Different life stages are associated with specific women’s sexual and reproductive health issues including:

• menstruation

• fertility

• cervical screening

• contraception

• pregnancy

• sexually transmissible infections

• chronic health problems (such as endometriosis and polycystic ovary syndrome)

• menopause

• unplanned pregnancy

• abortion.

What is the menstrual cycle?

The menstrual cycle is a natural but complex cycle of changes that your body goes through each month.

A menstrual cycle is measured from the first day of your period to the day before your next period. The average length of a menstrual cycle is 28 days, but everyone's cycle is different. For example, teenagers might have cycles that last 45 days, whereas people in their 20s to 30s might have cycles that last 21 to 38 days.

Phases of the menstrual cycle

The menstrual cycle has 4 phases.

1. Your period (menstruation)

When you have a period, your uterus lining sheds and flows out of your vagina. Your period contains blood, mucus and some cells from the lining of your uterus. The average length of a period is 3 to 7 days.

2. The follicular phase

The follicular phase starts on the first day of your period and lasts for 13 to 14 days. Changing hormone levels cause the lining of your uterus to thicken and follicles to grow on the surface of the ovaries. Usually only one follicle will mature into an egg.

3. Ovulation

Ovulation is when a mature egg is released from an ovary. This usually happens once a month, about 2 weeks before your next period.

You're most likely to get pregnant if you have unprotected sex around the time of ovulation.

4. The luteal phase

After ovulation, the egg travels through the fallopian tubes to your uterus. The uterus lining continues to thicken in preparation for pregnancy.

If you fall pregnant, you won't have a period. If you don't get pregnant, you'll have a period and the menstrual cycle will start again.

When to see your doctor

Talk to your doctor if you are worried about your periods. For example, if:

• your period patterns change

• your periods are getting heavier (i.e. you need to change your pad or tampon more often than every 2 hours)

• your periods last more than 8 days

• your periods come less than 21 days apart

• your periods come more than 2 to 3 months apart

• your symptoms are so painful they affect your quality of life

• you bleed between periods

• you bleed after sexual intercourse.

A woman is born with all the eggs she is going to have in her lifetime. Her eggs age with her, decreasing in quality and quantity. Age is the single most important factor affecting a woman 's fertility. While good health improves the chance of getting pregnant and having a healthy baby, it doesn 't override the effects of age on a woman 's fertility.

A woman in her early to mid-20s has a 25–30% chance of getting pregnant every month. Fertility generally starts to slowly decline when a woman is in her early 30s, and after the age of 35 the decline speeds up. By age 40, the chance of getting pregnant in any monthly cycle is around 5%.

Women's age and IVF

It's a common misconception that IVF treatment can overcome the effects of age on fertility. A woman's age also affects the chance of success with IVF. In Australia, the chance of a live birth from one complete IVF cycle (which includes all fresh and frozen-thawed embryo transfers following one ovarian stimulation) is about:

• 43% for women aged 30 to 34 years

• 31% for women aged 35 to 39 years

• 11% for women aged 40 to 44 years.

For older women the chance of having a baby increases if they use eggs donated by a younger woman.

Women's age and pregnancy complications

The risk of pregnancy complications increases with age too. The risk of miscarriage and chromosomal abnormalities in the fetus increase from age 35. Complications such as gestational diabetes, placenta praevia (when the placenta covers all or part of the cervix, which increases the risk of the placenta detaching), caesarean section and still birth are also more common among older women than younger women.

Conditions that may affect a woman 's fertility include endometriosis and polycystic ovary syndrome (PCOS).

Having regular cervical screening tests can prevent around 90% of cervical cancers through early detection and treatment.

Most people who develop cervical cancer in Australia are either overdue for screening or have never been screened.

Cervical cancer often has no symptoms, especially in the early stages when cervical cell changes take place.

The Cervical Screening Test checks for the presence of the human papilloma virus (HPV) – a virus that can cause cervical cancer.

Who is eligible for cervical screening?

Screening is available for eligible people through the National Cervical Screening Program.

A Cervical Screening Test is available to:

• Women and people with a cervix (25 to 74 years) who have ever been sexually active.

If you have had a hysterectomy, you should discuss whether you need a Cervical Screening Test with your healthcare provider.

Cervical screening is recommended (every 5 years) even if you feel healthy, or have had the HPV vaccine.

However, your GP or healthcare provider may charge a standard consultation fee for the appointment.

If you are unsure or would like to know more about fees, check with your clinic when booking the appointment.

If you are over 75, you can still ask to have a subsidised cervical screening test – talk to your GP or healthcare provider.

Even if you don’t fall into the categories above, if you experience any symptoms including abnormal vaginal bleeding, pain during sex or unusual vaginal discharge, see your GP or healthcare provider as soon as possible.

There are many contraceptive options available in Australia. Their level of effectiveness and the way they work varies.

Types of contraception include:

• implants

• intrauterine devices (IUDs)

• injections

• oral contraceptive pills (combined pill and progestogen only pill)

• vaginal rings

• barrier methods (external and internal condoms, diaphragms)

• tubal ligation and vasectomy

• emergency contraception

• natural methods (also known as natural family planning or fertility awareness based methods).

Barrier methods of contraception (such as condoms) are highly effective to protect you and your sexual partners from sexually transmissible infections (STIs).

It is important to remember, that no method of contraception is 100% effective against pregnancy.

A woman is born with all the eggs she is going to have in her lifetime. Her eggs age with her, decreasing in quality and quantity. Age is the single most important factor affecting a woman 's fertility. While good health improves the chance of getting pregnant and having a healthy baby, it doesn 't override the effects of age on a woman 's fertility.

A woman in her early to mid-20s has a 25–30% chance of getting pregnant every month. Fertility generally starts to slowly decline when a woman is in her early 30s, and after the age of 35 the decline speeds up. By age 40, the chance of getting pregnant in any monthly cycle is around 5%.

The risk of pregnancy complications increases with age too. The risk of miscarriage and chromosomal abnormalities in the fetus increase from age 35. Complications such as gestational diabetes, placenta praevia (when the placenta covers all or part of the cervix, which increases the risk of the placenta detaching), caesarean section and still birth are also more common among older women than younger women.

Conditions that may affect a woman 's fertility include endometriosis and polycystic ovary syndrome (PCOS).

AIDS (acquired immune deficiency syndrome) is the most advanced stage of HIV infection. This is when the immune system is at its weakest and a person has one or more specific illnesses.

AIDS is now very rare in Australia. HIV treatments are highly effective – they protect the immune system by:

• preventing the virus from multiplying

• reducing the damage to the specific cells targeted by HIV.

Most people living with HIV on effective treatment in Australia can expect to live long, healthy lives without ever developing AIDS.

How HIV spreads

HIV is a blood-borne virus – it carries through blood and some body fluids. HIV can spread from one person to another by:

• blood

• semen

• vaginal fluids

• anal mucus

• breastmilk.

Having another sexually transmissible infection (STI) can increase your chances of HIV transmission.

HIV can transmit through:

• Unprotected anal or vaginal sex – not using condoms or other biomedical prevention methods.

• Sharing any needles, syringes, or other injecting equipment.

• From mother to child during pregnancy, childbirth, or breastfeeding. This can occur when the mother doesn’t know she has HIV, or is not on effective treatment.

• Rarely through tattooing or other procedures that involve unsterile or reused equipment.

• Very rarely through needle stick injuries.

Menopause is when you have your final period. You have reached menopause if you haven’t had a period or spotting for 12 months.

Most women reach menopause between the ages of 45 and 55. In Australia, the average age to reach menopause is 51 to 52.
Menopause can happen naturally at the expected age or early.

Menopause before the age of 45 is called ‘early menopause’. If menopause happens before the age of 40 it’s called ‘premature menopause’.

‘Perimenopause’ is the time leading up to menopause.

What causes menopause?

Menopause happens because your hormone levels (e.g. oestrogen levels) drop and you stop ovulating and having periods.
Menopause can also happen due to surgery or cancer treatment.

As you approach menopause, your hormones (e.g. oestrogen and progesterone) go up and down. These changes can lead to different symptoms.

Symptoms of menopause

Changing hormone levels can cause different symptoms. Menopause is different for everyone. Some women have no symptoms at all, while others have symptoms that interfere with their daily lives. Your experience can also be affected by what is happening in your life, and your general health and wellbeing.

Common physical symptoms include:

• hot flushes and night sweats

• sleep problems

• headaches

• muscle and joint pains

• dry vagina (causing painful sex)

• sore breasts.

Common emotional symptoms include:

• mood changes (feeling unhappy or depressed)

• tiredness

• forgetfulness

• brain fog (difficulty concentrating)

• anxiety.

  Managing menopause

  There are many ways to manage menopause. It may take time to find a strategy that works for you.

  Lifestyle changes

  You can:

  • eat healthy food and drink lots of water

  • do regular physical activity

  • maintain a healthy weight

  • improve your sleep

  • reduce or stop unhealthy habits such as drinking alcohol or smoking.

  Practical tips

  Try:

  • using a hand fan or water spray when you feel hot

  • wearing layered clothing so you can remove clothes when you feel hot

  • relaxation classes like yoga and meditation.

  Therapies and medicines

  You can reduce menopausal symptoms with:

  • menopausal hormone therapy (MHT) – this is the most effective therapy to relieve many symptoms

  • medicines, such as antidepressants, which can reduce hot flushes and sweating

  • natural therapies.

Common issues in male reproductive health include:

• Contraception

• Avoiding sexually transmitted diseases

• Infertility/fertility

• Using contraception carefully, consistently, and correctly

• Minimizing the risk of sexually transmitted diseases

• Addressing factors that may reduce fertility and seeking treatment when required

Men should consult with their healthcare provider to discuss which contraceptive method is best for the couple, based on overall health, age, frequency of sexual activity, number of partners, desire to have children in the future, and family history of certain diseases. Contraceptive methods work best when they are used correctly and consistently. Using contraception incorrectly or inconsistently increases the risk of pregnancy and in some cases also increases the risk of STDs.

It is important to discuss the risk factors for STDs with a healthcare provider and ask about getting tested. It is possible to have an STD and not know it, because many STDs do not cause symptoms. Men with STDs need to ask a healthcare provider about treatment to address symptoms, reduce the progression of the STDs, and decrease or eliminate the risk of transmitting an STD to your partner.

If you and your partner are interested in having children, but have difficulty conceiving, it is important for both the male and the female partner to consult with a healthcare provider to assess fertility. Over one-third of infertility cases are caused by male reproductive issues, alone or in combination with female reproductive issues. However, treatments are available to address many of the causes of male infertility.

• Male condoms. This condom is a thin sheath that covers the penis to collect sperm and prevent it from entering the woman's body. Male condoms are generally made of latex or polyurethane, but a natural alternative is lambskin (made from the intestinal membrane of lambs). Latex or polyurethane condoms reduce the risk of spreading sexually transmitted diseases (STDs). Lambskin condoms do not prevent STDs. Male condoms are disposable after a single use.

• Vasectomy is a surgical procedure that cuts, closes, or blocks the vas deferens. This procedure blocks the path between the testes and the urethra.³The sperm cannot leave the testes and cannot reach the egg. It can take as long as 3 months for the procedure to be fully effective. A backup method of contraception is used until tests confirm that there is no sperm in the semen. Although vasectomy can sometimes be reversed, it is not always possible. Vasectomy, like other sterilization procedures, is considered a permanent form of birth control.

Different methods of contraception have different rates of effectiveness in preventing pregnancy.

Men can take the following measures to avoid STDs:

• Know your partner's STD and health history

• Talk to your healthcare provider about your risk, and get tested for STDs

• Practice safe sex (such using latex condoms correctly and consistently)

• Get vaccinated against hepatitis A virus, hepatitis B virus, and human papilloma virus

According to the U.S. Department of Health and Human Services, the male latex condom is the best method for protecting against STDs, including HIV/AIDS. Polyurethane condoms are an effective alternative if either partner has a latex allergy. Natural/lambskin condoms do not prevent the spread of STDs because of the presence of tiny pores (holes) that may allow viruses such as HIV, hepatitis B, and herpes to spread.

It is important to know that male condoms cannot completely protect you and your partner from contracting an STD. For example, the most common STD is the human papilloma virus, or HPV. No method of contraception can fully prevent the transmission of HPV, because it can infect areas not covered by a condom. However, using a condom with every sex act can lower the risk of transmission.

It is important to discuss the risk factors for STDs with your healthcare provider and ask about getting tested. It is possible to have an STD and not know it, because many STDs do not cause symptoms.

See your healthcare provider for treatment as soon as possible after receiving a diagnosis of an STD. Notify all recent sex partners and advise them to see their healthcare providers and be treated. All sexual partners should be treated at the same time, to prevent re-infection. All partners should avoid sex until treatment is complete and your healthcare provider advises that it is safe to resume.