May 27, 2025

Everything You Were Too Afraid to Ask, Women’s Health

Everything you were too afraid to ask

Women’s Health 101

Where everything is and what each part does, how the brain and the ovaries talk to each other, what happens across the cycle day by day, what counts as normal, plain answers to the questions people rarely ask out loud, and when to talk to a doctor

27 minute read · 5,998 words22 minute read · 4,839 words

Detailed explains the research and the reasons behind each point. Plain words gives the same main points in short, everyday language. Safety advice and emergency steps are the same in both.

A surprising number of adults were never properly taught how their own body works. Maybe you had one awkward lesson at school, a leaflet and a few half-answered questions at home, and after that it felt too late, or too embarrassing, to ask. So the questions stay with you: is this normal, is that supposed to happen, why does it hurt, what is that discharge, and where exactly is everything?

This article answers those questions plainly. It starts with where everything is and what each part does. Then it follows the conversation between your brain and your ovaries that runs the monthly cycle, and it ends with what counts as normal and when something is worth checking. Along the way, it answers the questions people tend to keep to themselves. If you’d like everything in plainer words, choose Plain words above.

It describes a body with ovaries and a uterus. Most of the research it draws on was done with women, so that’s the word it uses when describing studies, while recognizing that not everyone with this anatomy describes themselves that way. There’s nothing embarrassing about any of this. It’s how the body works, and knowing it makes it much easier to notice when something changes.

The short version

The vagina is only the canal inside, not everything you can see, and it cleans itself, so washing inside it upsets the bacteria that keep it healthy.
The vagina is only the canal inside. Everything you can see on the outside is the vulva. The vagina cleans itself, so washing inside it upsets the bacteria that keep it healthy.
The cycle is run by the brain and the ovaries passing hormones back and forth (like a ping pong ball), and when no pregnancy begins, those hormones fall and a period starts.
Your brain and your ovaries run your cycle by passing hormones back and forth (like a ping pong ball). If no pregnancy starts, those hormones drop and your period begins.
Ovulation often comes earlier or later than day 14, so the roughly six days each cycle when pregnancy can begin are hard to predict from the calendar alone.
Ovulation often comes earlier or later than day 14. So the six or so days each cycle when you can get pregnant are hard to predict from the calendar alone.
A normal cycle can be anywhere from 24 to 38 days long, and bleeding counts as heavy when it gets in the way of your life.
A normal cycle can be anywhere from 24 to 38 days long. Bleeding counts as heavy when it gets in the way of your life.
Most of the questions people keep to themselves have reassuring answers: a tampon cannot get lost inside you, and irregular cycles alone do not mean PMOS, the condition long called polycystic ovary syndrome.
Most of the questions people keep to themselves have reassuring answers. A tampon can’t get lost inside you, and irregular cycles alone don’t mean PMOS, the condition long called polycystic ovary syndrome (PCOS).
See a doctor about pain that stops your normal routine or bleeding that is unusual for you.
See a doctor about pain that stops your normal routine or bleeding that is unusual for you.

WHAT THIS ARTICLE COVERS · SIX PARTS

PART 1Where everything is4 sections · 3 min3 min

A short tour of the inside
The outside has its own name
It cleans itself
Fewer eggs than you might think, and more than you need

PART 2The messengers3 sections · 2 min2 min

The brain starts the conversation
Four hormones worth knowing
How the loop closes

PART 3The cycle, day by day4 sections · 2 min2 min

Day one is the first day of bleeding
The two halves are not equal
Discharge follows the hormones
The fertile window is about six days

PART 4What counts as normal6 sections · 7 min3 min

A normal cycle is a range, not a number
The first years have their own rules
How long, and how much
Pain is common, and it has a cause
Mood changes before a period
When irregular has a name

PART 5Everything you were too afraid to ask5 min6 min

PART 6When to talk to a doctor4 sections · 5 min5 min

Changes worth checking
When it cannot wait
Screening is not the same as symptoms
How to raise it

Part one of six

Where everything is

The organs inside and outside, and the parts people most often mix up

In plain words

Your reproductive organs sit low in your belly, behind your bladder and in front of your lower bowel. In the middle is the uterus, also called the womb. It’s a hollow organ made of muscle, about the size and shape of a small pear turned upside down. Its inner lining is called the endometrium. That’s the part that builds up and comes away each month.

On each side of the uterus is an ovary, about the size of an almond. The ovaries store your eggs and make two hormones, estrogen and progesterone. A fallopian tube leads out from each top corner of the uterus toward an ovary. Its soft, fringed end catches an egg when one is released. At the bottom of the uterus is the cervix, a narrow neck with a very small opening. Below that is the vagina, a stretchy canal that leads to the outside.

Lots of people call everything down there the vagina. The vagina is only the canal inside. Everything you can see on the outside is called the vulva. It has two sets of skin folds, the outer and inner labia, and the clitoris at the top, where the inner labia meet. Between the labia are two openings. The smaller one, the urethral opening, is where urine comes out. The larger one, the vaginal opening, is where period blood leaves. Further back is a third opening, the anus. So there are three openings in all, not one or two.

Choose any part in the figure below to see where it is and what it does.

A short tour of the inside

If you’ve never quite pictured what’s in there, start here. The reproductive organs sit low in your belly, behind the bladder and in front of the lower bowel. In the middle is the uterus, also called the womb. It’s a hollow, muscular organ, roughly the size and shape of a small pear turned upside down. Its inner lining, the endometrium, is the part that builds up and is shed each month.

On each side of the uterus is an ovary, about the size of an almond. The ovaries store eggs and make the hormones estrogen and progesterone. Two fallopian tubes lead out from the top corners of the uterus toward the ovaries, and they end in soft, fringed openings that catch an egg when it’s released.

At the lower end of the uterus is the cervix, a narrow neck with a very small opening. Below the cervix is the vagina, a stretchy, muscular canal that leads to the outside of the body.

The outside has its own name

Many people use the word vagina for everything down there. In fact the vagina is only the canal inside, and everything you can see on the outside is called the vulva.

The vulva includes the outer and inner labia, which are folds of skin that protect the openings, and the clitoris at the top, where the inner labia meet. Between the labia are two separate openings. The smaller one, the urethral opening, is where urine comes out. The larger one, the vaginal opening, is where period blood leaves the body. Further back, and separate again, is the anus.

So there are three openings in all, not one or two. If that’s news to you, it’s one of the most common gaps in what people were taught.

Where everything is

Choose a part to see what it is, what it does, and what people often get wrong about it

Choose a part

What it is

What it does

A common mix-up

Diagrams, not to scale, and simplified. Every body is a little different, and the outside in particular varies a great deal from person to person.

In plain words

You don’t need to clean inside the vagina, because it cleans itself. The discharge made by the vagina and the cervix above it carries away dead cells and keeps the vagina moist. Protective bacteria keep the inside slightly acidic, and that helps stop unwanted germs settling there.

That’s why doctors advise against washing inside, which is called douching. It washes away the protective bacteria that keep the vagina healthy. When that balance is upset, the result is called bacterial vaginosis. It’s one of the most common reasons for a change in discharge or smell.

The vulva is skin, and you can wash it. Wash the vulva with plain unperfumed soap and warm water, or with clear water alone if the skin is sore. Skip perfumed washes, sprays, deodorants and scented wipes, which are all advised against. If a smell is strong enough that you feel you need to cover it, see a doctor rather than buying a product.

Your eggs aren’t made during adult life. They’re all there before you’re born, each one resting in a tiny sac called a follicle. Each ovary holds the most it will ever have, about 300,000, before birth. One study estimated that by 30, almost all women have only about 12% of that left, and by 40 about 3%. That’s still several thousand in each ovary, and usually only one egg is released each cycle. The drop explains why fertility changes with age, and why the ovaries stop releasing eggs at menopause. Around the world that happens at about 49 on average, though it varies from region to region.

It cleans itself

If you’ve ever wondered how you’re supposed to clean inside, you don’t need to, because the vagina looks after itself. Its lining and the cervix above it make the discharge described later in this article, and that fluid carries away dead cells and keeps the tissue moist. The vagina also holds a population of bacteria, mostly lactobacilli, which keep the inside slightly acidic. That acidity is part of what stops less welcome organisms from settling there.

That’s why doctors advise against washing inside, which is called douching. It washes away the protective bacteria that keep the vagina healthy. Bacterial vaginosis, one of the most common reasons for a change in discharge or smell, is what happens when that balance is disturbed.

The outside, the vulva, is skin, and skin can be washed.

WHAT HELPS

Wash the vulva with plain unperfumed soap and warm water, or with clear water alone if the skin is sore.
Skip perfumed washes, sprays, deodorants and scented wipes, which are all advised against.
If a smell is strong enough that you feel you need to cover it, see a doctor rather than buying a product.

Fewer eggs than you might think, and more than you need

The eggs in your ovaries aren’t made during adult life. They’re all there before birth, each one resting inside a tiny sac of cells called a follicle. Each ovary holds its largest number of follicles, around 300,000, before birth. In a study that modeled the whole lifespan, almost all women had only about 12% of that peak left by the age of 30, and about 3% by 40.

If those percentages sound alarming, it helps to know that even 3% still means several thousand in each ovary, and in most cycles only one egg is released. What the decline does explain is why fertility changes with age, and why the ovaries eventually stop releasing eggs at menopause. Around the world that happens at about 49 on average, though it differs between regions.

Part two of six

The messengers

How the brain and the ovaries talk to each other every month

In plain words

Your monthly cycle begins in your brain. A small area called the hypothalamus sends a hormone to the pituitary gland just below it. The pituitary then sends two hormones into your blood, called FSH and LH for short.

Those two travel to your ovaries and tell them what to do. The ovaries answer by making estrogen and progesterone, which travel back to the brain and also to the uterus. The brain adjusts what it sends depending on what comes back. It’s a loop, and your cycle is that loop running for a month.

The brain starts the conversation

You might think the ovaries run the cycle on their own, but it begins in the brain, in a small region called the hypothalamus. That region sends a hormone to the pituitary gland just below it, and the pituitary then releases two hormones into the bloodstream: follicle-stimulating hormone, usually shortened to FSH, and luteinizing hormone, or LH.

Those two travel to the ovaries and tell them what to do. The ovaries answer by making estrogen and progesterone, which travel to the brain as well as to the uterus, and the brain adjusts what it sends according to what it hears. It’s a loop, and the cycle is what that loop looks like when it runs for a month.

In plain words

Each of the four hormones has its own job. FSH, short for follicle-stimulating hormone, makes the follicles, the tiny egg sacs, grow. Several start growing each cycle, and usually one gets ahead of the rest.

Estrogen comes mainly from that growing follicle. As it rises, it rebuilds the lining of the uterus and changes the mucus the cervix makes.

LH, short for luteinizing hormone, is the trigger. When estrogen has been high for long enough, the brain sends out a sudden burst of LH. About a day and a half after that burst begins, the follicle lets its egg go. This is ovulation. The ovulation tests sold in pharmacies work by picking up this burst in urine.

Progesterone comes after ovulation. The empty follicle turns into a small gland called the corpus luteum, and it makes progesterone. Progesterone gets the lining ready for a possible pregnancy.

If no pregnancy starts, the corpus luteum lasts about 12 days on average and then fades. Progesterone and estrogen drop. Without them, the lining can’t stay in place, so it comes away as your period. Chemicals called prostaglandins, made by the lining itself, help this happen, and they’re a big part of why periods can hurt.

When the hormones drop, the brain notices and sends more FSH, and a new group of follicles starts to grow. So one cycle ends as the next one begins.

Four hormones worth knowing

Follicle-stimulating hormoneFSH

Made by the pituitary gland

FSH does what its name says: it stimulates follicles to grow. At the start of each cycle several begin to develop, and usually one takes the lead.

Estrogen

Made mainly by the ovaries

Estrogen is made mainly by that growing follicle. As it rises, it rebuilds the lining of the uterus and changes the mucus made by the cervix.

Luteinizing hormoneLH

Made by the pituitary gland

LH is the trigger. When estrogen has been high for long enough, the brain responds with a sudden surge of LH, which begins roughly a day and a half before ovulation. That surge is what makes the follicle release its egg, and it’s what the ovulation tests sold in pharmacies pick up in urine.

Progesterone

Made by the ovaries, after ovulation

Progesterone comes afterward. Once the egg has been released, the empty follicle turns into a small gland called the corpus luteum, and that gland makes progesterone, which prepares the lining for a possible pregnancy.

How the loop closes

If no pregnancy begins, the corpus luteum lasts around 12 days on average and then fades. Progesterone and estrogen fall, and without them the lining of the uterus can’t be kept in place, so it’s shed as your period. Chemical messengers called prostaglandins, released by the lining itself, help this happen, and they’re also a big part of why periods can hurt.

As the hormones fall, the brain notices and starts sending more FSH, and a new group of follicles begins to grow. The first day of bleeding counts as day one of the next cycle, so the end of one cycle and the start of the next overlap.

Part three of six

The cycle, day by day

What happens in each phase, and what you might notice

In plain words

Each cycle is counted from the first day of one period to the first day of the next. Ovulation splits it into two halves. In the first half, a follicle grows and the lining builds back up. In the second half, the corpus luteum makes progesterone and the lining gets ready for a possible pregnancy.

Move through the cycle in the chart below to see what’s happening on each day.

Day one is the first day of bleeding

Every cycle is counted from the first day of one period to the first day of the next. It has two halves, split by ovulation. In the first half, a follicle grows and the lining rebuilds. In the second half, the corpus luteum makes progesterone and the lining prepares for a possible pregnancy.

The cycle, day by day

Four hormones across an example 28-day cycle, and what they do

Move through the cycleDay 1

In the body

What you might notice

An example, not a rule. Each curve is scaled to its own peak, so the chart shows timing and shape rather than amounts. Real cycles vary: very few are exactly 28 days, ovulation often happens earlier or later than day 14, and the second half of the cycle averages about 12 days rather than the 14 drawn here.This is only an example. Each line is drawn to its own highest point, so the chart shows when each hormone rises and falls, and not how much there is. Real cycles vary. Very few are exactly 28 days, ovulation often comes earlier or later than day 14, and the second half of the cycle is about 12 days on average, shorter than the 14 drawn here.

In plain words

The two halves aren’t equal. The first is usually the longer one, and it changes the most. In a very large study of cycles logged in a fertility app, the first half lasted about 17 days on average and the second about 12. Only 13% of cycles were exactly 28 days long. The app’s maker paid for that study, and app users aren’t a random sample, but earlier research points the same way. Ovulation often doesn’t happen on day 14. So if your cycle isn’t exactly 28 days long, you’re in the majority (the textbook cycle is the rare one)!

Discharge changes with your hormones too. Much of it is mucus made by the cervix. As estrogen rises before ovulation, there’s more of it, and around ovulation it often turns clear, slippery and stretchy. After ovulation, progesterone quite suddenly makes it thicker, and there’s less of it. Discharge that changes through the month is a sign of a cycle working as expected, not a sign that something is wrong. These changes describe what the body is doing, but on their own they aren’t a reliable way to avoid pregnancy.

You can only get pregnant on about six days of each cycle. These days are called the fertile window. They’re the five days before ovulation plus the day of ovulation, and the chance of pregnancy is highest in the last three of those days. When ovulation moves, the window moves with it. That’s why working out the fertile days from the calendar alone is unreliable.

The two halves are not equal

The first half of the cycle is usually the longer one, and it’s also the one that varies most. A very large study of cycles recorded in a fertility app found that the first half lasted about 17 days on average and the second half about 12. In the same study, only 13% of cycles were exactly 28 days long, and the researchers concluded that the common belief that ovulation happens consistently on day 14 isn’t correct.

That study was funded by the company that makes the app, and it used app users rather than a random sample, but earlier research points the same way. In a study that tracked hormones daily, only about 30% of women had their whole fertile window within days 10 to 17 of the cycle, the days usually described as the fertile ones. So if your cycle isn’t exactly 28 days long, you’re in the majority (the textbook cycle is the rare one)!

Discharge follows the hormones

If you’ve noticed your discharge changing through the month, that’s the cycle at work. Much of it comes from mucus made by the cervix, and it changes with your hormones. As estrogen rises before ovulation there’s more of it, and around ovulation it often becomes clear, slippery and stretchy. After ovulation, progesterone makes it thicker and scantier again, quite abruptly. In one long study, the slippery, fertile-type mucus lasted a little over six days in an average cycle.

Discharge that changes through the month is a sign of a cycle working as expected, not a sign that something is wrong. These changes describe what the body is doing, but on their own they aren’t a reliable way to avoid pregnancy.

The fertile window is about six days

Whether you’re hoping to get pregnant or not, these are the days that matter most. A pregnancy can only begin during a short stretch of each cycle. A well-known study of couples trying to conceive found that it only happened after sex during a six-day window that ended on the day of ovulation. The chance was lowest at the start of the window and highest in its last three days, up to and including the day of ovulation.

The window covers the five days before ovulation and the day itself, which is why it’s six days long rather than one. It’s also why working out the fertile days from the calendar alone is unreliable: the window moves when ovulation moves.

Part four of six

What counts as normal

Cycle length, bleeding and pain, and how much they vary

In plain words

A cycle doesn’t have to be 28 days. Doctors around the world use definitions from FIGO, the International Federation of Gynecology and Obstetrics. By those definitions, a normal cycle is anywhere from 24 to 38 days long.

US and UK guidance use a slightly tighter adult range of 21 to 35 days. So a cycle of 21 to 23 days, or 36 to 38, is normal by one definition and irregular by the other. If yours sits there, or is consistently much shorter or much longer than these, or has changed a great deal from what’s usual for you, mention it to a doctor.

Cycles can also vary a little from month to month. Try your own numbers in the figure below to see how much counts as regular at your age.

A normal cycle is a range, not a number

If your cycle isn’t a neat 28 days, that alone isn’t a sign that anything is wrong. Doctors around the world use a set of definitions from FIGO, the International Federation of Gynecology and Obstetrics, and by those definitions a normal cycle is anywhere from 24 to 38 days long, counted from the first day of one period to the first day of the next.

It’s also normal for cycles to vary a little from month to month. For adults aged 26 to 41, the shortest and longest cycles over six months count as regular if they’re within seven days of each other. For those aged 18 to 25, and 42 to 45, the allowance is nine days, because cycles are naturally less settled at those ages.

US and UK guidance, and the international guideline on polycystic ovaries, use a slightly tighter adult range of 21 to 35 days, so a cycle of 21 to 23 days, or 36 to 38, counts as normal by one definition and irregular by the other. If yours sits there, or is consistently much shorter or much longer than these, or has changed a great deal from what’s usual for you, mention it to a doctor.

Check your numbers

How your own cycle compares with the international definitions of normal

My cycle is usually

Difference between my shortest and longest cycle over six monthsGap between my shortest and longest cycle in the last six months

My period usually lasts

A guide, not a diagnosis. These are the FIGO definitions for adults, based on the previous six months and not during pregnancy. They are not defined for under-18s or over-45s, and cycles are naturally less regular in the first years after periods start and in the years before menopause. Nothing you set here is saved or sent.This is a guide, and it can’t diagnose anything. It uses FIGO’s definitions for adults, based on your last six months, and they don’t apply during pregnancy. They don’t cover anyone under 18 or over 45. Cycles are naturally less regular in the first years after periods start and in the years before menopause. Nothing you set here is saved or sent.

In plain words

Periods usually start between 10 and 15. In the first years they often come whenever they like, because the brain and ovaries are still learning the loop, and that’s usually normal. By the third year after the first period, most cycles have settled into the adult pattern of 21 to 34 days.

One line doesn’t stretch, though. More than 90 days between periods, even once, is worth having checked, at any age. So is a first period that hasn’t arrived by 15, or by three years after the breasts began to develop.

A period lasting up to eight days counts as normal by FIGO’s definitions, and UK and US guidance draw the line at seven. Bleeding counts as heavy when it gets in the way of your physical, social or emotional life. If you’re changing protection during the night, planning your day around it or worrying about leaks, that counts.

Period pain is very common. It’s caused mainly by prostaglandins, the chemicals from part two, which make the muscle of the uterus squeeze hard. Anti-inflammatory painkillers such as ibuprofen often help, because they reduce how much prostaglandin is made, but check with a pharmacist or doctor that they suit you.

Many people notice mood changes in the days before a period. For a smaller group, the changes are bad enough to disrupt work, relationships and daily life. This is called premenstrual dysphoric disorder, or PMDD. PMDD is a recognized condition, and it can be treated.

PMDD can also bring much darker days. People with it are more likely than others to have thoughts of ending their life. If that ever happens to you, please tell someone rather than waiting for the days to pass. Our article on suicidal thoughts says where to find someone to talk to, wherever you are. If you need someone to talk to now, you can find the crisis lines and emergency numbers for your country on our helplines page.

Most irregular cycles are just irregular. One condition explains a big share of the rest. You’ve probably heard of it as polycystic ovary syndrome, or PCOS. In 2026 it was renamed polyendocrine metabolic ovarian syndrome, or PMOS.

PMOS affects about one woman in eight. Once other causes, such as thyroid problems, have been ruled out, a diagnosis needs two of three things. The first is irregular cycles. The second is signs of higher androgen levels, most reliably unwanted hair growth. Androgens are hormones, testosterone among them, that every body makes. The third is how the ovaries look on a scan, or, for adults, a blood test called AMH.

The scan matters least. If irregular cycles and signs of extra androgens are both there, a scan isn’t needed, and in the first eight years after periods start, it isn’t recommended at all.

If it took a long time for anyone to name what you had, that’s common, and the guideline itself says diagnosis is still delayed.

There’s no cure, but a great deal can be done. Because the risk of type 2 diabetes is higher whatever your age or weight, the international guideline on PMOS asks for blood sugar to be checked at diagnosis and every one to three years after that. It also asks for cholesterol to be checked, and for everyone with PMOS, teenagers included, to be checked for depression, and every adult for anxiety too. If you have PMOS, it’s fine to ask your doctor whether these checks have been done, and when the next one is due.

The first years have their own rules

Periods usually start somewhere between the ages of 10 and 15. Where children are well nourished, the typical age is around 12, though in the United States it has edged earlier over recent decades, and almost every girl has started by 15.

If you’re a teenager, or the parent of one, and the periods seem to come whenever they like, you might well wonder whether something is wrong. At first, it usually isn’t. In the first years the brain and the ovaries are still learning the loop, many cycles pass without an egg being released, and the timing wanders.

In the teenage years, most cycles fall between 21 and 45 days, a much wider range than the adult one, and by the third year after the first period most have settled into the adult pattern of 21 to 34 days. The international guideline on polycystic ovaries agrees: irregular cycles are normal in the first year, 21 to 45 days is allowed for the next two, and the adult limits apply only from the third year.

How long, and how much

A period lasting up to eight days counts as normal by FIGO’s definitions, while UK and US guidance draw the line at seven. In one long study the average was about six.

If you’ve wondered whether your periods are too heavy, it helps to know that the amount of blood is smaller than most people imagine. Typical loss over a whole period is around 30 milliliters, a couple of tablespoons, though anywhere from about 20 to 90 is common. Researchers have long drawn the line for heavy bleeding at a measured amount, but in everyday life nobody measures, so the definitions have changed. Both FIGO and the UK’s national guidance now say that bleeding counts as heavy when it interferes with your physical, social or emotional life. If you’re changing protection through the night, planning your day around it, or worrying about leaks, that counts.

Pain is common, and it has a cause

If your period hurts, you’re far from the only one. Depending on how they asked, studies have found period pain in anywhere from about one woman in six to about nine in ten, and severe pain in up to about three in ten. It’s caused mainly by prostaglandins released by the lining of the uterus, which make its muscle contract strongly.

Anti-inflammatory painkillers such as ibuprofen often help, because they reduce how much prostaglandin is made, but check with a pharmacist or doctor that they suit you. Research also shows that period pain isn’t only physical: women with significant period pain tend to report poorer sleep and lower mood around their periods as well.

Mood changes before a period

Many people notice mood changes in the days before a period, such as irritability, tearfulness, tension or feeling low. For a smaller group the changes are severe enough to disrupt work, relationships and daily life. This is called premenstrual dysphoric disorder, or PMDD. A meta-analysis found that about 3% of women met the full criteria when their symptoms were confirmed by tracking them over two cycles, and about 1.6% in studies of the general population rather than clinics.

If that sounds like you, it helps to know that PMDD is a recognized condition, and it can be treated.

When irregular has a name

Irregular cycles are common, and most of the time they’re simply irregular. One condition accounts for a large share of the rest, and it’s worth knowing by name, partly because it has had a new name since 2026.

You’ve probably heard of polycystic ovary syndrome, or PCOS. In 2026 it was renamed, after a large international consensus involving dozens of academic, clinical and patient organizations. It’s now called polyendocrine metabolic ovarian syndrome, or PMOS.

The old name was part of why the condition was so often misunderstood. It suggested cysts on the ovaries and obscured the hormonal and metabolic features that matter most, and in the consensus statement’s own account it contributed to delayed diagnosis and to stigma. The UK’s national health service has already renamed its pages. Most articles, most leaflets and many doctors will say PCOS for a while yet, and the two names mean the same thing.

It’s common, affecting about one woman in eight. Once other causes, such as thyroid problems, have been ruled out, the diagnosis needs two of three things. The first is cycles that are irregular in the ways described above. The second is signs of higher androgen levels, most reliably unwanted hair growth. The third is the appearance of the ovaries on a scan, or, in adults, a blood test for a hormone called AMH.

The scan is the part people expect, and it’s the part that matters least. Around 28% of women have ovaries that look polycystic on an ultrasound, while only about one in eight have the syndrome, so the picture alone diagnoses nothing. The international guideline says so directly: where irregular cycles and signs of excess androgens are both present, an ultrasound is not necessary for the diagnosis. In the first eight years after periods start, it isn’t recommended at all.

If it took a long time for anyone to name what you had, that experience is common. In the largest survey of its kind, a third of women said it took more than two years, and almost half saw three or more health professionals before anyone named it. That survey recruited through support groups, so it almost certainly overstates the general picture, but the guideline itself says that diagnosis is still delayed and that the needs of people who have it aren’t being adequately met.

The UK’s national health service says plainly that there’s no cure, but a great deal can be done. The guideline asks for blood sugar to be checked at diagnosis and every one to three years after that, because the risk of type 2 diabetes is raised regardless of age or weight. It asks for cholesterol to be checked as well, and for everyone with the condition, teenagers included, to be screened for depression, and every adult for anxiety too, because both are common enough in this group to make looking for them routine care.

Those two recommendations show that the emotional side of this condition is clearly not an afterthought for the people who wrote it.

WHAT TO ASK, IF YOU HAVE PMOS

Has my blood sugar been checked, and when should it be checked again?
Has my cholesterol been checked?
Can we talk about my mood, and whether I’ve been feeling low or anxious?

Part five of six

Everything you were too afraid to ask

Plain answers to the questions people rarely say out loud

These are the questions people most often keep to themselves. Open any of them for a short answer.

Can you get pregnant during your period?

It’s less likely, but yes, it’s possible. The fertile window is the six days that end with ovulation, and ovulation doesn’t always happen in the middle of the cycle. In one study of women with regular cycles, there was at least a 10% chance of being in the fertile window on every day from day 6 to day 21. If your cycle is short, or your period is long, the fertile window can start soon after bleeding stops.

Is discharge normal?

Yes, it is. Discharge is how the vagina keeps itself clean and healthy, and much of it comes from the cervix. It changes through the cycle, becoming clearer and stretchier around ovulation and thicker afterward. It’s worth seeing a doctor if it changes color, smells unpleasant, or comes with itching, soreness or pain.

Can a tampon get lost inside you?

No, it can’t! The vagina is a closed canal, and the only way further in is the opening of the cervix, which is far too small for a tampon to pass through. A tampon can sometimes sit higher than you expect, or the string can tuck up out of reach, but it’s still in the vagina. If you can’t reach it, a doctor or nurse can remove it quickly, and it’s best not to leave it.

Tampon packets advise changing them regularly and using the lowest absorbency you need, because of a rare but life-threatening illness called toxic shock syndrome, which can happen with tampons and menstrual cups. It comes on quickly. If you develop a high temperature, muscle aches, flu-like symptoms or a raised rash that feels like sandpaper while using one, take it out and get urgent medical help.

Do periods really sync up when you live together?

They probably don’t, even though it’s a popular belief. When researchers followed women living together in university dormitories, their cycles didn’t synchronize. Because cycles vary in length, two people’s periods drift toward each other and then apart again over time, which can easily look like syncing for a month or two.

Does the hymen show whether someone has had sex?

No, it doesn’t. The hymen is a thin, stretchy rim of tissue around the vaginal opening, and it usually has an opening from birth. It varies a great deal between people and can change for many reasons. A systematic review, and a joint statement from the World Health Organization and other United Nations agencies, concluded that examining it can’t reliably show whether someone has had sex, and that so-called virginity testing has no scientific merit.

No, it doesn’t. The hymen is a thin, stretchy rim of tissue around the vaginal opening, and it usually has an opening from birth. It’s different from one person to the next, and it can change for lots of reasons. Researchers who reviewed all the studies on it, and the World Health Organization together with other United Nations agencies, agree that examining it can’t reliably show whether someone has had sex. So-called virginity testing has no scientific basis.

How much blood do you actually lose?

It’s less than it looks. A typical period loses around 30 milliliters of blood, a couple of tablespoons, spread over several days (I know, it feels like a lot more). It looks like more because it’s mixed with the lining and other fluid. What matters more than the amount is whether it gets in the way of your life, which is how heavy bleeding is now defined.

Is it normal for periods to hurt this much?

Some pain is very common, and it usually eases within a day or two of bleeding starting. But you don’t have to put up with pain that stops you going to work or school, that doesn’t improve with the usual painkillers, or that gets worse over the years. It’s worth raising with a doctor, because conditions such as endometriosis, where tissue similar to the lining of the womb grows elsewhere in the body, or fibroids and adenomyosis, can be behind it, and they can be treated.

Endometriosis alone affects around one in ten women of reproductive age worldwide, and it often takes years to diagnose, so if you’ve been told for a long time that your pain is normal, it’s fine to ask again.

Is it normal for the two sides to look different?

Yes, it is. Labia vary enormously in size, shape and color from person to person, and it’s common for one side to be longer or fuller than the other. Most of the images people see aren’t a good guide to the range of normal bodies.

Are my mood swings before my period just in my head?

No, they aren’t. Mood can genuinely change across the cycle, and for some people the change is large. If it regularly affects your relationships, your work or how you feel about yourself in the days before a period, try tracking it for a couple of months and taking the notes to a doctor, because PMDD is a recognized condition and it can be treated.

Should I be washing inside?

No, you shouldn’t, and the advice on this is unusually consistent. The vagina keeps its own balance of bacteria, and washing inside it, which is called douching, disturbs that balance rather than improving it. The vulva, on the outside, can be washed with plain unperfumed soap and warm water, or with water alone if the skin is irritated. If there’s a smell you feel you need to cover up, that’s a reason to see a doctor rather than to buy a product.

Does a positive HPV result mean someone has been unfaithful?

No, it doesn’t. HPV is extremely common, most people will have some type of it during their lives, and it can sit quietly in the body for years before a test picks it up. The UK’s national health service addresses this directly: a positive result does not mean your partner has had sex with someone else while you have been together. It can show up even when you haven’t been sexually active, or haven’t had a new partner, for a very long time.

No, it doesn’t. HPV, short for human papillomavirus, is very common. Most people will have some type of it during their lives, and it can stay in the body for years, unnoticed, before a test picks it up. The UK’s national health service is clear about this. A positive result does not mean your partner has had sex with someone else while you’ve been together. It can show up even if you haven’t had sex, or haven’t had a new partner, for a very long time.

I had the HPV vaccine. Do I still need cervical screening?

Yes, you do. The vaccine has made a striking difference: in England, the group offered it at 12 to 13 has had an estimated 87% lower rate of cervical cancer than the unvaccinated group just before them. But no version of the vaccine covers every type of HPV that can change the cells of the cervix, so screening still has something to look for. The two work better together than either does alone.

Yes, you do. Cervical screening is a regular test that looks for HPV or for changes in the cells of the cervix. The vaccine has made a big difference. In England, people offered it at age 12 to 13 have had an estimated 87% lower rate of cervical cancer than the group just before them, who weren’t vaccinated. But no version of the vaccine covers every type of HPV that can change the cells of the cervix, so screening still has something to look for. The two work better together than either does alone.

My cycles are irregular. Does that mean I have PCOS?

On its own, it doesn’t. Irregular cycles have many causes, including stress, a large change in weight, thyroid problems, and simply being in the first years after periods start or the last years before menopause. PMOS, the new name for PCOS, needs two of three features: irregular cycles, signs of higher androgen levels such as unwanted hair growth, and the appearance of the ovaries on a scan. It affects roughly one woman in eight, so it’s common enough to be worth asking about, and the diagnosis usually rests on the pattern of your cycles and a blood test rather than on the scan.

Not on its own. Irregular cycles have many causes. These include stress, a big change in weight, thyroid problems, and just being in the first years after periods start or the last years before menopause. PMOS is the new name for PCOS. A diagnosis needs two of three things. They’re irregular cycles, signs of higher androgen levels such as unwanted hair growth, and the way the ovaries look on a scan. Androgens are hormones, such as testosterone, that every body makes. PMOS affects about one woman in eight, so it’s common enough to be worth asking about. The diagnosis usually rests on the pattern of your cycles and a blood test rather than on the scan.

Part six of six

When to talk to a doctor

The changes worth checking, and how to raise them

In plain words

The list below shows the changes worth checking. None of these necessarily means something is wrong, but each one is worth mentioning to a doctor rather than waiting to see if it passes. After the list come the few signs that can’t wait.

Changes worth checking

None of these necessarily means something is wrong, but each one is worth mentioning to a doctor rather than waiting to see if it passes.

Worth checking with a doctor

Cycles that are regularly shorter than 24 days or longer than 38
Periods that last more than eight days
Bleeding heavy enough to disrupt your day or your nights
Bleeding between periods or after sex
Periods that stop for three months or more when you are not pregnant
Pain that stops you doing ordinary things, or that is getting worse
Unwanted hair growth or acne alongside irregular cycles
Mood changes before your period that affect your life
Any bleeding after menopause
Feeling tired or short of breath a lot alongside heavy periods

The day counts follow FIGO’s international definitions. UK and US guidance draw slightly tighter lines, at 21 to 35 days for a cycle and seven days for a period.

When it cannot wait

Almost everything on that list is a conversation for your next appointment rather than an emergency. There’s one exception worth knowing in advance, because it’s exactly the kind of thing people talk themselves out of at two in the morning.

The American College of Obstetricians and Gynecologists draws the line like this: if you’re changing pads or tampons every hour for more than two hours in a row, and you also have chest pain, shortness of breath and feel lightheaded or dizzy, seek emergency care right away. Bleeding that heavy still needs urgent medical advice, even without those feelings. And the UK’s national health service treats chest pain that doesn’t go away, or that comes with breathlessness or lightheadedness, as a reason to call 999 on its own, period or not. Elsewhere, that’s your local emergency number.

One other combination is urgent for a different reason. A recently missed period, unusual bleeding and pain anywhere in the abdomen can be signs of an ectopic pregnancy, where a pregnancy implants outside the uterus. The UK’s national health service asks for an urgent appointment or a call to 111 the same day, or your local urgent care number elsewhere. If a sharp, sudden and intense pain in your belly comes together with feeling very dizzy or fainting, feeling sick or looking very pale, call 999 or your local emergency number straight away, because that combination can mean a fallopian tube has burst.

And if you’re using a tampon or a menstrual cup and suddenly feel very unwell, with a high temperature, muscle aches or a rash that feels like sandpaper, take it out and get urgent help. It can be toxic shock syndrome, which is rare but comes on quickly.

In plain words

Cervical screening works the other way around. It’s an appointment you keep when nothing is wrong, and that’s the whole point of it. In the words of the UK’s national health service, it is not a test for cancer, it is a test to help prevent cancer. In England, the sample is first checked for the high-risk types of HPV, short for human papillomavirus, that can change the cells of the cervix. Only if those are found are the cells themselves looked at. HPV is very common, and the body usually clears it within about two years without anything happening.

How often you’re invited depends on where you live. The World Health Organization recommends a test such as an HPV test every five to ten years from age 30, and every three to five years from 25 for women living with HIV. England invites everyone with a cervix from 25 to 64 every five years. In the United States, screening starts at 21 with a cell test every three years, and from 30 there’s a choice of tests. Neither country screens anyone under 21, because cervical cancer is very rare that young and cell changes at that age usually settle on their own.

The HPV vaccine has made a big difference, but no vaccine covers every type of HPV, so screening carries on either way.

If you have symptoms, don’t wait for screening. Bleeding between periods, during or after sex, or after menopause, or discharge that isn’t usual for you, is a reason to see a doctor now rather than to wait for your next invitation.

Breasts have screening of their own, with mammograms, which are X-rays of the breasts. The World Health Organization describes it as usually for women aged 50 to 69. England invites women every three years from 50 until their 71st birthday, and in the United States the advice is a mammogram every two years from 40 to 74. In between, it helps to know how your breasts usually look and feel. A new lump, a change in the skin or shape of a breast, or a nipple that changes or leaks is worth checking now, whatever your age.

If you’re not sure how to bring it up, notes help. Write down when each period starts and stops, and how heavy it is. Note any pain, and anything else you’ve noticed, like changes in mood or sleep. Two or three months of notes is usually enough to show a pattern.

If you feel embarrassed, it may help to know these are some of the most ordinary conversations doctors have. FIGO estimates that at least one woman in three will have abnormal bleeding at some point in her reproductive years. You’re not wasting anyone’s time!

If you’re young, or a partner or family keeps an eye on your appointments, or there’s no doctor you can afford, a sexual and reproductive health clinic or a pharmacist is often an easier first step. Many will see you in confidence, and it’s fine to ask how they keep your information before you share anything.

Screening is not the same as symptoms

Everything above starts with noticing something. Cervical screening is the opposite: it’s an appointment you keep when nothing is wrong, and that’s the whole point of it.

It’s also widely misunderstood, and the UK’s national health service corrects the main misunderstanding in a single line. It is not a test for cancer, it is a test to help prevent cancer. In England the sample is checked first for the high-risk types of human papillomavirus that can change the cells of the cervix, and only if those are found are the cells themselves examined. HPV is very common. Most people will have some type of it at some point, and the body usually clears it within about two years without anything happening at all.

If you’ve read different advice in different places, that’s because the schedules differ between countries. The World Health Organization recommends a high-performance test, such as an HPV test, every five to ten years from age 30, and for women living with HIV every three to five years from 25. It also notes that taking the sample for an HPV test yourself is about as reliable as having a health worker take it, and some women prefer it. England invites everyone with a cervix from 25 to 64 every five years. Since July 2025 that includes 25 to 49 year olds whose last test found no HPV, who used to be invited every three.

In the United States, the Preventive Services Task Force advises starting at 21 with a cell test every three years, and from 30 offers a choice of the cell test every three years, an HPV test every five, or both together every five. Neither country screens under 21, because cervical cancer is very rare that young and cell changes at that age usually settle on their own.

The vaccine has changed the picture without replacing the test. In England, the year groups offered it at 12 to 13 had an estimated 87% lower rate of cervical cancer, and 97% fewer of the serious cell changes that come first, than the unvaccinated year group just before them. A very large study in Sweden, which followed individual girls and women rather than year groups, found the same pattern. No vaccine covers every type of HPV, so screening carries on either way.

Screening also isn’t where symptoms go. Bleeding between periods, during or after sex, or after menopause, or discharge that isn’t usual for you, is a reason to see a doctor now rather than to wait for your next invitation.

Breasts have screening of their own. The World Health Organization describes mammogram screening as usually for women aged 50 to 69. England invites women every three years from 50 until their 71st birthday, and in the United States the Preventive Services Task Force advises a mammogram every two years from 40 to 74. In between, it helps to know how your breasts usually look and feel. A new lump, a change in the skin or shape of a breast, or a nipple that changes or leaks is worth checking now, whatever your age.

How to raise it

If you’re not sure how to start, a few notes help.

WHAT HELPS

Note when each period starts and stops, and how heavy it is.
Write down any pain, and anything else you’ve noticed, such as changes in mood or sleep.
Keep this up for two or three months, which is usually enough to show a pattern.

If you feel embarrassed, it may help to know that these are some of the most ordinary conversations doctors have. Problems with periods are among the most common health concerns there are: FIGO estimates that at least one woman in three will have abnormal bleeding at some point in her reproductive years, and recent surveys suggest the true figure may be higher still. You’re not wasting anyone’s time!

Knowing how your body works won’t stop it from surprising you now and then, but it does make the surprises easier to read. Most of what people are too afraid to ask turns out to be normal, and the rest is worth asking about out loud.

WORTH BEING CLEAR ABOUT

The ranges in this article are for adults. In the first years after periods start, and again in the years before menopause, cycles are naturally less regular, and the adult definitions don’t apply in the same way. Some of the largest studies of cycles used app users rather than random samples, and much of the research was done in a small number of countries.

This article is a general introduction. It can’t tell you whether your own body is working as it should, so if anything worries you, raise it with a doctor, however small it seems.

REFERENCES

BOOKS FROM OUR SHELF

Gunter, J. (2019). The vagina bible: The vulva and the vagina, separating the myth from the medicine. Citadel Press.

Last reviewed October 2026

This article is general information, not medical advice. It cannot diagnose or rule out any condition. Changes in your cycle, bleeding that is heavy, irregular or happens between periods or after menopause, and pain that disrupts your life deserve proper medical assessment. If any of this sounds like your experience, please speak to your doctor or gynecologist. Psychological support is intended to work alongside appropriate medical care, never to replace it.

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