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Menopause and HRT Conditions Requiring Immediate Medical Attention There are conditions that mimic menopausal symptoms but are manifestations of different disorder.  If you experience any one of the following, consult your doctor or go to the emergency room if advised. See or Call Your Doctor If: If you have extreme pain during intercourse If you have pain or burning when urinating - Thick, white, or colored vaginal discharge If you have fever and/or chills If you have heavy bleeding with your periods or you pass many small clots or large ones which can leave you pale and very tired. If you have begun menstrual periods again after going without one for 6 months. If your hot flashes are severe, frequent, or persistent enough that they seriously disrupt your sleep, work, or daily activities. If you experience long-term heavy bleeding, or any bleeding one year after your period stops. This could be a sign of uterine cancer. If you have the following risk factors for osteoporosis or you suspect osteoporosis: Family history of osteoporosis Small bone frame Thin Fair skin (Caucasian or Asian race) Had surgery to remove ovaries before normal menopause or menopause before 48 years of age Lack of calcium in diet Lack of weight-bearing exercise Alcohol abuse Hyperthyroidism Use of steroid medicine If you are taking hormone replacement therapy (HRT) and you have any of the following? Side effects Return of menopausal symptoms

All women should have regular pelvic exams-as often as once a year if they are sexually active-so that any abnormalities can be detected and treated early. Here are some menstrual irregularities that may require medical assistance. Tell your doctor about theses and other menstrual irregularities. (We cover all menstrual irregularities; not just from menopause.)

You have missed menstrual periods or unusually heavy, painful periods; cramps, pain, or sense of pressure in lower abdomen; vaginal spotting or bleeding. This might be ectopic pregnancy ( pregnancy outside uterus, usually in Fallopian tube). Call doctor for immediate appointment. If bleeding or abdominal pain is severe call 911 or go to emergency room immediately.

You have unusually heavy or painful periods, especially toward the end; pain in lower abdomen, vagina, or lower back that may begin just before period and worsen just after; pain during intercourse; blood in urine or stool while menstruating; nausea and vomiting just before period begins. This could be endometriosis (disorder in which tissue that normally lines uterus appears outside uterus and becomes attached to other reproductive or abdominal organs) . If you are experiencing symptoms for the first time or if pain is severe, call doctor for immediate appointment.

You have unusually heavy, irregular, or missed menstrual periods; pain in lower abdomen or back; foul-smelling vaginal discharge; pain during intercourse; fever and sometimes chills. You may have pelvic inflammatory disease (infection of reproductive organs, often caused by sexually transmitted diseases). Call doctor for immediate appointment.

Compared to your usual pattern, you experience changes in heaviness of flow, length of periods, or time between periods; aches or pain in abdomen; sensation of fullness, swelling, or pressure in abdomen; frequent urination.

You may have

	Noncancerous ovarian cyst
	Noncancerous ovarian tumor
	Ovarian cancer.

Call your doctor for immediate appointment. It's important to diagnose condition as soon as possible.

You may have early pregnancy and miscarriage. If you think you may be pregnant and you are bleeding, call doctor for advice and appointment.

You have unusually heavy or painful menstrual period that begins a week or more late.

This is common. It may, however, signal a problem. Call your doctor for advice.

You have bleeding or spotting during pregnancy.

This is quite normal. If, however, you have more than two heavy periods after giving birth, call doctor for advice.

You experience unusually heavy menstrual period soon after childbirth.

You may have amenorrhea (absence of menstruation), which can be caused by emotional distress, hormone imbalance, dieting or eating disorders (see anorexia and bulimia), or strenuous athletic training. This also could be because of:

You have no menstrual period for several months.

	Pregnancy
	Breast-feeding.
	Menopause.
	Abnormality of reproductive organs.
	Use of certain drugs.
	Discontinuing use of birth control pills.

Call doctor for advice and appointment. Note: If a girl is over 16 and has never had a menstrual period, schedule appointment with doctor.

This may be a sign of uterine fibroid tumors.  Sometimes tumor becomes misted, cutting off its blood supply and causing severe pain. Call your doctor for advice and appointment. Write down dates you are bleeding and how many pads or tampons you use each day.

You have unusually heavy periods; bleeding between periods; pain or discomfort in lower back or abdomen; frequent urination; constipation; possibly sudden, sharp pain in lower abdomen.

This is a common side effect of IUDs. It is from the hormonal changes caused by going off the Pill. Call doctor for advice about your birth control method.

You experience unusually heavy or painful menstrual periods while using IUD or after you stop taking birth control pills.

Probably no underlying disorder, but heavy bleeding can result in anemia. If bleeding is extremely heavy (you use more than one pad or tampon in an hour), call doctor for advice.

You experience menstrual flow that is always heavy; periods that last more than seven days; large clots of blood.

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