Key facts

Endometriosis affects an estimated 10% (190 million) of reproductive age women worldwide.

Endometriosis is a chronic disease and symptoms include: severe pain during menstruation; heavy menstrual bleeding; chronic pelvic pain (pain that does not go away when the menstrual cycle ends); infertility; and abdominal bloating and nausea.

Endometriosis most commonly occurs in the pelvis but in some women, occurs elsewhere in the body, including the abdomen and chest.

Endometriosis can impact sexual intercourse, bowel movements and/or urination; and mental health (including depression and anxiety).

There is currently no cure for endometriosis; access to early diagnosis and effective treatment of endometriosis is limited in many settings and treatment aims to control symptoms and limit long-term impacts.

Overview

Endometriosis is a complex disease that affects many women, globally from the onset of their first period (menarche) through menopause, regardless of ethnic origin or social status. Endometriosis can also affect transgender men and non-binary individuals who menstruate. In women with endometriosis, endometrium-like tissue (usually found only in the lining of the uterus) grows outside the uterus, causing inflammation and scar tissue formation.

There is currently no known cure, but endometriosis symptoms can be treated with medicines or, in some women, surgery.

Endometriosis is diagnosed using imaging techniques such as ultrasound. Invasive procedures like surgery may also be necessary to confirm the diagnosis. Long delays in diagnosis are common, and symptoms often persist or recur after treatment is initiated.

Causes

The causes of endometriosis are unknown.

Emerging research suggests that endometriosis is associated with immune system dysregulation. People with endometriosis have higher rates of other immune-mediated conditions, such as lupus, multiple sclerosis, and inflammatory bowel disease, and a family history of endometriosis .

Diagnosis

Symptoms in individuals with endometriosis are variable and broad, meaning that health and care workers may not easily diagnose it. Individuals with symptoms may not be aware of the condition while there are those with endometriosis who are asymptomatic. Access to early diagnosis and effective treatment of endometriosis is limited in many settings, including in low- and middle-income countries. Currently, the average time to diagnosis is between 4 and 12 years.

A careful menstrual health history including pain, heaviness of bleeding, and associated symptoms can help with diagnosis of endometriosis.

Laparoscopic surgery, when the endometrial tissue may be directly visualized or tissue samples removed during surgery can be examined can be recommended, but is a procedure which is inaccessible to many women. A clinical diagnosis of endometriosis may also be made on the basis of women’s symptoms and imaging tests such as ultrasound or MRI, and surgery is not necessarily required before initiating treatment.

New and emerging diagnostic tests aimed at identifying endometriosis earlier include simple symptom checklists, blood tests, and increasingly self-tests using saliva or menstrual blood.

Treatment

There are no existing treatments that definitively cure the disease. Instead, treatments are based on severity, individual preferences, side effects, long-term safety, costs and availability, and whether pregnancy is desired.

Some medications can help manage endometriosis and its symptoms, including:

non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen and other analgesics (pain killers) are often used to treat pain;

hormonal medicines may also reduce pain severity and/or frequency in some women. These methods include: combined hormonal contraceptives (pill, patch, ring); progestins (hormonal IUD, DMPA); and GnRH analogues.

Other hormonal modulators include aromatase inhibitors. However, some of these methods may not be suitable for women who want to get pregnant.

Surgical treatment can remove endometriosis lesions, adhesions, and scar tissue. Hysterectomy (surgical removal of the uterus), usually with the removal of the ovaries, may be considered for individuals who do not respond to other treatments and are not planning to have a child. However, hysterectomy is not a cure, and some patients have symptoms that remain.

Success in reducing pain symptoms and increasing pregnancy rates through surgery are often dependent on the extent of disease. In addition, lesions may recur even after successful eradication, and pelvic floor muscle abnormalities can contribute to chronic pelvic pain.

Fertility treatments including ovulation induction, intrauterine insemination (IUI), or in vitro fertilization (IVF) may be recommended for individuals struggling to conceive due to endometriosis.

In addition to talking to their doctor, people affected by endometriosis may find additional advice and emotional assistance in local patient support groups. Multidisciplinary pain management approaches, including physiotherapy and cognitive behavioral therapy (CBT), can also help to reduce endometriosis-related pain and improve quality of life. These therapies target both physical symptoms and the emotional burden associated with the disease.

Some treatments are associated with side effects, and endometriosis-related symptoms can sometimes reappear after therapy ends. The choice of treatment depends on effectiveness in the individual, adverse side effects, long-term safety, costs, and availability.

Impact

Endometriosis has significant health, social and economic implications. Severe pain, heavy menstrual bleeding, fatigue, depression, anxiety, infertility, poor sexual health and social isolation can dramatically reduce quality of life.

Endometriosis is associated with infertility globally. Amongst women with infertility, as many as 25-50% have endometriosis. Heavy menstrual bleeding from endometriosis can contribute to iron deficiency and fatigue. Painful sex due to endometriosis can lead to interruption or avoidance of intercourse and impact the sexual health of affected individuals and their partners.

Some individuals with endometriosis experience debilitating pain or other symptoms that prevent them from going to work or school. This can cause lost income for individuals and their families and incur costs to society. Treatments often require out-of-pocket costs, adding financial strain to individuals affected by endometriosis.

These impacts are made worse by stigma and social beliefs that often ignore or downplay period pain.

Prevention

At present, there is no known way to prevent endometriosis. Enhanced awareness, early diagnosis and quality health care may slow or halt the progression of the disease and reduce long-term symptoms, including possibly the risk of central nervous system pain sensitization. Currently there is no cure.

Challenges and priorities

In many countries, the general public, family members and most health and care workers are not aware that the chronic pelvic pain people affected by endometriosis face is not normal. Normalization and stigmatization of pain and other symptoms negatively affect the mental health and well-being of people affected by endometriosis.

In low and middle-income countries, there is a lack of multi-disciplinary teams with the wide range of skills and equipment needed for the early diagnosis and effective treatment of endometriosis. In addition, many knowledge gaps exist, and there is need for non-invasive diagnostic methods as well as medical treatments that do not prevent pregnancy.

Addressing these issues is the current focus of endometriosis response.

WHO response

The World Health Organization recognizes the importance of endometriosis and its impact on people’s sexual and reproductive health and rights, quality of life and overall well-being. WHO aims to develop global normative guidance and tools to support the adoption of effective policies and interventions to address endometriosis globally, including in low- and middle-income countries, and for affected individuals from underserved communities.

WHO is partnering with multiple stakeholders, including academic institutions, non-State actors and other organizations that are actively involved in research to identify effective models of endometriosis prevention, diagnosis, treatment, and care.

For more than a year, no one could figure out Lauren Keefe’s strange constellation of symptoms.

The 40-year-old was plagued by chronic fatigue, anxiety, night sweats, and insomnia. Her joints ached. Her hair transformed into a wiry texture. Her skin became perpetually dry. Her ears started itching, then ringing.

She dismissed some of these symptoms as merely growing older and not exercising enough. It was when the heart palpitations began that Keefe decided to see a doctor.

“I just felt deranged. I felt like I didn’t even know who I was,” Keefe, now 46, says. “I just felt like something is going on with me. I have to have some kind of explanation for it.”

One doctor sent her to a cardiologist. Another made her do a sleep study to see if she had sleep apnea. And a gynecologist suggested low vitamin D might be the problem.

AMA News Wire What doctors wish patients knew about menopause

Menopause is a natural phase of a woman’s life that marks the end of her reproductive years. While it is a normal and inevitable process, it can bring about significant physical and emotional changes that can affect a woman’s overall well-being. Understanding the intricacies of menopause and being aware of the various challenges and opportunities it presents is crucial for women to effectively manage this transition.

The AMA’s What Doctors Wish Patients Knew™ series gives physicians a platform to share what they want patients to understand about today’s health care headlines.

Why vaccines matter to your health With a rise in conflicting information about vaccines, the AMA encourages you to talk to your doctor to help make informed decisions about your family’s health. Don’t rely on social media—get answers from someone you trust. Learn More

In this installment, three AMA members took time to discuss what patients need to know about menopause. They are:

Madelyn E. Butler, MD, an ob-gyn in Tampa, Florida.

Laura Katz, MD, an ob-gyn who is in private practice at Laura A. Katz, MD, PC, in Monroe, Michigan, and a member of Professional Medical Corp.

Lanny F. Wilson, MD, an ob-gyn in Hinsdale, Illinois.

Professional Medical Corp. is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.

It starts with perimenopause It starts with perimenopause

“Perimenopause is a transitional period that can be anywhere from 35 to 55 years old, and sometimes can last that long when the hormones are just starting to change,” said Dr. Katz, noting that some people can go through perimenopause in a shorter time frame while others it can take longer.

“So, it’s that transition period where you’re wondering what is going on. You become not yourself and you’re having hot flashes, but those ovaries are occasionally functioning just enough to make you feel normal for a second,” she said.

“What’s happening during perimenopause is it’s a transition phase from your fertile years to your unfertile years. And it’s not something that just kind of happens instantaneously,” Dr. Butler said during a video interview with the AMA about menopause. “It happens gradually and it’s a period of transition that can last three to eight years. And it’s characterized by a decrease in estrogen.”

“When you have a decrease in estrogen, you can have hot flashes, you can have night sweats, you can have anxiety … insomnia, changes in your sex drive, and just a whole host of symptoms,” she explained. “And it’s very individual to the patient. So, it’s a time of transition and it can last a lot longer than we think.”

Perimenopause is a transitional time that ends in menopause. Menopause means your periods have ended. During perimenopause, levels of estrogen start to decrease. You may begin having menopause-like symptoms, such as hot flashes or irregular periods. Perimenopause can last for years.

Symptoms gradually occur over time Symptoms gradually occur over time

It starts with perimenopause, which is a transitional time that ends in menopause. While some people will experience menopause-like symptoms during perimenopause, “normal menopause is a gradual transition that takes place over a three-to-eight-year time frame. Usually in perimenopause, periods start becoming a bit more irregular,” Dr. Wilson said. “Sometimes hot flashes begin in this perimenopausal time frame and some of the other symptoms of full menopause occur, which include night sweats, vaginal dryness, and problems with sleep—for example, insomnia and waking up during the night with hot flashes or cold sweats.

“The vagina contains receptor sites stimulated by estrogen. Without the estrogen stimulating those receptor sites, the vagina begins to dry,” he added. “Rarely, women experience weight gain as well. Since this can be controlled, it shouldn’t be blamed on menopause. It is more likely related to changes in diet and activity than the hormonal changes of menopause.”

“A more subtle kind of change is happening in the bones where the bones begin thinning and become weaker. Early thinning of the bones is called osteopenia,” Dr. Wilson said. “As it gets worse, it becomes osteoporosis. Women with osteoporosis are at increased risk for fractures of their bones.”

There are lesser-known symptoms There are lesser-known symptoms

In addition to traditional symptoms, Dr. Katz noted that there are other “unsuspected things that are actually menopause related.”

“There is also anxiety, mood swings, irritability, depression and a loss of sexual interest,” she said. Others include facial hair growth and pain during sexual intercourse.

Then there are “panic attacks, weird dreams, urinary tract infections, vaginal itching, lower back pain, bloating, farting too much, indigestion, osteoporosis,” Dr. Katz continued, noting that the increased flatulence is “because of a natural result of hormonal changes and shifts in digestion.”

Postmenopause doesn’t mean symptoms are over Postmenopause doesn’t mean symptoms are over

“There’s a thought that once menopause is ‘done,’ you don’t have these symptoms anymore,” said Dr. Katz. But “it means that the last period was at least 12 months ago. It doesn’t mean you can never have symptoms again.”

“People have this misconception that once you’re done with menopause, you’re good, but I have 90-year-old women who still have hot flashes,” she said. “Some people won’t have symptoms anymore, but then there are some who are off one day to the next and you don’t know when your symptoms will appear or disappear. You can’t really tell who is going to be who, but postmenopause doesn’t mean you’re in the clear.”

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Menopause usually happens between 45 and 55 Menopause usually happens between 45 and 55

“The normal age of menopause occurs around age 51 in the U.S. So, anywhere from about 45 to 55 would be a normal time frame to go into menopause,” Dr. Wilson said, noting “menopause is the time in a woman’s life when menstrual periods have stopped. The diagnosis is made when a woman has not had a period for one year.

“Menopause occurs because the ovaries have stopped producing estrogen, and the egg follicles have stopped producing other hormones as well, including progesterone” he added. “Ovulation and hormone production have ceased. So, the ovaries have gone quiet.”

There are four causes of menopause There are four causes of menopause

“Natural menopause occurs because as a woman grows older, her ovaries have gradually released the eggs with which she was born,” Dr. Wilson explained. “And so, as the follicles have gradually diminished, along with the eggs that were within them, natural menopause takes place.”

“We start off with millions of eggs in our ovaries when we’re still in the womb and then by the time we’re born, we’re down to 600,000—which sounds like a ton, but that’s a huge decrease just by being born,” Dr. Katz said. “So, those eggs are slowly breaking down every day, every minute, every hour, naturally.”

“Surgical menopause occurs when a woman has surgical removal of her ovaries. Oftentimes it occurs during a hysterectomy, but occasionally the ovaries can be removed just by themselves if someone is concerned about ovarian cancer,” he said. “Chemotherapy or radiation-induced menopause can occur when cancer therapies are directed at the ovaries.”

“Premature menopause occurs because of a fairly rare condition called primary ovarian insufficiency, or premature ovarian failure. In these instances, a young woman stops having menstrual periods early in life before the age of 40,” Dr. Wilson said.

Many are not prepared Many are not prepared

Patients are “very unprepared in many ways because coalescing with that time of transition, many of them are taking care of elderly, ill parents,” or they may have children leaving home for the first time or are going through career transitions, Dr. Butler said, noting that patients are going through different changes at different points in their lives.

“In the middle of all these transitions and all these life challenges, they’re experiencing hot flashes, the inability to sleep, the emotional changes that occur,” such as anxiety, stress or depression, she said. “So, they are unprepared because they don’t know that the symptoms can last quite a long time.

“Is it stress? Is it the things that I’m going through—just in my life in general?,” Dr. Butler added. “And sometimes patients overlook their need for help, and they don’t know how to differentiate what are symptoms of perimenopause [or menopause] and what are symptoms of the stresses that” they may be facing in their daily life.

They know that their periods “are going to stop, but they don’t know what to expect leading up to that,” she said adding that “many times they think that it’s just going to happen overnight, and they don’t understand that some of the symptoms can last for years.”

Each transition is different Each transition is different

“We, as physicians, have to take the time to listen to patients and see what symptoms they’re experiencing, because every transition is unique to every patient,” Dr. Butler said, noting that “perimenopause and menopause can vary so much from woman to woman” with most experiencing minimal to moderate symptoms.

But some people will have “symptoms that require treatment. And it can run the whole gamut from emotional symptoms to vasomotor symptoms—which are the hot flashes, the migraine headaches, the insomnia, all of those things,” she added. “So, most of us, thankfully, don’t have significant amounts of suffering.”

“The key here is how the symptoms affect your quality of life,” Dr. Butler emphasized. “If the symptoms are affecting your quality of life, your ability to carry on your day-to-day routine, that’s when we really need to discuss treatment.”

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Menopause before 40 is rare Menopause before 40 is rare

“It’s a rare instance to go into menopause before the age of 40—that’s called primary ovarian insufficiency or premature ovarian failure,” Dr. Wilson said. “To go into menopause before the age of 40 is not good, especially if a person waited until later in life to start their family” because it impacts fertility.

Primary ovarian insufficiency typically affects about 1% of women between 15 and 44 years old. It can affect both those who have had children and those who have not. Meanwhile, it is more common in people who are older than 30.

“And if they go into premature ovarian failure, it’s very unlikely that they’ll be able to get pregnant,” he said. “Plus, when you go into premature ovarian failure, that means the estrogen has decreased and so you’re at increased risk for menopausal symptoms as well.”

Herbal remedies might help Herbal remedies might help

When it comes to menopause treatments, “it requires a lot of time drilling down to what the patient’s most troublesome symptoms are and what sorts of things you can offer her for help,” Dr. Butler said. “There are a lot of proprietary herbal remedies that don’t totally take care of all the symptoms, but they can help with quite a few of the most troublesome symptoms like hot flashes.

“And as long as the patients are informed that it’s going to take the edge off, but it’s not going to totally treat the symptoms, having knowledge of what to expect is very important,” she added.

Hormone therapy is very individualized Hormone therapy is very individualized

“In menopause, the ovaries have stopped producing estrogen, progesterone and another less commonly known hormone in women called testosterone,” Dr. Wilson said, noting “all of these work together to help prevent the menopausal phenomenon.”

When it comes to hormonal therapy, it “is very individualized depending on the patient’s personal history, her risk factors, her family history for cancer” and other factors, Dr. Butler explained. “It starts with the different kinds of menopause.”

“Systemic estrogens are a little bit more controversial because they have been associated with an increased risk of breast cancer. And certainly, if a person has a predisposition to uterine cancer, estrogens can stimulate the lining of the uterus and can cause uterine cancer as well,” Dr. Wilson said. “If a person still has a uterus, they must combine estrogen and progesterone to decrease the risk of developing uterine cancer.”

“If a person has had a hysterectomy, she can use estrogen only. The North American Menopause Society recommends that we use the lowest dose of estrogen and/or progesterone to achieve our goal, which is helping prevent hot flashes and helping decrease vaginal dryness,” he said. “So, you want to take the lowest dose amount to achieve your goal and then use it for the shortest amount of time needed to control those bothersome symptoms.”

But remember, “if hormone replacement is required, the recommended treatment is tailored to the individual patient and her medical history,” Dr. Butler emphasized.

Related Coverage What doctors wish patients knew about UTI prevention

Avoid triggers with hot flashes Avoid triggers with hot flashes

“Education about menopause, as we are doing here, and speaking with health care professionals will help women navigate the transition through menopause,” said Dr. Wilson. “When counselling is not enough, there are various things that people can do to help.”

“First of all, women should be aware that there are triggers for hot flashes,” he said. “Triggers include such things as caffeine, smoking, warm or tight-fitting clothes, alcohol, spicy foods, hot weather, stressful situations, and even stressful relationships.”

Maintain a healthy lifestyle Maintain a healthy lifestyle

“There’s nothing like good, healthy habits. They work to help prevent cancers. They help prevent diabetes. They also help transition through menopause,” Dr. Wilson said. “There are just so many good things that come from a healthy lifestyle.”

So, drink “plenty of water, rest, exercise and maintain a healthy diet—that means a nice balance of proteins, vegetables and fruits,” he said.

Try lubricants for vaginal dryness Try lubricants for vaginal dryness

“There are certainly other things that we can do to treat symptoms that really affect her quality of life, like vaginal dryness,” Dr. Butler said. “If you have a patient who’s dealing with cancer, she’s had chemo and now she can’t have intercourse with her partner, that is something that really affects relationships and quality of life and just satisfaction with life in general.”

With sexual intercourse, “the partners should use extra lubrication—as part of their foreplay—in order to help prevent trauma during intercourse. Embrace the lubricant!” Dr. Wilson said. “However, if they still find that they have too much vaginal dryness, estrogens can be applied locally. A small amount can be applied in the form of a cream to help prevent vaginal dryness.”

“Hyaluronic acid—a clear gel or suppository—can also be used if vaginal lubricants haven’t sufficiently helped dryness especially in patients who can’t use estrogen due to cancer history,” Dr. Butler said.

Do not be ashamed Do not be ashamed

“It is important for women going through perimenopause or menopause to not be ashamed,” Dr. Wilson said, noting that “as women transition from the childbearing years through menopause, they’re joining an even larger group of women, since more and more women are living longer into post menopause.”

“You’ve got to communicate,” said Dr. Katz. “You’ve got to get familiar with your body. You have to advocate yourself.

“That is so important,” she added. “You’re not alone in this.”

AMA News Wire What doctors wish patients knew about UTI prevention

A strong urge to urinate that doesn’t go away, a burning feeling when urinating and blood in the urine, can be signs of a urinary tract infection (UTI), which is very common in the U.S. While most UTIs are not serious, some can lead to further complications such as kidney infections. That is why knowing the first signs of a UTI and what to do are key.

UTIs cause more than 8 million visits to the doctor annually. About 60% of women and 12% of men will have at least one UTI during their lifetime, according to the American Urological Association.

The AMA’s What Doctors Wish Patients Knew™ series provides physicians with a platform to share what they want patients to understand about today’s health care headlines.

Why vaccines matter to your health With a rise in conflicting information about vaccines, the AMA encourages you to talk to your doctor to help make informed decisions about your family’s health. Don’t rely on social media—get answers from someone you trust. Learn More

For this installment, two physicians took time to discuss what patients need to know about UTIs and how to manage the symptoms. They are:

Hattiesburg Clinic and University of Iowa Health Care are members of the AMA Health System Program provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.

UTIs shouldn’t be taken lightly UTIs shouldn’t be taken lightly

Most people “who are having symptomatic UTIs will present with burning with urination. So, all of a sudden, they have this onset of pain with urination,” Dr. Steers said. “The other kind of classic symptoms would be needing to go to the bathroom more frequently or urgently—so needing to get to the bathroom quickly.

“If those symptoms are new, that could be concerning for a urinary tract infection,” she added. “In older women, especially, sometimes urinary tract infections are a little bit more subtle, and they may not notice that burning with urination but might notice more abdominal pain or they might just feel generally unwell.”

“If the infection has set up a little and has developed, it might be a little bit more serious—you might develop some back pain or even fever, chills, nausea, vomiting and just feeling bad in general,” Dr. Bryan said. “It’s important to pay attention to those symptoms and to seek care when they develop.”

“We think of urinary tract infections a lot of times as just being an infection of the bladder or urethra,” Dr. Steers said. “But when that urinary tract infection goes upwards up the urinary tract, it can start to climb up the ureter and enter the kidney.

“That’s called pyelonephritis. So, that would be an infection of the kidney. From there, it’s very easy for the bacteria to jump into the bloodstream and cause sepsis,” she added. “And from there, sepsis can cause multiple organ failure, kidney or lung problems—those kinds of things.”

“A UTI is often thought of as being a minor issue, but it can be life threatening,” Dr. Bryan said. “It’s not anything to take lightly. Even if the symptoms are minor, you need to get it taken care of.”

Listen to your body Listen to your body

There are times where symptoms may not show and it leads to a worsening condition, which is seen “more in our elderly patients or maybe somebody who lacks sensation. For example, if they have a neurologic issue where they can’t sense that they’re having symptoms,” Dr. Bryan said. “So, it’s important to know if you’ve had a history in the past, because certainly we’ve seen those patients.”

“But know your body and listen. Pay attention and if something even begins to feel off to contact your doctor and get evaluated,” she said.

Advancing public health AMA membership offers unique access to savings and resources tailored to enrich the personal and professional lives of physicians, residents and medical students. Join the AMA

Have a plan if prone to UTIs Have a plan if prone to UTIs

“There seems to be an unfortunate subset of people who have recurrent urinary tract infections,” said Dr. Steers. Those more prone to UTIs include “postmenopausal women, women who have prolapse, people with decreased immune response like diabetes or women who get kidney stones more frequently.”

“If you have urinary tract infections frequently, we call it recurrent urinary tract infections,” she said, noting that people “meet those criteria by either having two culture-proven urinary tract infections in six months or three within 12 months.”

And those patients “often will be synced up pretty closely with either a urogynecologist or a urologist and they … might be on a daily prophylactic antibiotic,” Dr. Steers added.

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Drink cranberry juice Drink cranberry juice

“We do know that cranberry juice does help urinary tract infections to some degree,” Dr. Steers said. Drinking cranberry juice “works by helping to prevent adherence of the bacteria to the cells of the bladder, so it certainly does help.”

“You can drink cranberry juice if you have a history of UTIs as a preventative measure and then increase the frequency if you start to develop symptoms,” she said. “The more concentrated or the higher the volume of the cranberry juice is probably a bit more helpful.”

“But the other thing is, patients with diabetes would come in and they would drink a jug of cranberry juice and their blood glucose would be high,” said Dr. Bryan. So, as long as a patient doesn’t have diabetes, “then certainly it’s fine to flush the urinary tract and drink cranberry juice.”

Patients can also take a cranberry tablet, which is a pill that “comes with some recommendations,” said Dr. Steers. Evidence for cranberry juice or supplements in older adults, those with bladder emptying problems or pregnant women is not sufficient to make a clear recommendation for or against, however.

Practice proper bathroom hygiene Practice proper bathroom hygiene

“Hygiene in the bathroom is also a predisposing factor for UTIs,” Dr. Bryan said, which means it is important to “make sure that we cleanse from the front to the back to minimize the spread of bacteria.”

“That’s because the bacteria that cause a urinary tract infection usually comes from stool or” from proximity to the rectum “from E. coli and other bacteria found in the gastrointestinal tract,” she explained. “Attention to general hygiene can reduce the risk of UTIs.”

Urinate before and after sex Urinate before and after sex

“Sexual activity is definitely a predisposing factor in urinary tract infections,” Dr. Bryan said, noting that sexual intercourse itself does not directly cause UTIs, but it can increase the likelihood.

This is because “bacteria in the genital or anal region can enter the urethra during sex, so urinating before and after sex can definitely decrease the risk of a UTI,” she said.

Pregnancy requires quick attention Pregnancy requires quick attention

“Pregnant women oftentimes don’t know that they are at increased risk for urinary tract infections, or they may not be aware of the risk of progression of UTIs,” Dr. Steers said.

“While they are common for women and mild for most women outside of pregnancy, they can be quite dangerous in pregnancy,” she added, emphasizing that “pregnant women need to present to the doctor … and get treated for a UTI.”

After surgery, move around if you can After surgery, move around if you can

“Just like any infection, there’s more bacteria that are present in the hospital because there are lots of sick people around,” said Dr. Steer, noting “the biggest risk to developing a UTI in the hospital is having some sort of catheter in your bladder during the hospitalization or having some sort of procedure near your urethra.”

To prevent a hospital-acquired urinary tract infection, “the biggest thing would be minimizing the amount of time the catheter is in place,” she said. “From my perspective as a gynecologist, there are a lot of times where we need the catheter in your bladder, but then we try and remove it as soon as possible.”

“From the patient perspective, if you’ve had some sort of surgery, the quicker you can tolerate being out of bed and trying to go to the bathroom on your own, that helps us get the catheter out sooner,” Dr. Steer explained.

Go to the bathroom more often Go to the bathroom more often

“Holding your urine can definitely increase your risk for a lot of different issues,” said Dr. Bryan. “And a urinary tract infection is one of those.”

“Your body is giving you an alarm there and telling you that if you need to go to the bathroom, you need to go,” she added.

Stay hydrated Stay hydrated

“The biggest thing for prevention is drinking a lot of water,” said Dr. Steers. “Increasing the amount of water that you drink dilutes out that bacteria and then by going to the bathroom more frequently, you’re not letting that bacteria sit in that pool of urine and populate.”

“We recommend about eight glasses of water a day, unless you have other reasons why you’re not supposed to be drinking that much fluid,” she said.

Related Coverage What doctors wish patients knew about pain during sex

Use topical or vaginal estrogen Use topical or vaginal estrogen

“Postmenopausal women who have a lot of vaginal atrophy—thinning, drying and inflammation of the vaginal walls that may occur when your body has less estrogen—might need other forms of prevention,” Dr. Steers said. “We know that by using topical estrogen or vaginal estrogen that can help prevent urinary tract infections.

“It helps boost the genital urinary health and helps keep the good bacteria around,” she added, noting “that vaginal estrogen is really important for postmenopausal women.”

Take care of yourself Take care of yourself

“General overall health is so important. If you’ve got other medical conditions, tend to those,” Dr. Bryan said. “If your diabetes is out of control or you’ve got some inflammatory disorder or something that’s not controlled, take care of your general health.”

That means “getting plenty of rest, making sure that you’re getting plenty of nutrients in your diet … exercise, get a good night’s sleep, stay hydrated,” she said. “Take all those things into account when you try to prevent getting infected with something. It’s just about being healthy.”

Irregular periods are not usually a sign of a problem. But speak to a GP if your periods are irregular or your normal pattern of periods changes.

What are irregular periods?

The average gap between periods starting (the menstrual cycle) is around 28 days. It can sometimes be a bit shorter or longer.

A woman’s periods are irregular if the gap between them is less than 21 days or more than 35 days.

Irregular periods can affect anyone who has periods.

It’s more likely for your periods to be irregular when they first start during puberty, and when you’re nearing menopause.

Keeping track of your periods

Using an app or a diary to keep track of your periods can help you see if they’re irregular.

Day 1 of your menstrual cycle is the first day of your period. The last day of your cycle is the day before your next period.