Marie Stopes is the leading sexual and reproductive healthcare charity in the UK. Janet Pearce, a nurse from Marie Stopes International, answered questions from the iVillage Community on periods and sexual health

1. Endometriosis management

Omnopop wrote: I have had Endometriosis for about 12 years. In between my two pregnancies, I luckily had a very welcome break from most of my symptoms. However, my periods returned after my second baby eight months ago and the endometriosis has returned. I have been experiencing a lot of pain, heavy periods and often pain around ovulation too.

I took Microgynon for six weeks (which worked well at reducing all symptoms) but then experienced nasty side effects, so have recently stopped and am waiting for the side effects to clear out of my system before we try something else.

I have been advised to try the Mirena, but am not sure about it, especially as I believe it has the same hormone as Microgynon (albeit at a lower level), or to try another pill.

Just wondering what your advice would be for managing the endometriosis? We don't want any more children, but the treatment doesn't necessarily need to involve contraception, as we are happy to use condoms. I am 38, slightly on the heavy side for my height and am generally in good health.

Janet Pearce: I think the suggestion to give the Mirena intra uterine system (IUS) a try is very good advice. Mirena does contain pregestogen like Microgynon, however it does not contain oestrogen which is the hormone that can cause side effects in some women.

Mirena acts locally on the lining of the womb and has been one of the major advances in contraception that is of particular benefit to women with endometriosis. It is also one of the most effective forms of contraception available at 99.8 per cent. It reduces or in many cases stops period pain and blood loss during a period.

Mirena is effective for five years but can be removed at any time and fertility returns immediately. Condoms are good for preventing sexually transmitted infections and helping to prevent a pregnancy but do require thought and planning.

I'd advise you to visit your GP or local family planning clinic to talk through your contraceptive options.

Missing period?

mumjane wrote: I am 36 years old and a mum to two. My husband had a vasectomy two and a half years ago, but my period hasn't shown up this month. It's almost two weeks late now. I've done three pregnancy tests, all of which have been negative.

I went to my doctor last Thursday about it and was told to wait another week and see if it arrived, if not to do another pregnancy test and go back. I don't feel pregnant and surely three tests wouldn't all be negative.

This is totally abnormal for me, I've always been a four-weekly person, give or take a day or two. I have lost some weight recently but not a drastic amount or quickly. I also do exercise but not an extreme amount. I'm not under stress or unhappy so no real reason to why my period wouldn't happen.

My Mum didn't go through the menopause till she was almost 50 so it's not as if early menopause runs in the family.

What is the most common reason for a missed period in someone who is not pregnant? What is the most likely thing my doctor would do, or would it be a case of wait and see what happens next month? I'm not worrying about it, although I'd say I'm a little curious as to what is going on in my body.

Janet Pearce: The most common cause of a missed period in someone of reproductive age is pregnancy. However, there can be other factors (of which you mention above) such as stress (which could be just worrying that your period is late), being of low weight and excessive exercise that can also contribute to a late period.

As well as this, sometimes a period may be late for no reason at all or a slight imbalance of your hormones which may be temporary and absolutely noting to worry about.

As pregnancy is the most common cause of a missed period it is important to rule this out. One possible reason for a pregnancy test to be negative is that in early pregnancy there is not sufficient pregnancy hormone to register on a test.

In this instance, I do agree that a test should be repeated in a week's time. Your GP may also wish to do a blood test to test for the pregnancy hormone.

Your GP will probably not do any further investigations as this stage but if you miss several periods and pregnancy is not the case then more investigations or a referral to a gynaecologist may be considered.

Coil

curio wrote: I had a coil (not mirena) fitted in December 2008 after the birth of my first child (Sep 08). Although still breastfeeding, I believe I had my first period last month but I am still spotting every 2-3 days. Is this normal with the coil and will it ever stop?

Janet Pearce: It is not unusual for women who have a coil (Intra uterine device) to have some spotting and some women with this type of coil do have heavier periods.

As you have not had a period for so long it may take a few cycles for your bleeding to settle. One reason for spotting could be because you may be breastfeeding less frequently than you were following the birth of your baby.

If you have any pain or if there is an offensive smell to the spotting I would suggest you see your GP for further advice. You also do not mention if you are up to date with your cervical smear visits?

If your symptoms continue to worry you I would advise you to see your GP for reassurance or any checks.

Question about contraception

brejen wrote: I am currently using a withdrawal method of contraception after a bad experiences on the pill. I was just wondering how effective this method is?

It seems to be quite successful for us at the moment. We have three children and another pregnancy wouldn't be a major problem. Can sperm enter the vagina and lead to pregnancy after withdrawal occurs?

Janet Pearce: Using the withdrawal method as a form of contraception is not reliable. However if you are not worried about another addition to your family then it may be adequate for you.

Sperm can enter the vagina and you can get pregnant even if the man ejaculates on your thigh. As well as this, there are several million sperm in the clear fluid that a man produces when aroused before he ejaculates which can make you pregnant.

One option for you could be natural family planning; however this does involve quite a commitment in terms of taking your temperature and monitoring cervical mucus.

This method would require teaching from a specialist family planning nurse or your local family planning clinic would also be able to help with this.

Alternatively, there are other very effective forms of contraception available other than the contraceptive pill. There is the Mirena intra uterine system (IUS - also known as a 'coil'), the copper intra uterine device (IUD - also known as a 'coil') and the contraceptive implant.

The Mirena (IUS) and the contraceptive implant do not contain the hormone oestrogen, and the copper IUD does not contain any hormones at all which means that these methods do not have the many side effects of the pill.

If you are interested in any of these contraceptive options further advice can be obtained from your GP, local family planning clinic or specialist private clinic such as Marie Stopes International.

Mirena

melandy12200 wrote: I had the Mirena Coil fitted about 10 weeks ago after we decided to try a more permanent option (I was on cerasette).

We don't want to go through another pregnancy as we have a bad history with Neonatal death, late miscarriage/stillbirth due to Antiphospholipid syndrome.

The insertion went OK but I got terrible pain on my right hand side, which I had been warned may happen. All was well after that, apart from a few days of on and off spotting. I checked the strings about four weeks afterwards and I think I felt them.

Unfortunately, the six-week check-up wasn't until around eight weeks and a couple of nights before the appointment I woke in the night with terrible pain in the right hand side again.

It did subside about 30 minutes after it started but when I checked for string I couldn't find them. I went for a check-up and after a good examination the nurse confirmed she couldn't find strings either though the nurse suspects from what I said that coil is still in but moved higher up.

I was referred for a scan, which has arrived but appointment isn't for a while.

If it is found to be still inside at scan what will happen? Does it have to be removed? If not, how will they know if it's in the correct place? And how will they remove it without strings if it has to be removed?

Janet Pearce: Unfortunately, occasionally the Mirena (IUS) can move within the uterine cavity and the strings will move up with it.

The purpose of the ultrasound scan is to find out exactly where the IUS is situated. The scan may involve a scan on your lower abdomen and/or a trans vaginal scan which is a very slim ultrasound probe that is placed in the vagina which offers a better view of the uterus.

Please do not worry as this is painless and just sits in the vagina - it does not enter the uterus.

How the situation is managed will depend on the result of the scan and how your symptoms are. If the IUS is in the correct place and your pain has subsided then it may be left where it is. If you do not like the idea of not being able to feel the threads then it can be removed and replaced with an IUS with longer threads.

Similarly, the removal method will depend on where the IUS is positioned. If it is close to the neck of the womb it may be possible to remove relatively easily. However, in some cases, it may be removed under anaesthetic, but please do not worry as this would not involve any surgery.

In the meantime, if your pain gets any worse or more frequent, you should return to your GP for a more urgent referral and investigation.

Let's talk about sex

cl-nicolaturner wrote: My daughter is nine and I'm wondering when I should talk to her about periods.

I'm not sure what her school will tell her and when. Perhaps I should check that with them? I thought maybe I should answer her questions when they arise about babies and such, but it's never come up in conversation.

Janet Pearce: Some girls can start their periods as early as ten years old so it is a good idea to introduce the subject prior to them starting their periods so that it is not a shock and does not frighten them.

It is a good idea to introduce the subject a small chunk at a time. Perhaps begin with how people's bodies change as they get older, how different her body is to when she was a baby and how she is growing up and changing already.

You could have a look in book shops and libraries for age-appropriate books that will help and have a chat with her school to see what their teaching programme is.

It's important to keep it simple. Obviously you are aware of your daughter's ability to understand things and you will tailor the information accordingly. A useful tip is to think about how you felt when your periods first started and remember to try not to feel embarrassed; it is probably more embarrassing for you than it is for your daughter!

Janet Pearce qualified as a Registered General Nurse (RGN) and RSCN at the United Bristol Hospitals and has extensive experience in obstetrics, family planning, and school nursing, including delivering sex and relationship education in the classroom.

Her work involves discussing and advising on all contraceptive methods and counselling women about a wide range of concerns including sexual health and unplanned pregnancy.