Frequently Asked Questions

Most medical guidelines recommend that the first gynecological visit take place between the ages of 13 and 15. Typically, this is a conversation rather than a physical exam—an opportunity for young women to ask questions in a safe and confidential environment, without pressure.

If there are symptoms such as pelvic pain, heavy bleeding, foul-smelling discharge, or a delayed first period, an earlier exam is recommended.

For most girls, their first period starts between the ages of 8 and 15, with the average age being around 12. It is normal for cycles to be irregular in the first few years as the body adjusts to hormonal changes.

If the first period has not started by the age of 15, or if signs of puberty appear delayed or absent, a check-up is necessary. In most cases, this provides reassurance rather than a diagnosis.

Some pain and cycle irregularity are common in the first year or two after menstruation begins. However, pain that regularly prevents a girl from going to school, pain that worsens over time, or consistently heavy bleeding should not be considered normal.

Conditions such as endometriosis can manifest as early as adolescence. Early evaluation can provide real help for long-term health and, for some young women, future fertility.

Heavy menstrual bleeding in teenage girls is often related to the body's natural hormonal adaptation, but bleeding disorders such as von Willebrand disease are an important and often overlooked cause.

An exam is necessary if bleeding lasts more than 7 days, soaks through pads or tampons quickly, causes symptoms of anemia such as fatigue or dizziness, or is heavy right from the start.

Yes. Thin, clear, or white discharge is a normal part of puberty and usually appears 6 to 12 months before the first period. It is a sign of normal hormonal development. It is reassuring when there is no itching, burning, foul odor, or pelvic pain.

If the discharge is yellow, green, or gray, has a foul odor, or is accompanied by discomfort, it is advisable to have it evaluated. Parents should also seek an exam if fever or bleeding occurs, or if the discharge appears in a very young child.

Discharge is more concerning when it is yellow, green, or gray, has a strong or fishy odor, or is accompanied by itching, burning, pain during urination, or pelvic discomfort. Common causes include bacterial vaginosis, yeast infections, and in sexually active girls, sexually transmitted infections.

Color alone is not sufficient for a diagnosis—symptoms, medical history, and appropriate tests are essential. A gynecological evaluation can quickly establish the cause so that the correct treatment can be started on time.

Premenstrual syndrome (PMS) is a group of physical and emotional symptoms that appear in the days or weeks before menstruation and usually subside after bleeding begins. Symptoms can include irritability, mood swings, anxiety, bloating, breast tenderness, fatigue, and difficulty concentrating.

These symptoms are real and manageable. If they significantly impact daily life or school attendance, it is worth discussing them with a doctor, rather than assuming they just have to be endured.

A delayed first period should be evaluated if it has not occurred by age 15, or if signs of puberty, such as breast development, have not appeared by age 13. An earlier evaluation is also appropriate in the presence of fatigue, unexplained weight changes, or unusual discharge.

In most cases, the exam provides reassurance. When further testing is needed, an earlier evaluation means earlier answers and, if necessary, earlier support.

Yes. Hormonal contraceptives are frequently prescribed to young women to manage heavy or painful periods, acne, or irregular cycles—not just to prevent pregnancy. The decision is always individualized and takes into account the young woman's health history, symptoms, and preferences.

A consultation can clarify the available options, explain what each approach involves, and help make an informed decision.

An urgent exam is necessary for severe or sudden pelvic pain, fever accompanied by genital symptoms, very heavy or unexpected bleeding, new lesions or sores, or discharge accompanied by significant pain or signs of systemic illness.

When in doubt, it is better to schedule an exam sooner rather than later. A timely evaluation leads to faster answers and avoids unnecessary anxiety.

If you are under 35 and have been trying to conceive for more than 12 months without success, a fertility evaluation is recommended. If you are 35 or older, 6 months is sufficient. If you are over 40 or have a known condition such as endometriosis, irregular cycles, or a history of fertility problems, it is better not to wait.

An early consultation can help you understand your situation clearly, review any tests that have already been done, and avoid unnecessary delays.

Yes. Male and female factors contribute equally to difficulty conceiving, and testing both partners from the beginning provides a more complete picture. Delaying the male evaluation frequently leads to a loss of valuable time and, in some cases, to a missed diagnosis that radically changes the treatment plan.

See also the "Men's Health and Fertility" section for more information regarding the male side of fertility evaluation.

A standard first consultation usually includes a complete reproductive history, an evaluation of ovulation, an ultrasound examination of the pelvic organs, testing for fallopian tube patency (HSG), and a semen analysis for the partner.

Additional tests are added depending on the clinical picture. If you have previous results, bring them—the goal is to build upon what is already known, not to start everything from scratch.

Fertility begins to decline gradually around age 30 and drops more rapidly after the mid-30s. By age 40, the chance of natural conception is significantly reduced, and the success rate of IVF also decreases with age.

However, age is not the only factor. Ovarian reserve, the condition of the uterus, hormones, and the partner also play a role. A proper evaluation provides a more complete and individualized picture and helps avoid both unnecessary panic and unnecessary waiting.

IVF is a treatment method in which eggs are retrieved, fertilized outside the body in a laboratory, and the resulting embryos are transferred to the uterus. It is applied for a wide range of problems, including blocked tubes, male factor infertility, endometriosis, and unexplained infertility.

IVF is not necessarily the first or only option. A consultation can help determine whether it is suitable for your specific situation or if simpler treatment methods should be discussed.

The most common reasons are related to embryo quality—which is closely linked to age—uterine or uterine cavity factors affecting implantation, tubal problems such as hydrosalpinx, and the involvement of the male factor. Even in a well-managed cycle, not every embryo implants.

If the cycle was not successful, a thorough review before repeating treatment is highly recommended. Repeating the same plan without investigating the causes is often not the most effective approach.

A hysteroscopy is a procedure in which a thin camera is inserted into the uterus to evaluate the uterine cavity directly. It can detect and treat polyps, adhesions, fibroids, or structural abnormalities that ultrasound examinations sometimes miss or underestimate.

Routine hysteroscopy before every IVF cycle is not recommended, but when there is a clinical reason to suspect a uterine problem—especially after multiple failed transfers—it can provide information that significantly changes the treatment plan.

Egg freezing preserves your eggs now for possible future use. It is considered by women wishing to delay pregnancy for personal or professional reasons, or by those who are about to undergo medical treatment affecting fertility. Success rates are generally higher when freezing before the age of 38.

Egg freezing is not a guarantee of future pregnancy, but it can be a valuable option at the right time. A consultation can help you understand your current ovarian reserve and whether now is the right time.

Yes. Endometriosis is one of the most common causes of fertility problems and can affect the ovaries, tubes, and the environment around the uterus. It can be present without obvious symptoms, which is why assessment is important even when pain or cycles appear relatively normal.

Assessment usually begins with medical history, symptoms, and an ultrasound. A thorough fertility review will include an evaluation of the risk of endometriosis and guidance towards appropriate treatment options.

The most useful documents are the complete stimulation protocol and medication details, hormone results, data on retrieved and fertilised eggs, embryo assessments or genetic testing reports, transfer documentation, uterine imaging, semen analyses, and surgical history. In the case of more than one failed cycle - bring documents from all of them.

A thorough review of the previous cycle can reveal what influenced the outcome and guide towards the most appropriate approach before a new attempt.

Perimenopause is a transitional phase in which oestrogen levels begin to fluctuate and menstruation undergoes changes in duration, frequency, or heaviness. Menopause is reached after 12 consecutive months without a period.

Many of the symptoms women associate with menopause - hot flashes, mood changes, sleep disturbances - can appear significantly before this 12-month threshold, sometimes years earlier. Understanding which phase of the transition you are in helps guide the right approach.

Natural menopause most commonly occurs between the ages of 45 and 55, with the average age being around 51–52. The experience is highly individual - some women go through the transition with few symptoms, while for others the years leading up to menopause can be quite challenging.

If symptoms are affecting your quality of life at any stage of the transition, they deserve proper medical attention, not simply patient endurance.

Early menopause means the cessation of menstruation before the age of 45. Premature ovarian insufficiency (POI) is a separate condition in which ovarian function is impaired before the age of 40, and can sometimes be intermittent rather than permanent.

Both have important implications for bone health, cardiovascular health, and future pregnancy options. In both cases, seeking specialist advice is strongly recommended, rather than relying on self-treatment or a wait-and-see approach.

The most common symptoms include hot flashes, night sweats, sleep disturbances, mood changes, brain fog, vaginal dryness, reduced libido, urinary changes, and irregular periods. They can appear years before menstruation stops and vary significantly in severity.

Medical assessment is particularly important for severe symptoms affecting daily life, for bleeding that becomes heavier rather than lighter, or for any bleeding after 12 months without a period. There is no need to simply endure these changes — effective treatment options exist.

The severity of symptoms varies considerably and is influenced by the nature of hormonal fluctuations, individual sensitivity, sleep disturbances, mental health, and overall health and lifestyle. The exact mechanism behind some symptoms — particularly mood changes — is not yet fully understood.

What is important is that your symptoms are real, they are not a sign of weakness, and they deserve proper assessment. Various treatment approaches exist - both hormonal and non-hormonal.

In most healthy women over 45, a menopause diagnosis is made primarily on the basis of age, symptoms, and menstrual history - routine blood tests are not always necessary or more informative than a careful clinical assessment.

In women aged 40–45 with symptoms, or in any woman under 40 in whom early menopause is suspected, FSH testing is recommended. A specialist can assess whether tests are necessary and what additional information they would provide.

HRT is the most effective treatment for menopause symptoms. For most women under 60 without significant contraindications, the benefits are considered to outweigh the risks. Current NICE guidelines and leading menopause societies support its use in appropriate patients.

The decision is always individual and takes into account symptoms, age, personal medical history, and the presence of oestrogen-sensitive cancers or clotting disorders in the patient's history.

When symptoms are caused by vasomotor disturbances such as night sweats, HRT can be very effective in suitable patients. Cognitive behavioural therapy (CBT) has a strong evidence base for managing mood, anxiety, and sleep during menopause.

Practical measures - regular physical activity, reducing alcohol intake, and regulating bedroom temperature - also contribute significantly. If symptoms are considerably affecting daily life, the right approach is a thorough assessment by a specialist, rather than continuing to self-treat.

Premature ovarian insufficiency (POI) is the loss of normal ovarian function before the age of 40. The diagnosis is made on the basis of symptoms such as absent or infrequent periods, combined with elevated FSH levels confirmed on two separate blood tests taken 4 to 6 weeks apart. A single result is not sufficient for the diagnosis.

Early consultation with a specialist is important due to the implications for bone health, cardiovascular health, and future pregnancy options.

A specialist consultation is appropriate for early or premature menopause, for symptoms that are difficult to manage despite initial treatment, for uncertainty regarding HRT, for a complex medical history, or for persistent sleep disturbances, urological, sexual, or mental health symptoms affecting daily life.

There is no need to wait until things become very difficult. An early consultation with Dr. Shefketova can help you understand which stage of the transition you are in and how to approach the next period with a clear and personalised plan.

Yes. Fertility is a couple's matter, not just the woman's. Male factors contribute to difficulties conceiving in a significant proportion of cases, and a semen analysis is one of the main first tests for a reason. Early testing of both partners saves lost time and provides a clearer and more complete treatment plan.

There is no benefit in delaying male testing while only the female partner undergoes extensive investigations.

A semen analysis examines the number, concentration, motility, and morphology of sperm, as well as semen volume. It can also show signs of infection or inflammation. The WHO provides standardised laboratory methods for semen testing so that results can be interpreted consistently across different clinics.

It is the primary first test in the assessment of male fertility and, together with the reproductive history, forms the foundation of any male investigation.

Most clinics recommend 2 to 5 days of abstinence from ejaculation before providing the sample. The sample must be collected and delivered according to the clinic's instructions, usually within a specified timeframe. Illness, fever, or significant stress in the weeks prior to the test may affect the results.

More than one test may be necessary, as sperm parameters can vary between individual samples — a single result is not always sufficient for a clinical decision.

A low sperm count (oligospermia) means there are fewer sperm than expected in the semen. This does not necessarily mean that conception is impossible, but it may reduce the chance of natural conception and influences the choice of treatment. When no sperm are found in the semen, this is called azoospermia.

Before treatment decisions are made, a repeat test and a full medical assessment including reproductive history and physical examination are usually required.

Poor motility (asthenozoospermia) means that fewer sperm move well enough to reach and fertilise an egg. It can be associated with infection, varicocele, heat exposure, lifestyle factors, or hormonal problems.

In IVF, poor motility may necessitate the recommendation of intracytoplasmic sperm injection (ICSI), where a single sperm is injected directly into the egg. The underlying cause should be investigated wherever possible.

A varicocele is an enlarged vein in the scrotum, similar to a varicose vein in the leg. It can increase testicular temperature and impair sperm production or quality. Not every varicocele causes fertility problems, but it is one of the most common treatable causes of male infertility.

Scrotal ultrasound can confirm the diagnosis during a male fertility evaluation. Whether treatment is recommended depends on sperm quality, symptoms, and the couple's overall fertility picture.

Yes. Testosterone therapy and anabolic steroids can significantly suppress natural sperm production. In some men, the semen contains very few sperm, while in others, none are detected at all. The effect sometimes persists for months after discontinuation.

Any current or past use of testosterone, anabolic steroids, hormone-containing fitness supplements, or prescribed hormonal medications must be disclosed during a fertility consultation, even if it was some time ago.

Yes. Smoking, alcohol consumption, obesity, poor sleep, heat exposure to the testicles—from laptops, saunas, or tight clothing—and certain medications and drugs can affect sperm quality. Anabolic steroids are particularly harmful and should be avoided entirely when attempting to conceive.

Lifestyle changes do not correct every cause of male infertility, but they are often part of the treatment plan. Maintaining a healthy weight, reducing alcohol, and quitting smoking have the strongest evidence base.

Hormonal tests may be recommended in cases of very low sperm count, reduced libido or sexual function, unusual pubertal history, or signs of hormonal imbalance. Genetic testing may be recommended in cases of extremely low sperm concentration or their complete absence from the semen.

These tests are not a routine part of every initial examination—they are added based on the clinical presentation and the results of initial tests.

Sometimes, yes. Treatment depends on the underlying cause and may include treating an infection, surgical correction of a varicocele, managing hormonal problems, addressing ejaculation disorders, sperm retrieval, intrauterine insemination (IUI), IVF, or ICSI. In cases where no sperm are found in the semen, surgical retrieval may allow the couple to proceed with IVF and ICSI.

The right path becomes clear after a thorough evaluation of both partners. Many causes of male infertility can be overcome when they are correctly and timely identified.