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).
The greatest risk for a baby that is exposed to [Gestational Diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) Mellitus affect the newborn (GDM) in utero is [**large birth weight**](https://nabtahealth.com/articles/how-your-weight-can-affect-your-pregnancy/), which is known medically as [](https://www.mayoclinic.org/diseases-conditions/fetal-macrosomia/symptoms-causes)[macrosomia](https://nabtahealth.com/glossary/macrosomia/). #### [Macrosomia](https://nabtahealth.com/glossary/macrosomia/) This refers to babies who weigh over 4 KG or are above the 90th centile. Quite apart from the [difficulties for the mother](../i-have-gestational-diabetes-what-are-the-risks-to-me) in delivering such a large baby, [macrosomia](https://nabtahealth.com/glossary/macrosomia/) can have serious health consequences for the neonate, including an increased risk of [**birth injury**](https://nabtahealth.com/articles/5-types-of-vaginal-tears-from-giving-birth-and-what-they-mean/) and, fortunately only in exceptional cases, early [neonatal](https://nabtahealth.com/glossary/neonatal/) death. #### Other risks There is a slightly increased risk of **[foetal malformations](https://nabtahealth.com/glossary/foetal-malformations/)**. However, this is thought to be primarily due to undiagnosed type 2 diabetes, rather than GDM itself. GDM-induced malformations occur when the condition has been diagnosed early on in pregnancy. Most women are not diagnosed until after 24 weeks and thus, the risk of their babies developing malformations is negligible. GDM does increase the likelihood of interventional approaches such as [induced labour](../https://nabtahealth.com/induction-of-labour/) and [C-section](https://nabtahealth.com/is-caesarean-considered-a-better-choice/), each of which has its own complications. Furthermore, if these intervention techniques are implemented before 37 weeks, the birth will be classed as [**premature**](https://nabtahealth.com/articles/anemia-in-premature-infants/) and the baby may require further monitoring and additional care. Whilst studies are yet to find a direct link between maternal GDM and infant respiratory distress, babies that are more than 4 KG at birth have an increased risk of **respiratory distress**. A major problem in managing this situation is that premature birth and [C-section](https://nabtahealth.com/articles/is-performing-a-c-section-better-than-inducing-labour/) delivery are additional risk factors for respiratory distress. Therefore, even if you take steps to avoid [macrosomia](https://nabtahealth.com/glossary/macrosomia/) and its associated issues, your baby might still need additional medical support at birth. #### Later health problems In addition to the risk of complications during pregnancy and delivery, having untreated GDM can predispose your child to **health problems later in life**. These include impaired glucose tolerance, high blood pressure and obesity, which in combination increase the chances of them developing type 2 diabetes themselves. GDM is not the only risk factor for these conditions; genetics and lifestyle exposure almost certainly play an important role too. [Breastfeeding](https://nabtahealth.com/benefits-of-breastfeeding/) is one way of counteracting some of these negative effects, as it has been shown to improve glucose tolerance and lower the risk of childhood obesity. It has also been suggested that GDM in the mother can increase the likelihood of the child having **attention deficiencies and delayed language** as they reach middle childhood, around the age of 7. The offspring of less educated women are more affected, suggesting a concurrent environmental or genetic element. Recent studies have revealed that babies born to mothers with [GDM](https://nabtahealth.com/articles/i-have-gestational-diabetes-what-are-the-risks-to-me/) have different bacteria present in their gut. This is known as an **altered [microbiome](https://nabtahealth.com/glossary/microbiome/) profile**. It is thought that the presence of specific bacteria in the gut of a neonate helps with the maturation of their immune system. Thus, a disruption in this [homeostasis](https://nabtahealth.com/glossary/homeostasis/) can have long term effects on the child’s ability to overcome infections and put them at increased risk of [metabolic disease](https://nabtahealth.com/glossary/metabolic-disease/) later in life. Most of these adverse effects can be significantly reduced by successful management of the mother’s GDM; further highlighting the importance of [identifying](../how-is-gestational-diabetes-diagnosed) and treating the condition as soon as possible. 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#9ee7fff2f2ffdef0fffceafff6fbfff2eaf6b0fdf1f3) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Bener, A, et al. “Prevalence of [Gestational Diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) and Associated Maternal and [Neonatal](https://nabtahealth.com/glossary/neonatal/) Complications in a Fast-Developing Community: Global Comparisons.” _International Journal of Women’s Health_, vol. 3, 2011, pp. 367–373., doi:10.2147/IJWH.S26094. * Dionne, G, et al. “[Gestational Diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) Hinders Language Development in Offspring.” _Pediatrics_, vol. 122, no. 5, Nov. 2008, pp. e1073–1079., doi:10.1542/peds.2007-3028. * Groof, Z, et al. “Prevalence, Risk Factors, and Fetomaternal Outcomes of [Gestational Diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) Mellitus in Kuwait: A Cross-Sectional Study.” _Journal of Diabetes Research_, vol. 2019, no. 9136250, 3 Mar. 2019, doi:10.1155/2019/9136250. * Mitanchez, D. “Foetal and [Neonatal](https://nabtahealth.com/glossary/neonatal/) Complications in [Gestational Diabetes](https://nabtahealth.com/glossary/gestational-diabetes/): [Perinatal](https://nabtahealth.com/glossary/perinatal/) Mortality, Congenital Malformations, [Macrosomia](https://nabtahealth.com/glossary/macrosomia/), Shoulder Dystocia, Birth Injuries, [Neonatal](https://nabtahealth.com/glossary/neonatal/) Complications.” _Diabetes & [Metabolism](https://nabtahealth.com/glossary/metabolism/)_, vol. 36, no. 6, ser. 2, Dec. 2010, pp. 617–627. 2, doi:10.1016/j.diabet.2010.11.013. * Mitanchez, D, et al. “Infants Born to Mothers with [Gestational Diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) Mellitus: Mild [Neonatal](https://nabtahealth.com/glossary/neonatal/) Effects, a Long-Term Threat to Global Health.” _The Journal of Pediatrics_, vol. 164, no. 3, Mar. 2014, pp. 445–450., doi:10.1016/j.jpeds.2013.10.076. * Su, M, et al. “Diversified Gut Microbiota in Newborns of Mothers with [Gestational Diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) Mellitus.” _PloS One_, vol. 13, no. 10, 17 Oct. 2018, p. e0205695., doi:10.1371/journal.pone.0205695.
The risk factors for [Gestational Diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) Mellitus (GDM) occurs when the body does not produce enough insulin and blood sugar levels get too high during [pregnancy](https://nabtahealth.com/articles/complications-during-pregnancy-polyhydramnios/). It most commonly occurs in the second and third trimester. Prevalence varies around the world, but with [obesity](https://nabtahealth.com/what-is-body-mass-index-bmi/) considered a major risk factor, and the number of obese females increasing, GDM is becoming a significant health issue of the 21st Century. Having [GDM](https://nabtahealth.com/articles/i-have-gestational-diabetes-what-are-the-risks-to-my-unborn-baby/) does increase the risk of complications for both mother and baby. However, the risks from GDM can be reduced if it is detected early and managed well. This article looks at what impact GDM has on the mother’s health; to see the risks to her offspring click [here](../i-have-gestational-diabetes-what-are-the-risks-to-my-unborn-baby). #### Pregnancy complications Women who are diagnosed with GDM are at increased risk of [pregnancy complications](https://nabtahealth.com/articles/complications-during-pregnancy-polyhydramnios/) including [](https://nabtahealth.com/complications-during-pregnancy-polyhydramnios/)[polyhydramnios](https://nabtahealth.com/glossary/polyhydramnios/), which occurs when there is an excess of [amniotic fluid](https://nabtahealth.com/glossary/amniotic-fluid/). They are also at increased risk of developing [hypertension](https://nabtahealth.com/glossary/hypertension/) (high blood pressure) and [](../what-is-preeclampsia)[preeclampsia](https://nabtahealth.com/glossary/preeclampsia/). [Preeclampsia](https://nabtahealth.com/glossary/preeclampsia/) is a life-threatening condition that requires close medical monitoring. In severe cases it can [lead](https://nabtahealth.com/glossary/lead/) to maternal seizures and will often result in premature delivery. #### Delivery In terms of delivery, women with GDM are more likely to experience [premature labour](https://nabtahealth.com/glossary/premature-labour/). In some cases this is spontaneous, but, in many cases, rapid growth of the baby in utero necessitates medical intervention. Babies born to mothers with GDM are frequently above the 90th percentile and if allowed to go to [full term](https://nabtahealth.com/glossary/full-term/) can weigh more than 4.5 KG at birth. Delivering such a large baby puts the mother at increased risk of complications and, therefore, [induced delivery](https://nabtahealth.com/induction-of-labour/) and planned [C-sections](https://nabtahealth.com/is-caesarean-considered-a-better-choice/) are common following a GDM diagnosis. The mother also has an increased risk of postpartum haemorrhage, which can be very dangerous if not attended to rapidly. #### Long-term health impact GDM can also have longer-term effects on the mother’s health. Women who are diagnosed with GDM are over 7 times more likely to develop [type 2 diabetes](https://nabtahealth.com/product/type-2-diabetes-starter-pack-copy/); most often in the first 5 years post-childbirth. Some women actually find that the GDM that is diagnosed during pregnancy persists after delivery and is reclassified as type 2 diabetes. The risk of a woman developing GDM during a subsequent pregnancy is approximately 48%, but can be significantly higher if she falls into a [high risk group](../risk-factors-for-gestational-diabetes). 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#c6bfa7aaaaa786a8a7a4b2a7aea3a7aab2aee8a5a9ab) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Bellamy, L, et al. “Type 2 Diabetes Mellitus after [Gestational Diabetes](https://nabtahealth.com/glossary/gestational-diabetes/): a Systematic Review and Meta-Analysis.” _The Lancet_, vol. 373, no. 9677, 23 May 2009, pp. 1773–1779., doi:10.1016/S0140-6736(09)60731-5. * Bener, A, et al. “Prevalence of [Gestational Diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) and Associated Maternal and [Neonatal](https://nabtahealth.com/glossary/neonatal/) Complications in a Fast-Developing Community: Global Comparisons.” _International Journal of Women’s Health_, vol. 3, 2011, pp. 367–373., doi:10.2147/IJWH.S26094. * “[Gestational Diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) (Overview).” _NHS_, [www.nhs.uk/conditions/gestational-diabetes/](http://www.nhs.uk/conditions/gestational-diabetes/). * Groof, Z, et al. “Prevalence, Risk Factors, and Fetomaternal Outcomes of [Gestational Diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) Mellitus in Kuwait: A Cross-Sectional Study.” _Journal of Diabetes Research_, vol. 2019, no. 9136250, 3 Mar. 2019, doi:10.1155/2019/9136250. * Schwartz, N, et al. “The Prevalence of [Gestational Diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) Mellitus Recurrence–Effect of Ethnicity and Parity: a Metaanalysis.” _American Journal of Obstetrics and Gynecology_, vol. 213, no. 3, Sept. 2015, pp. 310–317., doi:10.1016/j.ajog.2015.03.011.
Ethnicity is at risk for [Gestational Diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) Mellitus (GDM) is a glucose intolerance that develops during pregnancy; which, if left untreated, can have long-term health implications for both the [mother](../i-have-gestational-diabetes-what-are-the-risks-to-me) and her [baby](../i-have-gestational-diabetes-what-are-the-risks-to-my-unborn-baby). Worldwide, the prevalence of GDM is increasing, paralleling the rise in cases of type 2 diabetes. Obesity is a major [risk factor](../how-can-i-reduce-my-risk-of-developing-gestational-diabetes) for the development of both [GDM](https://nabtahealth.com/articles/how-is-gestational-diabetes-diagnosed/) and type 2 diabetes, with over 70% of women with GDM having a [Body Mass Index](https://nabtahealth.com/what-is-body-mass-index-bmi/) ([BMI](https://nabtahealth.com/glossary/bmi/)) of over 25. These women have a 50% chance (at least) of developing type 2 diabetes in the decade that follows their [GDM diagnosis](https://nabtahealth.com/articles/how-is-gestational-diabetes-diagnosed/). Addressing obesity is key to reducing the growing number of women being diagnosed with GDM. Ethnicity: a significant risk factor ------------------------------------ However, obesity is not the only factor that increases a [woman’s risk of developing GDM](https://nabtahealth.com/articles/i-have-gestational-diabetes-what-are-the-risks-to-me/); with one of the greatest non-modifiable risk factors thought to be ethnicity. Ethnicity is defined as “belonging to a social group that has a common national or cultural tradition” (Oxford English Dictionary), and the differences in prevalence rates of GDM across different ethnicities are quite striking. **Women from the Middle East have amongst the highest rates of GDM**, at up to 20%; whilst the risks in part of Europe are almost negligible, for example, the risk of developing GDM in Sweden is only 0.4-1.5%. Which populations are at highest risk? -------------------------------------- One large scale study looked at Kuwait in detail. It identified that 12.6% of pregnancies were affected by GDM. This figure increased to 18% when only women aged over 35 were considered (age is another major risk factor for GDM diagnosis). Prevalence rates across neighbouring countries are not dissimilar; Bahrain (10%), Saudi Arabia (15.4%), Qatar (16.3%) and UAE (20.6%). In the Kuwait study it was actually found that Kuwaiti women were at lower risk of GDM than non-Kuwaiti women living in Kuwait (10.2% vs 16.5%). This is probably due to a high proportion of Asian women living in the region. South Asian women have a 7-fold greater risk of developing GDM than women from the US or Australia. Their risk is significantly greater than the risk for women from other Asian sub-populations, including South East Asia and East Asia. The problem with cross-country comparisons ------------------------------------------ There are, however, problems with comparing across different countries, primarily because there is a distinct lack of universally accepted diagnostic criteria and screening approaches. Furthermore, the management of the condition should vary according to ethnicity, and the potential maternal and [perinatal](https://nabtahealth.com/glossary/perinatal/) outcomes will differ depending on where in the world you are. For a start, [BMI](https://nabtahealth.com/glossary/bmi/) is widely used as a screening tool and it can be highly successful at identifying those women at greatest risk in some parts of the world. It will potentially successfully identify over 90% of African-American women with the condition. However, in Asia, its use is questionable, as many women with the condition have a healthy, or even low [BMI](https://nabtahealth.com/glossary/bmi/). Perhaps in this part of the world, the best option is for all women to undergo diagnostic screening. Where obesity is identified as a concurrent risk, it is important to assess the normal diet and eating habits of a particular cultural group. In parts of Asia the diet is very rice-heavy; in the Middle East it is usual to have a large meal mid-afternoon, a small breakfast and a very late dinner. Therefore, carbohydrate intake and timing can vary substantially in different parts of the world, regardless of GDM prevalence. The impact of fasting during the holy month of Ramadan also needs to be taken into account, as many diabetics will still wish to fast. As a final note, extra care should be taken of migrants living in a foreign country. They may struggle to manage their condition if all their health care is provided in a language that they are unfamiliar with. These women are at greater risk of additional complications if their GDM remains untreated. 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#2158404d4d40614f404355404944404d55490f424e4c) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Bener, A, et al. “Prevalence of [Gestational Diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) and Associated Maternal and [Neonatal](https://nabtahealth.com/glossary/neonatal/) Complications in a Fast-Developing Community: Global Comparisons.” _International Journal of Women’s Health_, vol. 3, 2011, pp. 367–373., doi:10.2147/IJWH.S26094. * Fadl, H E, et al. “Maternal and [Neonatal](https://nabtahealth.com/glossary/neonatal/) Outcomes and Time Trends of [Gestational Diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) Mellitus in Sweden from 1991 to 2003.” _Diabetic Medicine_, vol. 27, no. 4, Apr. 2010, pp. 436–441., doi:10.1111/j.1464-5491.2010.02978.x. * Groof, Z, et al. “Prevalence, Risk Factors, and Fetomaternal Outcomes of [Gestational Diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) Mellitus in Kuwait: A Cross-Sectional Study.” _Journal of Diabetes Research_, vol. 2019, no. 9136250, 3 Mar. 2019, doi:10.1155/2019/9136250. * Yuen, L, and V W Wong. “[Gestational Diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) Mellitus: Challenges for Different Ethnic Groups.” _World Journal of Diabetes_, vol. 6, no. 8, 25 July 2015, pp. 1024–1032., doi:10.4239/wjd.v6.i8.1024.
 _**Week 1**: Y_ou aren’t officially pregnant yet, but your pregnancy will be dated from the first day of your last menstrual period, making this week 1. Congratulations! You are menstruating (shedding your [uterus](https://nabtahealth.com/glossary/uterus/) lining and last cycle’s unfertilised egg\] and a new cycle is starting. Now is a good time to start your prenatal vitamins, cut back on alcohol and smoking, and follow a healthy and balanced diet. _**Week 2:**_ You haven’t conceived yet. Your body is preparing to ovulate. You’ll notice your cervical mucus changes in volume, texture, and colour as your fertility increases. Just before [ovulation](https://nabtahealth.com/glossary/ovulation/) your cervical mucus will be thinner and cloudy, or yellowish, and your basal body temperature (BBT) will drop. _**Week 3:**_ You are at your most fertile. During [ovulation](https://nabtahealth.com/glossary/ovulation/) your cervical mucus is the colour and consistency of egg whites and your BBT rises. An egg is released from one of your [ovaries](https://nabtahealth.com/glossary/ovaries/) into your [fallopian tubes](https://nabtahealth.com/glossary/fallopian-tube/) and waits to be fertilised by a [sperm](https://nabtahealth.com/glossary/sperm/). Your egg can wait for 12-24 hours for a [sperm](https://nabtahealth.com/glossary/sperm/) to successfully push through its outer surface. You’ve conceived! Your fertilised single cell [zygote](https://nabtahealth.com/glossary/zygote/) will divide and multiply rapidly over the coming days. This cell cluster, the blastocyst, then travels from your [fallopian tubes](https://nabtahealth.com/glossary/fallopian-tube/) to your [uterus](https://nabtahealth.com/glossary/uterus/). _**Week 4:**_ The blastocyst arrives in your [uterus](https://nabtahealth.com/glossary/uterus/) and implants in your uterine lining. You may notice some [implantation](https://nabtahealth.com/glossary/implantation/) spotting or bleeding, no need to worry, this is normal. Now connected to you, the blastocyst divides into the embryo (your baby) and the [placenta](https://nabtahealth.com/glossary/placenta/) which will soon take over from the yolk sac to nourish your baby and remove waste. Your pregnancy hormones will start to kick in around now and you may start to feel some hormonal symptoms such as mood swings and tender breasts. Your embryo is the size of a poppy seed this week. _**Week 5:**_ Your period is late and with your hCG levels now high enough to return a positive home pregnancy test things are getting exciting. Your body’s working overtime to establish the [placenta](https://nabtahealth.com/glossary/placenta/) and major organs and systems in the embryo, which is now the size of an apple pip. You’ll probably start to feel some fatigue and light nausea this week and you might notice those famous pregnancy food cravings (and aversions) kick in. _**Week 6:**_ Your baby is growing quickly and is the size of a pea, with the look of a tiny tadpole! Organs are continuing to develop and an ultrasound might detect your baby’s heartbeat now. The [neural tube](https://nabtahealth.com/glossary/neural-tube/) is closing – the spinal cord and brain will develop from this – and small buds are the start of arms forming. Your pregnancy symptoms are more pronounced. Fatigue, nausea (morning sickness), tender breasts, bloating and indigestion are all common. And with your growing [uterus](https://nabtahealth.com/glossary/uterus/) putting pressure on your bladder, you may need to urinate more frequently. _**Week 7:**_ This week your baby is the size of a blueberry. Its brain cells and face start to develop, small leg buds will form, and the little arm buds will lengthen. The pregnancy hormones [oestrogen](https://nabtahealth.com/glossary/oestrogen/) and [progesterone](https://nabtahealth.com/glossary/progesterone/) are responsible for your sore, swollen breasts. Your food aversions, nausea, [heartburn](https://nabtahealth.com/glossary/heartburn/), need to pee and utter exhaustion aren’t going away anytime soon. But you are building a baby! _**Week 8:**_ Your baby is the size of a kidney bean. Fingers and facial features are forming, and retinas are developing (although you won’t know the colour of your baby’s eyes for another 7 months). Your baby’s internal sexual organs also start to grow now. You can add tightening clothes (your [uterus](https://nabtahealth.com/glossary/uterus/) is the size of a tennis ball right now), vaginal discharge and [constipation](https://nabtahealth.com/glossary/constipation/) to the list of pregnancy symptoms. Remember to go easy on yourself, you are creating a little human. _**Week 9:**_ Your baby is the size of an olive. Arms lengthen, elbows appear, and toes are forming. The spinal cord ‘tadpole tail’ has almost gone and your baby’s heartbeat is strong enough for your doctor to hear using a doppler device. Extreme pregnancy fatigue takes over. This is normal; your body’s coping with a spike in hormone and [metabolism](https://nabtahealth.com/glossary/metabolism/) levels and is working flat out to develop a healthy [placenta](https://nabtahealth.com/glossary/placenta/) for your baby. _**Week 10**:_ Your baby is the size of a strawberry. Now officially a foetus, your baby’s head is rounder, eyelids and ears continue to develop, elbows can bend, and fingers and toes are lengthening. What’s more, tooth buds are now forming under the gums. You are probably seeing some roundness in your lower belly now (your [uterus](https://nabtahealth.com/glossary/uterus/) is the size of a large orange). Nausea, [constipation](https://nabtahealth.com/glossary/constipation/), and indigestion may be making life uncomfortable, and the fatigue isn’t going anywhere. Remember to keep your fluids up. _**Week 11**:_ Your baby is the size of a fig. Its head is oversized at about half the length of its body; but this will soon catch up. Eyes are wide apart, eyelids are fused shut, and ears are low. Your baby’s external reproductive organs start to grow but it will keep you guessing its gender for now. With your body pumping 50% more blood you may feel hot and dizzy. Morning sickness might ease while your appetite increases. Try to eat delicious and nutritious food and not give into the temptation to eat for two! _**Week 12:**_ Your baby is the size of a plum. The [placenta](https://nabtahealth.com/glossary/placenta/) has taken over from the yolk sac and is nourishing your growing baby. Your baby’s internal organs and muscles are now fully formed, skeletal bones are hardening, and nails are forming. Some women will notice their hair and nails growing stronger and shinier, and the arrival of the ‘mask of pregnancy’ (chloasma), triggered by hormonal changes. Your early pregnancy symptoms of nausea, need to pee and indigestion may be lessening now. _**Week 13:**_ Your baby is the size of a lemon. Your baby is swallowing [amniotic fluid](https://nabtahealth.com/glossary/amniotic-fluid/), and its kidneys are making and releasing urine. Its head is now a third of its body length, vocal cords are forming, and you might see your baby making jerky movements on an ultrasound. You won’t feel these flutters and kicks for a few more weeks though. You are in your second trimester and it’s all starting to feel more real! Your [uterus](https://nabtahealth.com/glossary/uterus/) is pushing up and out and you might be thinking about your maternity wardrobe. Headaches, nosebleeds, and bleeding gums sometimes show up around this time; try using a toothbrush for sensitive gums. _**Week 14:**_ Your baby is the size of a nectarine. Hair follicles are forming, and senses of taste and smell are developing. External sex organs are in place. And your baby can suck its thumb and make facial expressions now! You are in the ‘honeymoon’ period of your pregnancy (in theory!). Hopefully you are feeling less tired and nauseous, and more energetic. You may experience a jabbing ‘[round ligament pain](https://nabtahealth.com/glossary/round-ligament-pain/)’ in your lower abdomen, caused by your expanding [uterus](https://nabtahealth.com/glossary/uterus/) – why not put your feet up and rest a little. _**Week 15:**_ Your baby is the size of a pear. And it might have hiccups! Facial features are moving into position and a scalp pattern is forming. Your baby is growing rapidly and becoming more active. Its developing bones will soon show on an ultrasound. As your bump grows your belly skin might be feeling itchy, try massaging in some unscented lotion. Apart from the common pregnancy symptoms, bleeding gums, nosebleeds, and increased vaginal discharge… you are feeling more energised this week. People may even comment on your pregnancy ‘glow’. _**Week 16:**_ Your baby is the size of an avocado. As your baby’s muscles and bones strengthen, its head straightens in line with its body, and movements become more coordinated. Your baby’s eyes are moving beneath its closed eyelids, skin is thickening, and facial hair is appearing. Be aware that urinary tract and vaginal infections (you’ll have noticed an increase in vaginal discharge) are more common now. You’ll find your weight increases as your baby grows. Remember to eat a healthy diet and stay active. Walking, swimming, pregnancy yoga and Pilates are all ideal for exercise during pregnancy. Ask your doctor if you aren’t sure. _**Week 17:**_ Your baby is the size of a pomegranate. And you might feel your baby move this week! Those little flutters could be kicks, or backflips, or hiccups. You won’t know for sure but isn’t it exciting. Your baby is also developing fat stores for energy and insulation. And it now has its own unique fingerprints. Your bump is getting bigger and is beginning to show. With your organs making space for your growing bump and [placenta](https://nabtahealth.com/glossary/placenta/) the indigestion is back. You may also notice an increase in breast size due to hormones and milk-producing glands. _**Week 18:**_ Your baby is the size of a sweet potato. Eyes are moving into position, ears are standing out, and your baby might start hearing muffled sounds this week. Myelin, an insulating substance, now coats and protects the spinal cord and nervous system, helping messages travel along nerve pathways faster. And your baby’s digestive system is working. It’s all going on! Your [linea nigra](https://nabtahealth.com/glossary/linea-nigra/) (or pregnancy line) is showing and you have the odd dizzy spell as your centre of gravity shifts and your blood pressure dips mid-pregnancy. Avoid standing for long periods and keep your fluids up. _**Week 19:**_ Your baby is the size of a mango. Arms and legs are in proportion with the body and its little wriggles are still flutters. [Vernix caseosa](https://nabtahealth.com/glossary/vernix-caseosa/), a white wax-like coating will soon cover your baby, protecting its delicate skin during its months sitting in [amniotic fluid](https://nabtahealth.com/glossary/amniotic-fluid/). [Round ligament pain](https://nabtahealth.com/glossary/round-ligament-pain/), dizziness, [constipation](https://nabtahealth.com/glossary/constipation/), and now maybe backaches and leg cramps. Your appetite is good though (remember to eat healthy amounts of fibre to keep things moving) and you’ll hopefully still be feeling bursts of energy. _**Week 20**:_ Your baby is the size of a bell pepper. Your baby is developing its own sleep-wake cycle and might even wake to the sound of your voice. You can see your baby’s gender on an ultrasound now. If it’s a little girl she already has 6-7 million eggs in her tiny [ovaries](https://nabtahealth.com/glossary/ovaries/), imagine that! You’re halfway through your second trimester. Your bump is popping, and your tummy button looks different (is your innie now an outie?) It’s normal to feel breathless at times. This is due to pregnancy hormones and your growing [uterus](https://nabtahealth.com/glossary/uterus/) now pushing against your lungs. _**Week 21:**_ Your baby is the size of a banana. And it’s now heavier than the [placenta](https://nabtahealth.com/glossary/placenta/). A thin downy layer of hair called [lanugo](https://nabtahealth.com/glossary/lanugo/) helps bind the vernix to your baby’s skin. Bone marrow begins to take over red blood cell production from the liver and spleen. And you can now hear your baby’s heartbeat with a stethoscope, does it sound like galloping horses? You continue to experience common second trimester symptoms. You may also notice new [stretch marks](https://nabtahealth.com/glossary/stretch-marks/), swelling in your feet and ankles, and [varicose veins](https://nabtahealth.com/glossary/varicose-veins/) (thanks to your changing hormones and the weight of your growing [uterus](https://nabtahealth.com/glossary/uterus/)). For relief, go for a swim or have a bath, keep your fluids up, and take your weight off your feet when you can. _**Week 22:**_ Your baby is the size of a papaya. Eyebrows and hair are visible. Tear ducts are forming, and although eyes are still shut, they are sensitive to light. Your baby’s sense of touch is developing, it can reach out and grab the [umbilical cord](https://nabtahealth.com/glossary/umbilical-cord/). The hormone [relaxin](https://nabtahealth.com/glossary/relaxin/) loosens ligaments around your pelvis to prepare for childbirth. This increased mobility can [lead](https://nabtahealth.com/glossary/lead/) to pelvic, hip, and other joint pain. Avoid heavy lifting or standing for too long. Oh, and your indigestion is off the charts. On the plus side, your hair is lustrous, and everyone says you have that pregnancy bloom. _**Week 23:**_ Your baby is the size of an eggplant. The lungs are learning to breathe, while the [placenta](https://nabtahealth.com/glossary/placenta/) still provides all the baby’s oxygen in the [uterus](https://nabtahealth.com/glossary/uterus/). Fat and muscle are building and your baby is more active. You can definitely feel those kicks now. Pay attention and you’ll soon identify your baby’s regular patterns of movement. Your growing bump may be attracting attention. And you’ll find everyone has a theory about your baby’s gender based on the shape of your belly! Leg cramps are more common. Try to stretch and flex your foot to ease the cramping. _**Week 24:**_ Your baby is the size of a rockmelon. Your baby’s taste buds are becoming more sensitive and when your baby swallows [amniotic fluid](https://nabtahealth.com/glossary/amniotic-fluid/) it can taste the food and drinks you have been eating! Your baby’s skin is still wrinkled and translucent; the fat it is adding will help smooth the wrinkles and regulate body temperature. The top of your [uterus](https://nabtahealth.com/glossary/uterus/) reaches just above your tummy button. You might start to feel sporadic [Braxton Hicks](https://nabtahealth.com/glossary/braxton-hicks/) ‘practice’ [contractions](https://nabtahealth.com/glossary/contraction/) when your bump briefly tightens and relaxes. Your [uterus](https://nabtahealth.com/glossary/uterus/) is preparing for labour. Now is a good time to start doing gentle pelvic floor exercises. During weeks 24-28 a glucose intolerance test will check for signs of [gestational diabetes](https://nabtahealth.com/glossary/gestational-diabetes/). _**Week 25:**_ Your baby is the size of a cauliflower. Senses are still evolving, and nostrils are unplugged, ready to smell and breathe fresh air in a few months. Your baby is looking pinker due to capillaries forming under the skin. The brain, lungs, nervous and digestive systems are all developing rapidly. Guess what, your [uterus](https://nabtahealth.com/glossary/uterus/) is now the size of a football! Unsurprisingly, your growing [uterus](https://nabtahealth.com/glossary/uterus/) puts pressure on your stomach and organs, which affects digestion. Your belly size (also known as the fundal height) is measured by the distance between your pubic bone and top of the [uterus](https://nabtahealth.com/glossary/uterus/). _**Week 26:**_ Your baby is the size of an iceberg lettuce. Your baby’s startle reflexes are working, and you might feel a sharp jab in response to sudden loud sounds. Eyelashes are sprouting and your baby’s eyelids will open this week. The retinas are developed but the iris pigmentation, which determines your baby’s eye colour, is still filling in. You might feel tired and uncoordinated as you grapple with pregnancy [insomnia](https://nabtahealth.com/glossary/insomnia/) and sharing your body with your growing baby. If you seem more forgetful than usual this is normal – ‘baby brain’ really is a thing. Go easy on yourself and if anything doesn’t feel right talk to your doctor. _**Week 27:**_ Your baby is the size of a zucchini. If you are carrying a boy the testicles drop into the scrotum around now. Your baby is gaining fat and weight and is moving around more and changing positions. Get a sense for your baby’s activity and alert your doctor if you notice decreased fetal movement. You are in the final week of the second trimester! Your breasts feel heavier due to the growth of glandular, milk-making, tissue. If you feel bloated drink lots of fluids and eat foods high in fibre, and fresh fruit and veg. And you may find it more comfortable to sleep on your side. _**Week 28:**_ Your baby is the size of an eggplant. Your baby is making more facial expressions and an ultrasound might show your baby sticking out its tongue! Your baby’s nervous system can control breathing movements (fresh air breathing comes later) and regulate temperature. This is also a time of rapid brain growth. You’re in your third trimester. You and your baby still have some growing to do. You may feel more back and pelvic discomfort, and need to pee frequently, as the bump puts pressure on your bladder, pelvis, and lower back. Keep up the light activity and stretching. _**Week 29:**_ Your baby is the size of a butternut squash. Calcium intake is up, bones are strengthening, and your baby is adding fat and weight. This will continue until birth. Your baby is busy in there: kicking, turning, stretching, and grabbing…you may see your tummy forming odd shapes! Your healthcare team might talk to you about a birth plan if you don’t have one. Restless legs syndrome (RLS) is common during the third trimester. If RLS is keeping you up at night (along with the [heartburn](https://nabtahealth.com/glossary/heartburn/), need to pee, [insomnia](https://nabtahealth.com/glossary/insomnia/), and leg cramps…) now is a good time to check your [iron](https://nabtahealth.com/glossary/iron/) levels, and continue the gentle daytime exercise. _**Week 30:**_ Your baby is the size of a pomelo. If you feel a repetitive tapping your baby might have hiccups. Don’t worry, they are totally normal. They could even be from the food you ate! Your baby’s skin is thicker now and the downy [lanugo](https://nabtahealth.com/glossary/lanugo/) covering your baby’s body is falling away. You’re starting to feel tired again and everyone wants to touch your belly. Regular gentle exercise will help you sleep better, manage the aches and pains, and stay strong for labour. Take the pressure off those [varicose veins](https://nabtahealth.com/glossary/varicose-veins/) with regular feet-up time. _**Week 31:**_ Your baby is the size of a pineapple. Brain connections are developing, eyes are open and eyelids are blinking (slowly at first). Your baby’s lungs are still maturing and its bones are hardening. You are in the home stretch. Your expanding [uterus](https://nabtahealth.com/glossary/uterus/) is now a couple of inches above your belly button. This is putting pressure on your diaphragm and lungs, making it hard for you to catch your breath. You may find your breasts start leaking small amounts of creamy yellowish [colostrum](https://nabtahealth.com/glossary/colostrum/). _Week 32:_ Your baby is the size of a small pumpkin. Your baby continues to add weight, making your [uterus](https://nabtahealth.com/glossary/uterus/) less roomy by the day. Finger and toenails are growing, they may even need clipping by the time your baby arrives in the world. A lot of babies move into head-down position around now. Some will keep flipping around, others will stay in bottom-down position ([breech](https://nabtahealth.com/glossary/breech/)) just before birth. Your face may feel puffy due to water retention. Always mention any puffiness or swelling to your doctor. Your baby’s head-down position is increasing the weight on your bladder, you need to pee little and often! Remember to keep up your pelvic floor exercises. _**Week 33:**_ Your baby is as big as a celery head. All five senses are well-developed now. Your baby can hear and react to your voice, and your baby’s pupils can respond to light changes. While your baby’s bones are hardening, the skull will stay soft and flexible to fit through the birth canal. You are overheating (that’s hormones for you), headachy, out of breath, you need to pee all the time, and you have pelvic pain. Oh, and you aren’t sleeping (and everyone is telling you to sleep while you can)! But you are also nesting and feeling some nervous anticipation. Remember to sign up for antenatal classes. _**Week 34**:_ Your baby is the size of a honeydew melon. The vernix protecting your baby’s skin is coming off in the [amniotic fluid](https://nabtahealth.com/glossary/amniotic-fluid/) which reaches its highest volume this week. Wriggling, swallowing, and breathing in the [amniotic fluid](https://nabtahealth.com/glossary/amniotic-fluid/) helps your baby’s muscles, bones, digestive system, and lungs mature. To ease your [heartburn](https://nabtahealth.com/glossary/heartburn/) try eating regular small meals during the day and avoid rich, spicy foods. Blurry vision and dry eyes can cause discomfort at this stage. Eyedrops help, and if you are a contact lens wearer you may find it more comfortable to wear glasses. _**Week 35:**_ Your baby is the size of a honeydew melon. Your baby’s brain is going through another period of explosive development in neurons and wiring. In fact, your baby’s brain weight increases by a third in the third trimester. The skin has filled out and is plumper. Your baby is putting on around half a pound a week. It’s normal for your baby to feel more wriggly in the last few weeks of pregnancy. It’s a squash in there and you can feel your baby jostling for space. Contact your healthcare team if your baby’s movements seem less regular. Pack your hospital bag and do a dummy hospital run if you haven’t already. _**Week 36:**_ Your baby is the size of coconut. Things are getting cramped in your [uterus](https://nabtahealth.com/glossary/uterus/). Your curled up baby has an established sleep-wake cycle and hearing is sharper. Your baby is now considered ‘late preterm’ or ‘near-term’. While still maturing, if born now your baby would need little, if any, assistance after delivery. You will have your group B strep swab this week to check for group B streptococcus. Your midwife will check your baby’s presentation (position). Your baby may engage this week. This is when the head drops into your pelvis and means your baby is in position for labour. Don’t worry if the head doesn’t engage yet, the timing is different for everyone. Your midwife will also go through your birth plan. _**Week 37:**_ Your baby is the size of chard. Although ‘early term’ at 37 weeks, your baby could arrive any day now. In the meantime, your baby is fine-tuning facial expressions, sucking its thumb and swallowing. Lungs, brain and liver are still maturing, and the digestive system will continue to develop during your baby’s first few years of life. Your body is preparing for labour and delivery. If your baby’s head has dropped into your pelvis you’ll notice pressure here and a ‘lightening’ around your diaphragm and lungs. If your baby is still in [breech](https://nabtahealth.com/glossary/breech/) position your doctor might talk to you about options to turn your baby. Any painless [Braxton Hicks](https://nabtahealth.com/glossary/braxton-hicks/) should ease when you change positions. Contact your healthcare team if you feel regular, increasingly strong [contractions](https://nabtahealth.com/glossary/contraction/) that don’t ease when you move. _**Week 38:**_ Your baby is the size of a rhubarb. You are still ‘early term’ and your baby has shed most [lanugo](https://nabtahealth.com/glossary/lanugo/). Your baby’s grasp is firm, practising by grabbing fingers and the [umbilical cord](https://nabtahealth.com/glossary/umbilical-cord/). Your baby is adding weight daily, with head and abdomen now the same circumference. You’ll notice an increase in thin white vaginal discharge. This is normal. Look out for the mucous plug, bloody show and any sign of your waters breaking. Keep rubbing lotion on that tummy to soothe your stretched skin. If you can, take the weight off your swollen feet and ankles. Your nesting instinct is strong; now is a good time to fill your freezer with delicious nutritious meals. _**Week 39:**_ Your baby is the size of a watermelon. Congratulations! You are ‘[full term](https://nabtahealth.com/glossary/full-term/)’. Your baby’s entrance into the world may still be a week or two away, but your baby’s lungs and vocal cords are now strong enough to take breaths and cry out in the world. Your baby is still building up essential fat for temperature regulation after birth. With your baby’s head putting pressure at the bottom of your bump you feel you are waddling about! This is a common sensation for this stage of pregnancy. Rest as much as possible, keep your fluids up, and try to sleep on your side. If you notice any signs of [preeclampsia](https://nabtahealth.com/glossary/preeclampsia/) – headache, swollen face and hands, nausea, changes in vision – contact your healthcare team immediately. _**Week 40:**_ Your baby is the size of a… slightly larger watermelon! Your baby is still putting on around half a pound a week in preparation for life outside the womb. Don’t worry if your baby isn’t quite ready to leave its cosy home, about a third of babies are born after the [due date](https://nabtahealth.com/glossary/due-date/).. Keep monitoring fetal movement. There isn’t much room for wriggling, but if you are concerned your baby’s movements have decreased contact your healthcare team straightaway. A good tip is to drink a large glass of cold orange juice and lie down – you should feel at least 10 nudges in an hour. You probably feel like you’ve been pregnant forever. Why not go for a long walk or practise your breathing techniques and some birthing positions while you wait for your baby? The wait is nearly over…
 ### Know your skin Your skin is the biggest organ in your body. It makes up about 16% of your overall body mass and is about 2 mm thick. It’s also a complex organ. It plays vital roles in protecting your internal organs and is a physical, airtight, watertight barrier between the outside world. And it literally holds everything in. Your skin synthesises [vitamin D](https://nabtahealth.com/glossary/vitamin-d/) for strong bones and healthy organs. It sweats out waste products. And it regulates body temperature. Our skin is divided into three layers: #### Epidermis The epidermis is the outer layer of skin and is half a millimetre thick. It is also our first line of defence against bacteria and infections. Made up of keratinocytes (skin cells) and Langerhans cells (immune system ‘guard dogs’), the epidermis stops moisture, pathogens, and chemicals from entering or leaving the body. The bottom layer of the epidermis produces melanin which gives your skin its natural colour and protects us from UV (ultraviolet) rays. Hair follicles, sweat glands and sebaceous (oil) glands extend between the dermis layer below and the skin’s surface. Sweat and sebum (oil) act as antibacterial and anti-inflammatory barriers on the skin. The epidermis is constantly renewing and regenerating. This process slows down as you get older so keeping your skin clean and exfoliated avoids your complexion looking dull and lifeless. #### Dermis The dermis is a thicker layer of connective tissue behind the epidermis. It holds blood vessels, nerves and receptors for a sense of touch. The dermis contains two proteins: fibrous collagen, a structural protein responsible for skin’s fullness and strength; and ‘elastic’ elastin which gives skin resilience and flexibility. Hair follicles, oil glands, and the start of pores, push hair, sweat, and oil from the dermis to the skin’s surface. When we are young the dermis is full of elastin and collagen. As we age, those proteins break down faster than our cells can replace them, leading to dry skin and wrinkles. #### Subcutaneous tissue Also known as hypodermis or subcutis, the deepest layer of skin is mostly fat and connective tissue. Subcutaneous tissue protects muscles, bones, blood vessels and internal organs. And it insulates and regulates the body’s temperature. Our subcutaneous tissue thins as we age. Skin looks less smooth and starts to sag, underlying veins show through. #### How to take care of your skin Simple, practical skincare tips (that cost nothing) to support your skin’s long-term health: * Get enough **sleep**. It’s called beauty sleep for a reason. * **Don’t smoke**. Or vape. It leaches the oxygen out of your face and triggers the destruction of collagen and elastin. And try to avoid being around cigarette smoke. * **Limit alcohol** intake. And cut back on refined sugars. Sugar destroys collagen. * **Eat well**. Gut health is linked to healthy skin function. Eat antioxidant rich fruit and vegetables, particularly foods high in vitamin C (kiwi fruit, oranges, strawberries), [vitamin E](https://nabtahealth.com/glossary/vitamin-e/) (avocados, spinach), beta carotene (carrots, sweet potatoes). * Drink lots of **water**. Hydration is important for your skin to perform at its best. * **Limit sun** exposure. Wear a high SPF daily. Get a little [vitamin D](https://nabtahealth.com/glossary/vitamin-d/) from the sun, not a lot. * Do regular **skin checks** for skin cancer. * Maintain a **healthy body weight**. Fluctuating weight can result in loose skin due to collagen and elastin loss. * Have a **skincare routine**. Cleanse and moisturise your skin every morning and night. Use good quality skincare and always apply SPF. #### How do hormones affect your skin? Hormones are a major skin disruptor: – Skin changes at **[puberty](https://nabtahealth.com/glossary/puberty/)**: Hormone surges, particularly increased androgen levels, stimulate sebaceous glands to produce more sebum. Excess sebum can [lead](https://nabtahealth.com/glossary/lead/) to oily skin, enlarged pores, spots, blackheads and acne. Diets high in sugar, refined carbohydrates, foods with a high glycaemic index (GI) and milk, may worsen acne. [Puberty](https://nabtahealth.com/glossary/puberty/) is the ideal time to start a regular skincare routine, including light exfoliation. – **Menstrual cycle** skin changes: Fluctuating hormones trigger different skincare needs during a woman’s menstrual cycle. Skin tends to be dry and dull with more visible fine lines at the start of the cycle when estrogen and [progesterone](https://nabtahealth.com/glossary/progesterone/) levels are low. Towards the middle of the cycle rising estrogen and [testosterone](https://nabtahealth.com/glossary/testosterone/) means a burst of moisture and collagen production, and a healthy glow. And after [ovulation](https://nabtahealth.com/glossary/ovulation/), the increase in [progesterone](https://nabtahealth.com/glossary/progesterone/) leads to oilier skin. As you learn how your skin responds to each stage in your cycle you may wish to adapt your skincare and diet to manage the effect of hormonal fluctuations. – Skin changes during **pregnancy:** The surge of hormones in pregnancy can make skin redder and puffier. Melasma, stretchmarks and breakouts are common. Wear a daily SPF. Try lighter, fragrance-free skincare products. Avoid stronger skincare products and [vitamin A](https://nabtahealth.com/glossary/vitamin-a/) ([retinol](https://nabtahealth.com/glossary/retinol/)). And support body skin elasticity with moisturising oils. – Skin changes in **[perimenopause](https://nabtahealth.com/glossary/perimenopause/)** and **[menopause](https://nabtahealth.com/glossary/menopause/)**: The decline in estrogen levels has a profound effect on a woman’s skin during [perimenopause](https://nabtahealth.com/glossary/perimenopause/). Loss in hydration and decreased sebum production means an increase in fine lines, wrinkles, and itchy irritated skin. In postmenopausal women collagen declines rapidly, taking with it the skin’s volume and resilience, and skin becomes prone to deeper wrinkles and sagging. [HRT](https://nabtahealth.com/glossary/hrt/) rebalances hormone levels and with them some of the skin changes linked with [perimenopause](https://nabtahealth.com/glossary/perimenopause/) and [menopause](https://nabtahealth.com/glossary/menopause/). #### Skin conditions and disorders As the body’s external protection system, your skin is at also risk for various problems and health issues: * Bites: mosquitos, ticks, spiders * Skin allergies: contact dermatitis and rashes from plants * Skin cancers: melanoma, squamous cell carcinoma, and basal cell carcinoma * Skin rashes: hives, shingles, and dry, itchy skin * Skin disorders: acne, eczema ([atopic dermatitis](https://nabtahealth.com/glossary/atopic-dermatitis/)), psoriasis, rosacea, and vitiligo * Skin lesions: freckles, moles, skin tags, age or liver spots * Wounds: cuts, blisters, burns, sunburns, and scars * Skin infections: fungal, bacterial, viral, parasitic #### When to see a doctor or dermatologist A dermatologist specialises in skin, hair, nails. See a medical dermatologist when your skin symptoms are persistent: stubborn acne; an ongoing skin disorder such as eczema, psoriasis or rosacea; itchy hives or rashes that won’t go away; an unusual skin lesion; and regular screenings for skin cancer. ### Know your hair Hair has a physical and social function. Throughout the ages hair has had cultural and religious significance. It is associated with social and professional status, beauty and self-expression in both women and men. Hair also has an essential physiological role in protecting our bodies from external factors. #### What is hair made of? Hair is made of keratin, a fibrous ‘building block’ protein that supports the health and structure of hair, skin, and fingernails. A hair follicle is like a long cylinder plant pot holding the hair root and strand. Hair follicles live in the top two layers of skin (epidermis and dermis), and you are born with millions of hair follicles all over your body. They can’t be pulled out, but they can be damaged, leading to hair loss or reduced hair growth. #### How does hair grow? Hair growth occurs in cycles consisting of three phases: * Anagen: This is the growth or active phase when most new hair is formed. It lasts 3-5 years on average, with hair growing at around six inches in a year, more in summer than winter. Each hair spends several years in this phase. * Catagen: This is the second phase of growth, or transitional phase. Your hair separates from the blood supply and over a few weeks hair growth slows and the hair follicle shrinks. * Telogen: During the inactive or resting phase hair growth stops and your hair follicle gradually sheds the old hair. This process can take several months. The cycle begins again, with the growth phase and a new hair pushing up through the follicle. Hair shedding is part of a natural balance. On average women shed 50 to 100 hairs every day. New hair replaces it at the same time. Your scalp hair can last on your head for up to six years. Shorter, lighter hairs (eyelashes, eyebrows, body hair) fall out each month. #### What affects hair health? Hair health is affected by: * Harsh hairstyling, heat styling and chemicals * Nutritional deficiency * Rapid weight gain or loss * Toxic substances: Including [chemotherapy](https://nabtahealth.com/glossary/chemotherapy/), radiation therapy and some medications and supplements * Extreme physical or emotional stress #### Which hair conditions cause hair loss? Hair loss can be caused by medical conditions, hormonal fluctuations, and genetics: * Thyroid conditions: Prolonged [hypothyroidism](https://nabtahealth.com/glossary/hypothyroidism/) and [hyperthyroidism](https://nabtahealth.com/glossary/hyperthyroidism/). * Autoimmune conditions: [Alopecia](https://nabtahealth.com/glossary/alopecia/) areata and systemic [lupus](https://nabtahealth.com/glossary/lupus/) erythematosus (SLE). * Androgenic [alopecia](https://nabtahealth.com/glossary/alopecia/): Excess male hormones or [PCOS](https://nabtahealth.com/glossary/pcos/) (polycystic ovarian syndrome). * Trichotillomania: The irresistible urge to pull out your own hair. * Hormonal changes: Cause hair follicles to shrink and hair to thin. Common in the months following childbirth, during [menopause](https://nabtahealth.com/glossary/menopause/). * Infection: Fungal or bacterial infections can cause [inflammation](https://nabtahealth.com/glossary/inflammation/) of the hair follicles, hair shaft or scalp. Examples include folliculitis and piedra (trichomycosis nodularis), and ringworm (tinea capitis). * [Inflammation](https://nabtahealth.com/glossary/inflammation/): Dandruff (seborrheic dermatitis) is a scalp irritation causing itchy, scaly skin. * Genes and hereditary hair loss: Female and male pattern baldness. #### Habits for healthy hair You can keep your hair follicles (and therefore your hair) healthy by taking care of your hair and skin: * **Eat well**. Maintain a nutritionally balanced diet, eat foods rich in protein and vitamins C and E. * **Avoid** restrictive or rapid weight loss **diets**. * **Avoid** pulling on your hair, **tight hairstyles** and **harsh chemicals**. * **Reduce stress**, sleep more. * **Hydrate!** Drink lots of water. * **Wear a hat** in the sun. UV rays affect your scalp too. * **Check the ingredients** in your shampoo and conditioner. Aim for natural ingredients, if possible. #### When to see a dermatologist or trichologist Speak to your healthcare provider if you’re concerned about hair loss or thinning. They’ll ask about your medical history and may examine you for any underlying health conditions. Your doctor may also refer you to a dermatologist or trichologist, hair and scalp specialists who can recommend you on potential solutions and treatment options. #### Getting started with Nabta Health [Nabta Health](https://nabtahealth.com/shop/collections/type/skincare/) understands the importance of having access to the right hair and skincare advice and products. Our clinical experts have carefully selected hair and skin resources and information to support you, whatever your hair and skincare goals are. Whether you are going through [puberty](https://nabtahealth.com/glossary/puberty/), nursing your newborn, managing [PCOS](https://nabtahealth.com/glossary/pcos/), undergoing treatment for cancer, in search of a [perimenopause](https://nabtahealth.com/glossary/perimenopause/) skin ‘pick-me-up’, or looking for a conscious skincare serum, Nabta’s [marketplace](https://nabtahealth.com/shop/collections/type/skincare/) is your hair and skin go-to. Sources > [Women Experience Hair Loss too. We Look at the Triggers.](https://nabtahealth.com/articles/women-experience-hair-loss-too/) https://www.philipkingsley.co.uk/hair-guide/hair-science/hair-growth-cycle.html https://my.clevelandclinic.org/health/body/23435-hair-follicle https://www.webmd.com/skin-problems-and-treatments/picture-of-the-hair
 **[Perimenopause](https://nabtahealth.com/glossary/perimenopause/)** is a natural process in a woman’s life caused by a normal biological decline in reproductive hormones. [Perimenopause](https://nabtahealth.com/glossary/perimenopause/) onset varies from woman to woman and can take place at any stage from a woman’s mid-30s (premature [menopause](https://nabtahealth.com/glossary/menopause/)) into her late 50s. Also known as the ‘[menopause](https://nabtahealth.com/glossary/menopause/) transition’, [perimenopause](https://nabtahealth.com/glossary/perimenopause/) lasts between three and 10 years. The average length of [perimenopause](https://nabtahealth.com/glossary/perimenopause/) is 4-5 years, and the average age of [menopause](https://nabtahealth.com/glossary/menopause/) is 51 years. **[Menopause](https://nabtahealth.com/glossary/menopause/)** marks the end of [perimenopause](https://nabtahealth.com/glossary/perimenopause/), when a woman has gone a full 12 months without menstruating. After a year of no menstrual periods a woman is considered to have gone through [menopause](https://nabtahealth.com/glossary/menopause/) to her post-menopausal phase. **Induced [menopause](https://nabtahealth.com/glossary/menopause/)** is when a woman’s menstrual periods stop due to medical treatments or intervention. [Chemotherapy](https://nabtahealth.com/glossary/chemotherapy/) or radiation damage to the [ovaries](https://nabtahealth.com/glossary/ovaries/), and surgical removal of the [ovaries](https://nabtahealth.com/glossary/ovaries/) result in medically induced [menopause](https://nabtahealth.com/glossary/menopause/). **[Postmenopause](https://nabtahealth.com/glossary/postmenopause/)** is the ongoing phase of a woman’s life after [menopause](https://nabtahealth.com/glossary/menopause/). It’s important to note that many women continue to experience the classic [menopause](https://nabtahealth.com/glossary/menopause/) symptoms for years after their ‘official’ [menopause](https://nabtahealth.com/glossary/menopause/). #### What happens to a woman’s body when she is perimenopausal? The hormones that flooded a woman’s body during [puberty](https://nabtahealth.com/glossary/puberty/) and her fertile years start to fluctuate due to the decline in the female reproductive hormones (estrogen and [progesterone](https://nabtahealth.com/glossary/progesterone/)) produced by her [ovaries](https://nabtahealth.com/glossary/ovaries/). These hormonal deficiencies [lead](https://nabtahealth.com/glossary/lead/) to many physical changes taking place in a woman’s body long before her ‘official’ [menopause](https://nabtahealth.com/glossary/menopause/). #### What are the symptoms of [perimenopause](https://nabtahealth.com/glossary/perimenopause/) and [menopause](https://nabtahealth.com/glossary/menopause/)? * Hot flashes / flushes * Night sweats * Vaginal dryness * Irregular periods * Hair loss * Weight gain and slowed [metabolism](https://nabtahealth.com/glossary/metabolism/) * Itchy or dry skin * Disturbed sleep * Urinary incontinence * Mood swings and anxiety * Brain fog or memory loss * Low libido The physical changes and symptoms women experience due to the reduction in hormones can be debilitating. #### What are the long-term health risks of [menopause](https://nabtahealth.com/glossary/menopause/)? Long-term hormone deficiency increases women’s risk of chronic health conditions including cardiovascular disease, [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/), type 2 diabetes, dementia, and bowel cancer. #### How is [perimenopause](https://nabtahealth.com/glossary/perimenopause/) diagnosed? A doctor will assess symptoms and may recommend a blood test to check follicle-stimulating hormone ([FSH](https://nabtahealth.com/glossary/fsh/)) and estrogen levels. As hormones fluctuate during [perimenopause](https://nabtahealth.com/glossary/perimenopause/) the test may be repeated after a few months if the results are inconclusive. Women who want to confirm their symptoms can also take a [perimenopause](https://nabtahealth.com/glossary/perimenopause/) test measuring the levels of three hormones [from the comfort of their home](https://nabtahealth.com/product/perimenopause-test/). However, a hormone test isn’t always necessary, and some doctors will diagnose [perimenopause](https://nabtahealth.com/glossary/perimenopause/) based on physical symptoms. #### Can [perimenopause](https://nabtahealth.com/glossary/perimenopause/) be treated? [Perimenopause](https://nabtahealth.com/glossary/perimenopause/) and [menopause](https://nabtahealth.com/glossary/menopause/) are natural biological processes in a woman’s body and cannot be delayed or halted with treatment. That said, a healthcare professional may discuss Hormone Replacement Therapy ([HRT](https://nabtahealth.com/glossary/hrt/)) and lifestyle adjustments to help manage the physical impacts of hormone deficiency. #### What is [HRT](https://nabtahealth.com/glossary/hrt/)? [HRT](https://nabtahealth.com/glossary/hrt/) replaces the hormones the body is no longer producing. The hormone treatment includes estrogen, and sometimes [progesterone](https://nabtahealth.com/glossary/progesterone/) and [testosterone](https://nabtahealth.com/glossary/testosterone/) if needed, and is given as a skin patch, gel, spray, or pill. Most women report their [perimenopause](https://nabtahealth.com/glossary/perimenopause/) symptoms improving within 3-6 months of starting [HRT](https://nabtahealth.com/glossary/hrt/). Taking [HRT](https://nabtahealth.com/glossary/hrt/) reduces the risk of developing [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/), cardiovascular disease, type 2 diabetes, bowel cancer, osteoarthritis, and other health conditions due to hormone deficiency. There are risks associated with [HRT](https://nabtahealth.com/glossary/hrt/), including a small increased risk of breast cancer and blood clots in women with a family history. However, research has shown that for most women who take [HRT](https://nabtahealth.com/glossary/hrt/) the benefits outweigh the risks. A woman should always have a conversation with her healthcare team to decide the best approach for her individual circumstances. #### Are there natural ways to reduce the symptoms of [menopause](https://nabtahealth.com/glossary/menopause/)? Lifestyle adjustments can also be beneficial in managing perimenopausal symptoms. Women should try to eat a balanced diet with plenty of fresh fruit and vegetables, protein, whole foods, and foods rich in omega-3 fatty acids and calcium. Phytoestrogens can mimic the effects of estrogen in the body and occur naturally in foods including flaxseeds, sesame seeds, beans, soy, garlic, and cruciferous vegetables. Stop smoking and cut back on foods that might disturb sleep or trigger hot flashes, such as caffeine and alcohol. And exercise is essential. The decline in hormones affects bone and joint health, so it is more important than ever to maintain strength and flexibility with regular cardio and weight bearing exercise. As a woman’s [metabolism](https://nabtahealth.com/glossary/metabolism/) naturally changes with age, exercise will also help with weight control. #### Can I still become pregnant during [perimenopause](https://nabtahealth.com/glossary/perimenopause/)? While you are still having your period you can become pregnant. If you don’t want to be pregnant you should continue to use contraceptives until you are postmenopausal. #### Understanding [menopause](https://nabtahealth.com/glossary/menopause/) Health organisations and governments are increasingly recognising the gaps in knowledge and understanding of [perimenopause](https://nabtahealth.com/glossary/perimenopause/) and [menopause](https://nabtahealth.com/glossary/menopause/) and its enormous impact on women’s health and wellbeing. Efforts are now being made to address gender inequalities in broader healthcare provision and rebalance the lack of [menopause](https://nabtahealth.com/glossary/menopause/) research. The last few years have seen investment in improving education around [perimenopause](https://nabtahealth.com/glossary/perimenopause/) with the goal of empowering the more than 50% of the world’s population who will go through [menopause](https://nabtahealth.com/glossary/menopause/) with evidence-based therapeutic support. Sources: Internal > [What is](https://nabtahealth.com/articles/what-you-need-to-know-about-perimenopause/) [Perimenopause](https://nabtahealth.com/glossary/perimenopause/)? External: > [](https://www.balance-menopause.com/menopause-library/)[Menopause](https://nabtahealth.com/glossary/menopause/) Library https://www.mayoclinic.org/diseases-conditions/[menopause](https://nabtahealth.com/glossary/menopause/)/symptoms-causes/syc-20353397 https://flo.health/menstrual-cycle/[menopause](https://nabtahealth.com/glossary/menopause/)/changes/[menopause](https://nabtahealth.com/glossary/menopause/)\-symptoms-and-stages
 Men have a well-deserved reputation for avoiding the doctor and ignoring unusual symptoms. Sometimes until it’s too late. Unfortunately, it can often take a health scare to get a man in front of a doctor. This is despite men being just as likely to be affected by chronic diseases, cardiovascular disease, type 2 diabetes, cancer, kidney disease, stroke, dementia as women. And there are more unique health conditions such as prostate cancer, erectile dysfunction, and the andropause. #### Habits for a healthy lifestyle Men can protect health, wellbeing, and lifespan by avoiding damaging behaviours and focusing on positive lifestyle actions: * **Exercise** regularly: A combination of cardiovascular exercise and strength training for 30 to 45 minutes at least 3 to 4 times a week. * **Eat well**: Eat a nutritionally balanced diet. Follow a diet low in fat, with a balanced mix of fruit, vegetables, fibre, protein, lean meats and fish, and complex carbohydrates. Limit processed foods and refined sugars. * **Drink water**: Stay hydrated. * **Avoid** excessive **weight gain or loss.** * **Don’t smoke**. **Limit alcohol** intake. **Avoid drugs.** * Reduce stress: Get outside. Change your environment. Take a break. * Get some **sleep**: Aim for a minimum seven hours’ beauty sleep each night. * Go for **routine health checks** and screenings. #### Essential screening tests for men Routine health check-ups and health screening tests (even without pre-existing medical conditions or symptoms) are designed to spot early signs of health problems before they become an issue. Heart disease, stroke, type 2 diabetes, kidney disease and dementia all have early warning markers and can significantly compromise quality of life if not picked up early. Health checks recommended for all adult men include: * Dental: Get your teeth checked yearly at the minimum. * Skin cancer: Check moles and skin lesions every few months. See a doctor every two years for a full body check. * Heart health, blood pressure and [cholesterol](https://nabtahealth.com/glossary/cholesterol/): High [cholesterol](https://nabtahealth.com/glossary/cholesterol/) and elevated blood pressure ([hypertension](https://nabtahealth.com/glossary/hypertension/)) can increase the risk of developing coronary heart disease and type 2 diabetes. * Testicular cancer: Monthly self-examinations are recommended after [puberty](https://nabtahealth.com/glossary/puberty/). See a doctor for a full examination as soon as you notice a lump or any changes. Further screening tests are recommended for men over 50 years: * Prostate cancer: Accounts for high numbers of cancer deaths in older men. Screening includes a PSA (prostate specific antigen) test and DRE (digital rectal examination). * Bowel cancer: Another leading cause of death in older men. Go for a faecal occult blood test every two years. * Hearing and eyesight: Hearing loss and eyesight problems become more common after 50 and can affect quality of life. * Diabetes type 2: Depending on the level of risk a fasting blood sugar test will be recommended every 1 to 3 years. * Dementia: Screening for cognitive impairment is typically included in an annual health check for all adults from 65 years. * Abdominal Aortic Aneurysm (AAA): Affects more men than women. Males over 65 are offered regular screenings. Doctors decide whether to screen earlier based on medical and family history. #### What affects male fertility? Male fertility problems can be caused by low [sperm](https://nabtahealth.com/glossary/sperm/) count, poor quality [sperm](https://nabtahealth.com/glossary/sperm/), or blockages preventing [sperm](https://nabtahealth.com/glossary/sperm/) moving through the reproductive tract. [Sperm](https://nabtahealth.com/glossary/sperm/) can be vulnerable to lifestyle and environmental factors including raised body temperature, weight gain, exposure to toxins, smoking, heavy alcohol intake and drug use. Fertility specialists may recommend blood work to check hormone levels and scan for certain infections or a possible genetic cause for [infertility](https://nabtahealth.com/glossary/infertility/). A doctor may request a [sperm](https://nabtahealth.com/glossary/sperm/) sample to assess [sperm](https://nabtahealth.com/glossary/sperm/) count, shape and movement, and a scrotal ultrasound to check if there are any problems or blockages in the testicles preventing [sperm](https://nabtahealth.com/glossary/sperm/) getting into a man’s ejaculate. #### What is the male [menopause](https://nabtahealth.com/glossary/menopause/)? Men also experience age-related hormonal decline. The ‘male [menopause](https://nabtahealth.com/glossary/menopause/)’ is more a gradual flattening out in [testosterone](https://nabtahealth.com/glossary/testosterone/) and other hormone levels over a number of years, than the dramatic cliff-plunge of female reproductive hormones during [menopause](https://nabtahealth.com/glossary/menopause/). Also called the andropause, age-related low [testosterone](https://nabtahealth.com/glossary/testosterone/), or late-onset hypogonadism, this period of a man’s life is sometimes described as the ‘midlife crisis’. Still, it brings associated physical and emotional health problems for men in their late 40s and into their 50s: * Low moods and depression * Low libido * Erectile dysfunction * Fatigue and low energy levels * Hot flashes or flushes and increased sweating * Loss of muscle mass * Increase in body fat * Dry skin The symptoms of low [testosterone](https://nabtahealth.com/glossary/testosterone/) can have a very real impact on everyday life. If you are concerned, speak to a healthcare professional who will assess your symptoms and may recommend hormone levels testing and possible treatment options. [Testosterone](https://nabtahealth.com/glossary/testosterone/) therapy has its pros and cons, and your doctor will want to weigh up options with you. For any men still reluctant to go to the doctor, at-home [men’s health](https://nabtahealth.com/product/mens-health-test/) and [](https://nabtahealth.com/product/testosterone-test/)[testosterone](https://nabtahealth.com/glossary/testosterone/) tests offer convenient and private testing options. #### Getting started with Men’s Health and Nabta Health [Nabta’s marketplace](https://nabtahealth.com/shop/collections/type/mens-health/) features products to support men wherever they are in their health journeys. At-home [testosterone](https://nabtahealth.com/glossary/testosterone/) level and men’s health tests allow men to screen essential hormone levels in the comfort and privacy of home. While wellness and pampering packages are designed to provide men with that well-deserved lifestyle boost.
 #### What is maternal health and why is it so important? Pregnancy and childbirth are exciting, scary, life-changing events. They can be joyful experiences, and they can be fraught with anxiety, and physical and emotional challenges. Maternal health is about the wellbeing of women and their babies during pregnancy, childbirth, and the postnatal period. Women should feel comfortable and confident in the medical care and attention they receive each stage of their pregnancy journey. Lack of awareness about the potential complications associated with pregnancy and childbirth can [lead](https://nabtahealth.com/glossary/lead/) to devastating outcomes. Most maternal complications are preventable with prompt support by trained maternal health professionals. The goal for maternal health is always positive outcomes for both mother and baby. #### What are maternal health services? A pregnant woman will usually meet some or all the following skilled healthcare practitioners during and after her pregnancy: * Doctor or General Practitioner (GP): Provides basic pregnancy care. Doctors with added expertise may share pregnancy care with a hospital. * [Obstetrician](https://nabtahealth.com/glossary/obstetrician/): A doctor qualified in specialist antenatal and postnatal care for women and their babies. Obstetricians deliver babies and manage high-risk pregnancies and births. * Midwife: Medically trained to care for women during pregnancy, labour and after childbirth. Often a pregnant woman will be cared for by a team of midwives. * Doula: Some women choose a Doula as a companion for support during pregnancy and labour. A Doula is not a medically trained professional. * [Lactation](https://nabtahealth.com/glossary/lactation/) consultant: Helps mother and baby establish breastfeeding and overcome difficulties with latching, low milk supply, and sore nipples. * Maternal and child health nurses: Monitor the child’s development and growth from newborn until around 3.5 years old. #### Antenatal checks, tests, and screenings Routine antenatal checks and tests are an important part of a woman’s pregnancy care. As the pregnancy progresses, blood tests, urine samples and ultrasound scans are accompanied by scheduled check-ups to assess the mother’s health and wellbeing, and the baby’s development. Screening and scans during pregnancy typically include a full blood count, infectious disease screen, urine culture, dating scan, screens for genetic abnormalities, [gestational diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) screening, and Group B strep screen. It’s a personal choice to have all the antenatal tests. A mother’s healthcare team will recommend that she has all tests and scans as scheduled for a complete picture of her health and her baby’s development. The tests are also designed to pick up any medical problems and identify possible genetic conditions affecting the baby. This will enable the mother and her doctors to make informed decisions about further testing or actions. #### What are maternal health concerns during pregnancy? Major maternal health problems can [lead](https://nabtahealth.com/glossary/lead/) to serious illness or death for both mother and baby. Complications can include excessive blood loss during labour, infections, [anaemia](https://nabtahealth.com/glossary/anaemia/), high blood pressure ([hypertension](https://nabtahealth.com/glossary/hypertension/)), obstructed labour, and heart disease. Maternal mental health is also an important consideration. Pregnancy and childbirth are different for every woman. Access to the right healthcare before, during and after pregnancy will reduce the risk of complications. #### – Before pregnancy Medical history and pre-existing conditions: The healthcare team should be made aware of any medical conditions, medications, or family history that may affect the mother’s health, or the unborn baby’s health during pregnancy. #### – During pregnancy The mother should attend all recommended check-ups and screenings. The maternal health team will monitor and treat pregnancy-related health issues including [anaemia](https://nabtahealth.com/glossary/anaemia/), urinary tract infections, [hypertension](https://nabtahealth.com/glossary/hypertension/), [gestational diabetes](https://nabtahealth.com/glossary/gestational-diabetes/), mental health conditions, excess weight gain, infections, [hyperemesis gravidarum](https://nabtahealth.com/glossary/hyperemesis-gravidarum/) (severe and persistent vomiting). #### – After pregnancy The postpartum period usually refers to the first six weeks after childbirth. While there’s (understandably) lots of focus on the new arrival, postpartum health is just as important: * Physical recovery: Allow time for physical recovery from a vaginal birth or C-section. Mothers should prepare for perineal pain, vaginal bleeding (lochia) and uterine [contractions](https://nabtahealth.com/glossary/contraction/). * Postpartum or postnatal depression: Take care of emotional health. It’s normal to experience the ‘baby blues’ when hormones dip a few days after giving birth. Prolonged low moods and feelings of helplessness should be raised with the healthcare team. * Rest is best: Try to sleep or rest when the baby sleeps. Rest will help with recovery. * Eat regularly: Eat regular, healthy meals. What a mother eats, her baby eats. * Hydrate: Drink water, lots of it. Hydration will aid milk supply. * Feeding routines: Get support establishing feeding routines, whether breast-feeding or bottle-feeding. * Physical exertion: Avoid heavy lifting for the first 4 to 6 weeks after delivery and especially after a C-section. Exercise should be gentle walks with the baby. Try not to do any physically demanding activities (no running up and down the stairs and definitely no gym sessions!). * Vitamins: Continue taking antenatal vitamins #### What are postpartum complications? Postpartum complications to be aware of include mastitis, postnatal depression, excessive bleeding (hemorrhage) after giving birth, infection or sepsis, [hypertension](https://nabtahealth.com/glossary/hypertension/), pulmonary [embolism](https://nabtahealth.com/glossary/embolism/), cardiomyopathy, and cardiovascular disease. Postpartum mothers should be counselled to recognise the signs and symptoms of a problem. Contact a doctor at once at any sign of high fever, flu-like symptoms, a red and swollen breast, a headache that doesn’t improve with medication, chest pain, shortness of breath, seizures, bleeding through one maternity pad in an hour, and a red or swollen leg painful to touch. #### What happens at a postpartum check-up? Postpartum maternal checks are about the mother’s health. At your postpartum check-ups your doctor will check your abdomen, [vagina](https://nabtahealth.com/glossary/vagina/), [cervix](https://nabtahealth.com/glossary/cervix/), and [uterus](https://nabtahealth.com/glossary/uterus/) to make sure you are healing well. They will talk to you about when it is safe to have sex again and birth control (remember that even if you don’t have your periods while you breastfeed you can still become pregnant). And your doctor will also talk to you about your emotional health, whether you are getting enough rest, eating well and how you are bonding with your baby. Use these check-ups to raise any concerns you might have with your recovery and emotional wellbeing. #### Getting started with Nabta Health Nabta’s marketplace and resources are designed to support mothers at every stage of their maternal health journey. From at-home tests to prenatal courses; on-demand Doulas to hypnobirthing courses; maternity pads to nursing bras; prenatal yoga to postpartum care packages… Nabta’s team of healthcare and wellness experts has carefully selected products to meet a woman’s maternal health needs.
Taking diabetes medication during pregnancy, globally the number of women of reproductive age who have diabetes is increasing. This means more women than ever are having to manage their condition through pregnancy. Added to which, approximately 10% of women will develop a form of glucose intolerance, known as [](https://nabtahealth.com/gestational-diabetes-8-things-you-should-know/)[Gestational Diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) Mellitus (GDM), during pregnancy, which if left untreated can cause adverse health outcomes to both the [mother](https://nabtahealth.com/i-have-gestational-diabetes-what-are-the-risks-to-me/) and the [unborn child](https://nabtahealth.com/i-have-gestational-diabetes-what-are-the-risks-to-my-unborn-baby/). The main options for managing diabetes are via nutrition, insulin injections, or oral anti-diabetic agents (OAAs). Nutrition would be the preferred choice if success was guaranteed. However, dietary changes are only thought to help about 50% of women with GDM and if a rapid improvement is not seen, your doctor will probably encourage additional medication to help control your blood sugar levels and minimise stress to your unborn child. #### **Insulin** Insulin is the standard treatment for diabetes. It has unparalleled safety and efficacy and is favoured by many doctors for the treatment of diabetes during pregnancy as it does not cross the [placenta](https://nabtahealth.com/glossary/placenta/), meaning there is no foetal exposure to the drug. The downside to this treatment is that it is delivered via injection (syringe, pen or pump), so there is a risk of low compliance. #### **Oral anti-diabetics** The main OAAs in use are metformin and glyburide. Glyburide increases the release of insulin from the pancreas. In studies investigating its effectiveness compared to metformin, it has performed less well, with expectant mothers gaining more weight and giving birth to heavier infants. As such, metformin is often the drug of choice for treating diabetes during pregnancy. [Metformin](https://nabtahealth.com/what-is-metformin/) works by reducing the amount of glucose produced by the liver. It also enhances insulin sensitivity, thus is often given as an adjunct to insulin therapy. Clinical studies have revealed that diabetic women who used metformin during pregnancy gave birth to babies with a lower birth weight and these infants had a reduced risk of [hypoglycaemia](https://nabtahealth.com/glossary/hypoglycaemia/). However, questions do still remain over the long-term safety of the drug and guidelines for its usage differ between countries. The UK National Institute for Health and Clinical Excellence ([NICE](https://www.nice.com/)) and the International Federation of Gynecology and Obstetrics (FIGO) consider it an appropriate treatment option; whereas the American Congress of Obstetricians and Gynecologists (ACOG), the American Diabetes Association (ADA), and the International Diabetes Federation (IDF) suggest that there is insufficient evidence at presence to prescribe it routinely. It has been classified as Category B by the American Food and Drug Administration ([FDA](https://nabtahealth.com/glossary/fda-2/)), meaning animal studies have not revealed any risk, but there remains a shortage of human studies. In fact, the [FDA](https://nabtahealth.com/glossary/fda-2/) has yet to approve any OAA for use in pregnancy. Certainly, there are unknowns with regards to metformin; not least, a lack of awareness regarding any long term effects on child development. Metformin does cross the [placenta](https://nabtahealth.com/glossary/placenta/), resulting in significant foetal exposure. The concern is that this exposure could cause defective programming events and thus, affect the child years later. In the short-term, metformin does not increase the risk of birth defects, [](https://nabtahealth.com/causes-of-miscarriage/)[miscarriage](https://nabtahealth.com/glossary/miscarriage/), [stillbirth](https://nabtahealth.com/glossary/stillbirth/), or premature delivery. It is well tolerated and is regularly prescribed to restore ovulatory menstrual cycles in women with [polycystic ovary syndrome](https://nabtahealth.com/what-is-pcos/) ([PCOS](https://nabtahealth.com/glossary/pcos/)). #### **Why timing is important** The first trimester is considered to be the most critical time for minimising foetal exposure to [xenobiotics](https://nabtahealth.com/glossary/xenobiotics/), including therapeutic medications. This is when the baby’s organs are being formed and risk of damage is highest. However, many women with [PCOS](https://nabtahealth.com/glossary/pcos/) take metformin prior to conception and during the early weeks of pregnancy and there is no evidence of increased birth defects as a result. Incidentally, most women who develop GDM will be diagnosed at approximately weeks 24-28 of pregnancy, which is well past the critical first trimester. Those that are diagnosed earlier are at greater risk of [foetal malformations](https://nabtahealth.com/glossary/foetal-malformations/) and pregnancy complications as a direct result of their condition. In these instances, the risks to the mother and baby of leaving their condition untreated far outweigh the risks of taking medication during the first trimester. When considering how best to manage your diabetes during pregnancy, the main thing to bear in mind is minimising adverse outcomes for both you and your baby. In terms of health outcomes, OAAs seem to be as effective as insulin, suggesting they are viable alternative. Those preliminary studies that suggested a high incidence of adverse outcomes following metformin use have since been questioned for their validity and scientific soundness. 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#0d746c61616c4d636c6f796c65686c617965236e6260) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Kalra, B, et al. “Use of Oral Anti-Diabetic Agents in Pregnancy: A Pragmatic Approach.” _North American Journal of Medical Sciences_, vol. 7, no. 1, Jan. 2015, pp. 6–12., doi:10.4103/1947-2714.150081. * “Metformin.” _Bumps (Best Use of Medicines in Pregnancy)_, UK Teratology Information Service, [www.medicinesinpregnancy.org/Medicine–pregnancy/Metformin/](http://www.medicinesinpregnancy.org/Medicine--pregnancy/Metformin/). * Polasek, T M, et al. “Metformin Treatment of Type 2 Diabetes Mellitus in Pregnancy: Update on Safety and Efficacy.” _Therapeutic Advances in Drug Safety_, vol. 9, no. 6, June 2018, pp. 287–295., doi:10.1177/2042098618769831. * “Prenatal Care.” _American Diabetes Association_, [www.diabetes.org/living-with-diabetes/complications/pregnancy/prenatal-care.html](http://www.diabetes.org/living-with-diabetes/complications/pregnancy/prenatal-care.html). * Priya, G, and S Kalra. “Metformin in the Management of Diabetes during Pregnancy and [Lactation](https://nabtahealth.com/glossary/lactation/).” _Drugs in Context_, vol. 7, 15 June 2018, p. 212523., doi:10.7573/dic.212523.
* High [cortisol](https://nabtahealth.com/glossary/cortisol/) levels can [lead](https://nabtahealth.com/glossary/lead/) to metabolic syndrome. * [Cortisol](https://nabtahealth.com/glossary/cortisol/) is known as the ‘stress hormone’. * [Cortisol](https://nabtahealth.com/glossary/cortisol/) is linked with higher risk for developing components of metabolic syndrome. * Metabolic syndrome is a collection of symptoms that increase risk of several chronic health conditions. * You can manage your [cortisol](https://nabtahealth.com/glossary/cortisol/) levels by following a healthy lifestyle. #### What is metabolic syndrome? Metabolic syndrome is a combination of conditions that together raise a person’s risk for heart disease, diabetes, stroke and other chronic health issues. The five components of [metabolic syndrome](https://nabtahealth.com/articles/what-controls-metabolism/) are: high blood pressure; [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/); low [HDL](https://nabtahealth.com/glossary/hdl/) (good) [cholesterol](https://nabtahealth.com/glossary/cholesterol/); high [triglycerides](https://nabtahealth.com/glossary/triglycerides/); and being overweight around your middle (abdominal obesity). A person is diagnosed as having metabolic syndrome when they have three or more of these components. #### Why is [cortisol](https://nabtahealth.com/glossary/cortisol/) important? Known as the ‘stress hormone’, [cortisol](https://nabtahealth.com/glossary/cortisol/) is a glucocorticoid hormone produced by the adrenal (suprarenal) glands, part of the body’s endocrine system. For optimal levels of [cortisol](https://nabtahealth.com/glossary/cortisol/) your [](https://my.clevelandclinic.org/health/articles/22187-cortisol)[hypothalamus](https://nabtahealth.com/glossary/hypothalamus/), pituitary gland and adrenal glands must all work together. [Cortisol](https://nabtahealth.com/glossary/cortisol/) gets its ‘stress hormone’ reputation for its role in regulating our body’s stress response. What many of us don’t realise is the part [cortisol](https://nabtahealth.com/glossary/cortisol/) plays in maintaining functions in nearly every organ in the body. [Cortisol](https://nabtahealth.com/glossary/cortisol/) balance is essential for our body’s healthy functioning. When released into the bloodstream [cortisol](https://nabtahealth.com/glossary/cortisol/) acts on different parts of body and helps: · [stimulate fat and carbohydrate](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3602916/) [metabolism](https://nabtahealth.com/glossary/metabolism/) and regulate [metabolism](https://nabtahealth.com/glossary/metabolism/) of glucose · control blood pressure · manage immune system functions · reduce [inflammation](https://nabtahealth.com/glossary/inflammation/) · control the body’s response to stress or danger. [Cortisol](https://nabtahealth.com/glossary/cortisol/) release is also linked with our [circadian rhythm](https://my.clevelandclinic.org/health/articles/22187-cortisol) (sleep/wake cycles). Normal blood [cortisol](https://nabtahealth.com/glossary/cortisol/) levels follow a diurnal rhythm; [cortisol](https://nabtahealth.com/glossary/cortisol/) levels fluctuate during the day and in a diurnal rhythm are typically higher when we wake up and lower before we go to sleep. #### [Cortisol](https://nabtahealth.com/glossary/cortisol/) is associated with components of metabolic syndrome [Studies show](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3124722/) that there is a relationship between increased risk of metabolic imbalance and related health issues, and elevated levels of [cortisol](https://nabtahealth.com/glossary/cortisol/): · [Cortisol](https://nabtahealth.com/glossary/cortisol/) triggers the release of glucose into the bloodstream. Consistently high [cortisol](https://nabtahealth.com/glossary/cortisol/) levels can [lead](https://nabtahealth.com/glossary/lead/) to high blood sugar (hyperglycemia) which in turn can [lead](https://nabtahealth.com/glossary/lead/) to type 2 diabetes. · Raised levels of [cortisol](https://nabtahealth.com/glossary/cortisol/) in the body can cause [hypertension](https://nabtahealth.com/glossary/hypertension/) (high blood pressure) and an increase in [LDL](https://nabtahealth.com/glossary/ldl/) (bad [cholesterol](https://nabtahealth.com/glossary/cholesterol/)), both risk factors in cardiovascular disease. · [Cortisol](https://nabtahealth.com/glossary/cortisol/) regulates appetite and cravings and there is a direct relationship between abdominal weight gain and high [cortisol](https://nabtahealth.com/glossary/cortisol/) levels. Other disorders are related to the adrenal glands not functioning properly including [Cushing syndrome](https://www.mayoclinic.org/diseases-conditions/cushing-syndrome/symptoms-causes/syc-20351310), [Addison’s disease](https://www.mayoclinic.org/diseases-conditions/addisons-disease/symptoms-causes/syc-20350293), [Congenital](https://www.mayoclinic.org/diseases-conditions/congenital-adrenal-hyperplasia/symptoms-causes/syc-20355205) [adrenal hyperplasia](https://nabtahealth.com/glossary/adrenal-hyperplasia/) and [Conn’s syndrome](https://www.urologyhealth.org/urology-a-z/c/conns-syndrome). #### How can you manage your [cortisol](https://nabtahealth.com/glossary/cortisol/) levels? Persistent high levels of [cortisol](https://nabtahealth.com/glossary/cortisol/), caused by constant stress and negative lifestyle factors, can be harmful to our health and in some cases can [lead](https://nabtahealth.com/glossary/lead/) to metabolic syndrome. You can take steps to manage your stress levels by following a healthy lifestyle – getting sufficient sleep, regular exercise and eating a diet high in whole and plant foods. In some cases, your doctor may decide to prescribe synthetic corticosteroids such as prednisone, hydrocortisone or dexamethasone to help manage your [cortisol](https://nabtahealth.com/glossary/cortisol/) levels. \_\_\_ If you are concerned you may have issues with your [metabolism](https://nabtahealth.com/glossary/metabolism/), get tested in the privacy of your own home by ordering a blood test [here](https://nabtahealth.com/product/metabolism-test/). 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#0d283f3d746c61616c4d636c6f796c65686c617965236e6260) if you have any questions about this article or any aspect of women’s health. We’re here for you.
* There are many factors that control [metabolism](https://nabtahealth.com/glossary/metabolism/). * Each person’s [metabolism](https://nabtahealth.com/glossary/metabolism/) is influenced by their genes, age, illness, medications and stress. * [Metabolism](https://nabtahealth.com/glossary/metabolism/) is the process by which our body converts the food and drink we consume into energy. * [Metabolism](https://nabtahealth.com/glossary/metabolism/) is controlled by our endocrine system, which produces and releases hormones. * Imbalances in hypothalamic and pancreatic regulation of [metabolism](https://nabtahealth.com/glossary/metabolism/) can [lead](https://nabtahealth.com/glossary/lead/) to increased risk for metabolic disorders such as [diabetes type 2.](https://nabtahealth.com/articles/the-diabetes-epidemic-and-why-it-is-killing-the-middle-east/) It’s tempting to dismiss or blame [metabolism](https://nabtahealth.com/glossary/metabolism/) as being about fast or slow, weight gain or loss. The truth is [metabolism](https://nabtahealth.com/glossary/metabolism/) lies at the core of our body’s healthy functioning. Our bodies need metabolic processes to sustain life. [Metabolism](https://nabtahealth.com/glossary/metabolism/) keeps us alive. #### What is [metabolism](https://nabtahealth.com/glossary/metabolism/)? [Metabolism](https://nabtahealth.com/glossary/metabolism/) is the internal process by which our body converts the food and drink we consume into energy. This energy is stored and released as needed for use in cells. [Metabolism](https://nabtahealth.com/glossary/metabolism/) is at the root of all work in our cells and enables other essential chemical reactions to happen. Without these chemical processes we can’t breathe, circulate blood, build and repair cells and everything else our bodies require to survive. #### So how does [metabolism](https://nabtahealth.com/glossary/metabolism/) work? [Metabolism](https://nabtahealth.com/glossary/metabolism/) is a balancing act between anabolism and catabolism. Our digestive enzymes turn carbohydrates into simple sugars like glucose, fats into fatty acids, and proteins into amino acids. These nutrients are absorbed in the blood and carried through our body to cells, where they are metabolized in two finely balanced chemical processes. Catabolism is the breakdown of nutrients and the release of energy. Anabolism uses that energy for bodily processes, growth and maintenance. #### What controls [metabolism](https://nabtahealth.com/glossary/metabolism/)? The whole process of [metabolism](https://nabtahealth.com/glossary/metabolism/) is controlled by our endocrine system, a network of glands all over the body which produce and release hormones. Those hormones in turn manage most functions in our bodies, including our [metabolism](https://nabtahealth.com/glossary/metabolism/), reproduction, growth and development, energy levels, emotions, response to injury, stress, sexual function, and sleep. It’s a finely tuned process. Sometimes glands produce too much or not enough of a hormone. This can [lead](https://nabtahealth.com/glossary/lead/) to imbalance and health problems such as weight gain, high blood pressure, changes in mood and sleep. Many external and internal factors affect how our bodies create and release hormones. Age, medications, illness and stress can all cause hormonal imbalance. The hormones that regulate your [metabolism](https://nabtahealth.com/glossary/metabolism/), your body’s ability to break down food and create energy, are produced by your thyroid, adrenal gland, [hypothalamus](https://nabtahealth.com/glossary/hypothalamus/) and pancreas. Each plays a different and complementary role in controlling and influencing your body’s metabolic health. #### How is the thyroid important for [metabolism](https://nabtahealth.com/glossary/metabolism/)? The **Thyroid** is vital in [regulating the metabolic processes needed for healthy growth and development, as well as regulating the body’s](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4044302/) [metabolism](https://nabtahealth.com/glossary/metabolism/). The thyroid [uses iodine from the food you consume](https://www.endocrine.org/patient-engagement/endocrine-library/hormones-and-endocrine-function) to produce its two primary hormones thyroxine (T4) and triiodothyronine (T3). These are stored and secreted as needed. The link between a [healthy functioning thyroid, body weight and energy expenditure](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4044302/) is well established. [Hypothyroidism](https://nabtahealth.com/glossary/hypothyroidism/) (underactive thyroid) is when the [thyroid gland](https://nabtahealth.com/glossary/thyroid-gland/) doesn’t release enough hormones and [metabolism](https://nabtahealth.com/glossary/metabolism/) slows down, affecting the entire body. This is often linked with autoimmune condition [Hashimoto’s disease](https://www.nhs.uk/conditions/thyroiditis/) which is an [inflammation](https://nabtahealth.com/glossary/inflammation/) of the [thyroid gland](https://nabtahealth.com/glossary/thyroid-gland/). Symptoms of [hyperthyroidism](https://nabtahealth.com/glossary/hyperthyroidism/) in women include [unusual weight gain, muscle weakness and pain, fatigue, thinning hair and](https://www.mayoclinic.org/diseases-conditions/hypothyroidism/symptoms-causes/syc-20350284) [constipation](https://nabtahealth.com/glossary/constipation/). In [hyperthyroidism](https://nabtahealth.com/glossary/hyperthyroidism/) (overactive thyroid) overproduction of hormones can [lead](https://nabtahealth.com/glossary/lead/) to accelerated [metabolism](https://nabtahealth.com/glossary/metabolism/) causing unintentional weight loss, [changes in menstrual patterns, more frequent bowel movements, sweating, tachycardia (rapid heartbeat),](https://www.mayoclinic.org/diseases-conditions/hyperthyroidism/symptoms-causes/syc-20373659) [arrhythmia](https://nabtahealth.com/glossary/arrhythmia/) (irregular heartbeat), anxiety, hair thinning and can cause [Grave’s disease](https://www.niddk.nih.gov/health-information/endocrine-diseases/graves-disease). #### How does the adrenal gland regulate [metabolism](https://nabtahealth.com/glossary/metabolism/)? **Adrenal or suprarenal glands** sit on top of your kidneys. Adrenals produce and release [cortisol](https://nabtahealth.com/glossary/cortisol/) (steroid) hormones and epinephrine ([adrenaline](https://nabtahealth.com/glossary/adrenaline/)) that help regulate your [metabolism](https://nabtahealth.com/glossary/metabolism/), immune system, blood pressure and maintain your response to stress. Among other important functions, [](https://www.hopkinsmedicine.org/health/conditions-and-diseases/adrenal-glands)[cortisol](https://nabtahealth.com/glossary/cortisol/) helps control the body’s use of fats, proteins and carbohydrates, regulates blood pressure and increases blood sugar. Disorders related to the adrenal glands not functioning properly include [Cushing syndrome](https://www.mayoclinic.org/diseases-conditions/cushing-syndrome/symptoms-causes/syc-20351310), [Addison’s disease](https://www.mayoclinic.org/diseases-conditions/addisons-disease/symptoms-causes/syc-20350293), [Congenital](https://www.mayoclinic.org/diseases-conditions/congenital-adrenal-hyperplasia/symptoms-causes/syc-20355205) [adrenal hyperplasia](https://nabtahealth.com/glossary/adrenal-hyperplasia/) and [Conn’s syndrome](https://www.urologyhealth.org/urology-a-z/c/conns-syndrome). #### Hypothalamic regulation of [metabolism](https://nabtahealth.com/glossary/metabolism/) Studies are increasingly demonstrating that the **[hypothalamus](https://nabtahealth.com/glossary/hypothalamus/)** is critical in coordinating [metabolism](https://nabtahealth.com/glossary/metabolism/) and central to energy balance. The [hypothalamus](https://nabtahealth.com/glossary/hypothalamus/) region of the brain regulates [metabolism](https://nabtahealth.com/glossary/metabolism/) by controlling food intake, energy storage and release [“through the ability of neurons to sense, integrate, and respond to numerous metabolic signals.”](https://academic.oup.com/endo/article/159/10/3596/5091402) #### How does the pancreas control [metabolism](https://nabtahealth.com/glossary/metabolism/)? The two glands in the **pancreas** are crucial to [metabolism](https://nabtahealth.com/glossary/metabolism/) regulation, playing a key role in nutrient digestion and blood sugar control. The endocrine gland makes hormones that manage blood sugar levels; insulin lowers blood sugar and glucagon raises blood sugar levels. The exocrine gland [secretes digestive enzymes crucial for breaking down carbohydrates, fats, proteins and acids in the duodenum](https://www.hopkinsmedicine.org/health/conditions-and-diseases/the-pancreas). Imbalances in both hypothalamic and pancreatic regulation of [metabolism](https://nabtahealth.com/glossary/metabolism/) can [lead](https://nabtahealth.com/glossary/lead/) to increased risk for metabolic disorders such as diabetes type 2. #### What are inherited metabolic disorders? Inherited metabolic disorders are rare genetic conditions that cause a person’s [metabolism](https://nabtahealth.com/glossary/metabolism/) to not work properly from birth. Typically caused by a family history of inherited genetic disorders or by gene changes causing a deficiency in hormones or enzymes needed for the digestion process. These deficiencies cause abnormal chemical reactions that keep the body’s [metabolism](https://nabtahealth.com/glossary/metabolism/) from working properly, with the processes that convert food into energy and remove waste and toxins from the body compromised. Doctors have identified many different and rare disorders, each of which has varying symptoms and treatment options. #### Why is it important to understand [metabolism](https://nabtahealth.com/glossary/metabolism/)? Knowing how [metabolism](https://nabtahealth.com/glossary/metabolism/) is controlled by your body’s endocrine system, and that each person’s [metabolism](https://nabtahealth.com/glossary/metabolism/) is also influenced by their genes, age, illness, medications and stress, can help you have a better understanding of your body. Whenever you have weight changes (gain or loss) you can’t explain you should talk to your doctor, especially if accompanied by other possible symptoms of [metabolism](https://nabtahealth.com/glossary/metabolism/) imbalance. Your doctor will run tests and advise you of treatment options and medications are available to regulate hormones. And a healthy lifestyle – staying active, eating a healthy diet and getting lots of sleep – will always have a positive impact on weight and energy levels. \_\_\_ If you are concerned you may have issues with your [metabolism](https://nabtahealth.com/glossary/metabolism/), get tested in the privacy of your own home by ordering a blood test [here](https://nabtahealth.com/product/metabolism-test/). 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#0b2e393b726a67676a4b656a697f6a636e6a677f6325686466) if you have any questions about this article or any aspect of women’s health. We’re here for you.
