In Full Stride

Health and Wellness

Alcohol and Health

What is at-risk drinking?

At-risk drinking means drinking more than seven drinks a week or three drinks on a single day. At-risk drinking also includes binge drinking.

For some women, drinking any amount of alcohol is at-risk drinking. These include women who are

  • unable to keep their drinking at a moderate level
  • younger than 21 years
  • pregnant or planning to become pregnant
  • about to drive or perform a task that may result in injury
  • taking prescription or over-the-counter medications that interact with alcohol

What is binge drinking?

For women, binge drinking is having more than three drinks per occasion. Binge drinking is a major problem among women in the United States. About one in eight women 18 years and older report binge drinking in the past 30 days. For girls younger than age 18, one in five report binge drinking.

How does my body process alcohol?

Women and men react differently to alcohol. A chemical in the body that breaks down alcohol is less active in your body than it is in men’s bodies. This means that more of the alcohol that you drink enters your bloodstream. Women typically weigh less than men and have less body water, so the alcohol that you drink is not diluted as quickly as the alcohol a man drinks. You will become intoxicated more quickly and have a higher blood alcohol level than a man who drinks the same amount.

What are the health risks of at-risk drinking for women?

Regular at-risk drinking can lead to alcohol dependence (also called alcoholism). Women who are alcohol dependent keep using alcohol even when it causes problems with their health, safety, or relationships. Increased physical risks include the following:

  • Injuries
  • Interpersonal violence
  • Sexually transmitted infections and unintended pregnancy
  • Birth defects
  • Menstrual disorders and altered fertility
  • Heart and liver disease
  • Seizures
  • Certain types of cancer

What are the signs and symptoms of alcohol dependence?

The following signs and symptoms are associated with alcohol dependence:

  • Craving—A strong urge to drink
  • Loss of control—After starting to drink, not being able to stop
  • Dependence—Alcohol withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety after stopping drinking
  • Tolerance—The need to drink greater amounts of alcohol to feel the same effect

How can drinking alcohol during pregnancy affect my baby?

Drinking alcohol during pregnancy is a leading cause of birth defects. Alcohol can harm a fetus throughout pregnancy. This includes the first few weeks before you know you are pregnant and during the last weeks of pregnancy when the fetal brain is maturing. Even moderate alcohol use during pregnancy can cause lifelong problems with a child’s learning and behavior. Any amount is risky for women who are pregnant or trying to become pregnant. All types of alcohol are harmful, including beer and wine.

What are fetal alcohol spectrum disorders (FASDs)?

Fetal alcohol spectrum disorders (FASDs) are health problems that can occur in a person whose mother drank alcohol during pregnancy.

What is fetal alcohol syndrome (FAS)?

The most severe FASD is fetal alcohol syndrome (FAS). FAS causes

  • problems with brain development
  • lower-than-average height and weight
  • smaller-than-normal head size
  • abnormal facial features

For every child born with FAS, many more are born with other FASDs. These children may have problems with coordination, behavior, attention, learning, and understanding consequences without any of the physical signs of FAS.

How can I prevent birth defects related to alcohol use?

Birth defects related to alcohol are 100% preventable by not drinking during pregnancy. Prevention involves these three steps:

  1. If you do not want to get pregnant and you drink alcohol, use effective birth control.
  2. If you are planning to become pregnant, do not drink.
  3. If you are pregnant and have been drinking, stop. This will reduce the risk of harm to your baby.

What if I drank a small amount of alcohol before I knew I was pregnant?

Although it is true that no amount of alcohol use is safe during pregnancy, serious harm from this kind of use is unlikely. The important thing is to not drink any alcohol for the rest of the pregnancy.

How can I get help to reduce my drinking or stop drinking?

Your obstetrician–gynecologist or other health care professional can refer you to resources near you.

Information from ACOG

BRCA 1 and BRCA 2 Mutations

What is cancer?

Normal cells in the body grow, divide, and are replaced on a routine basis. Sometimes, cells divide abnormally and begin to grow out of control. These cells may form growths or tumors. Tumors can be benign (not cancer) or malignant (cancer). Benign tumors do not spread to other body tissues. Cancer tumors can invade and destroy nearby healthy tissues, bones, and organs. Cancer cells also can spread to other parts of the body and form new cancerous areas.

What causes cancer?

Cancer is caused by several different factors. A few types of cancer run in families. These types are called “hereditary” or “familial” cancer. They are caused by changes in genes that can be passed from parent to child. Changes in genes are called mutations.

What is hereditary breast and ovarian cancer syndrome?

Hereditary breast and ovarian cancer (HBOC) syndrome is an inherited increased risk of breast cancer, ovarian cancer, and other types of cancer. HBOC syndrome is linked to mutations in several genes, but the most common are called BRCA1 and BRCA2.

What are BRCA1 and BRCA2?

BRCA1 and BRCA2 are tumor suppressor genes, which means that they keep cells from growing too rapidly. Everyone has these genes. Changes or mutations in these genes mean they do not work properly and cells can grow out of control, which can lead to cancer.

How much do BRCA mutations increase the risk of breast cancer?

The risk of breast cancer for the average American woman is about 12% in her lifetime. Having a BRCA mutation greatly increases the risk. The estimated risk of breast cancer in women with a BRCA mutation is 45–85% by age 70 years.

How much do BRCA mutations increase the risk of ovarian cancer?

The risk of ovarian cancer for the average American woman is about 2% in her lifetime. The estimated risk of ovarian cancer in women with a BRCA1 mutation is 39–46% by age 70 years. For women with a BRCA2 mutation, the risk of ovarian cancer by age 70 years is 10–27%.

Do BRCA mutations increase the risk of other types of cancer?

Yes. Women who have a BRCA mutation also have an increased risk of cancer of the fallopian tube, peritoneum, pancreas, and skin (melanoma). Men who have a BRCA mutation have an increased risk of cancer of the breast, prostate, and pancreas.

How common are BRCA mutations?

About 1 in 300 people to 1 in 800 people carry a BRCA1 or BRCA2 mutation. Anyone can have these mutations, but they are found more often in certain ethnic groups. These groups include people of the following backgrounds:

  • Eastern or Central European Jewish
  • French Canadian
  • Icelandic

Should I be tested for BRCA mutations?

Your obstetrician–gynecologist (ob-gyn) or other health care professional should ask you questions about your personal and family history of breast cancer and ovarian cancer. The questions may include the following:

  • Have you had cancer of the ovary, fallopian tubes, or peritoneum?
  • Have you had breast cancer at age 45 years or younger?
  • Have you had breast cancer and do you have a close relative with breast cancer at age 50 years or younger, or a close relative with cancer of the ovary, fallopian tubes, or peritoneum?
  • Have you had breast cancer and do you have two or more close relatives with breast cancer at any age?
  • Have you had breast cancer and do you have two or more close relatives with cancer of the pancreas or prostate?
  • Have you had breast cancer and are you of Eastern or Central European Jewish ancestry?
  • Do you have a close relative with a BRCA1 or BRCA2 mutation?

If your answers to these or other questions suggest that you may have a BRCA mutation, genetic counseling and testing may be offered.

What is genetic counseling?

Before you have genetic testing, a genetic counselor or a physician who specializes in inherited types of cancer can help you understand how the testing is done, what the results may mean, and what you may do depending on the test results.

Why don’t doctors test everyone for BRCA mutations?

BRCA testing is only recommended for people with a high risk of having BRCA mutations. It is important to remember that most cases of breast and ovarian cancer are not caused by gene mutations. If there is a low chance of finding a BRCAmutation, your ob-gyn or other health care professional may not recommend genetic testing.

How is testing for BRCA mutations done?

Genetic testing requires a sample of blood or saliva. There are several ways that testing can be done:

  • If a relative with breast cancer or ovarian cancer is available, the relative’s BRCA genes can be analyzed. If your relative carries a mutation, you can have testing to see if you have the same mutation as your relative. This is the best way to know if you are at increased risk of cancer.
  • If no relative is available, and you and your family belong to an ethnic group with high numbers of people with a specific BRCA mutation, you can be tested for this mutation.
  • If you are not part of a high-risk ethnic group but your family history suggests there may be a hereditary mutation, another option is to have testing of your BRCA genes. If your family has a member with breast cancer or ovarian cancer, it is always best to test that relative first. But if that is not possible, you may have individual testing and counseling.

What does a negative test result mean?

A negative test result can mean several things:

  • When a family member with cancer gives a sample and a BRCA mutation is found, you can be tested for that mutation. If you have a negative test result for that BRCA mutation, you have not inherited it and your risk of cancer is the same as the general population.
  • If you have a family history of cancer but no family member with cancer has given a sample, and you have a negative test result for a BRCA mutation, it can mean that your family has a BRCA mutation but you did not inherit it. It also can mean your family carries a mutation in a gene that researchers have not yet identified.

What does an unclear test result mean?

An unclear test result means there is a change in a BRCA gene, but it is not known whether the change increases the risk of cancer. Researchers continue to study BRCA and other genes to find out how they may influence cancer risk. If you have an unclear result, a genetic counselor can explain strategies that may reduce your risk.

What does a positive test result mean?

A positive test result means you have a BRCA mutation for which you have been tested. That means you have an increased risk of getting cancer. It does not mean you will get cancer. There is no test that can tell which women with a BRCA mutation will develop cancer or at what age. It is important to discuss your results with your genetic counselor and learn what you can do to decrease your risk of cancer.

Having a BRCA mutation means you can pass the mutation to your children. Your siblings also may have the gene mutation. You are not obligated to tell your family members, but sharing the information could be life-saving for them. With this information, your family members can decide whether to be tested and get cancer screenings at an early age.

How can you prevent cancer if you test positive for a BRCA mutation?

If you test positive for a BRCA mutation, you may discuss prevention options with your ob-gyn, genetic counselor, or other health care professional. Prevention includes screening tests, medications, and surgery.

What breast cancer screening tests are available?

Breast cancer screening may include the following tests for women with BRCA mutations:

  • Clinical breast exam by your ob-gyn or other health care professional every 6–12 months
  • Annual breast imaging starting at age 25 years. Magnetic resonance imaging (MRI) is recommended annually for women aged 25–29 years. Beginning at age 30 years, breast MRI and mammography are recommended annually.

What ovarian screening tests are available?

Currently there is no recommended screening test for ovarian cancer for average-risk patients. For high-risk patients, one ovarian cancer screening method that has been studied is a blood test that measures levels of a marker called CA 125. A marker is a substance made by cancer cells. Levels of CA 125 sometimes are increased in women with ovarian cancer. An ultrasound exam of the ovaries also may be recommended for women with a BRCA mutation. If your ob-gyn or other health care professional recommends these tests, you may begin testing between the ages of 30 years and 35 years.

It is important to know that these screening tests have a limited ability to find ovarian cancer at an early, more treatable stage. Test results may be normal even when cancer is present. There also is a high rate of false-positive results (a positive test result in someone who does not have ovarian cancer). There are ongoing studies to find an accurate and reliable screening test for ovarian cancer.

What medication can help prevent breast cancer?

A medication called tamoxifen has been shown to reduce the risk of breast cancer in women with BRCA2 mutations. Tamoxifen is a drug that blocks the effects of estrogen on cancer cells that respond to this hormone.

Tamoxifen works better in women with BRCA2 mutations because most breast cancer tumors in this group grow in response to estrogen. Tamoxifen does not appear to reduce breast cancer risk in women with BRCA1 mutations because fewer cancer tumors in this group respond to estrogen.

What medications can help prevent ovarian cancer?

Combined hormonal birth control pills (those that contain estrogen and progestin) have been shown to reduce the risk of ovarian cancer. The longer a woman takes the pill, the more the risk is reduced—for every 5 years on the pill, a woman reduces her risk by about 20%. But this benefit needs to be balanced against the risks of using the pill. The pill is safe for most women, but it is associated with a small increased risk of deep vein thrombosis (DVT), heart attack, and stroke. Your ob-gyn or other health care professional can help you understand how to balance the benefits and risks of using the pill.

Can surgery help prevent breast cancer?

Yes. Surgical removal of both breasts is called risk-reducing bilateral mastectomy. It can reduce the risk of breast cancer by 85–100% in women with a BRCA mutation. Total mastectomy, in which all breast tissue is removed, including the nipple, is the most effective surgery for reducing the risk of breast cancer. Mastectomy that removes the breast tissue and leaves the nipple also can be considered and is very effective. Some women choose to have breast reconstruction after a mastectomy.

What are the side effects of a mastectomy?

Side effects of a mastectomy can include the following:

  • Pain, tenderness, or swelling
  • Buildup of blood or fluid in the wound or arms
  • Limited arm or shoulder movement
  • Numbness in chest or arm
  • Burning or shooting pain in the chest, armpit, or arm
  • Inability to breastfeed

Can surgery help prevent ovarian cancer?

Yes. The removal of both ovaries and both fallopian tubes is called risk-reducing bilateral salpingo-oophorectomy. In women with a BRCA mutation, this surgery can reduce the risk of ovarian cancer by about 80%. The surgery also reduces the risk of cancer of the fallopian tubes and peritoneum. If it is done before menopause, this surgery also can reduce the risk of breast cancer. Women with a BRCA mutation should consider this surgery between the ages of 35 years and 40 years or after they have completed childbearing. Some women may be able to delay slightly longer. Removal of the ovaries means you will not be able to get pregnant.

Researchers also are studying the removal of only the fallopian tubes (salpingectomy) to prevent ovarian cancer. Some cases of ovarian cancer may start in the fallopian tubes, so removing the tubes may help prevent ovarian cancer without putting a woman into menopause. More research is needed in this area.

What are the side effects of removing the ovaries?

Removal of the ovaries before menopause will cause you to go through menopause immediately. This is called surgical menopause. Symptoms may be more severe than if you were to go through menopause naturally over several years. Menopause symptoms often can be managed with hormone therapy and other treatments. You can discuss these treatment options with your ob-gyn or other health care professional before your surgery.

What else should I think about before choosing risk-reducing surgery?

If you are thinking about having preventive surgery, you and your ob-gyn or other health care professional will discuss the risks and benefits. You should consider the psychological effects as well as short- and long-term complications. Timing of surgery should be based on your cancer risk, your desire to have children, and the effect that surgery will have on your well-being.

I am concerned about discrimination based on genetic testing results. What should I know?

Many people are concerned about possible employment discrimination or denial of insurance coverage based on genetic testing results. The Genetic Information Nondiscrimination Act of 2008 (GINA) makes it illegal for health insurers to require genetic testing results or use results to make decisions about coverage, rates, or preexisting conditions. GINA also makes it illegal for employers to discriminate against employees or applicants because of genetic information. GINA does not apply to life insurance, long-term care insurance, or disability insurance.

What should I know about direct-to-consumer genetic tests?

A direct-to-consumer genetic test is a genetic test that you can order over the internet. You do not need a doctor’s order for it. The American College of Obstetricians and Gynecologists discourages use of direct-to-consumer genetic tests because the results may be misleading. For example, one test for BRCA mutations only looks for three mutations, even though there are more than 500 BRCA mutations linked to cancer. The test results could cause unnecessary fear, or a false sense that you are not at risk. You should always see a health care professional if you want a genetic test.

Information from ACOG

Cholesterol and Heart Health

What is cholesterol?

Cholesterol is a fatty, wax-like substance. Your body uses cholesterol to make the outer coverings of cells. Cholesterol is a part of certain hormones, including estrogen and testosterone. It also helps your body make vitamin D and produces the bile that helps you digest food.

Where does cholesterol come from?

The liver makes most of the cholesterol in your body. A small amount comes from foods, such as meat and dairy products. The fat in these foods is turned into triglycerides. Triglycerides travel through the bloodstream and are stored in fat cells as a source of energy. The body also converts sugars in fruits and sugary foods into triglycerides.

What is “good” and “bad” cholesterol?

In the body, cholesterol is packaged with a protein and triglycerides into a substance called a lipoprotein. There are two main types of lipoproteins:

  1. LDL (low-density lipoprotein)—This type of lipoprotein carries cholesterol to where it is needed in the body. If there is too much of it, it tends to collect in the walls of blood vessels. LDL sometimes is called “bad cholesterol.”
  2. HDL (high-density lipoprotein)—This type of lipoprotein picks up cholesterol in the bloodstream and takes it back to the liver. The liver breaks down cholesterol so that it can pass out of the body. HDL sometimes is called “good cholesterol.”

What is dyslipidemia?

Having abnormal levels of cholesterol or triglycerides is called dyslipidemia. A common dyslipidemia in the United States is having an LDL cholesterol level that is too high, an HDL cholesterol level that is too low, and elevated levels of triglycerides. This type of dyslipidemia increases the risk of cardiovascular disease.

How does having a high LDL cholesterol level lead to cardiovascular disease?

When the level of LDL is high, it can collect inside the walls of blood vessels. When the level of HDL is low, there may not be enough available to remove the “bad cholesterol” from the blood vessels. LDL within the walls of blood vessels triggers a response by the body’s immune system. Eventually, this immune response can lead to a buildup of a substance called plaque in the blood vessels. Plaque can narrow and harden the arteries, a condition called atherosclerosis.

Over time, plaque can develop into a blood clot that narrows or blocks the flow of blood in an artery. If this occurs in an artery in the heart, it can cause a heart attack. If this occurs in an artery in the brain, it can cause a stroke.

Besides abnormal cholesterol, what are other risk factors for cardiovascular disease?

Other risk factors are advancing age, male sex, family history, smoking, physical inactivity, obesity, a poor diet, and medical conditions such as diabetes mellitus and high blood pressure.

What are some risk factors for cardiovascular disease that are unique to women?

Polycystic ovary syndrome, high blood pressure disorders that occur during pregnancy, and gestational diabetes are all risk factors for cardiovascular disease that are unique to women.

How are my cholesterol levels measured?

A simple blood test can show if your cholesterol levels are healthy. A complete lipoprotein analysis measures the levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.

When should my cholesterol levels be measured?

Women without risk factors should have their cholesterol levels measured every 5 years beginning at age 45 years. Women who have risk factors for cardiovascular disease may need to start cholesterol screening earlier.

What lifestyle changes can I make to reduce my risk of cardiovascular disease?

The following changes may reduce your risk of cardiovascular disease:

  • Eat a heart-healthy diet. A heart-healthy diet is one that emphasizes vegetables, fruits, beans, and low-fat dairy products; includes fish and poultry; and limits red meat, sugary foods and drinks, and sodium.
  • Exercise. Exercise strengthens your heart and promotes the health of your blood vessels. It helps boost your HDL levels and lower blood pressure levels.
  • Lose weight. Weight loss is recommended if you are overweight or obese.
  • Stop smoking. Smoking is one of the biggest risk factors for heart disease. It decreases HDL levels and may increase the level of triglycerides in your blood.

Is there medication that can help reduce my cholesterol levels?

Statins are drugs that cause the liver to make less cholesterol. In addition to lowering LDL levels, they also may help decrease the levels of triglycerides and increase levels of HDL.

Information from ACOG

High Blood Pressure

What is blood pressure?

Blood pressure is the force of blood pushing against the walls of the blood vessels called arteries. The arteries carry blood from your heart to your lungs, where the blood picks up oxygen, which is delivered to your organs and tissues. The organs and tissues use the oxygen to power their activities. Other blood vessels called veins bring the now oxygen-poor blood and waste products back to the heart and lungs.

How often should I have my blood pressure checked?

You should have your blood pressure measured at least every 2 years if your blood pressure is normal and more often if it is higher than normal.

How is my blood pressure checked?

A cuff with a balloon inside is wrapped around your upper arm. Air is pumped into the balloon. Your pressure reading is taken while the cuff is squeezing your arm.

What do the numbers in my blood pressure reading mean?

Your blood pressure reading has two numbers. Each number is separated by a slash: 110/80, for instance. You may hear this referred to as “110 over 80.” The first number is the pressure against the artery walls when the heart contracts. This is called the systolic blood pressure. The second number is the pressure against the artery walls when the heart relaxes between contractions. This is called the diastolic blood pressure.

Does my blood pressure stay the same all of the time?

Blood pressure can go up and down. It goes down when you sleep and goes up when you are active or nervous. This is normal. Your blood pressure is the average of several readings taken on different occasions.

How is my blood pressure reading categorized?

Your blood pressure reading is classified into one of four categories: normal, prehypertension, stage 1 hypertension, or stage 2 hypertension. People who have prehypertension have twice the risk of developing hypertension compared with those who have normal blood pressure. Recognizing prehypertension is important. If you have prehypertension, you often can make lifestyle changes to prevent the development of high blood pressure.

How can high blood pressure harm my body?

Long before high blood pressure causes symptoms, it can damage vital organs in your body:

  • Blood vessels—Long-term high blood pressure can damage the walls of the arteries. Damaged artery walls are more likely to attract a sticky substance called plaque. Plaque can build up inside blood vessel walls and, over time, cause the arteries to narrow and harden. This condition is called atherosclerosis. The combination of atherosclerosis and high blood pressure sets the stage for a stroke or heart attack.
  • Heart—As blood pressure increases, the heart has to work harder to deliver oxygen to the tissues. Over time, the heart may enlarge. Its walls may thicken or thin. The heart may no longer pump efficiently enough to keep up with the body’s demands. Tissues become starved of oxygen, causing fatigue, breathing problems, and weakness.
  • Brain—High blood pressure can cause a blood vessel in the brain to become blocked, cutting off oxygen to that part of the brain. A blood vessel also can burst. This is called a stroke. During a stroke, cells in that part of the brain may die. A stroke can cause permanent brain damage or death.
  • Kidneys—The kidneys filter the blood to remove wastes from your body. The blood vessels in the kidneys can be damaged easily by high blood pressure. When the kidneys are not working normally, their ability to control salt and water balance in the body is disrupted. This can lead to kidney failure.
  • Eyes—High blood pressure can cause the blood vessels in your eyes to constrict. This can cause vision problems and may even lead to blindness.

What are risk factors for high blood pressure that cannot be changed?

The following factors that increase the risk of high blood pressure cannot be changed:

  • Age—Blood pressure increases with increasing age.
  • Race—High blood pressure is more common in African Americans than in any other racial group.
  • Family history—High blood pressure tends to run in families.
  • Medical conditions—Certain diseases, such as diabetes and kidney disease, increase the risk of high blood pressure.
  • History of preeclampsia

What lifestyle habits can affect my blood pressure?

Lifestyle habits also can affect blood pressure. These are things you can change. You are at greater risk of high blood pressure if you

  • are overweight
  • are not physically active
  • smoke cigarettes
  • drink more than two alcoholic drinks per day
  • eat a poor diet (too much fat, not enough fruits and vegetables)
  • eat too much salt

What can I do to help decrease my risk of high blood pressure?

Adopting certain lifestyle habits can decrease your risk of developing high blood pressure in the future:

  • Quit smoking.
  • Lose weight if you are overweight.
  • Limit your intake of alcohol.
  • Exercise regularly.
  • Cut back on salt.
  • Change your diet—The DASH (Dietary Approaches to Stop Hypertension) eating plan focuses on heart-healthy foods.
  • Relieve stress.

What treatment is available if my blood pressure is not lowered by lifestyle changes?

If lifestyle changes alone do not lower your blood pressure, medications usually are recommended. Many types of medications are available that work in different ways. It is important to continue taking your medication even when you are feeling healthy. It also is important to continue your healthy lifestyle habits even if taking medication lowers your blood pressure readings into the healthy range.

Can high blood pressure affect pregnancy?

High blood pressure during pregnancy can cause serious problems, including growth problems with the baby, preterm birth, and worsening of any preexisting conditions that you have because of high blood pressure. If you have chronic (long-lasting) high blood pressure and are planning to become pregnant, see your health care provider for a prepregnancy check-up. This will give you a chance to stabilize your blood pressure and to become as healthy as possible. During pregnancy, your blood pressure will be measured often. You will be monitored for signs and symptoms of preeclampsia. You may have special tests to monitor the well-being and growth of the fetus.

What is gestational hypertension?

High blood pressure that first occurs in the second half (after 20 weeks) of pregnancy is called gestational hypertension. Management depends on how high your blood pressure is. Most women with gestational hypertension have only a mild increase in blood pressure. Some women, however, develop severe hypertension and are at risk of serious complications. All women with gestational hypertension are monitored closely to make sure their blood pressure does not go too high and to look for signs of preeclampsia.

What is preeclampsia?

Preeclampsia is a serious high blood pressure disorder that can occur during pregnancy and in the weeks after pregnancy. If it is not diagnosed and managed, it can cause severe complications in both the woman and her baby. Women who have had preeclampsia have an increased risk of developing high blood pressure and cardiovascular disease later in life.

Are certain types of birth control not recommended if I have high blood pressure?

Some birth control methods are not recommended for women with high blood pressure. These methods include the following:

  • Combined hormonal birth control methods—These methods contain estrogen and progestin and include the combined hormonal pill, patch, and ring. If you are being treated for high blood pressure—even if your blood pressure is normal—discuss the use of these methods with your health care provider.
  • Injection—This form of birth control should not be used if your systolic blood pressure is 160 or higher or if your diastolic pressure is 100 or higher.

Can hormone therapy for menopause symptoms affect my blood pressure?

Blood pressure usually does not change much with hormone therapy. In some women, hormone therapy actually decreases blood pressure. In others, some types of hormone therapy increase blood pressure. Because the effects of hormone therapy on blood pressure are not predictable, all women who are taking hormone therapy should have their blood pressure checked more often.

Information from ACOG

Deep Vein Thrombosis (DVT)

What is deep vein thrombosis (DVT)?

Deep vein thrombosis is a condition in which blood clots (or thrombi) form in deep veins in the legs or other areas of the body. Veins are the blood vessels that carry blood from the body’s tissues to the heart. Deep veins are located deep in the body, away from the skin’s surface.

How does a clot form in a vein?

Clotting is a normal process that helps stop bleeding, such as from a cut in the skin. A clot also can form if

  • blood flow is too slow
  • the lining of a vein is damaged
  • a problem in the blood makes it clot more easily

When a clot forms in a deep vein, blood flow in the vein slows down and causes the vein to swell. If a piece of a clot breaks free and moves through the blood vessels to the lungs, it is very serious. This condition, called pulmonary embolism (PE), can be fatal. Nearly one third of people who have DVT develop PE. It is important to find and treat DVT early in order to prevent PE.

Who is at risk of DVT?

DVT can occur in anyone, but some factors can increase the risk. Having more than one risk factor further increases the risk. Events or conditions that increase the risk of DVT include the following:

  • Surgery
  • Trauma
  • Long periods of not moving (bed rest, sitting, long car or airplane trips)
  • Cancer and cancer therapy
  • Past history of DVT
  • Increasing age
  • Pregnancy and the 4–6 weeks after giving birth
  • Use of birth control methods that contain estrogen or hormone therapy for menopause symptoms
  • Certain illnesses, including heart failure, inflammatory bowel disease, and some kidney disorders
  • Obesity
  • Smoking
  • Varicose veins
  • Having a tube in a main vein (sometimes needed to give medications over a period of time)
  • Having a thrombophilia, one of several diseases in which the blood does not clot correctly

What can be done before and after surgery to prevent DVT?

Your doctor may prescribe medications to prevent blood clots from forming before or after surgery. You also may be told to stop taking certain medications before surgery. At the hospital, you may wear special elastic stockings or inflatable boots. These devices squeeze the muscles to help keep blood flowing. You may need to wear them until you leave the hospital. You may be urged to get up and walk around soon after the procedure. Your feet or the foot of your bed may be raised.

How can DVT be prevented during pregnancy?

If you are pregnant, medication or other treatments may be prescribed to prevent DVT if you have certain risk factors:

  • Strong family history of DVT
  • An inherited thrombophilia
  • Need for bed rest
  • Likely to have a cesarean birth

If medication is prescribed for you, your health care provider will make sure you know how to take the medication and what you should avoid while taking it.

How can DVT be prevented during travel?

When planning a long trip, the following preventive steps are recommended, especially if you are pregnant or have other risk factors for DVT:

  • Drink lots of fluids.
  • Wear loose-fitting clothing.
  • Walk and stretch at regular intervals (for example, when traveling by car, make frequent stops to allow you to get out and stretch your legs).
  • Special stockings that compress the legs below the knee may help prevent blood clots from forming. However, talk to your health care provider first before you try these stockings because some people should not wear them (for example, those with diabetes or problems with blood circulation).

What are signs of DVT?

Only about one half of people who have DVT show any signs or have symptoms. Signs and symptoms of DVT in the ankle, calf, or thigh include

  • warmth or tenderness
  • pain or sudden swelling
  • redness of the skin
  • constant pain in one leg while standing or walking

What are signs of pulmonary embolism (PE)?

PE can be life-threatening. If you have any of the following signs or symptoms, you should contact your health care provider or go to the emergency room:

  • A sudden cough, which may produce blood
  • Sudden shortness of breath
  • Pain in the ribs when breathing
  • Sharp chest pain under the breast or on one side
  • Burning, aching, or dull heavy feeling in the chest
  • Rapid breathing
  • Rapid heart rate

How is DVT diagnosed?

The following tests are used to diagnose DVT:

  • Blood tests—You may be tested for blood disorders that are known to increase the risk of DVT.
  • Doppler ultrasound—A handheld device is placed over veins that uses sound waves to check blood flow. Pressure is applied to see if the vein responds normally. This test is most often used to confirm DVT in the legs.
  • Magnetic resonance imaging (MRI)—MRI, a special type of imaging test, can show clots in the legs or pelvis.
  • Venogram—In this test, dye is put into a vein, and an X-ray is taken. The dye can show whether there is a clot in the vein.

Other tests may be done if the clot is thought to be in the lungs:

  • Spiral computed tomography (CT)—This imaging test is done to see if any clots have moved to the lungs.
  • Ventilation/perfusion (V/Q) scan—This imaging test measures how well air and blood move through the lungs. It is used to diagnose PE.

How is DVT treated?

DVT is most often treated with medications. Drugs may include anticoagulants to prevent clots or, less commonly, thrombolytics to dissolve them.

Information from ACOG


What is depression?

Depression is a common but serious illness. It is more than just feeling sad or upset for a short time or feeling grief after a loss. Depression changes your thoughts, feelings, behavior, and physical health. It can affect how you relate to your family, friends, and coworkers. It can occur at different times of life or in different situations. It also can occur as part of other disorders.

What are the symptoms of depression?

Depression causes a mix of emotional and physical symptoms. You have depression if you have five of the following symptoms most of the day, every day, during the same 2-week period. One of the symptoms must be either sad or depressed mood or loss of interest or pleasure in previously enjoyed activities:

  • Sad or depressed mood
  • Loss of interest or pleasure in activities you used to enjoy
  • Weight loss when not dieting or weight gain; decrease or increase in appetite
  • Trouble sleeping or sleeping too much
  • Moving more slowly or moving more quickly than usual
  • Fatigue or loss of energy
  • Feelings of worthlessness or guilt
  • Having trouble thinking, concentrating, or making decisions
  • Thoughts of death or suicide

Are there different levels of depression?

Depression can be mild, moderate, or severe. If you have mild depression, it may take extra effort to do what you have to do, but often you can still do those things. With moderate depression, you may not be able to do some of the things you need to do. If you have severe depression, you may not be able to do any of the daily tasks you need to do.

What causes depression?

Researchers do not know for certain what causes depression. They do know that depression is a brain disorder in which the parts of the brain that control mood, sleep, and thinking are not functioning properly. Depression may be caused by an imbalance in certain chemicals in the brain.

What factors increase the risk of depression?

Factors that increase the risk of depression include the following:

  • Genetics—A family history (someone in your immediate family has depression) can put you at high risk.
  • Hormonal changes—Depression in women may be related to hormonal changes that happen during the menstrual cycle, during pregnancy, after childbirth, and at menopause. When depression occurs after childbirth, it is called postpartum depression (see the FAQ Postpartum Depression).
  • Stress—Stressful circumstances such as trauma, loss of a loved one, a difficult relationship, unemployment, or abuse may trigger the onset of depression.
  • Other illnesses—Some disorders can lead to or occur with depression. Anxiety disorders often occur with depression. Alcohol and drug problems and chronic (long-lasting) pelvic pain also can occur with depression.

How is depression diagnosed?

To diagnose your depression, your health care provider will discuss your symptoms, how often they occur, and how severe they are. You also will be asked about your medical history, any medications you are taking, and whether you use drugs or drink alcohol. Certain medications and health conditions, such as an infection or a thyroid disorder, can cause symptoms similar to depression.

How is depression treated?

Depression is treated with psychotherapy, medications called antidepressants, or both.

What is psychotherapy?

In psychotherapy or “talk therapy,” a therapist will work with you to identify problems and suggest ways you might change your behavior to help relieve your symptoms.

You may have one-on-one therapy (with just you and the therapist) or group therapy where you meet with a therapist and other people with problems similar to yours. Another option is family or couples therapy, in which you and family members or your partner may work with a therapist.

What are antidepressants?

Antidepressants are medications that work to balance the chemicals in the brain that control your moods. There are many types of antidepressants. If one type does not work for you, your health care provider can prescribe another. Drugs often can be combined. It may take some time to find the drug or combination of drugs that works best for you. It often takes at least 3–4 weeks of taking the medication before you start to feel better.

Can antidepressants cause side effects?

Antidepressants can cause side effects; however, most are temporary and go away after a short time. Listed are some of the most common side effects:

  • Headache
  • Nausea
  • Trouble falling asleep or waking often during the night
  • Feeling jittery
  • Loss of sex drive
  • Difficulty having an orgasm

In teenagers and young adults taking certain kinds of antidepressants, the risk of suicidal thoughts and actions is increased. Close monitoring by a health care provider is necessary while taking these medications.

Can herbal supplements be used to treat depression?

Some people believe that certain herbal supplements, such as the plant St. John’s wort, are effective in treating depression. Research has shown that St. John’s wort does not work for treating major depression. It even can be harmful because it can make some medications, including those taken to treat heart disease, seizures, and certain types of cancer, not work as they should. St. John’s wort also can make birth control pills not work as well.

Information from ACOG


What is diabetes?

Diabetes is a disease in which the body does not make enough insulin or does not use it as it should. Insulin is a hormone that helps balance the amount of glucose in your blood.

Normally, your body changes most of the food you eat into glucose. Glucose is then carried to the body’s cells with the help of insulin. If your body does not make enough insulin, or the insulin does not work as it should, the glucose cannot enter the body’s cells. Instead, it stays in the blood. This makes your blood glucose level too high.

What are the types of diabetes?

There are two types of diabetes: type 1 and type 2. A person with type 1 diabetes needs to take insulin to survive because the body makes little or no insulin on its own. In people with type 2 diabetes, insulin is produced, but it does not work as it should. The body becomes resistant to the effects of insulin and produces more insulin to keep glucose levels normal. Over time, the body cannot maintain high enough levels to keep the glucose levels normal, and diabetes occurs. Type 2 diabetes also may occur as a result of other diseases or as a side effect of certain medications.

People with type 2 diabetes may not need to take insulin. They may be able to control their glucose levels with proper diet, medication, or both.

What are risk factors for diabetes?

Diabetes may run in families or be linked to certain lifestyle factors. You should be tested if you have any of these risk factors:

  • Age 45 years or older
  • Overweight
  • Family history of diabetes
  • Physical inactivity
  • Ethnic background:
    • — Native American
    • — Asian
    • — Hispanic
    • — African American
    • — Pacific Islander
  • Previous abnormal glucose screening results
  • High blood pressure
  • High cholesterol
  • History of gestational diabetes or a baby weighing more than 9 pounds at birth
  • Polycystic ovary syndrome
  • History of cardiovascular disease

What are the symptoms of diabetes?

The symptoms of type 1 and type 2 diabetes are listed as follows:

Type 1 diabetes

  • Increased thirst or urination
  • Constant hunger
  • Weight loss without trying
  • Blurred vision
  • Extreme fatigue

Type 2

  • Any symptoms of type 1 diabetes
  • Sores that are slow to heal
  • Dry, itchy skin
  • Loss of feeling or tingling in feet
  • Infections, such as a yeast infection, that keep coming back

What tests are available to detect diabetes?

There are three types of tests used to diagnose diabetes:

  1. Fasting plasma glucose test—This is the easiest and most common way to test for diabetes. Before the test, you must fast (not eat or drink anything but water) for at least 8 hours. One sample of blood is obtained.
  2. Random, also called casual, plasma glucose test—Your health care provider may screen you when you are not fasting by measuring your glucose levels.
  3. Oral glucose tolerance test—Before you have this test, you must fast overnight. You will first have a fasting plasma glucose test. Next, you will drink a liquid that contains glucose. Blood samples are taken to measure your blood glucose level over several hours.

If diabetes is not controlled, what problems can it lead to?

If diabetes is not controlled, long-term, severe health problems may occur:

  • Kidney disease that can lead to high blood pressure or kidney failure
  • Eye problems that can lead to blindness
  • Nerve damage and blood vessel damage in the feet that can cause pain, numbness, infection, and possibly the need to remove a toe, foot, or leg
  • High blood cholesterol levels that can lead to stroke and heart disease
  • Certain infections, such as bladder or kidney infections, vaginal infections, yeast infections, and skin infections
  • Problems in pregnancy
  • Thyroid problems

How can women with diabetes prepare for pregnancy?

If you have diabetes, preparing for pregnancy can improve your health and that of your future child. Plan to see your health care provider before you get pregnant to discuss your care. You should try to have good control over your glucose level a number of weeks before you become pregnant. Your health care provider may suggest changes in your care that will help lower your glucose to a normal range.

Can diabetes be prevented?

To help prevent diabetes, follow a healthy diet and get regular exercise. This also can help keep your weight down—a key part of preventing diabetes. The following steps can help prevent the disease:

  • Keep your weight in the range that is healthy for you. Many doctors use the body mass index (BMI) to assess healthy weight.
  • Eat a well-balanced diet to help keep your cholesterol, blood pressure, and weight at a healthy level.
  • Try to exercise for at least 30 minutes on most days of the week.
Information from ACOG

DIgestive Tract Issues

What are some common digestive problems?

Common digestive problems include the following:

  • Constipation
  • Diarrhea
  • Acid reflux
  • Hemorrhoids

Most common digestive problems are short term and easy to control with lifestyle changes and sometimes medication. In some cases, these problems can be a sign of more serious medical problems.

What is constipation?

Constipation involves having fewer than three bowel movements a week. Stools may be firm or hard to pass. Swelling or bloating of the abdomen may occur.

What causes constipation?

Common causes of constipation include not eating enough fiber, not drinking enough water, certain medications, and changes in routine (such as travel). Constipation can occur during pregnancy. The increased levels of hormones during pregnancy can slow down the digestive system.

How can constipation be treated?

If constipation continues, your health care provider may suggest a laxative. Most of these products are available without a prescription.

How do laxatives work?

Different types of laxatives work in different ways:

  • Bulk-forming laxatives absorb water and expand, which increases moisture in the stool and makes it easier to pass (these are thought to be the safest laxatives).
  • Stool softeners add liquid content to the stool to soften it.
  • Stimulants use a chemical to increase bowel activity, which moves the stool through the intestines.

How can constipation be prevented?

You can help prevent constipation by

  • drinking plenty of fluids
  • eating at least 25 grams of fiber a day
  • exercising
  • not holding your stool—using the bathroom when you feel the urge to have a bowel movement

What is diarrhea?

Diarrhea is having three or more loose bowel movements a day. Cramping also may occur.

What causes diarrhea?

Several things can cause diarrhea:

  • Infection with harmful bacteria or viruses, which can be caused by eating or drinking contaminated food or water
  • Drinking water or eating foods that contain germs your body is not used to (when traveling to foreign countries, for instance)
  • Consuming dairy products (if you are lactose intolerant), caffeine, artificial sweeteners, or certain additives
  • Taking medications, especially antibiotics
  • Digestive diseases, such as irritable bowel syndrome

What should I do if I have diarrhea?

If you have diarrhea, drink plenty of fluids to replace those that are lost. If diarrhea does not go away in a few hours, drink fluids and liquid foods that contain salt, such as sports drinks or broth. Avoid drinking dairy products, soda, and juices.

They may contain lactose, caffeine, or sugar, which may make diarrhea worse. Over-the-counter anti-diarrheal medications can be helpful. However, they should not be taken if you have a high fever or bloody diarrhea, which can be signs of a bacterial infection.

When do I need to see my health care provider about diarrhea?

If diarrhea lasts more than 2 days, see your health care provider. Also see your health care provider if your stools contain blood or pus or if you have a fever, severe abdominal pain, or signs of dehydration (thirst, dry skin, fatigue, dizziness, less frequent urination, or dark-colored urine).

What should I know about diarrhea if I use birth control pills?

If you use birth control pills, diarrhea or vomiting may decrease their effectiveness. Call your health care provider about what to do if you have vomiting or diarrhea that lasts for 48 hours or more after taking a combined birth control pill or that lasts for 3 hours or more after taking a progestin-only pill.

What is acid reflux?

Acid reflux occurs when the muscle in your esophagus that opens and closes when you swallow does not work properly. When this happens, food and digestive fluids, which contain acid, back up into your esophagus. Acid reflux can cause a burning feeling in your chest and throat, which sometimes is called heartburn.

How can I control acid reflux?

You can control or even prevent acid reflux by taking these steps:

  • Elevate the head of your bed.
  • Eat small, more frequent meals.
  • Quit smoking.
  • Avoid foods and drinks that make your symptoms worse.
  • Avoid lying on your back right after eating.

How can acid reflux be treated?

Several over-the-counter medications are available that may help reduce your symptoms. Antacids reduce the acid content in the stomach. Other medications stop the digestive system from making too much acid. Some of these medications are available over the counter.

What if I have acid reflux more than twice a week?

If acid reflux occurs more than twice a week, or if you have been taking over-the-counter medications for more than 2 weeks with no relief, you may have a condition called gastroesophageal reflux disease (GERD). Treatment includes lifestyle changes and medication. Surgery also is used to treat GERD in some cases. GERD that is not treated can lead to complications, including ulcers in the esophagus, narrowing of the esophagus, and a precancerous condition called Barrett esophagus. If you have GERD, it is important to see your health care provider regularly for treatment and follow-up.

What are hemorrhoids?

Hemorrhoids are swollen blood vessels in and around the anus and lower rectum. They can become painful, itchy, and irritated.

What causes hemorrhoids?

Hemorrhoids can result from several factors:

  • Being overweight
  • Pregnancy
  • Standing or sitting for long periods
  • Straining during physical labor
  • Constipation

Can hemorrhoids be treated?

The symptoms of hemorrhoids can be relieved with ice packs to reduce swelling. Sitting in a bath of warm water may relieve symptoms. You also may use a hemorrhoid cream or suppositories. Surgery may be needed to remove hemorrhoids in some cases. Adding fiber and fluids to your diet can help prevent hemorrhoids.

What are examples of common digestive disorders?

Common digestive disorders include the following:

  • Irritable bowel syndrome (IBS)
  • Celiac disease

These disorders affect more women than men. They can last for weeks or months, although symptoms can come and go.

What is irritable bowel syndrome?

Irritable bowel syndrome mainly affects women between the ages of 30 years and 50 years. Symptoms of irritable bowel syndrome may include the following:

  • Cramps
  • Gas
  • Bloating
  • Changes in bowel habits—constipation, diarrhea, or both
  • An urge to have a bowel movement that does not happen
  • Stools that have mucus in them

IBS cannot be cured, but it can be managed to reduce the symptoms. Changes in your diet, such as eating frequent small meals rather than two or three large meals a day and adding fiber to your diet, may help. Your health care provider also may suggest medications to relieve the symptoms.

What is celiac disease?

People with celiac disease cannot tolerate gluten. Gluten is a protein found naturally in wheat, rye, and barley. When gluten is eaten, the immune system reacts by damaging the lining of the small intestine. As a result of this damage, nutrients cannot be absorbed properly. Some people with celiac disease have no symptoms. Others may have diarrhea, constipation, fatigue, or abdominal pain and bloating. If it is not treated, the disease can increase the risk of serious health problems, including osteoporosis, anemia, and cancer. Treatment involves avoiding gluten in your diet.

What is colorectal cancer?

Colorectal cancer is cancer of the rectum and colon. It often begins as a polyp—a tissue growth in the colon or rectum. Routine screening can help prevent colon cancer. Polyps that are found during routine screening can be removed easily before they become cancerous.

When and how should I be screened for colon cancer?

If you are at average risk of colon cancer, the preferred screening method is a colonoscopy performed every 10 years beginning at age 50 years. A colonoscopy is an exam of the entire colon using a small, lighted instrument called a colonoscope. It is recommended that you stop having colonoscopy screening if you are older than 75 years. Screening with colonoscopy for people at high risk should begin at age 40 years or at 10 years younger than the age when the youngest affected relative received the diagnosis.

How can I know if I am at high risk of colon cancer?

You are at high risk of colon cancer if you

  • have a first-degree relative (a parent or sibling) younger than 60 years with colorectal cancer or colon polyps
  • have two or more first-degree relatives of any age with colorectal cancer or colon polyps
  • have had colorectal cancer
  • have had colon polyps
  • have a family history of familial adenomatous polyposis or hereditary nonpolyposis colon cancer

What are the signs and symptoms of colorectal cancer?

Colorectal cancer usually shows no signs in the early stages of the disease. In the more advanced stages, signs and symptoms may include the following:

  • A change in bowel habits
  • Bleeding from the rectum
  • Blood in the stool
  • Stools that are more narrow than usual
  • Abdominal discomfort (bloating, cramps, or frequent gas pains)
  • A feeling that you need to have a bowel movement (that does not go away after a bowel movement)
  • Loss of appetite
  • Weakness and feeling tired

Having these symptoms does not mean that you have cancer. The same symptoms can result from other digestive disorders. Talk to your health care provider if you have any of these symptoms.

Information from ACOG

Sleep and Health

Sleep affects your mental and physical health. Getting good sleep helps boost your mind and mood and can help prevent health problems. Women are more likely than men to have insomnia and other sleep problems.1 Changing hormones during the menstrual cycle, pregnancy, and menopause can affect how well a woman sleeps. But there are steps you can take to get the rest you need.

How does sleep affect my mental health?

Your mind and body are healthier when you sleep well. Your body needs time every day to rest and heal. Some sleep disorders, such as insomnia, sleep apnea, and restless leg syndrome, make it harder to fall asleep or stay asleep. This can lead to daytime sleepiness and make it more difficult to stay in good mental health.

Having a sleep problem can also trigger a mental health condition or make current mental health conditions worse. Also, mental health conditions or treatments can sometimes cause sleep problems.

How much sleep do women need each night?

Most adults need between 7 and 9 hours of sleep a night to feel refreshed, although women who are pregnant may need more and older adults may average less.

What sleep problems affect women?

Sleep problems that affect women more or differently from men include:

  • Insomnia. More than 1 in 4 women in the United States experience insomnia, or the inability to fall asleep or stay asleep. Insomnia is also more common in people with depression and anxiety, which also affect more women than men.
  • Restless leg syndrome. More women than men experience restless leg syndrome. It can happen to women of all ages, but it happens most often during pregnancy. Also, some medicines used to treat depression can cause restless leg syndrome. Depression is more likely to affect women compared to men.
  • Sleep apnea. Sleep apnea may be underdiagnosed in women. Snoring is one of the main signs of sleep apnea. Women with sleep apnea may be underdiagnosed, because they usually report more general symptoms, such as insomnia, anxiety, and nightmares.

Why do women have more sleep problems?

Women may be more likely to have sleep problems because women experience hormonal changes during certain times and events that are unique to women. These include:

  • Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). Women with PMS commonly report trouble sleeping. Nearly 7 in 10 women with PMDD say they have problems going to sleep and staying asleep in the days leading up to their period.
  • Pregnancy, especially in the third trimester, when women may wake up more often than usual because of discomfort, leg cramps, or needing to use the bathroom.
  • Perimenopause, when hot flashes and night sweats often can disturb sleep. Also, about half of women report problems sleeping after menopause.

How do I know if I have a sleep disorder?

Talk to your doctor if:

  • You often have difficulty sleeping and the sleeping tips are not working for you
  • You awaken during the night gasping for breath
  • Your partner says that your breathing stops when you are sleeping
  • Your partner says that your legs move rapidly during sleep
  • You snore loudly
  • You have to get up more than twice during the night to urinate
  • You wake up feeling like you haven’t slept or are exhausted
  • You fall asleep often during the day

How are sleep disorders diagnosed?

To determine whether your sleep problems are caused by a sleep disorder or another mental or physical health problem, your doctor will ask you questions about your medical and sleep history. Sometimes it can take several visits to a doctor to figure out the cause of your sleep problems.

Your doctor or nurse may:

  • Ask about any new or ongoing health problems or stress.
  • Ask about your sleep habits. Consider keeping a sleep diary for 1 or 2 weeks before you see your doctor. Write down when you go to sleep, wake up, and take naps.11 Keep track of how long you sleep each night and you how feel throughout the day. Some free apps for your mobile phone may also help you track sleep.
  • Do a physical exam. This can help your doctor rule out other medical problems that might cause sleep problems. You might need blood tests to check for thyroid problems or other health problems.
  • Recommend a sleep study. If your doctor thinks a sleep disorder is causing your sleep problems, you may be asked to do a sleep study. Sleep studies may record brain activity, eye movements, heart rate, and breathing patterns while you stay overnight at a sleep center. A study can also record how much oxygen is in your blood and how much air moves through your nose while you breathe, as well as your snoring and other measurements.

Can I take an over-the-counter (OTC) medicine to help me sleep?

Yes, but talk to your doctor or nurse about your sleep problems before using an OTC product. Your sleep problem may be a symptom of a different medical problem that needs to be treated. Also, OTC products are not meant for regular or long-term use. If you decide to use a sleep medicine, doctors recommend that you:

  • Read the medicine label and directions first.
  • Use the medicine at the time of day directed by your doctor or nurse.
  • Do not drive or do activities that require you to be alert.
  • Always take only the amount your doctor or nurse tells you to take.
  • Tell your doctor or nurse about other medicines you use.
  • Call your doctor or nurse right away if you have any problems while using the medicine.
  • Do not drink alcohol or use drugs.
  • Talk to your doctor or nurse if you want to stop using the sleep medicine. Some medicines must be stopped gradually.

What can I try at home to help me sleep better?

Try these tips to help improve your sleep:

  • Try to go to sleep when you feel sleepy and then get up at the same time each morning.
  • Do not take naps after 3 p.m. if you normally sleep at night.
  • Do not drink caffeinated or alcoholic drinks or smoke late in the day or at night.
  • Exercise on most days. Exercise or physical activity done too close to bedtime can make it harder to fall asleep. Experts recommend exercising at least 5 or 6 hours before your bedtime, especially if you have insomnia.
  • Do not eat or drink a lot within about 3 hours of bedtime.
  • Keep your bedroom dark, quiet, and cool. If light is a problem, try a sleeping mask. If noise is a problem, try earplugs, a fan, or a “white noise” machine to cover up the sounds.
  • Follow a routine to help relax and wind down before sleep, such as reading a book, listening to music, or taking a bath.
  • If you cannot sleep within 20 minutes of going to bed or don’t feel drowsy, get out of bed. Read or do a quiet activity until you feel sleepy. Then try going back to bed.
  • Do not do anything in your bed that could make you more awake. Using a mobile phone, watching TV, or eating in bed can make it harder for you to fall asleep in bed.
  • Do not look at lighted screens like a laptop or smartphone before bed.
  • See your doctor or a sleep specialist if you think that you have a sleep problem.
Information from

Thyroid Disease

What is thyroid disease?

The thyroid gland is located at the base of your neck in front of your trachea (or windpipe). The thyroid gland makes, stores, and releases two hormones—T4 (thyroxine) and T3 (triiodothyronine). Certain disorders can cause the thyroid gland to make too much or too little hormone. Women at risk of thyroid disease include those who have or have had an autoimmune disease (such as diabetes).

What is the function of the thyroid gland?

Thyroid hormones control your metabolism, which is the rate at which every part of your body works. When your thyroid gland is working the way it should, your metabolism stays at a steady pace—not too fast or not too slow.

The thyroid gland is controlled by the pituitary gland (a gland in your brain). The pituitary gland makes thyroid-stimulating hormone (TSH). TSH tells the thyroid gland to make more hormone if needed.

How is thyroid disease diagnosed?

Thyroid disease is diagnosed by your symptoms, an exam, and tests. Symptoms of thyroid disease can be much like symptoms of other health problems.

Your health care provider will examine your neck while you swallow. The thyroid gland moves when you swallow. This makes it easier for your health care provider to feel. Your health care provider also may examine your skin and eyes and check your weight and temperature.

What tests are used to diagnose thyroid problems?

The following tests may be used to help find the exact cause of a thyroid problem:

  • Blood tests
  • Ultrasound exam of the thyroid
  • Thyroid scan

During a thyroid scan, you drink a small amount of radioactive iodine. A special camera then detects the areas of the thyroid gland that absorb the radioactive iodine. Results of this test show areas of the thyroid gland that are underactive or overactive. This test will not be done if you are pregnant.

What is hypothyroidism?

Hypothyroidism occurs when the thyroid gland does not make enough of the thyroid hormones to maintain your normal body metabolism.

What causes hypothyroidism?

The most common cause of hypothyroidism is a disorder known as thyroiditis—an inflammation of the thyroid gland. The most common type of thyroiditis is called Hashimoto disease. In this disease, the immune system—your body’s natural defense against disease—mistakes cells in the thyroid gland for harmful invaders. Your body sends out white blood cells to destroy the thyroid gland. The pituitary gland then releases TSH to tell the thyroid gland to make more thyroid hormone. This demand on the thyroid gland can cause it to enlarge. This enlargement is called a goiter. Hypothyroidism also can result from a diet that does not have enough iodine, although this type of hypothyroidism is rare in the United States.

What are the symptoms of hypothyroidism?

The symptoms of hypothyroidism are slow to develop. Common symptoms of hypothyroidism include the following:

  • Fatigue or weakness
  • Weight gain
  • Decreased appetite
  • Change in menstrual periods
  • Loss of sex drive
  • Feeling cold when others do not
  • Constipation
  • Muscle aches
  • Puffiness around the eyes
  • Brittle nails
  • Hair loss

What treatment is available for hypothyroidism?

In most cases, hypothyroidism is treated with medication that contains thyroid hormone. The dosage of the medication is increased slowly until a normal level of thyroid hormone has been reached in the blood.

What is hyperthyroidism?

Hyperthyroidism results when the thyroid gland makes too much thyroid hormone. This causes your metabolism to speed up.

What are the causes of hyperthyroidism?

The most common cause of hyperthyroidism is a disorder known as Graves disease. It most often affects women between the ages of 20 years and 40 years. A late sign of Graves disease is often a wide-eyed stare or bulging eyes.

Hyperthyroidism also may result from medication. Taking too much thyroid hormone when being treated for hypo-thyroidism can lead to symptoms of an overactive thyroid. Lumps in the thyroid called hot nodules are another cause. These lumps produce excess thyroid hormone.

What are the symptoms of hyperthyroidism?

Common symptoms of hyperthyroidism include the following:

  • Fatigue
  • Weight loss
  • Nervousness
  • Rapid heart beat
  • Increased sweating
  • Feeling hot when others do not
  • Changes in menstrual periods
  • More frequent bowel movements
  • Tremors

What treatment is available for hyperthyroidism?

Anti-thyroid medication can be used to reduce the amount of thyroid hormone your body is making. Medications known as beta-blockers control rapid heart beat.

If these medications do not help, your health care provider may suggest treatment with high-dose radioactive iodine to destroy parts of the thyroid gland. In some cases, surgery may be needed to remove the thyroid gland.

What are thyroid nodules?

A nodule is a lump in the thyroid gland. When a thyroid nodule is found, it will be checked to see if it is benign (not cancer) or malignant (cancer).

Your health care provider may use ultrasound to examine the nodule. Nodules may be further examined by a procedure known as fine needle aspiration or biopsy.

If no cancer cells are found, your health care provider may either prescribe medication to decrease the size of your nodule or suggest surgery to remove it. If cancer cells are found, further treatment will be needed. Thyroid cancer usually can be treated with success.

Can I be treated for thyroid disease if I am pregnant?

Many medications used to treat thyroid disease in pregnancy are safe for your unborn child. However, your health care provider may monitor you closely while you are being treated. Radioactive iodine, which is sometimes used to treat hyperthyroidism, cannot be taken during pregnancy. It may injure the thyroid gland of the fetus and may cause the baby to have hypothyroidism.

What is postpartum thyroiditis?

Some women may not have thyroid problems during pregnancy, but develop problems after childbirth. This condition is called postpartum thyroiditis. It often is a short-term problem and hormone levels quickly return to normal.

Is regular screening recommended for thyroid disease?

Regular screening for thyroid disease should be done every 5 years beginning at age 50 years. Women at risk may need to be screened earlier or more often.

Information from ACOG


Vaccines aren’t just for babies and young children. Adults also need to get vaccines.

What are vaccines?

Vaccines (sometimes called vaccinations or immunizations) are given to people to prevent disease. Vaccines are a mixture of cells and chemicals. Mostvaccines are given by injections (shots), but a few can be taken by nose, as a nasal spray.

If I am a healthy person, do I need vaccines?

Vaccines can help you stay healthy and avoid certain diseases. For example, a yearly flu shot can help keep you from catching the flu or greatly decrease the effect of the flu if you do catch it. Even though you are healthy, your work, travel, or life in general may expose you to serious illnesses like hepatitis. Vaccines can help you avoid illness, great expense, or even death.

Are there risks to vaccines?

Vaccines are very safe. Generally, being sick with the disease is much more dangerous than getting the vaccine. Most vaccines used in the United Statesare made from a killed or inactive virus, so the vaccines cannot give you the disease. People with some health conditions – like pregnancy – should notget certain vaccines. Most vaccines cause soreness at the injection site and a few can cause a flu-like feeling, which lasts for a day or so. Ask your healthcare professional which vaccines are safe for you and how you should expect to feel after getting them.

How do I know if I need any vaccines?

The table in this handout has information on which vaccines you may need as an adult. If you work or travel outside the United States, you may also needother vaccines. Your local health department or the Centers for Disease Control & Prevention (CDC) can provide information about what vaccines youwill need for travel.

a You are at risk for Hepatitis A if you: 1) live in a community that has a high incidence of Hepatitis A, 2) use street drugs, or 3) have chronic liver disease.
b You are at risk for Hepatitis B if you: 1) have had more than one sex partner in 6 months, 2) have sex or household contact with a person who has Hepatitis B, 3) use streetdrugs, or 4) are a health care or public safety worker who could have contact with body fluids.
cYou should get a flu vaccine with inactivated virus every year if you: 1) are over age 65, 2) are a health care worker, 3) are pregnant, or 4) have long-term health problems such a diabetes, asthma, kidney disease, or heart disease.

Can I get vaccines if I am pregnant?

The flu vaccine and the tetanus, diphtheria, and pertussis (Tdap) vaccine are recommended for all pregnant women. The hepatitis A and B vaccines are also recommended for women at risk for the infection. Some vaccines should not be given to pregnant women. These include the human papillomavirus (HPV), live flu, measles, mumps, and rubella (MMR), and varicella (chickenpox) vaccines. Right after pregnancy is a good time to get the hepatitis, MMR,and varicella vaccines if you need them.

From the Journal of Midwifery

HPV Vaccine

What is human papillomavirus (HPV)?

Human papillomavirus (HPV) is a virus. Like all viruses, HPV causes infection by entering cells. Once inside a cell, HPV takes control of the cell’s internal machinery and uses it to make copies of itself. These copies then infect other nearby cells.

How many types of HPV are there?

There are more than 150 types of HPV. About 40 types infect the genital area of men and women and are spread by skin-to-skin contact during vaginal, anal, or oral sex. Genital HPV infection can occur even if you do not have sexual intercourse.

How common is HPV infection?

HPV infection is the most common sexually transmitted infection (STI) in the United States. Almost everyone who is sexually active will get an HPV infection at some point during their life.

What are the signs and symptoms of HPV infection?

Like many other STIs, genital HPV infection often has no signs or symptoms. The infected person usually is not aware that he or she has been infected and can unknowingly pass the infection to others.

What diseases are caused by HPV?

HPV can cause the following diseases:

  • Genital warts—About a dozen types of HPV cause genital warts. These types are called “low-risk types.” Most cases of genital warts are caused by just two low-risk types of HPV: 1) type 6 and 2) type 11. Genital warts are growths that can appear on the outside or inside of the vagina or on the penis and can spread to nearby skin. Genital warts also can grow around the anus, on the vulva, or on the cervix. Genital warts are not cancer and do not turn into cancer. Warts can be removed with medication or surgery.
  • Cancer—At least 13 types of HPV are linked to cancer of the cervix, anus, vagina, penis, mouth, and throat. Types of HPV that cause cancer are known as “high-risk types.” Most cases of HPV-related cancer are caused by just two high-risk types of HPV: 1) type 16 and 2) type 18.

Does being infected with HPV mean a person will get genital warts or cancer?

No. In most people, the immune system fights most high-risk and low-risk HPV infections and clears them from the body.

What happens if the immune system does not fight HPV infection?

Infections that are not cleared from the body are called persistent infections. A persistent infection with a high-risk HPV type can cause cells to become abnormal and can lead to a condition called precancer. It usually takes years for this to happen. Cervical cancer screening can detect signs of abnormal cell changes of the cervix and allows early treatment so they do not become cancer.

What is the best way to protect against HPV infection?

A vaccine is available that can prevent infection with HPV. The vaccine protects against the HPV types that are the most common cause of cancer, precancer, and genital warts.

Who should get the HPV vaccine and when?

Girls and boys should get the HPV vaccine as a series of shots. Vaccination works best when it is done before a person is sexually active and exposed to HPV, but it still can reduce the risk of getting HPV if given after a person has become sexually active. The ideal age for HPV vaccination is age 11 years or 12 years, but it can be given starting at age 9 years and through age 26 years.

For those aged 9–14 years, two shots of vaccine are recommended. The second shot should be given 6–12 months after the first one. For those aged 15 years through 26 years, three shots of vaccine are recommended.

What if my child does not get all doses of the HPV vaccine on time?

If your child has not gotten all of the recommended shots, he or she does not need to “start over.” He or she can get the next shot that is due even if the time between them is longer than recommended. This is also true for you if you have not completed the recommended number of shots through age 26 years.

How effective is the HPV vaccine?

Studies show that getting all doses of the HPV vaccine before you are sexually active can reduce your risk of getting certain types of HPV-related cancer by up to 99%. If you have had sex, you may already be infected with one or more types of HPV, but you can still get the vaccine if you are younger than 26 years. The vaccine may help protect you against the other types of HPV included in the vaccine that you are not infected with.

Does the HPV vaccine cause any side effects?

Millions of people have been vaccinated against HPV since the vaccine came out. There have been no reports of severe side effects or bad reactions to the vaccine. The most common side effect of the HPV vaccine is soreness and redness where the shot is given.

Do I still need regular cervical cancer screening if I have gotten the HPV vaccine?

Yes. HPV vaccination helps prevent HPV infection. It is not a cure for an HPV infection that has already occurred. Women who have been vaccinated still need to have regular cervical cancer screening as recommended for their age group and health history (see FAQ085 Cervical Cancer Screening).

In addition to the HPV vaccine, how can I protect myself against HPV infection?

Even if you get the HPV vaccine, it still is important to take other steps to protect yourself against HPV and other STIs:

  • Limit your number of sexual partners. The more partners you have over the course of your life, the greater your risk of infection.
  • Use a male or female condom to reduce your risk of infection when you have vaginal, anal, or oral sex. But be aware that condoms cover only a small percentage of skin and do not completely protect against HPV infection. HPV can be passed from person to person by touching infected areas not covered by a condom. These areas may include skin in the genital or anal areas.
Information from ACOG

Vulvar Skin Care



    • Use mild enzyme-free soap (such as Woolite Gentle Cycle or All Free and Clear) on any clothing that comes in contact with your vulva (use 1/3 to 1/2 the suggested amount per load). Other clothing may be washed in the soap of your choice.
    • Do not use fabric softener or dryer sheets on any clothing that comes in contact with your vulva.


    • Look for underwear or exercise clothes with “cool max” or breathable “wick-away” fabric. Wear all-cotton underpants—not nylon with cotton crotch.
    • Thongs may cause irritation due to mechanical rubbing.
    • Avoid pantyhose. Many manufacturers are making thigh-high stockings. Opt for these instead.
    • Avoid tight clothing and clothing made of synthetic fabrics. Remove wet bathing suits and exercise clothing as soon as you can. These will not cause a yeast infection but can mechanically irritate the vulvar area.

Bathing and Hygiene:

    • Avoid bathing soaps, body washes, lotions, gels, and other products which contain perfume. No soap is best in the vaginal region. If you must use soap, Aveeno Oatmeal and Neutrogena soaps are recommended.
    • Do not scrub vulvar skin with a washcloth; washing with your hands or running water is sufficient.
    • Avoid all bubble baths, bath salts, scented oils, and hot water.
    • Pat dry rather than rubbing with a towel.
    • Avoid all over-the-counter creams or ointments and anti-yeast medications with asking your health care provider first. Remember: anything used locally in the vaginal are has the potential to cause during irritation. Do not use Vagisil.
    • Never douche
    • Avoid the use of deodorized pads and tampons. Do not use Always pads or minipads. Tampons should only be used when the flow of blood is enough to soak one tampon in four hours or less. Tampons are safe for most women, but wearing them too long or when the flow of blood is light may result in vaginal infection, increased discharge, or toxic shock syndrome. If pads are irritating, consider using “natracare pads.” These pads can be found in health food stores.
    • Do not shave the vulvar area. Shaving may cause irritation and lead to infection
    • Avoid scented toilet paper.
    • Avoid all feminine hygiene sprays, perfumes, adult, or baby wipes. Pour lukewarm water over the vulva after urinating if urination causes burning. Pat dry rather than rubbing with a towel.

Comfort Measures:

    • Soak in lukewarm bathwater with 4-5 tablespoons of baking soda or Aveeno Oatmeal soak to soothe vulvar itching and burning. Soak 2-3 times a day for 10-15 minutes. If you are busy, a cool compress with help, as will splashing down with cool water.
    • To decrease irritation, small amounts of A&D Ointment or Crisco Shortening may be applied to the vulva as often as needed to protect skin. This may also help to decrease skin irritation during your period and after urination.
    • Dryness during intercourse may be helped by using a lubricant. A small amount of almond oil, which can be obtained at health food stores, is recommended for lubrication. Astroglide, available from the pharmacy, should be used with condoms. If you use condoms, we suggest you use non-latex polyurethane condoms, such as Avanti or Trojan (certain ones) brands. Latex condoms cannot be used with almond oil.

Birth Control:

    • The new low-dose birth control pills do not seem to increase the chances of getting a yeast infection.
    • Contraceptive jellies, creams, or sponges may cause itching and burning. A brand change may be helpful. Discuss the different brands available with your health care provider.


    • Smoking has anti-estrogenic properties. Stop smoking! This will contribute to vaginal health.

Weight Management


As health care providers, we often hear, “How can I lose this weight? I eat very little and I exercise a lot and the weight just doesn’t come off.”

Here are some tips that may help to turn this situation to your benefit.

  1. First get a good physical examination. There may be a medical reason for the weight gain. Discuss with your provider any symptoms you may be having. Also review your activity level and diet with your provider. Before your appointment, make a list of the medications and herbs that you take routinely. Discuss these meds with your provider to make sure that they are not the cause of the weight gain. Your provider may order labwork to rule out medical conditions that could impair weight loss.
  2. Monitor your heart and breathing. A simple way to monitor your output is to use the Borg Scale of Perceived Exertion. You want to make sure that you are exercising at a high enough level to get results but not push yourself so hard you are gasping for breath. The scale has a 1- 10 rating, where 1 is napping and 10 is running as fast as you can. You should be at about 6-7 on the scale—short of breathe but still able to talk and you should be sweating too. Of course, before starting any exercise program, check with your provider first if you have any medical issues.
  3. Keep a food diary. It is easy to underestimate the calories that we consume in a day. A slice of cheese, a handful of pretzels , and a latte can pack on 300-500 calories in no time. For 1 week weigh, measure and write down EVERYTHING you eat. There are great apps for smartphones and the ipod/ipad that can help you with this chore. There are also some great calories counting sites on If, after one week, you cannot figure out where to cut calories, schedule a visit with a dietician, who can help you put together a realistic plan to help you lose weight. We can direct you to these professionals if you need assistance.
  4. Use a pedometer. Many cardiologists recommend the 10,000 step program. Keep a record for 1 week of how many steps you take in your normal day, using your pedometer of course! Then try to increase your daily steps to 10,000/day. If you are already walking that much, add another 2,000 steps to get the results you want. Remember, you add lots of extra steps a day by just doing things like parking your car to the far side of a parking lot and walking from there to a store, or climbing up 1 or 2 flights of stairs instead of taking an elevator. Every little bit helps!!
  1. Add strength training. Muscle is more metabolically active than fat. Adding strength to your muscles by using free weights, resistance bands, or the machines at your gym , will increase your lean tissue and boost your overall metabolism. You should try to do weight training 2 times per week. Yoga is another way to build body strength. It can also improve your flexibility, help prevent osteoporosis, and relieve stress . Stress relief, by the way, is another way to lose weight. High cortisol levels that occur when we are under a lot of stress really can cause us to “pack on the pounds”.
  2. Change your pace. The same exercise routine daily can lead to boredom . This may be causing you to not exercise at a “fat burning” capacity. Add a few short bursts of quick-paced intensity to your routine, whether that is while you are riding your bike, taking your daily walk with your dog, or sitting on your stationary bike in front of the TV. Listening to high-energy music on your ipod can really help you pick up the pace also.
  3. Enjoy what you are doing. Find an exercise routine that you like. Get a friend to exercise with you . Don’t worry about how many pounds are coming off. Just enjoy the fact that you are making yourself healthier and, hopefully, happier too.
  4. Get plenty of rest. Sleep deprivation can actually increase fat storage in your body. Also fatigue during the day can sabotage your exercise program and cause you to eat more.

Good luck and enjoy the path to a healthier you!

*Much of the information here was excerpted from the column by Linda Buch, a personal trainer and Lancaster native, in the Lancaster Sunday News of September 11, 2011.

Nutrition Information: Fiber, Folate, Iron, Protein


Why is fiber so important?

Fiber or roughage is the indigestible part of a plant that pushes through our digestive tract. There are two main types of dietary fiber: soluble and insoluble. Soluble fiber, such as bran, nuts, seeds and beans, holds water and turns to gel during digestion. Insoluble fiber, by contrast, speeds the passage of foods through the stomach.

You should aim for 25 grams of fiber per day.

Getting adequate fiber has many benefits:

  • relieves constipation and other digestive trouble
  • makes stool easier to pass, preventing constipation, hemorrhoids and diverticulitis (inflammation of the intestine), as well as helping some of the symptoms of irritable bowel syndrome (IBS), such as diarrhea, abdominal pain, and gas
  • aids in weight management, since high-fiber foods take longer to chew, sending the signal to your body that you are full faster
  • helps lower serum cholesterol levels, improving heart health
  • better blood sugar control

If you need to increase your fiber intake, here are some great sources from real food:

  • Fresh fruits (including skins when possible), such as apples, apricots, bananas, berries, grapes, grapefruit, oranges, peaches, pears, pineapple, and tangerines.
  • Fresh vegetables, such as asparagus, bean sprouts, broccoli, brussel sprouts, cabbage, carrots, cauliflower, celery, corn, cucumber, green beans, leafy greens, okra, peppers, potatoes (with skin), squash, sweet potatoes, tomatoes.
  • Dried fruits, such as apples, dates, figs, peaches, pears, and prunes.
  • Dried beans, peas or lentils, such as black-eyed peas, black beans, garbanzo beans, kidney beans, lima beans, navy beans, pinto beans, split peas
  • Whole grains, such as barley, bran, brown rice, buckwheat, bulgar, cornmeal, grits, graham, millet, oatmeal, oat bran, rye, whole wheat, wheat germ, wheat berries, cracked wheat, wild rice
  • Whole grain crackers, such as AK mok, sesame crackers, graham crackers, Rye Krisp, Triscuits, Stoned Wheat crackers, Wheatsworth, whole wheat/bran matzos, oat bran crackers
  • Other: bran muffins, granola bars, nuts, oatmeal cookies, popcorn, peanuts, seeds (sesame, sunflower, pumpkin), trail mix, whole wheat pasta

NOTE: increase fiber intake gradually, drink fluids liberally, avoid excessive amounts of fiber.


Folate, or Folic Acid, is a type of B Vitamin. It helps to:

  • make DNA
  • repair DNA
  • produce red blood cells (RBCs)

If you don’t have enough folate in your diet, you may end up with a folate deficiency. Certain drinks and foods, such as citrus juices and dark green vegetables, are particularly good sources of folate. Not eating enough folate can lead to a deficiency in just a few weeks. Deficiency may also occur if you have a disease or genetic mutation that prevents your body from absorbing or converting folate to its usable form.

Folate deficiency can cause anemia. Anemia is a condition in which you have too few RBCs. Anemia can deprive your tissues of oxygen it needs because RBCs carry the oxygen. This may affect their function.

Folate is particularly important in women of childbearing age. A folate deficiency during pregnancy can lead to birth defects. Most people get enough folate from food. Many foods now have additional folate to prevent deficiency. Nevertheless, supplements are recommended for women who may become pregnant. For more information on this, check out Oh, Baby! Prenatal Vitamins

Here are some great ways to get folate from food:

  • Fortified Breakfast Cereal
  • Black-eyes peas
  • Orange juice
  • Asparagus
  • Greens (collard, turnip, kale, mustard)
  • Pineapple juice
  • Liver, organ meats
  • Brussel sprout
  • Avocado
  • Cauliflower
  • Spinach

Vegetables should be eaten raw or cooked briefly in a small amount of water.


Low iron is the most common nutritional deficiency in the U.S. Almost 10% of women are iron deficient, according to figures from the Centers for Disease Control and Prevention, but many people do not know what a vital nutrient it is.

Iron transports oxygen through your body. Iron is an important component of hemoglobin, the substance in red blood cells that carries oxygen from your lungs to transport it throughout your body. Hemoglobin represents about two-thirds of the body’s iron.

That’s one reason why, if you are low in iron, you may feel exhausted or fatigue easily with moderate exertion. You may also have decreased brain function and an impaired immune system.

Iron is also important for healthy cells, skin, hair, and nails.

Young women, ages 9 to 13 need about 8 grams of iron. Starting in adolescence, a woman’s iron needs increase due to losing blood each menstrual cycle. Women through about age 50 need 18 grams of iron daily.

Here are some great ways to get iron through food. If this is not adequate, talk to you provider about adding an iron supplement.

  • Liver and other organ meats
  • Clams, oysters, sardines
  • Beef and pork
  • Pork and beans
  • Chili con carne
  • Spinach
  • Blackstrap molasses
  • Raisins, dried apricots/figs/prunes
  • Prune juice
  • Dried peas, beans
  • Fortified breakfast cereals (check your labels!)


Protein is used by the body for building and preparing cells, muscles, and tissues, and for energy. There is some debate over how much protein a person should have every day, so you may need to experiment to find what works best for your body. The Recommended Daily Allowance (RDA) is about 10% of your daily calories. This is a minimum. Many people suggest at least 20% of daily calories or 1.6-2 grams per kilogram of body weight should come from protein.

Protein is found mostly in foods which come from animals, but some plant foods also have protein. 

Foods which are high in protein are:

Milk Products group:

  • milk
  • yogurt
  • all types of cheese, including cottage cheese

Animal Sources group:

  • poultry: chicken, turkey, duck, goose, pheasant, etc.
  • fish
  • beef
  • pork and ham
  • veal
  • lamb
  • eggs

Plant Sources group:

  • beans and peas: canned or dry including lentils, navy beans, kidney beans, garbanzo beans, pinto beans, lima beans, soybeans
  • nuts and nut butter, such as peanut, walnut, almonds, cashews, etc.

Cigarettes Facts and Smoking Cessation


Tobacco contains over 4,000 chemicals. Here are just a few:

Ammonia: used in household cleaners and dry cleaning fluid Polonium:radiation equal to 300 chest x-rays in one year
Cadmium:found in phosphate fertilizers and batteries Nicotine: addictive drug that effects your mood and performance
Hydrazine:used in jet and rocket fuel Toluene:used in polyurethane
Formaldehyde: embalming fluid, must have a license to obtain Benzene: found in all gasoline grades; caution recommended when exposed to this chemical
Acetic Acid: found in hair dye and photo developer; gloves must be worn when handling both of these substances Acetone:used as a solvent, found in paint, fingernail polish remover
Naphthalene: ingredient in explosives, moth balls, and paint pigments Hydrogen Cyanide: found in all gas chambers
Arsenic: used in rat poison; most rats love the taste Butane: used in cigarette lighters
Carbon Monoxide: a colorless, odorless, highly poisonous gas that comes out of car exhausts Over 50 of these 4,000 chemicals can cause cancer in humans? Take control today.


If you smoke for stimulation, try:

  • getting enough rest
  • exercising regularly (moving is a drug-free stimulant)
  • eating regular, nutritious meals
  • drinking lots of cold water

If you smoke for pleasure, remember:

  • how good foods taste now
  • you feel and look fresh in social situations without smoking
  • how much easier it is to walk, run, and climb stairs without smoke in your lungs
  • how good it feels to be in control of the urge to smoke
  • that you can spend the money you save on something else you enjoy
  • all the myriad health benefits of quitting

If your obstacle is handling the cigarettes, try to:

  • picking up a pen or pencil
  • playing with a coin, twisting a ring, or handling any harmless object
  • eating regular meals
  • finding a hobby that keeps your hands busy
  • having a low-fat, low-sugar snack like carrot sticks, apple slices, or a bread stick

Tips for tension reduction:

  • use relaxation techniques
  • exercise regularly
  • remember that smoking does not resolve problems; figure out what will, and act
  • avoid or get out of stressful situations
  • get enough rest
  • enjoy relaxation: take a hot bath, have a massage, lay in the hammock, listen to music

To deal with cravings:

  • explore using nicotine replacement therapy
  • smoke more than you want for a day or two before you quit; this “overkill” may spoil your taste for cigarettes
  • remember that smoking even one cigarette will make you want more
  • tell family and friends that you’ve quit; ask for help, let them know what they can do
  • think of yourself as a non-smoker; hang up “No Smoking” signs
  • remember that physical withdrawal lasts about 2 weeks; you can make it, hang on!

If you are having problems dealing with the habit of smoking:

  • change your smoking routines; keep your cigarettes in a different place, smoke with the opposite hand; limit smoking to certain places
  • be aware of every cigarette you smoke; ask “do I REALLY want this cigarette?”
Information from the Clean Air for Healthy Children chapter of the American Academy of Pediatrics

Cigarette Withdrawal and Recovery


One of the reasons that nicotine is believed to be an addictive drug is the a variety of physical symptoms and certain feels are experienced when the drug is stopped. These are called physical and psychological withdrawal or symptoms of recovery. They are signs that the body is healing and adjusting itself back to when it was nicotine-free.

Because each person’s smoking habit is unique, her recovery experience in quitting will be as well. The variation of feelings, symptoms, and degrees of discomfort will be unique to each smoker. Most symptoms are temporary and decrease sharply during the first few days of cessation, followed by a continued, but slower rate in decline in the following weeks. For some smokers, dealing with withdrawal symptoms may be like “riding a roller coaster” with sharp turns, and ups and downs. The good news is that most symptoms will pass within two to four weeks after quitting.

Remember: having even one cigarette after you have tried to qui will only cause symptoms of recovery to return and last longer.





Craving physical addition to nicotine, habits, and psychological dependence; the body misses nicotine and sends signals by giving you cravings to smoke most frequent during first 2-3 days, may continue for months or years wait out the urge

distract yourself


Nicotine Replacement Therapy (NRT)

Emotional symptoms: irritability, impatience, anger, sadness body’s physical and emotional craving for nicotine 2 to 4 weeks express your emotions

ask others to be patient

relaxation techniques

walks, hot baths


Fatigue no loner have nicotine as an artificial stimulant in the body 2 to 4 weeks take naps

increase physical activity

do not push yourself

Sleep Disturbances: difficulty falling asleep, waking up too early, frequent awakenings Nicotine affects brain wave functions, influences sleep patterns; dreams about smoking are common a few days increase awake activity

avoid caffeine after 6 pm

deep breathing to relax

regular sleep patterns

drink milk before bed

Dizziness or Light-headedness carbon monoxide is no longer robbing blood cells of oxygen, you are now functioning on a normal supply and need to adjust 1 to 2 days take extra caution

change position slowly

this feeling will pass

Lack of Concentration body needs time to adjust to not having constant stimulation from nicotine a few days plan work accordingly

avoid additional stresses

avoid caffeine


Hoe the body repairs itself:

After 20 minutes:

  • Blood pressure drops to normal
  • Pulse rate drops to normal
  • Body temperature of hands and feet increase to normal

After 8 Hours:

  • Oxygen level in blood increases to normal

After 24 Hours:

  • Chance of heart attack decreases
  • Less short of breath

After 36 Hours:

  • Carbon monoxide levels return to non-smoking levels

After 48 Hours:

  • Nerve endings start re-growing
  • Ability to smell and taste is enhanced

After 2-3 Weeks:

  • Circulation improves
  • Walking becomes easier
  • Lung function increases up to 30%

After 1-9 Months:

  • Coughing, sinus congestion, fatigue, shortness of breath decreases
  • Cilia re-grow in lungs, increasing ability to handle mucous, clean the lungs, and reduce infection
  • Body’s overall energy increases

After 1 Year:

  • Excess risk of coronary heart disease is half that of a smoker

After 5 Years:

  • Lung cancer death rate for average former smoker decreases by almost half
  • Stroke risk is reduced to that of a nonsmoker 5-15 years after quitting
  • Risk of cancer in the mouth, throat, and esophagus is half that of a smoker’s

After 10 Years:

  • Lung cancer death rate similar to that of non-smokers
  • Pre-cancerous cells are replaced
  • Risk of cancer of the mouth, throat, esophagus, bladder, kidney, and pancreas decreases

After 15 Years:

  • Risk of coronary heart disease is that of a non-smoker