Women have unique health issues. And some of the health issues that affect both men and women can affect women differently.

Unique issues include pregnancy, menopause, and conditions of the female organs. Women can have a healthy pregnancy by getting early and regular prenatal care. They should also get recommended breast cancer, cervical cancer, and bone density screenings.

Women and men also have many of the same health problems. But these problems can affect women differently. For example,

• Women are more likely to die following a heart attack than men
• Women are more likely to show signs of depression and anxiety than men
• The effects of sexually transmitted diseases can be more serious in women
• Osteoarthritis affects more women than men
• Women are more likely to have urinary tract problems

Are you male or female? The answer to this seemingly simple question can have a major impact on your health. While both sexes are similar in many ways, researchers have found that sex and social factors can make a difference when it comes to your risk for disease, how well you respond to medications, and how often you seek medical care. That’s why scientists are taking a closer look at the links between sex, gender, and health.

Many people use the words sex and gender interchangeably, but they’re distinct concepts to scientists.

Defining Differences — Sex is biological. It’s based on your genetic makeup. Males have one X and one Y chromosome in every cell of the body. Females have two X chromosomes in every cell. These cells make up all your tissues and organs, including your skin, heart, stomach, muscles, and brain.

Gender is a social or cultural concept. It refers to the roles, behaviors, and identities that society assigns to girls and boys, women and men, and gender-diverse people. Gender is determined by how we see ourselves and each other, and how we act and interact with others. There’s a lot of diversity in how individuals and groups understand, experience, and express gender. Because gender influences our behaviors and relationships, it can also affect health.

Influences on Health — “Sex and gender play a role in how health and disease affect individuals. There was a time when we studied men and applied those findings to women, but we’ve learned that there are distinct biological differences between women and men,” explains Dr. Janine Austin Clayton, who heads research on women’s health at NIH. “Women and men have different hormones, different organs, and different cultural influences—all of which can lead to differences in health.”

As scientists learn more about the biology of males and females, they’re uncovering the influences of both sex and gender in many areas of health.

For instance, women and men can have different symptoms during a heart attack. For both men and women, the most common heart attack symptom is chest pain or discomfort. But women are more likely than men to have shortness of breath, nausea and vomiting, fatigue, and pain in the back, shoulders, and jaw. Knowing about such differences can lead to better diagnoses and outcomes.

Men and women also tend to have different responses to pain. NIH-funded researchers recently learned that different cells in male and female mice drive pain processing.

“Without studying both sexes, we wouldn’t know if we’re taking steps in the right direction toward appropriate clinical treatment for men and women,” Clayton says. “Our differences also affect how we respond to medications, as well as which diseases and conditions we may be prone to and how those diseases progress in our bodies.” For example, women metabolize nicotine faster than men, so nicotine replacement therapies can be less effective in women.

Attention to Addiction — Scientists are finding that addiction to nicotine and other drugs is influenced by sex as well. “When it comes to addiction, differences in sex and gender can be found across the board,” says Dr. Sherry McKee, lead researcher at an NIH-funded center at Yale University that studies treatments for tobacco dependence. “There are different reasons men and women pick up a drug and keep using a drug, and in how they respond to treatment and experience relapse. Sex also influences disease risk in addiction. For example, women who smoke are more susceptible to lung and heart disease than men who smoke.”

One NIH-funded research team has detected some of these differences in the brain. In a recent study, 16 people who smoke—8 men and 8 women—underwent brain scans while smoking to create “movies” of how smoking affects dopamine, the chemical messenger that triggers feelings of pleasure in the brain.

These brain movies showed that smoking alters dopamine in the brain at different rates and in different locations in males and females. Dopamine release in nicotine-dependent men occurred quickly in a brain area that reinforces the effect of nicotine and other drugs. Women also had a rapid response, but in a different brain region—the part associated with habit formation. “We were able to pinpoint a different brain response between male and female smokers, a finding that could be useful in developing sex-specific treatments to help smokers quit,” says lead study researcher Dr. Kelly Cosgrove, a brain-imaging expert at Yale University.

Finding better ways to help men and women quit smoking is important for everyone’s health. More than 16 million Americans have diseases caused by smoking. It’s the leading cause of preventable death in the U.S.

Autoimmune Disorders — Scientists have found sex influences in autoimmune disorders as well. About 80% of those affected are women. But autoimmune conditions in men are often more severe. For instance, more women than men get multiple sclerosis (MS), a disease in which the body’s immune system attacks the brain and spinal cord. But men seem more likely to get a progressive form of MS that gradually worsens and is more challenging to treat.

“Not only are women more susceptible to MS, but women also have many more considerations in the management of the disease, especially since it often begins during child-bearing years,” says Dr. Ellen Mowry, a specialist who studies MS at Johns Hopkins University.

“There are a lot of unanswered questions when it comes to the study of sex differences in MS and other autoimmune disorders,” Mowry explains. “Researchers can learn a lot by studying women and men separately and together, considering possible risk or predictive factors that may differ based on sex or gender, and working collaboratively with other scientists to improve the likelihood of detecting these factors.”

Building Our Understanding — “NIH now requires scientists to ask: ‘What are my research results for males and for females?’” Clayton says. “We need to learn more about the roles of sex and gender in health and disease. Understanding these influences improves health and saves the lives of both men and women.”

You can improve your health and that of your loved ones by being more aware of sex and gender differences. Talk to your health care provider about any concerns you might have.

Women, Men, and Health

• Women and men have different symptoms of heart attack.
• Women are twice as likely as men to experience depression.
• Men are less likely than women to admit to negative moods and seek treatment for mental health issues.
• Men are more likely than women to have gout, a type of arthritis. Female risk for gout increases after menopause.
• Osteoporosis is more common in women than men, yet it still poses a risk to men as they age.
• Some medicines affect women and men differently, such as aspirin and some sleep medications.
• Females are more likely to injure their knees playing sports.
• Males are more likely than females to develop autism spectrum disorders and certain other neurodevelopmental conditions.
• Two-thirds of people age 40 and up who are visually impaired or blind are women.
• Pain disorders like chronic TMJ are more common in women.
• Women are often primary caretakers of children, household needs, and aging family members, but they are more likely to delay their own health needs.

Women experience unique health issues and conditions, from pregnancy and menopause to gynecological conditions, such as uterine fibroids and pelvic floor disorders. The health topics listed below affect women only. Some other conditions affect men too but affect women primarily or more severely.

Gynecological health and disorders affecting women include menstruation and menstrual irregularities; urinary tract health, including urinary incontinence and pelvic floor disorders; and such disorders as bacterial vaginosis,vaginitis, uterine fibroids, and vulvodynia.

Pregnancy issues include pre-pregnancy care and prenatal care, pregnancy loss (miscarriage and stillbirth), preterm labor and premature birth, sudden infant death syndrome (SIDS), breastfeeding, and birth defects.

Disorders related to infertility include uterine fibroids, polycystic ovary syndrome, endometriosis, and primary ovarian insufficiency.

Other disorders and conditions that affect only women include Turner syndrome, Rett syndrome, and ovarian and cervical cancers.

Issues related to women’s overall health and wellness include violence against women, women with disabilities and their unique challenges, osteoporosis and bone health, and menopause.

Some health issues that are common to both men and women affect women differently. Although the symptoms may be similar, the effects of the condition and the care necessary can differ significantly for women. In addition, some of these conditions might affect women primarily or more severely than men. For example, U.S women are at higher risk for breast cancer than men.

Certain health issues and their effects on women are listed below.

Alcohol abuse

Millions of women in the United States abuse alcohol, putting their health, safety, and general well-being at risk. While men are more likely to become dependent on or addicted to alcohol than women are throughout their lifetime, the health effects of alcohol abuse and alcoholism (when someone shows signs of addiction to alcohol) are more serious in women. These health effects include an increased risk for breast cancer, heart disease, and fetal alcohol syndrome, in which infants born to mothers who drank during pregnancy suffer brain damage and learning difficulties.

Heart disease

Heart disease is the leading cause of death for women in the United States. Although heart disease is also the leading cause of death for men in the United States, women are more likely to die following a heart attack than men are. In addition, women are more likely than men are to experience delays in emergency care and to have treatment to control their cholesterol levels.

Mental health

Women are more likely to show signs of depression and anxiety than men are. Depression is the most common women's mental health problem, and more women than men are diagnosed with depression each year.

Osteoarthritis

Osteoarthritis is the most common form of arthritis. It causes joint pain, stiffness, and swelling. Arthritis is the leading cause of physical disability in the United States. The condition affects millions of people in the United States and seems to affect more women than men.

Sexually transmitted diseases/sexually transmitted infections (STDs/STIs)

The effect of STDs/STIs on women can be more serious than on men. Leaving STDs/STIs untreated can cause infertility in women. STDs/STIs often go untreated in women because symptoms are less obvious than in men or are more likely to be confused with another less serious condition, such as a yeast infection.

Stress

According to a survey by the American Psychological Association (APA), stress is on the rise for women. For example, almost 50% of all women in the APA survey reported that their stress had increased over the past 5 years, compared to 39% of the men. Stress also has unique effects on women. A recent NICHD study found that stress might reduce a woman's chance of becoming pregnant.

Stroke

More women than men suffer a stroke each year. Although many of the risk factors for stroke are the same for men and women, including a family history of stroke, high blood pressure, and high cholesterol, some risk factors are unique to women. These include:

• Taking birth control pills
• Being pregnant
• Using hormone replacement therapy, a combined hormone therapy of progestin and estrogen designed to relieve menopausal symptoms
• Having frequent migraine headaches
• Having a thick waist (larger than 35.2 inches), particularly if post-menopausal, and high triglyceride (blood fat) levels

Urinary tract health

Women are more likely than men are to experience urinary tract problems. For example, urinary incontinence affects twice as many women as men due to the way the female urinary tract is structured.

A branch of medicine that specializes in the care of women during pregnancy and childbirth and in the diagnosis and treatment of diseases of the female reproductive organs. It also specializes in other women’s health issues, such as menopause, hormone problems, contraception (birth control), and infertility. Also called ob/gyn.

Studies show that asthma may affect women differently than men.

• Women may experience more asthma symptoms than men do. Women with asthma go to the hospital for asthma treatment more often and use more quick-relief or "rescue" medicines than men with asthma do.
• Women with asthma report more trouble sleeping and more anxiety than men with asthma do.
• Women's lungs are smaller than men's. This may make women more sensitive to asthma triggers and make it harder for women to breathe during an asthma attack.

Changing hormone levels throughout your menstrual cycle may make your asthma symptoms worse during some parts of the cycle.

If your asthma symptoms get worse during certain parts of your cycle every month, track your symptoms and menstrual cycle on a calendar. After a few months, you might be able to predict when your asthma symptoms will flare up based on your menstrual cycle. You can then stay away from other asthma triggers during these times.

Tell your doctor or nurse:

• If your asthma attacks happen during a certain time in your menstrual cycle
• If you take birth control
• If you take any kind of hormones
• About any over-the-counter medicines you take. Some common pain medicines that women take to relieve menstrual cramps, such as aspirin and ibuprofen, can trigger asthma attacks in some women.

For some women, asthma symptoms do not change after menopause.

However, other women report that their asthma symptoms get better after menopause. Researchers think very low levels of estrogen after menopause may be a reason why asthma symptoms can get better and why fewer women develop asthma after menopause. This may also explain why women who take menopausal hormone therapy for menopause symptoms are at higher risk for developing asthma.

Diabetes affects women and men in almost equal numbers. However, diabetes affects women differently than men.

Compared with men with diabetes, women with diabetes have:

• A higher risk for heart disease. Heart disease is the most common complication of diabetes.
• Lower survival rates and a poorer quality of life after heart attack
• A higher risk for blindness
• A higher risk for depression. Depression, which affects twice as many women as men, also raises the risk for diabetes in women.

Some health and wellness issues are unique to women, and others are more common in women than men. Women are more likely than men to experience depression, have a harder time quitting smoking, and may experience more rapid bone loss due to hormonal changes at menopause.

Menopause

Some medicines may help if troubling menopause symptoms—such as hot flashes—develop. Some women report symptom relief with complementary therapies, such as black cohosh, red clover, and soy. (However, none of these products has been proven effective, and some may carry potential risks, such as liver damage.) Mind and body practices such as yoga, tai chi, hypnosis, and acupuncture may help with some menopause symptoms. However, it’s always a good idea to talk with a health care professional before trying any of these substances or practices.

Urinary Tract Infections

Cranberry has been promoted for urinary tract infections (UTIs), and there’s evidence that it might be helpful in reducing the risk of these infections in women who have had a previous UTI. However, there’s still some uncertainty about the effectiveness of cranberry because some of the research has not been of high quality.

The U.S. Food and Drug Administration allows manufacturers of cranberry dietary supplements to claim on product labels that there is “limited” evidence that daily consumption of specified amounts may reduce the risk of recurrent UTI in healthy women who have had a UTI. A similar claim may be made for cranberry juice beverages, but the evidence must be described as “limited and inconsistent.”

Cranberry has not been shown to be effective as a treatment for an existing UTI. If you have symptoms of a UTI, see your health care provider.

Pregnancy and Breastfeeding

Like other physical activities, yoga can be safe and beneficial during pregnancy if appropriate precautions are taken. Yoga may help reduce stress, anxiety, and depression during pregnancy. If you’re pregnant, talk with your health care provider to make sure there’s no medical reason why you shouldn’t exercise and to learn if you should adjust your physical activities, including yoga, while you’re pregnant.

Ginger may be helpful for mild nausea and vomiting during pregnancy. However, the evidence that it’s safe for use during pregnancy is not conclusive. If you’re considering using ginger dietary supplements while you’re pregnant, consult your health care provider. Little is known about whether it’s safe to use ginger while breastfeeding.

The herb fenugreek has been thought to stimulate milk production during breastfeeding. However, it’s uncertain whether fenugreek actually has this effect; studies have had mixed results. Little is known about whether it’s safe to use fenugreek in amounts greater than those found in food while breastfeeding. Fenugreek is not safe for use during pregnancy in amounts greater than those found in food; its use has been linked to increased risks of birth defects in both animals and people.

Dietary Supplements and Pregnancy

The U.S. Centers for Disease Control and Prevention (CDC) recommends that all women of reproductive age get 400 micrograms (mcg) per day of the B vitamin folic acid from supplements or fortified foods. Taking folic acid before and during pregnancy helps to prevent birth defects of the brain and spine. Most multivitamin/multimineral supplements contain an appropriate amount of folic acid. Check the label.

If you’re considering taking a dietary supplement other than a vitamin/mineral supplement while you are pregnant, it’s a good idea to discuss it with your health care provider. Some supplements may not be safe for use when you are pregnant, or their safety may be uncertain.

Osteoporosis

Osteoporosis is a bone disease that develops when bone mass or density decreases, leading to a decrease in bone strength and an increase in the risk of fractures. It is the major cause of bone fractures in postmenopausal women and older men.

Dietary supplements containing soy isoflavone mixtures probably have a beneficial effect on bone health in postmenopausal women, but the evidence is not entirely consistent. Red clover also contains isoflavones, but only a small amount of research has been done on the effects of red clover on bone density in menopausal women, and the results have been inconsistent.

Millions of American women have a disability, including physical, learning, and intellectual and developmental disabilities. The challenges faced by women with disabilities increase as they age and their abilities become increasingly limited. Some of the challenges faced by women with disabilities include:

• Barriers to health care services, including a lack of knowledge among health care providers about disabilities.
• Younger women with disabilities are often less likely to seek health care.
• Increased risk for health issues such as depression, stress, being overweight, and high blood pressure
• Decreased levels of physical activity
• Fewer opportunities to be screened for cancer, blood pressure, cholesterol, osteoporosis, and sexually transmitted diseases and infections
• Additional challenges faced during pregnancy, including a lack of health care providers who are familiar with managing pregnancy in women with disabilities and increased discomfort and health complications as the pregnancy advances

What is endometriosis?

The uterus, or womb, is the place where a baby grows when a woman is pregnant. It is lined with tissue (endometrium). Endometriosis is a disease in which tissue that is similar to the lining of the uterus grows in other places in your body. These patches of tissue are called "implants," "nodules," or "lesions." They are most often found

• On or under the ovaries
• On the fallopian tubes, which carry egg cells from the ovaries to the uterus
• Behind the uterus
• On the tissues that hold the uterus in place
• On the bowels or bladder

In rare cases, the tissue may grow on your lungs or in other parts of your body.

What causes endometriosis?

The cause of endometriosis is unknown.

Who is at risk for endometriosis?

Endometriosis is most commonly diagnosed in women in their 30s and 40s. But it can affect any female who menstruates. Certain factors can raise or lower your risk of getting it.

You are at higher risk if

• You have a mother, sister, or daughter with endometriosis
• Your period started before age 11
• Your monthly cycles are short (less than 27 days)
• Your menstrual cycles are heavy and last more than 7 days

You have a lower risk if

• You have been pregnant before
• Your periods started late in adolescence
• You regularly exercise more than 4 hours a week
• You have a low amount of body fat

What are the symptoms of endometriosis?

The main symptoms of endometriosis are

• Pelvic pain, which affects about 75 percent of women with endometriosis. It often happens during your period.
• Infertility, which affects up to half of all women with endometriosis

Other possible symptoms include

• Painful menstrual cramps, which may get worse over time
• Pain during or after sex
• Pain in the intestine or lower abdomen
• Pain with bowel movements or urination, usually during your period
• Heavy periods
• Spotting or bleeding between periods
• Digestive or gastrointestinal symptoms
• Fatigue or lack of energy

How is endometriosis diagnosed?

Surgery is the only way to know for sure that you have endometriosis. First, however, your health care provider will ask about your symptoms and medical history. You will have a pelvic exam and may have some imaging tests.

The surgery to diagnose endometriosis is a laparoscopy. This is a type of surgery that uses a laparoscope, a thin tube with a camera and light. The surgeon inserts the laparoscope through a small cut in the skin. Your provider can make a diagnosis based on how the patches of endometriosis look. He or she may also do a biopsy to get a tissue sample.

What are the treatments for endometriosis?

There is no cure for endometriosis, but there are treatments for the symptoms. Your health care provider will work with you to decide which treatments would be best for you.

Treatments for endometriosis pain include

• Pain relievers, including nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen and a prescription medicine specifically for endometriosis. Providers may sometimes prescribe opioids for severe pain.
• Hormone therapy, including birth control pills, progestin therapy, and gonadotropin-releasing hormone (GnRH) agonists. GnRH agonists cause a temporary menopause, but also help control the growth of endometriosis.
• Surgical treatments for severe pain, including procedures to remove the endometriosis patches or cut some nerves in the pelvis. The surgery may be a laparoscopy or major surgery. The pain may come back within a few years after surgery. If the pain is very severe, a hysterectomy may be an option. This is a surgery to remove the uterus. Sometimes providers also remove the ovaries and fallopian tubes as part of a hysterectomy.

Treatments for infertility caused by endometriosis include

• Laparoscopy to remove the endometriosis patches
• In vitro fertilization

Excessive alcohol use is associated with more than 43,000 deaths among women. Excessive alcohol use poses unique health and safety risks to females.

Alcohol Use is Common Among Women and Girls

• Nearly half of adult women report drinking alcohol in the past 30 days.
• Approximately 13% of adult women report binge drinking and on average do so 4 times a month, consuming 5 drinks per binge.
• About 18% of women of child-bearing age (i.e., ages 18–44 years) binge drink.
• In 2019, about 32% of female high school students consumed alcohol compared with 26% of male high school students. Binge drinking was also more common among female (15%) than male (13%) high school students.
• In 2019, 4% of women overall and 8% of women aged 18 to 25 years had an alcohol use disorder.

Alcohol Affects Women Differently than Men

Although men are more likely to drink alcohol and consume larger amounts, biological differences in body structure and chemistry lead most women to absorb more alcohol and take longer to metabolize it. After drinking the same amount of alcohol, women tend to have higher blood alcohol levels than men, and the immediate effects of alcohol usually occur more quickly and last longer in women than men. These differences make women more susceptible to the long-term negative health effects of alcohol compared with men.

Alcohol is Associated with other Diseases, Injuries, and Harms

• Liver Disease: The risk of cirrhosis and other alcohol-related liver diseases is higher for women than for men.
• Impact on the Brain: Alcohol-related cognitive decline and shrinkage of the brain develop more quickly for women than for men.
• Impact on the Heart: Women who drink excessively are at increased risk for damage to the heart muscle at lower levels of consumption and over fewer years of drinking than men.
• Breast and other Cancers: Alcohol consumption increases the risk of cancers of the mouth, throat, esophagus, liver, and colon. In women, drinking is also associated with breast cancer, even at low levels of consumption.
• Sexual Violence: Excessive alcohol use, particularly binge drinking, is a major contributing factor to sexual violence. Changes in alcohol-related policies can reduce sexual violence in communities.

There is No Known Safe Amount of Alcohol Use during Pregnancy

• In a recent study, 10% of respondents who were pregnant drank alcohol and 4.5% binge drank.
• Alcohol use during pregnancy increases the risk of having a baby with fetal alcohol spectrum disorders (FASD). The most severe form is fetal alcohol syndrome (FAS), which is associated with intellectual disabilities and birth defects.
• FASD are 100% preventable if a person does not drink while pregnant or while trying to become pregnant. It is not safe to drink at any time during pregnancy.
• Excessive alcohol use increases the risk of miscarriage, stillbirth, premature delivery and Sudden Infant Death Syndrome (SIDS).

Women can reduce the amount of alcohol they drink to reduce their risk of harms.

Women are more likely to get Graves' disease than men. Graves' disease also affects women differently than men. In addition to causing heart problems and osteoporosis, Graves' disease in women can cause:

• Problems with your menstrual period. Your thyroid hormone can affect your menstrual cycle. Too much thyroid hormone can cause irregular menstrual periods and make your periods lighter than normal.
• Problems getting pregnant. Irregular menstrual cycles can make it harder for women with Graves' disease to get pregnant. About half of women with Graves' disease have problems getting pregnant.
• Problems during pregnancy. Graves' disease can cause problems for you during pregnancy and for your unborn baby's development.
• Problems after pregnancy. Graves' disease often gets better during the last three months of pregnancy, but it may get worse after delivery.

Women are more likely than men to get Hashimoto's disease. It also affects women differently than men. Most problems from Hashimoto's disease happen when women develop hypothyroidism. Hypothyroidism can cause:

• Problems with your menstrual cycle. Your thyroid hormone can affect your menstrual cycle. Too little thyroid hormone can lead to irregular menstrual cycles or periods that are heavier than normal.
• Problems getting pregnant. Irregular menstrual cycles can make it harder for women with Hashimoto's to get pregnant. Studies show that almost half of women with hypothyroidism due to Hashimoto's disease had problems getting pregnant. Most of these women were recently diagnosed with hypothyroidism or had not yet started treatment for hypothyroidism.
• Problems during pregnancy. The unborn baby's brain and nervous system need thyroid hormone to develop. Untreated or poorly treated Hashimoto's disease can lead to miscarriage, birth defects, or other problems.

The U.S. Preventive Services Task Force identified health screenings that are important for adults at every stage. The screenings recommended specifically for women include:

• Breast cancer screening. A mammogram (X-ray of the breast) is recommended for all women beginning at age 50, or earlier if a woman has a family history of breast cancer. Screening is recommended every 2 years.
• Cervical cancer screening. Screening for cervical cancer should include a Pap test, a screening performed during a pelvic exam that checks for changes in the cells of the cervix, and an HPV (human papillomavirus) test, which finds certain infections that can lead to cell changes and cancer. The American Cancer Society website outlines the cervical screening recommendations for specific age groups.
• Osteoporosis screening. A bone mineral density test should begin at age 65 or earlier if a woman is at risk for osteoporosis. Risk factors include older age (post-menopause), a family history, low body weight or a small, thin frame, a history of broken bones, a lack of calcium and vitamin D, smoking, an inactive lifestyle, an unhealthy diet, and drinking too much alcohol.

The screenings listed above are just a few of the many tests that women should seek throughout their lives. Some screenings, such as blood pressure and cholesterol checks and colonoscopies (to screen for colon cancer) are important for both men and women. Other screenings, such as tests conducted during pregnancy at regular prenatal visits, help protect the health, and could even save the lives, of the mother and her fetus as well as prevent complications during pregnancy and beyond.

Hormonal changes occur throughout a woman’s life. During certain stages, she may have special oral health needs. Puberty, menstruation, pregnancy, menopause and oral contraceptives (birth control pills) can have an effect on a woman’s mouth.

Puberty. During puberty, sex hormones (estrogen and progesterone) cause a female’s body to mature. In addition to the visible body changes, the sex hormone increase can change the way the gums respond to germs (bacterial plaque) in the mouth. The gums can become more susceptible to infections (gingivitis) and may become very red and swollen, and they can bleed a lot.

Menstruation. The oral concerns associated with the onset of puberty are much the same during the menstrual cycle. Occasionally, women who are prone to canker sores and cold sores may develop a pattern where these sores recur during every menstrual cycle.

Pregnancy. Gingivitis is the most common oral condition associated with being pregnant. It occurs in close to 60 percent to 75 percent of all women who are pregnant. As during puberty and menstruation, the increase in hormones exaggerates the gum tissue’s response to bacterial plaque. In addition to the overall gum changes, one area of the gum (usually between the teeth) may swell and produce what is called a “pregnancy tumor.” Often times, this area is enlarged, dark red or bluish in color, and is difficult to keep clean. Generally, the tissue will decrease in size after the birth of the baby, but sometimes the tissue may need to be removed by a dentist.

Often times, women will avoid dental checkups for fear that treatment might harm the baby. Untreated decayed teeth put a mother and her baby at risk for infection. For example, researchers have found a link between periodontal (a certain type of gum disease) and preterm low birth weight babies. One recent study suggests that women who have periodontal disease are at a 7.5 times higher risk for delivering preterm low birth weight babies than women who do not have periodontal disease. Therefore, it is extremely important that an expectant mother have a healthy mouth and see a dentist early in her pregnancy.

Some women experience dry mouth while pregnant. Frequent sips of water and chewing on sugarless gum or candy can help alleviate this symptom.

Diet can affect cavity formation, as well as the health of the developing baby. It is very important that a mother eat nutritious foods while pregnant and avoid high sugar or empty calorie foods. Nutritional guidance from an obstetrician is recommended.

After your baby is born, you will want him/her to start early with good oral health habits. To avoid the risk of baby bottle tooth decay, never put your baby to bed with milk, formula, juice or any other sugary liquid.

Researchers have recently found that a mother can pass on germs that cause tooth decay to her baby. Therefore, it is very important to brush and floss your baby’s teeth and to have the baby’s teeth examined by the dentist between 12 and 18 months of age. It is just as important for a woman to keep her teeth and gums very clean and healthy, so that she does not pass germs to the baby.

Oral Contraceptives. Because the birth control pill mimics the effects of pregnancy, women may experience the gum tissue changes previously discussed. In addition to these changes, women on birth control pills may be more prone to healing problems after tooth extraction. This can lead to what is known as a “dry socket,” a painful condition that can increase the likelihood of bone inflammation during the healing process. To help avoid this condition, schedule the extraction appointment during the non-estrogen “sugar pill” days (days 23-28) of the pill cycle.

Menopause. Menopause, a normal event in a woman’s life, also can bring about certain oral changes. The most common are pain, a burning sensation in the oral tissue, changes in taste and dry mouth.

Post Menopause. After menopause, there is an increased risk of developing osteoporosis (a condition of reduced bone mass and strength), which may increase the chance for tooth loss. Hormone replacement therapy may prevent this type of tooth loss. It is best to consult with your physician about the benefits and risks of hormone replacement therapy.

How can women help avoid oral conditions associated with hormone changes/fluctuations?

• Most importantly, maintain good daily oral care by brushing twice daily with toothpaste containing fluoride and by flossing once daily.
• Have your teeth professionally cleaned by your dentist or dental hygienist every six months (or more frequently if recommended by your dentist).
• Discuss with your dentist or dental hygienist any questions you may have as a woman about your oral health care. Together, you can outline a treatment plan specific to your needs.

Other Helpful Tips

• Pregnant women still need routine checkups. Always tell your dentist and his/her staff if you are pregnant.
• Always tell the dentist and his/her staff about any and all medications you are taking. Sometimes women feel uncomfortable telling a dentist about taking birth control pills. However, it is important for your dentist to know this information, especially when prescribing antibiotics. (It is possible to have an interaction between birth control pills and antibiotics that causes the birth control pill to be less effective).
• Eat a well balanced diet. Doing so in all phases of a woman’s life is important. However, certain vitamins and nutrients may be especially beneficial for oral health. Folate, B vitamins, protein, calcium and vitamin C help to maintain the support system around the teeth.

Remember, with good oral care, regular dental visits and good nutrition, a woman can keep her teeth for a lifetime.

Pain medicines can be effective in reducing pain when used as directed. However, these medicines can also cause serious injury or death when misused or abused. They can also be addictive. It is important to talk to your healthcare provider about how to safely use pain medicines. Also, ask your healthcare provider about other options to treat pain.

Women experience pain differently than men

• Women report more pain than men.
• Some types of long-term (chronic) pain, like migraines and back pain, are more common in women.
• Women may become dependent on prescription pain medicines more quickly than men.
• Women are more likely to be prescribed prescription pain medicines, be given higher doses, and use them for longer time periods than men.

Types of Pain Medicines

Over-the-Counter (OTC) Medicines

OTC pain medicines are in many common products for headaches, colds, and menstrual (period) cramps. Common types of OTC pain medicines are acetaminophen and NSAIDs (Nonsteroidal Anti-Inflammatory Drugs), such as aspirin and low-dose ibuprofen.

Prescription Medicines

• Non-opioid medicines – Medicines that treat pain. Types of non-opioid prescription medicines include diclofenac and ibuprofen. While ibuprofen is also available over-the-counter, your healthcare provider may give you higher doses.
• Opioids – Medicines that may be effective for reducing moderate to severe pain, like after a surgery. Common opioids include oxycodone, hydrocodone, fentanyl, and morphine. 

Take steps to protect yourself and your loved ones.

• Ask your healthcare provider if you should take opioids or use other options to effectively manage your pain. Opioids are not right for everyone or every type of pain.
• Keep track of your pain. Make note when you feel pain, what it feels like, and where your body hurts. Share these notes with your healthcare provider.
• Don’t share prescription pain medicines. Keep pain medicines locked up and away from children and others.
• Don’t take pain medicines for longer than you are supposed to. Get the facts about your medicine. Find out how long you should take it. If you are taking other medications, ask your healthcare provider if pain medications are safe to take at the same time.
• Don’t drink alcohol or use medicines like antihistamines and benzodiazepines when you take certain pain medicines. Combining alcohol and different types of pain medicines or other drugs can cause you to stop breathing.
• Tell your healthcare provider if you have been addicted to medications, other drugs, or alcohol.
• Get rid of unused prescription pain medicines. Check the FDA website or ask your healthcare provider about the best way to get rid of unused medication.

Infection with a number of parasites can lead to unique consequences for women. Some examples are given below.

• Infection with Toxoplasma gondii, a parasite found in undercooked meat, cat feces, soil, and untreated water can lead to severe brain and eye disorders in a fetus when a pregnant woman becomes newly infected.
• Trichomonas vaginalis, a sexually transmitted parasite that can be passed between partners, can lead to vaginal infection and increase a woman’s susceptibility to human immunodeficiency virus (HIV) infection.
• Pregnant women in malaria-endemic countries are at increased risk for adverse effects of malaria infection (for example, miscarriage, low birth weight).
• Women with young children and children in day care are more likely to be exposed to parasites that cause diarrhea such as Giardia intestinalis and Cryptosporidium spp., ectoparasites such as lice (Pediculus spp.), and pinworms (Enterobius vermicularis) that cause anal itching.
• Chagas disease is a vector-borne parasitic illness prevalent in areas of Central and South America, caused by the parasite Trypanosoma cruzi. The disease may lead to cardiac, gastrointestinal, and brain abnormalities. An infected mother can transmit this disease to the fetus (congenital transmission).
• Hookworm infection and malaria can cause anemia. Women who have severe anemia more often deliver infants with low birth weight.
• Pregnant women often need special consideration when being treated for parasitic diseases in order to avoid harm to the fetus, especially during the first trimester.

Getting early and regular prenatal care is important for a healthy pregnancy and birth. Before a woman gets pregnant, a pre-pregnancy care visit can help her take steps for a safe and healthy pregnancy. This is important because early fetal development occurs often before women even know they are pregnant. Certain behaviors, such as exposure to tobacco smoke and drinking alcohol, can increase the risk for complications, while other behaviors, like taking the recommended 400 micrograms of folic acid a day, can reduce the risk for neural tube defects, like spina bifida, by two-thirds.

During pregnancy, a woman's prenatal care visits will include education and counseling about how to handle different aspects of pregnancy, the importance of good nutrition and physical activity, and what to expect during labor.