Sexual and Reproductive Health

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How does a woman’s reproductive system work?

Emergency contraception

Emergency contraception can stop you getting pregnant after sex or sexual abuse where protection has not been used or has failed. You need to use emergency contraception as soon as possible afterwards to be the most effective and always before 5 days.

There are two types of emergency contraception. There is the emergency contraceptive pill (sometimes called the morning after pill) or an IUD (intrauterine device, sometimes called the copper coil). You can get either of these free from most sexual health clinics and GP surgeries. You can get just the emergency pill from some NHS walk in centres and pharmacies (some pharmacies do charge for this). Some pharmacies also sell the emergency contraceptive pill online.

Find your nearest emergency contraception here.

An IUD can be fitted within 5 days. It is a plastic T shaped device that a specially trained nurse or doctor can put into your womb. You’ll need for make an appointment for this and it can be done at a sexual health clinic or GP surgery. These can act as long term contraception, some lasting 5-10 years after which time it will need to be removed. More information can be found here.

There are two main types of emergency pill that may be used depending on how quickly you go to get it. Levonorgestrel needs to be taken within 72 hours and ulipristal acetate, within 5 day. More information can be found here.

Contraception

There are lots of options for contraceptives and it is worth being aware of all of the side effects before deciding on any. There are hormonal or non hormonal methods of preventing pregnancy. If you are using the withdrawal method as a form of contraception, it still has a 20% failure rate due to any fluid potentially containing sperm. Cycle planning or natural planning also has a failure rate of between 5 and 24%.

Hormonal contraception:

Progestogen and oestrogen are used in 3 methods of contraception: the combined pill, contraceptive patch and vaginal ring. Some methods are progestogen only: progestogen only pull (mini pill), IUS (hormone coil), contraceptive implant and the contraceptive injection. Side effects of hormonal contraceptives can include headaches, feeling sick, mood swings, weight gain, sore breasts and acne. These may get better within 3 months, some may not get them at all. If side effects are bothering you, contact the GP surgery or sexual health clinic. These kind of contraceptives may affect your period. They also raise the risk of blood clots and breast cancer which means they aren’t suitable for everyone.

Find out more

Non hormonal contraception:

The non hormonal methods are condoms (which also prevent some sexually transmitted infections), IUD, diaphragm and cap. Side effects of these depends on the type. With a diaphragm or cap, it may increase the chances to get a urine infection (UTI) or the spermicide you use may cause irritation. An IUD can cause pain in your tummy or back for a few days after it’s fitted and periods may be heavier or more painful for a few months. There are additional risks with having an IUD such as infections after fitting, risk of failure and ectopic pregnancy and a risk that your IUD can move or come out. Always get help from 111 when the pain increases suddenly, you can’t feel the threads for the IUD, you have a high temperature or you have abnormal discharge.

Find out more:

How does a woman’s reproductive system work?

A woman’s menstrual cycle is the monthly hormonal cycle a woman’s body goes through. It is measured from the first day of a woman’s period to the day before her next period starts. The length varies from woman to woman, the average lasts 28 days but regular, normal cycles can still be anywhere between 21 and 35 days. Girls can start their periods anywhere from 8 upwards and they stop when menopause happens. Menopause can generally start at any age between 45 and 55 but may also happen sooner which is called premature menopause.

In each cycle, rising levels of the hormone oestrogen cause the ovary to develop and release an egg. This is called ovulation which roughly occurs on day 14 in a 28 day cycle. The womb lining also starts to thicken and the hormone progesterone helps the womb to prepare for implantation of any potential embryo. The egg travels down the fallopian tubes and if pregnancy does not occur, the egg is reabsorbed back into the body. If this happens, the levels of the hormones fall, the womb lining comes away and leaves the body as a period. Most people bleed for anywhere between 3 and 7 days.

If an egg gets fertilised by sperm and implants itself to the uterine wall, you become pregnant. You are most fertile and more likely to get pregnant around the time of ovulation. It should also be noted that using the withdrawal method as a form of contraception has a 20% failure rate and cycle planning has a failure rate of between 5 and 24%.

Unusual periods

These is also called irregular menstruation. Signs your period may be irregular include:

Periods occurring less than 21 days or 35 days apart
Bleeding through a tampon or pad every 1-2 hours
Passing blood clots larger than 10
Periods last longer than 7 days
Bleeding through to clothes or bedding
Blood that is much heavier or lighter than usual
Bleeding or spotting in between periods
Pain causing you to avoid daily activities
Feeling tired and short of breath often

It is important you see your GP if heavy periods are affecting your life, you have heavy periods, you’ve had severe pain during your periods, you are bleeding between periods or after sex or if going for a wee or poo or having sex is painful. Heavy periods could be caused by certain medications but may be signs of something more going on. Conditions may include polycystic ovary syndrome, fibroids, endometriosis, adenomyosis and pelvic inflammatory disease. In rare circumstances it may be a sign of womb cancer but may also be the signs of a thyroid condition or bleeding condition like Von Willebrand disease.

Struggling to get pregnant

If you are having regular sex every 2-3 days without contraception around the time you are ovulating every month and you are not pregnant within a year, it may be time to visit the GP. You may also want to speak to the GP if you are on medications or are aged over 36.

Menopause

Menopause affects anyone who has a period. Periods stop due to lower hormone levels, usually between the ages of 45 and 55, but it can happen earlier. If it happens to someone who is below 40, it is called premature menopause. Menopause may happen naturally, due to surgeries such as those that remove ovaries or the uterus, cancer treatments or genetics. Perimenopause is where symptoms of the menopause have started but you still have a period. Perimenopause ends and you reach menopause when you have not had a period for 12 months. Symptoms may last for months or years.

Menopause and perimenopause symptoms can have a big impact on your daily life, including relationships, social life, family life and work. It can feel different for everyone. You may have a number of symptoms or none. Symptoms usually start months or years before your periods stop. This is called the perimenopause.

Signs of the menopause:

changes to your period
Low mood, anxiety, mood swings, low self esteem or problems with memory/ concentration
Hot flushes (sudden feelings of hot or cold in face, neck and chest which can make you dizzy)
Difficulty sleeping which can be caused by night sweats
Palpitations
Headaches and migraines
Muscles aches and joint pain
Changed body shape and weight gain
Skin changes including itchy and dry skin
Reduced sex drive
Vaginal dryness, pain, itching or discomfort during sex
Recurrent urine infections (UTIs)
Sensitive teeth, painful gums or mouth problems

If you need treatment for symptoms, the main treatment is HRT or hormone replacement therapy but there are other treatments too. It works by replacing hormones that are at low levels. HRT can be skin patches, gel or spray, implants or tablets. You may also need to take progesterone to protect your womb (if you have one) from the effects of this treatment through patches, IUS (coil) or tablets. You may also be offered testosterone for a low sex drive or anti depressants and Cognitive Behaviour Therapy can be prescribed to help with mood symptoms. Other medications can be prescribed to help with hot flushes and night sweats.

Many local areas have menopause support groups.

Abortion

An abortion or termination, is a way of ending a pregnancy. Abortions are usually free and can only be carried out under the care of an NHS hospital or legal clinic. They may be done via medicine or surgery depending on the stage of pregnancy and any health issues. Some people are eligible to have an at home abortion by taking medicine sent to you in the post by a doctor. The decision to have an abortion is yours alone.

Some organisations, usually called crisis pregnancy centres, also offer pregnancy counselling, but they will not refer you for an abortion and may not offer you balanced or accurate advice.

You can ask for an abortion from: your GP, a local sexual health clinic, an abortion provider directly such as BPAS, MSI or NUPAS or find more locations on the NHS website.

At a face to face appointment, you may have an STI test, blood test and ultrasound scan. You will be told about your abortion options, told about risks and given the option to speak to a counsellor if you wish.

For a phone appointment, you’ll speak to a nurse or midwife about your health and situation and be given abortion options based on what is suitable. If they need to confirm your stage of pregnancy you may need to go and have an ultrasound scan. If you are less than 10 weeks pregnant you may be able to have a medical abortion at home.

After the first appointment you'll either be sent abortion medicine to take at home, or you'll have another appointment at a hospital or clinic to have the abortion. The abortion usually happens within 1 week of your first appointment. You can change your mind any time until the start of the abortion.

When you have a medical abortion, a doctor prescribes 2 medicines called mifepristone and misoprostol. You take 1 mifepristone tablet then wait 1-2 days and take the misoprostol tablet (which may be dissolved in your mouth or inserted into your vagina). Around 4-6 hours after the second medication, the pregnancy should begin to come out through the vagina. If it does not come out completely, you will need to speak to a doctor or nurse to have more medication. You should never buy these tablets online not only is it unsafe, but it is also against the law to do so.

For a surgical abortion, which is usually done after 10 weeks of pregnancy, there are two types. Firstly using suction to remove the pregnancy through the vagina. This takes around 5-10 minutes and can be done between 7-14 weeks of pregnancy. The second option is forceps to remove the pregnancy through the vagina from week 15 and takes 10-20 minutes. You may have local anaesthetic to numb the area, a general anaesthetic to make you sleep or sedation medication to keep you relaxed. You usually can go home the same day but may need someone to drive you home and stay with you for 24 hours.

Medication may give you diarrhoea and make you feel sick but should go within a day. With all forms of abortion you’ll usually get tummy cramps and pain for a few days and vaginal bleeding which can last several weeks.

Contact your GP or 111 if you have pain or bleeding that does not get better after a few days, you’re still pregnant after a week, have any signs of infection such as high temperature, flu like feelings or unusual vaginal discharge or if you have any other concerns. Always call 999 in an emergency or if you are bleeding heavily. Do not drive yourself to hospital, call 999 or ask someone else to drive you.

Complications can include part of the pregnancy remaining and needing an operation to remove it, heavy bleeding, damage to the womb or infection, including sepsis.

There is no evidence that there are any links between abortion and infertility.

If you need support deciding contact Brook, BPAS, NUPAS or MSI Choices