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MERCK MANUAL
Consumer Version
HEALTH TOPICS
HEALTHY LIVING
SYMPTOMS
EMERGENCIES
DRUG INFO
RESOURCES
COMMENTARY
ABOUT US
HEALTH TOPICS
HEALTHY LIVING
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Health Topics
Women's Health
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Biology of the Female Reproductive System
Overview of the Female Reproductive System
Female External Genital Organs
Female Internal Genital Organs
Vagina
Uterus and cervix
Fallopian tubes
Ovaries
Puberty in Girls
Menstrual Cycle
Follicular phase
Ovulatory phase
Luteal phase
Effects of Aging on the Female Reproductive System
Symptoms of Gynecologic Disorders
Vaginal Bleeding
Causes
Common causes
Less common causes
Evaluation
Warning signs
When to see a doctor
What the doctor does
Testing
Treatment
Essentials for Older Women
Key Points
Pelvic Pain in Women
Causes
Gynecologic disorders
Nongynecologic disorders
Evaluation
Warning signs
When to see a doctor
What the doctor does
Testing
Treatment
Essentials for Older Women
Evaluation
Key Points
Vaginal Itching or Vaginal Discharge
Abnormal discharge
Causes
Infections
Other causes
Evaluation
Warning signs
When to see a doctor
What the doctor does
Treatment
General measures
Medications
Essentials for Older Women
Key Points
Female Pelvic Mass
Evaluation
Treatment
Key Points
Female Pelvic Mass in Children
Evaluation
History
Physical examination
Testing
Treatment
Key Points
Vaginal Bleeding in Infants and Children
Causes
Evaluation
Warning signs
When to see a doctor
What the doctor does
Testing
Treatment
Key Points
Vaginal Itching or Discharge in Children
Causes
Evaluation
Warning signs
When to see a doctor
What the doctor does
Treatment
Key Points
Diagnosis of Gynecologic Disorders
Obstetric and Gynecologic History
Gynecologic Tests and Procedures
Pregnancy Testing
Other Laboratory Tests
Testing for Gynecologic Infections
Testing for vaginitis
Testing for sexually transmitted infections
Cervical Cancer Testing
Screening for cervical cancer
Cervical diagnostic and treatment procedures
Colposcopy
Endocervical curettage
Loop electrical excision procedure
Gynecologic Biopsies
Cervix or vagina
Vulva
Uterus
Gynecologic Imaging Studies
Ultrasonography
Magnetic resonance imaging (MRI) or computed tomography (CT) scan
Saline sonography
Hysterosalpingography
Diagnostic Procedures
Dilation and curettage
Hysteroscopy
Laparoscopy
Well-Woman Visits
More Information
Pelvic Examination
Rectovaginal examination
Endometriosis
Vulvar Endometriomas
Symptoms
Diagnosis
Treatment
Endometriosis
Causes
Symptoms
Diagnosis
Treatment
Medications used to treat endometriosis
Endometriosis surgery
Family Planning
Overview of Contraception
More Information
Permanent Contraception
Vasectomy
Tubal Sterilization (Tubal Ligation)
Permanent contraception by laparoscopy
Minilaparotomy
Permanent contraception by hysteroscopy
Possible problems
Abortion
Methods
Procedural abortion
Medication abortion
Complications
Hormonal Methods of Contraception
Oral Contraceptives
Starting oral contraceptives
Advantages
Disadvantages
Conditions that prohibit the use of estrogen-progestin oral contraceptives
Other considerations
Contraceptive Skin Patches and Vaginal Rings
Skin patches
Vaginal rings
Side effects
Contraceptive Implants
Contraceptive Injections
Side effects
Benefits
Barrier Contraceptives
Condoms
Diaphragm
Cervical Cap
Contraceptive Gel
Contraceptive Sponge
Spermicides
More Information
Intrauterine Devices (IUDs)
Possible problems
Possible benefits
Fertility Awareness-Based Methods of Contraception
Calendar method
Mucus method
Symptothermal method
Lactational amenorrhea method
Emergency Contraception
Fibroids
Uterine Fibroids
Symptoms
Diagnosis
Treatment
Medications to treat fibroids
Procedures to treat fibroids
Surgery for fibroids
Choice of treatment for fibroids
Cervical Fibroids
Symptoms
Diagnosis
Treatment
Fibroids in Pregnancy
Infertility and Recurrent Miscarriage
Infertility Problems With Cervical Mucus
Diagnosis
Treatment
Problems With Sperm
Causes
Diagnosis
Semen analysis
Biopsy
Other tests
Treatment
Clomiphene
Assisted reproductive technologies and other procedures
Infertility Problems With Ovulation
Causes
Diagnosis
Treatment
Letrozole
Clomiphene
Metformin
Human gonadotropins
Other medications
Infertility Problems With the Fallopian Tubes and Abnormalities in the Pelvis
Causes
Diagnosis
Sonohysterography (saline infusion sonography)
Hysterosalpingography
Hysteroscopy
Laparoscopy
Treatment
Infertility Problems With Eggs
Diagnosis
Treatment
Unexplained Infertility
Treatment
Prognosis
Overview of Infertility
Causes
Diagnosis
Treatment
More Information
Assisted Reproductive Technologies (ARTs)
Intrauterine insemination
In vitro (test tube) fertilization (IVF)
Additional options related to ARTs
Intracytoplasmic sperm injection
Egg or sperm donation
Gestational carrier
Recurrent Miscarriage
Causes
Diagnosis
Treatment
Menopause
Menopause
Symptoms
Perimenopause symptoms
Symptoms after menopause
Diagnosis
Treatment
General measures
Nonhormonal medications
Herbal or dietary supplements
Hormone Therapy for Menopause
Estrogens with or without a progestogen: Potential benefits and risks
Progestogens: Benefits and risks
Side effects
Forms of hormonal therapy
Selective estrogen receptor modulators (SERMs)
Dehydroepiandrosterone (DHEA)
Menstrual Disorders and Abnormal Uterine Bleeding
Premenstrual Syndrome (PMS)
Causes
Symptoms
Diagnosis
Premenstrual dysphoric disorder
Treatment
General measures
Medications
Surgery
Pelvic Venous Disorders
Symptoms
Diagnosis
Treatment
Premature Menopause
Causes
Symptoms
Diagnosis
Treatment
Overview of Menstrual Cycle Problems
Menstrual Cramps
Causes
Common causes
Less common causes
Evaluation
Warning signs
When to see a doctor
What the doctor does
Testing
Treatment
General measures
Medications
Other treatments
Key Points
Absence of Menstrual Periods
Types of amenorrhea
Hormones and menstruation
Causes
Primary amenorrhea
Secondary amenorrhea
Evaluation
Warning signs
When to see a doctor
What the doctor does
Testing
Treatment
Key Points
Abnormal Uterine Bleeding (AUB)
Causes
Symptoms
Diagnosis
Tests to check for possible causes of abnormal uterine bleeding
Imaging tests and procedures
Treatment
Medications
Procedures
Management of acute uterine bleeding
Polycystic Ovary Syndrome (PCOS)
Causes
Symptoms
Diagnosis
Treatment
General measures
Medications
Treatment of excess body hair
Treatment of acne
Miscellaneous Gynecologic Abnormalities
Bartholin Gland Cyst and Bartholin Gland Abscess
Symptoms
Diagnosis
Treatment
Treatment of abscesses
Vulvar Inclusion and Epidermal Cysts
Diagnosis
Treatment
Skene Gland Cyst
Symptoms
Diagnosis
Treatment
Uterine Adenomyosis
Symptoms
Diagnosis
Treatment
Introduction to Miscellaneous Gynecologic Abnormalities
Adnexal Torsion
Symptoms
Diagnosis
Treatment
Cervical Stenosis
Symptoms
Diagnosis
Treatment
Ovarian Cysts and Other Benign Ovarian Masses
Functional ovarian cysts
Benign ovarian tumors
Symptoms
Diagnosis
Treatment
Ovarian cysts
Ovarian tumors
Cervical Polyps
Symptoms
Diagnosis
Treatment
Pelvic Organ Prolapse (POP)
Pelvic Organ Prolapse (POP)
Types and Symptoms
Cystocele and cystourethrocele
Rectocele
Enterocele
Prolapse of the uterus
Prolapse of the vagina
Diagnosis
Treatment
Exercises
Pessaries
Surgery
Sexual Function and Dysfunction in Women
Sexual Dysfunction During Pregnancy and Postpartum
Overview of Sexual Function and Dysfunction in Women
Normal Sexual Function
Desire (libido)
Arousal
Orgasm
Resolution
Causes
Psychological factors
Physical factors
Diagnosis
Treatment
Medications
Psychological therapies
Other treatments
Genito-Pelvic Pain/Penetration Disorder
Causes
Vulvar pain
Vaginal pain
Deep abdominal pain
Symptoms
Diagnosis
Treatment
General measures
Pelvic floor physical therapy
Psychological therapies
Specific therapies
Sexual Interest/Arousal Disorder
Causes
Diagnosis
Treatment
Treatment of contributing factors
Testosterone therapy
Other therapies
Orgasmic Disorder in Women
Causes
Symptoms
Diagnosis
Treatment
Persistent Genital Arousal Disorder
Treatment
Vaginitis, Cervicitis, and Pelvic Inflammatory Disease
Pelvic Inflammatory Disease (PID)
Causes
Symptoms
Complications
Diagnosis
Treatment
Prevention
Overview of Vaginitis (Vaginal Infection or Inflammation)
Causes
Children
Women of childbearing age
Postmenopausal women
Women of all ages
Symptoms
Diagnosis
Medical history
Physical examination and testing
Evaluation of children
Treatment
Prevention
Bacterial Vaginosis (BV)
Causes
Symptoms
Diagnosis
Treatment
Trichomonal Vaginitis
Causes
Symptoms
Diagnosis
Treatment
Prevention
Vaginal Yeast Infection (Candidiasis)
Causes
Symptoms
Diagnosis
Treatment
Prevention
Cervicitis
Causes
Symptoms
Diagnosis
Treatment
Symptoms During Pregnancy
Pelvic Pain During Early Pregnancy
Causes
Risk factors
Evaluation
Warning signs
When to see a doctor
What the doctor does
Testing
Treatment
Pain due to normal changes during pregnancy
Key Points
Vaginal Bleeding During Early Pregnancy
Causes
Risk factors
Evaluation
Warning signs
When to see a doctor
What the doctor does
Testing
Treatment
Key Points
Nausea and Vomiting During Early Pregnancy
Causes
Pregnancy-related causes
Other causes
Evaluation
Warning signs
When to see a doctor
What the doctor does
Testing
Treatment
Key Points
Swelling During Late Pregnancy
Causes
Common causes
Less common causes
Risk factors
Evaluation
Warning signs
When to see a doctor
What the doctor does
Testing
Treatment
Key Points
Vaginal Bleeding During Late Pregnancy
Causes
Risk factors
Evaluation
Warning signs
When to see a doctor
What the doctor does
Testing
Treatment
Key Points
Introduction to Symptoms During Pregnancy
Common pregnancy symptoms
Symptoms that may raise concern about the pregnancy
Symptoms that may raise concern about other disorders
Complications of Labor and Delivery
Introduction to Complications of Labor and Delivery
Timing of Labor and Delivery
Fetal Distress
Fetal Presentation, Position, and Lie (Including Breech Presentation)
Variations in Fetal Position and Presentation
Occiput posterior position
Breech presentation
Other presentations
Umbilical Cord Prolapse
Overt prolapse
Occult prolapse
Amniotic Fluid Embolism
Risk factors
Symptoms
Diagnosis
Treatment
Excessive Uterine Bleeding at Delivery
Causes
Diagnosis
Treatment
Prevention
Uterine Inversion
Placenta Accreta
Risk factors
Diagnosis
Treatment
Uterine Rupture
Shoulder Dystocia
Intraamniotic Infection
Risk factors for intraamniotic infection
Complications of intraamniotic infection
Symptoms
Diagnosis
Treatment
Prevention
Complications of Pregnancy
Overview of High-Risk Pregnancy
Maternal Mortality and Perinatal Mortality
Maternal mortality
Perinatal mortality
Risk Factors for Pregnancy Complications
Physical Characteristics
Age
Weight
Reproductive organ abnormalities
Problems in a Previous Pregnancy
Disorders Present Before Pregnancy
Disorders During Pregnancy
Multiple Gestation
Exposures During Pregnancy
Mercury in seafood
More Information
Problems With Amniotic Fluid
Too much amniotic fluid
Too little amniotic fluid
Symptoms
Diagnosis
Treatment
Cervical Insufficiency
Causes
Symptoms
Diagnosis
Treatment
Hyperemesis Gravidarum
Symptoms
Diagnosis
Treatment
Stillbirth
Causes
Diagnosis
Treatment
Placenta Previa
Symptoms
Diagnosis
Treatment
Preeclampsia and Eclampsia
Causes
Symptoms
Diagnosis
Treatment
Preeclampsia that does not cause severe symptoms
Severe preeclampsia and eclampsia
After delivery
Hemolytic Disease of the Fetus and Newborn
Diagnosis
Treatment
Prevention
Prelabor Rupture of Membranes (PROM)
Diagnosis
Treatment
If labor needs to be delayed
Preterm Labor
Diagnosis
Treatment
Pemphigoid Gestationis
Symptoms
Diagnosis
Treatment
Placental Abruption (Abruptio Placentae)
Risk factors
Symptoms
Diagnosis
Treatment
Polymorphic Eruption of Pregnancy
Vasa Previa
Symptoms
Diagnosis
Treatment
Detection of Genetic Disorders Before and During Pregnancy
Genetic Counseling and Genetic Testing Before Pregnancy
Types of and Risk Factors for Genetic Disorders
Chromosomal abnormalities
Single-gene disorders
Neural tube defects
Abnormalities due to several factors
Family History Assessment
Genetic Carrier Screening
Abnormal Results of Genetic Carrier Testing
More Information
Prenatal Testing for Genetic Disorders and Birth Defects
Noninvasive Prenatal Tests for Genetic Abnormalities
Cell-Free DNA Screening Test
Serum Marker Screening Test
Testing for Neural Tube Defects
Ultrasonography
Invasive Tests for Prenatal Diagnosis
Amniocentesis
Chorionic Villus Sampling
Percutaneous Umbilical Blood Sampling
Preimplantation Genetic Testing
More Information
Early Pregnancy Disorders
Septic Abortion
Symptoms
Diagnosis
Treatment
Ectopic Pregnancy
Symptoms
Diagnosis
Treatment
Miscarriage
Causes
Symptoms
Diagnosis
Treatment
Emotions after miscarriage
Medication and Substance Use During Pregnancy
Medication and Substance Use During Breastfeeding
Medications That Are Relatively Safe During Breastfeeding
Medications That Require a Doctor’s Supervision During Breastfeeding
Medications and Substances That Should Not Be Taken While Breastfeeding
Safety of Medications During Pregnancy
Vaccines During Pregnancy
Medications Used to Treat Heart and Blood Vessel Disorders During Pregnancy
Antidepressants During Pregnancy
Antiviral Medications During Pregnancy
Medications Used During Labor and Delivery
Substance Use During Pregnancy
Caffeine
Aspartame
Smoking (Tobacco)
Alcohol
Amphetamines
Bath Salts (Synthetic Stimulants)
Cocaine
Hallucinogens
Cannabis
Opioids
Labor and Delivery
Vaginal Birth
Birth of the baby
Delivery of the placenta
After birth
Overview of Labor and Delivery
Labor
Start of labor
Admission to a hospital or birthing center
Induction of Labor
More Information
Operative Vaginal Delivery
Cesarean Delivery
More Information
Fetal Heart Rate Monitoring During Labor and Delivery
Types of Fetal Heart Monitoring
Pain Relief for Labor and Delivery
Natural childbirth
Labor That Progresses Too Slowly
Normal Pregnancy
Pregnancy Test and Due Date
Home pregnancy tests
Laboratory pregnancy tests
Due date
Stages of Fetal Development
Fertilization
Development of the Blastocyst
Development of the Embryo and Placenta
Development of the Fetus
Physical Changes During Pregnancy
General health
Reproductive tract
Breasts
Heart and blood flow
Urinary tract
Respiratory tract
Digestive tract
Skin
Hormones
Joints and muscles
Medical Care During Pregnancy
First prenatal visit
Ongoing prenatal visits
Ultrasound
Immunizations
Self-Care During Pregnancy
Diet and supplements
Weight gain
Physical activity
Sexual activity
Medications, substance use, and toxic exposures
Preparing for breastfeeding
Travel during pregnancy
Preventive care
Anemia During Pregnancy
Symptoms
Diagnosis
Treatment
Anemia Due to Iron or Folate Deficiency
Sickle Cell Disease
Infections During Pregnancy
Treatment.
Blood Clot Disorders During Pregnancy
Diagnosis
Treatment
Urinary Tract Infections During Pregnancy
Late-Term and Postterm Pregnancy
Multiple Pregnancy
Risks
Diagnosis
Management
Postpartum Care
Overview of Postpartum Care
Care During the First 2 Days After Childbirth
Vaginal bleeding
Pain or swelling of the vagina, vulva, and perineum
Urination
Bowel movements
Diet and activity
Showering and bathing
Medications
Immunizations
Rh-negative blood type
Before discharge from the hospital or birthing center
Care During the First 6 Weeks After Childbirth
Vaginal bleeding and discharge
Care of the vulva, vagina, and perineum
Care of a cesarean incision
Changes in other parts of the body
Mood
Weight
Exercise
Sexual activity and family planning (birth control, or contraception)
Breastfeeding
Initiating breastfeeding
Breast care
Diet during breastfeeding
Breast engorgement
Infections After Childbirth
Postpartum Depression
Causes
Symptoms
Diagnosis
Treatment
Infections of the Uterus After Delivery
Causes
Symptoms
Diagnosis
Treatment
Bladder and Kidney Infections After Childbirth
Symptoms
Diagnosis
Treatment
Mastitis
Treatment
Pregnancy Complicated by Disease
COVID-19 During Pregnancy
Symptoms
Diagnosis
Treatment
Prevention
COVID-19 Vaccine
Breastfeeding
More Information
Overview of Disease During Pregnancy
Asthma During Pregnancy
Treatment
Autoimmune Disorders During Pregnancy
Antiphospholipid Syndrome
Immune Thrombocytopenia (ITP)
Treatment
Myasthenia Gravis
Rheumatoid Arthritis
Systemic Lupus Erythematosus (Lupus)
Cancer During Pregnancy
Rectal cancer
Cervical cancer
Other gynecologic cancers
Breast cancer
Leukemia and Hodgkin lymphoma
Diabetes During Pregnancy
Gestational diabetes
Risks
Diagnosis
Treatment
Controlling blood sugar levels
Monitoring the fetus
Labor and delivery
After delivery
Heart Disease During Pregnancy
Peripartum cardiomyopathy
Heart valve disorders
Treatment
High Blood Pressure During Pregnancy
Diagnosis
Treatment
Antihypertensive medications
Kidney Disorders During Pregnancy
Liver and Gallbladder Disorders During Pregnancy
Cholestasis of pregnancy
Cirrhosis
Fatty liver of pregnancy
Gallstones
Hepatitis
Seizure Disorders During Pregnancy
Disorders That Require Surgery During Pregnancy
Appendicitis
Gallbladder disease
Ovarian cyst
Obstruction of the intestine
Thyroid Disorders During Pregnancy
Graves disease
Hypothyroidism
Hashimoto thyroiditis
Subacute thyroiditis
Postdelivery thyroid disorders
