PAINFUL PERIODS: A VISUAL GUIDE

What causes menstrual cramps?

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Menstrual cramps (also called primary dysmenorrhea) are caused by contractions of the uterus. These contractions are triggered by a substance normally produced by our body called prostaglandin. In some women, these prostaglandins are produced in excess.

 

What are the symptoms?

Dysmenorrhea symptoms_CollagePain in the low abdomen, sometimes very intense, occasionally with some of the following:

  • Feeling of pressure in the abdomen
  • Back pain, pain in the hips or thighs
  • Headache
  • Nausea or vomits
  • Diarrhea (loose stools)

 

What can I do to to relieve menstrual cramps?

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  • Place a heating pad on your abdomen or back
  • Take a warm bath
  • Massage your abdomen and your back
  • Rest
  • Avoid caffeine and salt, that may worsen pain.

 

Medications

acetaminophen

You may take painkillers such as acetaminophen (also called paracetamol), ibuprofen, mefenamic acid. Medications are more effective if taken as soon as cramping starts, or even better, before pain starts (if you have regular cycles and you know when pain is about to start).

 

Dietary changes

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A low fat diet seems to reduces menstrual pain according to some studies. Other proposed dietary changes:

Increase consumption of :

  • calcium: almonds, dark green leafy vegetables (spinach, kale), low fat diaries
  • antioxidants: blueberries, cherries, tomatoes, squash, pepper
  • proteins: lean meats, cold-water fish, tofu, beans

To avoid:

  • “bad” carbohydrates: white bread, pasta, sugar, sweets
  • “bad” fats: french fries, donuts, processed foods.

 

Herbal products and dietary supplements

Dysmenorrhea supplements Collage

These are the supplements that have proved to be effective in several studies:

  • Omega-3 fatty acids
  • Thiamine (vitamin B1)
  • Vitamin B6
  • Magnesium
  • Vitamin E

 

Other interventions

Dysmenorrhea other interventions Collage

The following help relieving menstrual cramps:

  • Exercise
  • Yoga
  • Acupuncture
  • Homeopathy (not much scientific evidence, but it seems to help some women)

 

What if nothing works?

Contraceptives resized

You may discuss with your doctor the following:

  • Oral contraceptives or other hormonal treatments
  • Stronger painkillers
  • Other possible treatments such as surgery (reserved for very severe cases).

 

Are menstrual cramps always normal?

Dysmenorrhea secondary Collage

Sometimes menstrual pains are not normal and indicate a medical problem; this is called secondary dysmenorrhea. Some conditions that can cause painful periods are:

  • Endometriosis: a condition in which the tissue lining the uterus (the endometrium) is found outside of the uterus
  • Pelvic inflammatory disease: an infection that starts in the uterus and spreads to other reproductive organs
  • Narrowing of the cervix (stenosis), often caused by scarring
  • Fibroids: benign tumors of the uterus
  • Congenital (birth) abnormalities of the uterus or vagina (such as the presence of a diaphragm).

 

When should I see a doctor?

Call the doctor medical-563427_1280

Most of the times menstrual cramps are not a cause for concern, especially if you started menstruating within the past few years. But you should see a doctor if menstrual cramps:

  • Interfere with your everyday life every month
  • Get increasingly worse
  • Start after age 25
  • Last more than 2 or 3 days
  • Are accompanied by heavy bleeding, fever or foul smelling discharge.

Painful periods, whatever the cause, can be treated, so go ahead and get checked!

 

References

  1. http://emedicine.medscape.com/article/253812-overview
  2. http://www.aafp.org/afp/1999/0801/p489.html
  3. Proctor M, Farquhar C. Diagnosis and management of dysmenorrhoea. BMJ. May 13 2006;332(7550):1134-8.
  4. Hansen SO, Knudsen UB. Endometriosis, dysmenorrhoea and diet. Eur J Obstet Gynecol Reprod Biol. 2013 Jul;169(2):162-71
  5. Dennehy CE. The use of herbs and dietary supplements in gynecology: an evidence-based review. J Midwifery Womens Health. 2006;51(6):402-9.

 

PREGNANCY DO’S AND DON’T’S (Part 3)

EXERCISE, SEX, WORK AND TRAVEL

The first post on Pregnancy do’s and dont’s analysed what is allowed and what discouraged during pregnancy concerning food, beverages, alcohol and cigarette (see here). The second part dealt with beauty treatments and medications (see here). Check out this third article on do’s and dont’s regarding exercise, sex, working and travel while pregnant…

EXERCISE 

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Why to exercise: Beginning or continuing a moderate course of exercise during pregnancy is not associated with adverse outcomes. In fact, exercise may have many health benefits: it lessens some of the discomforts of pregnancy, it helps strengthen the muscles used in labor and delivery, it may give you more energy and make you feel better. There is also some evidence that exercise may prevent pregnancy-related diabetes and high blood pressure. The American College of Obstetrics and Gynecology recommends for pregnant women 30 minutes of moderate exercise per day on most days of the week.

Pregnant woman by pool resizedCheck with your doctor first! There are certain circumstances in which women should not exercise, such as those with asthma or heart problems, or pregnancies complicated with bleeding, low placenta, weak cervix or premature contractions.

Exercises that are safe: The type of exercise you can do during pregnancy depends on your health and how active you were before getting pregnant. This is not a good time to start a very demanding sport. But if you were active before, you can continue to be, within reason. The following activities, in moderation, are especially good during pregnancy:

  • Swimming (it should be OK even in chlorinated pools)
  • Brisk walking
  • Prenatal exercise classes
  • Prenatal yoga

Prenatal aqua yoga 2-swimming-1387531814252Exercises to avoid: Pregnant women should avoid the following:

  • High-impact or vigorous sports that may involve the risk of abdominal trauma, falls or excessive joint stress.
  • Holding your breath during activity
  • Exercises that require lying flat on your back for more than three minutes (especially after the third month of pregnancy)
  • Heavy exercise spurts followed by periods of no activity
  • Exercise in hot and humid weather
  • Activities in hot water (see more here)
  • Vigorous racquet sports
  • Activities where falling is likely (e.g. skiing, horseback riding, mountain biking)
  • Contact sports: football, basketball, volleyball, softball
  • Scuba diving, which may result in birth defects and fetal decompression disease.

Tips for safe exercise:  Even though exercise can be beneficial, you should be careful. During pregnancy, your centre of gravity shifts and your balance changes. Your joints and ligaments get more relaxed. This may put you at a greater risk for falls. You tire more easily. Caution should be the rule!

Pregnant yoga on the beach 4495406433_45030db1e5_bThese are some tips for exercising while pregnant:

  • Avoid getting overheated.
  • Limit outdoor exercise in hot weather.
  • Avoid exercise that makes you very tired, or with high risk of falling or getting an abdominal trauma
  • Get up slowly after doing floor exercises, to avoid getting dizzy
  • Drink lots of water
  • Consume extra calories if you exercise regularly
  • Wear good support shoes and bra
  • Don’t push yourself too much! Listen to your body and slow down when you feel tired.

Signs to stop exercising: You should stop exercising and call you doctor if you feel one of the following:

  • Dizziness, fainting or nauseated
  • Rapid or irregular heatbeat
  • Short of breath
  • Pain in your chest
  • Recurring abdominal pain or uterine contractions
  • Swelling in your calf
  • Intense headache
  • Blurred vision
  • Vaginal bleeding
  • Fluid leaking from your vagina
  • A decreased or absence of baby’s movements

SEX

Sex and pregnancy resizedIs it safe? Sexual intercourse in pregnancy is not known to be associated with any adverse outcomes; therefore, it can be safely continued throughout pregnancy.

The baby is well protected inside the uterus! The uterine wall, the amniotic sac and the mucus plug (thick mucus that seals the cervical canal to prevent infections) will all keep the baby safe.

Keep in mind that intercourse can cause uterine contractions: the orgasm itself, nipple stimulation and prostaglandins (a substance contained in sperm) will all may make the uterus contract. In general, these contractions are mild and harmless.

Love making has been long proposed as a measure to induce labor at term. Although there is no scientific evidence that sex triggers labor, it may help, and it won’t harm!

pregnant woman and man resized 2Does sex feel the same while pregnant? Sex during pregnancy can be different than before. For some women, it may be more pleasurable, due to the high hormonal levels, genital engorgement and increase in vaginal secretions. For others though, sexual desire may be reduced for many reasons: nausea and dizziness during the first trimester, genital swelling which may sometimes cause discomfort, or you may just feel uneasy with your body changes…

Furthermore, your breasts get very engorged and tender, which may be pleasant for some women, but annoying for others…

Love making in practice… needless to say, certain positions will be uncomfortable, or impossible as your womb gets bigger…You may need to experiment a little bit to find which positions are fine for you… Especially during the third trimester, you should avoid lying flat on your back, because the pressure of the womb on the major blood vessels may cause a drop in blood pressure and dizziness. Although oral sex is fine, blowing into the vagina is to be avoided, as it may cause air embolism (a bubble of air entering the blood circulation), which may have fatal consequences.

When to avoid intercourse: there are certain situations, in which sexual intercourse is discouraged: if you have vaginal bleeding, a history of repeated miscarriages, preterm uterine contractions, or a weak cervix. In addition, you will be told to abstain from sex if you have a diagnosis of placenta previa (when the placenta lyes low in the uterus or covers the cervix). Always check with your doctor to make sure it’s OK for you to have sex.

When to call your doctor: you should call your healthcare provider if, after sex, you have intense abdominal pain, cramping, foul smelling discharge or bleeding coming from the vagina.

WORKING DURING PREGNANCY

Embed from Getty ImagesIf you are a healthy woman and you have a normal pregnancy, most likely it will be safe to continue working during pregnancy. Don’t forget to talk to your doctor about your work environment. There are certain occupations that may be dangerous, and others that may require certain modifications:

Lab tech 4-medical-and-laboratory-shots-stephen-smithExposure to radiation and radioactivity: there is evidence to support an association between x-rays or radioactivity exposure and miscarriages, birth defects and other pregnancy complications. You should inform right away your doctor and your employer if you receive occupational x-rays or radioactivity exposure.

Exposure to chemicals: Studies results are less conclusive for occupational exposure to chemicals, but there seems to be some increased risk of miscarriages and eventually malformations. Some examples of jobs with chemical exposure are dry-cleaning, painting industries, operating rooms, jobs involving pesticide or heavy metals exposure (lead, mercury). Inconclusive evidence also exists for women working in beauty salons (for more info check here).

Physically demanding work: jobs with prolonged standing (such as cooks, police officers, nurses) and heavy weight lifting may be associated with poor pregnancy outcome, that is, more likely to deliver prematurely, have low-birth-weight-babies and develop high blood pressure.

Woman Cook o-CHEF-COOKING-facebookStressful jobs and long working hours: Some research has shown that pregnant women who reported high work stress in combination with a long workweek (more than 32 hours a week) have two times higher risk of giving birth to a small baby.

The evidence on prolonged hours and shift working is inconclusive.

Desk jobs: Although some studies in the 80s had suggested that computers may increase the risk of pregnancy complications, many studies have been done since then, and these findings have not been confirmed. In fact the dose of radiation emitted by a computer is extremely low. The problem of a desk job lies mostly in sitting for a long period of time, which may lead to neck, eyes, wrist and back strain. If you have an office job, try to get up frequently and take a break from time to time.

Other possible occupational risks may include exposure to infections or heavy noise.

TRAVEL

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Is it safe? For uncomplicated pregnancies, it is safe to travel throughout most of the pregnancy, usually until the last month (36 weeks). Inform your doctor whether you plan to travel, and precise where and when you plan to go. There are certain women that should not be traveling, such us those with vaginal bleeding, high risk of preterm labor or increased chances of forming blood clots.

Land travel: It is fine to travel by car, train or bus. It is very important that you wear your three-point seatbelt (shoulder and lap), above and below the womb, not over it. Try to avoid very long trips, stop or walk from time to time to stretch your legs in order to keep the blood circulating.

Sea travel: Traveling by boat is safe in pregnancy, but keep in mind that the boat’s motion may accentuate, or provoke, nausea and vomiting. So be prepared for that! In addition, avoid destinations which may not have easy medical access; if you are on a cruise make sure they have a healthcare provider on board.

Woman airport luggage Header_Samsonite2013Air travel:

  • For most of pregnant women, traveling by plane is permitted. Most of the companies will allow traveling up to 32 weeks of pregnancy, many others up to 36 weeks (you will need to provide a doctor’s permission). Check always with the airline company before making your reservation…
  • You should’n worry about walking through metal detectors at the airport security check, the radiation dose they emit is extremely low.
  • In order to avoid heavy luggage lifting, you may prefer to use suitcases with wheels to make travel as easy as possible.
  • Long-haul air travel is associated with an increased risk of venous thrombosis (blood clots formation), a potentially serious pregnancy complication. This risk is attributed predominantly to immobility during air travel, especially when traveling in economy class, where the space between the seats is very narrow. Precautionary measures include:
    • wear loose-fitting clothes and comfortable shoes,
    • do isometric calf exercises (stretch your legs from time to time),
    • walk regularly around the aircraft cabin,
    • avoid dehydration: drink plenty of water, minimise alcohol and caffeine intake,
    • check with your healthcare provider the possibility of wearing special elastic stockings in order to improve blood circulation.

pregnant woman sunbathing at a Caribbean beachTravelling abroad: Travelling overseas may present certain challenges. Keep in mind the following:

  • Discuss with your doctor possible safety risks for you and your baby.
  • Certain destinations are best avoided: places with difficult access to health care, or high risk of contracting infections or other diseases.
  • Special consideration should be taken when travelling to countries where yellow fever vaccination or malaria prevention medication may be needed. Make sure that any vaccines or medications required are not contraindicated in pregnancy. You may check the authoritative site of the US Centers for Disease Control and Prevention (CDC) for useful information (see here), but you must talk about it with your doctor.
  • You may take with you a copy of your medical records, in case anything is needed in your foreign destination.

References

NICE: Antenatal Care- Routine Care for the Healthy Pregnant Woman. March 2008, UK

HAS: Comment mieux informer les femmes enceintes? Avril 2005, France

http://www.nhs.uk/conditions/pregnancy-and-baby/pages/pregnancy-exercise.aspx#close

http://www.hse.gov.uk/pubns/indg373.pdf

http://www.cdc.gov/niosh/topics/repro/employers.html

http://www.abcd-study.nl

Planning Your Pregnancy and Birth Third Ed. The American College of Obstetricians and Gynecologists, Ch. 5.

http://wwwnc.cdc.gov/travel

Photo credits

Exercise: Getty images; media3.onsugar.com;  sohanews2.vcmedia.vn; Jose Gabriel Lugo, Flickr.com;

Sex: Trevor, Flickr.com; Melissa Segal, Flickr.com;

Work: Getty images; fineartamerica.com; huffpost.com;

Travel: Getty images; globalblue.comtravelingtoworld.com

WANT TO GET PREGNANT?

You have decided to get pregnant, that’s great! Before you start trying, here are some tips you may find useful….

  1. Schedule a visit to your gynecologist
  2. Start taking folic acid
  3. Give up drinking, smoking, drugs…
  4. Eat healthy
  5. Reduce caffeine intake
  6. Watch your weight
  7. Exercise, but not too much
  8. Don’t forget your oral health
  9. Reduce your stress levels
  10. Avoid certain infections
  11. Reduce exposure to environmental hazards
  12. Figure out your fertile days

1. Schedule a visit to your gynecologist

Embed from Getty ImagesIt is a good idea, before trying to get pregnant to consult your gynecologist. At that visit, you may want  to discuss:

-any medical problem you may have. Some diseases may get better or worse while you are pregnant, some others may affect your baby.

-any medication you are taking. Certain medications are dangerous during pregnancy, and some have to be switched before you even try to conceive.

-your family history. There are diseases that run in families, and you may be able to do some tests to understand if you are at risk. Be sure to mention whether someone in your family has any health problem (e.g. Down syndrome, thalassemia or sickle-cell disease, cystic fibrosis, mental retardation), or if someone was born with a cardiac, neurological or other defect.

-your habits: diet, weight, exercise, any unhealthy habit (such as smoking, drinking, or taking drugs).

If it’s been a year since you had a checkup, you can also expect to have a pelvic exam, eventually an ultrasound and a Pap smear. You may also get tested for sexually transmitted diseases and other bacteria that can reduce your chances of getting pregnant.

Some couples may decide to undergo some prenatal blood exams, including genetic testing for specific conditions, such as hemoglobinopathies (e.g. thalassemia) or cystic fibrosis, based on their ethnic background or family history.

A folic acid supplement may be prescribed at that point.

2. Start taking folic acid

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Taking a folic acid supplement is very important. By taking 400 mcg of folic acid a day for at least one month before you conceive and during your first trimester, you reduce your chances of having a baby with some births defects (such as spina bifida) by 50 to 70 percent.

You may also consider some multivitamin supplements that may help you get pregnant. Make sure though, not to exceed the recommended doses of vitamin A (unless it’s in a form called beta-carotene). Getting too much vitamin A can cause birth defects.

3. Give up drinking, smoking, drugs…

4322475363_b7d6a1c20d_qIf you smoke, drink or take drugs, now’s the time to stop!

Tobacco use can affect fertility both in women and men, and this seems to be true even for secondhand smoking. Smoking or taking drugs while you are pregnant can lead to miscarriage, premature birth, low-birthweight babies and (according to recent studies)  congenital malformations.

Alcohol can also reduce fertility, therefore it’s a good idea to cut back when you start trying to get pregnant. Drinking alcohol during pregnancy can cause birth defects and other severe problems to you baby.

4. Eat healthy

9577668909_02670b3797_qIt is now a good time to start eating healthy: plenty of fruits and vegetables every day, as well as whole grains and foods that are high in calcium – like milk and yogurt. Eat a variety of protein sources, such as beans, nuts, seeds, and meats.

While fish is an excellent source of omega-3 fatty acids (which are very important for your baby’s brain and eye development), as well as proteins, vitamin D and other nutrients, it also contains mercury, which can be harmful. It is usually recommended that pregnant women eat up to 2 servings a week of fish that are not high in mercury (such as herring, trout, salmon, and sardines), and avoid shark, swordfish, king mackerel, tilefish. The consumption of white canned tuna should be limited to 1 serving per week.

5. Reduce caffeine intake

3155462396_d7f6b94586_qThere seems to be an association between high caffeine consumption and reduced fertility. Too much caffeine has also been linked to a risk of miscarriage in some studies, but not in others. To be on the safe side, it is recommended to limit coffee consumption to 1 cup a day.

 

 

6. Watch your weight

belly-2354_1280You may have an easier time conceiving if you’re at a healthy weight. Being over or under the ideal weight makes it harder for some women to become pregnant.

 

7. Exercise, but not too much

8552318056_f938f51ff2_qA fitness program will result in a healthy body, fit for pregnancy. In addition, exercising is a great way to relieve the stress that can be both the cause and consequence of not getting pregnant…

You may consider walking or cycling or swimming, on most days of the week, for about 30 minutes. To increase flexibility, you may try stretching, Pilates or yoga.

But be careful not to overdo it. Very intense exercise seems to have the opposite effect, as it has been related to infertility in some studies.

8. Don’t forget your oral health

Woman with toothbrush

Hormonal changes during pregnancy can make women more susceptible to gum disease, causing the gums to bleed easily while flossing or brushing. But if you take care of your oral health before trying to conceive you have less chances of experiencing problems while pregnant.

 

 

9. Reduce your stress levels

7676579466_42b4fd82d1_qIt is becoming clearer that stress is responsible for infertility; indeed, several studies reveal that relaxation techniques increase the chances of getting pregnant. Furthermore, a recent study confirms something we see in everyday practice: pregnancy is much more likely to occur during months when couples report feeling happy and relaxed and is less likely to happen during the months they report feeling tense or anxious. The influence of stress on infertility, though is not straightforward, and it may vary in different women.

10. Avoid certain infections

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You’ll want to stay away from certain foods such as raw and undercooked red meat, fish and poultry, raw eggs, unpasteurised milk and soft cheeses. These foods can cause dangerous infections, such as listeriosis, salmonella and toxoplasmosis.

In order to avoid toxoplasmosis it’s also a good idea to wear gloves when digging in the garden or the cat’s litter box, if you have one.

11.Reduce exposure to environmental hazards

2575598759_f2109d9152_qThere is some evidence to support that routine exposure to certain chemicals or radiation may be harmful for pregnant women. If you work in such an environment, you’ll need to make some changes before you conceive. In addition, some cleaning products, pesticides, solvents, etc, can be dangerous during pregnancy.

 

12. Figure out your fertile days

2827062969_951d6cf19b_qInitially, you may prefer to let fate decide when you will conceive. But if you want to be more precise in calculating your fertile days:

First, you should understand when your ovulation occurs. For that, you may use an ovulation calculator, that is, a web tool or application where you write down your period days for some months and you learn when you are fertile; you will find several online, many are designed for smart phones. With these calculators, you get a rough estimate of your fertile days.

If you want to be even more exact, you may start recording your basal body temperature (BBT) and your cervical mucus changes. If you chart them over several months, you may more easily understand when you’re ovulating each month.

Ovulation predictor kits can also help you figure out when you’re ovulating by detecting a hormone (LH) in your urine.

Once you have a clear picture of your cycle, there’s only one thing left to do — get to work! It is advised to have sex every day or every other day beginning about five days before ovulation, and continuing through the day after ovulation. This is because, though sperm can live as long as five days inside a woman’s body, an egg’s life span is only about 12 to 24 hours. By having intercourse before you ovulate, as well as on the day of and the day after ovulation, you maximize your chances of getting pregnant.

 

Good luck! And hopefully soon with good news!

More info at gofertile.eu

Photo credits
1. Getty images; 2. @Doug88888 Flickr.com; 3. Paul Heskes Flickr.com; 4. PeterFranz Flickr.com; 5. Adam Selwood Flickr.com; 6. pixabay.com; 7. Richard foster Flickr.com; 8. Wagner Cesar Munhoz Flickr.com; 9. MeditationMusic.net Flickr.com; 10. Joost Nelissen Flickr.com; 11. tk-link Flickr.com; 12..craig Flickr.com