As young women we are often so preoccupied with all the wonderful experiences of life that we don’t take a moment to really assess our health. When we are able to find the time, we aren’t always prepared to ask the questions that are most helpful. As a pediatric, adolescent and young adult gynecologist, I believe there are 3 questions that every young woman should ask her gynecologist or reproductive health provider:
Are there actions I can take now to improve my chances of having children and a healthy pregnancy later?
The great news is that the vast majority of women will never experience difficulty conceiving, and for those that do – modern medicine provides many treatment options. However, when it comes to our reproductive health, the way we care for our bodies as adolescents and young women can affect our future reproductive capacity.
Let’s take the age-old battle of maintaining a healthy weight. A healthy weight is not just about how you look – we are beautifully and wonderfully made – big, small, short or tall. As important, being underweight or overweight can affect our reproductive function by disrupting ovulation, or the release of an egg, on a regular, monthly basis. When an egg is not released, the chances of spontaneous pregnancy are low in both underweight and overweight women and menstrual bleeding does not occur regularly. Women who are overweight and miss periods are at increased risk of pelvic pain and uterine cancer due to retained menstrual tissue. Excessive weight may also be associated with hormonal abnormalities such as excess insulin and testosterone which result in increased acne and abnormal hair production and can lead to difficulties with ovulation. Women who are underweight and miss periods are at risk for decreased estrogen production with underdevelopment of the uterus, early onset osteoporosis (decreased bone strength), cardiac disease and difficulty with memory and concentration.
Postponing sexual activity until we are better able to make long-lasting dating and romantic decisions also has a positive impact on future reproductive health. Most sexually transmitted infections (STIs) can be cured, with the exception of HIV, HSV (herpes) and HPV, which can be managed but not cured at this time. Timing of treatment is crucial to minimizing long term negative outcomes. STIs such as gonorrhea and chlamydia that are not treated early can result in pelvic inflammatory disease (PID) which can lead to scarring of the fallopian tubes and pelvic adhesions, both of which may lead to infertility and pelvic pain.
Sexual activity can also cause an increase or disturbance of “normal bacteria” that live in a delicate balance in our reproductive canal which can also lead to PID. The young, developing reproductive tract is more susceptible to these bacteria; therefore, postponing sexual activity can be helpful. Barrier and some hormonal contraceptives can decrease the likelihood of transmission of bacteria and STIs, but are extremely unreliable.
Smoking, alcohol and drug use – we always have to include these. Tobacco and marijuana use has been shown to result in infertility in both females and males. Excessive alcohol intake can affect many organ systems, and it is important for women to keep in mind that even less than moderate amounts of alcohol (1-2 drinks per day) can increase the risk of breast cancer. Excessive alcohol intake during pregnancy results in birth defects, abnormal growth and intellectual disability. Minimizing alcohol intake before pregnancy can decrease the likelihood of excessive drinking during pregnancy.
Overall, a lifestyle that promotes a balanced diet, minimal alcohol consumption, regular moderate exercise and eliminates all smoking can minimize risks to reproductive health. It is never too late to make the choice to live a healthier lifestyle. Your future family is counting on you.
Stay tuned for more answers from Dr. Leslie Appiah. In the coming months she will continue to answer the following questions.
When are menstrual cramps not just menstrual cramps?
How early and how often should I be seen by my gynecology provider?