Humza Khizer

Prenatal vitamins like vitamin C, vitamin D, and folic acid provide nutrients to expecting mothers. Prenatal pregnancy tablets ensure a healthy mother and baby.

Popping The Right Pills: Prenatal Vitamins

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ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

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Time For Men To Share The Burden Of Pregnancy

Introduction

A fast-growing population is one of the greatest challenges currently faced by Pakistan. Increasing poverty, food shortage, health challenges, depletion of natural resources, and overcrowding are just some of the problems associated with overpopulation. According to the 2017 Census of Pakistan, with a population of more than 207 million, the country is the fifth most populated country in the world<a href="#accordion">[1]</a>. Therefore, effective birth control methods are a need of the hour to prevent the risks associated with overpopulation.

However, the use of contraception is largely stigmatized in Pakistan due to various reasons. As per the Pakistan Demographic and Health Survey (PDHS), the current contraceptive prevalence rate (CPR) is only 34%<a href="#accordion">[2]</a>. Moreover, the use of contraceptive methods among men is extremely low. Thus, resulting in the burden of pregnancy and contraception lying largely with women. This could probably be due to a lack of awareness among men regarding various contraceptive methods that are readily available. Raising awareness about these methods is the first step in ensuring that the financial and emotional burden of <a href="https://merisehat.pk/article/how-to-practice-safe-sex">safe sex</a> is shared among both partners in a couple.&nbsp;

Almost 200 years ago, humans invented the world&#39;s first condom, and for a long time that was the greatest discovery in the world of contraception. However, scientists soon discovered methods specifically designed for women that could aid further in population control. Several female contraceptive options ranging from hormonal pills to invasive tubal ligation were introduced. However, each of the proposed methods comes with its side effects. Contraception methods have been widely politicized and various speculations exist regarding the reasons behind the disparity among male and female contraceptives. However, it is important to mention that male contraceptive methods are generally safer than their female counterparts, which is why in recent years significant work has been done to search for effective male contraceptive options. This shift in tide is also perpetuated in part by the increasing awareness among men and their willingness to use contraceptives.&nbsp;&nbsp;

&nbsp;

Understanding Male Contraceptives

Currently, two widely acceptable male contraceptive methods exist: condoms and the invasive vasectomy.

&nbsp;

<h5 dir="ltr">Condoms</h5>

These are a form of barrier method and stop the sperm from entering and fertilizing the egg. Along with being an effective and inexpensive birth control, condoms also prevent sexually transmitted infections (STIs). However, incorrect use is associated with a high failure rate, and they can easily break or get damaged. In Pakistan, condoms are the most used form of contraceptive method, with a frequency of 65.5%<a href="#accordion">[3]</a>.&nbsp;

In recent years, the Pakistani government has stepped up its social media campaigns in a bid to educate the public regarding the use of condoms and other effective family planning methods. This is aimed at controlling the growing population by promoting birth spacing and awareness of women&#39;s fertility. Doorstep availability and affordable prices have significantly increased the use of condoms among the general population.&nbsp;

Unfortunately, misconceptions about condoms and other family planning methods still need to be overcome.&nbsp;

&nbsp;

<h5 dir="ltr">Vasectomy</h5>

Also called male sterilization, the surgical procedure has been in use since the 1970s. The procedure involves cutting or blocking the vas deferens that carry sperm to the urethra. As a result, the semen is devoid of sperm and the egg cannot be fertilized. It is not easily reversed; therefore, it is mostly advised to men who are sure of not wanting children or who believe their family is complete.&nbsp;

With a success rate of 99.85%, it is the most reliable contraceptive option. Moreover, compared to tubal ligation in women, it is less invasive, has fewer risks, and has a quicker recovery time. However, only 2.4% of men around the world have undergone the procedure<a href="#accordion">[4]</a>. In Pakistan, the prevalence is only 0.4%<a href="#accordion">[3]</a>.&nbsp;

The lack of knowledge regarding vasectomy plays a major role in its low acceptance. Moreover, a majority of men hold the view that it leads to impotency or reduces sex drive. However, a recent study has found that men in Pakistan are becoming more accepting of vasectomy and recognizing their role in sharing the responsibility of family planning<a href="#accordion">[5]</a>.&nbsp;

&nbsp;

While female birth control pills have been around for more than 50 years, researchers have only recently started looking into pills for men.&nbsp;

In 2019, a team of scientists conducted a clinical trial for a male birth control pill among 82 healthy men<a href="#accordion">[6]</a>.&nbsp;They administered dimethandrolone undecanoate (DMAU) in varying doses over a period of 28 days. The two active hormones, progestin, and modified testosterone, helped suppress levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) in the study participants. Thus, suppressing sperm production without causing symptoms of low testosterone levels.&nbsp;

Although the study did not measure sperm count, the pill was found to be safe, even in high dosages. The team is currently conducting a longer trial to assess the drug&#39;s effect on sperm production and any long-term effects on the body.&nbsp;

However, men are often hesitant to use hormonal options due to the presence of adverse effects. Therefore, a team at the University of Minnesota have developed a non-hormonal male contraceptive pill. According to early results from a trial in mice, the contraceptive was 99% effective at preventing pregnancy<a href="#accordion">[7]</a>. Moreover, it had no obvious side effects in the mice.

Called YCT529, the non-hormonal pill works by targeting a protein called the retinoic acid receptor alpha (RAR-&alpha;). Through inhibition of this receptor, the retinoic acid in the body is unable to cause cell growth and differentiation, both of which contribute to sperm formation. As a result, the contraceptive helped cause reversible sterility in male mice.&nbsp;

Researchers now plan to conduct human trials for the compound. However, it is too early to tell whether the results in mice will also translate to humans.&nbsp;

&nbsp;

Conclusion

Pakistan faces several challenges to the acceptability of various family planning methods. These range from religious and cultural beliefs, low literacy levels, misconceptions about side effects, lack of knowledge regarding various options for men and women, and reluctance to adopt a method. According to a study from Karachi, fear of side effects was the most common reason for low prevalence among users<a href="#accordion">[8]</a>.&nbsp;

Several trials are currently underway to look for safe and effective male contraceptive pills. However, it can take years till a pill is available in store. Even then, its availability will not matter until there is a change in beliefs regarding family planning.

Despite the safety and availability of male contraception, men are reluctant to use the contraception methods due to various reasons ranging from misconceptions about side effects to a lack of knowledge about safe sexual practices.&nbsp;

Therefore, there is a need for campaigns aimed at educating men about the importance of adopting contraception methods.&nbsp;

&nbsp;

Key Points

<ul>
</ul>

<ul>
	<li>A growing population poses several challenges to a country&#39;s health and economic stability.</li>
	<li>Effective implementation of family planning measures can help control overpopulation.</li>
	<li>In Pakistan, use of contraceptives is highly stigmatized due to various reasons.</li>
	<li>While several advances have been made in the search for female contraception, men have only been presented with two options: condoms and vasectomy.</li>
	<li>Condoms are the most commonly used form of contraception; however, there is a need to raise awareness on its correct usage.</li>
	<li>Vasectomy is the most effective male contraceptive method, but the lack of education and widespread myths regarding its side effects has resulted in a low frequency (0.4%) of the procedure in Pakistan.</li>
	<li>Recently, scientists have begun testing various hormonal and non-hormonal compounds as male contraceptive pills.&nbsp;</li>
	<li>In 2019, a team of scientists tested varying doses of dimethandrolone undecanoate (DMAU) among healthy males and found it was well-tolerated. They are now planning long-term clinical trials to test the compound&#39;s effect on sperm production.</li>
	<li>Recently, a team at the University of Minnesota developed a non-hormonal contraceptive pill. They tested the compound in mice and found it to be 99% effective, with no observable side effects. The team now plans to conduct human trials of the compound.</li>
	<li>The development of male contraceptive pills can help men share some of the burden of contraception and pregnancy.</li>
</ul>

&nbsp;

[1] Statistics, P. B. o., 2021. Brief on Census - 2017. [Online].

[2] Meherali, S., Ali, A., Khaliq, A. & Lassi, Z. S., 2021. Prevalence and determinants of contraception use in Pakistan: trend analysis from the Pakistan Demographic and Health Surveys (PDHS) dataset from 1990 to 2018. F1000 Research, Volume 10.

[3] Shattuck, D., Perry, B., Packer, C. & Quee, D. C., 2016. A Review of 10 Years of Vasectomy Programming and Research in Low-Resource Settings. Global Health, Science and Practice, 4(4), pp. 647-660.

[4] Siddiqui, M. et al., 2020. Prevalence and Predictors of Contraception Usage in Karachi, Pakistan. Cureus, 12(10).

[5] Hatesh, H., Maheshwari, B. K., Shah, S. Q. & Kumar, D., 2020. Males’ perception and motivation for Vasectomy. Pakistan Journal of Public Health, 10(4).

[6] Thirumalai, A. et al., 2019. Effects of 28 Days of Oral Dimethandrolone Undecanoate in Healthy Men: A Prototype Male Pill. The Journal of Clinical Endocrinology & Metabolism, 104(2).

[7] Society, A. C., 2022. A non-hormonal pill could soon expand men’s birth control options. [Online].

[8] Bibi, S., Memon, A., Memon, Z. & Bibi, M., 2008. Contraceptive knowledge and practices in two districts of Sindh, Pakistan: A hospital based study. Journal of the Pakistan Medical Associatio, 58(5).

Nimrah H. Sattar

Ismail Munir

To Meat Or Not To Meat?

Research over the years has shown that a strict vegetarian diet excluding all animal fats can lead to vitamin B12 deficiency. Thus, increasing the risk of developing anemia. Newer research also suggests that a more lenient diet puts people at risk of developing <a href="https://www.merisehat.pk/disease/anemia">anemia </a>and heart disease.

There are various reasons behind people giving up eating meat and animal products (milk, cheese, and eggs). However, doing so might increase their risk of anemia, which is a potentially serious condition in which the body does not make enough red blood cells. For vegetarians, vitamin B12 deficiency anemia is typically caused because of eliminating meat from their diet. Similarly, for vegans, giving up all animal products including dairy, eggs, and even honey increases the risk of developing anemia.&nbsp; 
&nbsp;

Understanding Ways To Diversify Iron Sources In Vegetarian And Vegan Diets

A lack of vitamin B12 in your diet can cause pernicious anemia. The body needs vitamin B12 from foods such as meat, poultry, fish and eggs to make red blood cells. Pernicious anemia is a rare type of anemia in which the body is unable to absorb vitamin B12. The vitamin is only available in meat and animal products. While vegetarians who eat dairy and eggs are getting enough vitamin B12 through these sources, vegans must find other ways to include it in their diets, for example, through vitamin B12 supplements. 
&nbsp;

Vitamin B12 deficiency can boost the levels of homocysteine in the blood, a common amino acid that is associated with a higher risk of heart disease. Studies also suggest that the level of this amino acid can over time cause blockages in arteries and lead to heart disease or stroke. Vitamin B12, unlike B vitamins, is not found in any plant derived foods and fortified cereals. However, many types of meat and fish are abundant in vitamin B12. Thus, making it difficult for people following a strict vegetarian diet to get the necessary amount of vitamin B12. The answer is to eat a well-balanced diet and get the needed B12 from other sources, such as vitamin B12 supplementation, to prevent anemia.&nbsp; 
&nbsp;

Look for foods fortified with vitamin B12. Read the nutrition label on packaged foods. Some examples of processed foods that contain vitamin B12 are:&nbsp;

<ul>
	<li>Fortified rice&nbsp;</li>
	<li>Soy milk&nbsp;</li>
	<li>Grain products and cereal&nbsp;</li>
	<li>Meat substitutes</li>
	<li>Dietary supplements containing B complex&nbsp;</li>
	<li>Nutritional yeast&nbsp; 
	&nbsp;</li>
</ul>

Whether you are on a vegan or vegetarian diet, you need to create a healthy and balanced diet that includes enough vitamin B12 to prevent anemia. While fortified cereals are a good choice because of their good bioavailability, meaning it doesn&rsquo;t need to break down before the body absorbs them, vegetarians should consume the following foods on a regular basis:&nbsp;

<ul>
	<li>8 ounces (oz) of yogurt contains about 1.1 mcg of vitamin B12</li>
	<li>1 cup of low-fat milk can provide 1.2 mcg of vitamin B12</li>
	<li>1 oz of Swiss cheese can contain 0.95 mcg of vitamin B12</li>
	<li>1 large egg contains 0.6 mcg of vitamin B12</li>
</ul>

Nutritional yeast is also popular among vegetarians because of its rich, cheesy, and nutty flavor. The yeast can either be added to cooked meals or sprinkled on foods and snacks.

<div>
Since vegans avoid all animal-derived products, they may rely on vitamin B12 fortified breakfast cereals and nutritional yeast, as an alternative source of vitamin B12. For example, fortified non-dairy milk, meat substitutes, breakfast cereals, nutritional yeast, and vegan spreads. However, it is essential to read the labels of the foods as some may not be fortified in vitamin B12.&nbsp;

For those who are deficient in vitamin B12, supplemental vitamins in the form of capsules may be required.&nbsp; 
&nbsp;
</div>

<h4>"All that meat is great for your anemia. But can it also be affecting the heart rate? Get your reading with our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a>!" </h4>

If you decide on taking a dietary supplement, there are some ground rules. A healthy body does not readily absorb all the vitamin B12 in a supplement. Food supplements should never be used as a substitute for a balanced diet and healthy lifestyle. Therefore, it is essential that you talk to your doctor or nutritionist to know the amount of vitamin B12 supplement that is right for you.&nbsp; 
&nbsp;

<ul>
	<li>Vegetarians and vegans need to take steps to make sure that they are including an adequate amount of vitamin B12 in their diet. Not maintaining proper levels of vitamin B12 increases the risk of developing anemia.</li>
	<li>Similarly, since there are no plant-derived foods that contain vitamin B12, it is essential to look into alternative sources, for example, fortified foods and vitamin B12 supplements.</li>
	<li>Speak with a healthcare provider for advice on how much you need to take and where to find sources of vitamin B12.</li>
</ul>

[1] Pawlak, R., Parrott, S.J., Raj, S., Cullum-Dugan, D. and Lucus, D., 2013. How prevalent is vitamin B12 deficiency among vegetarians? Nutrition reviews, 71(2), pp.110-117.

[2] Walsh, S., Appleby, P., Baron, L., Dallas-Chapman, G., Davis, B. and Harris, W., 2001. What every vegan should know about vitamin B12. Birmingham: Vegan Society.

[3] Watanabe, F., Yabuta, Y., Bito, T. and Teng, F., 2014. Vitamin B12-containing plant food sources for vegetarians. Nutrients, 6(5), pp.1861-1873.

Staff Writer

AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

I'm A Heart Patient - Are Oral Contraceptive Pills Safe For Me?

Dialogues concerning sexuality, reproductive health, contraception, and sexually transmitted illnesses (STIs) are limited worldwide. One of the biggest reasons for these decreased dialogues is the fear of spreading indecency among the younger population. Unfortunately, the failure to discuss these topics has had a great impact on public health and led to an increase in the prevalence of abortions and STIs, such as HIV, in the country. The current abortion rate in Pakistan stands at 50 per 1,000 women aged 15-49 years; one of the highest in the world<a href="#accordion">[1]</a>.

The lack of education on such topics also means that both men and women are generally unaware of reproductive health issues. Moreover, the lack of knowledge and awareness of contraception increases the risk of teenage pregnancies, unplanned pregnancies, and unsafe abortions. Thus, resulting in poor health outcomes for both mother and child.&nbsp;

As per estimates, only 35% of married women of reproductive age in Pakistan, use some form of contraception<a href="#accordion">[1]</a>. Condoms are the most common method of contraception, followed by pills and withdrawal methods<a href="#accordion">[2]</a>. Although the use of oral contraceptive pills has increased over the years, there is still poor knowledge of the drug&#39;s effects. This lack of awareness can lead to the misuse of these medications, leading to adverse effects in at-risk individuals for e.g. women with existing cardiovascular disease (CVD) are often at a higher risk of these side effects.&nbsp;

Across Europe and the world, CVD accounts for a majority of deaths in women, while contrastingly in Pakistan, men and women are at an equal risk of coronary artery disease<a href="#accordion">[3]</a>. Due to the high prevalence, it is important that women are aware of the risks associated with using oral contraceptives with pre-existing heart conditions.&nbsp;

&nbsp;

Oral contraceptive pills (OCPs) are often the most popular option among users. They range in effectiveness from 89-99%. They are of two types: combined estrogen-progesterone and the progesterone-only pill. While both are a form of birth control, they can also be used for treating medical conditions such as endometriosis, <a href="https://www.merisehat.pk/disease/polycystic-ovary-syndrome-pcos">polycystic ovary syndrome (PCOS)</a>, and other menstrual disorders.

&nbsp;

1. Combined Oral Contraceptive (COC) - These contain a combination of the hormones, estrogen and progesterone that help prevent ovulation; thus, preventing pregnancy. The pills may contain the same dose of the hormones (monophasic), or varying weekly doses of both or either component (multiphasic). A single packet typically contains 21 pills that are taken over a 28-day period and 7 placebo pills for menstruating days. Although they have a generally safe profile, nausea, vomiting, weight gain, fluid retention, and bloating are common side effects of drug use. However, in some cases, they can also cause other severe side effects, such as:

<ul>
	<li>Increased risk of blood clots</li>
	<li>Hypertension</li>
	<li>Increased risk of stroke and myocardial infarction</li>
</ul>

These drugs are usually contraindicated in smokers and those older than 35 years of age.

&nbsp;

2. Progestin-Only Pill (POP) - Unlike COCs, these only contain a synthetic progestin. The lack of estrogen reduces the risk of adverse side effects such as thromboembolism, stroke, or cardiovascular diseases. However, it can cause breast tenderness, heavy bleeding, mood swings, anxiety, and weight gain among users. POPs are typically prescribed to women who cannot have COCs or estrogen-containing compounds.

3. Emergency Contraception Pill (ECP) - Also called the morning-after pill, it may contain higher doses of the hormone estrogen, progestin, or both. They help delay ovulation or fertilization and are commonly used following unprotected sexual intercourse or a condom breakage. However, they are not meant for regular birth control.

Understanding The Correct OCP For Heart Patients

Doctors usually prescribe contraceptive methods based on a patient&#39;s health and preference. As per current guidelines, doctors must weigh the risks and benefits for each patient prior to selection of contraception.&nbsp;

Women with cardiac disease are not only at a higher risk of maternal death during pregnancy, but also complications such as stillbirth, preterm delivery, or intrauterine growth restriction. Due to the high incidence of unplanned pregnancies, it is important that these women are counselled on effective and safe contraceptive options. Moreover, they are more likely to develop adverse effects to oral contraceptives. Therefore, caution is practiced when prescribing them pills or other contraceptive options.&nbsp;

OCP use among smokers older than 35 years of age is associated with a significantly higher risk of cardiovascular side effects such as deep vein thrombosis. As per estimates, such women have a ten-fold increased risk of myocardial infarction<a href="#accordion">[4]</a>. Therefore, women older than 35 are typically assessed for risk factors such as CVD, hypertension, diabetes, and kidney disease prior to use.&nbsp;

Compared to non-users, combined oral contraceptive users have a much higher risk of myocardial infarction and stroke. Moreover, women with pre-existing hypertension have a 9-16% chance of exacerbation when using OCPs<a href="#accordion">[4]</a>.

&nbsp;

Ideally, contraception is meant to be safe, effective, and protect against sexually transmitted infections. However, no one method can guarantee all three.&nbsp;

&nbsp;

<ul>
	<li>Barrier Methods - These methods are all safe for cardiac patients; however, they have a high failure rate. Therefore, should not be prescribed in cardiac patients to avoid pregnancies.&nbsp;</li>
	<li>Combined Oral Contraceptive Pill - Due to the estrogen component, COCs are associated with multiple risks to women with cardiovascular disease. Therefore, women with CVD risk factors and existing heart disease are not prescribed COCs.</li>
	<li>Progestin-Only Pill - In women with an increased risk of thromboembolism, POPs are usually the preferred option. They are generally considered safe for all CVD patients. However, they can interfere with warfarin metabolism and decrease its therapeutic role. Therefore, careful monitoring of INR is required in such patients.&nbsp;</li>
	<li>Depo-Provera Injection - These injectable contraceptives last 12 weeks and are very effective. However, discontinuation causes a rapid return to fertility. Moreover, it can put patients at risk of ischemic heart disease.</li>
	<li>Mirena Intra-uterine Device (IUD) - Although extremely effective, its insertion can induce a vasovagal reaction in 5% of patients, and lead to a cardiovascular collapse<a href="#accordion">[5]</a>. It is contraindicated in women with pulmonary vascular disease and those at high risk of endocarditis.&nbsp;</li>
	<li>Hormonal Implants - Subcutaneous progestogen implants are highly effective and work as a form of sterilization. Moreover, they have no cardiac contraindications.</li>
</ul>

&nbsp;

According to the Pakistan Demographic and Health Survey (PDHS), the current contraceptive prevalence rate (CPR) is only 34%<a href="#accordion">[6]</a>. There are several barriers to contraceptive use among Pakistani women of reproductive age. These range from religious factors, and lack of access to low socioeconomic status. Although oral contraceptive pills are commonly used as a form of birth control, there are a lot of misconceptions regarding infertility and weight gain that further limits their use.&nbsp;

The lack of dialogue around sexual and reproductive health has left a huge majority of Pakistani women unaware of their health condition and the best health options for their bodies. Moreover, in Pakistan, there is a high prevalence of cardiovascular diseases among women. This puts them at an even higher risk of pregnancy complications; thus, emphasizing the need for better contraceptive methods for these individuals.&nbsp;

Currently, progestin-only pills and hormonal implants are considered the most effective and safe contraceptive options for women with CVD. However, newer formulations of oral contraceptive pills with lower overall risk are being developed. These are expected to help lower blood pressure in users and prevent weight gain.&nbsp;

For now, the best method is to weigh all benefits and risks associated with a particular method before use. Moreover, women should be counseled on the various options available to them and the adverse effects associated with these options.&nbsp;

&nbsp;

<ul>
</ul>

<ul>
	<li>In Pakistan, only 35% of married women of reproductive age practice some form of contraception.</li>
	<li>The stigma surrounding sexual health has placed several barriers for women to access safe contraception methods in the country.</li>
	<li>The lack of awareness of various contraceptive methods has led to an increase in abortions and sexually transmitted infections among the younger population.</li>
	<li>Due to their overall safety profile, easy availability, and high effectiveness oral contraceptive pills are mostly prescribed to women. The two common oral contraceptives include the progestin-only pill and the combined oral pill.</li>
	<li>Despite the overall safety profile, OCPs can increase the risk of several side effects, especially among women with a cardiovascular disorder.</li>
	<li>Women with existing cardiac disease are at a higher risk of maternal death during pregnancy, and complications such as preterm birth, growth restriction, and stillbirth. Therefore, there is a greater need for safe and effective contraceptive methods for these high-risk individuals.&nbsp;</li>
	<li>COCs increase the risk of stroke, thromboembolism, and myocardial infarctions. Therefore, they are contraindicated in smokers above 35 years of age and women with CVD risk factors or existing cardiac disease.</li>
	<li>POPs and hormonal implants are generally considered safe and effective in cardiac patients.</li>
	<li>Newer contraceptive pills are being developed that are expected to have a lower overall risk for cardiac patients.</li>
</ul>

&nbsp;

[1] Siddiqui, M. et al., 2020. Prevalence and Predictors of Contraception Usage in Karachi, Pakistan. Cureus, 12(10).

[2] Mushtaq, K., Ashraf, M. & Thaver, I. H., 2020. Who are the women wishing to opt for contraception?. Journal of the Pakistan Medical Association, 70(12).

[3] Jafar, T. H., Jafary, F. H., Jessani, S. & Chaturvedi, N., 2005. Heart disease epidemic in Pakistan: women and men at equal risk. American Heart Journal.

[4] Cooper, D. B., Patel, P. & Mahdy, H., 2022. Oral Contraceptive Pills. s.l.:StatPearls Publishing.

[5] Kaminski, P., Szpotanska-Sikorska, M. & Wielgos, M., 2013. Cardiovascular risk and the use of oral contraceptives. Neuro Endicrinology Letters.

[6] Hudsmith, L. & Thorne, S., 2007. Contraception in women with cardiac disease. Women's Health, 3(6), pp. 711-717.

[7] Meherali, S., Ali, A., Khaliq, A. & Lassi, Z. S., 2021. Prevalence and determinants of contraception use in Pakistan: trend analysis from the Pakistan Demographic and Health Surveys (PDHS) dataset from 1990 to 2018. F1000 Research, Volume 10.

Iqra Mazhar

Impact Of OCP On Mental Health

Oral contraceptive pills (OCPs) are popular among women of reproductive age due to their ease of use and high efficacy. However, sociodemographic disparities in its use persist around the world. Those with greater awareness and education, who are unmarried and from the upper class, are more likely to use it than others. In Pakistan, this figure is close to 8% of girls and women<a href="#accordion">[4]</a>. 
&nbsp;

Understanding OCP's Influence on Mental Health

The effects of OCPs vary depending on individual factors, the specific formulation of the pill, and how it is used. 
&nbsp;

<ul>
	<li>
	<h5>Mood Swings</h5>
	</li>
</ul>

OCPs change your body&#39;s hormone levels by preventing ovulation and thickening cervical mucus. These hormonal changes may have an impact on your brain&#39;s neurotransmitters and hormonal signaling pathways, which may have an impact on your mood and cognitive function. As a result, you go through emotional changes, such as increased feelings of irritability, sadness, or anxiety.

Some studies have pointed out a possible connection between OCP and depression. This might be brought on by pill-induced bloating, decreased sex desire, and weight gain. Headaches, fatigue, and nausea may also have an impact on mental health. 
&nbsp;

These fluctuations in mood and an increase in symptoms of depression are the most common reasons girls and women discontinue OCPs. In general, adolescent girls who use OCPs are more likely to experience hypersomnia, eating problems, and increased crying than their counterparts who do not use OCPs. According to one study, it may be related to the type and amount of progestin in these pills<a href="#accordion">[1]</a>.

Many older OCPs that contain ethinyl estradiol are linked to severe mood problems. In contrast, newer OCPs with physiological forms of estrogen are usually easier to tolerate and have a weak link to mood problems<a href="#accordion">[1]</a>.

A Danish study found an increased risk of the first diagnosis of depression and the first use of an antidepressant among users of various types of OCPs. They were highest among adolescents. However, more research is needed to fully understand this relationship.

On the plus side, studies show that OCPs improve mood and mental health while alleviating premenstrual symptoms. 
&nbsp;

<ul>
	<li>
	<h5>Cognitive Function</h5>
	</li>
</ul>

The impact of OCPs on cognitive function and brain health is complicated.

Estrogen, for example, is thought to be neuroprotective in the hippocampus, hypothalamus, amygdala, and brainstem. It helps to protect the brain from cognitive decline, neurodegenerative disease, and affective disorders. 
&nbsp;

Furthermore, estrogen can influence brain regions involved in emotional processing, such as the dorsolateral prefrontal cortex.

Progesterone, on the other hand, is not thought to be neuroprotective. It can also aggravate mood symptoms.

The clinical significance of these findings is still under investigation. 
&nbsp;

Note: It should be noted that scientific research on this topic is still ongoing, and the long-term effects of OCPs on brain health are not fully understood.

Any changes in mood or brain function associated with OCP use are likely to be temporary and reversible in many cases. When you stop using OCPs, your hormone levels will return to normal, and any negative effects on brain health will fade.

Some girls, however, may have specific sensitivities or reactions to the hormones in OCPs. In rare cases, stopping the use of OCPs may not immediately reverse certain effects on mood or brain function.

Decisions about the use of OCPs should be made in consultation with a healthcare professional who can take into account individual health needs and medical history. 
&nbsp;

This includes:

<ul>
	<li>
	<h5>Pre-Existing Mental Health Conditions</h5>
	</li>
</ul>

If you already have a mental health condition, such as depression or anxiety, OCPs may exacerbate your symptoms. Furthermore, OCPs may interact with your current medications.

Inform your doctor so that he or she can tailor your treatment to your specific needs, medical history, and potential risks and benefits of OCPs. 
&nbsp;

<ul>
	<li>
	<h5>Individual Response</h5>
	</li>
</ul>

Individual reactions to OCP use can differ greatly. Some girls tolerate OCPs well and experience no adverse effects on brain health.

At the same time, some girls may be more sensitive to the hormonal changes caused by OCPs, resulting in emotional or mental health issues. Or they may be predisposed to side effects due to risk factors. 
&nbsp;

Note: Please consult a professional doctor if you have any concerns about the effects of OCPs on your brain health or mood. They can offer personalized advice, consider alternative contraceptive options, or modify the prescription to reduce side effects. 
&nbsp;

Few studies have looked into the relationship between oral contraceptives and mental health, such as mood swings and cognitive function.

According to the Harvard Study of Moods and Cycles, 16.3% of people reported a decline in their mood, while 12.3% reported an improvement. However, the vast majority of people reported no change in their mood<a href="#accordion">[2]</a>. 
&nbsp;

32-60% of women discontinue the pill within 6 months for a variety of reasons, the most common of which are mood changes<a href="#accordion">[3]</a>.

It&rsquo;s important to talk to a doctor before starting a contraceptive pill, especially if you have known potential risks, like a history of depression.

It&rsquo;s also important for healthcare providers and adult supervisors to monitor depressive symptoms in adolescents using OCPs because it may put them at risk for nonadherence if the pill affects their quality of life. 
&nbsp;

Key Takeaways

<ul>
	<li>OCPs may have significant benefits, such as providing contraceptive protection, regulating menstrual cycles, and managing certain medical conditions like PCOS.</li>
	<li>The potential effects of OCPs on brain health in girls vary depending on the individual.</li>
	<li>According to the limited research available, it&#39;s been observed that not all girls will experience these symptoms, and those who do may have different degrees of severity.</li>
	<li>Some possible symptoms include mood swings, depression, anxiety, and changes in cognitive function like memory or concentration issues.</li>
	<li>Symptoms such as headaches, nausea, fatigue, and decreased libido can also have an impact on the overall well-being and brain health of girls who use OCPs.</li>
	<li>In most cases, these symptoms are transient and disappear once the pill is discontinued.</li>
	<li>It&#39;s crucial to weigh the potential benefits of OCP use (such as contraceptive protection, regulation of menstrual cycles, and management of certain medical conditions like PCOS) against potential risks. 
	&nbsp;</li>
</ul>

[1] Mu E, Kulkarni J. Hormonal contraception and mood disorders. Australian prescriber.

[2] MGH Center for Women’s Mental Health. Do oral contraceptives cause mood swings or depression? MGH Center for Women’s Mental Health.

[3] Anouk E. de Wit Bs. Association of use of oral contraceptives with depressive symptoms among adolescents and young women. JAMA Psychiatry.

[4] Meherali S, Ali A, Khaliq A, Lassi ZS. Prevalence and determinants of contraception use in Pakistan: trend analysis from the Pakistan Demographic and Health Surveys (PDHS) dataset from 1990 to 2018. F1000Res. 2021;10:790. Published 2021 Aug 11. doi:10.12688/f1000research.55204.1

Shermeen Zuberi

Stop Popping (ECP) Pills Like Candy

In conservative societies, where certain topics remain taboo, it is no surprise that social media has become a great tool for finding answers to questions. Online forums allow people to remain anonymous and ask queries without worrying about judgment. 
&nbsp;

Moreover, several closed groups on social media sites, like Facebook, have provided women with safe spaces to discuss issues pertaining to marriage, sexual health, workplace harassment, dating, and much more. These women-only groups are often full of posts inquiring about effective birth control methods and the use of emergency contraception. 
&nbsp;

Interestingly, in Pakistan, 20% of married women of reproductive age have an unmet need for contraception<a href="#accordion">[1]</a>, while the country&rsquo;s contraceptive prevalence rate (CPR) is only 34%<a href="#accordion">[2]</a>, indicating gaps in knowledge about safe contraception.&nbsp;This makes one wonder why women feel safer asking about emergency contraception on a Facebook group or their friends rather than discussing it with their physician.&nbsp; 
&nbsp;

In a survey conducted across a tertiary care hospital in Karachi, Pakistan<a href="#accordion">[3]</a>:&nbsp; 
&nbsp;

<ul>
	<li>40% of the participants did not find emergency contraception to be an appropriate topic of discussion with their <a href="https://merisehat.pk/doctor-now">physicians&nbsp;</a></li>
	<li>69% of the physicians felt uncomfortable prescribing emergency contraception&nbsp;&nbsp;</li>
	<li>The promotion of promiscuity was another major reason cited for the reluctance of the <a href="https://merisehat.pk/">healthcare providers</a>&nbsp; 
	&nbsp;</li>
</ul>

Similar results were seen in a study conducted among community health workers in Rawalpindi, Pakistan. Approximately four-fifths of the workers attributed emergency contraceptive pills to the promotion of &lsquo;evil&rsquo; practices in society<a href="#accordion">[4]</a>.&nbsp; 
&nbsp;

As a result of the misinformation, women have turned online for answers. This has led to the self-administration of emergency contraceptive pills. Many women report using the pills several times a month, instead of their intended emergency use. You could almost say, they&rsquo;re popping emergency contraceptive pills like candy. But is that safe?

&nbsp;

Emergency contraceptive pills (ECPs) are a type of emergency contraception method commonly used for preventing <a href="https://merisehat.pk/article/time-for-men-to-share-the-burden-of-pregnancy">pregnancies</a>.&nbsp; 
&nbsp;

In Pakistan, Greenstar&rsquo;s ECP pill<a href="#accordion">[5]</a>&nbsp;and ZAFA Pharmaceutical laboratories&rsquo; Emkit are the two commonly available options. Both contain the hormone Levonorgestrel; it helps prevent or delay <a href="https://www.merisehat.pk/article/ovulation-are-you-eggspecting">ovulation</a>.&nbsp; 
&nbsp;

Typically,&nbsp;

<ul>
	<li>1.5 mg of the hormone is taken at once&nbsp;</li>
</ul>

or&nbsp;

<ul>
	<li>Two 0.75 mg pills are taken 12 hours apart.&nbsp; 
	&nbsp;</li>
</ul>

Also called the morning-after pill, ECPs are most effective when taken within 72 hours of unprotected sexual intercourse. Women using these particular ECPs have a pregnancy rate of 1.2-2.1%<a href="#accordion">[6]</a>. Moreover, they reduce the risk of unintended pregnancy by 72-89%<a href="#accordion">[4]</a>. 
&nbsp;

As per a cross-sectional study conducted in Karachi, Pakistan, 42.9% of the study participants were aware of emergency contraception methods, whereas only 6% reported practicing the method<a href="#accordion">[1]</a>. Another study reported awareness of ECP among only 7.5% of women of childbearing age<a href="#accordion">[7]</a>. 
&nbsp;

Similar to other emergency contraception methods, ECPs are used after unprotected sexual intercourse or possible contraceptive failure, such as condom breakage or failed withdrawal.&nbsp;

&nbsp;

Understanding Dangers Of Regular ECP Use

ECPs are recommended for single use, but women often report using the pill multiple times, sometimes in the same menstrual cycle.&nbsp; 
&nbsp;

Although studies have not found any health risks, frequent ECP use could lead to increased side effects. These include: 
&nbsp;

<ul>
	<li>Menstrual irregularities</li>
	<li>Nausea</li>
	<li>Vomiting</li>
	<li>Breast tenderness</li>
	<li>Abdominal pain</li>
	<li>Fatigue</li>
	<li>Headache</li>
	<li>Dizziness 
	&nbsp;</li>
</ul>

However, if your period is unusually heavy or light, or is delayed by more than 5 days, it is best to <a href="https://merisehat.pk/doctor-now">consult a doctor</a>.&nbsp; 
&nbsp;

According to the World Health Organization (WHO), frequent or repeated ECP use has harmful effects in women that are classified as medical eligibility criteria (MEC) category 2, 3, or 4 for combined hormonal contraception or Progestin-only contraceptives (POC)<a href="#accordion">[8]</a>. 
&nbsp;

In lactating women, the use of ECPs has been associated with ectopic pregnancy<a href="#accordion">[9]</a>.&nbsp; 
&nbsp;

Also, the pills are less effective in obese women (BMI &gt; 30 kg/m2)<a href="#accordion">[8]</a>, who might require a higher dose of the drug.&nbsp;

&nbsp;

<ul>
	<li>Although repeated ECP use is relatively safe, it does not increase the drug&rsquo;s effectiveness or minimize your risk of pregnancy further.&nbsp;</li>
	<li>Nor is an ECP as effective as regular contraception.&nbsp;</li>
	<li>Furthermore, once fertilization or implantation has taken place, the pills are no longer effective at preventing pregnancy.&nbsp; 
	&nbsp;</li>
</ul>

The timing of an ECP is key in deciding how well it will protect the user.

&nbsp;

The WHO recommends that every girl at risk of unintended pregnancy have access to emergency contraception. Moreover, the methods should be part of a country&rsquo;s national family planning programs. The health authority recommends the following methods of emergency contraception:

<ul>
	<li>ECPs And Combined Oral Contraceptive Pills (COCs)&nbsp;</li>
</ul>

Emergency contraceptive pills would contain either levonorgestrel (LNG) or ulipristal acetate (UPA). ECPs with UPA are taken as a single dose of 30 mg, while ECPs with LNG are taken as a single 1.75 mg dose, or 2 doses of 0.75 mg each, 12 hours apart.&nbsp;

While both have similar efficacies, UPA is more effective if used within 2-5 days of unprotected sexual intercourse than LNG<a href="#accordion">[6]</a>. Moreover, UPA is preferred for obese women.&nbsp;

However, none of these pills can prevent sexually transmitted infections (STIs).

Combined oral contraceptive pills (COCs) are generally taken as a split dose. This includes a single dose of 100 &mu;g of ethinyl estradiol plus 0.50 mg of LNG, followed by a second dose of 100 &mu;g of ethinyl estradiol plus 0.50 mg of LNG 12 hours later. These pills are less effective than ECPs at preventing pregnancies.&nbsp;

<ul>
	<li>Copper-Bearing Intrauterine Devices (IUDs)&nbsp;</li>
</ul>

A copper IUD could be inserted within 5 days of unprotected sexual intercourse. It is the most effective emergency contraceptive method<a href="#reference">10</a>.&nbsp;

Unlike ECPs and COCs which only provide temporary protection, copper IUD has the added advantage of delivering continued contraception. Moreover, it also prevents implantation.&nbsp;

Although it carries a risk of pelvic inflammatory disease, researchers believe the benefits of a copper IUD outweigh these risks.&nbsp;&nbsp;

&nbsp;

Emergency contraception methods prevent more than 95% of pregnancies if taken within 5 days of sexual intercourse<a href="#accordion">[6]</a>.&nbsp;However, ECPs are not to be used as regular contraception as they are not long-acting and are less effective than regular contraception methods.&nbsp; 
&nbsp;

Although frequent ECPs are considered safe, their effectiveness does not increase with repeated doses. Nor do they protect against STIs. However, researchers believe that the use of ECPs significantly reduces maternal deaths and unsafe abortions in the country. But, in a country where contraception use is not well understood<a href="#accordion">[1]</a>, the use of ECPs remains a sensitive topic.&nbsp; 
&nbsp;

Pakistan currently has the highest abortion rate in the world: 50 per 1,000 women aged 15-49 years<a href="#accordion">[1]</a>. The lack of sex education has increased unplanned pregnancies and maternal mortality in the country. Therefore, there is a need to raise awareness about the various contraception options available to the community, including emergency contraception methods.&nbsp; 
&nbsp;

Although pre-marital sex is against the law in Pakistan, many teenagers and young adolescents in the country are reportedly sexually active. A cross-sectional survey conducted among urban men in Pakistan found that 11% of men participated in pre-marital sex out of the 29% who reported participating in non-marital sex<a href="#accordion">[11]</a>. However, researchers believe that the actual number is probably higher. Therefore, an implementation of sex education programs in school curriculums is needed to educate the youth about safe sex practices.&nbsp;

&nbsp;

<ul>
	<li>Emergency contraceptive pills (ECPs) are a type of emergency contraception method commonly used for preventing pregnancies. In Pakistan, Greenstar&rsquo;s ECP pill and ZAFA Pharmaceutical laboratories&rsquo; Emkit are the two commonly available options. Both contain the hormone Levonorgestrel.</li>
	<li>Frequent or repeated use of ECP could cause increased side effects, such as menstrual irregularities, <a href="https://merisehat.pk/disease/nausea">nausea</a>, vomiting, breast tenderness, abdominal pain, fatigue, <a href="https://merisehat.pk/disease/tension-headaches">headache</a>, and dizziness. Moreover, in lactating women, there is a <a href="https://merisehat.pk/disease/ectopic-pregnancy">risk of ectopic pregnancy</a> with ECP use.</li>
	<li>Although frequent ECP use is relatively safe, it is less effective than regular contraception methods at preventing pregnancy. Nor does it protect against STIs.&nbsp;</li>
	<li>As per the WHO, a copper IUD is the<a href="https://merisehat.pk/disease/female-contraception"> best emergency contraception</a> method as it could also serve as a long-term option.&nbsp;</li>
	<li>There is a need to counsel the youth and adults on safe sex practices. Moreover, women should be educated on the correct use of ECP and the various long-term contraception methods available to them.</li>
</ul>

&nbsp;

[1] Siddiqui, M., Fatima, K., Ali, S. N., Fatima, M., Naveed, W., Siddiqui, F., Naqvi, T., Khan, S., Amin, M., Liaquat, A., & Bibi, Z. (2020). Prevalence and Predictors of Contraception Usage in Karachi, Pakistan. Cureus, 12(10), e11265

[2] Meherali, S., Ali, A., Khaliq, A., & Lassi, Z. S. (2021). Prevalence and determinants of contraception use in Pakistan: trend analysis from the Pakistan Demographic and Health Surveys (PDHS) dataset from 1990 to 2018. F1000Research, 10, 790.

[3] Abdulghani, H. M., Karim, S. I., & Irfan, F. (2009). Emergency contraception: knowledge and attitudes of family physicians of a teaching hospital, Karachi, Pakistan. Journal of health, population, and nutrition, 27(3), 339–344. https://doi.org/10.3329/jhpn.v27i3.3376

[4] Mir, A. S., & Malik, R. (2010). Emergency contraceptive pills: Exploring the knowledge and attitudes of community health workers in a developing Muslim country. North American journal of medical sciences, 2(8), 359–364. https://doi.org/10.4297/najms.2010.2359

[5] Greenstar. (n.d.). Emergency Contraceptive Pill. Greenstar Social Marketing.

[6] World Health Organization. (2021, November 9). Emergency contraception. WHO | World Health Organization.

[7] Khan, S. A., Hafeez, H., & Akbar, R. (2015). EMERGENCY CONTRACEPTION: AN OVERVIEW AMONG USERS. Journal of Ayub Medical College, Abbottabad : JAMC, 27(1), 51–54.

[8] Mir, A.M., Wajid, A., Pearson, S. et al. Exploring urban male non-marital sexual behaviours in Pakistan. Reprod Health 10, 22 (2013).

[9] Masud, N., AlShaibi, S., AlBassri, T., Khan, S., & Khan, F. (2021). Case of rupture ectopic pregnancy with emergency contraception levonorgestrel 0.075 mg in a lactating woman. Clinical case reports, 9(3), 1605–1609.

[10] Mittal S. (2016). Emergency contraception: which is the best?. Minerva ginecologica, 68(6), 687–699.

This article or video has been recorded by a subject / domain specialists with a proven track record of excellence in their area. 

Just A Little Dose

Microdosing, as the name suggests, is the process of administration of small doses of new or pre-approved chemicals to improve physiological functions.

 
Microdosing sounds a lot like drug abuse, doesn&rsquo;t it? But that&rsquo;s far from the truth. The aim of microdosing is to enhance brain functioning and, in many cases, even treat mental illness through unconventional ways to minimize the side effects and possible dependency on drugs. 
&nbsp;

Understanding The Pros And Cons Of Microdosing

Microdosing, as the name suggests, is the process of administration of small doses of new or pre-approved chemicals to improve physiological functions. The microdose is also referred to as sub pharmacological dose.&nbsp;

&nbsp;

The pharmacokinetic predictors are the users, ensuring the dosage does not have an impact on the clearance, distribution or bioavailability of the compound<a href="#accordion">[1]</a>.

&nbsp;

Microdosing is often used in the process of drug development to determine the therapeutic index of the drug. This practice dates back all the way to the 16th century.

<div>&nbsp;</div>

In order for a dose to be considered sub pharmacological or a microdose, it has to be 1/10th or 1/20th of the normal dose. The target is to avoid the high and/or the intoxication associated with the drug, along with ensuring that possible addiction to the drug does not occur. Since the phenomenon is not widely supported by scientists or healthcare practitioners, there is no set schedule and people who are practicing this have been doing it all on their own based on their own observations and hypotheses<a href="#accordion">[2]</a>. A lot of the positive results are disregarded by many professionals in the name of a placebo effect, but is it what microdosing really is?&nbsp;

&nbsp;

So far, these are the benefits that have been promised by people practicing microdosing from all over the world:

<ul>
	<li>Microdosing on psychedelics has been associated with improved mood.</li>
	<li>Some psychedelics are used to treat anxiety and depression. They exert effects similar to serotonin reuptake inhibitors.</li>
	<li>Improved sleep and an increased sense of well-being.</li>
	<li>Microdosing may help manage symptoms of ADHD.</li>
	<li>It improves cognition.</li>
	<li>It boosts energy.</li>
	<li>It enhances psychomotor performance especially in people over 55 years of age.</li>
</ul>

<div>&nbsp;</div>

Lysergic acid diethylamide is known for its hallucinogenic effects in people and it is very commonly used by artists of all kinds to change their perspectives and broaden their horizons. It is now widely used for microdosing as well. 5-10% of the usual dose if taken, can induce mood enhancing effects, is beneficial for cognitive health, and even helps deal with pain.&nbsp;

&nbsp;

LSD microdosing was an open secret. The game changed when Apple founder Steve Jobs talked about how LSD played a vital role in his life.&nbsp;

&nbsp;

LSD microdosing should never be done continually. It is always better to start off with microdosing 2 days and then skip 2 days (avoid microdosing). So, you can be microdosing from Monday to Friday and leaving the weekends sober. Alternatively, it can also be done by taking small doses of LSD every other day.

&nbsp;

The following effects of LSD microdosing have been reported by many users<a href="#accordion">[8]</a>:&nbsp;&nbsp;

<ul>
	<li>Reduced anxiety</li>
	<li>Reduced depression</li>
	<li>Enhanced energy levels</li>
	<li>Reduced pain</li>
	<li>Headache&nbsp;</li>
	<li>Better sleep quality</li>
</ul>

<div>&nbsp;</div>

Though it is important to bear in mind that many, if not all of the previously mentioned&nbsp; effects, might be placebo effects as suggested by&nbsp; several researchers including the research conducted by the University of Chicago. The main issue is that these beneficial effects are reported in uncontrolled environments by regular users who have literally no idea of psychiatry and how the brain works.&nbsp;

&nbsp;

According to the research done by University of Chicago, they administered small doses of the psychedelic to people but ensured that the people were unaware of it in order to truly monitor their impact &ndash; without involving the bias from the subject&rsquo;s thoughts or attitudes towards the drug that would automatically alter the results. It was found that while the people experienced a little high, there was no actual mood enhancement or improved cognitive action in the brain<a href="#accordion">[9]</a>.

<div>&nbsp;</div>

Psilocybin is one of the most common substances that is used for microdosing. Researchers are heavily invested in trying to determine the true extent of its therapeutic uses and its impact on depression and anxiety: the two mental illnesses it is mostly used for treating. Microdosing Psilocybin has garnered mixed perspectives over the years, with experts on one hand calling it a mere placebo effect, and on the other there are studies that discuss its impact on the brain<a href="#accordion">[6]</a>.

&nbsp;

According to many researches based on experiments and data extracted from people who practice microdosing psilocybin, there has been a significant impact on their cognitive function and mental concentration<a href="#accordion">[3]</a>. However, research also indicates that&nbsp; full doses of the substance may lead to permanent behavioral changes, making it a very slippery slope with different possible outcomes, some of which may not even be desirable.&nbsp;

&nbsp;

Psilocybin administration is sometimes mixed with other substances like lion&rsquo;s mane mushrooms or niacin. This combination may not have a huge impact on younger users, but it is known to increase psychomotor functions in people over 55 years i.e., psychomotor performance was limited to older adults<a href="#accordion">[4]</a>.

&nbsp;

Interestingly, in many case studies, psilocybin users have been compared to placebo groups and both groups have reported similar effects<a href="#accordion">[7]</a>. Its impact on mood and mental health is still considered to be minimal and gradual.&nbsp;

&nbsp;

The issue is that since these <a href="https://merisehat.pk/article/the-rise-of-new-weight-loss-drugs-a-comprehensive-overview-and-accessibility-concerns">drugs</a>, especially psilocybin are illegal, there is little to no long-term extensive research on its use and its long-term effects. However, data accumulated from long-term abusers of such drugs suggests that prolonged use of psilocybin may lead to valve damage or cardiac valvulopathy<a href="#accordion">[5]</a>.

<div>&nbsp;</div>

The biggest risk with microdosing is the entire unsupervised practice itself. In many cases, people are just subjecting themselves to long-term health issues with no actual outcome because many studies have proven that in most cases, the benefits are caused due to placebo effects and the drugs may not have any significant impact on the individual at all.

&nbsp;

Despite this, the ever-growing community of microdosers is attracting a lot of people who are not well-versed with science. This not only gives rise to misuse and possible overdosing incidents; it also promotes the practice of illegal substance use that can potentially cause irreversible damage to the user.

<div>&nbsp;</div>

<ul>
	<li>Microdosing has been used in professional practices for a very long time for the determination of therapeutic index of the drugs.</li>
	<li>Currently, the process is used for inducing psychiatric effects on people with mental illnesses or just to enhance your brain function.</li>
	<li>While microdosing can be done on any drugs, the most commonly used type of drugs are psychedelics, including psilocybin and LSD</li>
	<li>Many researchers have reported that there is no robust evidence backing the self-proclaimed therapeutic effects of microdosing and these benefits are solely due to placebo effects.&nbsp;</li>
</ul>

<div>&nbsp;</div>

[1] Anderson T, Petranker R, Christopher A, et al. Psychedelic microdosing benefits and challenges: An empirical codebook. Harm Reduction Journal. 2019;16(1). doi:10.1186/s12954-019-0308-4

[2] Smith DG. More people are microdosing for mental health. but does it work? The New York Times.

[3] Nichols DE. Psychedelics. Pharmacological Reviews. 2016;68(2):264-355. doi:10.1124/pr.115.011478

[4] Rootman JM, Kiraga M, Kryskow P, et al. Psilocybin microdosers demonstrate greater observed improvements in mood and mental health at one month relative to non-microdosing controls. Nature News.

[5] Radcliffe S. Microdosing psilocybin mushrooms may improve mental health and mood. Healthline.

[6] Siebert A. Microdosing psychedelics is trendy, but does it work? here's what science says. Forbes.

[7] Kuypers KPC. The therapeutic potential of microdosing psychedelics in depression. Therapeutic Advances in Psychopharmacology. 2020;10:204512532095056. doi:10.1177/2045125320950567

[8] Microdosing LSD: Benefits, risks, and more. Medical News Today.

[9] Loomis I. Study of LSD microdosing doesn't show a therapeutic effect. UChicago Medicine.

Umna Salah

Erectile Dysfunction Pills - Hit Or Miss?

Sexual dysfunction is a common problem among both men and women. Approximately 43% of women and 31% of men report suffering from some form of problem during sex.<a href="#accordion">[1]</a>&nbsp;In men, sexual dysfunction encompasses sexual desire, orgasm, pain, and sexual arousal (maintaining erections).<a href="#accordion">[2]</a>&nbsp;Difficulty achieving or maintaining an erection is not unusual. One can experience such problems from time to time, especially if facing relationship problems or dealing with stress. However, if it progressively worsens and affects one&#39;s sexual life, it becomes a health concern.

<a href="https://www.merisehat.pk/disease/erectile-dysfunction">Erectile dysfunction</a>, or ED, is defined as an inability to maintain a firm enough and lasting erection for satisfactory sexual intercourse or achieve an erection when one wants. Although its prevalence increases with age, aging isn&#39;t a cause of ED.<a href="#accordion">[3]</a>&nbsp;Instead, several physical and psychological conditions can predispose one to ED; these include <a href="https://www.merisehat.pk/disease/depression">depression</a>, diabetes, cardiovascular disorders, and obesity.<a href="#accordion">[4]</a>&nbsp;Moreover, the use of certain medications, smoking, drug use, and alcohol consumption can also affect a person&#39;s sexual function.&nbsp;

ED is highly prevalent in the Pakistani male population, affecting 80.8% of men attending primary care clinics.<a href="#accordion">[5]</a>&nbsp;However, the true burden of the disease in the country cannot be established due to underreporting of cases. The stigma surrounding sexual health makes men hesitant to discuss their issues with a healthcare professional and at times even friends and family. Moreover, many are unaware that ED is a highly treatable condition. Thus, it not only affects one&#39;s sexual and mental health but also the overall quality of life. 
&nbsp;

Understanding Erectile Dysfunction Pills

Over the years, researchers have developed several treatment options for ED, ranging from pills and aids to surgical implants. However, oral pills such as phosphodiesterase (PDE) 5 inhibitors continue to be the first line of treatment for erectile dysfunction.<a href="#accordion">[6]</a>&nbsp;The widely popular pill, Viagra (sildenafil) was one of the first FDA-approved oral pills for ED.&nbsp;

PDE5 inhibitors relax the penile muscles during sexual arousal, thus increasing blood flow to the chambers and causing an erection. They are typically 60-80% effective at treating the symptoms of ED.<a href="#accordion">[7]</a>&nbsp;Although all are similar in safety and effectiveness, there is a difference in how long the drug&#39;s effect lasts and the side effects of the medication.&nbsp; 
&nbsp;

There are four FDA-approved PDE5 inhibitors for use against ED. They include:

<ol>
	<li>Viagra (Sildenafil) - The famous blue pill was the first PDE5 inhibitor approved for ED. It is typically taken at least an hour prior to sexual intercourse and has a quick onset of action (30 minutes). The recommended dosage is 50 milligrams(mg), and its effect typically lasts for 4-5 hours. For maximum absorption, it is advised to take the drug on an empty stomach.&nbsp;</li>
	<li>Cialis (Tadalafil) - Unlike other ED pills, tadalafil has an extremely long duration of action (36 hours). It is often prescribed as a daily 5mg dose in patients suffering from benign prostatic hyperplasia and ED. Although similar to Viagra in terms of onset and safety, people often prefer tadalafil because it improves sexual confidence.<a href="#accordion">[8]</a>&nbsp;Therefore, it is often prescribed for people with psychological factors causing ED.&nbsp;</li>
	<li>Stendra (Avanafil) - Avanafil is a newer class of PDE5 inhibitors and is typically taken 30 minutes before sexual intercourse. Compared to other ED pills, avanafil is preferred in people with cardiovascular disorders as it has fewer effects on blood pressure<a href="#reference" target="_blank">9</a>. Thus, making it safe to use in those taking anti-hypertensives.&nbsp;</li>
	<li>Levitra (Vardenafil) - This particular drug has the shortest onset of action (10 minutes) and is effective for 4-5 hours. However, it can lengthen the QTc interval and is not prescribed in patients with prolonged QTc or those taking antiarrhythmics.</li>
</ol>

Note: ED pills can have mild side effects, such as flushing, dizziness, headaches, diarrhea, and vision problems. Moreover, the medications are contraindicated in those taking nitrate drugs, or suffering from blood pressure-related problems, liver disease, or severe kidney disease. A more severe side effect of the drug is a painful, prolonged erection. In case of an erection lasting more than 4 hours, professional help should be sought. 
&nbsp;

As per a 2013 meta-analysis, all PDE5 inhibitors are more effective than a placebo for treating ED.<a href="#accordion">[7]</a>&nbsp;They have a similar safety profile; however, the study found tadalafil to be the most effective among other PDE5 inhibitors, followed by vardenafil.&nbsp;

If all are safe and effective, what is the best option? The truth is that the best option will vary from person to person. It will depend on your medical history, the underlying cause of ED, whether you want it for regular use or occasional use, and your lifestyle. Therefore, it is best to discuss all your options with a healthcare professional and then make a decision. 
&nbsp;

Sexual health has a huge impact on a person&#39;s quality of life. Letting societal pressures and social stigmas influence your decisions will only negatively affect your health. And while living with any form of sexual dysfunction can be frustrating, it is important to note that treatment is very much possible. And the presence of a sexual problem is in no way reflective of one&#39;s masculinity.&nbsp;

Therefore, if one suffers from ED or any other sexual dysfunction, seeking a healthcare professional can significantly improve the overall quality of life. Moreover, combining various treatment options such as oral pills. counselling and lifestyle changes can further improve one&#39;s sexual problems.&nbsp; 
&nbsp;

<ul>
</ul>

<ul>
	<li>Erectile dysfunction is defined as an inability to maintain an erection firm enough for satisfactory sexual intercourse. It can result from a variety of physical (obesity, diabetes, cardiovascular disease) and psychological (anxiety, depression) conditions.</li>
	<li>Phosphodiesterase (PDE) 5 inhibitors are the first line of treatment for ED. There are currently four FDA-approved pills: sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra).&nbsp;</li>
	<li>All ED pills are similar in safety and efficacy; however, doctors prescribe the drugs based on your medical history, lifestyle, and underlying cause of ED. It is best to consult your doctor before starting any medication.</li>
	<li>Seeking professional help is an important step in treating ED and improving one&#39;s sexual health&nbsp;and overall quality of life.</li>
</ul>

[1] Rosen, R. C., 2000. Prevalence and risk factors of sexual dysfunction in men and women. Current Psychiatry Reports, Volume 2, pp. 189-195.

[2] Wincze, J. P. & Weisberg, R. B., 2015. Sexual Dysfunction: A Guide for Assessment And Treatment. 3rd Edition ed. s.l.:Guilford Press.

[3] Johannes, C. B. et al., 2000. Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study. The Journal of Urology, 163(2), pp. 460-3.

[4] McMahon, C. G., 2019. Current diagnosis and management of erectile dysfunction. Medical Journal of Australia, 210(10), pp. 469-476.

[5] Shaeer, K. Z. M. et al., 2003. Prevalence of erectile dysfunction and its correlates among men attending primary care clinics in three countries: Pakistan, Egypt, and Nigeria. International journal of impotence research, Volume 15.

[6] Kalsi, J. S. & Kell, P. D., 2004. Update on oral treatments for male erectile dysfunction. Journal of the European Academy of Dermatology and Venereology, 18(3), pp. 267-274.

[7] Yuan, J. et al., 2013. Comparative effectiveness and safety of oral phosphodiesterase type 5 inhibitors for erectile dysfunction: a systematic review and network meta-analysis. European Urology, 63(5), pp. 902-12.

[8] Gong, B. et al., 2017. Direct comparison of tadalafil with sildenafil for the treatment of erectile dysfunction: a systematic review and meta-analysis. International Urology and Nephrology, 49(10).

[9] Katz, E. G., Tan, R. B., Rittenberg, D. & Hellstrom, W. J., 2014. Avanafil for erectile dysfunction in elderly and younger adults: differential pharmacology and clinical utility. Therapeutics and Clinical Risk Management, Volume 10, pp. 701-11.

Madeeha Syed

The Importance Of Calcium And Vitamin D For The Elderly

As individuals age, the importance of proper nutrition becomes increasingly crucial for maintaining optimal health and well-being. Two key nutrients that play a significant role in elderly health are calcium and <a href="https://merisehat.pk/disease/vitamin-d">vitamin D</a>. Let&rsquo;s delve into the vital functions of calcium and vitamin D in the body, discuss their specific benefits for the elderly and explore practical strategies to ensure adequate intake of these nutrients. 
&nbsp;

Importance of Calcium and Vitamin D

Calcium: The Building Block Of Strong Bones &ndash; Calcium is a mineral that is essential for maintaining bone health and density. It serves as the primary building block for bones and teeth, providing structural support and strength. Adequate calcium intake is particularly crucial for the elderly, as bone mass tends to decline with age, leading to an increased risk of <a href="https://merisehat.pk/disease/osteoporosis-80">osteoporosis </a>and fractures.

&nbsp;

Key Functions Of Calcium In The Elderly &ndash; The significance of calcium for the elderly extends beyond bone health. Here are some key functions of calcium:

<ol>
	<li style="list-style-type:decimal">Muscle Function &ndash; Calcium plays a vital role in muscle contraction and relaxation, including the heart muscles. Adequate calcium levels support optimal muscle function and help prevent age-related muscle weakness.</li>
	<li style="list-style-type:decimal">Blood Clotting &ndash; Calcium is involved in the blood clotting process, ensuring that wounds heal properly and preventing excessive bleeding.</li>
	<li style="list-style-type:decimal">Nerve Transmission &ndash; Calcium ions are necessary for transmitting nerve impulses throughout the body, enabling proper communication between the brain and other organs. 
	&nbsp;</li>
</ol>

Vitamin D: The Sunshine Vitamin &ndash; Vitamin D is unique among vitamins because the body can produce it in response to sunlight exposure. It also plays a crucial role in the absorption and utilization of calcium. For the elderly, who may spend less time outdoors and have reduced skin synthesis of vitamin D, maintaining adequate levels becomes particularly important. 
&nbsp;

Benefits Of Vitamin D For The Elderly &ndash; Vitamin D offers several benefits for the elderly population:

<ol>
	<li style="list-style-type:decimal">Calcium Absorption &ndash; Vitamin D facilitates the absorption of calcium from the digestive system into the bloodstream, ensuring that the body can utilize calcium effectively.</li>
	<li style="list-style-type:decimal">Bone Health &ndash; Vitamin D works in conjunction with calcium to promote strong and healthy bones, reducing the risk of fractures and osteoporosis.</li>
	<li style="list-style-type:decimal">Muscle Strength &ndash; Vitamin D deficiency has been linked to muscle weakness and an increased risk of falls in the elderly. Sufficient vitamin D levels support muscle strength and balance, reducing the likelihood of falls and related injuries.</li>
	<li style="list-style-type:decimal">Immune Function &ndash; Emerging research suggests that vitamin D plays a role in immune system regulation, potentially contributing to a lower risk of infections and autoimmune disorders in the elderly. 
	&nbsp;</li>
</ol>

Ensuring Adequate Calcium And Vitamin D Intake &ndash; To meet the calcium and vitamin D needs of the elderly, consider the following strategies:

<ol>
	<li style="list-style-type:decimal">Dietary Sources &ndash; Calcium-rich foods include dairy products (milk, yogurt, cheese), leafy greens (kale, broccoli), fortified plant-based milk alternatives and fish with edible bones (sardines, canned salmon). Vitamin D can be obtained from fatty fish (salmon, mackerel), egg yolks, fortified dairy products and exposure to sunlight.</li>
	<li style="list-style-type:decimal">Supplements &ndash; In cases where dietary intake is insufficient, calcium and vitamin D supplements may be recommended. Consult with a healthcare professional to determine appropriate supplementation based on individual needs.</li>
	<li style="list-style-type:decimal">Sunlight Exposure &ndash; Spending time outdoors in sunlight, particularly during the midday hours, allows the body to produce vitamin D naturally. However, caution should be exercised to avoid overexposure and protect the skin from harmful UV rays. 
	&nbsp;</li>
</ol>

Considerations and Precautions

While calcium and vitamin D are crucial for elderly health, it&#39;s important to be mindful of potential interactions or contraindications with certain medications or underlying health conditions. Consulting a healthcare professional or registered dietitian is advisable to ensure appropriate nutrient intake and address any individual concerns.

The Potential And Pitfalls Of Vitamin E Oil: Benefits, Risks, And Therapeutic Insights

Overview

Vitamin E oil, with its rich antioxidant properties and potential therapeutic benefits, has captured the attention of health-conscious individuals seeking natural remedies for various skin and health issues. Yet, beneath its promising exterior lies a complex story that intertwines both healing potential and potential toxicity. In this article, we will delve into the multifaceted world of Vitamin E oil, exploring its therapeutic range, possible benefits, and crucial considerations regarding its safety and usage. 
&nbsp;

Understanding Vitamin E

Vitamin E is a fat-soluble antioxidant known for its ability to neutralize free radicals, which can cause cellular damage. This antioxidant action makes Vitamin E a potential ally against aging, inflammation, and oxidative stress, the culprits behind many health issues. 
&nbsp;

<h5>The Therapeutic Benefits Of Vitamin E Oil</h5>

<ol>
	<li>Skin Health: Vitamin E oil is a staple in skincare routines, renowned for its moisturizing properties and potential to promote healing. It&#39;s often used to address dryness, scars, and skin irritations.</li>
	<li>Anti-Aging: Its antioxidant properties can help protect skin from environmental stressors, potentially reducing the appearance of fine lines and wrinkles.</li>
	<li>Wound Healing: Vitamin E&#39;s ability to accelerate cell regeneration makes it a candidate for promoting wound healing, including minor burns and cuts.</li>
	<li>Hair Health: Applied to hair, Vitamin E oil may contribute to hydration, shine, and overall hair health.</li>
	<li>Immune System Support: Vitamin E&#39;s role in immune function is believed to contribute to the body&#39;s defense against infections and illnesses. 
	&nbsp;</li>
</ol>

<h5>Navigating The Safety Spectrum: Balancing Potential Benefits And Risks</h5>

While Vitamin E oil presents a range of potential therapeutic benefits, it&#39;s essential to acknowledge the risks and limitations:

<ol>
	<li>Possible Toxicity: Vitamin E is a fat-soluble vitamin, meaning it can accumulate in the body over time. Excessive intake, especially through supplements, may lead to adverse effects, including gastrointestinal issues, increased bleeding risk, and interactions with blood-thinning medications.</li>
	<li>Allergic Reactions: Some individuals may be sensitive to Vitamin E oil, experiencing skin irritation, redness, or itching upon application.</li>
	<li>Acne Breakouts: In certain cases, using Vitamin E oil on the face can exacerbate <a href="https://merisehat.pk/disease/acne">acne</a>, especially for individuals with oily or acne-prone skin.</li>
	<li>Conflicting Studies: The scientific consensus on Vitamin E&#39;s effectiveness for certain health claims, like preventing heart disease or cancer, remains debated and inconsistent.</li>
	<li>Natural Vs. Synthetic: Natural Vitamin E (d-alpha-tocopherol) and synthetic Vitamin E (dl-alpha-tocopherol) have differing bioavailabilities. Natural forms are generally better absorbed and utilized by the body. 
	&nbsp;</li>
</ol>

<h5>Navigating Safe Usage And Therapeutic Range</h5>

To harness Vitamin E oil&#39;s potential while avoiding risks:

<ol>
	<li>Moderation: Focus on obtaining Vitamin E through a balanced diet rich in nuts, seeds, leafy greens, and whole grains. Excessive supplementation should be avoided.</li>
	<li>Patch Testing: Before applying Vitamin E oil to the skin, conduct a patch test to assess your skin&#39;s reaction and prevent adverse reactions.</li>
	<li>Quality Matters: When using Vitamin E oil, opt for high-quality, reputable brands to ensure you&#39;re getting the most benefit from the product.</li>
	<li>Consult A&nbsp;Professional: If you&#39;re considering Vitamin E supplementation, consult a healthcare professional to determine whether it&#39;s necessary and safe for your individual health profile.</li>
	<li>Diet Diversity: A well-rounded diet provides a broad spectrum of nutrients, including antioxidants, which collectively contribute to overall health and wellness. 
	&nbsp;</li>
</ol>

Bottom Line

Vitamin E oil holds great potential as a natural remedy, particularly for skin health and antioxidant support. However, its benefits should be approached with caution, considering potential toxicity and individual sensitivities. Striking a balance between informed usage and excessive supplementation is essential to harness Vitamin E oil&#39;s therapeutic properties effectively. By integrating Vitamin E-rich foods into your diet and practicing responsible application, you can tap into the potential of this antioxidant while avoiding unnecessary risks. Remember, balance and informed decisions are the keys to unlocking Vitamin E&#39;s true healing potential.

What You Need To Know Before Having Milk

Were you also a baby once? If yes, then chances are milk was the first thing you ever had. As we grow up, the importance of that daily glass of milk is drilled into us. Which begs the question what really is milk? Why is this one liquid so precious to us?

Milk is a nutrient-rich liquid produced by mammals such as cows, sheep and goats. None of us have been able to escape the barrage of information about how essential milk is to our existence. But is it all it&rsquo;s made out to be? Let&rsquo;s see the pros and cons:

&nbsp;

pros and cons

<ul>
	<li>Packed with all kinds of nutrients, vitamins, fats and even antioxidants</li>
	<li>Great source of protein</li>
	<li>Essential for bone and teeth health. Women can especially benefit a lot from consuming milk as they are prone to <a href="https://www.merisehat.pk/disease/osteoporosis-80">osteoporosis</a> 
	&nbsp;</li>
</ul>

<ul>
	<li>Some people can&rsquo;t digest lactose, a major component of milk. This can lead to bloating, diarrhea and a wide array of problems</li>
	<li>Some people are allergic to the protein present in cow milk</li>
	<li>Whole milk contains fats and cholesterol that are not safe for children with family history of heart disease 
	&nbsp;</li>
</ul>

Locally, whether we put it into the tea we drink 3-4 times a day (sometimes more!) or the various delicacies (kheer),&nbsp;we consume milk in enormous quantities. So, what are the options available to us? The main choice is between these two:&nbsp; 
&nbsp;

<ul dir="ltr">
	<li>
	<h5 dir="ltr">Fresh Milk</h5>
	</li>
</ul>

The milk man carrying steel containers full of milk on either side of his motorcycle and the huge trough at the milk shop are familiar sights. Most of our population prefers this based on the assumption that it does not contain chemicals and you get what you see. It&rsquo;s also what most of us can afford. But is it safe?&nbsp;

Milk that comes straight from the dairy farm to your home can be found to contain bacteria, such as E. coli and Salmonella. There is no strict check and balance when it comes to this option. We don&rsquo;t know what the animal was fed, what kind of cloth was used to filter it, whether the container it comes in was clean, what about the person who handled it? If you happen to walk past an open container of milk, you might see flies buzzing about, which begs the question: how hygienic is that? Another worst-kept secret is the fact that sometimes water is mixed into this milk, and sometimes even detergent is added to increase froth! All this can lead to myriads of health issues and stunted growth in children.

&nbsp;

<ul dir="ltr">
	<li>
	<h5 dir="ltr">Pre-packaged Or Milk In A Tetra-pack</h5>
	</li>
</ul>

A quick google search will tell you that Pakistan ranks second on the list of countries with contaminated milk. What is to be done then? Several brands of pre-packaged or tetra-pack milk are now available locally. Most of these are affordable for the general population.&nbsp;

Tetra-packs are sterile packaging containing milk that undergoes pasteurisation or UHT treatments which removes all impurities. The milk is heated and cooled to kill the bacteria and this is done following strict guidelines. So, what you eventually end up consuming has the least possibility of causing disease and infection.&nbsp;&nbsp;

Recently, the Punjab Food Authority (PFA) tested 16 different brands that are available locally and found that only six of them were safe to consume. These were Olper&rsquo;s, Nestle, Milk Pak, Day Fresh, Good Milk, and Nurpur Original.&nbsp;

We also have a bunch of brands that give us the option of hormone free milk such as Safe Milk, Prema Milk, PakMilk, Anhaar and Day Fresh.

<div>&nbsp;</div>

Lactose Intolerant

If you are, the good news is you have options.&nbsp;

Lactose is the main culprit (protein) that your body can&rsquo;t process. So, lactose free milk essentially contains the molecule already broken down into smaller bits. This way your milk won&rsquo;t end up wreaking the havoc that you might usually experience.&nbsp;

Lactose-free milk is as nutritious as regular milk and might be sweeter as well. Locally, we have brands such as Day Fresh that give us this option. Some other options are your plant and nut-based milk such as almond, coconut, cashew, soy and oat milk. These are as nutrient packed but have low quantities of protein. Now you can go ahead and enjoy your daily smoothie without having to pay for it heavily.&nbsp;

Dr. Safia Mehmood

As you know, a healthy pregnancy starts with a healthy diet. It&#39;s easy to focus on what you&#39;re eating, but it&#39;s also important to think about the <a href="https://www.merisehat.pk/article/a-guide-to-essential-vitamins-and-micronutrients-and-should-you-be-taking-them">nutrients </a>in your food and how they affect your body<a href="#accordion">[1]</a>. That&#39;s where prenatal vitamins come in! These supplements contain important vitamins and minerals that help you avoid certain complications and give your baby a head start in life.&nbsp;

With so many options out there, it can be hard to know which one is best for you and your baby. This guide will elaborate on what makes a good prenatal vitamin, so you can make the right choices. 
&nbsp;

Understanding The Importance Of Prenatal Vitamins

Prenatal vitamins are a supplement used by pregnant women in order to ensure they get the recommended daily allowance of nutrients. These vitamins may also be referred to as &quot;prenatal supplements.&quot;

They are usually taken as a single dose but it&rsquo;s also okay to divide them into smaller doses throughout the day as long as you take them according to the directions on your prenatal vitamin package.&nbsp;

The recommended daily allowance (RDA) is an estimate of how much nutrition you need each day based on what&#39;s recommended for maintaining good health. The amount varies depending on factors like your age, gender, and activity level &mdash; the RDA is higher if you&#39;re pregnant or breastfeeding because during those periods your body needs more nutrition than usual. Prenatal vitamins help fill in any gaps that might exist between what you consume through food alone and what your body actually needs. 
&nbsp;

Prenatal vitamins are important for you and your baby in several ways, including:&nbsp;

Preventing Birth Defects: Prenatal vitamins help prevent neural tube defects, like spina bifida, by building your baby&#39;s brain and spinal cord during pregnancy.

Reducing The Risk Of Preeclampsia: Prenatal vitamins can also reduce your risk of preeclampsia, a pregnancy-related complication that causes high blood pressure and organ damage to mom and baby alike.

Lowering Your Chances Of Premature Birth Or Low-Birth-Weight Baby: Prenatal vitamins help keep the baby&rsquo;s organs healthy so they can grow inside your belly properly &mdash; making it less likely that you&rsquo;ll go into labor too early or have a low-birth-weight baby (less than 5 pounds)<a href="#accordion">[2]</a>. 
&nbsp;

To choose the right prenatal, look for one that has all the essential vitamins and minerals. Your doctor or midwife will recommend a brand they like, but you can also read reviews online to see what other women are saying about them.

&nbsp;

Keep in mind that there are 2 types of prenatal vitamins:&nbsp;

<ol>
	<li>Standard</li>
	<li>Chewable (or coated).&nbsp;</li>
</ol>

&nbsp;

If you don&#39;t like taking pills, go with a chewable option. If your doctor recommends one type over another given your condition, it&rsquo;s best to follow their advice<a href="#accordion">[3]</a>.

&nbsp;

<ul>
	<li>
	<h5>Vitamin D</h5>
	</li>
</ul>

Vitamin D is a fat-soluble vitamin that plays an important role in bone health and immune function.&nbsp;

There are 2 types of vitamin D &ndash; vitamin D2 (also called ergocalciferol) and vitamin D3 (also called cholecalciferol). Vitamin D2 is synthesized by plants, while the more bioactive form, vitamin D3, can only be obtained from animal sources like fish or fortified foods.

Its deficiency has been linked to an increased risk of conditions, like osteoporosis, heart disease, and cancer. So, pregnant women need to get enough vitamin D. You should aim for 600 IU daily during pregnancy or any other time when you&#39;re not breastfeeding.

You can get vitamin D through food sources such as salmon and cheese. If you don&#39;t eat these foods often enough, then consider taking a supplement with at least 400 IU per day.

&nbsp;

<ul>
	<li>
	<h5>Vitamin C</h5>
	</li>
</ul>

Ideally, the first prenatal vitamin you should be taking is a high-quality multivitamin. Most prenatal vitamins contain additional iron and folic acid. Choose one with 0% sugar and minimal ingredients as this will reduce the chance of diarrhea.

Vitamin C helps your body absorb iron from other foods, but it does not contain any iron itself. The recommended dose for adults is about 90 mg daily, however, you may need more if you are pregnant or breastfeeding because vitamin C helps with skin health and morning sickness (both common issues in pregnancy).

&nbsp;

<ul>
	<li>
	<h5>Folic Acid</h5>
	</li>
</ul>

Folic acid plays an important role in pregnancy as it helps prevent neural tube defects (NTDs). NTDs are serious birth defects that can lead to lifelong disabilities. They occur during the first month of pregnancy when a baby&#39;s spinal cord and brain are developing.&nbsp;

Folic acid works with other nutrients to help form red blood cells, which carry oxygen throughout your body. And since you need adequate red blood cell levels for your growing baby, you need folic acid, too!

Leafy green vegetables, like kale and spinach, are rich in folic acid. Beans and legumes are other great sources of this nutrient; just one cup of cooked lentils contains 35 micrograms (mcg) of folate! Whole grains, like oatmeal, also contain some folic acid naturally; one serving has about half the recommended amount per day (400 mcg). Not only that but fortified cereals and breads provide some additional doses too at 100% Daily Value or 25% Daily Value depending on which type they claim on their packaging label(s).

However, with morning sickness and mood swings, the chances of you eating all these green veggies in the right amounts are very minimal, which is why supplements are your best bet.&nbsp; 
&nbsp;

In conclusion, prenatal vitamins are an easy and effective way to make sure you and your baby are getting the nutrients you need. Prenatal vitamins support a healthy pregnancy, reducing the risk of neural tube defects, preterm birth, and low birth weight. As always, be sure to talk to <a href="https://www.merisehat.pk/doctor-now">your doctor</a> before starting any new supplement routine. They will be able to help you figure out the best option for you and your developing baby! 
&nbsp;

Prenatal vitamins are the supplements recommended for pregnant women to take during their pregnancies. <ul><li>They contain a good blend of multiple nutrients in safe amounts to allow a healthy pregnancy and support your baby’s growth.</li><li>Prenatal vitamins support a healthy pregnancy, reducing the risk of neural tube defects, preterm birth, and low birth weight.&nbsp;</li><li>Be sure to talk to your doctor before starting any new supplement routine.</li></ul>