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University Park, Pa. - Female athletes often lose their menstrual cycle when training strenuously, but researchers have long speculated on whether this infertility was due to low body fat, low weight or exercise itself. Now, researchers have shown that the cause of athletic amenorrhea is more likely a negative energy balance caused by increasing exercise without increasing food intake.

"A growing proportion of women are susceptible to losing their menstrual cycle when exercising strenuously," says Dr. Nancy I. Williams, assistant professor of kineseology and physiology at Penn State. "If women go six to 12 months without having a menstrual cycle, they could show bone loss. Bone densities in some long distance runners who have gone for a prolonged time period without having normal menstrual cycles can be very low."

In studies done with monkeys, which show menstrual cyclicity much like women, researchers showed that low energy availability associated with strenuous exercise training plays an important role in causing exercise-induced amenorrhea. These researchers, working at the University of Pittsburgh, published findings in the Journal of Clinical Endocrinology and Metabolism showing that exercise-induced amenorrhea was reversible in the monkeys by increasing food intake while the monkeys still exercised.

Williams worked with Judy L. Cameron, associate professor of psychiatry and cell biology and physiology at the University of Pittsburgh. Dana L. Helmreich and David B. Parfitt, then graduate students, and Anne Caston-Balderrama, at that time a post-doctoral fellow at the University of Pittsburgh, were also part of the research team. The researchers decided to look at an animal model to understand the causes of exercise-induced amenorrhea because it is difficult to closely control factors, such as eating habits and exercise, when studying humans. They chose cynomolgus monkeys because, like humans, they have a menstrual cycle of 28 days, ovulate in mid-cycle and show monthly periods of menses.

"It is difficult to obtain rigorous control in human studies, short of locking people up," says Williams.

Previous cross-sectional studies and short-term studies in humans had shown a correlation between changes in energy availability and changes in the menstrual cycle, but those studies were not definitive.

There was also some indication that metabolic states experienced by strenuously exercising women were similar to those in chronically calorie restricted people. However, whether the increased energy utilization which occurs with exercise or some other effect of exercise caused exercise-induced reproductive dysfunction was unknown.

"The idea that exercise or something about exercise is harmful to females was not definitively ruled out," says Williams. "That exercise itself is harmful would be a dangerous message to put out there. We needed to look at what it was about exercise that caused amenorrhea, what it was that suppresses ovulation. To do that, we needed a carefully controlled study."

After the researchers monitored normal menstrual cycles in eight monkeys for a few months, they trained the monkeys to run on treadmills, slowly increasing their daily training schedule to about six miles per day. Throughout the training period the amount of food provided remained the standard amount for a normal 4.5 to 7.5 pound monkey, although the researchers note that some monkeys did not finish all of their food all of the time.

The researchers found that during the study "there were no significant changes in body weight or caloric intake over the course of training and the development of amenorrhea." While body weight did not change, there were indications of an adaptation in energy expenditure. That is, the monkeys' metabolic hormones also changed, with a 20 percent drop in circulating thyroid hormone, suggesting that the suppression of ovulation is more closely related to negative energy balance than to a decrease in body weight.

To seal the conclusion that a negative energy balance was the key to exercise-induced amenorrhea, the researchers took four of the previous eight monkeys and, while keeping them on the same exercise program, provided them with more food than they were used to. All the monkeys eventually resumed normal menstrual cycles. However, those monkeys who increased their food consumption most rapidly and consumed the most additional food, resumed ovulation within as little as 12 to 16 days while those who increased their caloric intake more slowly, took almost two months to resume ovulation.

Williams is now conducting studies on women who agree to exercise and eat according to a prescribed regimen for four to six months. She is concerned because recreational exercisers have the first signs of ovulatory suppression and may easily be thrust into amenorrhea if energy availability declines. Many women that exercise also restrict their calories, consciously or unconsciously.

"Our goal is to test whether practical guidelines can be developed regarding the optimal balance between calories of food taken in and calories expended through exercise in order to maintain ovulation and regular menstrual cycles," says Williams. "This would then ensure that estrogen levels were also maintained at healthy levels. This is important because estrogen is a key hormone in the body for many physiological systems, influencing bone strength and cardiovascular health, not just reproduction."

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fitness; diet and weight loss; menopause; staying healthy; men's health; obesity; fertility; women's health

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Energy Balance, Not Exercise, Key To Athletic Menstrual Disturbance

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Female athletes often lose their menstrual cycle when training strenuously, but researchers have long speculated on whether this infertility was due to low body fat, low weight or exercise itself. Now, researchers have shown that the cause of athletic amenorrhea is more likely a negative energy balance caused by increasing exercise without increasing food intake.

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Different is Normal - Planned Parenthood

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Different is Normal - Planned Parenthood

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Different is Normal - Changing Bodies and Genitals | Planned Parenthood Video

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This is Your Period in 2 Minutes | Glamour

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How to keep your vagina clean - Planned Parenthood

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How to keep your vagina clean - Planned Parenthood

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Episode 3: How to Keep Your Vagina Clean & Healthy | Planned Parenthood Video

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What teens really want to know about sex - TEDEd

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What teens really want to know about sex - TEDEd

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On the first day of the high school Sexuality and Society class that I teach, I don't pass around anatomy drawings or hand out pamphlets about safer sex - although those are stacked on a table near the door. Instead, the first thing I do is establish ground rules in the classroom: People should speak for themselves, laughter is OK, we won't ask "personal history" questions, and we'll work to create a community of peers who care about and respect one another. Then, I introduce the Question Box - a safe place where students can drop any question they have about human sexuality. The Question Box (an old shoebox with a hole cut into the top of it) usually stays in the back corner of my classroom, next to some scraps of paper and some pencils.

Below are some actual questions from students and my answers to them. I haven't done any fancy editing; these are the questions just as the kids asked them. They run the gamut from innocent to downright technical. My answers are exactly as I gave them, to show how even a simple question allows for both information and value clarification to be offered in response. Here goes:

"Why is sex so good?" There are two ways to answer this question. From the biological perspective, sex feels good for an important evolutionary reason. If a species, like ours, is going to reproduce sexually, then there's an advantage if that action also feels good. As I've often said, if sex felt like getting your tooth drilled at the dentist, people wouldn't have it very often, and that could eventually threaten the survival of our species. Our bodies have evolved so that our genital regions, as well as many, many other parts of the body, are sensitive to sexual stimulation.

A part of the body that brings sexual pleasure when stimulated is called an erogenous zone. This does not mean just our genitals. All of us have many places on our bodies that result in sexual pleasure when stimulated. Knowing your own and your partner's erogenous zones can lead to much more fulfilling sexual experiences. The mechanisms of sexual pleasure involve a combination of nerve impulses, blood flow, and muscle tension. To find out more about this, you might Google the phrase " human sexual response cycle " and look at the work of Masters and Johnson, two famous sex researchers who studied the body changes that happen when people get sexually excited.

The second reason sex feels good is that humans have developed the emotional capacity to feel love, intimacy, and passion. These emotional states highlight and deepen sexual pleasure. While pleasure can exist without these emotions, it is much more significant when they are present.

"When is someone emotionally and physically ready for sex?" I wish I had an answer that would be right for all people at all times, but the real answer is "it depends." We are all unique individuals, and our relationships are all unique. Because of that, there can't be a standard answer to this question. Wouldn't it be great if we could say, "The Thursday following your sixth date is the most appropriate day to start having sex"? But, of course, that's not the way it works.

I think it's appropriate to start being sexually active with a sweetheart (and remember: I define sexually active as being involved with someone else's body for the purpose of giving and receiving sexual pleasure) when intimacy, commitment, and passion are established and both people have pretty equal amounts of these feelings for each other. I don't think these things develop quickly, so I don't think sexual activity is appropriate on a first date or early in a new relationship.

I also think people aren't ready to become sexually active if they can't talk about it with their partners in a serious way, and also talk about safer sex practices, contraception (if appropriate), and possible positive and negative consequences and how they'd deal with them. Emotionally, a person has to be ready to face other people's response, positive or negative, to the sexual activity, and be willing to share those emotional reactions with his or her partner.

As you can see, I think it takes a lot for a couple to be ready to engage in sexual activity. If any of the above things aren't in place, I'd say you're not ready.

"Could you use a balloon as a condom?" Short Answer-ABSOLUTELY NOT!!! UNSAFE! UNHEALTHY! DANGER! DANGER! Longer Answer: OK, I'm calmer now. Condoms are made to be condoms; balloons are made to be balloons. Both can be made of latex, but that doesn't mean they're interchangeable. You wouldn't use a pencil eraser as a car tire even though they're both made of rubber, would you?

Condoms, when used correctly, are an essential tool in reducing the risk of pregnancy and STIs. They work so well because they're designed for that purpose. No condom substitute (balloon, plastic baggie, sock - whatever) will provide the same level of protection, and some can do more harm than good. So insist on the original! Sometimes people ask about condom substitutes because they don't know where to get condoms or are embarrassed to get them. Condoms can be purchased at any local drugstore; there are no age requirements for buying condoms and no prescriptions are necessary. Free condoms are available from many health clinics, sexual health agencies, and even some schools (although ours does not provide free condoms at this time).

Here's an important thing to consider. If a person doesn't feel confident enough to acquire condoms, then maybe they shouldn't be having intercourse. Being ready for sexual intercourse means being able to handle all aspects of the situation, including protecting oneself and one's sweetheart from unwanted consequences. Remember my rule about sexual activity-" If you can't look your partner in the eye and talk about it, then you can't do it with them." My rule for condoms is, "If you can't take responsibility for securing condoms, then you're not allowed to have the kind of sexual activity that calls for using condoms."

"How can you tell if a guy likes you?" I know you're really hoping for a clear-cut answer here, but that's just not the way it works, I'm afraid. People can react in all kinds of ways when they like you. Some people get really quiet around you. Others will make sure you notice them. Some will tease you or act annoying. Some will just silently stare at you (yes, that can feel a little creepy).

The best way to figure out if a guy likes you is to ask him! Might it feel awkward to do that? Sure, but it's also a way to get a clear answer. You might want to resort to the middle-school tactic of asking your friends to ask his friends if he really likes you or not, but that makes the whole thing so much more public than it needs to be. You could try using Facebook or texts to figure it out, but they're not great ways to get clear information.

Why not try the kind of "I message" we use in class? In an I message, you describe the situation, say what you feel, and say what you want or need. Below are two different I messages you might try (or make up your own!).
#1: "I'm trying to figure something out and I could use your help. I'm feeling a bit confused about what you think of me. I'm wondering, can you be honest with me and tell me whether you like me or not?" #2: "It's hard for me to figure out if someone likes me or not. I'd be a lot less anxious if I knew for sure. So, I was just wondering, do you like me?"
Asking such a question might seem scary, but remember, the worst a person can say is no, and you're absolutely strong enough to hear that and be OK. Believe it! Then go ask him.

This article is adapted for TED-Ed from the Ideas.ted.com article, and excerpted with permission from the book, For Goodness Sex: Changing the Way We Talk to Teens About Sexuality, Values, and Health. W atch Al Vernacchio's TED Talk: Sex needs a new metaphor. Here's one.

Featured image via iStock.
To learn more about health and human development, watch this TED-Ed Lesson series. To learn something new every week, sign up here for the TED-Ed Newsletter.

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What teens really want to know about sex

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On the first day of the high school Sexuality and Society class that I teach, I don't pass around anatomy drawings or hand out pamphlets about safer sex - although those are stacked on a table near the door.

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Female Reproductive System - Teens Health

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Female Reproductive System - Teens Health

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The Female Reproductive System

Like other living things, human beings reproduce. It's what keeps the population going.

In humans, this happens when the male and female reproductive systems work together to make a baby.

The Female Reproductive System

The female reproductive system has several parts. The uterus is where a fetus, or baby, grows. It is a hollow, pear‑shaped organ with a muscular wall.

The Female Reproductive System

There are two ovaries, one on either side of the uterus. Ovaries make eggs and hormones like estrogen and progesterone. These hormones help girls develop, and make it possible for a woman to have a baby.

The ovaries release an egg as part of a woman's cycle. When an egg is released, it's called ovulation. Each egg is tiny - about one‑tenth the size of a poppy seed.

The Female Reproductive System

The cervix is the lower part of the uterus that opens into the vagina. During childbirth, the cervix expands about 4 inches (10 centimeters) so the baby can travel from the uterus through the vagina and into the world.

The Female Reproductive System

The vagina is a tube that connects the uterus to the outside of the body. The entrance to the vagina is on the outside of the body. It's called the vaginal opening.

The Female Reproductive System

During sex, sperm cells travel through the vagina to the uterus and fallopian tubes.

In the fallopian tube, the sperm meets the egg that was released from the ovary during ovulation.

What Is the Female Reproductive System?

The external part of the female reproductive organs is called the vulva, which means covering. Located between the legs, the vulva covers the opening to the vagina and other reproductive organs inside the body.

The fleshy area located just above the top of the vaginal opening is called the mons pubis. Two pairs of skin flaps called the labia (which means lips) surround the vaginal opening. The clitoris, a small sensory organ, is located toward the front of the vulva where the folds of the labia join. Between the labia are openings to the urethra (the canal that carries pee from the bladder to the outside of the body) and vagina. When girls become sexually mature, the outer labia and the mons pubis are covered by pubic hair.

A female's internal reproductive organs are the vagina, uterus, fallopian tubes, and ovaries.

The vagina is a muscular, hollow tube that extends from the vaginal opening to the uterus. Because it has muscular walls, the vagina can expand and contract. This ability to become wider or narrower allows the vagina to accommodate something as slim as a tampon and as wide as a baby. The vagina's muscular walls are lined with mucous membranes, which keep it protected and moist.

The vagina serves three purposes:

1. It's where the penis is inserted during sexual intercourse.

2. It's the pathway (the birth canal) through which a baby leaves a woman's body during childbirth.

3. It's the route through which menstrual blood leaves the body during periods.

A very thin piece of skin-like tissue called the hymen partly covers the opening of the vagina. Hymens are often different from female to female. Most women find their hymens have stretched or torn after their first sexual experience, and the hymen may bleed a little (this usually causes little, if any, pain). Some women who have had sex don't have much of a change in their hymens, though. And some women's hymens have already stretched even before they have sex.

The vagina connects with the uterus, or womb, at the cervix (which means neck). The cervix has strong, thick walls. The opening of the cervix is very small (no wider than a straw), which is why a tampon can never get lost inside a girl's body. During childbirth, the cervix can expand to allow a baby to pass.

The uterus is shaped like an upside-down pear, with a thick lining and muscular walls - in fact, the uterus contains some of the strongest muscles in the female body. These muscles are able to expand and contract to accommodate a growing fetus and then help push the baby out during labor. When a woman isn't pregnant, the uterus is only about 3 inches (7.5 centimeters) long and 2 inches (5 centimeters) wide.

At the upper corners of the uterus, the fallopian tubes connect the uterus to the ovaries. The ovaries are two oval-shaped organs that lie to the upper right and left of the uterus. They produce, store, and release eggs into the fallopian tubes in the process called ovulation (pronounced: av-yoo-LAY-shun).

There are two fallopian (pronounced: fuh-LO-pee-un) tubes, each attached to a side of the uterus. Within each tube is a tiny passageway no wider than a sewing needle. At the other end of each fallopian tube is a fringed area that looks like a funnel. This fringed area wraps around the ovary but doesn't completely attach to it. When an egg pops out of an ovary, it enters the fallopian tube. Once the egg is in the fallopian tube, tiny hairs in the tube's lining help push it down the narrow passageway toward the uterus.

The ovaries (pronounced: OH-vuh-reez) are also part of the endocrine system because they produce female sex

hormonessuch as estrogen (pronounced: ESS-truh-jun) and progesterone (pronounced: pro-JESS-tuh-rone).

How Does the Female Reproductive System Work?

The female reproductive system enables a woman to:

produce eggs (ova)

have sexual intercourse

protect and nourish a fertilized egg until it is fully developed

give birth

Sexual reproduction couldn't happen without the sexual organs called the gonads. Most people think of the gonads as the male testicles. But both sexes have gonads: In females the gonads are the ovaries, which make female gametes (eggs). The male gonads make male gametes (sperm).

When a baby girl is born, her ovaries contain hundreds of thousands of eggs, which remain inactive until puberty begins. At puberty, the pituitary gland (in the central part of the brain) starts making hormones that stimulate the ovaries to make female sex hormones, including estrogen. The secretion of these hormones causes a girl to develop into a sexually mature woman.

Toward the end of puberty, girls begin to release eggs as part of a monthly period called the menstrual cycle. About once a month, during ovulation, an ovary sends a tiny egg into one of the fallopian tubes.

Unless the egg is fertilized by a sperm while in the fallopian tube, the egg leaves the body about 2 weeks later through the uterus - this is menstruation. Blood and tissues from the inner lining of the uterus combine to form the menstrual flow, which in most girls lasts from 3 to 5 days. A girl's first period is called menarche (pronounced: MEH-nar-kee).

It's common for women and girls to have some discomfort in the days leading to their periods. Premenstrual syndrome (PMS) includes both physical and emotional symptoms that many girls and women get right before their periods, such as:

PMS is usually at its worst during the 7 days before a girl's period starts and disappears after it begins.

Many girls also have belly cramps during the first few days of their periods caused by prostaglandins, chemicals in the body that make the smooth muscle in the uterus contract. These involuntary contractions can be dull or sharp and intense.

It can take up to 2 years from menarche for a girl's body to develop a regular menstrual cycle. During that time, her body is adjusting to the hormones puberty brings. On average, the monthly cycle for an adult woman is 28 days, but the range is from 23 to 35 days.

What Happens If an Egg Is Fertilized?

If a female and male have sex within several days of the female's ovulation, fertilization can happen. When the male ejaculates (when semen leaves the penis), a small amount of semen is deposited into the vagina. Millions of sperm are in this small amount of semen, and they "swim" up from the vagina through the cervix and uterus to meet the egg in the fallopian tube. It takes only one sperm to fertilize the egg.

About 5 to 6 days after the sperm fertilizes the egg, the fertilized egg (pronounced: zygote) has become a multicelled blastocyst. A blastocyst (pronounced: BLAS-tuh-sist) is about the size of a pinhead, and it's a hollow ball of cells with fluid inside. The blastocyst burrows itself into the lining of the uterus, called the endometrium. The hormone estrogen causes the endometrium (pronounced: en-doh-MEE-tree-um) to become thick and rich with blood. Progesterone, another hormone released by the ovaries, keeps the endometrium thick with blood so that the blastocyst can attach to the uterus and absorb nutrients from it. This process is called implantation.

As cells from the blastocyst take in nourishment, another stage of development begins. In the embryonic stage, the inner cells form a flattened circular shape called the embryonic disk, which will develop into a baby. The outer cells become thin membranes that form around the baby. The cells multiply thousands of times and move to new positions to eventually become the embryo (pronounced: EM-bree-oh).

After about 8 weeks, the embryo is about the size of a raspberry, but almost all of its parts - the brain and nerves, the heart and blood, the stomach and intestines, and the muscles and skin - have formed.

During the fetal stage, which lasts from 9 weeks after fertilization to birth, development continues as cells multiply, move, and change. The fetus (pronounced: FEE-tis) floats in amniotic (pronounced: am-nee-AH-tik) fluid inside the amniotic sac. The fetus gets oxygen and nourishment from the mother's blood via the placenta (pronounced: pluh-SEN-tuh). This disk-like structure sticks to the inner lining of the uterus and connects to the fetus via the umbilical (pronounced: um-BIL-ih-kul) cord. The amniotic fluid and membrane cushion the fetus against bumps and jolts to the mother's body.

Pregnancy lasts an average of 280 days - about 9 months. When the baby is ready for birth, its head presses on the cervix, which begins to relax and widen to get ready for the baby to pass into and through the vagina. Mucus has formed a plug in the cervix, which now loosesn. It and amniotic fluid come out through the vagina when the mother's water breaks.

When the contractions of labor begin, the walls of the uterus contract as they are stimulated by the pituitary hormone oxytocin (pronounced: ahk-see-TOE-sin). The contractions cause the cervix to widen and begin to open. After several hours of this widening, the cervix is dilated (opened) enough for the baby to come through. The baby is pushed out of the uterus, through the cervix, and along the birth canal. The baby's head usually comes first. The umbilical cord comes out with the baby. It's clamped and cut close to the navel after the baby is delivered.

The last stage of the birth process involves the delivery of the placenta, which at that point is called the afterbirth. After it has separated from the inner lining of the uterus, contractions of the uterus push it out, along with its membranes and fluids.

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Why do girls get periods? What goes on when a woman gets pregnant? What can go wrong with the female reproductive system? Find the answers to these questions and more in this article for teens.

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Pregnancy lasts about 40 weeks, counting from the first day of your last normal period. The weeks are grouped into three trimesters. Find out what's happening with you and your baby in these three stages.

First trimester (week 1-week 12)

During the first trimester your body undergoes many changes. Hormonal changes affect almost every organ system in your body. These changes can trigger symptoms even in the very first weeks of pregnancy. Your period stopping is a clear sign that you are pregnant. Other changes may include:

Extreme tiredness

Tender, swollen breasts. Your nipples might also stick out.

Upset stomach with or without throwing up (morning sickness)

Cravings or distaste for certain foods

Mood swings

Constipation (trouble having bowel movements)

Need to pass urine more often

Headache

Heartburn

Weight gain or loss

As your body changes, you might need to make changes to your daily routine, such as going to bed earlier or eating frequent, small meals. Fortunately, most of these discomforts will go away as your pregnancy progresses. And some women might not feel any discomfort at all! If you have been pregnant before, you might feel differently this time around. Just as each woman is different, so is each pregnancy.

Second trimester (week 13-week 28)

Most women find the second trimester of pregnancy easier than the first. But it is just as important to stay informed about your pregnancy during these months.

You might notice that symptoms like nausea and fatigue are going away. But other new, more noticeable changes to your body are now happening. Your abdomen will expand as the baby continues to grow. And before this trimester is over, you will feel your baby beginning to move!

As your body changes to make room for your growing baby, you may have:

Body aches, such as back, abdomen, groin, or thigh pain

Stretch marks on your abdomen, breasts, thighs, or buttocks

Darkening of the skin around your nipples

A line on the skin running from belly button to pubic hairline

Patches of darker skin, usually over the cheeks, forehead, nose, or upper lip. Patches often match on both sides of the face. This is sometimes called the mask of pregnancy.

Numb or tingling hands, called carpal tunnel syndrome

Itching on the abdomen, palms, and soles of the feet. (Call your doctor if you have nausea, loss of appetite, vomiting, jaundice or fatigue combined with itching. These can be signs of a serious liver problem.)

Swelling of the ankles, fingers, and face. (If you notice any sudden or extreme swelling or if you gain a lot of weight really quickly, call your doctor right away. This could be a sign of preeclampsia.)

Third trimester (week 29-week 40)

You're in the home stretch! Some of the same discomforts you had in your second trimester will continue. Plus, many women find breathing difficult and notice they have to go to the bathroom even more often. This is because the baby is getting bigger and it is putting more pressure on your organs. Don't worry, your baby is fine and these problems will lessen once you give birth.

Some new body changes you might notice in the third trimester include:

Shortness of breath

Heartburn

Swelling of the ankles, fingers, and face. (If you notice any sudden or extreme swelling or if you gain a lot of weight really quickly, call your doctor right away. This could be a sign of preeclampsia.)

Hemorrhoids

Tender breasts, which may leak a watery pre-milk called colostrum (kuh-LOSS-struhm)

Your belly button may stick out

Trouble sleeping

The baby "dropping", or moving lower in your abdomen

Contractions, which can be a sign of real or false labor

As you near your due date, your cervix becomes thinner and softer (called effacing). This is a normal, natural process that helps the birth canal (vagina) to open during the birthing process. Your doctor will check your progress with a vaginal exam as you near your due date. Get excited - the final countdown has begun!

Your developing baby

First trimester (week 1-week 12)

At four to five weeks:

Your baby's brain and spinal cord have begun to form.

The heart begins to form.

Arm and leg buds appear.

Your baby is now an embryo and one-twenty-fifth inch long.

At eight weeks:

All major organs and external body structures have begun to form.

Your baby's heart beats with a regular rhythm.

The arms and legs grow longer, and fingers and toes have begun to form.

The sex organs begin to form.

The eyes have moved forward on the face and eyelids have formed.

The umbilical cord is clearly visible.

At the end of eight weeks, your baby is a fetus and looks more like a human. Your baby is nearly 1 inch long and weighs less than one-eighth ounce.

At 12 weeks:

The nerves and muscles begin to work together. Your baby can make a fist.

The external sex organs show if your baby is a boy or girl. A woman who has an ultrasound in the second trimester or later might be able to find out the baby's sex.

Eyelids close to protect the developing eyes. They will not open again until the 28th week.

Head growth has slowed, and your baby is much longer. Now, at about 3 inches long, your baby weighs almost an ounce.

Second trimester (week 13-week 28)

At 16 weeks:

Muscle tissue and bone continue to form, creating a more complete skeleton.

Skin begins to form. You can nearly see through it.

Meconium (mih-KOH-nee-uhm) develops in your baby's intestinal tract. This will be your baby's first bowel movement.

Your baby makes sucking motions with the mouth (sucking reflex).

Your baby reaches a length of about 4 to 5 inches and weighs almost 3 ounces.

At 20 weeks:

Your baby is more active. You might feel slight fluttering.

Your baby is covered by fine, downy hair called lanugo (luh-NOO-goh) and a waxy coating called vernix. This protects the forming skin underneath.

Eyebrows, eyelashes, fingernails, and toenails have formed. Your baby can even scratch itself.

Your baby can hear and swallow.

Now halfway through your pregnancy, your baby is about 6 inches long and weighs about 9 ounces.

At 24 weeks:

Bone marrow begins to make blood cells.

Taste buds form on your baby's tongue.

Footprints and fingerprints have formed.

Real hair begins to grow on your baby's head.

The lungs are formed, but do not work.

The hand and startle reflex develop.

Your baby sleeps and wakes regularly.

If your baby is a boy, his testicles begin to move from the abdomen into the scrotum. If your baby is a girl, her uterus and ovaries are in place, and a lifetime supply of eggs have formed in the ovaries.

Your baby stores fat and has gained quite a bit of weight. Now at about 12 inches long, your baby weighs about 1½ pounds.

Third trimester (week 29-week 40)

At 32 weeks:

Your baby's bones are fully formed, but still soft.

Your baby's kicks and jabs are forceful.

The eyes can open and close and sense changes in light.

Lungs are not fully formed, but practice "breathing" movements occur.

Your baby's body begins to store vital minerals, such as iron and calcium.

Lanugo begins to fall off.

Your baby is gaining weight quickly, about one-half pound a week. Now, your baby is about 15 to 17 inches long and weighs about 4 to 4½ pounds.

At 36 weeks:

The protective waxy coating called vernix gets thicker.

Body fat increases. Your baby is getting bigger and bigger and has less space to move around. Movements are less forceful, but you will feel stretches and wiggles.

Your baby is about 16 to 19 inches long and weighs about 6 to 6½ pounds.

Weeks 37-40:

At 39 weeks, your baby is considered full-term. Your baby's organs are ready to function on their own.

As you near your due date, your baby may turn into a head-down position for birth. Most babies "present" head down.

At birth, your baby may weigh somewhere between 6 pounds 2 ounces and 9 pounds 2 ounces and be 19 to 21 inches long. Most full-term babies fall within these ranges. But healthy babies come in many different sizes.

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Pregnancy lasts about 40 weeks, counting from the first day of your last normal period. The weeks are grouped into three trimesters. Find out what's happening with you and your baby in these three stages. During the first trimester your body undergoes many changes. Hormonal changes affect almost every organ system in your body.

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Having a Healthy Pregnancy - Teens Health

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Having a Healthy Pregnancy - Teens Health

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If you've decided to have a baby, the most important thing you can do is to take good care of yourself so you and your baby will be healthy. Girls who get the proper care and make the right choices have a very good chance of having healthy babies.

Prenatal Care

See a doctor as soon as possible after you find out you're pregnant to begin getting prenatal care (prenatal care is medical care during pregnancy). The sooner you start to get medical care, the better the chances that you and your baby will be healthy.

If you can't afford to go to a doctor or clinic for prenatal care, social service organizations can help you. Ask a trusted adult, like a parent or school counselor, to help you find low-cost or free care in your community.

During your first visit, the doctor will ask you lots of questions, including the date of your last period. This helps the doctor work out how long you have been pregnant and your due date.

A baby's due date is only an estimate. In fact, women don't usually deliver exactly on their due dates. Most babies are born between 38 and 42 weeks after the first day of a woman's last period, or 36 to 40 weeks after conception (when the sperm fertilizes the egg).

Timelines

A pregnancy is divided into three phases called trimesters. The first trimester is from conception to the end of week 13. The second trimester is from week 14 to the end of week 26. The third trimester is from week 27 to the end of the pregnancy.

The doctor will examine you and do a pelvic exam. Your doctor may also do blood tests, a urine test, and tests for sexually transmitted diseases (STDs). Doctors do this because some STDs can cause serious medical problems in newborns, so it's important to get treatment to protect the baby.

The doctor will probably recommend that you get some immunizations, like a Tdap vaccine to protect your baby against pertussis (whooping cough).

Your doctor will explain the types of physical and emotional changes you can expect during pregnancy. He or she will also teach you to how to recognize the signs of possible problems during pregnancy (you might hear your doctor call problems "complications"). Teens are more at risk for certain problems during pregnancy, such as anemia, high blood pressure, and giving birth earlier than usual (called premature delivery).

Your doctor will want you to start taking prenatal vitamins that contain folic acid, calcium, and iron as soon as possible. The doctor may prescribe the vitamins or recommend a brand that you can buy over the counter. These vitamins and minerals help ensure the baby's and mother's health as well as prevent some types of birth defects.

Ideally, you should see your doctor once each month for the first 28 weeks of your pregnancy, then every 2 weeks until 36 weeks, then once a week until you deliver the baby. If you have a medical condition such as diabetes that needs careful monitoring during your pregnancy, your doctor will probably want to see you more often.

During visits, your doctor or nurse will check your weight, blood pressure, and urine. The doctor or nurse will measure your abdomen to keep track of the baby's growth. After the baby's heartbeat can be heard with a special device, the doctor will listen for it at each visit. Your doctor will probably also send you for some other tests during the pregnancy, such as an ultrasound, to make sure that everything is OK with your baby.

One part of prenatal care is attending classes where moms to be can learn about having a healthy pregnancy and delivery. You can also learn the basics of caring for a new baby. These classes may be offered at hospitals, medical centers, schools, and colleges in your area.

It can be difficult for adults to talk to their doctors about their bodies and even more difficult for teens to do so. Your doctor is there to help you stay healthy during pregnancy and have a healthy baby - and there's probably not much he or she hasn't heard! So don't be afraid to ask questions.

Be frank when your doctor asks questions, even if they seem embarrassing. A lot of the issues the doctor brings up could affect your baby's health. Think of your doctor not just as someone who can help, but also as someone you can confide in about what's happening to you.

Changes to Expect in Your Body

Pregnancy causes lots of physical changes in the body. Here are some common ones:

Breast Growth

An increase in breast size is one of the first signs of pregnancy, and the breasts may continue to grow throughout the pregnancy. You may go up several bra sizes during the course of your pregnancy.

Skin Changes

Don't be surprised if people tell you your skin is "glowing" when you are pregnant - pregnancy causes an increase in blood volume, which can make your cheeks a little pinker than usual. And hormonal changes increase oil gland secretion, which can give your skin a shinier appearance. Acne is also common during pregnancy for the same reason.

Other skin changes caused by pregnancy hormones may include brownish or yellowish patches on the face called chloasma and a dark line on the midline of the lower abdomen, known as the linea nigra.

Also, moles or freckles that you had prior to pregnancy may become bigger and darker. Even the areola, the area around the nipples, becomes darker. Stretch marks are thin pink or purplish lines that can appear on your abdomen, breasts, or thighs.

Except for the darkening of the areola, which can last, these skin changes will usually disappear after you give birth.

Mood Swings

It's very common to have mood swings during pregnancy. Some girls may also experience depression during pregnancy or after delivery. If you have symptoms of depression such as sadness, changes in sleep patterns, thoughts of hurting yourself, or bad feelings about yourself or your life, tell your doctor so he or she can help you to get treatment.

Pregnancy Discomforts

Pregnancy can cause some uncomfortable side effects. These include:

nausea and vomiting (especially early in the pregnancy)

leg swelling

varicose veins in the legs and the area around the vaginal opening

hemorrhoids

heartburn and constipation

backache

fatigue

sleep loss

If you have one or more of these side effects, keep in mind that you're not alone! Ask your doctor for advice on how to deal with these common problems.

If you are pregnant and have bleeding or pain, call the doctor immediately, even if you are not planning to continue the pregnancy.

Things to Avoid

Smoking, drinking alcohol, and taking drugs when you are pregnant put you and your baby at risk for a number of serious problems.

Alcohol

Doctors now believe that it's not safe to drink any amount of alcohol when you are pregnant. Drinking can harm a developing fetus, putting a baby at risk for birth defects and mental problems.

Smoking

When a woman smokes while she is pregnant, she can have a

miscarriage or stillbirth. Her baby might be premature (born early), and sudden infant death syndrome (SIDS). SIDS is the sudden, unexplained death of an infant who is younger than 1 year old.

Drugs

Using drugs such as cocaine or marijuana during pregnancy can cause miscarriage, prematurity, and other medical problems. Babies can also be born addicted to some drugs.

Ask your doctor for help if you are having trouble quitting smoking, drinking, or drugs. Check with your doctor before taking any medication while you are pregnant, including over-the-counter medications, herbal remedies and supplements, and vitamins.

Unsafe Sex

Talk to your doctor about sex during pregnancy. If your doctor says it's OK to have sex while you're pregnant, you must use a condom to help prevent getting an STD. Some STDs can cause blindness, pneumonia, or meningitis in newborns, so it's important to protect yourself and your baby.

Taking Care of Yourself During Pregnancy

Eating

Many girls worry about how their bodies look and are afraid to gain weight during pregnancy. But now that you are eating for two, this is not a good time to cut calories or go on a diet. Both you and your baby need certain nutrients so the baby can grow properly. Eating a variety of healthy foods, drinking plenty of water, and cutting back on high-fat junk foods will help you and your developing baby to be healthy.

Doctors generally recommend adding about 300 calories a day to your diet to provide adequate nourishment for the developing fetus. You should gain about 25 to 35 pounds during pregnancy, most of this during the last 6 months - although how much a girl should gain depends on how much she weighed before the pregnancy. Your doctor will advise you based on your individual situation.

Eating additional fiber - 25 to 30 grams a day - and drinking plenty of water can help to prevent common problems such as constipation. Good sources of fiber are fresh fruits and vegetables and breads, cereals, or muffins that have lots of whole grain in them.

You'll need to avoid eating or drinking certain things during pregnancy, such as:

certain types of fish, such as swordfish, canned tuna, and other fish that may be high in mercury (your doctor can help you decide which fish you can eat)

foods that contain raw eggs, such as mousse or Caesar salad

raw or undercooked meat and fish

processed meats, such as hot dogs and deli meats

soft, unpasteurized cheeses, such as feta, brie, blue, and goat cheese

unpasteurized milk, juice, or cider

It's also a good idea to limit food or drinks that contain caffeine and artificial sweeteners.

Exercise

Exercising during pregnancy is good for you as long as you are having an uncomplicated pregnancy and choose appropriate activities. Doctors generally recommend low-impact activities such as walking, swimming, and yoga. Contact sports and high-impact aerobic activities that pose a greater risk of injury should generally be avoided.

Also, working at a job that involves heavy lifting is not recommended for women during pregnancy. Talk to your doctor if you have questions about whether particular types of exercise are safe for you and your baby.

Sleep

It's important to get plenty of rest while you are pregnant. Early in your pregnancy, try to get into the habit of sleeping on your side. Lying on your side with your knees bent is likely to be the most comfortable position as your pregnancy progresses. Also, it makes your heart's job easier because it keeps the baby's weight from applying pressure to the large vein that carries blood back to the heart from your feet and legs.

Some doctors recommend that girls who are pregnant sleep on the left side. Because of where some of your major blood vessels are, lying on your left side helps keep the uterus from pressing on them. Ask what your doctor recommends - in most cases, lying on either side should do the trick and help take some pressure off your back.

Throughout your pregnancy, but especially toward the end, you may wake up often at night to go to the bathroom. While it's important to drink enough water while you're pregnant, try to drink most of it during the day rather than at night. Use the bathroom right before going to bed.

As you get further along in your pregnancy, you might have a difficult time getting comfortable in bed. Try positioning pillows around and under your belly, back, or legs to get more comfortable.

Stress can also interfere with sleep. Maybe you're worried about your baby's health, about delivery, or about what your new role as a parent will be like. All of these feelings are normal, but they may keep you up at night. Talk to your doctor if you are having problems sleeping during your pregnancy.

Vaccines

Your doctor may recommend that you get several vaccines during pregnancy. The flu shot can lessen the awful effects of that illness. And the vaccine is safe - studies show no harmful effects to a fetus. It also helps protect a mother and her baby from getting the flu (and other viruses) in the baby's first year of life. Pregnant women should only get the shot made with the inactivated virus. The flu vaccine previously also came in a nasal spray (or mist) form, but it contained live strains of the virus and was never safe for moms-to-be. Currently, the nasal spray is not recommended for anyone because it didn't prevent cases of the flu between 2013 and 2016.

The Tdap vaccine (against tetanus, diphtheria, and pertussis) is now recommended for all pregnant women in the second half of each pregnancy, regardless of whether they've gotten it before or when it was last given. This recommendation is in response to a rise in pertussis (whooping cough) infections, which can be fatal in newborns who have not yet had their routine vaccinations.

Emotional Health

It's common for pregnant teens to feel a range of emotions, such as fear, anger, guilt, confusion, and sadness. It may take a while to adjust to the fact that you're going to have a baby. It's a huge change, and it's natural for pregnant teens to wonder whether they're ready to handle the responsibilities that come with being a parent.

How a girl feels often depends on how much support she has from the baby's father, from her family (and the baby's father's family), and from friends. Each girl's situation is different. Depending on your situation, you may need to seek more support from people outside your family. It's important to talk to the people who can support and guide you and help you share and sort through your feelings. Your school counselor or nurse can refer you to resources in your community that can help.

Sometimes girls who are pregnant have miscarriages and lose the pregnancy. This can be very upsetting and difficult to go through for some girls, although it may bring feelings of relief for others. It is important to talk about these feelings and to get support from friends and family - or if that's not possible, from people such as counselors or teachers.

School and the Future

Some girls plan to raise their babies themselves. Sometimes grandparents or other family members help. Some girls decide to give their babies up for adoption. It takes a great deal of courage and concern for the baby to make these difficult decisions.

Girls who complete high school are more likely to have good jobs and enjoy more success in their lives. If possible, finish high school now rather than trying to return later. Ask your school counselor or an adult you trust for information about programs and classes in your community for pregnant teens.

Some communities have support groups especially for teen parents. Some high schools have child-care centers on campus. Perhaps a family member or friend can care for your baby while you're in school.

You can learn more about what to expect in becoming a parent by reading books, attending classes, or checking out reputable websites on child raising. Your baby's doctor, your parents, family members, or other adults can all help guide you while you are pregnant and after the baby is born.

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If you've decided to have a baby, the most important thing you can do is to take good care of yourself so you and your baby will be healthy. Girls who get the proper care and make the right choices have a very good chance of having healthy babies.

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What is menstruation? Planned Parenthood

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What is menstruation? Planned Parenthood

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What is menstruation?

Menstruation - aka having your period - is when blood and tissue from your uterus comes out of your vagina. It usually happens every month.

What's the menstrual cycle?

Your menstrual cycle helps your body prepare for pregnancy every month. It also makes you have a period if you're not pregnant. Your menstrual cycle and period are controlled by hormones like estrogen and progesterone. Here's how it all goes down:

You have 2 ovaries, and each one holds a bunch of eggs. The eggs are super tiny - too small to see with the naked eye.

During your menstrual cycle, hormones make the eggs in your ovaries mature - when an egg is mature, that means it's ready to be fertilized by a sperm cell. These hormones also make the lining of your uterus thick and spongy. So if your egg does get fertilized, it has a nice cushy place to land and start a pregnancy. This lining is made of tissue and blood, like almost everything else inside our bodies. It has lots of nutrients to help a pregnancy grow.

About halfway through your menstrual cycle, your hormones tell one of your ovaries to release a mature egg - this is called ovulation. Most people don't feel it when they ovulate, but some ovulation symptoms are bloating, spotting, or a little pain in your lower belly that you may only feel on one side.

Once the egg leaves your ovary, it travels through one of your fallopian tubes toward your uterus.

If pregnancy doesn't happen, your body doesn't need the thick lining in your uterus. Your lining breaks down, and the blood, nutrients, and tissue flow out of your body through your vagina. Voilà, it's your period!

If you do get pregnant, your body needs the lining - that's why your period stops during pregnancy. Your period comes back when you're not pregnant anymore.

When in life do periods start and stop?

At some point during puberty, blood comes out of your vagina, and that's your first period. Most people get their first period between ages 12 and 14, but some people get them earlier or later than that. There's no way to know exactly when you'll get it, but you may feel some PMS symptoms (link to PMS section) a few days before it happens.

If you don't get your period by the time you're 16, it's a good idea to visit a doctor or nurse. Read more about getting your first period.

Most people stop getting their period when they're between 45 and 55 years old - this is called menopause. Menopause can take a few years, and periods usually change gradually during this time. After menopause is totally complete, you can't get pregnant anymore. Read more about menopause.

Your period may start and stop around the time it did for other people you're related to, like your mom or sisters.

Do transgender guys get a period?

Not everybody who gets a period identifies as a girl or woman. Transgender men and genderqueer people who have uteruses, vaginas, fallopian tubes, and ovaries also get their periods.

Having a period can be a stressful experience for some trans folks because it's a reminder that their bodies don't match their true gender identity - this discomfort and anxiety is sometimes called gender dysphoria. Other trans people might not be too bothered by their periods. Either reaction is normal and okay.

Sometimes trans people who haven't reached puberty yet take hormones (called puberty blockers) to prevent all of the gendered body changes that happen during puberty, including periods. And people who already get periods can use certain types of birth control (like the implant or hormonal IUD) that help lighten or stop their periods. Hormone replacement therapy, like taking testosterone, may also stop your period.

If you start taking testosterone, your period will go away. But this is reversible - if you stop taking testosterone, your period will come back. There can be some changes in your menstrual cycle before it stops for good. Periods get lighter and shorter over time, or come when you don't expect it. You may have spotting or cramping every once in a while until you stop getting your period, and sometimes even after it seems to have stopped - this is normal. Testosterone injections make your periods go away faster than testosterone cream.

If you experience gender dysphoria when you get your period, know that you're not alone. It may be helpful to check out our resources and find a trans-friendly doctor in your area that you can talk to.

When can I get pregnant during my menstrual cycle?

You have the highest chance of getting pregnant on the days leading up to ovulation (when your ovary releases a mature egg) - these are called fertile days.

Ovulation usually happens about 14 days before your period starts - but everyone's body is different. You may ovulate earlier or later, depending on the length of your menstrual cycle.

Your egg lives for about 1 day after it's released from your ovary, and sperm can live in your uterus and fallopian tubes for about 6 days after sex. So you can usually get pregnant for around 6 days of every menstrual cycle: the 5 days before you ovulate, and the day you ovulate. You can also get pregnant a day or so after ovulation, but it's less likely.

Many people track their menstrual cycles and other fertility signs to help them figure out when they're ovulating. This is called fertility awareness - some people use it to prevent pregnancy, and others use it to try to get pregnant. Check out our app, which makes it easy to chart your cycle and figure out your fertile days.

Some people have very regular cycles, and other people's cycles vary from month to month. It's really common for young people to have irregular periods. Since your period can be unpredictable, it's hard to know for sure when you'll ovulate (even if you're carefully tracking your menstrual cycle). So if you don't want to get pregnant, use birth control every time you have vaginal sex.

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What is Menstruation? | Get Facts About Having Your Period

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Menstruation - aka having your period - is when blood and tissue from your uterus comes out of your vagina. It usually happens every month. Your menstrual cycle helps your body prepare for pregnancy every month. It also makes you have a period if you're not pregnant.

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A period is a release of blood from a girl's uterus, out through her vagina. It is a sign that she is getting close to the end of puberty.

There is a lot to learn about periods. Here are some common questions that teens have.

When Do Most Girls Get Their Period?

Most girls get their first period when they're around 12. But getting it any time between age 10 and 15 is OK. Every girl's body has its own schedule.

There isn't one right age for a girl to get her period. But there are some clues that it will start soon:

Most of the time, a girl gets her period about 2 years after her breasts start to develop.

Another sign is vaginal discharge fluid (sort of like mucus) that a girl might see or feel on her underwear. This discharge usually begins about 6 months to a year before a girl gets her first period.

What Causes a Period?

A period happens because of changes in

hormonesin the body. Hormones are chemical messengers. The ovaries release the female hormones estrogenand progesterone. These hormones cause the lining of the uterus (or womb) to build up. The built-up lining is ready for a fertilized egg to attach to and start developing. If there is no fertilized egg, the lining breaks down and bleeds. Then the same process happens all over again.

It usually takes about a month for the lining to build up, then break down. That is why most girls and women get their periods around once a month.

How Does Ovulation Relate to Periods?

Ovulation (pronounced: ov-yoo-LAY-shun) is the release of an egg from the ovaries. The same hormones that cause the uterus lining to build up also cause an egg to leave one of the ovaries. The egg travels through a thin tube called a fallopian tube to the uterus.

If the egg is fertilized by a sperm cell, it attaches to the wall of the uterus, where over time it develops into a baby. If the egg is not fertilized, the uterus lining breaks down and bleeds, causing a period.

Do Periods Happen Regularly When Menstruation Starts?

For the first few years after a girl starts her period, it may not come regularly. This is normal at first. By about 2-3 years after her first period, a girl's periods should be coming around once every 4-5 weeks.

Can a Girl Get Pregnant as Soon as Her Period Starts?

Yes, a girl can get pregnant as soon as her period starts. A girl can even get pregnant right before her very first period. This is because a girl's hormones might already be active. The hormones may have led to

ovulationand the building of the uterine wall. If a girl has sex, she can get pregnant, even though she has never had a period.

How Long Do Periods Last?

Periods usually last about 5 days. But a period can be shorter or last longer.

How Often Does a Period Happen?

Periods usually happen about once every 4-5 weeks. But some girls get their periods a little less or more often.

Should I Use a Pad, Tampon, or Menstrual Cup?

You have many choices about how to deal with period blood. You may need to experiment a bit to find which works best for you. Some girls use only one method and others switch between different methods.

Most girls use pads when they first get their period. Pads are made of cotton and come in lots of different sizes and shapes. They have sticky strips that attach to the underwear.

Many girls find tampons more convenient than pads, especially when playing sports or swimming. A tampon is a cotton plug that a girl puts into her vagina. Most tampons come with an applicator that guides the tampon into place. The tampon absorbs the blood. Don't leave a tampon in for more than 8 hours because this can increase your risk of a serious infection called toxic shock syndrome.

Some girls prefer a menstrual cup. Most menstrual cups are made of silicone. To use a menstrual cup, a girl inserts it into her vagina. It holds the blood until she empties it.

How Much Blood Comes Out?

It may look like a lot of blood, but a girl usually only loses a few tablespoons of blood during the whole period. Most girls need to change their pad, tampon, or menstrual cup about 3‒6 times a day.

Will I Have Periods for the Rest of My Life?

When women reach menopause (around age 45‒55), their periods will permanently stop. Women also won't have a period while they are pregnant.

What Is PMS?

PMS (premenstrual syndrome) is when a girl has emotional and physical symptoms that happen before or during her period. These symptoms can include moodiness, sadness, anxiety, bloating, and acne. The symptoms go away after the first few days of a period.

What Can I Do About Cramps?

Many girls have cramps with their period, especially in the first few days. If cramps bother you, you can try:

a warm heating pad on your belly

taking ibuprofen (Advil, Motrin, or store brand) or naproxen (Aleve or store brand)

Should I Watch for Any Problems?

Most girls don't have any problems with their periods. But call your doctor if you:

are 15 and haven't started your period

have had your period for more than 2 years and it still doesn't come regularly (about every 4-5 weeks)

have bleeding between periods

have severe cramps that don't get better with ibuprofen or naproxen

have very heavy bleeding (bleeding that goes through a pad or tampon faster than every 1 hour)

have periods that last more than about a week

have severe PMS that gets in the way of your everyday activities

Looking Ahead

Periods are a natural, healthy part of a girl's life. They shouldn't get in the way of exercising, having fun, and enjoying life. If you have questions about periods, ask your doctor, a parent, health teacher, school nurse, or older sister.

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Periods can be confusing. Get the facts in this article for teens.