Intermenstrual bleeding is bleeding at times other than menstrual flow. In a normal [ovulatory cycle](https://nabtahealth.com/news/cycle-monitoring-with-ovusense/), one [ovum](https://nabtahealth.com/glossary/ovum/) is released from the [ovaries](https://nabtahealth.com/glossary/ovaries/); if fertilization does not occur, the [ovum](https://nabtahealth.com/glossary/ovum/) and a part of thickened endometrial tissue (endometrium is the inner layer of the [uterus](https://nabtahealth.com/glossary/uterus/)) are sloughed off with the beginning of menstruation. [Menstrual cycles](https://nabtahealth.com/article/what-is-abnormal-uterine-bleeding/) usually range between 21 and 35 days in length, although most women begin their periods around 10-14 days following [ovulation](https://nabtahealth.com/glossary/ovulation/). If the person is not using hormonal contraception, menstruation a regular intervals indicates that [ovulation](https://nabtahealth.com/glossary/ovulation/) has occurred, and the person is not pregnant. Usually, the amount of blood discharged is less than 80 ml. What is Abnormal Uterine Bleeding? ---------------------------------- Bleeding outside the normal menstrual cycle in a woman female who is not on hormones, for instance, bleeding before day 20 of the cycle is [abnormal uterine bleeding](https://nabtahealth.com/article/what-is-abnormal-uterine-bleeding/). Bleeding between periods has explicitly been variously described as intermenstrual bleeding. It is estimated that 14-17% of women bleed between periods. If anyone gets vaginal bleeding after stopping hormones or after [menopause](https://nabtahealth.com/glossary/menopause/) are also considered as abnormal uterine bleeding. Causes of Intermenstrual Bleeding --------------------------------- **Age and Developmental Stage**: On the occasions of younger girls who have just started going through menstruation, it is very typical for them to possess irregular cycles. This may take as much as six years to get the cycle right. Similarly, during [perimenopause](https://nabtahealth.com/glossary/perimenopause/)\-a transition stage before [menopause](https://nabtahealth.com/glossary/menopause/)\-the irregularity of the cycle occurs because of changes in levels of hormones. **Spotting vs. Heavy Bleeding**: First and foremost, distinguish between spotting and heavy bleeding. Light bleeding, or spotting, may occur in early pregnancy or as a side effect of hormonal birth control and is generally not a concern. Heavy bleeding can be indicative of structural problems, such as [polyps](https://nabtahealth.com/glossary/polyps/), uterine a or [fibroids](https://nabtahealth.com/glossary/fibroids/), or hormonal imbalances contributing to ovulatory dysfunction. **Structural Abnormalities**: Heavy bleeding during periods may be caused by living conditions such as [polyps](https://nabtahealth.com/glossary/polyps/) and [fibroids](https://nabtahealth.com/glossary/fibroids/). Monitoring hormone levels, specifically estrogen and [progesterone](https://nabtahealth.com/glossary/progesterone/) levels, is recommended in heavy bleeding as it may point to endocrine disorders. **Infection**: Infection along the reproductive tract may cause bleeding from the [vagina](https://nabtahealth.com/glossary/vagina/). In most instances, the body clears the infection itself; however, medical consultation may be helpful to avoid future complications, such as scarring of the affected area, which can reduce fertility. **Cancer**: This is rarely the cause, but intermenstrual bleeding can be a sign of cancer, such as that of the [cervix](https://nabtahealth.com/glossary/cervix/), endometrium, or [vagina](https://nabtahealth.com/glossary/vagina/). Medical advice must be sought to rule out these severe conditions. What causes intermenstrual bleeding? ------------------------------------ Anemia: Heavy bleeding between periods carries some primary risks, one of which is anemia, an outcome of blood loss that results in a deficiency of hemoglobin in the blood. Anemia-related symptoms include fatigue, dizziness, headaches, and irregular heartbeat. It can be treated with [iron](https://nabtahealth.com/glossary/iron/) supplements. If the anemia is severe, someone might need a [blood transfusion](https://nabtahealth.com/glossary/blood-transfusion/). **Impact on Fertility**: Whether intermenstrual bleeding results in [infertility](https://nabtahealth.com/glossary/infertility/) depends upon the cause. Hormonal imbalances may affect [ovulation](https://nabtahealth.com/glossary/ovulation/) and, hence, make conception tough. Structural causes make fertilization difficult. Single episodes of intermenstrual bleeding may not result in any difference in fertility, but frequent episodes diminish this opportunity. Persistent bleeding between periods does not necessarily need to be ignored. Although related to common issues such as hormonal fluctuations or structural problems, the problem can denote other severe conditions in certain instances. It requires timely diagnosis, and only a proper investigation by a healthcare provider will determine the cause and recommended treatment. The first thing to consider is whether **age** may be contributing. ------------------------------------------------------------------- [Irregular periods](https://nabtahealth.com/articles/why-are-my-periods-irregular/) are very common in girls who have only just started their periods. In fact, it can take up to six years for the menstrual cycle to become regular. Thus, whilst it is worth monitoring dates and timings, irregularities in menstruation in females of this age are rarely anything to be concerned about. Abnormal cycles are also frequently seen in women who are approaching the [menopause](https://nabtahealth.com/glossary/menopause/). The years that precede the [menopause](https://nabtahealth.com/glossary/menopause/) are known as the [](https://nabtahealth.com/about-the-three-stages-of-menopause/)[perimenopause](https://nabtahealth.com/glossary/perimenopause/). It is during these years that [ovulation](https://nabtahealth.com/glossary/ovulation/) starts to slow down and menstruation becomes irregular, then sporadic, before ceasing altogether. It is also important to establish the **type of bleeding**; whether it is heavy and period-like, or spotting. Spotting is light, there will not be enough to fill a tampon or pad, and the blood will usually be dark red or brown. It can happen during pregnancy (particularly in the early stages when the fertilised egg first implants) and as a side effect to [hormonal birth control](https://nabtahealth.com/articles/what-types-of-hormonal-birth-control-are-there/). Spotting is not usually anything to worry about and can simply be an indication that not all of the endometrial tissue was removed during menstruation. Monitor any spotting and if it is consistent and becoming heavier see your doctor. Heavy bleeding between periods can be caused by structural abnormalities, such as [](https://nabtahealth.com/what-are-uterine-polyps/)[polyps](https://nabtahealth.com/glossary/polyps/) and [](https://nabtahealth.com/a-simple-guide-to-fibroids/)[fibroids](https://nabtahealth.com/glossary/fibroids/); or hormonal imbalances causing ovulatory dysfunction. If you are experiencing heavy intermenstrual bleeding your doctor may want to check your [oestrogen](https://nabtahealth.com/glossary/oestrogen/) and [](https://nabtahealth.com/what-happens-if-my-progesterone-levels-are-too-low/)[progesterone](https://nabtahealth.com/glossary/progesterone/) levels across your cycle to identify whether you have an endocrine disorder. Another cause of intermenstrual bleeding is **infection**. [Vaginal bleeding](https://nabtahealth.com/articles/i-keep-bleeding-between-periods-is-this-normal/) can be a symptom of an [infection of the reproductive tract](https://nabtahealth.com/causes-of-female-infertility-infection). Often the body is able to clear infections without the need for medical intervention; but you should still consult a doctor for confirmation and to ensure that there will be no lasting negative effects. In severe cases, infection-induced scarring of the reproductive organs can result in difficulties in conceiving. In rare cases, intermenstrual bleeding can be a sign of **cancer**. _Abnormal bleeding_ between periods can be a symptom of [cervical](https://nabtahealth.com/cervical-cancer-symptoms/), [endometrial](https://nabtahealth.com/a-guide-to-endometrial-cancer/) or vaginal cancer. You should consult a doctor, who will be able to perform the necessary tests to rule this out as a possibility. The health risks of intermenstrual bleeding ------------------------------------------- One of the main health risks of [heavy bleeding](https://nabtahealth.com/articles/what-can-i-do-to-regulate-my-periods/) between periods is [anaemia](https://nabtahealth.com/glossary/anaemia/). The symptoms of [anaemia](https://nabtahealth.com/glossary/anaemia/) are fatigue, headaches, dizziness and an irregular heartbeat. It can be treated with [iron](https://nabtahealth.com/glossary/iron/) supplements. You may also wonder whether frequent episodes of intermenstrual bleeding will have an effect on fertility. This will largely depend on the reason for the bleeding. If fluctuating hormone levels are responsible, you may experience difficulty conceiving because your hormones need to be present at exactly the right levels for [](https://nabtahealth.com/causes-of-female-infertility-failure-to-ovulate)[ovulation](https://nabtahealth.com/glossary/ovulation/) to occur. Likewise, [structural barriers](https://nabtahealth.com/causes-of-female-infertility-structural-issues-with-the-reproductive-tract) can impede fertilisation. If the bleeding occurs as a single episode, you are unlikely to [fall pregnant](https://nabtahealth.com/articles/calculate-if-im-pregnant/) that cycle, but may find that your fertility is actually enhanced during the cycle that follows. Subsequent cycles should not be affected. Repetitive episodes of intermenstrual bleeding probably will lower your overall chances of conceiving. No woman should have to put up with _persistent bleeding_. It can be draining from a financial, physical and emotional perspective. Diagnosis may have to be made via a process of elimination, but it is essential that doctors consider all eventualities and perform the necessary tests, so that the right treatment can be instigated. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#3b425a57575a7b555a594f5a535e5a574f5315585456) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * “Abnormal Uterine Bleeding (Booklet).” ReproductiveFacts.org, The American Society for Reproductive Medicine, [www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/abnormal-uterine-bleeding/](http://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/abnormal-uterine-bleeding/). Revised 2012. * Crawford, Natalie M., et al. “Prospective Evaluation of the Impact of Intermenstrual Bleeding on Natural Fertility.” Fertility and Sterility, vol. 105, no. 5, May 2016, pp. 1294–1300., doi:10.1016/j.fertnstert.2016.01.015. * Shapley, M, et al. “An Epidemiological Survey of Symptoms of Menstrual Loss in the Community.” The British Journal of General Practice, vol. 54, no. 502, May 2004, pp. 359–363. * “Vaginitis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 13 Nov. 2019, [www.mayoclinic.org/diseases-conditions/vaginitis/symptoms-causes/syc-20354707](http://www.mayoclinic.org/diseases-conditions/vaginitis/symptoms-causes/syc-20354707). * Whitaker, L, and H O D Critchley. “Abnormal Uterine Bleeding.” Best Practice & Research. Clinical Obstetrics and Gynaecology, vol. 34, July 2016, pp. 54–65., doi:10.1016/j.bpobgyn.2015.11.012.
Your new baby has arrived, and you are eager to get back into shape. However, [losing weight after pregnancy](https://nabtahealth.com/articles/7-healthy-eating-tips-for-postpartum-weight-loss/) takes time and patience, especially because your body is still undergoing many hormonal and metabolic changes. Most women will lose half their baby weight by 6-weeks postpartum and return to their pre-pregnancy weight by 6 months after delivery. For long-term results, keep the following tips in mind. Prior to beginning any diet or exercise, [please consult with your physician](https://nabtahealth.okadoc.com/). 1\. **Dieting too soon is unhealthy.** Dieting too soon can delay your recovery time and make you more tired. Your body needs time to heal from labor and delivery. Try not to be so hard on yourself during the first 6 weeks postpartum. 2\. **Be realistic**. Set realistic and attainable goals. It is healthy to lose 1-2 pounds per week. Don’t go on a strict, restrictive diet. Women need a minimum of 1,200 calories a day to remain healthy, and most women need more than that — between 1,500 and 2,200 calories a day — to keep up their energy and prevent mood swings. And if you’re nursing, you need a bare minimum of 1,800 calories a day to nourish both yourself and your baby. 3\. **Move it**. There are many benefits to exercise. Exercise can promote weight loss when combined with a reduced calorie diet. Physical activity can also restore your muscle strength and tone. Exercise can condition your abdominal muscles, improve your mood, and help prevent and promote recovery from postpartum depression. 4\. **Breastfeed**. In addition to the many benefits of breastfeeding for your baby, it will also help you lose weight faster. Women who gain a reasonable amount of weight and breastfeed exclusively are more likely to lose all weight six months after giving birth. Experts also estimate that women who breastfeed retain 2 kilograms (4.4 pounds) less than women who don’t breastfeed at six months after giving birth. 5\. **Hydrate**. Drink 8 or 9 cups of liquids a day. Drinking water helps your body flush out toxins as you are losing weight. Limit drinks like sodas, juices, and other fluids with sugar and calories. They can add up and keep you from losing weight. 6. **Don’t skip meals**. Don’t skip meals in an attempt to lose weight. It won’t help, because you’ll be more likely to binge at other meals. Skipping meals will also make you feel tired and grouchy. With a new baby, it can be difficult to find time to eat. Rather than fitting in three big meals, focus on eating five to six small meals a day with healthy snacks in between. 7\. **Eat the rainbow.** Stock up on your whole grains, fruits, and vegetables. Consuming more fruits and vegetables along with whole grains and lean meats, nuts, and beans is a safe and healthy diet. ose weight after postpartum Is one of the biggest challenge women face worldwidely. Different Expertise and studies indicated that female might lose approximately 13 pounds’ weight which is around 6 KG in the first week after giving birth. The essential point here is that dieting not required for losing the weight, diet often reduce the amount of some important vitamins, minerals and nutrients. **Here are seven tips from the professional nutritionist perspective that can be considered for losing weight after postpartum these are;** 2\. Considered food like fish, chicken, nuts, and beans are excellent sources of protein and nutrients. 3\. A healthy serving of fat, such as avocado, chia seeds or olive oil 4\. With the balance diet please consider to drink plenty of water to stay hydrated. 5\. Regular exercise helps to shed extra pounds and improve overall health. 6\. Fiber-rich foods should be included to promote digestive health and support weight loss efforts. 7\. Don’t forget about self-care. By making these dietary changes and incorporating physical activity, you can achieve postpartum weight loss sustainably and healthily. **Sources:** * Center for Disease and Control and Prevention * Healthy Weight: it’s not dieting, it’s a lifestyle. Obstetrics and Gynecology * The risks of not breastfeeding for mothers and infants. The American College of Obstetrics and Gynecologists * Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. Powered by Bundoo®
Food-borne illnesses do not discriminate — anyone can become sick. Raw oysters have earned a reputation as a potentially dangerous food. Also, some groups of people have a [greater risk of serious illness](https://nabtahealth.com/articles/is-fish-oil-safe-for-children/) than others, including children. Eating raw oysters comes with the risk of being exposed to Vibrio vulnificus, a potentially life-threatening bacteria. Young children, those under 5 years of age, are more susceptible to food-borne illness because their immunity isn’t fully developed. Here are some facts you should know before you give your young child raw oysters: ##### What will happen if my child eats a contaminated oyster? In reality, allowing your [child to eat](https://nabtahealth.com/articles/is-it-safe-for-toddlers-and-children-to-eat-raw-oysters/) raw oysters might have zero consequences, no matter how many he or she eats. Unlike other bacteria, V. vulnificus cannot be smelled, seen, or tasted. There is no way to determine if the raw oyster is safe to eat. V. vulnificus cannot be killed by a lot of hot sauce, nor are you guaranteed safety by letting your child just try one or two oysters. If your [child eats a raw oyster](https://nabtahealth.com/articles/is-it-safe-for-toddlers-and-children-to-eat-raw-oysters/) that is contaminated with V. vulnificus, it is important to be familiar with the signs and symptoms of food poisoning. In generally healthy people, V. vulnificus can cause vomiting, diarrhea, and abdominal pain. In some cases, it can become worse and infect the blood (invasive septicemia) resulting in fever, chills, and septic shock. V. vulnificus is a serious cause for concern because about half of people who contract the blood infection die. If you are suspicious of food poisoning and/or your child has symptoms, get in touch with your healthcare provider, or even head to the ER. ##### What should I do? To be safe, you may want to hold off on feeding your child raw oysters for a few years, or at least until he or she is five years of age. If oysters are a staple in your household, or a special treat here and there, make sure to thoroughly cook a few for your little one to try. Cooking (prolonged exposure to high heat) is the only way to kill the bacteria and make sure you and your family will be safe. Get yourself a [coach](https://nabtahealth.com/product/conscious-motherhood-coaching-session/) and learn more. **Sources:** * Food & Drug Administration * Raw Oyster Myths. Powered by Bundoo®
Ovarian torsion occurs when the ovary rotates, either completely or partially, hindering blood flow and causing acute abdominal pain. It is a rare condition, but is potentially very serious as, if left untreated, it can cause permanent damage to the ovary and [](https://nabtahealth.com/articles/causes-of-female-infertility-environmental-lifestyle-factors/)[infertility](https://nabtahealth.com/glossary/infertility/). As such, ovary torsion is considered to be a gynaecological emergency and treatment should be initiated as soon as possible. The [ovaries](https://nabtahealth.com/glossary/ovaries/) are a paired structure located either side of the lower abdomen. They play a fundamental role in reproduction and hormone production, including the dominant female sex hormones, [oestrogen](https://nabtahealth.com/glossary/oestrogen/) and [progesterone](https://nabtahealth.com/glossary/progesterone/). If a doctor suspects an issue with one or both of the [ovaries](https://nabtahealth.com/glossary/ovaries/) he or she will likely use exploratory ultrasound and investigative [](https://nabtahealth.com/what-is-a-laparoscopy/)[laparoscopy](https://nabtahealth.com/glossary/laparoscopy/) (keyhole surgery) for diagnostic purposes. **What causes ovarian torsion?** -------------------------------- Rotation of the [ovaries](https://nabtahealth.com/glossary/ovaries/) can affect women of any age, from childhood to [post-](https://nabtahealth.com/articles/nabta-health-celebrates-women-during-their-age-of-hope/)[menopause](https://nabtahealth.com/glossary/menopause/), although the underlying causes vary according to age. Younger patients will often have normal, healthy [ovaries](https://nabtahealth.com/glossary/ovaries/), but the ligaments that support them (the infundibulopelvic ligaments) will be elongated. Longer ligaments can cause the [ovaries](https://nabtahealth.com/glossary/ovaries/) to rotate at a young age. Once a female reaches [](https://nabtahealth.com/what-is-puberty/)[puberty](https://nabtahealth.com/glossary/puberty/), these ligaments naturally shorten, reducing the risk of ovarian torsion. Post-[puberty](https://nabtahealth.com/glossary/puberty/), women with healthy [ovaries](https://nabtahealth.com/glossary/ovaries/) are unlikely to experience torsion. The risk increases with disrupted [blood flow to the](https://nabtahealth.com/articles/do-polycystic-ovaries-equal-pcos/) [ovaries](https://nabtahealth.com/glossary/ovaries/), which occurs when the veins supplying the pelvic organs become compressed, for example during pregnancy, or when the colon is distended. Another significant risk factor for ovarian torsion is the presence of cysts or abnormal masses. [Ovarian cysts](https://nabtahealth.com/are-ovarian-cysts-the-same-thing-as-pcos/) are usually harmless, but they can cause the surrounding ligaments to rotate. This is more likely when the [ovaries](https://nabtahealth.com/glossary/ovaries/) have multiple, large follicular cysts, which can occur following [ovulation](https://nabtahealth.com/glossary/ovulation/) induction treatment, or in women with [polycystic ovary syndrome](https://nabtahealth.com/what-is-pcos/). Studies have shown that larger ovarian growths correlate with an increased incidence of torsion. However, torsion is less likely with malignant masses, than with [benign](https://nabtahealth.com/glossary/benign/) tumour growth. Ovarian cysts and [benign](https://nabtahealth.com/glossary/benign/) tumour masses are most common in females of reproductive age and, therefore, this is the age group at most risk of experiencing ovarian torsion. **Diagnosis and treatment of ovarian torsion** ---------------------------------------------- The predominant symptoms of ovarian torsion include acute abdominal pain, alongside nausea and vomiting. Unfortunately the generic nature of these symptoms means that the condition often gets misdiagnosed as appendicitis, kidney [inflammation](https://nabtahealth.com/glossary/inflammation/) ([pyelonephritis](https://nabtahealth.com/glossary/pyelonephritis/)) or kidney stones (nephrolithiasis). There are no known serum markers indicative of ovarian torsion; however, blood tests might still be used to identify tumour markers if a tumour is suspected. Diagnosis of the condition can be challenging as direct visualisation of the [ovaries](https://nabtahealth.com/glossary/ovaries/) and their associated ligaments is usually required. Even if masses are present, they are not always palpable from outside the body. Ultrasound scans can be used to assess arterial blood flow, but some women with torsion appear to have normal blood flow when scanned. Often surgery is the only way to definitively diagnose the condition. At one time the treatment of choice for ovarian torsion was removal of the [ovaries](https://nabtahealth.com/glossary/ovaries/) ([oophorectomy](https://nabtahealth.com/glossary/oophorectomy/)). Today, however, doctors will usually attempt a more conservative approach, with a view to preserving ovarian function. Detorsion via [laparoscopy](https://nabtahealth.com/glossary/laparoscopy/) is generally the preferred treatment approach; although, with this technique, retorsion is possible. To reduce the likelihood of retorsion, doctors may carry out simultaneous procedures, such as cyst removal, fixing of the ovary to surrounding tissue or shortening any elongated ligaments by plication. The specific approach taken will depend on many factors, including the patient’s age, their fertility status and what the suspected cause of their rotated ovary is. Women with [malignant ovarian tumours](https://nabtahealth.com/the-diversity-of-ovarian-cancer/) will usually need to have their entire ovary removed. Ovarian torsion can be a difficult condition to manage and there is no standardised approach, as there is with testicular torsion in males. Unlike the testes, the [ovaries](https://nabtahealth.com/glossary/ovaries/) are intra-abdominal, meaning that other, nearby organs can be impacted by any treatment. The condition is also [multifactorial](https://nabtahealth.com/glossary/multifactorial/), necessitating a more individualised treatment approach for each patient. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#364f575a5a577658575442575e53575a425e1855595b) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Ding, Dah-Ching, et al. “A Review of Ovary Torsion.” Tzu Chi Medical Journal, vol. 29, no. 3, 2017, pp. 143–147., doi:10.4103/tcmj.tcmj\_55\_17. * Gibson, E, and H Mahdy. Anatomy, Abdomen and Pelvis, Ovary. StatPearls Publishing, 2019, [https://www.ncbi.nlm.nih.gov/books/NBK545187/](https://www.ncbi.nlm.nih.gov/books/NBK545187/). * Mehmetoğlu, Feride. “How Can the Risk of Ovarian Retorsion Be Reduced?” Journal of Medical Case Reports, vol. 12, no. 1, 4 July 2018, doi:10.1186/s13256-018-1677-0. * Robertson, Jennifer J., et al. “Myths in the Evaluation and Management of Ovarian Torsion.” The Journal of Emergency Medicine, vol. 52, no. 4, Apr. 2017, pp. 449–456., doi:10.1016/j.jemermed.2016.11.012
Breast cancer treatment will depend on the [stage of the cancer](https://nabtahealth.com/breast-cancer-staging/) at diagnosis. Usually those with stage I – III breast cancer will be offered surgery, in combination with [radiotherapy](https://nabtahealth.com/glossary/radiotherapy/) and some form of drug treatment ([chemotherapy](https://nabtahealth.com/glossary/chemotherapy/) and/or hormone treatment). The type of surgery will depend on tumour size and location, as well as personal preference. Breast-conserving surgery, known as a lumpectomy, removes the tumour, whilst preserving as much of the breast tissue as possible. A mastectomy removes the entire breast and can be unilateral (one-sided) or bilateral (both breasts). Breast reconstruction surgery is an option for those who want to preserve the appearance of their breasts, although it should be noted that any reconstructed tissue will have little, if any, sensation. Of course, not all women will want to undergo breast reconstruction. Some will choose to use removable prosthetics or simply ‘go flat’. The most important thing is for each woman to take the time to consider which option is best for her. **When to undergo breast reconstruction surgery** ------------------------------------------------- Breast reconstruction can be immediate, delayed or staged. * **Immediate**. Performed at the same time as a mastectomy/lumpectomy. The advantages to this are that it provides a neater cosmetic result with less scarring and will probably require fewer surgical procedures. The disadvantages are that the reconstruction might be damaged by subsequent [radiotherapy](https://nabtahealth.com/glossary/radiotherapy/) and if there are complications during the procedure, it might delay the start of [chemotherapy](https://nabtahealth.com/glossary/chemotherapy/). Women who have [prophylactic](https://nabtahealth.com/glossary/prophylactic/) breast removal, i.e. a preventative mastectomy because they are at high risk of developing cancer, will usually undergo immediate breast reconstruction. * **Delayed**. Reconstructive surgery can be performed weeks, or even months after breast cancer surgery. This can be advantageous as it gives a woman time to carefully consider her options. It also means that subsequent treatment will be unaffected by the reconstructive surgery. The drawbacks are that it can result in more scarring and the woman will spend time with no breast (or breasts), which could impact her confidence and quality of life. * **Staged**. Some reconstruction is performed during the mastectomy or lumpectomy, with additional procedures later on. This usually involves inserting a temporary expander to preserve the shape of the breast for the short-term. It can then be replaced with a permanent implant once the next stage of treatment is complete. Also called delayed-immediate reconstruction. ### **Types of reconstruction** Implants can be artificial or made from a flap of tissue taken from elsewhere in the body (autologous). * **Artificial implant**. An implant made of either saline or silicon is inserted either underneath or on top of the pectoral chest muscles. Implants can be teardrop-shaped, or round; smooth, or slightly rough. The advantages to artificial implants are that they generally require a shorter recovery time and fewer surgical procedures, as there is no need for concurrent surgery at a donor site. Scarring can also be kept to a minimum by using the same incision site that was used during the mastectomy. The disadvantages to this type of reconstruction are that with time the implant might need replacing; most have a lifespan of between 10 and 20 years. There is also a risk of deflation, rupture and contracture of the implant. Women who have unilateral breast cancer may choose to have artificial implants inserted into their healthy breast too, so that both sides match. * **Autologous reconstruction**. A ‘flap’ of tissue is taken from elsewhere in the body, formed into the shape of a breast and used to manufacture an implant. The tissue taken is skin, fat or muscle and it is most often taken from the abdomen, the back, the buttocks or the inner thigh. The abdomen is the preferred donor site. “Free flaps” are completely separated from their original blood vessels and reattached to blood vessels within the chest wall. This requires advanced skills in microsurgery. “Pedicled flaps” are tissue samples that are moved underneath the skin and remain attached to their original blood vessels. This is considered to be a simpler technique. Autologous reconstruction can be delayed or immediate. Advantages to this technique include a more natural looking result, with no risk of implant rupture. These implants also tolerate [radiotherapy](https://nabtahealth.com/glossary/radiotherapy/) more than artificial implants. The disadvantages include more extensive surgery and a longer recovery time; as well as multiple surgical sites. Women who undergo this procedure risk experiencing complications, such as hernias and muscle damage, at the donor site. Women that are of a slim build may require “stacked flaps”, whereby multiple free flaps are taken and layered to form the implant. * **Combination**. Sometimes tissue flap procedures are used in combination with an implant. For example, when a latissimus dorsi flap is taken from the tissue of the back, it is often used alongside an artificial implant to enhance the overall appearance of the reconstructed breast. **Reconstruction after breast-conserving surgery** -------------------------------------------------- Some women do not need a complete mastectomy and it is considered sufficient to remove the part of the breast where the tumour is located using a lumpectomy. Reconstruction is often not needed in these cases, but for those women who are left with a prominent dent, or a large discrepancy between breasts after surgery, there are options available. * **Quadrantectomy and mini flap reconstruction**. In a quadrantectomy the surgeon will remove about a quarter of the breast tissue, which can leave the patient with a noticeably smaller breast. To fill the gap, living tissue is taken from elsewhere in the body, often from the patient’s back. * **Reshaping**. This is also known as therapeutic mammoplasty and is more suitable for women with larger breasts. The doctor will remove the part of the breast where the cancer is located and then reshape the remaining breast tissue, so that the breast is smaller, but fully formed. Women who undergo this procedure might opt to have a simultaneous breast reduction on their healthy breast, so that the two sides match. Most breast-conserving surgeries will be followed by a course of [radiotherapy](https://nabtahealth.com/glossary/radiotherapy/) to the remaining breast tissue to reduce the chances of the cancer returning. **Additional surgery** ---------------------- Nipple and areola reconstruction is usually done 3-4 months after the original procedure, so that the breast has had time to heal. Normally the artificial nipple is formed from the tissue of the new breast and the surgeon will attempt to match the position, size and projection of it to the other nipple. Tattooing is used to match the colour. Some women choose to have surgery on their healthy breast, to make both sides match. This is a matter of personal choice and something to discuss with you doctor when considering options. After the surgery try Nabta’s [Post-surgery pack](https://nabtahealth.com/product/post-surgery-selfcare-pack-copy). Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [](https://nabtahealth.com/glossary/menopause/)[menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#ea938b86868baa848b889e8b828f8b869e82c4898587) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * “Breast Cancer.” About Breast Reconstruction | Breast Cancer Surgery | Cancer Research UK, 25 Oct. 2017, [https://www.cancerresearchuk.org/about-cancer/breast-cancer/treatment/surgery/breast-reconstruction/about](https://www.cancerresearchuk.org/about-cancer/breast-cancer/treatment/surgery/breast-reconstruction/about). * “Breast Reconstruction Options.” American Cancer Society, [https://www.cancer.org/cancer/breast-cancer/reconstruction-surgery/breast-reconstruction-options.html](https://www.cancer.org/cancer/breast-cancer/reconstruction-surgery/breast-reconstruction-options.html). * Djohan, R., et al. “Breast Reconstruction Options Following Mastectomy.” Cleveland Clinic Journal of Medicine, vol. 75, no. Suppl\_1, Mar. 2008, pp. 17–23., doi:10.3949/ccjm.75.suppl\_1.s17. * Farhangkhoee, Hana, et al. “Trends and Concepts in Post-Mastectomy Breast Reconstruction.” Journal of Surgical Oncology, vol. 113, no. 8, June 2016, pp. 891–894., doi:10.1002/jso.24201. * “Types of Breast Reconstruction.” Breastcancer.org, 29 Aug. 2019, [https://www.breastcancer.org/treatment/surgery/reconstruction/types](https://www.breastcancer.org/treatment/surgery/reconstruction/types).
* Charting your basal body temperature (BBT) is a way to understand where you are in your menstrual cycle, helping you to predict the exact point of [ovulation](https://nabtahealth.com/glossary/ovulation/). * Basal body temperature is your body temperature when it is at rest and it increases by around 0.3 – 0.6°C during [ovulation](https://nabtahealth.com/glossary/ovulation/). * Measuring basal body temperature can be done orally, vaginally or rectally and is best taken each morning, after sleep. * Vaginal monitoring is the most precise method with 99% accuracy and can be done using the [OvuSense vaginal thermometer](https://nabtahealth.com/product/cycle-monitoring-with-ovusense/) alongside the [Nabta app.](https://nabtahealth.com/our-platform/nabta-app) A woman’s menstrual cycle lasts from the first day of menstruation to the day before her next period starts. For women who have a very regular 28 day cycle, [ovulation](https://nabtahealth.com/glossary/ovulation/) will usually occur around day 15, which is approximately 2 weeks before the start of the next menstrual cycle. However, a ‘normal’ menstrual cycle can vary from 21 to 40 days, so determining the exact point at which [ovulation](https://nabtahealth.com/glossary/ovulation/) occurs is not that simple. It is, however, possible to use physiological cues (the way the body functions) to determine the likely start of [ovulation](https://nabtahealth.com/glossary/ovulation/); the body produces certain physical signs in response to fluctuating hormone levels and by accurately monitoring these, you may be able to deduce when you are most fertile. Approaches such as [observing cervical mucus](../cervical-discharge-through-the-menstrual-cycle) and measuring Basal Body Temperature (BBT) are types of fertility awareness-based methods that can be used for natural family planning. #### What is Basal Body Temperature? BBT is the temperature of the person at rest. During [ovulation](https://nabtahealth.com/glossary/ovulation/), the BBT usually rises by 0.3 – 0.6°C (0.5 – 1.0°F). By accurately recording the BBT every day, a woman may be able to determine if and when [ovulation](https://nabtahealth.com/glossary/ovulation/) occurred. Typical temperature fluctuations during a normal cycle: * The follicular phase of the cycle is the time before [ovulation](https://nabtahealth.com/glossary/ovulation/). BBT is influenced by [oestrogen](https://nabtahealth.com/glossary/oestrogen/) levels and [progesterone](https://nabtahealth.com/glossary/progesterone/) levels are low. Normal BBT range: 36.4 – 36.8°C (97 – 98°F). * One day before [ovulation](https://nabtahealth.com/glossary/ovulation/) there is a peak in luteinising hormone. BBT reaches its lowest point, known as the nadir. * After [ovulation](https://nabtahealth.com/glossary/ovulation/), [progesterone](https://nabtahealth.com/glossary/progesterone/) levels increase up to 10-fold.Temperature increases 0.3 – 0.6°C (0.5 – 1.0°F) and typically remains above 37°C for the next 10-14 days. This is known as the luteal phase of the cycle. * If fertilisation does not occur, [progesterone](https://nabtahealth.com/glossary/progesterone/) levels and BBT both reduce 1-2 days before menstruation starts. [](https://nabtahealth.com/wp-content/uploads/2019/09/Charting-Your-Basal-Body-Temperature-300x224-1.webp) It is important to always measure BBT in the same way, orally, vaginally, or rectally, using the same thermometer. Measuring under the armpit is not considered to be accurate enough. The best time to record BBT is first thing in the morning before undertaking any physical activity. Ideally, BBT measurements should be taken after at least 3-4 hours sleep. BBT can be affected by increased stress, illness, medication use, alcohol consumption and changes in time zone/circadian rhythm. It is not recommended to take measurements if you are using hormonal contraceptives, as the synthetic hormones will disrupt the normal ovulatory cycle. #### What can you use basal body temperature for? As a means of contraception, recording BBT is not without its drawbacks. At best it predicts peak fertility, with the rise in temperature indicating that [ovulation](https://nabtahealth.com/glossary/ovulation/) has occurred. To completely avoid pregnancy, a female would need to abstain from intercourse from the start of menstruation until 3-4 days after the rise in BBT. The most valuable use for BBT plotting is perhaps as a tool for determining the best time to have intercourse if trying to conceive. For those women who have regular periods, measuring BBT for 3-4 cycles can give a fairly accurate prediction of which days they are most fertile. Male [sperm](https://nabtahealth.com/glossary/sperm/) can survive for 5-7 days inside the female reproductive tract, but once [ovulation](https://nabtahealth.com/glossary/ovulation/) triggers the release of the female egg from the [ovaries](https://nabtahealth.com/glossary/ovaries/), the egg only has a 24 hour period of viability. This means that a female is fertile from 5 days before [ovulation](https://nabtahealth.com/glossary/ovulation/), to 2 days afterwards. Outside of this window, she cannot conceive. By the time the BBT spike is seen, the female is reaching the end of her fertile period for that month. #### Can measuring basal body temperature help fertility? The major benefits to using BBT to identify [ovulation](https://nabtahealth.com/glossary/ovulation/) are that it is low-cost, easily accessible (the only equipment you need are a thermometer and chart paper to plot your readings) and non-invasive. One means of improving the efficacy of BBT is to combine it with other fertility awareness-based methods, such as the cervical mucus method. This method is based on the theory that cervical secretions change throughout the menstrual cycle. Using these two approaches in combination is known as the symptothermal approach. BBT can also be tracked alongside using our [OvuSense device](https://nabtahealth.com/products/ovusense/), which is a realtime fertility monitor, aimed to predict [ovulation](https://nabtahealth.com/glossary/ovulation/) with 99% accuracy. The benefits of tracking your basal body temperature ---------------------------------------------------- Tracking your basal body temperature (BBT) is a simple and effective way to gain insights into your menstrual cycle and fertility. BBT is the lowest body temperature that you experience during a 24-hour period, and it can be measured using a basal body thermometer. By taking your temperature every morning at the same time and recording it, you can create a chart that shows any changes in your BBT throughout your menstrual cycle. **There are several benefits to tracking your BBT, including:** 1. Identifying [ovulation](https://nabtahealth.com/glossary/ovulation/): Your BBT typically rises slightly during [ovulation](https://nabtahealth.com/glossary/ovulation/), which is when an egg is released from the [ovaries](https://nabtahealth.com/glossary/ovaries/) and can be fertilized. By tracking your BBT, you can identify when you are most likely to be ovulating, which can help you plan or avoid pregnancy. 2. Monitoring your menstrual cycle: By charting your BBT over time, you can get a better understanding of your menstrual cycle and how it varies from month to month. This can be helpful for identifying any changes or irregularities in your cycle, which can be a sign of underlying health issues. 3. Assessing your fertility: Your BBT can provide valuable insights into your fertility, and tracking it over time can help you and your doctor assess your overall reproductive health. For example, if your BBT remains consistently high over several cycles, it could indicate that you are not ovulating, which can affect your ability to conceive. 4. Predicting [ovulation](https://nabtahealth.com/glossary/ovulation/): By tracking your BBT and identifying when it rises, you can predict when you are most likely to ovulate and plan accordingly. This can be helpful for those who are trying to conceive or avoid pregnancy. The [Nabta App](https://nabtahealth.com/our-platform/nabta-app/) can be used to record the Basal Body Temperature and store and plot the data. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#a1d8c0cdcdc0e1cfc0c3d5c0c9c4c0cdd5c98fc2cecc) if you have any questions about this article or any aspect of women’s health. We’re here for you. Don’t forget you can register [here](https://nabtahealth.com/my-account) to become a Nabta member free of charge. **Sources:** * NHS Choices, _NHS_, [https://www.nhs.uk/conditions/contraception/natural-family-planning/](https://www.nhs.uk/conditions/contraception/natural-family-planning/). * “Fertility Awareness-Based Methods of Family Planning.” ACOG, _Women’s Health Care Physicians_, [https://www.acog.org/Patients/FAQs/Fertility-Awareness-Based-Methods-of-Family-Planning](https://www.acog.org/Patients/FAQs/Fertility-Awareness-Based-Methods-of-Family-Planning). * Pallone, S. R., and G. R. Bergus. “Fertility Awareness-Based Methods: Another Option for Family Planning.” _The Journal of the American Board of Family Medicine_, vol. 22, no. 2, 2009, pp. 147–157., doi:10.3122/jabfm.2009.02.080038. * Su, Hsiu-Wei, et al. “Detection of [Ovulation](https://nabtahealth.com/glossary/ovulation/), a Review of Currently Available Methods.” _Bioengineering & Translational Medicine_, vol. 2, no. 3, 16 May 2017, pp. 238–246., doi:10.1002/btm2.10058.
Can duct tape remove wart; * Warts are a common childhood ailment. * Warts are caused when a virus infects the top layer of the skin, the stratum corneum, and sets up residence. * One of the most common warts in children is known as molluscum contagiosum * Warts can remain for months and even years but often spontaneously go away, especially in children. Warts and molluscum are highly contagious and affect most children. They often spread and grow in size because the body fails to recognize the virus as being a pathogen. Warts can be transmitted from one area of skin to another by rubbing. They can heal themselves and go away on their alone. Nevertheless, many families look for treatment and solutions to speed up the recovery. #### What is molluscum? One of the most common warts in children is known as molluscum contagiosum. These tiny pearly papules are usually no more than 5 millimeters in size and often appear in clusters. The best advise is to leave molluscum alone. With time (months) they resolve on their own with no treatment. Sometimes, ignoring molluscum is not an option. In cases where they are spreading quickly (because they are in an area where there is skin on skin contact, like under the arm), are painful, your child continues to pick at them, or they are causing a cosmetic problem, treatment may be indicated. There are various treatment methods and your provider can help determine what might be best for your child. #### Using duct tape on molluscum One of the easiest methods to try at home is the duct tape method as described by the [Schmitt Paediatric Guide:](https://publications.aap.org/patiented/pages/schmitt) * “Covering molluscum with duct tape can irritate them. This turns on the body’s immune system. * Cover as many of the molluscum as possible. (Cover at least 3 of them.) * The covered molluscum become red and start to die. When this happens, often ALL molluscum will go away. * Try to keep the molluscum covered all the time. * Remove the tape once per day, usually before bathing. Then replace it after bathing. * Some children don’t like the tape on at school. At the very least, tape it every night.” To prevent passing molluscum to others, avoid bathing with or sharing a hot tub with others and avoid sharing towels and washcloths. If the child is in contact sports, it will be helpful to cover molluscum if located in an area where there could be skin to skin contact. It takes 4-8 weeks after contact for molluscum to develop. A physician can apply a medication known as cantharidin to the top of each little wart. The medication causes the top layer of the skin, where the virus lives, to blister and peel off, taking the virus with it. Cantharidin can also be used with other small warts but is not ideal for large warts. While the treatment is rarely uncomfortable, it is also often ineffective. Multiple applications may be necessary before the wart is fully gone. If your child already has molluscum, to prevent more from developing, advise them to avoid scratching. Keeping nails cut short can also help. Also avoid rubbing the affected area with a washcloth or towel and then touching this on the skin. #### Using duct tape on warts Duct tape is also popular as a wart treatment and can be attempted at home. Duct tape can be used on any non-tender wart. In this treatment, the wart is cleaned and softened with soapy water. Then an unused emery board is used to gently file the wart down, stopping if it becomes uncomfortable. It is dried completely and a clean square of duct tape is applied over the wart. The duct tape is left on for a week and then gently removed with baby oil. The whole process is repeated weekly until the wart resolves. There are many over-the-counter treatments for warts, but it’s a good idea to check with your physician before using them as many are irritating to the skin and can burn. It bears repeating that warts are usually self-limited so doing nothing is a good option for children who are not bothered by them. How long does it take for duct tape to remove a wart? ----------------------------------------------------- Duct tape is a popular home remedy for removing warts. However, the effectiveness of this treatment can vary and it is not backed by scientific evidence. The process of using duct tape to remove a wart involves covering the wart with a piece of duct tape for several days. The idea behind this treatment is that the duct tape will cut off the wart’s supply of oxygen and nutrients, causing it to die and eventually fall off. It is difficult to predict exactly how long it will take for a wart to be removed using duct tape, as it can vary depending on the individual and the size and location of the wart. Some people may see results within a week, while others may not see any improvement for several weeks or even months. In general, it is recommended to use duct tape as a wart treatment for no longer than two months. If the wart has not improved or disappeared after this time, it is best to discontinue the treatment and talk to a doctor about other options. While duct tape may be a low-cost and convenient option for removing warts, it is not always effective. It is important to consult with a healthcare provider for advice and guidance on the best treatment for your specific situation. Powered by Bundoo® Edited by Nabta Health \_\_\_ Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). You can track your menstrual cycle and get [personalised support by using the Nabta app.](https://nabtahealth.com/our-platform/nabta-app/) [Get in touch](/cdn-cgi/l/email-protection#be9b8c8ec7dfd2d2dffed0dfdccadfd6dbdfd2cad690ddd1d3) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources** ClearTriage. Copyright 2000-2019 Schmitt Pediatric Guidelines LLC. Author: Barton Schmitt MD, FAAP
Diabulimia, cited as the ‘world’s most dangerous eating disorder’, is a condition where people with type 1 diabetes mellitus (T1DM) deliberately and regularly ration their use of insulin in [order to lose weight](https://nabtahealth.com/im-struggling-to-lose-weight/). Challenging to both diagnose and treat, many people with the condition keep their eating habits secret. Optimal management necessitates different specialists joining forces to combat both the medical and psychological aspects of the condition. **Type 1 Diabetes** ------------------- T1DM is a chronic, lifetime condition, for which there is no cure. Worldwide, 5-10% of people with diabetes will have this form of the condition. Unlike [type 2 diabetes](https://nabtahealth.com/product/type-2-diabetes-starter-pack-copy/), T1DM has nothing to do with eating unhealthily or living a sedentary lifestyle. It happens when the immune system attacks the beta cells in the pancreas, preventing them from producing insulin. Without insulin, the glucose that is taken in through the diet, cannot be converted into energy and, instead, accumulates in the bloodstream. This can be very dangerous as the body enters starvation mode and starts to break down muscle and fat, releasing ketones, which rapidly build up, increasing the [risk of diabetic ketoacidosis](https://nabtahealth.com/articles/a-guide-to-type-1-diabetes/), which can be fatal. Receiving a diagnosis of T1DM can be daunting; it is a condition that requires daily monitoring and continual insulin therapy. It is also an early onset condition, meaning that patients are often diagnosed during childhood or early adolescence. Facing up to a lifetime of medical intervention at such a young age can certainly be emotionally challenging and typically comes at a time when body awareness is naturally heightened by [puberty](https://nabtahealth.com/glossary/puberty/). **Bulimia Nervosa is an eating disorder** ----------------------------------------- Bulimia Nervosa is an eating disorder characterised by periods of binging on food and then purging to prevent weight gain. The most frequently observed purging behaviours are self-induced vomiting, laxatives, diuretics and excessive exercise. People with T1DM have a unique purging behaviour available to them, the deliberate misuse or avoidance of insulin. [Diabetics need insulin](https://nabtahealth.com/articles/taking-diabetes-medication-during-pregnancy-is-it-safe/) to survive, so by withholding it in an attempt to control their weight, people with the condition are actually putting their lives at risk. **Why are people with T1DM at increased risk of developing an eating disorder?** -------------------------------------------------------------------------------- Unfortunately people with T1DM are at increased risk of developing an eating disorder, and this can be due to both physical and emotional factors. For a start, people with the condition have a disrupted metabolic system, meaning they do not break down food in the normal way. They also spend a disproportionate amount of time dissecting food labels and recipe content, analysing numbers and having to take control of their diet. Control, and the fear of losing it, is a major factor in the development of an eating disorder. A further issue comes from the fact that, prior to diagnosis, many people with [T1DM](https://nabtahealth.com/articles/exercise-and-diabetes/) have lost a significant amount of weight. Insulin therapy can cause weight gain, which can negatively impact a person’s self esteem and body confidence. In fact, insulin therapy and weight gain can form a vicious cycle, with insulin-induced weight gain necessitating a higher [dose of insulin](https://nabtahealth.com/articles/what-is-insulin-resistance/). This increased insulin leads to increased hunger and dietary intake, which, naturally, increases weight further and thus, the cycle continues. At a time when a person may already be feeling emotional, anxious and out of control, this unwanted weight gain might come at a critical time. Diabetic burnout can also increase the [risk of developing an eating disorder](https://nabtahealth.com/articles/how-eating-disorders-can-affect-your-pregnancy/), as patients become increasingly frustrated, start disregarding their blood glucose levels and look for ways to escape the confinements of their condition. **How big a problem is it?** ---------------------------- Whilst diabulimia is not currently a medically recognised term, it does represent a growing problem and the condition was included in the UK’s National Institute of Health and Care Excellence ([NICE](https://www.nice.com/)) 2017 [guidelines for eating disorders](https://nabtahealth.com/articles/how-eating-disorders-can-affect-your-pregnancy/). The extent of the problem is highlighted by the fact that up to 40% of women with T1DM, who are between 15 and 30 years of age, regularly omit insulin for weight control. These women are also at increased risk of adopting other purging behavious to control their weight and overcome body dissatisfaction, including restricting their food intake, misusing laxatives and over-exercising. It is estimated that in their lifetime: * 0.5 – 3.7% women will experience anorexia nervosa. * 1.1 – 4.2% women will exhibit symptoms of bulimia. * 11% women with T1DM will develop an eating disorder. These figures represent a significant, worldwide health issue, that urgently requires research, funding and support. A major issue comes from understanding how best to treat the condition. For many eating disorders, a key part of the therapy involves removing the focus a patient has on food. Those patients with T1DM cannot do this; in order to stay healthy and avoid serious diabetes complications (visual disturbances, increased infection risk, neuropathies, kidney damage and amputations, to name just a few), patients must carefully monitor and regulate their food intake. Treatment of diabulimia requires a multidisciplinary team, comprising diabetes specialists and psychiatrists to manage both elements of the condition. For further information on this and other mental health conditions, [Choosing Therapy](https://www.choosingtherapy.com/diabulimia/) is a very useful resource. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#067f676a6a674668676472676e63676a726e2865696b) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * “Diabetes Burnout.” _Diabetes.co.uk_, [www.diabetes.co.uk/emotions/diabetes-burnout.html](http://www.diabetes.co.uk/emotions/diabetes-burnout.html). * “Diabulimia.” _National Eating Disorders Association_, [www.nationaleatingdisorders.org/diabulimia-5](http://www.nationaleatingdisorders.org/diabulimia-5). * Evry, N. “Diabulimia: Signs, Symptoms, & Treatments.” _Choosing Therapy_, 20 Nov. 2020, [www.choosingtherapy.com/diabulimia/](http://www.choosingtherapy.com/diabulimia/). * Torjesen, I. “Diabulimia: the World’s Most Dangerous Eating Disorder.” _BMJ_, vol. 364, 1 Mar. 2019, doi:10.1136/bmj.l982. * “What Is Type 1 Diabetes?” _Diabetes UK_, [www.diabetes.org.uk/diabetes-the-basics/what-is-type-1-diabetes](http://www.diabetes.org.uk/diabetes-the-basics/what-is-type-1-diabetes).
A normal menstrual cycle lasts between 21 and 35 days. Day one of the cycle is always the first day of menstrual bleeding (also known as having your period). Menstrual bleeding typically lasts for between 2 and 7 days and is often incorrectly used as a sign that [ovulation](https://nabtahealth.com/glossary/ovulation/) has occurred. In fact, women can have apparently normal periods without ovulating, click [here](https://nabtahealth.com/i-have-regular-periods-could-i-still-have-pcos/) to find out more. Normal [ovulation](https://nabtahealth.com/glossary/ovulation/) is essential for maintaining healthy levels of [oestrogen](https://nabtahealth.com/glossary/oestrogen/) and [progesterone](https://nabtahealth.com/glossary/progesterone/). Whilst these two hormones play a pivotal role during pregnancy, their beneficial effects are not limited to this; they are also vital for maintaining general health and help to protect against [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/), breast cancer and heart disease. #### What defines abnormal uterine bleeding? Abnormal uterine bleeding affects 2-5% of women of reproductive age. It occurs when the cycle length and period duration differ from the normal values. It is a broad term that also encompasses bleeding or spotting between periods. Unfortunately this wide categorisation means that there are many potential causes of abnormal uterine bleeding and, often, diagnosis becomes a process of elimination. When abnormal uterine bleeding takes the form of prolonged, or heavy bleeding it is termed [menorrhagia](https://nabtahealth.com/glossary/menorrhagia/). Medically a ‘heavy’ period is defined as losing more than 80ml blood and/or it having a duration of over 7 days. Young teenagers and women experiencing the [perimenopause](https://nabtahealth.com/glossary/perimenopause/) are most at risk. For young teenagers it is usually just a case of their bodies settling into a regular cycle. Women who are perimenopausal are nearing the end of their reproductive years and will probably find the bleeding becomes more irregular and sporadic, before stopping altogether. Treatment options range from non-steroidal anti-inflammatory drugs, which block [prostaglandins](https://nabtahealth.com/glossary/prostaglandins/) (easing painful period cramps) and reduce menstrual flow; to hormonal treatment, such as the combined [oral contraceptive pill](https://nabtahealth.com/the-oral-contraceptive-pill/%MCEPASTEBIN%), which stabilises the endometrial lining and ensures controlled monthly bleeds. In the most severe cases a female may need to undergo a [hysterectomy](https://nabtahealth.com/glossary/hysterectomy/). Broadly speaking, abnormal uterine bleeding occurs because of structural abnormalities, lifestyle disruptions or [ovulation](https://nabtahealth.com/glossary/ovulation/) disorders. #### Structural abnormalities These can include [benign](https://nabtahealth.com/glossary/benign/) lesions such as [](../a-simple-guide-to-fibroids)[fibroids](https://nabtahealth.com/glossary/fibroids/), [](../what-are-uterine-polyps)[polyps](https://nabtahealth.com/glossary/polyps/) and [](../what-is-adenomyosis)[adenomyosis](https://nabtahealth.com/glossary/adenomyosis/), as well as lesions of the [cervix](https://nabtahealth.com/glossary/cervix/) and the [vagina](https://nabtahealth.com/glossary/vagina/). [](../what-is-endometriosis)[Endometriosis](https://nabtahealth.com/glossary/endometriosis/) is a well characterised condition that results from a build-up of endometrial-like tissue elsewhere in the body; chronic period pain and heavy periods are two of the main symptoms. Complications during the early stages of pregnancy, such as [miscarriage](https://nabtahealth.com/glossary/miscarriage/) and [](../what-is-an-ectopic-pregnancy)[ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/) can also result in abnormal bleeding. Sometimes women who have an intrauterine device ([IUD](https://nabtahealth.com/glossary/iud/)) fitted for contraception will experience abnormal bleeding. Most structural abnormalities can be identified with ultrasound; for lesions deep within the pelvic region, a high resolution [transvaginal ultrasound](https://nabtahealth.com/glossary/transvaginal-ultrasound/) is a very useful diagnostic aid. Occasionally surgery will be required; [hysteroscopies](../what-is-a-hysteroscopy) (within the uterine cavity) and [laparoscopies](../what-is-a-laparoscopy) (outside the [uterus](https://nabtahealth.com/glossary/uterus/)) can be used for both diagnosis and ablation of unwanted lesions. #### Lifestyle disruptions Certain medications and medical conditions can disrupt the menstrual cycle. Diabetes is one example. There appears to be some association between [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/) and a thickening of the uterine lining, the latter of which results in heavy periods. Emotional and physical stress can cause the menstrual cycle to become irregular, as can [obesity](https://nabtahealth.com/what-is-body-mass-index-bmi/%MCEPASTEBIN%) ([BMI](https://nabtahealth.com/glossary/bmi/) >30) and smoking. These are known as modifiable risk factors because through making behavioural adjustments, the risk of experiencing menstrual irregularities is reduced. #### [Ovulation](https://nabtahealth.com/glossary/ovulation/) disorders If no other cause can be established for abnormal uterine bleeding then an [ovulation](https://nabtahealth.com/glossary/ovulation/) disorder will probably be considered. These are classed as dysfunctional uterine bleeding and the most common examples are [polycystic ovary syndrome](../treating-the-associated-symptoms-of-pcos) ([PCOS](https://nabtahealth.com/glossary/pcos/)), thyroid disease and premature ovarian insufficiency ([POI](https://nabtahealth.com/glossary/poi/)). Thyroid disease is frequently misdiagnosed as [PCOS](https://nabtahealth.com/glossary/pcos/) because it shares a number of common symptoms, including [anovulation](https://nabtahealth.com/glossary/anovulation/) and [hair loss](../coping-with-pcos-hair-loss). However, thyroid disease itself has a strong association with irregular menstrual cycles. One study found that 44% of people with menstrual disorders had an underlying thyroid issue. The predominant thyroid issue is [hypothyroidism](https://nabtahealth.com/glossary/hypothyroidism/), which suppresses [ovulation](https://nabtahealth.com/glossary/ovulation/), impairs insulin sensitivity and reduces the availability of cellular energy (ATP). Normal ovarian function requires significant energy. The advantage to finding out you have an [ovulation](https://nabtahealth.com/glossary/ovulation/) disorder is that often it is [reversible](https://nabtahealth.com/is-it-possible-to-reverse-pcos/) with changes to the diet and lifestyle. For example, losing weight can improve the symptoms of [PCOS](https://nabtahealth.com/glossary/pcos/). [POI](https://nabtahealth.com/glossary/poi/) is one case where lifestyle modifications will unfortunately not help. It happens when the [ovaries](https://nabtahealth.com/glossary/ovaries/) stop producing eggs and can come on gradually or occur suddenly. The first sign of the condition will usually be irregular menstrual cycles. In 50% of cases the cause is unknown, although there is thought to be a familial component. This condition can also occur in women who have undergone [](https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/radiotherapy/about)[radiotherapy](https://nabtahealth.com/glossary/radiotherapy/) or [](https://nabtahealth.com/articles/skin-changes-after-chemotherapy/)[chemotherapy](https://nabtahealth.com/glossary/chemotherapy/). Symptoms can be alleviated with hormone replacement therapy, but to date there is no cure. Unfortunately doctors are often unsure how best to manage _abnormal uterine bleeding_ and treatment is, at best, random and speculative, and at worst, ineffective. It is of fundamental importance to identify the reasons for your [irregular cycles](https://nabtahealth.com/articles/why-are-my-periods-irregular/) and abnormal bleeding because only that way will you be able to find a solution that provides complete symptomatic relief. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [](https://nabtahealth.com/articles/effects-of-menopause-on-the-body/)[menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#0a736b66666b4a646b687e6b626f6b667e6224696567) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * “Abnormal Uterine Bleeding (Booklet).” ReproductiveFacts.org, The American Society for Reproductive Medicine, www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/abnormal-uterine-bleeding/. Revised 2012. * Ajmani, N S, et al. “Role of Thyroid Dysfunction in Patients with Menstrual Disorders in Tertiary Care Center of Walled City of Delhi.” Journal of Obstetrics and Gynaecology of India , vol. 66, no. 2, Apr. 2016, pp. 115–119., doi:10.1007/s13224-014-0650-0. * Bae, J, et al. “Factors Associated with Menstrual Cycle Irregularity and [Menopause](https://nabtahealth.com/glossary/menopause/).” BMC Women’s Health, vol. 18, no. 1, 6 Feb. 2018, p. 36., doi:10.1186/s12905-018-0528-x. * Koutras, D A. “Disturbances of Menstruation in Thyroid Disease.” Annals of the New York Academy of Sciences, vol. 816, 17 June 1997, pp. 280–284. * “Overview: Heavy Periods.” NHS, [www.nhs.uk/conditions/heavy-periods/](http://www.nhs.uk/conditions/heavy-periods/). Page last reviewed: 07/06/2018. * “What Is Premature Ovarian Insufficiency (Also Called Premature Ovarian Failure)? .” ReproductiveFacts.org, The American Society for Reproductive Medicine, [www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/what-is-premature-ovarian-insufficiency-also-called-premature-ovarian-failure/](http://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/what-is-premature-ovarian-insufficiency-also-called-premature-ovarian-failure/). Revised 2015.
Ablation of the endometrium is a gynaecological procedure that has been in use since the late 19th century. The aim of the procedure is to control vaginal bleeding without the need for a [hysterectomy](https://nabtahealth.com/glossary/hysterectomy/). It works by destroying (ablating) the lining of the [uterus](https://nabtahealth.com/glossary/uterus/) (endometrium). #### **When will an endometrial ablation be recommended?** Endometrial ablations are generally recommended to those women who experience prolonged bouts of heavy menstrual bleeding. They are rarely the first approach as most doctors will be keen to reduce blood loss using medications or an intrauterine device ([IUD](https://nabtahealth.com/glossary/iud/)) first. Your doctor might recommend an endometrial ablation if your: * Periods are so heavy that your pad or tampon needs changing every two hours. * Blood loss is putting you at risk of becoming anaemic. * Periods regularly last for longer than eight days (defined as [abnormal uterine bleeding](https://nabtahealth.com/what-is-abnormal-uterine-bleeding/)). Whilst not used for sterilisation, most women who undergo the procedure end up infertile, so you should not have an endometrial ablation if you intend to have children in the future. Pregnancies that follow endometrial ablations are very high risk and can be [ectopic](https://nabtahealth.com/what-is-an-ectopic-pregnancy/) or end in [](https://nabtahealth.com/causes-of-miscarriage/)[miscarriage](https://nabtahealth.com/glossary/miscarriage/). #### **How is an endometrial ablation performed?** Once you and your doctor have decided that an endometrial ablation is the best option for you, he or she will first of all want to rule out any possibility of pregnancy. Assuming a pregnancy test comes back negative, your doctor will prepare you for the procedure. Sometimes medications are given or a [](https://nabtahealth.com/what-is-a-dilation-and-curettage-and-why-is-it-done/)[dilation](https://nabtahealth.com/glossary/dilation/) and curettage (D&C) is performed to thin the endometrium, prior to the ablation. Advances in modern medicine have meant that many endometrial ablations carried out today can be performed as outpatient procedures and you will be able to go home the same day. Unlike some of the more invasive gynaecological techniques, a uterine ablation does not require any incisions to be made to the abdomen. Instead, the required tools are passed through the [vagina](https://nabtahealth.com/glossary/vagina/) and [cervix](https://nabtahealth.com/glossary/cervix/) to reach the [uterus](https://nabtahealth.com/glossary/uterus/). The first stage is to gently widen (dilate) the [cervix](https://nabtahealth.com/glossary/cervix/) using a series of rods to increase the diameter. This will give your doctor the room to maneuver whichever instruments he/she is using. A hysteroscope will usually be inserted to enable the doctor to see the inside of the [uterus](https://nabtahealth.com/glossary/uterus/) and sometimes carbon dioxide gas will be used to expand the [uterus](https://nabtahealth.com/glossary/uterus/) for the duration of the procedure. The exact method used will depend on the size and condition of your [uterus](https://nabtahealth.com/glossary/uterus/), as well as resource availability. #### **Types of endometrial ablation** * **Electrosurgery ([electrocautery](https://nabtahealth.com/glossary/electrocautery/)):** A wire loop is heated with an electric current and passed into the [uterus](https://nabtahealth.com/glossary/uterus/). Once there, it carves furrows into the endometrium. Requires general anaesthetic. * **Cryoablation:** Extreme cold is used to create ice balls that destroy the lining of the [uterus](https://nabtahealth.com/glossary/uterus/). Each freeze cycle lasts about 6 minutes and the number of cycles required will depend on the size and shape of the [uterus](https://nabtahealth.com/glossary/uterus/). Real-time ultrasound is used to track the state of the endometrium throughout. * **Free-flowing hot fluid:** Saline solution, heated to between 80 and 90°C is circulated within the [uterus](https://nabtahealth.com/glossary/uterus/) for about 10 minutes. This is ideal for women who have an irregular shaped [uterus](https://nabtahealth.com/glossary/uterus/), or one distorted by abnormal tissue growth, for example, [](https://nabtahealth.com/a-simple-guide-to-fibroids/)[fibroids](https://nabtahealth.com/glossary/fibroids/). * **Heated balloon:** A balloon device is inserted through the [cervix](https://nabtahealth.com/glossary/cervix/) and inflated once in the [uterus](https://nabtahealth.com/glossary/uterus/), using fluid heated to 87°C. The procedure takes between two and ten minutes, depending on the condition and size of the [uterus](https://nabtahealth.com/glossary/uterus/). * **Microwave:** A slender tool is inserted through the [cervix](https://nabtahealth.com/glossary/cervix/). Once in place, it emits microwaves to heat and destroy the endometrial tissue. The usual duration for this procedure is 3-5 minutes. * **Radiofrequency:** A flexible, mesh device is inserted into the [uterus](https://nabtahealth.com/glossary/uterus/), where it transmits radiofrequency energy that vaporises the endometrial tissue within a couple of minutes. Some doctors will advocate a **partial endometrial ablation**, whereby only part of the endometrial wall is destroyed. This is with a view to reducing the number of late-onset complications seen with total ablations. Up to a quarter of women who have an endometrial ablation will end up needing a [hysterectomy](https://nabtahealth.com/glossary/hysterectomy/) and this is particularly true for younger women. Preliminary data suggests that partial ablations have no long-term complications and result in improved quality of life scores and fewer hysterectomies. However, larger studies are required to validate this finding. #### **Do endometrial ablations work?** Approximately 80% of women see a reduction in menstrual blood loss following endometrial ablation. Documented risks, such as damage to nearby organs and puncturing of the uterine wall occur very rarely and few women report procedure-related complications. Side effects are minimal; cramps, which can last a few days, and a watery, bloody vaginal discharge and increased need to pass urine, which usually passes within 24 hours. Overall, the procedure is considered safe, effective and minimally invasive. It has reduced [hysterectomy](https://nabtahealth.com/glossary/hysterectomy/) rates and improved the quality of life for many women trapped in a cycle of relentless heavy periods. Try Nabta’s [post-surgery pack](https://nabtahealth.com/product/post-surgery-selfcare-pack-copy/) after the procedure. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#374e565b5b567759565543565f52565b435f1954585a) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * “Endometrial Ablation.” _Johns Hopkins Medicine_, [www.hopkinsmedicine.org/health/treatment-tests-and-therapies/endometrial-ablation](http://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/endometrial-ablation). * “Endometrial Ablation.” _Mayo Clinic_, Mayo Foundation for Medical Education and Research, 8 Sept. 2018, [www.mayoclinic.org/tests-procedures/endometrial-ablation/about/pac-20393932](http://www.mayoclinic.org/tests-procedures/endometrial-ablation/about/pac-20393932). * Laberge, Philippe, et al. “Endometrial Ablation in the Management of Abnormal Uterine Bleeding.” _Journal of Obstetrics and Gynaecology Canada_, vol. 37, no. 4, 1 Apr. 2015, pp. 362–376., doi:10.1016/s1701-2163(15)30288-7. * Mccausland, Vance, et al. “Partial Endometrial Ablation: A 10–20-Year Follow-Up of Impact on Bleeding, Pain, and Quality of Life.” _Journal of Gynecologic Surgery_, vol. 32, no. 4, 22 July 2016, pp. 230–235., doi:10.1089/gyn.2016.0012. * Wortman, Morris. “Late-Onset Endometrial Ablation Failure.” _Case Reports in Women’s Health_, vol. 15, July 2017, pp. 11–28., doi:10.1016/j.crwh.2017.07.001.
The primary difference between deodorants and antiperspirants is that deodorants are designed to minimise odour, whilst antiperspirants minimise odour by reducing sweat production. The active ingredient in antiperspirants that reduces hyperhidrosis (sweating) is [aluminium](https://nabtahealth.com/glossary/aluminium/), which has been in use since the start of the 20th century and seems to work by blocking the sweat gland ducts. Headlines announcing that ‘[Aluminium](https://nabtahealth.com/glossary/aluminium/) in Deodorants Trigger Breast Cancer’, unsurprisingly caused significant concern amongst consumers. However, was the worry justified and should women really avoid these products as a result? #### Deodorants The first thing to note is that deodorants do not contain any [aluminium](https://nabtahealth.com/glossary/aluminium/) salts, only antiperspirants do. So, any [aluminium](https://nabtahealth.com/glossary/aluminium/)\-based risk will be restricted to those products marketed as antiperspirants. Secondly, [aluminium](https://nabtahealth.com/glossary/aluminium/) is used in processed food, drugs (particularly vaccine composition) and cosmetic products. It is also the third most abundant element in the earth’s composition, making avoiding it altogether quite a challenge. Furthermore, the extent of exposure via the skin is thought to be less than 0.002%. Finally, and perhaps most importantly of all, the Journal of the National Cancer Institute carried out an extensive case study in direct response to the [aluminium](https://nabtahealth.com/glossary/aluminium/) fear-mongering and they concluded that antiperspirants did not increase the risk of breast cancer. #### Antiperspirants So [aluminium](https://nabtahealth.com/glossary/aluminium/) in antiperspirants is unlikely to cause breast cancer, but should women who already have the condition limit their use of [aluminium](https://nabtahealth.com/glossary/aluminium/)\-containing products? The answer is, probably not. There is usually an increased aggregation of [aluminium](https://nabtahealth.com/glossary/aluminium/) in tumour tissue; however, there is an increased build-up of other minerals too. Breast tumours typically arise in the upper, outer quadrant of the breast, near the armpit, close to where antiperspirant is applied. However, this is far more likely to be due to the composition of the breast and the fact that there is more glandular tissue in that region. There is no evidence that aluminum-containing antiperspirants exacerbate a cancer diagnosis. It is, however, recommended that women avoid antiperspirants on the days that they are undergoing mammograms, as the [aluminium](https://nabtahealth.com/glossary/aluminium/) particles can resemble regions of micro-calcification, hindering the results. It is far more important for women to select products that will provide maximum benefit for their individual needs. In general, antiperspirants are best suited for those with significant hyperhidrosis; whereas odour-neutralising deodorants are sufficient for most women’s requirements. The [Ozalys Smoothing Care Deodorant Cream](../) offers hydration and soothing relief to sensitive skin. It contains sinodor and [diatomaceous earth](../benefits-of-diatomaceous-earth) to neutralise odours, and zincidone to avoid bacterial build up. Sweat is odourless and only causes body odour when it reacts with bacteria that is present on the surface of the skin. [Dry skin](../conditions-that-cause-dry-skin) is a common side effect of many chemotherapeutics. Incorporating the Ozalys products, which are rich in [moisturising](../what-is-a-humectant-and-why-is-it-essential-for-cosmetics) ingredients, into your [beauty regime](../what-is-a-nicu), including your underarm care, can help to alleviate some of the associated discomfort. **About Ozalys** Ozalys’ products have been designed with women who have been affected by cancer in mind. Ozalys allows women to continue to care for themselves every day using products that innovate through their formulas, optimal absorption and packaging. Ozalys’ specially-formulated solutions are catered for physiological conditions that cause dermal sensitivity, or for the side effects of certain treatments that may result in olfactory and dermal ultra-sensitivity. Ozalys’ personal hygiene, face and body care products have all been developed with the utmost care, minimising preservatives and excluding all substances suspected of being harmful to the body. Their highly soothing, moisturising and protective properties, as well as their delicate application and scent, turn daily beauty routines into moments of well-being and comfort. **Sources:** * Klotz, K, et al. “The Health Effects of Aluminum Exposure.” _Deutsches Arzteblatt International_, vol. 114, no. 39, 29 Sept. 2017, pp. 653–659., doi:10.3238/arztebl.2017.0653. * Mirick, D K, et al. “Antiperspirant Use and the Risk of Breast Cancer.” _Journal of the National Cancer Institute_, vol. 94, no. 20, 16 Oct. 2002, pp. 1578–1580. * Namer, M, et al. “The Use of Deodorants/Antiperspirants Does Not Constitute a Risk Factor for Breast Cancer.” _Bulletin Du Cancer_, vol. 95, no. 9, Sept. 2008, pp. 871–880., doi: 10.1684/bdc.2008.0679. * “Antiperspirants and Breast Cancer Risk.” _American Cancer Society_, [www.cancer.org/cancer/cancer-causes/antiperspirants-and-breast-cancer-risk.html](http://www.cancer.org/cancer/cancer-causes/antiperspirants-and-breast-cancer-risk.html).
Many of us are guilty of hoarding an extensive collection of cosmetics and skincare products; some of them are favourites that we use everyday, others barely used and relegated to the back of the cupboard. How many of us though, can honestly say we know exactly what ingredients our beauty staples contain? How many of us have stopped to consider that many of these products are full of chemicals, things added to extend the shelf-life, or keep our make-up from sliding off our face? Do we ever stop to question what these additives and preservatives might be doing elsewhere in our body? #### **What are [endocrine disruptors](https://nabtahealth.com/glossary/endocrine-disruptors/)?** [Endocrine disruptors](https://nabtahealth.com/glossary/endocrine-disruptors/) are attracting more attention globally, not least because they are found in so many products we use on a daily basis, including personal care items and cosmetics. They are environmental chemicals that mimic or block hormone action; sometimes by binding to the sites that endogenous hormones are supposed to bind to, sometimes by preventing the synthesis or [metabolism](https://nabtahealth.com/glossary/metabolism/) of these hormones. Reproduction is a process regulated by hormones and, as such, it is susceptible to the negative effects of endocrine disrupting chemicals. These can manifest as subfertility, [infertility](https://nabtahealth.com/glossary/infertility/), menstrual cycle irregularities, [anovulation](https://nabtahealth.com/glossary/anovulation/) and impaired [oocyte](https://nabtahealth.com/glossary/oocyte/) (and [sperm](https://nabtahealth.com/glossary/sperm/)) quality. The exact mechanisms by which [endocrine disruptors](https://nabtahealth.com/glossary/endocrine-disruptors/) impede fertility are unclear; however, as our awareness of how widespread these chemicals are grows and as [infertility](https://nabtahealth.com/glossary/infertility/) rates continue to rise, perhaps a deeper understanding is needed. #### **Which chemicals should I look out for in my products?** One of the problems with [endocrine disruptors](https://nabtahealth.com/glossary/endocrine-disruptors/) is that there are a large number of them and avoiding them altogether may prove difficult. Particularly as identifying which, in a sometimes very long and very unpronounceable list, are the questionable ingredients. Many of the [endocrine disruptors](https://nabtahealth.com/glossary/endocrine-disruptors/) found in beauty products are non-persistent, meaning they are removed from the body rapidly, thus there is no build-up effect. However, repeated usage of the same products, over a prolonged time period, means exposure can be consistent and long-term. Here we present a list of some of the [endocrine disruptors](https://nabtahealth.com/glossary/endocrine-disruptors/) most commonly found in cosmetics and personal hygiene products. It is fair to say that the data is minimal for the vast majority of these and definitive conclusions are lacking, but we will attempt to provide a summary of the information that is currently available. #### **Phthalates** These are found in personal care products. In the case of cosmetics, most phthalates enter the body via dermal absorption, i.e. through the skin. Animal studies have suggested that high dose phthalates lower [oestrogen](https://nabtahealth.com/glossary/oestrogen/) levels and inhibit [ovulation](https://nabtahealth.com/glossary/ovulation/), but there is no equivalent data in humans. Human studies have predominantly focused on couples undergoing [IVF](https://nabtahealth.com/glossary/ivf/), where higher phthalate exposure seems to correlate with a lower [oocyte](https://nabtahealth.com/glossary/oocyte/) yield. One study found that increased phthalates in the urine, correlated with a reduced follicle count. However, this could not be replicated in other work. Time To Pregnancy (TTP) is a marker of fecundability. When exploring the effects of phthalates, TTP has varied across different studies. There was even some evidence that certain phthalates reduced the TTP. Furthermore, effects were not always consistent between men and women, so in future studies it would be important to assess the exposure levels of both members of a couple. Overall, there is currently insufficient data on which to draw definitive conclusions. #### **Triclosan (TCS) and triclocarbon (TCC)** TCS and TCC are [antimicrobials](https://nabtahealth.com/glossary/antimicrobials/) found in soaps and personal hygiene products, such as toothpaste and deodorant. Exposure is via dermal absorption and ingestion and, growing concerns over their potential safety profile has led to their use in consumer products being regulated by the Food and Drug Administration ([FDA](https://nabtahealth.com/glossary/fda-2/)) in the USA. Animal studies have suggested that TCS may be anti-oestrogenic, that it disrupts the synthesis of [LH](https://nabtahealth.com/glossary/lh/) and [FSH](https://nabtahealth.com/glossary/fsh/) and that its presence correlates with lower ovarian and uterine weight. Studies in humans are limited, but high levels correlate with poorer [IVF](https://nabtahealth.com/glossary/ivf/) outcomes and it can affect [sperm](https://nabtahealth.com/glossary/sperm/) quality in males. There is currently no data showing any link between TCS or TCC and TTP. #### **Benzophenones** Benzophenones are added to products to extend their lifespan by providing protection from UV light. They are found in sunscreen, lipstick, hairspray and body lotions and, therefore, usually enter the body via the skin. Concerns about their effects on fertility came from _in vitro_ (cell culture) studies and animal work where they were shown to have oestrogenic-like activity and affect menstrual cycle length in rats. To date, there has been no work supporting these findings in humans and the only study looking at TTP was performed on males. Whilst the experimental data is currently lacking, the knowledge that the metabolites of these products can be stored in adipose (fat) tissue, extending the time in which they can exert a negative effect elsewhere in the body; warrants further research into their mechanism of action. #### **Parabens** Parabens are widely used in cosmetics because they act as preservatives. Often, more than one paraben will be added to a product, as they can act synergistically. They are very widely used; in fact, the National Health and Nutrition Examination Survey in 2005/2006 found that some of the most common parabens were detectable in more than 90% of participants. They were also found at much higher levels in women than in men. Animal studies have suggested that parabens have weak oestrogenic activity and are anti-androgenic, meaning they block the action of the [male sex hormones](https://nabtahealth.com/male-hormones-in-women/). Human studies have suggested an association between high paraben levels and shortened menstrual cycles and lower follicle counts. High exposure to particular paraben metabolites has been associated with a longer TTP, but the relationship is only seen with female exposure. Furthermore, this finding has not been replicated in other studies. #### **Glycol ethers** These are solvents that were traditionally used in an industrial setting, but are now increasingly added to personal care products such as perfume and liquid soap because they are considered to have low acute toxicity. There are more than 30 glycol ethers in use, all with differing properties and toxicities. Most work to date has involved occupational studies, whereby those working in the semiconductor industry reported disrupted menstrual cycles and an increased risk of [miscarriage](https://nabtahealth.com/glossary/miscarriage/). Animal studies have suggested that various glycol ethers have an adverse effect on ovarian function, but this has yet to be extrapolated to human studies. There is a possible association between high levels of exposure to certain metabolites and increased TTP, but validation of these preliminary results is necessary. #### **Conclusion** The titular question asked by this article is surprisingly difficult to answer. Could the contents of your bathroom shelf and/or make-up bag really affect your ability to conceive? Furthermore, when we are exposed to so many different chemicals in our everyday lives, is it really ever going to be possible to identify which, if any, are causing us actual, measurable harm? In researching this topic, it soon became abundantly clear that there are significant gaps in our knowledge and many unanswered questions remain: * Where multiple [endocrine disruptors](https://nabtahealth.com/glossary/endocrine-disruptors/) are present in the same product, do they have a synergistic or cumulative effect? * The ability to successfully produce live offspring (fecundability) is complex and couple-dependent. Males will also be exposed to [endocrine disruptors](https://nabtahealth.com/glossary/endocrine-disruptors/) in their daily lives, how much of an effect does this exposure have on a couple’s fertility? Are the chemicals typically the same, or different; and could things that are relatively harmless to females, have a more drastic effect on the male reproductive system? * The conclusions we are trying to make at this stage are largely based on animal studies. Those looking at human cases, tend to use the success and/or failure rate of [IVF](https://nabtahealth.com/glossary/ivf/) as a measure. There is a need for more studies designed to look at TTP, using environmentally-relevant doses of chemicals. So where does this leave us? Preliminary work provides few definitive conclusions, but certainly raises awareness of just how widely used some of these chemicals are. Perhaps it is time we all made a switch away from chemically-laden products with incomplete safety profiles? Whilst the data remains inconclusive from a scientifically significant perspective, the fact is that more and more people want to understand exactly what ingredients are in the products they are using. So much so, that there are a growing number of ‘clean beauty’ products available; products that promote their use of natural, chemical-free ingredients. Taking care of the skin is one of the most important part of a good and healthy lifestyle, try Nabta’s [Cystic acne pack](https://nabtahealth.com/product/cystic-acne-luxury-selfcare-pack/). **Sources:** * Cho, Yeon Jean, et al. “Nonpersistent Endocrine Disrupting Chemicals and Reproductive Health of Women.” _Obstetrics & Gynecology Science_, vol. 63, no. 1, Jan. 2020, pp. 1–12., doi:10.5468/ogs.2020.63.1.1. * Hipwell, Alison E, et al. “Exposure to Non-Persistent Chemicals in Consumer Products and Fecundability: a Systematic Review.” _Human Reproduction Update_, vol. 25, no. 1, 1 Jan. 2019, pp. 51–71., doi:10.1093/humupd/dmy032. * Rattan, Saniya, et al. “Exposure to [Endocrine Disruptors](https://nabtahealth.com/glossary/endocrine-disruptors/) during Adulthood: Consequences for Female Fertility.” _Journal of Endocrinology_, vol. 233, no. 3, June 2017, pp. R109–R129., doi:10.1530/joe-17-0023. * Smarr, Melissa M., et al. “Urinary Concentrations of Parabens and Other Antimicrobial Chemicals and Their Association with Couples’ Fecundity.” _Environmental Health Perspectives_, vol. 125, no. 4, Apr. 2017, pp. 730–736., doi:10.1289/ehp189.
