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Chapter Summary Menstruation The menstrual cycle is regulated by hormones, brain structures, and reproductive organs. Attitudes toward menstruation remain somewhat negative, despite evidence that physical and psychological performances do not change meaningfully over the menstrual cycle. Some women experience menstrual joy, a feeling of heightened creativity and energy. A small minority of women experience the symptoms of premenstrual syndrome (PMS). Contraception Contraceptive use has increased among adolescents, but many use contraceptives sporadically or not at all. The type of contraception chosen by women changes as their reproductive goals change. Abortion Most abortions occur within the first trimester by means of the vacuum aspiration method. Early abortion is physically safe and generally has no negative psychological aftereffects. Pregnancy Physical effects of pregnancy include nausea, fatigue, and weight gain. Women have both positive and negative feelings during pregnancy. People may react negatively to a pregnant woman. Most miscarriages result from genetic defects in the embryo or fetus. The teenage pregnancy rate is higher in the United States than in most industrialized nations, but the teenage birth rate is declining, probably due to increased condom use. Teen pregnancy has serious economic, social, and medical costs. Programs stressing a combination of abstinence, contraception, and life skills can delay sexual activity and reduce pregnancy rates. Childbirth The three stages of childbirth are dilation of the cervix, birth of the baby, and expulsion of the placenta. Rates of cesarean delivery and induction of labor are high in the United States. Family-centered approaches to childbearing include the Lamaze method, home birth, birthing rooms and centers, and use of midwives. Older women have more difficulty conceiving but generally have healthy babies. Many women experience maternity blues shortly after giving birth. A small percentage of women experience the more severe postpartum depression and postpartum psychosis. About 15 percent of infertile couples have tried reproductive technologies, such as in vitro fertilization, frozen embryos, donor eggs, and surrogate motherhood. Reproductive Functioning in Midlife and Beyond Menopause, caused by a decrease in estrogen production, causes hot flashes and vaginal dryness but is not linked to heightened psychological distress. Menopausal experiences and attitudes differ across ethnic and cultural groups. Middle-aged women usually have positive attitudes toward menopause. Benefits of hormone replacement therapy (HRT) include decrease in menopausal symptoms and decrease in the risk of osteoporosis and colon cancer. Risks of HRT include increased risk of heart attack, stroke, breast and ovarian cancer, gall bladder disease, and urinary incontinence. Alternatives to HRT include synthetic estrogens and phyto-estrogens.