Dear Iris,
Do you stop releasing eggs when you are on the pill? How does the pill ensure that you do not become pregnant? Is it ok if your period does not begin on the day you take your "sugar pill" but before or after?
Thanks, —Baileyjuice

Dear Baileyjuice,
You are right on with how most pills work. You do not ovulate. No egg, no pregnancy. The period usually begins two to three days after the last active pill. If you are getting a period earlier, check to be sure you are not forgetting to take your pill sometimes. This is the most common reason for earlier periods. Call your doctor and ask him/her about your cycle length. I'm sure this is acceptable. —Iris

Dr. Iris,
Is there any way to tell when you have ovulated? If your period comes two times in one month is another egg released? How often and why would your period come twice in one month?
Thanks, —A.B.

Dear A.B.,
Don't think of your period as "once a month." Think of it as a cycle that occurs every 21, 26, 28, 32....you fill in the number of days your cycle lasts. So if your cycle is less than 30 or 31 days, you are bound to get two periods in one calendar month. For example, if your period is on a 26-day cycle, you could get your period on May 1 and then again on May 27. If your cycle is shorter, it is even more likely that two periods may come in one month. Usually you ovulate 14 days before your period starts. I hope this clarifies this issue for you. —Iris

Dear Iris,
What are some causes of amenorrhea, and at what point should you consult a doctor? I know that I am not pregnant, having taken a pregnancy test that was negative.
Thanks, —Alison

Dear Alison,
There are many causes of amenorrhea, or lack of menstrual periods. Excessive exercise, eating disorder, stress or physical problems may cause amenorrhea. If you have less than six menstrual periods per year, you should see your gynecologist. Keep a menstrual calendar so you can offer the dates of your last year's worth of periods. —Iris

Dear Iris,
How long after ovulation can you get pregnant?
Thanks, —Dani

Dear Dani,
You are most fertile 14 days BEFORE the onset of your next menstrual period. You can usually tell when this is because your vaginal discharge becomes wetter and heavier at this time. You are liable to get pregnant if you have intercourse a week before you ovulate, the day you ovulate, or a day or two after you ovulate. If you do not want to become pregnant, you should avoid intercourse for one week before, and at least 48 hours after, ovulation. Good luck, —Iris

Dear Iris,
I heard that you can get pregnant and your baby can grow on the outside of the uterus. What is this called?
Thanks, —Jennifer

Dear Jennifer,
What you are referring to is called an ectopic pregnancy. This occurs when a fertilized egg implants anywhere other than in the uterus — most likely in the fallopian tubes. Only a doctor can determine whether or not this is occurring. That's why it is very important to see a doctor as soon as you believe you may be pregnant. Ectopic pregnancies can be very serious and, in some cases, life threatening to the mother.
Hope this helps, —Iris

Dear Iris,
Can you continue to engage in sex when you are pregnant?
Please reply, —Bonnie

Dear Bonnie,
It is perfectly normal and appropriate to continue having sex while pregnant. Some women are comfortable engaging in sex up until they are ready to give birth. If you are an at-risk patient or are uncomfortable when having sex, you should stop and consult with your obstetrician.
Good luck, —Iris

Dear Iris,
What types of multiple births are there? For example, what makes twins?
Thanks, —Heather

Dear Heather,
There are several ways of producing multiple births. One type of twinning occurs during in-vitro fertilization when several eggs are fertilized outside the woman's body and then implanted. However, the most common types of natural twinning are identical twins and fraternal twins. With identical twins, one egg is fertilized and somehow splits in two. These twins share one placenta and have identical DNA. Fraternal twins are created when two eggs are released at the same time and are fertilized by two sperm. They live in separate placentas and are as related as any brother or sister may be. Twins are usually born one following the other ... sometimes rather quickly; sometimes 10-15 minutes apart. Hope this helps, —Iris

Dear Iris,
I am 39 years old and for the first time (except when I was pregnant) my period was two weeks late. I noticed last night that after I urinated there was bright red blood on the toilet paper. I was surprised to see how red the blood was. This morning it was spotty, to the point I never needed a pad. Tonight the discharge was a dark brownish color. I never got a period. My mother started going through menopause at the early age of 35. Could this possibly be the start? My husband had a vasectomy six years ago so I don't think I am pregnant. Any suggestions? Thank you so much for your time. —Karla

Dear Karla,
For many years before you actually go through menopause you are in perimenopause. This time is characterized by menstrual irregularities, hot flashes, night sweats, itchy skin, dry vagina, etc. What you are describing may be entirely normal. It is certainly possible that you are entering perimenopause (menopause is the last menstrual period and is only that occurrence). It does not follow that daughters inherit their mothers' patterns of menopause. Make an appointment with your gynecologist and discuss menopause with him/her. Good luck, —Iris

Dear Iris,
I just want to know — what is menopause? At what age do women get menopause? Are there symptoms before menopause and if so, what are they? A friend of mine is going through depression and insomnia at age 45 years. Is she going through menopause? I want to find out for her, please. Thank you for answering.
Best regards, —Catherine

Dear Catherine,
Menopause means your last menstrual period. But you are not considered having gone through menopause until you have not had a period for one full year. The average age for menopause is between 47 and 55. The changes associated with menopause start some 10 years before you actually have your last period. This time is called "perimenopause" and is characterized by many symptoms — for instance, hot flashes, insomnia, itchy skin, dry vaginal area, fatigue, etc. A doctor can examine your friend and check her hormone levels. This will give the doctor the clues s/he needs to decide if perimenopause is the diagnosis.
—Iris

Hi Iris,
I am almost 45 years old, very fit and in good health. For the past year or so, I have had the most dreadful itchy forearms. It feels like something is crawling under my skin! It mostly happens at night, but the need to scratch is unbearable. My limited knowledge tells me it could be connected to the onset of menopause — formication. What should I do? How long will it last? Is it common? Help! (What a wonderful service this is! I live in Malaysia, and there's not much support here.)
Regards, —Carol

Hello Carol,
Yes, formication is linked with menopause, but unfortunately the cause is unknown. The good news is that the symptom usually disappears on its own. Why not discuss this with your doctor?
Good luck, —Iris

Dear Iris,
I am a 47-year-old woman. My cycle has been predictable for years, but recently I have been unable to predict when my period will come. Sometimes I get my period two or three times per month. Sometimes it is very light, and other times very heavy. This month it was a 27-day cycle. What does all this mean? What can I expect for future months? Is my body going through another change?
—May

Dear May,
Yes, your body is going through a change. At your stage of life you may begin to experience irregularity due to "perimenopause," the time (sometimes ten years) that precedes actual menopause. Why not visit your gynecologist and make sure there is no medical problem that is causing these changes? Since s/he knows you and your medical history, s/he can explain menopause and what you will likely experience in the future.
—Iris

Dear Iris,
Maybe you can help. I am 43 and my period this month has lasted 12 days. It normally lasts four and always has since the age of 12. I've never had any problems with my period. Since the age of 40 I seem to pass a lot of clots and have a little more pain — but other than that I've been quite regular. Why would my period last so long this month? Anything I have read about menopause tells me the flow should be decreasing, so I'm not sure it has anything to do with menopause. Also, it seems to stop during the night and starts up during the day. Can you shed some light on this for me? Thanks, —Connie

Dear Connie,
Menopause is the last menstrual cycle. But for as many as ten years prior to menopause (this time is called perimenopause), you may experience a variety of symptoms. Some women experience heavier flows, some lighter flows; some experience hot flashes, others night sweats. But the bottom line is, it is normal to experience menstrual changes over the years, culminating with menopause. You should be having regular gynecological exams. Call your gynecologist and let your doctor know what you are experiencing.
—Iris