Women's Health: The Complete Guide

Key numbers at a glance

Why women's health needs its own attention

Women and men share most health risks, but there are real differences in how some conditions show up, how common they are and how they are treated. Some issues are specific to female anatomy and hormones: periods, contraception, pregnancy, menopause and cancers of the cervix, uterus and ovaries. Others affect everyone but behave differently in women, including heart disease, osteoporosis, autoimmune conditions, thyroid disease, depression and urinary problems.

There is also a long history of women's symptoms being underestimated. Severe period pain is often dismissed as normal for years before endometriosis is considered. Menopause symptoms are put down to stress or depression. Heart attack symptoms that do not fit the classic pattern of crushing chest pain are missed. None of this means you will be dismissed, but it does mean that knowing what is and is not normal, and being prepared to ask direct questions, can make a real difference to the care you receive.

Heart disease is the leading cause of death for women in the US, a fact that surprises many people who think of it as a male problem. Breast cancer, lung cancer and colorectal cancer are the cancers most likely to affect women. Most of these risks can be reduced through the same foundations that protect everyone: not smoking, staying active, eating well, limiting alcohol, keeping blood pressure, blood sugar and cholesterol in check, and getting recommended screening on time.

Periods: what is normal and what is not

A menstrual cycle is counted from the first day of one period to the first day of the next. Cycles vary between people and over a lifetime, and they are often irregular in the first few years after periods start and again in the years before menopause. What matters most is what is normal for you. A clear change, such as periods becoming much heavier, much more painful, or stopping for three months or more when you are not pregnant, is worth discussing with your doctor.

Tracking your cycle, whether in an app or a notebook, is one of the most useful things you can do. Note when each period starts and ends, how heavy it is, how much pain you have, and any bleeding between periods. A few months of records turns a vague sense that something is wrong into information your doctor can act on.

Period pain

Period cramps, called dysmenorrhea, are caused by prostaglandins, chemicals that make the muscle of the uterus contract. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen reduce prostaglandin production and work best when started at the first twinge of pain, or the day before your period if it is predictable. A heating pad, regular exercise and hormonal birth control can also help. Do not take NSAIDs without advice if you have had a stomach ulcer, have kidney disease, or have asthma that worsens with these medicines, and do not combine two different NSAIDs.

Pain that stops you working, studying or doing normal activities is not something you should simply put up with. It can be a sign of endometriosis, a common condition in which tissue similar to the lining of the uterus grows elsewhere in the pelvis, causing pain, sometimes heavy bleeding, pain during sex or bowel movements, and difficulty getting pregnant. Endometriosis often takes years to diagnose, so if your pain is severe or getting worse, ask about it directly.

Heavy periods

Heavy menstrual bleeding is defined by its effect on your life rather than an exact volume. Warning signs include soaking through one or more pads or tampons every hour for several hours in a row, needing to double up on protection, waking at night to change, passing large clots, or bleeding for longer than a week. Heavy periods are a leading cause of iron-deficiency anemia, which causes tiredness, shortness of breath and reduced exercise tolerance. A complete blood count and a ferritin test, which measures iron stores, can show whether you are affected.

Heavy bleeding has many possible causes, including fibroids, polyps, hormonal changes, bleeding disorders and some medicines, and it is treatable. Options include the hormonal IUD, birth control pills and other hormonal methods, as well as non-hormonal medicines such as tranexamic acid and NSAIDs taken during the period. Do not start iron supplements without a blood test, and always report bleeding between periods or after sex.

Contraception

Choosing contraception is about matching a method to your health, your priorities and your life. The single most important thing to understand is the difference between perfect use and typical use. Methods that depend on you doing something every day or every time you have sex, such as pills, condoms and fertility awareness, are much less effective in real life than in ideal conditions. Long-acting reversible methods, the implant and the hormonal and copper IUDs, are the most effective reversible options precisely because they do not rely on remembering anything.

Some methods are not suitable for everyone. The CDC's US Medical Eligibility Criteria for Contraceptive Use guide doctors on which methods are safe for people with particular conditions. Combined methods containing estrogen, including most pills, the patch and the ring, are generally not recommended if you have migraine with aura, smoke and are 35 or older, have a history of blood clots, or have certain other conditions such as uncontrolled high blood pressure. Progestin-only and non-hormonal methods are options in these situations. Tell your prescriber about all of these, and review your method when your health or medicines change.

Emergency contraception is more effective the sooner it is used. Levonorgestrel emergency contraceptive pills are sold over the counter at pharmacies with no age limit or prescription. A prescription pill containing ulipristal works for longer after unprotected sex, and a copper IUD inserted within 5 days is the most effective emergency option of all and then continues as ongoing contraception. Condoms are the only method that also protects against sexually transmitted infections, so many people use them alongside another method.

• Continue contraception after 40 until your doctor confirms you no longer need it; irregular periods alone do not mean you cannot get pregnant
• Under the Affordable Care Act, most health plans cover FDA-approved contraception with no copay when you use an in-network provider
• A progestin-only birth control pill is now available over the counter in the US

Preconception health and pregnancy

Many pregnancies are unplanned, and some of the most important steps for a healthy pregnancy need to happen before you know you are pregnant. The baby's neural tube, which becomes the brain and spinal cord, closes within the first month of pregnancy. Taking folic acid beforehand reduces the risk of neural tube defects such as spina bifida. The US Preventive Services Task Force recommends that anyone who could become pregnant take a daily supplement containing 400 to 800 mcg of folic acid. If you have had a previous pregnancy affected by a neural tube defect, or take certain medicines, your doctor may advise a much higher dose.

If you are planning a pregnancy, a preconception visit is worthwhile. Your doctor can review your medicines, since some, including certain acne, epilepsy and blood pressure drugs, need changing before conception. Long-term conditions such as diabetes, high blood pressure, thyroid disease and epilepsy are best brought under good control first. Check that you are immune to rubella and chickenpox, as these vaccines cannot be given during pregnancy, and that your cervical screening is up to date. Avoid high-dose vitamin A (retinol) supplements, and stop smoking and drinking alcohol; no amount of alcohol is known to be safe in pregnancy.

Pregnancy itself is covered in depth in our pregnancy guide. From a long-term women's health perspective, it is worth knowing that some pregnancy complications, including preeclampsia, gestational diabetes and high blood pressure in pregnancy, are linked to a higher risk of heart disease and type 2 diabetes later in life. If you had any of them, make sure your doctor knows, and keep up with blood pressure and blood sugar checks in the years afterward.

Screening and preventive care

Screening tests look for disease, or early changes that could become disease, in people who feel well. They work best when done on schedule, which is often the hard part, because in the US there is usually no national reminder system and it is up to you and your doctor to keep track. A yearly well-woman visit is a good moment to check what you are due for. Under the Affordable Care Act, most health plans must cover well-woman visits and recommended preventive screenings with no copay when you use an in-network provider.

Cervical screening prevents cancer rather than only finding it, by detecting cell changes and high-risk HPV infection that can be treated before cancer develops. The USPSTF recommends screening from 21 to 65. From 21 to 29, that means a Pap test every 3 years. From 30 to 65, you can choose an HPV test every 5 years, a Pap test every 3 years, or both together every 5 years. Screening is still needed if you have had the HPV vaccine and if you are not currently sexually active, because HPV can persist silently for years.

Several other screenings apply to most women. Mammograms are covered in the next section. Colorectal cancer screening is recommended from 45 to 75, using either a stool-based test or a colonoscopy. Blood pressure should be checked regularly from 18, and cholesterol and diabetes screening are offered based on age and risk. Younger sexually active women, and older women at higher risk, should be screened for chlamydia and gonorrhea. Screening for HIV is recommended at least once for everyone 15 to 65, and for hepatitis C at least once for adults 18 to 79. Women aged 50 to 80 with a significant smoking history may be eligible for yearly lung cancer screening.

Making screening easier

If pelvic exams are difficult for you, because of pain, anxiety or past trauma, you can ask for a longer appointment, a female clinician, a smaller speculum, or to have someone with you. You can stop the exam at any time. Avoid booking cervical screening during a heavy period if you can, as it can make sampling harder. If your family has a history of breast, ovarian or certain other cancers, ask whether genetic counseling and testing for BRCA and related genes would be appropriate for you.

Breast awareness and mammograms

Breast awareness means knowing what is normal for your breasts so that you notice when something changes. There is no single correct technique or schedule. Look as well as feel, including in a mirror with your arms raised, and remember that breast tissue extends up toward the armpit. Breasts change through the menstrual cycle, so being familiar with your own pattern helps you tell normal variation from something new.

Changes to report include a new lump or thickening, a change in size or shape, skin dimpling or puckering, a nipple that has turned inward, discharge from the nipple, a rash or crusting around the nipple, or persistent pain in one breast or armpit. Most breast changes are not cancer; cysts and benign lumps are common. But every one deserves to be checked promptly, and a painless lump is not less concerning than a painful one.

The USPSTF recommends a screening mammogram every 2 years for women aged 40 to 74. Your doctor may suggest a different schedule or additional imaging if you have a strong family history, a known genetic variant, or dense breast tissue, which is common, makes mammograms harder to read and is now reported to you after a mammogram. Checking your own breasts does not replace screening, and a normal mammogram does not mean you should ignore a new change.

Menopause and the years around it

Menopause is defined as the point 12 months after your last period. The average age in the US is about 51. It is preceded by perimenopause, a transition that commonly lasts several years, during which hormone levels fluctuate and periods become irregular. Most symptoms happen during this transition rather than after it. Menopause before 45 is considered early, and before 40 it is called primary ovarian insufficiency; both should be discussed with your doctor because of their long-term effects on bone and heart health.

Hot flashes and night sweats are the best-known symptoms, but they are far from the only ones. Many women experience disturbed sleep, mood changes, anxiety, difficulty concentrating, joint aches, reduced libido, and changes in the vagina and urinary tract, including dryness, pain during sex, urgency and more frequent urinary infections. These symptoms are frequently attributed to stress, overwork or depression instead. For women over 45 with typical symptoms, diagnosis is usually based on symptoms alone, without blood tests.

Effective treatments are available. For many healthy women with bothersome symptoms who are in their 50s or within the first several years after menopause, the benefits of hormone therapy outweigh the risks, though the decision depends on your personal and family history. Non-hormonal prescription medicines and cognitive behavioral therapy can also reduce hot flashes and improve sleep. Vaginal and urinary symptoms, which tend to persist and worsen without treatment, respond well to low-dose vaginal estrogen and to nonhormonal moisturizers and lubricants.

Any bleeding after menopause, meaning after 12 months without a period, must be reported to your doctor. It is often caused by something minor, but it can be an early sign of uterine cancer and always needs investigating. Also continue using contraception until your doctor confirms you no longer need it, since pregnancy is still possible during perimenopause even when periods have become infrequent.

Bone health

Bone is living tissue that is constantly broken down and rebuilt. You reach peak bone mass, the strongest your bones will ever be, usually by around age 30. Estrogen acts as a brake on bone breakdown, so when estrogen falls at menopause, bone loss speeds up for several years. That is why osteoporosis, a condition in which bones become thin and fragile, is much more common in women than in men, and why the years before menopause are when the most useful prevention happens.

Exercise is one of the most effective ways to protect bone, but not all exercise works equally. Bone responds to load, so resistance training such as lifting weights or using resistance bands, and weight-bearing activities such as brisk walking, dancing, stair climbing and racquet sports, are the most useful. Swimming and cycling are excellent for the heart but put little load on bone. Balance exercises, such as tai chi, reduce the risk of falls and therefore fractures.

Calcium and vitamin D are the key nutrients. The RDA for calcium is 1,000 mg a day for women 19 to 50 and 1,200 mg from 51. Dairy foods, fortified plant milks, calcium-set tofu, canned fish with bones and some leafy greens are good sources, and food is the preferred source because high-dose calcium supplements have downsides, including a link to kidney stones. Vitamin D, which helps you absorb calcium, comes from fortified foods, fatty fish and sunlight, and many women benefit from a modest supplement.

The USPSTF recommends osteoporosis screening with a bone density scan for women 65 and older, and for younger postmenopausal women at increased risk. Risk factors include a previous fracture from a minor fall, a parent who broke a hip, low body weight, smoking, heavy drinking, early menopause, and long-term use of steroid tablets. Periods that stop for three months or more outside pregnancy, for example because of intense training or very low food intake, also affect bone and should be checked.

Heart health and conditions that affect women differently

Because heart disease is the leading cause of death for women, knowing your numbers matters: blood pressure, cholesterol, blood sugar and weight. High blood pressure is especially important because it usually has no symptoms. Women have some extra risk factors to consider, including the pregnancy complications described above, early menopause, polycystic ovary syndrome (PCOS) and autoimmune conditions such as lupus and rheumatoid arthritis, which raise cardiovascular risk.

Chest pain or discomfort is the most common heart attack symptom in women, as in men, but women are more likely to also have, or only have, other symptoms: shortness of breath, nausea or vomiting, lightheadedness, unusual tiredness, and pain in the back, jaw, neck or arms. Women sometimes wait longer before seeking help because the symptoms do not match what they expect. Do not wait. Call 911 for any of these symptoms, and do not drive yourself to the hospital.

Hormonal and autoimmune conditions

PCOS is one of the most common hormonal conditions in women of reproductive age. It can cause irregular or absent periods, acne, excess hair growth and difficulty getting pregnant, and it is linked to insulin resistance, type 2 diabetes and heart disease. Thyroid disorders, both underactive and overactive, are also much more common in women and can cause tiredness, weight change, mood changes and changes to periods. Autoimmune diseases as a group affect women more than men. All of these are diagnosed with straightforward tests, so persistent, unexplained symptoms are worth raising.

Bladder health, urinary infections and the pelvic floor

Urinary tract infections are much more common in women than in men, largely because the urethra is shorter. Typical symptoms are burning when you urinate, needing to go urgently and often, and lower abdominal pain. A urine test confirms the diagnosis, and simple infections can usually be treated through your doctor, a telehealth visit or urgent care. Fever, chills, back or side pain, or vomiting suggest the infection has reached the kidneys and needs prompt care. If infections keep coming back, ask for further tests rather than repeated courses of antibiotics alone. In older women, new confusion may be the main sign of a urinary infection.

The pelvic floor is a sling of muscles that supports the bladder, bowel and uterus. Pregnancy, childbirth, menopause, chronic constipation and chronic coughing can all weaken it, leading to bladder leakage when you cough, sneeze, laugh or exercise, or to a feeling of heaviness or bulging in the vagina, which can indicate pelvic organ prolapse. These problems are very common and frequently go unreported because people assume they are a normal part of having children or getting older.

Pelvic floor muscle training, often called Kegel exercises, is the first-line treatment for stress incontinence and works well when done correctly and consistently for several months. Many women do the exercises incorrectly without guidance, so ask for a referral to a pelvic floor physical therapist. Avoid cutting back on fluids to manage leakage, which concentrates the urine and can make urgency worse, and treat constipation, which strains the pelvic floor.

Mental health, relationships and safety

Depression and anxiety are more commonly diagnosed in women than in men, and some periods of life carry particular risk: the days before a period for women with premenstrual dysphoric disorder, pregnancy and the year after birth, and the menopause transition. Perinatal depression is common and treatable, and it is not a sign of weakness or of being a bad parent. If you are struggling during or after pregnancy, the National Maternal Mental Health Hotline is available 24 hours a day by call or text at 1-833-852-6262.

Persistent low mood, loss of interest in things you used to enjoy, changes in sleep and appetite, constant worry, or feeling unable to cope for more than two weeks are reasons to talk to your doctor. Effective treatments include talking therapies, medicines and practical support. If you are having thoughts of harming yourself, or are in crisis, call or text 988 to reach the 988 Suicide & Crisis Lifeline at any time.

Intimate partner violence affects women of every age and background, and it often begins or escalates during pregnancy. It includes physical violence, sexual violence, threats, controlling behavior and financial control. Your doctor can talk with you privately, and the National Domestic Violence Hotline offers confidential support around the clock at 1-800-799-7233. If you are in immediate danger, call 911.

Talking to your doctor and a yearly plan

Appointments are short, so preparation helps. Before a visit, write down your main concern and any other symptoms, even ones that seem unrelated or embarrassing; vaginal, urinary, sexual and bowel symptoms are routine for your doctor even if they are not for you. Bring a record of your periods if they are relevant, a list of all medicines and supplements, and your family history, especially of heart disease, breast, ovarian, uterine and colorectal cancer, osteoporosis and blood clots.

Be direct. If your symptoms are affecting your work, sleep or relationships, say so plainly, because impact is often what determines treatment. It is reasonable to ask "Could this be endometriosis?", "Should I have a ferritin test?" or "Could this be perimenopause?" If you feel your concerns have not been taken seriously, ask what else could explain your symptoms, what the next step would be if things do not improve, or for a referral to a gynecologist or another doctor. A simple yearly routine keeps the important things from slipping. Pick a month that is easy to remember, such as your birthday month, and use it as your checkpoint for the items below.

• Book a well-woman visit or yearly checkup, and ask which screenings you are due for this year
• Check your cervical screening and mammogram dates against the USPSTF schedules, and book anything that is due
• Have your blood pressure checked, and ask whether your cholesterol, blood sugar or bone density need testing
• Review your contraception, or your preconception plan and folic acid if you might become pregnant
• Update your vaccines, including a yearly flu shot and HPV catch-up doses if you are eligible
• Review your activity: at least 150 minutes of moderate activity a week plus muscle-strengthening activities on 2 days, including some that load your bones
• Check your calcium and vitamin D intake, and look at any changes in your periods, bladder or mood since last year

Every guide in this topic

• The Evidence on Period Pain, Without the Hype
• Heavy Periods: What the Evidence Actually Says
• Menopause: What Published Guidance Supports
• Cervical Screening: What the Evidence Actually Says
• Breast Awareness: What Published Guidance Supports
• Contraception: Sorting the Evidence From the Noise
• Preconception Health: What the Evidence Actually Says
• Bone Health in Women: What the Evidence Actually Says
• Urinary Tract Infections: What the Evidence Actually Says
• Pelvic Floor: What the Evidence Actually Says

Frequently asked questions

How do I know if my period pain is normal?

Some cramping is common, especially in the first day or two. It is not normal if pain stops you working, studying or doing everyday activities, is not controlled by over-the-counter pain relievers such as ibuprofen, has gotten worse over time, or comes with pain during sex or bowel movements. These can be signs of endometriosis or another condition, so see your doctor and ask about it directly.

How heavy is too heavy for a period?

Warning signs include soaking through a pad or tampon every hour for several hours in a row, needing to double up on protection, changing during the night, passing large clots or bleeding for more than a week. Heavy periods can cause iron-deficiency anemia, which makes you tired and short of breath. See your doctor, who can check your blood count and iron stores and discuss treatments.

Do I still need a Pap test if I have had the HPV vaccine?

Yes. The HPV vaccine protects against the types of HPV that cause most cervical cancers, but not all of them, and it works best when given before any exposure to the virus. Screening is still recommended from 21 to 65 for everyone with a cervix, whether or not they have been vaccinated, and whether or not they are currently sexually active.

When should I start having mammograms?

The USPSTF recommends a screening mammogram every 2 years for women aged 40 to 74. If you have a strong family history of breast or ovarian cancer, a known genetic variant such as BRCA, or dense breasts, your doctor may recommend starting earlier, screening more often or adding other imaging. Any new breast change should be checked promptly, whatever your age or screening schedule.

How can I tell if I am starting perimenopause?

Changes in your periods, such as cycles getting shorter, longer or irregular, are often the first sign, typically in your 40s. Hot flashes, night sweats, poor sleep, mood changes, brain fog and vaginal dryness are also common. For women over 45 with typical symptoms, diagnosis is usually based on symptoms without blood tests. See your doctor sooner if symptoms start before 45.

Is hormone therapy for menopause safe?

For many healthy women with bothersome symptoms who are in their 50s or within the first several years after menopause, the benefits generally outweigh the risks. The balance depends on your age, how long since your last period, and your personal and family history of blood clots, stroke, heart disease and breast cancer. Discuss the options, including non-hormonal treatments, with your doctor.

Can I get emergency contraception without a prescription?

Yes. Levonorgestrel emergency contraceptive pills are sold over the counter at pharmacies with no age limit. They work best the sooner you take them after unprotected sex. A prescription pill called ulipristal works for longer, and a copper IUD placed within 5 days is the most effective option and can stay in as ongoing contraception. A pharmacist or your doctor can help you choose.

Why do I need folic acid before I get pregnant?

The neural tube, which becomes the baby's brain and spinal cord, closes within the first month of pregnancy, often before you know you are pregnant. Taking folic acid beforehand reduces the risk of defects such as spina bifida. The USPSTF recommends 400 to 800 mcg daily for anyone who could become pregnant. Some people need a higher dose, so ask your doctor.

Is bladder leakage after childbirth normal?

It is common, but it is not something you have to live with. Pelvic floor muscle training is the first-line treatment for leakage when you cough, sneeze or exercise, and it works best with guidance from a pelvic floor physical therapist and several months of daily practice. See your doctor for leakage, a feeling of bulging in the vagina, or pain during sex.

Are heart attack symptoms different in women?

Chest pain or discomfort is the most common symptom in both women and men, but women are more likely to also have shortness of breath, nausea or vomiting, lightheadedness, unusual fatigue, or pain in the back, jaw, neck or arms. Because these can seem less dramatic, women sometimes delay getting help. Call 911 right away for any of these symptoms.

When to speak to a doctor

See your doctor for period pain that stops you functioning, periods that become much heavier, bleeding between periods or after sex, periods that stop for three months or more outside pregnancy, any bleeding after menopause, a new breast lump or other breast change, menopausal symptoms before 45, bladder leakage or a feeling of bulging in the vagina, or low mood lasting more than two weeks. Go to the emergency room or call 911 for severe sudden pelvic pain, severe one-sided pain when you could be pregnant, bleeding that soaks a pad every hour for several hours, fainting, fever with back pain and urinary symptoms, chest pain or pressure, shortness of breath, sudden severe headache, weakness on one side, or calf pain and swelling while using hormonal contraception. If you are in crisis or thinking of harming yourself, call or text 988, and if you are in danger at home, call 911.

Where this comes from

• American College of Obstetricians and Gynecologists — Heavy Menstrual Bleeding
• CDC — U.S. Medical Eligibility Criteria for Contraceptive Use, 2024
• American College of Obstetricians and Gynecologists — Emergency Contraception
• US Preventive Services Task Force — Folic Acid Supplementation to Prevent Neural Tube Defects: Preventive Medication
• US Preventive Services Task Force — Cervical Cancer: Screening
• US Preventive Services Task Force — Breast Cancer: Screening
• US Preventive Services Task Force — Osteoporosis to Prevent Fractures: Screening
• American College of Obstetricians and Gynecologists — The Menopause Years
• NIH Office of Dietary Supplements — Calcium: Fact Sheet for Consumers
• HealthCare.gov — Preventive health services

How this page was put together

Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarized or generalized beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.

Medical disclaimer

This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to your doctor, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 911.