Problems with your Pelvic Floor? Blame your Firstborn
While cesarean delivery may mean longer recovery time after your baby is born, it may make it less likely that someday you’ll need to cross your legs when you cough or sneeze.
A study in the Dec. 18, 2018, issue of JAMA found that women who delivered their first baby by cesarean had half the risk of developing stress urinary incontinence (which causes urine to leak when you cough or sneeze) or overactive bladder, compared with first-time moms who had a spontaneous vaginal birth.
The finding was based on first-birth information for more than 1,500 women. Of these, 778 had a cesarean and 565 had a spontaneous vaginal delivery. The remaining 185 had what’s known as an operative vaginal delivery, or one in which the doctor had to use forceps or another device to deliver a baby vaginally.
Researchers followed the women for up to nine years to determine whether they developed pelvic floor disorders. The pelvic floor is a bowl-shaped group of muscles and connective tissue in your pelvis that supports your internal organs. When those structures are weak or injured, a woman may experience urinary incontinence, pain, and other problems.
In addition to having a lower incidence of stress incontinence and overactive bladder, women who had a cesarean also had a 70% lower risk of experiencing pelvic organ prolapse compared with the vaginal birth group. In this condition, the cervix and uterus drop from the pelvic cavity into the vaginal space.
It’s important to note that pelvic floor disorders are treatable. Exercises may help strengthen the muscles to relieve some symptoms, and medication and surgery are other treatment options.
When Cancer Threatens a Woman’s Fertility
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New research out this month from the American Cancer Society and published in the online journal Cancer, finds cancer survivors carry a greater financial burden compared to people without a personal history of cancer. The study involved nationally representative samples of 10,354 cancer survivors and 124,436 individuals without a cancer history.
Given the high cost of many cancer treatments, this isn’t shocking. What deserves attention is that younger survivors experience a greater financial burden than older survivors as the financial impact of cancer on adolescent and young adult survivors is particularly long-lasting.
Approximately 70,000 young Americans are diagnosed with cancer each year. Adolescent and young adult cancer survivors are often completing their educations and launching their careers, and many have relatively low financial reserves.
A cancer diagnosis and subsequent treatment disrupt their lives in many ways, including the emergence of psychosocial needs that require appropriate resources. Adding in fertility concerns is an additional burden for some.
I know this firsthand. I was 30 years old and five weeks pregnant in 2017 when I learned I was receiving a career development grant from the National Institute of Mental Health to fund my research and continued training. It was also when I found a lump in my breast.
Diagnosed with early-stage breast cancer approximately a month later, I was very lucky to have a relatively easy treatment course, an otherwise healthy pregnancy and the ability to continue working in a job that I’m passionate about. While I’ve been fortunate in many ways, I am continuously aware that many other young adult cancer survivors aren’t so lucky.
During my training as a clinical psychologist, and before my own diagnosis, I worked with young adults with new cancer diagnoses and saw firsthand how disruptive these diagnoses and subsequent treatments could be on their lives.
Fertility preservation is a unique concern for some of these patients, and it also can come with a tremendous financial burden at an otherwise stressful time of making treatment decisions.
While several funds have been established to help ease the financial burden of cancer for these patients, policies and programs on fertility preservation continues to be an area for significant improvement.
Fertility preservation can range from (but is not limited to) freezing sperm, creating and freezing embryos or surgically moving one’s ovaries to an area that won’t be receive radiation. These procedures can cost from hundreds to tens of thousands of dollars depending on the treatment or type of preservation.
Last August, Illinois became the fifth state to require insurance coverage for fertility preservation. Unfortunately, 45 states do not have this requirement.
Surely, not all young adult cancer survivors want to have children; some of those survivors who do want to have children may choose to focus on adoption instead. Yet the argument that young patients should solely focus on building families through adoption is unwise.
My husband and I, having dated since we were 18, had long considered the pros and cons of starting a family of our own. After I finished graduate school and we were both nearing 30, we began to explore adoption as a method for building our family.
Feeling intimidated by the costly and lengthy process, as private agency adoptions typically range from $20,000 to $45,000, we decided to first try for a biological child. Being pregnant at the time of diagnosis came with challenges, but it wasn’t until months later that I learned how much more challenging it may have been if we had been in the middle of trying to adopt a child.
Challenges to cancer survivors adopting have been well-documented. Certainly there are agencies willing to work with cancer survivors, but many adoption agencies require that potential parents submit letters from their physicians indicating that they have been cancer-free for at least five years.
Pressing for widespread fertility preservation insurance coverage is a small step. However, it is a worthy step to support whole patient care and ensure that young adult survivors are supported in making fertility decisions based on their own values and wishes, rather than on their finances.
The Health Checks Every Woman Needs in her 20s, 30s, 40s and 50s
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The first rule of health care? Prevention is always better than cure. That’s why screening for common health issues is so important – it can help you catch disease early so you can address any warning signs before they get serious. But, working out which checks you need and when can be pretty confusing.
“Frequent general check-ups each year of your life stage is highly recommended for women of all ages, as our body systems change from year to year,” explains Swisse Wellness Science Expert Regina Karim MD. “A check-up typically involves talking about your medical history, family history of disease and lifestyle choices such as diet and exercise habits as well as smoking and alcohol consumption.”
Regardless of age, every woman should be checking her boobs for changes on a regular basis (think every month). Keeping an eye on your BMI is also important, along with monitoring any suss moles. For the rest, book a date with your doc. While the checks you prioritise will depend on your personal and family health history, this guide is a good place to start…
In your 20s and 30s
You’re young, active and living your best life – so health checks in your 20s and 30s are all about ensuring you safeguard your bod while you’re at it. Here’s the tests that should be on your radar:
Sexual health: If you’re sexually active, book a urine test to check for chlamydia every year. “Chlamydia can affect fertility and often doesn’t show any symptoms, so it’s important to prioritise this during your regular health checks,” says Karim.
You should also be screened for STIs whenever you start a new relationship or change sexual partners.
Cervical health: Pap smears are out but cervical screening is in – the test feels the same but it’s now recommended that women 25 and over should be screened every five years if their results are normal. You should have your first cervical screening test two years after your last Pap test.
Reproductive health: If you’re planning to have a baby, chat to your GP about any potential issues. “Tests may include ultrasound scans, urine tests and blood tests,” says Karim.
Heart health: Ask your doc to check your blood pressure “every two years if your levels are normal,” suggests Karim. “However, if they’re on the high side or if there’s a personal or family history of high blood pressure and cholesterol, stroke or heart attack, check more frequently in consultation with your GP.”
Mental health: If you experience symptoms such as intense sadness, anxiety, irritability and changes to eating and sleeping habits for more than two weeks, chat to your GP about a mental health plan.
Eyes and teeth: Get a check-up once a year, or as advised by your dentist or optometrist.
In your 40s
As you hit the big 4-0, it’s likely your metabolism will begin to slow and weight will be easier to gain and harder to shift, says Karim. Now is also the time to watch out for changes to your menstrual cycle, heart health and cancer risk. In addition to the checks above, add these to the list…
Heart health: The Australian Heart Foundation recommends a heart health check at 45 (or 35 for Aboriginal and Torres Strait Islander people). Your doc will check your blood pressure and cholesterol and ask about your lifestyle and family history to assess your risk of heart attack and stroke.
Diabetes: “Everyone should be screened for a risk of diabetes from 40 years of age,” says Karim. Your GP will use a questionnaire known as AUSDRISK for this – you can also access an online version on the Diabetes Australia website.
Breast health: Ensure you’re keeping up with your monthly self-exams and see your doctor if you notice any abnormalities such as changes to the shape of your breast, discomfort, dimpling on the skin or redness.
Eye health: Ask your optometrist for a glaucoma check.
In your 50s
You’re likely to experience menopause, which can affect bone density. “Other important health checks to consider include ongoing cancer screening as well as mammograms and urine tests to assess kidney health,” notes Karim. Don’t forget cervical screening every five years.
Breast health: “It’s recommended that women aged between 50 and 74 years who have no personal or family history of breast cancer have a mammogram every two years,” says Karim. “If you have a personal or family history of breast cancerthough, your GP may suggest alternative screening timelines.”
Bone density: As your body winds back oestrogen production, bone density will begin to decrease. Your GP can let you know if you need to have a bone density test known as a DEXA scan.
Kidney health: Add a urine test to assess kidney health to your yearly schedule.
Heart health: Instead of every two years, your regular blood pressure and cholesterol checks should now be done every year.
Bowel cancer: When you reach 50, it’s recommended that you take a faecal occult blood test (FOBT) every two years to screen for bowel cancer (yes, it means testing your poo). The National Bowel Cancer Screening Program sends free at-home sample collection kits to people over 50 in the mail, but if you haven’t received one, chat to your GP or pharmacist.
Eyes and teeth: Bump up your check-ups to every six months.
Mediterranean Diet Reduces Stroke Risk, Particularly Among Women
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Eating a Mediterranean-style diet, which is rich in fruits and vegetables, lean meats, and nuts, may help women over 40 reduce the risk of stroke, according to a study published in the journal Stroke.
The study enrolled more than 20,000 adults, ages 40 to 77, who were asked to record what they ate in a seven-day diet diary. Researchers then compared their diet and their stroke risk over a 17-year period.
People in the study whose eating most closely resembled the Mediterranean-style diet had a lower risk of stroke compared with other participants in the study. For adults over all, the risk was 17% lower, but the benefit was far larger in women than in men — 22% reduced risk for women versus 6% for men.
It’s not clear what the reason was for the difference, and researchers said the finding warrants more study.
Can You Still Get Your Period While You’re Pregnant?
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One of the perks of pregnancy—you know, other than no one judging your weird Pringles-dipped-in-hot-sauce cravings—is that your period is basically MIA for months, right?
Technically, yes. You definitely don’t menstruate (a.k.a., shed blood and tissue from your uterus) each month, but that doesn’t mean your bathroom trips will always be blood-free (which can be scary AF).
So, what if you see something that looks like your period while you’re pregnant? First: Slow your roll. Bleeding a bit during pregnancy is pretty common, but it can be dangerous. Here’s what you need to know about bleeding while pregnant.
Wait, a little bleeding while you’re pregnant is normal?
It definitely can be, says Joanne Stone, M.D., director of maternal fetal medicine at Mount Sinai Health System in New York City. “Spotting occurs in about 30 percent of pregnancies in the first trimester,” she says. While you should always check in with your doctor if you notice blood, just to be safe, spotting isn’t usually a reason for concern, she says.
The spotting can happen anytime, but typically after sex, or about three to four weeks into the pregnancy. “Some people have bleeding around the time they would have expected their period, a few weeks in,” Stone says. “This is usually due to implantation and is just a coincidence.”
But keep in mind, there’s a big difference between spotting (very light bleeding, kind of like when your period is just starting or ending) and a full-on period. That’s because you need the blood your body normally sheds during your period to nourish the embryo or fetus.
When should I be worried about bleeding while pregnant?
If you know you’re pregnant and you’re bleeding enough to fill a pad, you need to get in touch with your doctor ASAP, says Nicole Bullock, D.O., an ob-gyn in Texas. “In the first trimester, up to about 20 weeks, we worry about miscarriage with heavy bleeding,” she says.
But miscarriage isn’t the onlyexplanation: Persistent bleeding can also mean that the placenta has grown low in the cervix. While you can have a completely normal and safe pregnancy with a low-lying placenta (called placenta previa), your doctor will likely ask you to abstain from sex and may recommend bed rest in your third trimester, says Bullock.
Heavy, period-like bleeding later in your pregnancy can be a sign of something more serious like preterm labor or placental abruption (when your placenta tears away from your uterus).
But even then, you’ll be dealing with much more than just bleeding; you’ll also notice extreme pain, says Bullock. In that case, you’ll need to go the hospital where doctors will deliver the baby, she says. Still, placental abruption is extremely rare (especially if you avoid drugs and alcohol, and go to all your prenatal checkups), says Bullock.
Of course, it’s best to play it safe. So if you’ve noticed blood and you’re worried about it—and especially if you experience any pain along with it—give your ob-gyn a call. Otherwise, enjoy your short vacay from tampons.
5 Ways to Boost Bone Strength Early
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The best prevention for bone-thinning osteoporosis begins early — during the first two decades of life, when you can most influence your peak bone mass by getting enough calcium and vitamin D and doing bone-strengthening exercise. If you are over age 20, there’s no need to be discouraged. It’s never too late to adopt bone-preserving habits.
If you are a man younger than 65 or a premenopausal woman, these five strategies can help you shore up bone strength as a hedge against developing osteoporosis.
- Monitor your diet. Get enough calcium and vitamin D, ideally through the foods you eat. Although dairy products may be the richest sources of calcium, a growing number of foods, such as orange juice, are calcium-fortified. Fruits, vegetables, and grains provide other minerals crucial to bone health, such as magnesium and phosphorus.
- Maintain a reasonable weight. This is particularly important for women. Menstrual periods often stop in women who are underweight — due to a poor diet or excessive exercise — and that usually means that estrogen levels are too low to support bone growth.
- Don’t smoke and limit alcohol intake. Smoking and too much alcohol both decrease bone mass.
- Make sure your workouts include weight-bearing exercises. Regular weight-bearing exercise like walking, dancing, or step aerobics can protect your bones. Also include strength training as part of your exercise routine.
- Talk with your doctor about your risk factors. Certain medical conditions (like celiac disease) and some medications (steroids and others) can increase the chances that you will develop osteoporosis. It’s important to talk with your doctor to develop a prevention strategy that accounts for these factors.
Bring on the Zinc Oxide!
As the temperatures begin to rise and the sun starts to shine means many of us will be flocking to the nearest body of water whether that’s the neighborhood pool or the breezing beach. As I am getting ready for my beach weekend, I head to the nearest drug store to stock up on all the essentials: diet coke, snacks, trashy tabloids and of course sunscreen. I always look dumbfounded in the sunscreen aisle since there are so many to pick from and how do you know which one works best? For those with fair skin like me I burn fairy quickly after being in the sun so I’m always looking for the highest SPF to protect my skin. Many dermatologists such that any SPF over 50 doesn’t significant protect much more against UVA/UVB rays and folks using the higher SPF sunscreens and feel more protected and therefore don’t practice other protective behaviors such as wearing hats and seeking shade. However, there is a new mineral that provides your skin an additional layer of protection, zinc oxide. Zinc oxide provides a physical barrier between your skin and the sun and deflects the sun off your skin while traditional sunscreens absorb the rays. So next time you are purchasing sunscreen make sure to check out those with zinc oxide! Published by:https://upstream.mj.unc.edu/2018/05/bring-on-the-zinc-oxide/
More Pregnant Women are Using Meth and Opioids, Study Finds
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Amphetamine and opioid use in pregnancy increased substantially over the last decade in the United States, a new Michigan Medicine-led study finds. And a disproportionate rise occurred in rural counties.
Among pregnant women in all parts of the country, amphetamine-affected births (mostly attributed to methamphetamine) doubled — from 1.2 per 1,000 hospitalizations in 2008-2009 to 2.4 per 1,000 delivery hospitalizations by 2014-2015, the new research finds.
The rate of opioid use also quadrupled from 1.5 per 1,000 delivery hospitalizations in 2004-2005 to 6.5 per 1,000 delivery hospitalizations in 2014-2015, according to the findings published in the American Journal of Public Health. The study sample included about 47million deliveries occurring in U.S. hospitals over the 12-year-period.
For pregnant women with amphetamine use, the risk of severe maternal morbidity and mortality was 1.6 times the rate identified among moms with opioid use. The incidence of preterm delivery, pre-eclampsia or eclampsia, heart failure or heart attack, and need for a blood transfusion were also higher among deliveries to moms with amphetamine use compared to opioid use.
“We know from our previous research on maternal health disparities that there are disproportionately higher rates of substance affected births in rural communities,” says lead author Lindsay Admon, M.D., M.Sc., an obstetrician-gynecologist at University of Michigan Von Voigtlander Women’s Hospital and a graduate of the National Clinician Scholar’s Program at U-M’s Institute for Healthcare Policy and Innovation.
“When we looked at the specific types of substances driving this disparity, we were surprised to find that amphetamine use accounted for such a significant portion,” Admon adds, noting that few, if any, studies have examined the incidence of amphetamine use in pregnancy in the last decade.
“Our findings suggest both amphetamine and opioid use are growing public health crises that affect delivery and birth outcomes.”
Admon, the study’s senior author Tyler Winkelman, M.D., M.Sc., and colleagues also recently examined 1.3 million hospitalizations related to amphetamines in the general adult population, finding that by 2015 amphetamine-related hospitalizations were associated with higher risk for in-hospital mortality and accounted for $2.2 billion dollars in hospital costs.
Geography influences health, recovery
An estimated 82,254 delivery hospitalizations during the decade-long study period included one or more amphetamine use diagnoses and 170,164 included one or more opioid use diagnoses.
By 2014-15, amphetamine use complicated roughly 1 percent of all deliveries in the rural West (11.2 per 1,000 hospital deliveries), which was higher than the incidence of maternal opioid use in most regions. The highest incidence of maternal opioid use was identified in the rural Northeast, complicating nearly 3 percent of all deliveries (28.7 per 1,000 hospital deliveries.)
Higher proportions of patients in both substance use groups were non-Hispanic white, from lower-income communities, and had public insurance compared to other hospital deliveries.
“Early and adequate access to prenatal care for women with substance use has been shown to improve birth outcomes,” Admon says. “However, geographic disparities have a major impact on the health and well-being of pregnant women and infants. There are significant barriers to obstetric care access in many rural communities, particularly for women with substance use.”
Barriers to treatment
Determining treatment specifically for prenatal amphetamine use is also a challenge.
While there’s gold standard medical treatment for maternal opioid use, Admon says, the evidence for amphetamine use disorder treatment among pregnant women is limited. Cessation is associated with improved birth outcomes, but obstetricians could use more guidance on how to promote cessation among their patients.
Federal efforts to curb access to precursor drugs used to make meth in the mid-2000s helped reduce amphetamine use overall, Admon notes. But as new methods were used to make the drug, meth use has again spiked.
Rural areas have the double whammy of greater access to amphetamines but less access to addiction treatment services. Further complicating the matter are laws that criminalize substance use during pregnancy that may discourage women from disclosing the concern to their health provider.
Neonatal intensive care units in rural counties may also not have adequate capacity to care for babies born with neonatal abstinence syndrome, which describe health problems a baby experiences when withdrawing from exposure to narcotics.
“We have seen a significant increase in infants born with symptoms of drug withdrawal,” says Winkelman, of Hennepin Healthcare in Minneapolis and graduate of the National Clinician Scholar’s Program at U-M’s IHPI.
“We need to devote more resources to prevent and treat substance use in pregnancy, especially in low-income and rural communities.”
Neonatal abstinence syndrome accounted for $3 billion in hospital costs between 2004 and 2014, according to another study led by Winkelman and colleagues.
More intervention needed
The new U-M-led study follows Admon’s previous research, which found that pre-existing, chronic conditions among delivering women have increased substantially and are linked to adverse birth outcomes.
Prior work by Admon and colleagues also examined racial and ethnic disparities in the incidence of behavioral health conditions, including substance use disorders. Substance use were less common among African-American and Hispanic women, but, when present, were associated with a higher risk for adverse birth outcomes compared to non-Hispanic white women.
“It is critical that health providers employ universal screening for substance use early in pregnancy,” Admon says. “Optimizing access to prenatal care is a crucial mechanism to connect women with the services they need for their health and their baby’s health.”
“We need to find better ways to prevent, detect, and treat maternal amphetamine and opioid use. Developing treatment programs that can reach women in the geographic areas most affected by these epidemics is key to improving outcomes for mothers and newborns.”
Screening after Age 75
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Screening guidelines often change after age 75. If you’re in that age group, how do you decide which tests you need?
If you’re close to age 75, you may have followed the same schedule for mammograms, Pap smears, and other screening tests for decades. And if you’re like many women, you may be surprised that your physician is suggesting fewer tests or longer intervals between them. The practice seems to fly in the face of conventional wisdom. After all, the risk for many degenerative diseases increases with age, so shouldn’t older women be monitored even more closely? The answer is, “It depends on the woman.”
By age 75, there’s a growing disparity in “biological” age among women of the same chronological age. “I have patients who are quite frail and others who are in better shape than many 50-year-olds,” says Dr. Monera Wong, clinical director of the Geriatric Medicine Unit at Massachusetts General Hospital in Boston. Statistics back her up: at age 75, 25% of women live an average of 6.8 more years, 50% live an average of 11.9 more years, and 25% live an average of 17 more years.
In general, the more chronic conditions a woman has, the shorter her life expectancy. A woman who has fewer years left and is focused on her overall function may not benefit from detecting a slow-growing cancer that’s unlikely to affect the length or quality of her life, while another woman who has a longer life expectancy probably would.
How screening guidelines are developed
Screening tests are examinations aimed at detecting disease before symptoms develop. They range from simple, noninvasive tests like blood pressure measurements to procedures such as colonoscopy, which requires preparation and sedation. By detecting disease before it becomes apparent, clinicians are usually able to treat it more effectively — and often cure it.
Medical organizations want to be sure that screening tests are used appropriately — in people for whom they’ve proven most effective. Accordingly, they may conduct studies of death rates from a disease in which they compare people who’ve been screened for the disease with people in the same category (for example, the same gender, age group, or risk level) who have not been screened. These studies help health officials to assess whether and for which groups of people the potential benefit of a test outweighs the risks. The studies can also be used to calculate statistically the number of people who would need to be tested in order to save a life.
The United States Preventive Services Task Force (USPSTF), an independent panel of primary care clinicians established by the U.S. Congress, is responsible for developing federal guidelines for all screening tests (see “USPSTF screening guidelines for women ages 50 and over”). Many medical specialty societies also formulate their own guidelines. For example, the American Congress of Obstetricians and Gynecologists (ACOG) publishes guidelines for Pap smears, and both the National Cancer Institute (NCI) and the American Cancer Society (ACS) make recommendations for cancer screenings. Guidelines from these other organizations don’t always match those of the USPSTF, but you and your clinician should be able to reconcile the differences.
USPSTF screening guidelines for women ages 50 and over
|Breast cancer||Mammogram every two years, to age 74.|
|Cervical cancer||Pap smear every one to three years, to age 65.*|
|Colorectal cancer||Screening by fecal occult blood testing, sigmoidoscopy, or colonoscopy, to age 75.|
|Hearing loss||No recommendation.|
|High blood pressure||Blood pressure measurement at unspecified intervals.|
|High cholesterol||Lipid test at unspecified intervals in women with one or more heart disease risk factors.**|
|Osteoporosis||Bone density testing with dual energy x-ray absorptiometry (DXA) at unspecified intervals in women ages 65 and over.+|
|Vision loss||No recommendation.|
|*Screening may stop in women over age 65 who have had “adequate recent screenings” and are not at high risk for cervical cancer.
**Diabetes, previous heart disease, family history of cardiovascular disease before age 60 in female relatives, tobacco use, high blood pressure, and obesity (body mass index of 30 or higher).
+Screening can start at age 60 in women at increased risk for osteoporotic fractures, although the exact risk factors that should trigger screening are not clearly defined.
Source: Guide to Clinical Preventive Services, 2010–2011: Recommendations of the U.S. Preventive Services Task Force, available online at www.ahrq.gov/clinic/pocketgd.htm.
What the guidelines don’t say
The USPSTF has found that there isn’t enough evidence to recommend screening women over age 75 for certain diseases, particularly breast cancer, cervical cancer, and colorectal cancer. That doesn’t necessarily mean the screening tests aren’t effective. In many cases, there just weren’t enough older people in the studies to permit a judgment for or against screening. In other cases, screening was recommended, but the panel couldn’t determine how often it should be done.
It’s important to understand that most screening guidelines are developed for the maximum benefit of a whole population rather than the individual. They aren’t designed to consider each woman’s unique family history, state of health, and risk factors — not to mention her expectations for her future, treatment preferences, and tolerance for uncertainty. You and your clinician can work together to develop a screening schedule that’s appropriate for you. “The result should be a marriage of the expert recommendations and your wishes,” Dr. Wong says.
When you review your screening tests, you might think about what you want them to accomplish. Ideally, they should offer more benefits than risks, and they should accurately identify a disease or condition for which you are at risk and for which you are willing to be treated.
Tests likely to benefit most women
The USPSTF and other medical organizations recommend some screening tests with no age limits. These tests, listed below, offer substantial potential benefits, pose little or no risk, and are covered by Medicare:
Blood pressure measurement. This risk-free test identifies hypertension, a highly treatable condition that affects 58% of women over age 65 and is a major risk factor for both heart disease and stroke — respectively, the first and third leading causes of death in women over age 75. The USPSTF didn’t find enough evidence to recommend an optimal screening interval, but the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends blood pressure measurement at least once every two years for all adults with blood pressure less than 120/80 mm Hg — and every year for those with “prehypertension,” that is, blood pressure between 120/80 and 139/89 mm Hg.
Serum lipid profile. This blood test measures total cholesterol, HDL (good) cholesterol, and LDL (bad) cholesterol. It’s important for calculating your risk of a heart attack or stroke and essential for anyone at risk for coronary disease, the top killer of women over age 65. The USPSTF guidelines don’t specify how often a lipid profile should be done but suggest that once every five years is “reasonable” for people at low risk. However, most people in their 70s and 80s are at higher risk simply because of age alone and therefore should be tested more often.
Bone density measurement. Your risk for osteoporosis — loss of bone density great enough to increase fracture risk — mounts steadily after menopause. About 20% of women have osteoporosis at age 70, 40% at age 80, and 67% at age 90. And one in three women will have an osteoporotic fracture at some time. The gold-standard bone-density test, dual energy x-ray absorptiometry (DXA), is noninvasive, uses minimal radiation, and takes about 20 minutes. The results are evaluated along with other risk factors, and the Fracture Risk Assessment (FRAX) tool developed by the World Health Organization (www.shef.ac.uk/FRAX) may be used to predict your risk of a fracture in the next 10 years. If your FRAX score indicates a high risk, you and your clinician can discuss your options for bone building.
Tests to discuss with your clinician
The tests below aren’t recommended by the USPSTF for women over age 75; the NCI and ACS, on the other hand, don’t set age limits. If your clinician recommends any of these tests, Medicare will cover the cost:
Mammography. It may seem paradoxical, but while your cumulative radiation exposure mounts with each mammogram, your risk of a radiation-induced breast cancer actually declines with age. So does your risk of an unnecessary biopsy because of a false-positive mammogram. That means mammography itself poses few risks for a woman over age 75, so the main issue is how much treatment you would be willing to undergo should breast cancer be discovered. About 20% of breast cancers occur in women ages 75 and over, but 90% of those cancers are confined to the breast and nearby lymph nodes and are thought to be less aggressive than tumors in younger women.
Colonoscopy. This test allows a clinician to look at the lining of the entire colon and remove polyps (growths that can sometimes become cancerous). It’s the only screening test that can actually prevent cancer. No one enjoys a colonoscopy or the required prep, so it may come as a relief to learn that the USPSTF doesn’t recommend any colon cancer screening after age 75. But other organizations, including the ACS and the American College of Radiology, advise screening for everyone over age 50. The rate of colon cancer increases with age: each year, 2.5% of 75-year-olds and 3.5% of 85-year-olds are diagnosed with the disease. If you’ve had a precancerous polyp removed or have a family history of colon cancer, the risk is higher. The rate of serious complications from colonoscopy such as colon perforation or major bleeding is relatively low but also increases with age.
Pap smear. This test identifies cancer cells and abnormal cervical cells that may progress to cancer. The USPSTF recommends against screening women over age 65 who have had normal Pap smears in “adequate recent screenings” and aren’t otherwise at high risk for cervical cancer. The ACS and ACOG are a little more specific; they suggest that screenings end at age 65 or 70 in low-risk women who’ve had three consecutive normal Pap tests or no abnormal smears for 10 years. Both guidelines acknowledge the declining rate of precancerous lesions in older women and the increased risk of a false-positive test that could result in unnecessary colposcopy (microscopic exam and biopsy of the cervix). ACOG recommends that women resume Pap screening if their risk factors increase, the main one being a new sexual partner.
Other tests you might need
The USPSTF guidelines don’t mention hearing or vision screening in adults, because there’s too little evidence of their risks and benefits. However, Dr. Wong would like the panel to make recommendations because these two senses are so important in preserving function. Here’s how things stand now:
Eye exams. The American Academy of Ophthalmology recommends eye examinations every year or two, including tests for age-related macular degeneration, cataracts, diabetic retinopathy, and glaucoma. Medicare may pay for these tests; it doesn’t cover routine exams for visual acuity, although your Medicare supplementary plan may.
Hearing tests. About 80% of us have some hearing loss by the age of 80, but there’s no standardized test to detect it. As a result, only 10% to 20% of older adults who could benefit from hearing aids actually wear them. There are several ways to evaluate hearing acuity, from a simple whisper test to the use of sophisticated audiology equipment. If you’re having difficulty hearing and are willing to try using a hearing aid, your clinician should be able to suggest the appropriate tests. Medicare will probably pay for the exam but not for hearing aids. Some Medicare supplement plans include an allowance for hearing aids.
Your clinician’s “informal” screening tests
Conversation with your clinician during a routine office visit likely includes a few informal screening tests. You may be asked about your alcohol consumption, your mood, and your memory. Your candid answers can help your clinician assess your risk for substance dependence, depression, and cognitive impairment. A question about recent falls may lead to a discussion about ways to improve your balance. This kind of screening can be critical in preserving your ability to function — and your independence.
Decisions about screening illustrate one of the upsides of later-life medical care: while you may be leaving years of standardized screening tests behind, you’re receiving care tailored specifically for you.
A First: Uterine Transplant from Deceased Donor Allows Live Birth
Innovation within the field of organ transplantation has grown tremendously in the past decade. Amongst this progress is a new story of success from São Paolo, Brazil.
A new study, revealed that for the first time ever, a baby was delivered via a uterus which had been transplanted from a deceased donor. The mother had an abnormality which rendered her infertile, and resultantly needed a transplanted uterus in order to conceive and give birth. This has been done before with living donors, but never had it been done with a deceased donor. The mother delivered the baby in c-section to a health newborn baby. Now, almost a year later, the child has continued to live a healthy, normal life.
This example is especially unique because of the donor. When transplanting from a deceased donor, there are always several hours of transport and surgery which leave the organ without oxygen. In this case, the uterus went without oxygen for nearly 8 hours. Dr. Andrew Shennan, an obstetrics professor at Kings College London noted the rareness and importance of this case in particular. This study demonstrated that the uterus can remain functioning and intact despite this 8-hour period. This information is invaluable, and can inform other operations in the future.
Published by: https://upstream.mj.unc.edu/category/womens-health/
Boy Or Girl? It’s In The Father’s Genes
A Newcastle University study involving thousands of families is helping prospective parents work out whether they are likely to have sons or daughters.
The work by Corry Gellatly, a research scientist at the university, has shown that men inherit a tendency to have more sons or more daughters from their parents. This means that a man with many brothers is more likely to have sons, while a man with many sisters is more likely to have daughters.
The research involved a study of 927 family trees containing information on 556,387 people from North America and Europe going back to 1600.
“The family tree study showed that whether you’re likely to have a boy or a girl is inherited. We now know that men are more likely to have sons if they have more brothers but are more likely to have daughters if they have more sisters. However, in women, you just can’t predict it,” Mr Gellatly explains.
Men determine the sex of a baby depending on whether their sperm is carrying an X or Y chromosome. An X chromosome combines with the mother’s X chromosome to make a baby girl (XX) and a Y chromosome will combine with the mother’s to make a boy (XY).
The Newcastle University study suggests that an as-yet undiscovered gene controls whether a man’s sperm contains more X or more Y chromosomes, which affects the sex of his children. On a larger scale, the number of men with more X sperm compared to the number of men with more Y sperm affects the sex ratio of children born each year.
Sons or daughters?
A gene consists of two parts, known as alleles, one inherited from each parent. In his paper, Mr Gellatly demonstrates that it is likely men carry two different types of allele, which results in three possible combinations in a gene that controls the ratio of X and Y sperm;
- Men with the first combination, known as mm, produce more Y sperm and have more sons.
- The second, known as mf, produce a roughly equal number of X and Y sperm and have an approximately equal number of sons and daughters.
- The third, known as ff produce more X sperm and have more daughters.
“The gene that is passed on from both parents, which causes some men to have more sons and some to have more daughters, may explain why we see the number of men and women roughly balanced in a population. If there are too many males in the population, for example, females will more easily find a mate, so men who have more daughters will pass on more of their genes, causing more females to be born in later generations,” says Newcastle University researcher Mr Gellatly.
More boys born after the wars
In many of the countries that fought in the World Wars, there was a sudden increase in the number of boys born afterwards. The year after World War I ended, an extra two boys were born for every 100 girls in the UK, compared to the year before the war started. The gene, which Mr Gellatly has described in his research, could explain why this happened.
As the odds were in favour of men with more sons seeing a son return from the war, those sons were more likely to father boys themselves because they inherited that tendency from their fathers. In contrast, men with more daughters may have lost their only sons in the war and those sons would have been more likely to father girls. This would explain why the men that survived the war were more likely to have male children, which resulted in the boy-baby boom.
In most countries, for as long as records have been kept, more boys than girls have been born. In the UK and US, for example, there are currently about 105 males born for every 100 females.
It is well-documented that more males die in childhood and before they are old enough to have children. So in the same way that the gene may cause more boys to be born after wars, it may also cause more boys to be born each year.
How does the gene work?
The trees (above) illustrate how the gene works. It is a simplified example, in which men either have only sons, only daughters, or equal numbers of each, though in reality it is less clear cut. It shows that although the gene has no effect in females, they also carry the gene and pass it to their children.
In the first family tree (A) the grandfather is mm, so all his children are male. He only passes on the m allele, so his children are more likely to have the mm combination of alleles themselves. As a result, those sons may also have only sons (as shown). The grandsons have the mf combination of alleles, because they inherited an m from their father and an f from their mother. As a result, they have an equal number of sons and daughters (the great grandchildren).
In the second tree (B) the grandfather is ff, so all his children are female, they have the ff combination of alleles because their father and mother were both ff. One of the female children has her own children with a male who has the mm combination of alleles. That male determines the sex of the children, so the grandchildren are all male. The grandsons have the mf combination of alleles, because they inherited an m from their father and f from their mother. As a result, they have an equal number of sons and daughters (the great-grandchildren).
Heart Attacks Increasingly Common in Young Women
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New research finds a worrying trend in the incidence of heart attacks in recent decades. The results indicate that young women are more likely than young men to need hospitalization for heart attacks, as well as to develop other cardiometabolic conditions.
Cardiovascular disease — an umbrella term that covers different types of conditions that affect the heart or blood vessels, including coronary heart disease, stroke, congenital heart defects, and peripheral artery disease causes about 1 in 3 deaths in the United States.
However, there are sex differences in the prevalence of some cardiovascular events, such as coronary heart disease — a cardiovascular condition that can ultimately lead to heart attacks.
An established body of research has shown that coronary heart disease is more prevalent among men at any age, which may have led to the common perception that “heart disease is a man’s disease.”
However, more recent studies have started to point out an “alarming” trend, which is a steady increase in the number of young women who die of coronary heart disease.
Now, new research, presented at the American Heart Association’s Scientific Sessions meeting in Chicago and subsequently published in the journal Circulation, adds to the mounting evidence that heart attacks are increasingly common among young women.
Dr. Sameer Arora, a cardiology fellow at the University of North Carolina School of Medicine, Chapel Hill, is the lead author of the study.
Dr. Arora and colleagues examined data on almost 29,000 people aged 35–74 years old who doctors admitted to hospital for acute myocardial infarction between 1995 and 2014.
The researchers found that the proportion of young patients who doctors admitted to the hospital for a heart attack “steadily increased, from 27 [percent] in 1995–1999 to 32 [percent] in 2010–2014.”
The study also found that this increase was even more substantial in women. Namely, 21 percent of the heart attack hospital admissions were of young women at the beginning of the study, but this proportion jumped to 31 percent by the end.
Additionally, the research revealed that young women were less likely than young men to receive cardiovascular treatments, such as antiplatelet drugs, beta blockers, coronary angiography, or coronary revascularization.
The study’s lead author comments on the findings, saying, “Cardiac disease is sometimes considered an old man’s disease, but the trajectory of heart attacks among young people is going the wrong way […] It’s actually going up for young women.”
“This is concerning,” continues Dr. Arora. “It tells us we need to focus more attention on this population.”
Dr. Arora explains why cardiologists and other healthcare professionals need to pay more attention to women’s cardiovascular health.
“Traditionally, coronary artery disease is seen as a man’s disease, so women who come to the emergency department with chest pain might not be seen as high-risk,” he says.
“Also, the presentation of heart attack is different in men and women. Women are more likely to present with atypical symptoms compared to men, and their heart attack is more likely to be missed.”
Dr. Ileana L. Piña, a cardiologist and professor of medicine and epidemiology at the Montefiore Medical Center in New York City, also chimes in on the findings.
She says that the results are “another wake-up call to physicians, especially male physicians” to take better care of women’s heart health.
Published by: https://www.medicalnewstoday.com/articles/323669.php
Nutrition During Pregnancy
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How can I plan healthy meals during pregnancy?
The United States Department of Agriculture has made it easier to plan meals during pregnancy by creating www.choosemyplate.gov. This website helps everyone from dieters and children to pregnant women learn how to make healthy food choices at each mealtime.How does MyPlate work?
With MyPlate, you can get a personalized nutrition and physical activity plan by using the “SuperTracker” program. This program is based on five food groups and shows you the amounts that you need to eat each day from each group during each trimester of pregnancy. The amounts are calculated according to your height, prepregnancy weight, due date, and how much you exercise during the week. The amounts of food are given in standard sizes that most people are familiar with, such as cups and ounces.
What are the five food groups?
- Grains—Bread, pasta, oatmeal, cereal, and tortillas are all grains.
- Fruits—Fruits can be fresh, canned, frozen, or dried. Juice that is 100% fruit juice also counts.
- Vegetables—Vegetables can be raw or cooked, frozen, canned, dried, or 100% vegetable juice.
- Protein foods—Protein foods include meat, poultry, seafood, beans and peas, eggs, processed soy products, nuts, and seeds.
- Dairy—Milk and products made from milk, such as cheese, yogurt, and ice cream, make up the dairy group.
Although they are not a food group, oils and fats do give you important nutrients. During pregnancy, the fats that you eat provide energy and help build many fetal organs and the placenta. Most of the fats and oils in your diet should come from plant sources. Limit solid fats, such as those from animal sources. Solid fats also can be found in processed foods.
Vitamins and minerals play important roles in all of your body functions. During pregnancy, you need more folic acid and iron than a woman who is not pregnant.
Taking a prenatal vitamin supplement can ensure that you are getting these extra amounts. A well-rounded diet should supply all of the other vitamins and minerals you need during pregnancy.
Folic acid, also known as folate, is a B vitamin that is important for pregnant women. Before pregnancy and during pregnancy, you need 400 micrograms of folic acid daily to help prevent major birth defects of the fetal brain and spine called neural tube defects. Current dietary guidelines recommend that pregnant women get at least 600 micrograms of folic acid daily from all sources. It may be hard to get the recommended amount of folic acid from food alone. For this reason, all pregnant women and all women who may become pregnant should take a daily vitamin supplement that contains folic acid.
Iron is used by your body to make a substance in red blood cells that carries oxygen to your organs and tissues. During pregnancy, you need extra iron—about double the amount that a nonpregnant woman needs. This extra iron helps your body make more blood to supply oxygen to your fetus. The daily recommended dose of iron during pregnancy is 27 mg, which is found in most prenatal vitamin supplements. You also can eat iron-rich foods, including lean red meat, poultry, fish, dried beans and peas, iron-fortified cereals, and prune juice. Iron also can be absorbed more easily if iron-rich foods are eaten with vitamin C-rich foods, such as citrus fruits and tomatoes.
Calcium is used to build your fetus’s bones and teeth. All women, including pregnant women, aged 19 years and older should get 1,000 mg of calcium daily; those aged 14–18 years should get 1,300 mg daily. Milk and other dairy products, such as cheese and yogurt, are the best sources of calcium. If you have trouble digesting milk products, you can get calcium from other sources, such as broccoli; dark, leafy greens; sardines; or a calcium supplement.
Vitamin D works with calcium to help the fetus’s bones and teeth develop. It also is essential for healthy skin and eyesight. All women, including those who are pregnant, need 600 international units of vitamin D a day. Good sources are milk fortified with vitamin D and fatty fish such as salmon. Exposure to sunlight also converts a chemical in the skin to vitamin D.
The amount of weight gain that is recommended depends on your health and your body mass index before you were pregnant. If you were a normal weight before pregnancy, you should gain between 25 pounds and 35 pounds during pregnancy. If you were underweight before pregnancy, you should gain more weight than a woman who was a normal weight before pregnancy. If you were overweight or obese before pregnancy, you should gain less weight.
Overweight and obese women are at an increased risk of several pregnancy problems. These problems include gestational diabetes, high blood pressure, preeclampsia, preterm birth, and cesarean delivery. Babies of overweight and obese women also are at greater risk of certain problems, such as birth defects, macrosomia with possible birth injury, and childhood obesity.
Although there have been many studies on whether caffeine increases the risk of miscarriage, the results are unclear. Most experts state that consuming fewer than 200 mg of caffeine (one 12-ounce cup of coffee) a day during pregnancy is safe.
Omega-3 fatty acids are a type of fat found naturally in many kinds of fish. They may be important factors in your fetus’s brain development both before and after birth. To get the most benefits from omega-3 fatty acids, women should eat at least two servings of fish or shellfish (about 8–12 ounces) per week before getting pregnant, while pregnant, and while breastfeeding.
Some types of fish have higher levels of a metal called mercury than others. Mercury has been linked to birth defects. To limit your exposure to mercury, follow a few simple guidelines. Choose fish and shellfish such as shrimp, salmon, catfish, and pollock. Do not eat shark, swordfish, king mackerel, marin, orange roughy, or tilefish. Limit white (albacore) tuna to 6 ounces a week. You also should check advisories about fish caught in local waters.
Food poisoning in a pregnant woman can cause serious problems for both her and her fetus. Vomiting and diarrhea can cause your body to lose too much water and can disrupt your body’s chemical balance. To prevent food poisoning, follow these general guidelines:
- Wash food. Rinse all raw produce thoroughly under running tap water before eating, cutting, or cooking.
- Keep your kitchen clean. Wash your hands, knives, countertops, and cutting boards after handling and preparing uncooked foods.
- Avoid all raw and undercooked seafood, eggs, and meat. Do not eat sushi made with raw fish (cooked sushi is safe). Food such as beef, pork, or poultry should be cooked to a safe internal temperature.
Listeriosis is a type of food-borne illness caused by bacteria. Pregnant women are 13 times more likely to get listeriosis than the general population. Listeriosis can cause mild, flu-like symptoms such as fever, muscle aches, and diarrhea, but it also may not cause any symptoms. Listeriosis can lead to miscarriage, stillbirth, and premature delivery. Antibiotics can be given to treat the infection and to protect your fetus. To help prevent listeriosis, avoid eating the following foods during pregnancy:
- Unpasteurized milk and foods made with unpasteurized milk
- Hot dogs, luncheon meats, and cold cuts unless they are heated until steaming hot just before serving
- Refrigerated pate and meat spreads
- Refrigerated smoked seafood
- Raw and undercooked seafood, eggs, and meat.
Don’t fall for these skin myths
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Think you know a lot about skin and skin care? You might be surprised at how much “common knowledge” about keeping your skin clear and healthy is simply not true.
Here, we debunk 10 common myths about skin.
1. The right skin cream can keep your skin looking young.
There are hundreds of skin treatments that claim to help you look younger or slow the aging process. For reducing wrinkles, the topical treatment with the best evidence behind it is retinoic acid (as in Retin-A). Many over-the-counter products contain retinoic acid, but it’s difficult to say if one is better than another. But the best ways to keep wrinkles at bay are using sunscreen and not smoking.
2. Antibacterial soap is best for keeping your skin clean.
Skin normally has bacteria on it. It’s impossible to keep your skin completely free of bacteria for any amount of time. In fact, many experts are concerned that the use of antibacterial soap could lead to more antibiotic-resistant bacteria. Antibacterial soap is not necessary for everyday use. Regular soap is fine. Thorough and consistent hand-washing, not antibacterial soap, is what helps prevent the spread of infection.
3. Eating chocolate or oily foods causes oily skin and acne.
The truth is that an oily substance called sebum causes acne. It’s made and secreted by the skin. In fact, there’s no evidence that any specific food causes acne.
4. Tanning is bad for you.
Spending an excessive amount of time in the sun or in a tanning booth can increase skin cancer risk, especially if sunscreen is not used. Skin cancer risk is correlated with total lifetime sun exposure and frequency of sunburns. Excessive tanning can also damage skin, causing it to wrinkle and age prematurely.
But developing a light or gradual tan through repeated, but careful, sun exposure isn’t dangerous. As long as you’re taking precautions — such as using a sunscreen of at least SPF 30, applying it thoroughly and reapplying when necessary, and avoiding peak sun exposure times — a light tan with no burning isn’t a warning sign.
5. Tanning is good for you.
People often associate a dark tan with the glow of good health. But there’s no evidence that tanned people are healthier than paler people. Sun exposure does have a health benefit, though. Sunlight activates vitamin D in the skin. Vitamin D helps keep bones strong, and may also lower the risk of certain cancers and boost immune function. Depending on how much vitamin D you’re getting in your diet, a lack of sun exposure could increase your risk of vitamin D deficiency.
6. The higher the SPF of your sunscreen, the better.
Above a certain level, a higher sun protection factor (SPF) has little added benefit compared with a lower SPF. Experts generally recommend using sunscreen with an SPF of at least 30, which blocks out 97% of UVB radiation. It may be worth a higher SPF if you’re planning to be outside for more than two to three hours, especially during hours of peak sun exposure (10 a.m. to 2 p.m.). But in most circumstances, a higher SPF may not be worth the extra cost.
7. A scar that is barely noticeable is the mark of a good surgeon.
The true skill of a surgeon is demonstrated by what he or she does between making and closing the incision. While surgeons routinely pay more attention to incisions on the face (using thinner suture, making stitches closer together, or avoiding the use of sutures altogether if possible), the appearance of a scar tells you little about the skill of your surgeon.
8. Vitamin E will make scars fade.
There’s little evidence to support this claim. Talk to your surgeon or dermatologist if you have concerns about the appearance of a scar. There are many options for improving the appearance of scars, including laser treatments.
9. Crossing your legs causes varicose veins.
There are a number of risk factors for varicose veins, but crossing your legs is not one of them. Heredity is one of the most important — an estimated 80% of people with varicose veins have a parent with the same condition. Other things that make a person prone to varicose veins include smoking, inactivity, high blood pressure, pregnancy, obesity, and having a job that requires prolonged standing. If you already have varicose veins, elevating your legs and using compression stockings may be helpful. But keeping your legs “uncrossed” won’t prevent or improve the condition.
10. Scalp massage can prevent baldness.
There’s simply no evidence that scalp massage prevents baldness, tempting as it is to believe.
If you see something unusual on your skin or have concerns about how to keep your skin healthy, talk to your doctor or dermatologist. And if you hear someone repeating these skin myths, you can set them straight.
Screening Guidelines for Women: Incontinence and Cervical Cancer
Older women: Take note of two new screening guidelines. One is for cervical cancer screening. Recommendations from the U.S. Preventive Services Task Force, published online Aug. 21, 2018, by the Journal of the American Medical Association, suggest that many women ages 30 to 65 can now approach cervical cancer screening in several ways: they can get a cervical cytology (Pap) test every three years; a test for human papillomavirus (which causes most cervical cancer cases) every five years; or they can get a combination of both tests every five years. If you’re older than 65, the USPSTF recommends against screening unless you haven’t had adequate tests before or you’re at high risk for cervical cancer. The other screening guidelines are for urinary incontinence. They come from the Women’s Preventive Services Initiative and were published online Aug. 14, 2018, by Annals of Internal Medicine. The guidelines recommend that women get screened for incontinence yearly, regardless of age. “I completely agree with brief annual screening for urinary incontinence for women. A simple question can be used to screen for it, such as, ‘Do you have any bothersome urinary incontinence or urinary leaking during the day or night?’ If the incontinence is treated early, in some cases, it will not progress and the patient will be able to avoid more invasive, costly, risky, or time-consuming treatment options,” says Dr. May Wakamatsu, vice chair of gynecology services at Harvard-affiliated Massachusetts General Hospital.
Peeing Blood Is Definitely Not Normal
Seeing blood in the toilet after peeing isn’t exactly a shocking event.Women get periods; periods equals blood; end of story.
But uh, what if that blood in the toilet or on your toilet paper doesn’t really look like the period kind say, if your urine is a pinkish, reddish, or brownish color, or you see spots of red blood in your stream (and you’re nowhere near that time of the month).
First: Don’t freak but don’t brush it off, either. Seeing blood in your urine is never a normal thing, so finding out what’s going on a.k.a., getting to a doctor ASAP should be the first thing on your list.
So…why might there be blood in my pee?
For starters, this has a medical name: hematuria, and, according to the?National Institute of Diabetes and Digestive and Kidney Diseases, there are two types: gross hematuria (when you can actually see blood in your urine) and microscopic hematuria (when the blood isn’t visible to the naked eye, but can be detected under a microscope).
There are a few reasons why you might suddenly have blood-laced pee. The likeliest causes are kidney stones small, but hard masses that can form in your kidneys and pass through your urine and your fave, urinary tract infections (UTIs), says Jennifer Linehan, M.D., urologist and associate professor of urologic oncology at the John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, Calif.
In some cases, vigorous exercise (think: running a marathon, not taking a Soul Cycle class), can cause you to have blood in your urine too, though it’s pretty rare and typically only happens in professional athletes, says Linehan.
Other, less frequent causes of bloody urine include endometriosis (when endometrial tissue grows outside of the uterus in this case, the bladder), an infection in the bladder or kidneys (or the prostate, for men), and in very rare cases, bladder or kidney cancer, says Linehan.
So…do I need to see a doctor about my bloody urine?
Um, yes please. Again, peeing blood is never okay or normal, says Linehan.
That’s true whether you’re having bloody pee with no other symptoms, or if it comes along with things like a burning sensation or pain in your back.
“If it’s to the point where you’re seeing the blood in your urine, you need to get it checked out, says Linehan. It could be an infection and advancing to the kidneys,” which could result in more complications like kidney failure or chronic kidney disease, per the NIDDK.
When you see your doctor, they’ll likely do a physical exam (i.e., pressing on your abdomen to check for tender areas), as well as a urinalysis (a.k.a. a pee test) to look for an infection, like a UTI, says Linehan.
If that’s all clear, you may then need to get an MRI or CT scan to see if you have kidney stones or (again, in rare cases) a tumor, she adds.
And if you couldn’t already guess: There is nothing you can and should do for this at home, other than grab your car keys and book it to the doctor, even if the internet tells you otherwise.
11 Reasons Why Your Period Is Suddenly Lasting Forever
Let’s not be coy here: Bleeding out of your vagina every single month is already kind of a pain, so when your period decides to extend its visit a little longer than usual, it can be downright infuriating?and concerning, TBH.
Honestly, there’s a pretty big range of normal when it comes to your period’s length (a typical one can last between two to seven days). If your period is a day or two more or less than your usual, and you don’t see any other issues (like extreme menstrual pain or very heavy bleeding), you likely don’t need to be concerned.
But and there’s always a but, isn’t there if your period lasts 10 days or more, or suddenly changes significantly in length for three or more cycles in a row, that warrants a call to your ob-gyn, says Tom Toth, M.D., a reproductive endocrinologist at?Boston IVF.
Still, there’s no need to panic?most causes of prolonged menstrual bleeding (like most of the ones below) aren’t a big deal and can be fixed or improved with the help of your doctor, says Toth.
1. You have an IUD.
One of the most common causes of long periods in younger women are intrauterine devices (IUDs), a type of birth control placed directly into your cervix. There are two main types: a non-hormonal, copper-based IUD (like Paraguard), and a hormonal, progestin-based IUD (like Mirena and Skyla).
If prolonged periods last more than 3 cycles, go see your doctor.
It turns out that both can cause abnormally long bleeding, especially right after insertion, Toth says. Longer,heavier periods are a known side effect of the copper IUD. The progestin IUD, however, is often marketed to women as a way to reduce or even eliminate their periods. And while it typically does have that effect over time, the first few cycles may have more or longer bleeding than usual, he says.
With either IUD, if the prolonged periods don’t settle down after three cycles, it’s time to go back to your doctor, as it’s possible the IUD moved out of position or simply doesn’t play nice with your body.
2. You’re actually ovulating.
Menstruation is your body’s way of getting rid of the extra blood and tissue it saved up in case your egg got fertilized and there’s a baby, but sometimes the hormonal signals get crossed and you can bleed when you release the egg too, says Sherry Ross, MD, an ob-gyn and author of She-ology.
That’s called “intermenstrual bleeding,” and it occurs when the slight dip in estrogen that happens around ovulation causes some spotting. If the bleeding lasts a few days or happens close to the end of your last cycle, it may seem like your period is continuing forever. It’s not normally something to worry about, but if it changes suddenly or if you have serious pain, it’s time to see your doctor.
3. You’re pregnant (yes, really).
Wait just a second: Isn’t the tell-tale sign of pregnancy no periods? Yes, but not all the time, Toth says. “A common cause for abnormal menses, including longer bleeding, is pregnancy,” he explains, adding that typical symptoms of pregnancy, like nausea, may be absent. “Any time a woman has unusual bleeding, it’s always best to eliminate possibility of pregnancy with a blood test for pregnancy for reassurance,” he says.
4. You’re on hormonal birth control.
Anything that manipulates your hormones has the potential to make your periods longer, says Toth. This includes all types of hormonal birth control like the pill, patches, rings, shots, and implants. The good news is that there are lots of options with varying levels and types of hormones, so if your body doesn’t respond well to one type or dosage, there’s a good chance you can find a different one that will work.
The length of your period is just one factor your doctor will use to help you determine which type of birth control works best for you.
5. You had an early miscarriage.
The only sign? An extra-heavy or long period. Your menstrual cycle length should return to normal within one to two cycles if it stays abnormally long after three cycles, call your doctor, Toth says. About one in 100 women suffer from repeat miscarriages, so it’s important to rule out a condition that affects fertility like endometriosis.
6. You have PCOS.
Polycystic ovary syndrome (PCOS) affects about 10 percent of women of childbearing age, per the OWH. It’s named for the cysts that grow on the ovaries, preventing eggs from maturing, and often making the woman infertile.
PCOS also wreaks havoc on hormone levels, causing weight gain, excess hair growth, and yes, prolonged periods, Toth says. You’d think that not ovulating would give you a free pass on bleeding, but the opposite is often true, he adds?no egg means long, wacky cycles.
If you’re experiencing super-long periods along with?other signs of PCOS, like migraines, facial hair growth, and weight gain, talk to your ob-gyn about getting tested for the condition.
7. You have thyroid issues.
One in eight women will suffer from low thyroid function, or hypothyroidism, at some point in their lives, according to?the OWH
Your thyroid is a little butterfly-shaped gland that controls the hormones that regulate many systems in your body, including how fast you burn calories, how fast your heart beats, and yes, menstruation. Having too little thyroid hormone can cause your period to be super long and heavy, they explain.
Other symptoms of hypothyroidism include weight gain, fatigue, and hair loss, so if you’re experiencing any of those, along with longer-than-normal periods, bring it up to your doctor, says Ross.
8. You have an underlying blood disorder.
It’s rare, but it’s possible that extra-long periods are a sign of an underlying illness, like a hematologic (blood) disease, says Toth. Some of these, like hemophilia or Von Willebrand disease, are genetic, so if you have this you likely already know about it.
Still, if your periods are lasting a super-long time, and you’ve already been cleared for other conditions, it’s worth checking in with your doctor about tests to rule out a blood disorder that you might not be aware of.
9. You have uterine polyps or fibroids.
“Uterine abnormalities, such as polyps or fibroids, can cause prolonged periods because they distort the endometrial cavity which can lead to increased blood flow,” Toth explains. Basically, your body senses something in your uterus that isn’t supposed to be there, and tries extra hard to get rid of it.
Abnormal periods can also be a sign of cervical cancer.
Polyps and fibroids sound scary, but they’re pretty common up to 80 percent of women will have at least one before they’re 50, per the Office on Women’s Health?(OWH). On their own, they don’t indicate a serious disease, like cancer.
These benign growths often don’t have any symptoms, and if they do, it’s usually prolonged periods, says Toth. Most likely your doc will just recommend keeping an eye on them, but if they cause pain or grow very large they can be surgically removed.
10. You have diagnosed cervical cancer.
Abnormal vaginal bleeding such as bleeding after vaginal sex, bleeding and spotting between periods can be a sign of cervical cancer. (Yet another reason to check in with your doctor if you notice something strange going on with your period.)
Because cervical abnormalities can be detected through Pap and HPV tests, make sure you stay on top of those, and always tell your doctor about your family history of female cancers.
11. Your body’s gearing up for menopause.
Oh yes, simply getting older can mess with your period. Menopause, which technically means you’ve gone 12 or more months without a period, hits women around age 50. However, your body starts the natural decline in hormones that leads up to menopause (a.k.a. perimenopause) as early as 35, says Christiane Northrup, M.D., author of Women?s Bodies, Women?s Wisdom.
When this happens, you may notice your periods getting longer or shorter, your cycle becoming more random, and other slight changes in your menstruation.
If you’ve ruled out everything else, and you’re in your mid- to late- thirties, your prolonged periods might simply be due to the natural process of aging. There is, however, such a thing as early menopause, which can affect women even in their twenties, so talk to your doctor if this runs in your family or if you’re showing other signs of menopause, like a low sex drive or insomnia.
5 Signs Of Breast Cancer That Have Nothing To Do With Lumps
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When Meghan Hall, 34, was diagnosed with breast cancer, it wasn’t because she (or a doctor) felt a lump.
“I noticed something green spilled on the front of my shirt, I didn’t think anything of it until I tried to take it off and realized it was stuck to my nipple,” says Meghan. “My breast was leaking green fluid.”
That’s right: Meghan’s breast cancer symptom was green fluid leaking from her nipples and her experience isn’t unique. According to preliminary research presented at the UK National Cancer Research Institute’s (NCRI) 2016 conference, one in six women who discovered their cancer themselves caught it based on a less-obvious symptom, like nipple abnormalities and weight loss (a.k.a. not a lump).
These self-reported cancers especially ones that don’t involve the typical lump highlight why it’s so important to pay attention to any strange symptoms or changes you may be experiencing, in addition to staying on top of your mammograms and annual checkups, says Neelima Denduluri, M.D., the associate chair of The U.S. Oncology Network Breast Committee.
Instead, it’s best to examine your breasts as a whole keeping track of what they normally feel and look like so you can report any changes to your doc, whether they’re cancer or not, she adds. Here’s what to look out for besides lumps:
1. Dimply, scaly, patchy, or inflamed skin
You know your boobs and all their little quirks (like how Leftie fills out your bra so much better than Rightie) so if you notice any changes to their normal appearance, pay attention, says Debra Patt, M.D., ob-gyn and breast cancer expert with Texas Oncology, a practice in The US Oncology Network.
“Any unusual thickening, redness, rash, dimpling, or puckering of your breast skin, or around the nipple, should be checked out by your doctor,” she explains.
2. Nipple changes
Only mannequins have perfect, pointy, well-behaved nipples; real, human women have to deal with different colors and sizes, positions, textures, and (gasp) hair.
Fortunately all of these things are totally normal and not a problem as long as they’re your normal, says Denduluri. For example, if your nips have always been inverted, that’s just how you’re shaped, but if they change suddenly, going from pointy to fully or partially inverted, call your doctor stat. Any change in your nipples, including their color and texture, needs to be checked to rule out cancer, she says.
Oh, and BTW, hairy nipples on women have nothing to do with cancer and are totally normal one in three women have nipple hair, even if they won’t admit it, she adds.
3. Nipple discharge
Is there anything more alarming than having your breasts start squirting liquid when there’s no baby involved? “It’s normal to have some leakage during pregnancy, while breastfeeding, and up to a year after weaning your baby, but if you notice any discharge any other time it needs to be evaluated by a doctor,” says Patt.
Random discharge, especially if it’s red or green or has an odor, can mean you have a problem, including cancer of the breast or the pituitary gland, she explains.
4. Painful swelling
Swollen and painful breasts are, well, a pain?and while they’re mainly due to hormonal changes (like PMS or pregnancy), they can be linked to breast cancer.
It’s all about the size and placement of the tumor, says Patt, which can be responsible for a change in the size or shape of your breast, or cause of painful swelling. While the vast majority of women who report breast pain do not have cancer, if breast pain and swelling isn’t linked to your menstrual cycle, you’re not breastfeeding, and it appears suddenly or doesn’t go away, give your doctor a call because whatever is happening needs to be addressed, adds Patt.
5. Changes that aren’t related to your boobs at all
Back pain, neck pain, and unexplained weight loss were all listed as other symptoms that led women to seek medical care and ultimately get diagnosed with breast cancer, according to the NCRI study.
That’s because breast cancer can spread before it’s caught, causing symptoms in body parts that have nothing to do with your boobs. It’s not possible to identify every possible sign of breast cancer (or, rather, that list would be way too long to be meaningful) so when it comes to early detection, you are your own best weapon, says Denduluri. Overall, any persistent, noticeable change should be checked by a doctor
11 Reasons Why Your Face Looks So Swollen
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So you woke up looking like a puffer fish, huh?
Before you blame those cocktails during dinner last night wait, did you even have cocktails during dinner? know that an actual medical issue could be to blame for your swollen face.
The reasons your face is swollen can vary widely but luckily, there’s something you can do about most of them.
1. You’ve got a nasty sinus infection.
If the lining of your sinuses the air-filled spaces between the eyes and behind your forehead, nose, and cheekbones becomes inflamed or infected, they can get clogged with mucus. The pressure caused by that backup causes a dull ache around your eyes, greenish-yellow discharge from your nose, pounding headaches and sometimes, a swollen face.
Most of the time, the infection is caused by a virus (translation: you don’t need antibiotics just wait it out). Focus on resting, drink lots of fluids, and try an over-the-counter antihistamine, says Rosalyn Stewart, M.D., associate professor of medicine at Johns Hopkins University School of Medicine
2. You have an abscessed tooth.
Having a cracked or chipped tooth or an untreated cavity can allow bacteria to sneak into the pulp the soft innards of your tooth, where they can multiply, says Stewart. The abscess (a.k.a. infection) results in a collection of pus (ew) and swelling around the tooth or gums. Translation: You?ll have a wicked toothache and jawline swelling.
Your dentist can prescribe antibiotics and will likely have to perform a root canal to remove the infected nerve; in the meantime, saltwater rinses and over-the-counter painkillers can make you more comfortable.
3. You have Cushing’s syndrome.
Yes, cortisol is a stress hormone, but it also helps regulate your blood pressure, blood sugar, and a slew of other things. When too much of it gets pumped out by your adrenal glands, it can lead to Cushing’s syndrome, a condition characterized by a round, moon-shaped face, skin that bruises easily, and thicker or more body hair.
Cushing’s affects women nearly three times more often than men, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and often crops up in people who have been on glucocorticoids, which help inflammation, per the NIDDK.
Left untreated, Cushing’s syndrome can lead to heart attack, stroke, and type 2 diabetes, among other medical issues, says he NIDDK
4. You’re allergic to something.
Beyond causing red eyes and a rapidly emptying tissue box, an allergic reaction to food, pollen, a medication, or any other substance can cause facial inflammation, especially around your eyes and nose, says Stewart.
Luckily there’s a quick fix: over-the-counter allergy meds can help dial down inflammation and reduce swelling.
5. You have a secret sunburn.
Yep, it’s possible to get a sunburn even if you don’t feel like you’ve been soaking up rays. “Ultraviolet light exposure from your everyday activities adds up, says Joshua Zeichner, M.D., director of cosmetic and clinical research in dermatology at Mount Sinai Hospital. Not only can this cause redness, but in some cases swelling, as well.
Nix your chances of getting a sunburn by applying sunscreen daily. And if you’ve already gotten a sunburn, Zeichner suggests applying a light moisturizing lotion to soothe and hydrate your skin. If the burn is uncomfortable or doesn’t improve in a few days, visit a dermatologist for professional treatment.
6. You have cellulitis.
Nope, we’re not talking dimpled skin here (that’s cellulite). Cellulitis is a bacterial skin infection that can cause your face (or anywhere else on your body, tbh)to rapidly inflate and become hot and red, says Stewart.
If you develop these symptoms and especially if the swelling spreads high-tail it to the emergency room, stat. Left untreated, the illness can be deadly. And it’s relatively easy to treat a weeklong course of antibiotics should clear it up.
7. You’ve got the mumps.
Sounds old school, but this highly contagious illness is actually making a (scary) comeback. If you come down with mumps, you’ll likely have a headache, fever, and muscle aches, in addition to telltale chipmunk cheeks, according to the U.S. National Library of Medicine.
If your doc confirms the condition through a saliva swab or blood test, your only choice is to wait it out. Most cases resolve in a few weeks, per the Centers for Disease Control and Prevention.
8. Your thyroid might be out of whack.
The butterfly-shaped gland in your throat pumps out a hormone that regulates your metabolism and body temperature. If it’s producing too little, metabolic changes can cause your subcutaneous tissues (a.k.a the stuff underneath your skin) to get bigger. Everything fills out a little, says Stewart, referencing overall swelling.
You’ll probably also feel chilly and weak and may notice that you have dry skin or that your periods have become irregular. Don’t freak: Your doctor can run a simple blood test and prescribe medication if necessary.
9. You have pink eye.
If the swelling is focused around your eye area, then you might be dealing with conjunctivitis (a.k.a., good ol’ pink eye), a nasty infection or inflammation of the membrane lining the eyelids.
Most causes of conjunctivitis are due to viruses, but it can also be triggered by allergies, bacteria, or even your contact lenses, says Kristamarie Collman, M.D., an Atlanta-based family medicine physician and health expert. In addition to swelling, you may also have redness, tearing, or itchy eyes.
Collman says treatment for pink eye will depend on the type could be a viral or bacterial infection. “Viral conjunctivitis is typically treated with supportive therapy to include cool compresses and artificial tears for comfort,” she says. “For a bacterial conjunctivitis, it will require antibiotic eye drops.”
10. You have rosacea.
If you have rosacea (whether you know it or not), certain triggers can lead to a flare-up, Zeichner says. Hot weather, spicy foods, alcohol, and even emotional stress can all lead to facial flushing, burning, and even swelling.
Zeichner says a gentle cleanser, moisturizer, and a daily application of sunscreen can help keep rosacea symptoms in check. Your dermatologist can also give you a prescription for a cream or pill that can help calm inflammation related to the condition.
11. You’re taking a steroid.
If you have been prescribed one of these bad boys, then your puffy face might be the result of that condition mentioned earlier called mom face chirag Shah, M.D., a board-certified emergency medicine physician and co-founder of Accesa Labs. While the presence of moon face might be an indicator of an underlying medical condition like Cushing’s disease, it can also be the result of taking prescribed steroid and higher doses could lead to more significant side effects.
If you are struggling on a dose of steroids, then you should discuss with your doctor the possibility of reducing the dosage. Possible good news? Actress Sarah Hyland who has been on prednisone as a result of a lifelong kidney condition swears by using a face roller to reduce the appearance of a puffy face.