

    Thank you so much for all of your help!
    I first had penetrative sex at 18, and it was quite painful and I bled/hurt for a week afterwards. I took the time to heal, and after a while sex felt great. When that relationship ended, I didn’t have sex again for a long time (nearly a year), and when I did, it was the same thing all over again–some bleeding, irritated labia and vagina, pain during urination, and this time I also developped a yeast infection. Now I am 21 and single and recently had recently had sex for the first time in a few months with a new partner, and am having the same blood/iritation/urination pain/abnormal discharge combo. But now that I am having non-monogamous sex, I am scared that these are the symptons of an STI. Yes, I do use condoms, but it’s still frightening after sex with a new partner that I have so many typical STI symptons! How do you reccomend that I determine when it is cause for concern and I should get tested, and when it is my body’s normal (albeit highly sensitive) reaction to sex after a hiatus?

    Thank you!

    • Leah Torres says:

      Hello Lili,
      Very good questions, I hope I can provide some insight! First of all, the symptoms of irritation and soreness are most likely due to not having enough lubrication during intercourse. It’s difficult to tell sometimes if, at the time, there is enough so having some lubrication (your over-the-counter KY, for example) nearby isn’t a bad idea. With new partners, your vaginal pH can change, making you more or less prone to things like yeast infections or bacterial vaginosis (BV) which are annoying but are not sexually transmitted infections (STIs). Seeing your health care provider who can do tests is really the only way to know that you do not have an STI. However, the BEST ways to keep yourself (and your partner) as safe as possible are to use condoms consistently and correctly, to have open discussions about previous sexual history/partners/infections, and for both to have complete STI testing before considering not using a condom. For example, I will ask new “potential” partners about exposures or treatments in the past of STIs before engaging in sexual activity with them. It just makes good sense and it sounds like you have that in spades so good on you! I am sure all of this falls into getting to know yourself sexually, too, and I encourage you to discuss with your partner(s) what you like, what you don’t, etc and keep an open dialogue. I wish you well and I hope this helped a little. Take care and thank you for posting!
      -Leah

  41. Sara says:

    So what are you are saying is all of the white pills are the same? So therefore it is nothing going to do anything if I took next Saturdays instead of my Sunday pill? I’m just worried because I’m very new to all this birth control.

    • Leah Torres says:

      Yes, that’s correct. I would definitely call your health care provider though to let him/her know what you’re experiencing.
      -Leah

      • Sara says:

        Hello , Is it normal to bleed before you period starts bc I’m bleeding? I mean my doctor said at first I might be spotting a lot before my period bc the birth control is getting use to me but I’m bleeding like I’m on my period and cramping….. And my period is not suppose to be untill two weeks from now. I was just wondering if this normal or not.

        • Leah Torres says:

          It can be normal, Sara, but I encourage you to call your doctor as you seem concerned about what you are experiencing. My opinion is that you are having irregular bleeding that can be a normal result of birth control use. Be well!

  42. patty says:

    Hello Dr. Torres

    First off I would like to thank you for all the work and advocacy you do for women you treat and in general. This question is in regards to the benefit of a colposcopy.

    I am a 43 yr old woman and have been in a committed relationship for 24 years (married for 18). We have a fulfilling sex life together and I know we are committed to each other. Regarding birth control my husband had a vasectomy 17 years ago (1 year after marriage), because we knew we didn’t want children.

    My pap smears through the years (including last year’s) have returned negative for abnormal cells. However, last year, for the first time, I had a HPV test. Well, as I figured the HPV test was positive, but my pap was negative. (I figured because of the percentage of people who have it and my husband was…”an easy lover” before being me.) My NP recommended that I have a colposcopy.

    I chose not to have a colposcopy this year. I didn’t see much benefit since my paps have come back negative (plus I would likely have to pay for it out of pocket). My next pap is scheduled for Jan. I am going to rely on the yearly pap results and not do further tests. If a future pap is negative then I would follow up with a colposcopy then. How would you advise I patient like me?

    Thank you for all that you do.

    Much love and peace
    Patty

    • Leah Torres says:

      Hi Patty,
      Thank you for your kind words, I’m more than happy to help if and when I can. Also I want to commend you on obtaining a second opinion as you are correct– you do not need a colposcopy. According to the ASCCP guidelines (www.ASCCP.org/guidelines) the appropriate follow-up for you is to repeat a Pap smear with HPV testing 1 year after your last result (normal Pap with +HPV). These guidelines changed back in 2010 but I know there are a lot of providers that have not become up-to-date with their habits.

      I would refer your practitioner to these guidelines and let him/her know that there is an app as well that I use frequently every day. (I have no financial conflict of interest, it’s just a really helpful app worth the $10.)

      Be well and know that your Pap history is very reassuring. Thank you for posting, I hope this helps others!
      -Leah

    • patty says:

      Dear Dr. Torres,

      Thank you so much for your response. I will talk to my health care provider about this in January. I do have a few follow up questions:

      How related are the HPV test and Pap smears? Is a positive HPV test similar to a positive Pap smear? (Your tweet suggested I had an abnormal pap smear when my pap was negative but the HPV test was positive).

      Was my description of my current/past sex life relevant to my main initial question? Do these recommendations change with changing sex partners they may relevant to other STIs/STDs?

      I appreciate your effort and time.
      Much love and peace (love following you on twitter)
      Patty

      • Leah Torres says:

        Sorry for any confusion! After age 30 I perform a Pap smear with HPV as the screening test for my patients. The Pap smear assesses abnormalities of the cells of the cervix that may have been caused by the HPV. Essentially if HPV is negative, your Pap smear (the cells of the cervix) won’t become abnormal. HPV status can change with change of sexual partners but previous negative results do not mean it hasn’t been there in the past. It’s very tricky, this virus, but followed appropriately it should not become anything life-threatening. It is not correlated with other STIs. The recommendations do not change with changing sex partners, which is a very good question. ARHP.org has some good patient education resources that I give to my patients. (As an aside, I generalized my tweet to apply to more people, which embellished your specific result. I didn’t mean to confuse!) Hope that helped and thanks again!
        -Leah

        • patty says:

          Thank you for the further clarification Leah! I appreciate you and what you are doing. Happy Thanksgiving and love and peace. Patty

  43. Crystal says:

    Could being postmenopausal and having vaginal dryness contribute to having problems with the speculum.?I usually tell the provider to use the smallest speculum they have.

  44. Crystal Evans says:

    I am afraid of Pap smears. I have done them before but I am afraid of the insertion of the speculum because it hurts. What do you think I should do make these exams more comfortable? How can I make Pap smears more comfortable. I hate the insertion of the speculum because it hurts.

    • Leah Torres says:

      Hi Crystal,
      I’m sorry you have a tough time with these exams, and they’re so important! But they don’t have to be painful. I can only assume you have told your health care provider that the speculum hurts and that you have pain with it–if that is the case, your provider should act accordingly. There are smaller specula that can be used, there are different techniques for inserting it, and it might even help if you placed it yourself with your provider’s guidance. There are conditions such as vaginismus that you may have which causes the pain, but without talking to you and understanding your full history I would doubt that you have that rare condition. If you are uncomfortable with the person who performs your exams, or if they do not adjust accordingly to try to help make the exam less painful, I recommend finding a different health care provider. I have taken care of many women who had concerns similar to yours and I was able to provide a pain-free exam for them–it is possible and your comfort should be your provider’s the top priority. I wish you well and I have hope that you will be able to overcome this.
      -Leah

  45. Mandy says:

    Dr. Torres,

    I was on BCPs for 7 years . The first two were fine but the following 5 were filled with persistent spotting starting a week after my period ended until the placebo pills started. I was on ortho tri cyclen, yaz, Yasmin, estrostep fe, and zovia 1/35. All resulted in spotting eventually. Doctors were unable to help and finally I decided it was time to take a break. After a year off and being in a committed relationship, I decided to go back on. I started taking minastrin 24 fe and the spotting has already started a day after my period. The year I was off I had a 28 day cycle with no issues of spotting. I take my pill (and did take) religiously every night at the same exact time. I have a healthy BMI, workout , and eat every healthy. Is it possible that the pill just may not be for me? I feel as though I am running out of options and no one can help.

    • Leah Torres says:

      Hi Mandy,
      Spotting while on the pill is a common issue that can usually be remedied by altering the dose of estrogen that’s in the pill. By the list you’ve provided it seems that route was attempted and failed. The only other thing I would explore is to assess the uterine cavity with either a hysteroscopy or a saline-infused sonogram. If there are no abnormalities such as a polyp or fibroid, you may simply need a different method of contraception. I wish I could be more helpful. If you were my patient I would do one of those tests. I hope you find some answers and a method that works for you. (If you haven’t already, you may find bedsider.org helpful)
      -Leah

  46. Sara says:

    Hello Dr. Torres,
    I have just started to take minastrin fe and I’ve never taken any sort of birth control before. I just have a very strange question well this month my period just started on friday and on sunday i was not bleeding anymore which is very strange for me because my cycle is usually 7-10days not 3 days like right now , so i was wondering what is causing my period to be shortened like that? iknow it can’t be the birth control pill because i started taking it yesterday which was sunday for my first time and my flow had stopped before i started taking it. Also i am very confused in how i am suppose to be taking this pill , because it says it is chewable but I have been swallowing the pill for the past two days and wondering if that is okay to do?
    Thank you!

    • Leah Torres says:

      Hello Sara,
      That’s not a pill I often prescribe, but if it’s chewable it shouldn’t matter whether you chew it or swallow it. Your period was short this month but that’s OK and nothing to worry about. Sometimes our periods act strangely for one or two or even three months, then they return to what we’re used to them doing. Also, throughout our lives the patterns of our periods can change and that is nothing to be alarmed about either. That said, I would definitely see your health care provider if you are concerned as that is always the right thing to do. In my opinion, without knowing more of your history, I believe you are just fine and there is nothing to worry about. Finally, if you find that you are not remembering to take the pill every day, please use a back-up method for birth control (such as condoms) for the month. If this happens often, it may be a good idea to consider other types of birth control methods that may work better for you. Take care and be well!
      -Leah

      • Sara says:

        My gynecologist said to wait atleast a month to have sexual intercourse , but does that mean that I cannot have sex even with a condom for the first month that I am on my birth control? Because I am confused. Thank you.

        • Leah Torres says:

          I think what your gynecologist meant was for the first month, the pill alone is not sufficient birth control and you should use a condom in addition to the pill. That is what I tell my patients. I hope that helps!

          • Sara says:

            Oh okay thank you! So then after a month I could have sex with out a condom and I will be fine If my parthner has already been checked out?

          • Leah Torres says:

            The pills is 80-85% effective at preventing an unplanned pregnancy with typical use, Sara. That means 15-20 women out of 100 will become pregnant while using the pill over a year’s time. I say this because I want you to understand that the pill works well most of the time, but it isn’t perfect because people aren’t perfect. Yes, please have both of you complete full STI testing and agree to behaviors that keep each other safe from STIs before stopping the use of condoms. Using condoms in addition to the pill is a good way to improve your ability to prevent an unplanned pregnancy. Personally, I recommend both but understand that often couples desire to stop using condoms. If you find that you never ever forget to take the pill and you are consistent about taking it, it is reasonable to stop using condoms after ensuring neither of you have an infection that would put the other at risk. Thank you for reading and posting helpful questions!
            -Leah

    • Sara says:

      Hello , so today when I took my birth control I noticed I took the pill that I am suppose to take next Saturday and today is Sunday and now I am freaking out thinking I messed up my whole process and idk if that is okay or not , so I was wondering if that is ok I did that or what should I do?

      • Leah Torres says:

        Sara,
        You are taking a monophasic pill which means they are all the same dose. (Except the sugar pills, of course.) Therefore as long as you take one pill a day, it doesn’t matter which specific day it came from. Just be sure to continue to take one a day. =)
        -Leah

  47. I don’t want to continue taking it and something go wrong with the pregnancy if I am pregnant I’m so beyond torn with taking it and not anyways no worries on the delay I would just really love some decent advice other than what I’ve been getting

  48. My only main reason of concern is the fact we’ve already went through one miscarriage and I don’t want it to happen again i have missed some days taking the pill and my obgyn put me on the pill because of the miscarriage I feel that I could be pregnant again because of the fact the pill isn’t in my system yet and my husband doesn’t pull out or use condoms and I always forget to take it even when I set an alarm also I don’t feel comfortable taking i and not knowing if I’m pregnant it not

  49. Please respond asap!!!!! Hi my name is ashley I started taking minastrin 24 Fe three days ago last night was my second night taking it and me and my husband had unprotected sex and he didn’t pull out I feel like I should stop taking it now because I’ve had one miscarriage already a few months back what should I do please contact me either by phone or email Ashley_parvin1@AOL.com or 1-(205)-589-3460 no worries on the number its an app ant my real number. Please responde asap

    • Leah Torres says:

      Ashley,
      I’m sorry this is a bit of a delayed response but I have been traveling. I would continue to take your pills however your chances of an unplanned pregnancy vary depending on where you are in your cycle. Stopping the pills will not change anything and taking them has a very low chance of possibly harming a pregnancy as women not uncommonly become pregnant while taking the pill. I encourage you to see your health care provider as soon as possible and you may consider emergency contraception options such as the copper IUD, ella, or Plan B (over the counter). I wish you the best.

  50. Shannon says:

    I plan on taking another test tomorrow morning. If still negative I will call my doctor. Thank you!

  51. Shannon says:

    I had the Mirena for almost a year when it went out of place and I had to get it removed. I then switched back to the pill (One I never took before), Minastrin 24 Fe, about 7 months ago. I take it at the same time every night, some occasions being 30 minutes to and hour late, and once or twice missing a pill. But I always get my period at the same time every month when starting the placebos and always with the same signs. Last week I should have started my period and it never came. I did, however, have some brown spotting. I took a test late at night about 3 days ago and it was negative, but this morning woke up pretty nauseated and not feeling my normal self. I already have two kids so I know the signs of pregnancy, but being I had a negative test, I’m not sure if I should trust that it was correct. Is it common to get pregnant on the pill? Should I test again? Do you think I could very well be pregnant? I know that the pill can sometimes change your cycle, but like I said, it hasn’t changed for 7 months until now.

    • Leah Torres says:

      S-
      Yes, I believe you should take another pregnancy test. While periods can change throughout our lifetimes, the pill is not perfect and can fail ~10% of the time. I think the prudent thing to do would be take another pregnancy test. I’m sorry to hear about your IUD needing removal. I want to encourage you that just because that happened doesn’t mean you cannot have successful IUD use. I wish you well and appreciate your questions.

  52. Kirsten says:

    Dr. Torres-
    This is so embarassing, anyway, when my new boyfriend and I have sex, I bleed. A lot. This has never happened with any other men. He may be more well-endowed than previous guys I’ve been with, I can’t really tell, and I do like it really rough so all I can figure is maybe he is slamming my cervix really hard but when we’re done it looks like a scene out of CSI. My question is: am I doing lasting damage? I’m done having kids thankfully, but is there some other reason for concern? My doctor appointment isn’t for another two weeks and I’m a bit anxious about this. Please advise!

    • Leah Torres says:

      K,
      Without being able to examine you, it is difficult for me to say what is going on. Sometimes there can be a polyp (a growth of normal tissue that is not dangerous) that can protrude from the cervix and bleed if manipulated, such as might happen during sex. I wonder, too, if you may have experienced a tear in the vaginal wall that has not completely healed. That can happen, too. I would abstain from intercourse until you can be examined by your doctor (and I dislike prescribing abstinence but I’m not sure if there’s an injury that needs to heal). If you’re that anxious, I would call your doctor’s office to see if they can see you sooner as you are having bleeding issues. They should be able to accommodate you. The vagina is, thankfully, very resilient and I doubt very much you would be doing any “lasting damage.” All in all, you need to be examined to know what is happening. I hope you’re able to see your doctor sooner rather than later. Take care and I hope this is soon resolved.

  53. Emily says:

    I started taking birth control at the age of 14 after having very long and heavy periods. Now at 29, I have been on the same pill for several years and would take it continuously for 3 months before having a period. My doctor was great in talking with me and prescribing the medication to meet my body’s needs. Recently, I picked up my prescription from the pharmacy and they had switched it to a different generic brand. When I asked the pharmacist he insisted that it is the same medication. Having taken it for 4 months now, it seems to be completely different than what I am used to. In trying to take continuous cycle pills, my body no longer holds off and will spot so heavily that I am forced to have my period each month. Is there a difference in generic versions of the “same pill”? As a patient, do I have any right to insist that the pharmacy provide me with the other generic pill that my body reacted well to? Thank you for always patiently and kindly helping – I love reading your posts!

    • Leah Torres says:

      E,
      It seems that there is a difference between generic and brand pills for you. Generally these issues of irregular bleeding can be helped by adjusting the amount of estrogen in the pill. I would call your doctor who prescribed them to ask how much estrogen was in your previous pill and make sure that this generic pill has the same dose of estrogen. Also, there’s no need for you to ever have a period. You may take the pills continuously without a break for years. The same goes for the vaginal ring which can be used for 28 days straight and then switched to a new one. I hope that helps and I hope things get back to good!

  54. Rick Williams says:

    Dr. Torres – I would deeply appreciate your wisdom. My wife is 59 and we’ve been married over 35 years. Until she was about 50-55, my wife had a pleasurable orgasm at least once a week; though more time and stimulation was required. Over the last 9 yrs she has continued this pattern although when making love she needs to stimulate her clitoris directly herself w/ or w/out a vibrator to eventually achieve climax. I take a lot of time helping to provide her pleasure as she directs me; 99% we do not engage in prolonged intercourse where I climax until she has. Now in about the last 2 years the climaxes still occur for her once a week 99% of the time (through the above process) when we make love. However, she often reports some pain from her climax “feeling too intense” and finally achieving climax can sometimes “not seem like all the effort.” I often give her direct clitoral stimulation (as directed) which was once enough before 50, but now she needs to take over at some point in order to move in further toward climax. I still stoke her etc. as she likes/directs… She is using a vaginal hormonal cream and intends to talk to her PP again soon. Her libido is very low but she reports still enjoying making love especially when leading with relaxing message. We’ve both searched the web about this “too intense pain,” and found mostly material related to cramping or dryness which does not seem applicable. I am writing you, even as a husband and as someone you may not have time to help, because from reading on the web, I have the impression that only someone very, very good in this field will be able to help… FYI: We do date nights; she reports mostly only average stress; she say’s she wants to continue making love/having sex and that it is not me or something related to our relationship. We use both water and silicone based lub. to her satisfaction… She has been on and off Prozac (10mg@ bedtime); but it didn’t seem to phase her sexuality when off for several months – she did feel more irritable and tired. Currently back on 10mg of Prozac @ bedtime which helps her mood but doesn’t seem to effect her sexuality specifically… I know her climax may not be necessary for satisfaction IF she feels this way. However, she still seems driven toward climax and the pleasure it brings despite this pain that is also occurring more often. I know this is too long and I apologize. Just wanted to try to give as much helpful info as possible. I want to assure you we are communicating and will more; and that I am being very understanding, while attempting to be truly helpful, although our communication is not as easy at times as it hopefully will be soon. We both have room to grow, of course. In All Sincerity, Rick

    • Leah Torres says:

      Hello Rick,
      I must applaud you in doing so many things right. The information you provide in your posted question shows me that you and your wife are approaching this in all the right ways. That is sometimes the biggest and most difficult hurdle to overcome so I’m quite impressed to know that the doors of communication are open and that your lines of thinking are on track.
      The question of human sexuality is always a cumbersome one but it is also an important one to answer. As with many things in life and humanity, our sexualities can change over time. What once turned us on may not do so one day. Something we never thought would be appealing one day may be. Sexuality is fluid and often requires us to open our minds and change with the times. That said, the first thing I tell my patients, for example, is to know how to please themselves first. It may be helpful for your wife to masturbate and take time to understand new things that feel good to her. I say this in case this option was not thought of, but from your post, again, I imagine you’ve already taken this into consideration.
      Another thing to note is the very real effect of medications and mental health on sexuality. Prozac is a known libido-killer and often people have to weigh its use against not using it and what both of those scenarios mean for general health, well-being, sexual health, and mental health. Also, I imagine that with hormonal changes after menopause there may be differences in how she is affected by the Prozac. With or without medication, menopause can alter libido and sexuality (though not always for the worse). Add a medication that is known to adversely affect libido and this may be compounding the situation. Regarding the “intense pain,” I have no idea what that is though there can be a thin line between pleasure and pain. Barring dryness or infection, I think it may be an intense orgasm that her brain may be interpreting as painful…? I would need to ask her questions to tease this out but that’s my theory if the other possibilities have been ruled out.
      Lastly, the stress of ruminating (and I do not mean that in a harsh way but rather a practical way) on this can also be a self-fulfilling prophecy. You say that she still wants to engage in sex, but is she not having orgasms as often as “she’d” like or as often as “you’d” like? There is a lot of messaging in our culture about how often is “normal” to have sex, with whom, doing what, etc, and that messaging doesn’t really apply to even a majority of people, in my experience. I wonder which aspects, if any, bother her most, or which aspects would she like to see changed. Again, it sounds like you are both communicating about the right things, so I think a piece of information that would be nice to complete this puzzle is this: what, if anything, is bothering her and how much is it bothering her?
      I can see how you may think this issue requires a specialist with specific expertise, and you may be right, but I think that you are well on your way to figuring this out. I can’t stress enough: is any of this bothering her and would she like anything to change? Maybe she doesn’t mind the frequency of orgasms she is having…? I wish I could be more helpful but I will leave you with this: if you go to a doctor who simply dismisses this as “not to worry, it’s normal,” –> change doctors. If there isn’t a discussion that ensues where he/she asks questions and validates that these are concerns you two have, then that is not the right doctor to be consulting, specialist or no. I wish you both well.
      [Disclaimer: I listen to Dan Savage’s podcast and take many leaves from his books. If you’re not already a subscriber, I suggest giving him a listen at savagelovecast.com. I do not work for him, he probably doesn’t even read my blog, but I have a high opinion of his work and respect the advice he gives his listeners.]

  55. Rebekah says:

    Hello Dr. Torres,
    I am curious about IUDs as opposed to a tubal ligation. What are the pros and cons of both forms of birth control? Thank you!

    • Leah Torres says:

      Rebekah,
      Both IUDs and female sterilization (tubal ligation) work equally well at preventing pregnancy. The IUD has the advantage of being reversible (having no effect on fertility) as well as not requiring a surgery like tubal ligation does. Bedsider.org also has great resources for comparing and contrasting!

  56. Liz says:

    Dr Torres, i read with deep appreciation and respect your editorial in the Opinion section of today’s Trib re the need for The Women’s Health and Safety Act to insure the best possible health care for all women. I have read many articles on the difficulties of women in challenging circumstances trying to obtain the health/abortion care they need and having the opinions and judgements of “others” infringe on their basic right to obtain this care. Until i read your article i didn’t know anything about the The Women’s Health Protection Act. Can you advise on who to contact and/or how to add a voice to the importance of passing this Law? Thank you for all your effort on behalf of us, our daughters, our future granddaughters. You are truly making a difference with your life work; that’s got to feel good:)

    • Leah Torres says:

      Elizabeth,
      Thank you so much for your feedback and thoughtful response. I commend you on wanting to take action and I encourage you to spread the word, tell your friends and colleagues about this and how they, too, can help. What I recommend are the following steps:

      1) To find your State House Representatives and Senators–
      Go to http://www.house.gov/representatives/find/
      Go to http://www.senate.gov/general/contact_information/senators_cfm.cfm

      2) Draft an email or letter to send to them. It can be something as simple as “My name is ____ and I am a voter in your district. Please support the Women’s Health Protection Act.” Leave contact info and send this weekly, daily, or however often you would like. The important thing is that they HEAR YOUR VOICE! You may also call their office and say something equally short, sweet and to the point.

      When contacting the Senate, or a Senator, it is helpful to refer to the bill by it’s “Senate number.” For the WHPA, it is “S. 1696.”

      When contacting the House, or a House Representative, it is helpful to refer to the bill by it’s “House number.” For the WHPA, it is “H.R. 3471.”

      Remember, our legislators are employed by us to represent us and our needs, not their political party or gain. MAKE THEM HEAR YOU. They are obligated to listen.

      Also, VOTE!

  57. east coast thirtysomething says:

    Hi Dr. Torres,

    A few years ago I was diagnosed with endometriosis following a surgery for an inflamed belly button that my doctor thought was a hernia. The endo later also inflamed my appendix, so I’ve had surgery twice. I’m on continuous oral contraceptives and don’t have periods, but I do have intermittent cramping. The real problem is that a year ago I started having pain with orgasms. Every time I have an orgasm, it’s followed by sometimes severe/frightening, sometimes tolerable uterine cramping, whether I’m alone or with my partner. It’s a major buzzkill, literally, and is making me not want to have sex. I asked my GYN for advice and she had no particular advice for the orgasm issue, but said that generally she increases the hormone level of birth control for endo issues, but I’m nervous about going on a higher level dose (already feel some libido loss since I’ve been on this dosage–or could be related to the orgasm issue–and know there’s some links to breast cancer with higher dose birth control). Any thoughts on what I can do? Thank you! I also found you through Dan Savage’s column–thank you for what you do πŸ™‚

    • Leah Torres says:

      So glad you wrote! All I can say is that if I were you, I would get a second opinion. For someone with your story, I would consider a surgery to remove any of the endometriosis as well as address any adhesions (scar tissue that can build up in the belly after surgeries) that may be causing the pain. Generally this is a laparoscopic surgery and a physician who specializes in endometriosis surgery (may be known as “minimally invasive”) might be the best second opinion to get. It sounds as though everything has been done right so far, but you’re still having concerns (which are valid) and should be addressed (probably with something more than an increase in dosage.) That is my humble opinion based on what you’ve written. I hope you are able to find someone that is able to help you with this. (As an aside, the Mirena IUD may also help with endometriosis.) Take care and don’t hesitate to get those second (sometimes third or fourth) opinions!

  58. Flora says:

    Hi Dr. Torres!

    I am 20 years old started birth control, Minastrin 24 Fe, 3 months ago when I began a monogomous relationship. My boyfriend and I recently stopped using condoms, but we’ve been tested, and I never forget my pill, so it hasn’t been a problem. I complained to my mom about frequent flair-ups of anxiety and mood-swings, and she thinks I should go off the pill. She may be right, but I do not want to rely solely on condoms. I asked my doctor about the copper IUD, but she thinks I am too young and would find it painful. Should I pursue it anyways? Are there other non hormonal methods that you recommend?

    Thank you so much for your advice and wisdom!

    • Leah Torres says:

      Flora,
      Please, please, please see another doctor. You are not too young for an IUD as there is no such thing (well, reasonably). I think an IUD would be perfect for you, especially if you are concerned about hormonal effects on your mood. The hormonal IUD may be an option as well, but I would need to speak with you further. I would encourage you to find a doctor who is comfortable placing IUDs in teenagers (I realize you are not a teenager but that can be a way to know if the doctor is keeping up with current literature) and if he/she sees LGBT patients (again, merely an indicator of forward-thinking doctor comfortable talking about sexual health issues.) Hopefully this helps and I would recommend an IUD as my top choice for you!
      -Leah

  59. Apiary says:

    Dear Dr. Torres:

    I am a 34 year-old woman. Over the course of my life I have had several things removed from my body: skin tags, an ovarian teratoma, and (most recently) a cervical polyp. What gives? Does my body just have a penchant for piling up cells in odd places? Or do you think these conditions are unrelated?

    Thank you again!

    • Leah Torres says:

      Apiary,
      I couldn’t be sure but I am inclined to think these are coincidences. Skin tags and polyps are quite common. I would not worry too much about these benign things but, as we all should do, it is important to keep vigilant of changes occurring in our bodies. Be well!
      -Leah

  60. sarah says:

    Hi Dr. Torres!

    Thanks for your excellent work; it is so needed.

    Here’s my question: I’m on health insurance for the first time in several years, and my provider requires I choose a primary care physician before the coverage kicks in, and also discourages switching. What’s the best way to find a great, sex-positive PCP?

    Cheers!

    • Leah Torres says:

      Sarah,
      I would call the office and ask if there are online evaluations or some sense of what the physician is like. You may ask the staff or you may ask to speak with the physician themselves, though they may take a day or two to return your call. It is perfectly reasonable to call a physician’s office and be honest about what you are looking for and to speak to them over the phone before making an appointment. Some questions to consider asking the staff: does the doc see LGBT patients? Does the doc prescribe birth control, place IUDs/implants? Does the doc counsel on safe sexual practices? The staff may not know the answers to these questions, but they may be able to better help you contact the doc directly either by phone or email. Any doc not desiring to speak to a potential new patient is probably one you don’t want as a provider anyway. Hope that helps!
      -Leah

      • Katie says:

        Thank you so much for this! Currently GP shopping now that I have comprehensive coverage through the ACA exchanges in NY. I had a great doc at home in Chicago and haven’t had to ask these questions in years. I feel better about my vetting process now!

  61. Allison says:

    Hello Dr. Torres,

    I found your website and twitter feed from listening to Dan Savage’s podcast. I am so glad that I’ve started following you! I am continually impressed with your graceful and respectful responses to all critics, and I hope you know how many people out here appreciate your respectful viewpoint.

    I have been a long-time user of ortho tri cyclen lo. I’ve used it since I was 18 years old, and u am now 28. I have no complaints about the medicine, but I have struggled to find unbiased information about the long-term effects of using birth control. Is there a risk associated with taking hormonal birth control this long (and longer, as I fully plan to continue taking it for tr foreseeable future). I am at a healthy weight, eat a healthy diet, exercise regularly, drink alcohol in moderation, and do not smoke. My doctor has told me there is very little risk, and long term use actually decreases the risk of ovarian cancer. I’d prefer not to switch to an IUD for a variety of reasons (predictable and light periods being a big reason), but would love to hear your advice.

    Thanks again for being an advocate for women. We need more doctors like you.

    • Leah Torres says:

      Hello Allison,
      Your doctor seems well-informed. There is no known long-term risk of using combined hormonal contraception unless there are other conditions or genetic factors at play. What I mean is, women over the age of 35 and who smoke should not use estrogen because of an increased risk of stroke. Women who have aura with migraine headaches should not use estrogen for the same reason, though estrogen is safe in women who have migraines without aura. Risks of breast cancer with long-term use are not well-studied and there are more general health risks with actual pregnancy and child birth than theoretical risks of possible breast cancer. Overall I encourage the use of combined hormonal contraception in women for whom there are no increased risk factors of blood clots or stroke and it sounds like you should continue using what works for you. Hope this helps and thank you!
      -Leah

  62. S says:

    Hi Leah,

    I recently read your tweets about IUDs, and I had a question. I have previously been on birth control, and one thing I noticed was that it really diminished my libido. I was wondering, is there a pill or IUD that wouldn’t cause this? Is it because of the hormones?

    Thanks!

    • Leah Torres says:

      S,
      Sometimes changing the type of progestin in the birth control pill can help, but overall an IUD with or without hormone is more effective with fewer libido-altering side effects. The copper IUD (ParaGard) has no hormone and I have not found the progesterone IUD (Mirena) to lower libido. If you want an IUD, I would say either one would be fine. If you prefer to stick with the pills, I would say changing the progestin component would be the way to go. Also, changes in our libidos are normal and this may just pass.
      -Leah

  63. Apiary says:

    Thank you for the work that you do, Dr. Leah!

    Two years ago I suffered a horrible outbreak of oral herpes after kissing a stranger in Mexico. I have not had a bad flare-up since then, just the occasional sore in my mouth or bump on my lips when I am not taking good care of my body (namely by not sleeping, eating, or drinking well). I have not disclosed my condition to my new boyfriend. If I’m not experiencing an episode, then am I contagious? What are the chances of his becoming infected? Thank you.

    • Leah Torres says:

      I did some quick research and though I cannot give you specific numbers about risk of transmitting HSV infection to your partner, I can tell you that when you have no symptoms or sores the risk is very small. If you do not have an active outbreak, and have very rare outbreaks, the chance of transmitting the virus to your partner, while not being 0, is very low. If you have regular outbreaks, you may want to ask your doctor about medication that helps reduce outbreaks (such as acyclovir.) Regarding disclosure: I am a proponent of full disclosure. Having said that, most people are reasonable and understand that taking appropriate precautions will reduce the risk of transmission to negligible: condoms, dental dams, abstinence from oral sex/kissing during outbreaks, etc. I believe you should tell any new partner about any infectious history and if they do not want to be with you because of it, then you probably do not want to be with them either. HSV is pesky but it’s very manageable and reducing the risk of transmitting the virus to partners is very doable.

  64. Nancy says:

    I just read your latest answers to questions on Savage Love. Thanks so much for being straight up with your responses. The answer to the enema question helped with my 50 year old question about why I had a sexual response to enemas when I was an older child. For so long I thought it was twisted & then a few years back I discovered in a therapy group that other people had this happen as a result of parental abuse (my case as well). Anyway, you are great. Keep up the good work!

  65. Beth says:

    Like most women I’ve had a few yeast infections in my life. In the last few months I’ve had a new exclusive sexual partner. I’ve been having a lot of vaginal irritation and repeated infections. We’ve both been tested for STIs and come back negative. I’ve never had this problem with any partner before and don’t know what to do. Could he somehow be causing this? I am at a loss for what to do. At first I thought it was a reaction to the lube we were using but we stopped using it and the problem has persisted.

    • Leah Torres says:

      This is unlikely a problem with lube but it could be the effect of a new partner. Honestly, there is not a lot of evidence to support that either, but it’s a possibility. My suggestion is not to change partners but rather to ensure a correct diagnosis. There can be a “resistant yeast” strain that is affecting you so your provider may want to send a swab for culture and sensitivity testing. This way you can be more certain of using the correct anti-fungal treatment. You may also benefit from what we refer to as “suppressive therapy,” essentially an initial treatment followed by weekly or twice weekly treatment. Also, there are specialists in the field of persistent yeast infections, you may have one in your area.

  66. Rachel Kaiser says:

    Ever since I gave birth I have had extreme rectal and vaginal pain. I had a significant tear during a procedure called the McRoberts. My baby’s shoulders got stuck on his way out. Sex is still painful. Having a bowel movement is almost always extremely painful. I have rectal bleeding often during and after bowel movements.
    I truly felt that when I was being stitched up, the doctor doing so was not paying attention. I even asked her to focus at one point because she was talking to the nurses mid-vaginal-stitching. I think she messed up the stitches. I think she sewed me too tight. I have been to two different doctors with no luck. The last gyno I saw gave me cortisone injections into my vagina and rectum. It was very painful and didn’t help.
    I don’t know what else to do or where else to go. The pain is constant and significant enough to make life challenging. Is this normal? Any suggestions? I’m 8 months PP next week. Thanks for taking the time to read this. And great job writing for Savage Love!

    • Leah Torres says:

      Thank you so much for reading my blog and Dan Savage’s column! You seem to have had a very traumatic delivery (meaning physical injury) and this will likely take time to heal. I could not predict if this will heal completely but here are a few things I would recommend: 1)try stool softeners like Colace 2)making an appt with a UroGyn or a Pelvic Pain specialist may offer a different perspective 3)re-operation may be necessary. It is difficult to offer advice without being able to ask many more questions and without a proper physical exam, but these are things I would recommend to start with as far as new alternatives go. I wish you well and you may just need to go from doctor to doctor until you find one that can help you. Don’t take “sorry, it’s just the way it is” for an answer, but you may need to weigh the risks and benefits of potential surgery when it comes down to it. I wish you well and hope you are able to feel better.

  67. Jessica says:

    Hello Dr. Torres!

    First off, thank you so much for everything you do! This site is an incredible resource.
    I guess this is less a question, and more an idea. I recently had a LEEP procedure. I’ve been dealing with HPV for the last year and a half, and am relieved to (hopefully) be free of it now. I wanted to suggest a blog entry on HPV? When I was diagnosed, I turned to the internet, but many of the conversational resources were scary and inaccurate. I’m thinking of writing a series of essays on my experience with HPV; when I’m not having Colposcopy parties, I’m a graduate student in creative writing. If you ever feel like partnering on a fun and informative writing project, I’m your girl!

    Thanks again!

    • Leah Torres says:

      Hello Jessica,
      So glad you find my resources useful. I will definitely consider an entry on HPV and thank you for your generous offer to help, I may take you up on it!

  68. j says:

    In April I had a medical abortion (my second) and since have been on a downward spiral of crushing depression, at times finding myself close to suicidal. Because of paranoia about becoming pregnant again (despite the fact that I am not currently having sex because I am terrified of becoming pregnant again) I have been taking Loestrin Fe. Because of prior problems with the pill – mostly related to moodiness and depression – I had stopped taking it 6 years ago and vowed to never go back on. At the moment I am hanging in limbo, waiting to see if I will be able to get the tubal ligation I have been wanting for many years. In the meantime, I am struggling with extremely low self esteem and depression heavy enough to prevent me from getting out of bed some days. Is this partially a side effect of the abortion – some twisted kind of postpartum depression – or is it more likely a result of the hormones in the pill?

    • Leah Torres says:

      J,
      I believe there is something more going on here than just the hormones of the pill and more than the medical abortion you had. I think you would benefit from an appointment with your doctor to discuss what you’re experiencing right now and there may be a variety of ways he/she can help you. Your description of a “downward spiral” is very concerning to me and if you feel that you might harm yourself or someone else you must go to the emergency room immediately. This may be a temporary hard time that you’re going through or there may be something else that’s been brewing for a while, but either way you may benefit from medical therapies. Unfortunately I cannot be much more help than that under the circumstances but I strongly urge you to go see your doctor and get help with these concerns.

  69. christine says:

    Hi Dr. Torres,

    I’m a second year medical student who started this journey into medicine because of my desire to become an OB/GYN. I worked as a medical assistant at Planned Parenthood and also on a GYN oncology floor before starting school, and I can’t wait to dive into this field!

    I read Dan Savage’s column this week and found your website. I just wanted to tell you that it was a pleasure to read through your posts, and that I appreciate you using your position to help shed light onto the realities of women’s health in all of its complicated aspects.

    So, my question is pretty general. What is your best piece of advice for this burgeoning medical student who is interested in going into OB/GYN and helping women thrive?

    Thank you for the inspiration!! Reading your site was a good reminder of why I started down this road!
    Best wishes for continued success in your practice,
    Christine

    • Leah Torres says:

      Your passion for patient care and advocating for them will see you through. That is my advice: allow your passion to guide you and drive you. You will serve your patients well and you will not choose poorly. Good luck and stick with it. I can’t think of many other things more fulfilling than what I do every day.

  70. your friend in sf says:

    This is just a matter of curiosity: My male partner and I have been using condoms as our only method of birth control for the entirety of our 10+ year relationship; we’ve probably had intercourse an average of 2x per week throughout that time.

    Given the published effectiveness rate of condoms (you recently cited 80-90%, for example), since I have not gotten pregnant during that time (to my knowledge), can we infer anything about our fertility?

    • Leah Torres says:

      I would not infer anything about your fertility but rather your very appropriate and correct use of condoms! I’ve heard many times, “I just didn’t think I could get pregnant,” and that’s a “surprise” that would best be avoided. Assume perfect fertility until you desire to prove otherwise. =)

    • anonymous says:

      My understanding is that effectiveness rates are per year. A 80% effectiveness rate per year works out to 10.7% effectiveness rate over a 10 year period. For a 90% effectiveness rate, the corresponding 10 year figure is ~35%. What this means is that if you have a large population of women all using condoms at the 90% effectiveness rate, at the end of 10 years one third of them will not have gotten pregnant, and you could easily be in that one third just out of statistical randomness!

  71. Sue says:

    I looked up venlafaxine and it seems to be used to treat depression & sometimes hot flashes, neither of which i have; also has a side effect of LOSS of libido. sounds like not what i need. will send your ref to my docs. any more ideas or suggestions are appreciated.

    • Leah Torres says:

      Yes, though I have had some experience with improving patients’ libidos with this medication despite the potential side effect of loss of libido. Everyone is so uniquely different but it may be worth a try. You would have to allow 1-2 months of use to see if it helps. I wish you well and please check back in later!

  72. Sue says:

    I read with interest Dan Savage’s column this week in the Stranger, and saw your blog mentioned. What are these non-hormonal remedies for post-menopause lower libido? I discussed these issues at length with my MD, but all she knows about are hormones, which I tried, including T, but had terrible side effects, including PMS-like mood-swings. Also I had breast cancer, and should stay away from estrogen. Any suggestions would be appreciated.

    • Leah Torres says:

      I might suggest a drug such as venlafaxine (AKA Effexor.) It is a serotonin-norepinephrine re-uptake inhibitor (no estrogen or progesterone involved) that may help. It is one of my first go-to medications for menopausal women with various symptoms. Sometimes it works, sometimes not. You may also want to refer your OB/Gyn to ACOG Practice Bulletins 119 and 126 (he or she should know how to access them.) I hope this helps and, remember, you are always able to obtain a consult from another physician.

      • sue says:

        I sent the names of the bulletins you referred to (ACOG Practice Bulletins 119 and 126); but my MD could not find them and asked if you could email them to me or fax them to her. if the latter please contact me by email for that info privately. thanks again.

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