Ask a Doctor: women’s health | HerCanberra

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Ask a Doctor: women’s health

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 Unsurprisingly, when we asked which questions HerCanberra readers wanted to ask our ACTIVE Expert Panel, women’s health was one of the topics that topped the list.

General Practitioner and Panel member Dr. Kelly Teagle this week answers your questions around birth control, breast cancer, and vaginal discharge.

I missed some of my contraceptive pills and then had sex… could I get pregnant?

This depends on a few things, firstly whether you’re on a combined contraceptive pill (which has estrogen and progestogen) or the “mini-pill” which is progestogen-only. Contraceptive pills containing estrogen work by preventing ovulation and are generally a bit more forgiving of the occasional missed pill. If you are on a progestogen-only minipill however it is critical to take it within three hours of the same time every day; it works by forming a thick mucus plug to stop sperm from entering the cervix, but if you’re late taking it, the mucus plug breaks down and you could fall pregnant. If you miss one of your minipills you need three full days of perfect pill use again before it’s safe to have unprotected sex, so use condoms in the meantime.

Secondly, the timing of the missed pills within your cycle is important. The most “dangerous” pills to miss for combined pill users are the ones immediately after your sugar pills. Most brands have seven days of sugar pills so when they’re finished you’ve not had any hormone pills for a week. If you go any longer than this without restarting the hormone pills you may ovulate and potentially fall pregnant in the next few weeks, so you absolutely should use condoms until your next period. Missing a pill or two in the second half of your cycle is unlikely to cause too many problems, but refer to this missed pill chart for details.

Finally don’t forget that if you have an episode of unprotected intercourse, or you are concerned that missed pills might put you at risk of pregnancy, you can buy emergency contraception (the “morning after” pill) over the counter from the chemist. This is most effective if used within 72 hours of intercourse but may work for up to five days. Copper IUDs can also be used as emergency contraception if inserted within a few days and they provide excellent ongoing contraception for those who have trouble remembering to take pills.

I have a strong family history of breast cancer; how can I reduce my risk of getting it?

It can be really tricky to work out who is at “increased risk” when it comes to breast cancer, especially when you consider that the “normal” lifetime risk is about one in eight for Australian women (Cancer Council). Many risk factors are things we can’t change like age, sex and genetics; you may be at increased genetic risk for example if there are a few women on one side of your family who’ve had breast cancer, particularly if they were unusually young. One way to work out your personal risk is to use the excellent iPrevent online assessment tool from the Peter MacCallum Cancer Centre in Melbourne. If you or your family have a known genetic mutation that predisposes you to breast cancer (such as a BRCA gene mutation) then have your GP refer you to a genetic counsellor for advice about your testing, prevention and screening options.

According to a review of the latest evidence by Cancer Australia, modifiable factors which can cause an increase in breast cancer risk include being overweight, drinking alcohol, low levels of physical activity and current use of certain types of hormones in contraceptive pills and HRT (particularly certain progestogens). To reduce your overall risk then it would make sense to make sure you are a healthy weight, physically active, have low levels of alcohol consumption and review your use of hormonal medications with your doctor.

I keep getting weird smelly vaginal discharge; what could that be?

Vaginal discharges vary a lot between individuals. Some women naturally produce a lot of vaginal secretions, others not so much. Many different factors can alter your vaginal biome (the balance of organisms present) and therefore change the nature of your mucus or discharge. For example, factors which cause a higher pH in the vaginal can cause a bacterial overgrowth called bacterial vaginosis. Using soaps or cosmetic products on your vulva can also throw out the vagina’s pH balance and strip the delicate skin’s protective oils causing itching or dermatitis. Diabetic women are more prone to thrush, as are those taking antibiotics.

If the discharge is smelly the most common cause is bacterial vaginosis, or BV. This presents as a thin white fishy-smelling discharge, usually in sexually active women (although strictly speaking it is not an STI). This is diagnosed by your GP or sexual health service using a vaginal swab but your doctor may decide to treat you with an antibiotic right away if your symptoms are very characteristic.

Thrush is also very common, with some women experiencing recurrences almost monthly just before their period. It is caused by an overgrowth of a yeast called candida and usually presents with a pasty white discharge and/or vaginal irritation or itching. Over the counter thrush creams and tablets are available from the chemist to treat thrush but you should still see your doctor if it persists or recurs.

There are many other potential causes for vaginal discharges including sexually transmitted infections like chlamydia and gonorrhea, which require specific antibiotic treatments. You should always see your doctor if the discharge persists or is associated with unusual bleeding, pain, systemic symptoms like fever and nausea, or if you’ve had recent unprotected sexual intercourse.

Do you have a burning question you want to be answered, or issue you’d like us to explore? Whether it’s about menopause, meditation, or your metabolism (or any other body part or function for that matter), our Panel is here to help. Submit your question anonymously and we’ll put it to the experts.

The information provided in this article is provided for information purposes only. You should seek assistance from a health care professional when interpreting these materials and applying them to your individual circumstances. If you have any concerns about your health, consult your general practitioner. Information provided in this article does not imply endorsement of third-party services or products and cannot provide you with health and medical advice.

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