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Ismail Munir

‘Don’t touch the pickle!’ ‘Don’t take a shower!’ Menstrual myths no more! Learn about the signs of period and menstrual cycle myths at Meri Sehat.

Common Menstrual Myths In The Society

Madeeha Syed

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What Anti-Vaxxers Get Wrong About the Polio Vaccine

Overview

Polio is a thing of the past, right? You don&rsquo;t see it much in the news anymore and it&rsquo;s not something we really have to worry about. Well, anti-vaxxers would like you to think that this is true. But it isn&rsquo;t. Polio still exists today and, if you&rsquo;re not vaccinated against it, you could get polio or spread it to someone else who might die from it. It&rsquo;s important for everyone not just parents with children to know how vaccines work and why they&rsquo;re safe.&nbsp;

<div>&nbsp;</div>

Anti-Vaxxers  About  Polio Vaccine

The anti-vaccine movement is growing increasingly popular, despite the fact that many of its arguments are based on erroneous historical facts. Here are just a few:

<ul>
	<li>Vaccines aren&rsquo;t effective</li>
	<li>They do not cause infertility</li>
	<li>No, your government is not injecting you with nanochips to track you</li>
	<li><a href="https://merisehat.pk/disease/autism" target="_blank">They cause autism</a></li>
	<li>They&rsquo;re not necessary because polio hasn&rsquo;t been around for decades now</li>
</ul>

&nbsp;

It&rsquo;s important to remember that, as we speak, polio is still a problem in many countries. In fact, the World Health Organisation still refers to it as an &ldquo;endemic&rdquo; disease. Since 1988 , when the UN certified that polio had been eradicated in every country on Earth, there have been only 21 cases of wild poliovirus found globally: 16 in Somalia and five in Pakistan (the last case on this list occurred just this past September).

But while anti-vaxxers are right that vaccines can&rsquo;t prevent all disease outbreaks, they&rsquo;re wrong about why we need them at all. Because the truth is this: vaccines aren&rsquo;t just useful for preventing one infectious illness, they&rsquo;re also useful for preventing other diseases from spreading by stopping people from getting sick with them too. That&rsquo;s why some people think of vaccines as a sort of &ldquo;immunity insurance&rdquo; against outbreaks rather than just something you need when you actually start showing symptoms of an illness like measles or mumps (which are both very contagious). 
&nbsp;

Thimerosal is a preservative that prevents the growth of harmful bacteria in vaccines. It has been used since the 1930s, and thimerosal-free vaccines have been available for several years. There is absolutely no scientific evidence that links thimerosal to any health problems. In fact, all credible studies have shown just the opposite. In fact, it&rsquo;s safe to use as a preservative in food items, too!

Although many anti-vaxxers will try to tell you otherwise, thimerosal isn&rsquo;t dangerous or toxic at all. It&rsquo;s just an additive used by doctors and manufacturers alike in order to make sure our vaccinations remain effective while they&#39;re being stored and transported around the world!

<div>&nbsp;</div>

It&rsquo;s important to note that the polio vaccine does not cause cancer. Nor does it cause autism, any other brain defect, autoimmune disease, or death. The idea that vaccines are some kind of hoax like climate change denialism or flat-Earth-ism is a conspiracy theory with no basis in reality. We know this because there is plenty of evidence to prove that vaccines work and are safe for children (and adults). 
&nbsp;

Vaccines Are Safe

Polio Vaccine Is Important, Polio Vaccine Is Safe: You may be thinking that anti-vaxxers are a bunch of crazy people, but there&rsquo;s actually a lot to like about them. They&rsquo;re confident in their beliefs and not afraid to stand up for what they believe in. They&rsquo;re also highly educated, which makes them more likely than others to be able to articulate their beliefs effectively.

What anti-vaxxers get wrong about polio vaccines is that it&rsquo;s not just one type of vaccine; it&#39;s two types: oral polio vaccine (OPV) and inactivated polio vaccine (IPV). The OPV is commonly used in Pakistan due to its ease of administration. The oral polio vaccine also eradicates the need for the presence of a healthcare professional and highly sterile equipment. This has allowed Pakistan to conduct vaccinations on a mass level. Whereas the IPV on the other hand, requires the presence of proper healthcare workers, sterile equipment and multiple doses. IPV is far more effective than OPV but since we are on a mission to completely eradicate polio from the face of earth, whatever vaccine you can get your hands on, works.&nbsp;

Many countries stopped using OPVs long ago because they discovered that although it could prevent children from getting paralysed by wild versions of poliovirus, these viruses would still circulate around the community throughout childhood &mdash; which meant other kids might get infected anyway! The risk/benefit ratio was no longer proportionate. 
&nbsp;

Bottom Line

I hope that this has helped to clear up some of the misconceptions about polio vaccines. It is important to note that the polio vaccine is not a one-size-fits-all approach, and there are many factors involved in deciding whether or not you should receive it. However, these arguments do not mean that anti-vaxxers are wrong about everything: they are right in their belief that public health decisions should be made on the basis of science rather than fear mongering.&nbsp;

Umna Salah

Mental Health Tips For Dysmenorrhea

Introduction

If you&#39;re a woman in your 20s, 30s, or really any age, there must have been days when you struggled with your mental health. Dark thoughts, anxiety, low mood, an inability to carry out normal day-to-day chores, chances are you&#39;ve experienced them all. And if you suffer from <a href="https://www.merisehat.pk/disease/dysmenorrhea">dysmenorrhea</a>, then the chances of anxiety, irritability, etc. become much higher. Despite society conditioning us into thinking that period pain is a part of life, there is nothing okay about having to deal with debilitating pain on a monthly basis.

<a href="https://www.merisehat.pk/disease/dysmenorrhea">Dysmenorrhea</a>, also called painful menstruation, affects more than 50% of university students in Pakistan<a href="#accordion">[1]</a>. Along with severe pain, many women also report sleep disturbances, difficulty concentrating on work or studies, and frequent leaves from work or school<a href="#accordion">[2]</a>. Additionally, women with dysmenorrhea have higher depression and anxiety scores<a href="#accordion">[3]</a>. Thus, significantly impacting their quality of life.

So, if you&#39;re someone struggling with dysmenorrhea and its mental health effects, here are some of the things you can do to feel better.

&nbsp;

Understanding Dysmenorrhea And Mental Health

Over five thousand years ago, people in Northern India developed what we now call yoga. The exercise and relaxation method has evolved over the years, but what has remained the same is its ability to help people heal, both physically and emotionally. Yoga isn&#39;t just some exercise. It is also a way for people ground themselves and connect with their thoughts.

In dysmenorrhea, the increased levels of prostaglandins and estrogen cause the uterine muscles to contract. As these muscles contract, they push against the surrounding blood vessels, temporarily cutting off the oxygen supply to the muscle. Thus, resulting in pain around the lower abdomen and back.&nbsp;

Various yoga poses can help relax the muscles and improve the blood supply to the pelvic region. Moreover, the various stretches also help calm the mind and revive your energy. However, no one&#39;s asking you to twist your body into crazy positions. You can start by practicing simple poses such as the pigeon pose, fish pose, bound angle pose, and child&#39;s pose. It&#39;s best to avoid leg lifts and any rigorous physical activity during the first few days of your periods.&nbsp;

&nbsp;

Deep breathing exercises involve a combination of slow, deep inhales and exhales. They help increase blood flow in the blood vessels, relax muscles, and reduce pain perception. Thus, relieving anxiety and depression symptoms among people. It is also one of non-pharmacological methods of reducing pain in women with dysmenorrhea.

&nbsp;

Here&#39;s a simple deep breathing exercise you can try next time you feel anxious or low on emery:

<ol>
	<li>Lie on your back in bed or on a yoga mat.</li>
	<li>Inhale and exhale to relax your body.</li>
	<li>Now place a hand on your belly.</li>
	<li>As you take a deep breath in, feel your belly rise into your hand.</li>
	<li>Breath out slowly and feel the belly move down as the air exits your body.</li>
	<li>Take three more breaths like this, focusing on the movement of your belly and feeling the air filling your body and leaving with every exhale.</li>
</ol>

&nbsp;

Conclusion

Dysmenorrhea can be an extremely debilitating condition for women. Coupled with pain, women are also affected with mental health disorders such as depression and anxiety. Therefore, it is important to increase awareness about the mental health implications of this gynecological disorder. Moreover, researchers believe that psychiatric intervention can help women and adolescent girls suffering from dysmenorrhea have a better quality of life.

Key Points

<ul>
</ul>

<ul>
	<li>Dysmenorrhea, defined as painful menstruation, is associated with higher depression and anxiety levels among women.</li>
	<li>Yoga is a simple exercise technique that can help relax muscles and calm the mind, helping ease symptoms of depression and anxiety in women with dysmenorrhea.</li>
	<li>Deep breathing exercises involve slow, deep breaths that increase oxygenation of muscles and blood vessels; thus, relaxing muscles and reducing anxiety and depression.</li>
	<li>There is a need for a multidisciplinary approach in women suffering from dysmenorrhea. Psychological intervention can help improve their quality of life.</li>
</ul>

&nbsp;

[1] Yasir, S., Kant, B. & Dar, M. F., 2014. FREQUENCY OF DYSMENORRHOEA, ITS IMPACT AND MANAGEMENT STRATEGIES ADOPTED BY MEDICAL STUDENTS. Journal of Ayub Medical College Abbotabad, 26(3).

[2] Unsal, A. et al., 2010. Prevalence of dysmenorrhea and its effect on quality of life among a group of female university students. Upsala Journal of Medical Sciences, 115(2), pp. 138-145.

[3] Sahin, N. et al., 2018. Assessment of anxiety-depression levels and perceptions of quality of life in adolescents with dysmenorrhea. Reproductive Health, Volume 15.

Nimrah H. Sattar

Medilink Consultant clinic

ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

Managing Pain In Dysmenorrhea

<a href="https://www.merisehat.pk/disease/dysmenorrhea">Dysmenorrhea</a> is a common occurrence among adolescent girls<a href="#accordion">[1]</a>. Also called painful menstruation, the condition affects 50% of university students across Pakistan<a href="#accordion">[2]</a>. In the majority of women, the pain is also associated with nausea, vomiting, fatigue, and mood disturbances.&nbsp;

Dysmenorrhea is of two types: primary and secondary. Primary dysmenorrhea develops in the absence of any underlying medical condition and is usually caused by an increase in prostaglandin activity. On the other hand, secondary dysmenorrhea results from pelvic pathology such as fibroids, endometriosis, pelvic inflammatory disease (PID), ovarian cysts, or several others.&nbsp;

While the level of pain varies from person to person, in many the symptom of dysmenorrhea significantly impacts their quality of life. Difficulty concentrating on studies, sleep disturbances, limited participation in sports, and frequent class and work absenteeism are common feature<a href="#accordion">[3]</a>.&nbsp;

Therefore, effective pain management techniques are highly important in helping women achieve some normalcy in life. There are several pharmacological and nonpharmacological methods available to help relieve pain.&nbsp;

&nbsp;

Understanding Dysmenorrhea And Pain Management

These include conventional treatments such as over-the-counter pain relief medications and hormonal contraceptives:

&nbsp;

<h5>1. Pain Relievers</h5>

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are effective at reducing the levels of prostaglandins in the body. This in turn reduces uterine contraction and helps relieve dysmenorrhea. They are used for both primary and secondary dysmenorrhea. However, their use is contraindicated in people with gastritis, peptic ulcer, renal problems, or bleeding conditions due to adverse effects. Moreover, for many women NSAIDs fail to provide the desired effect of pain relief.&nbsp;In some women, doctors may also prescribe analgesics such as aspirin and acetaminophen in combination with NSAIDs or alone.

&nbsp;

<h5>2. Hormonal Contraceptives</h5>

These work by blocking ovulation and decreasing menstrual flow; thus, alleviating pain. Some options include oral contraceptive pills, hormonal intrauterine contraceptive devices (IUCD), and hormonal injections. While they can provide better relief of pain than NSAIDs, they are associated with side effects such as weight gain, menstrual irregularities, and mood changes. Moreover, they are often prescribed to women not looking to conceive.&nbsp;

&nbsp;

Over the years, the use of nonpharmacological methods which commonly involve complementary and alternative medicine has steadily increased<a href="#accordion">[4]</a>.&nbsp;Bed rest is one of the most common methods employed by university students in Pakistan for pain management followed by oil massage, drinking turmeric milk, and using hot water bottles<a href="#accordion">[5]</a>.&nbsp;

 
Generally, at-home treatments for relieving dysmenorrhea include:

<ul>
	<li>Placing a heating pad or hot water bottle on the pelvic and back area can help reduce muscular spasms.</li>
	<li>Massaging the abdomen and back using essential oils such as lavender, rose, and peppermint.</li>
	<li>Taking warm baths.</li>
	<li>Taking vitamin B1 (thiamine) supplements daily.</li>
	<li>Avoiding caffeine, smoking, and alcohol.&nbsp;</li>
	<li>Daily exercise can also help prevent painful menstrual cramps.</li>
</ul>

&nbsp;

<ul>
	<li>
	<h5>Ginger</h5>
	</li>
</ul>

The use of ginger has also been shown to cause a significant reduction in pain. Researchers attribute the effects to ginger&#39;s anti-inflammatory action that is brought about by the inhibition of prostaglandin synthesis. In a study, ginger was shown to be as effective as ibuprofen and mefenamic acid in relieving pain in women with primary dysmenorrhea<a href="#accordion">[6]</a>.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Complementary Methods</h5>
	</li>
</ul>

Some alternative or complementary methods may also be employed for dysmenorrhea. These include:

&nbsp;

<h5>1. Yoga</h5>

Several yoga poses can provide relief from painful menstruation. The gentle exercise has been linked to the release of endorphins and reducing menstrual pain.

&nbsp;

<h5>2.&nbsp;Acupuncture And Acupressure</h5>

Certain acupuncture points help reduce muscular contractions by regulating blood flow to these areas. Thus, reducing pain.

&nbsp;

<h5>3. Herbs</h5>

Herbal remedies such as chamomile tea, fennel seeds, and cinnamon have anti-inflammatory and antispasmodic action that reduce muscular contractors and relieve pain.&nbsp;

&nbsp;

<h5>4.&nbsp;Transcutaneous Electrical Nerve Stimulation (TENS)</h5>

Through electrical pulses, the body is stimulated to release endorphins which help reduce pain.

&nbsp;

Menstrual pain is often dismissed as a normal part of women&#39;s lives. This results in young women never seeking medical attention for dysmenorrhea. Thus, causing significant physical and emotional distress. Not only can dysmenorrhea affect one&#39;s academic performance but also limit their day-to-day functioning.&nbsp;

Despite the high prevalence of dysmenorrhea, there is a lack of awareness among women about the various pain management methods available to them. The majority of women self-medicate with NSAIDs or analgesics. However, these often cause side effects and/or fail to provide relief. Therefore, there is a need for more effective and safe pain management strategies. Moreover, women should be counseled about the various complementary and alternative medicine methods such as yoga and breathing exercises that can provide relief of symptoms.

&nbsp;

<ul></ul><ul><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Dysmenorrhea is defined as painful menstruation and leads to significant reduction in quality of life.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Pharmacological methods for pain relief involve the use of over-the-counter pain medications such as NSAIDS and hormonal contraceptives.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Since pharmacological therapies can have side effects, many women resort to home remedies such as massage, heating pads, massage, and exercise.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Complementary and alternative medicine methods such as yoga, acupuncture, and herbal supplements are also gaining momentum for treatment of dysmenorrhea.</li></ul>

[1] Ullah, A. et al., 2021. Prevalence of Dysmenorrhea and Determinants of Pain Intensity Among University-Age Women. Pain Medicine, 22(12), pp. 2851-2862.

[2] Yasir, S., Kant, B. & Dar, M. F., 2014. FREQUENCY OF DYSMENORRHOEA, ITS IMPACT AND MANAGEMENT STRATEGIES ADOPTED BY MEDICAL STUDENTS. Journal of Ayub Medical College Abbotabad, 26(3).

[3] Unsal, A. et al., 2010. Prevalence of dysmenorrhea and its effect on quality of life among a group of female university students. Upsala Journal of Medical Sciences, 115(2), pp. 138-145.

[4] Yu, A., 2014. Complementary and alternative treatments for primary dysmenorrhea in adolescents. The Nurse Practitioner, 39(11), pp. 1-12.

[5] Mansoor, H. et al., 2020. Menstrual knowledge and practices of Pakistani girls: A multicenter, cross-sectional study. Heliyon, 6(1).

[6] Jenabi, E., 2013. The effect of ginger for relieving of primary dysmenorrhoea. Journal of the Pakistan Medical Association, 63(1).

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

To Bleed Or Not To Bleed?

Society, culture, and religion have fixed certain roles for each gender. For women, it is traditionally the role of the mother, the nurturer, and the caretaker. For centuries, they have prioritized family life. Whether they have been asked to, whether there was no other option available, whether out of choice; the thing is many women have come to put others&rsquo; needs above their own. They become givers and, in the process, forget they are also entitled to love and care.&nbsp;

&nbsp;

Moreover, in South Asian communities, women are often restricted in mobility. As a result, they have limited healthcare access, are subjected to male violence, and do not hold the power to make decisions for themselves or their families<a href="#accordion">[1]</a>. This further devalues their role in terms of how they perceive themselves as well as how society perceives them.&nbsp;

&nbsp;

When even their basic needs are not met, women stop paying attention to common and major healthcare concerns. Thus, they are less likely to seek care, especially when it concerns reproductive health. Of course, the existence of cultural taboos does not help this situation; they&rsquo;ve just internalized this lack of confidence along with a poor sense of worth.&nbsp;&nbsp; 
&nbsp;

Understanding Post Menopausal Bleeding

Although menstruation is a natural biological process, in low- and middle-income countries, there are several stigmas surrounding the physiological phenomenon<a href="#accordion">[2]</a>.&nbsp;

&nbsp;

The lack of knowledge regarding female reproductive health and the spread of incorrect information means many women are unaware of when to seek help. A cross-sectional survey conducted at a government hospital in Karachi, Pakistan, found that more than 90% of women had heard of menopause<a href="#accordion">[3]</a>. However, only 30% knew about the symptoms<a href="#accordion">[3]</a>.&nbsp;

&nbsp;

A lack of awareness of <a href="https://merisehat.pk/disease/menopause">menopause symptoms</a> means many women are also unaware of what&rsquo;s normal and what&rsquo;s not. Therefore, they often disregard symptoms such as postmenopausal bleeding.&nbsp;

&nbsp;

But is postmenopausal bleeding a cause for concern? Should you be booking a visit to the gynecologist?&nbsp;

&nbsp;

<h5>Menopause&nbsp;</h5>

Menopause is defined as the cessation of menstrual cycles for a period of 12 consecutive months. Postmenopause is the period following menopause. The average age of menopause is 51 years<a href="#accordion">[4]</a>, whereas in Pakistan, the mean age of menopause for women is 49.3 years<a href="#accordion">[5]</a>.&nbsp;

&nbsp;

The common symptoms of menopause include:

<ul>
	<li>Mood changes</li>
	<li>Hot flashes</li>
	<li>Hair loss</li>
	<li>Vaginal dryness</li>
	<li>Insomnia</li>
</ul>

&nbsp;

Often, these symptoms linger into the postmenopause period.&nbsp;

&nbsp;

IMPORTANT: One thing that&rsquo;s not a normal side effect of menopause, and should be a cause for concern, is the presence of vaginal bleeding.&nbsp;

&nbsp;

<h5>Postmenopausal Bleeding</h5>

Postmenopausal bleeding is defined as vaginal bleeding after a year or more of cessation of menstruation. Approximately 4-11% of postmenopausal women report vaginal bleeding<a href="#accordion">[4]</a>. And about 1-14% of postmenopausal bleeding is secondary to endometrial cancer<a href="#accordion">[4]</a>.&nbsp;

&nbsp;

Although vaginal atrophy is the most common cause of postmenopausal bleeding, 90% of postmenopausal women with endometrial cancer have vaginal bleeding as the presenting sign<a href="#accordion">[6]</a>. Therefore, there is a need for raising awareness about postmenopausal bleeding and its possible causes.&nbsp;

&nbsp;

After menopause, there is a drop in estrogen levels in the body. The tissues lining the vagina and endometrium begin to undergo atrophy. Micro-erosions along with chronic inflammation develop on the epithelial surface. This inflamed endometrium is then prone to slight bleeding.&nbsp;

&nbsp;

Other causes of postmenopausal bleeding include:

<ul>
	<li>Endometrial Or Uterine Cancer:&nbsp;Endometrial cancer could result in a thickening of the uterus lining. It causes the lining to shed and result in vaginal bleeding.&nbsp;</li>
	<li>Polyps:&nbsp;These result from an overgrowth of the endometrium and could appear in the uterus or cervix. They&rsquo;re not cancerous but likely to result in spotting or heavy bleeding.&nbsp;</li>
	<li>Fibroids:&nbsp;Also called leiomyomas, fibroids are noncancerous growth of muscle and tissue that form from the uterine walls. While small fibroids are typically asymptomatic, larger ones could cause vaginal bleeding.&nbsp;</li>
	<li>Endometrial Hyperplasia:&nbsp;Low progesterone levels and too much estrogen result in endometrial thickening. The thickened endometrium is at risk of bleeding and also able to transform into cancer.&nbsp;</li>
	<li>Sexually Transmitted Diseases (STDs):&nbsp;Vaginal bleeding after sexual intercourse might be a result of STDs such as chlamydia and gonorrhea.&nbsp;</li>
	<li>Medications:&nbsp;The use of certain drugs is associated with vaginal bleeding as a side effect. These include tamoxifen, blood thinners, or hormone replacement therapy.</li>
	<li>Pelvic Trauma:&nbsp;Injury to the vagina also causes bleeding.</li>
</ul>

&nbsp;

A cross-sectional study conducted in Mardan, Pakistan, determined the patterns of bleeding and endometrial biopsy in women presenting with postmenopausal bleeding. As per the results, 26% of the patients had atrophic endometrium while 23% had endometrial carcinoma<a href="#accordion">[7]</a>, thus, proving the need for a proper assessment of postmenopausal bleeding in women.

&nbsp;

Another cross-sectional study was conducted among postmenopausal women in Sahiwal, Pakistan. Half of the women were obese, which established obesity as a risk factor for postmenopausal bleeding<a href="#accordion">[8]</a>. Moreover, the incidence of endometrial carcinoma was 7% among women<a href="#accordion">[8]</a>. The study points to the need for endometrial cancer screening programs, especially among menopausal women complaining of vaginal bleeding.&nbsp;

&nbsp;

Regardless of the reason, postmenopausal bleeding is a cause for concern. Therefore, if you notice spotting or vaginal bleeding post-menopause, book an appointment with the obstetrician-gynecologist. Early diagnosis would improve prognosis for the patient, and their overall quality of life.&nbsp;

<ul><li>Postmenopausal bleeding is defined as vaginal bleeding that occurs 12 months after the cessation of the menstrual cycle.&nbsp;</li><li>Vaginal or endometrial atrophy is the most common cause of postmenopausal bleeding. However, 90% of postmenopausal women with endometrial cancer have vaginal bleeding as the presenting sign.</li><li>Other common causes of postmenopausal bleeding include polyps, fibroids, endometrial hyperplasia, medications, and sexually transmitted diseases.&nbsp;</li><li>All cases of postmenopausal bleeding require immediate consultation with the obstetrician-gynecologist. A delay in diagnosis could have a poor outcome for the patient.&nbsp;</li></ul>

[1] Fikree, F. F., & Pasha, O. (2004). Role of gender in health disparity: the South Asian context. BMJ (Clinical research ed.), 328(7443), 823–826.

[2] Arshad Ali S, Baloch M, Riaz L, et al. (August 20, 2020) Perceptions, Practices, and Challenges Regarding Menstrual Hygiene Among Women in Karachi, Pakistan: A Comparison Between General Population and Healthcare Workers. Cureus 12(8): e9894. doi:10.7759/cureus.9894

[3] Karim, F., Ghazi, A., Ali, T., Jabbar, S., Naz, S., & Aslam, R. (2013). Women’s Perception Towards Menopause. Journal of Surgery Pakistan (International), 18(3).

[4] Sung S, Abramovitz A. Postmenopausal Bleeding. [Updated 2022 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.

[5] Jadoon AK, Sohail F, Qabulio SN, et al. Perception and Awareness of Menopause among Premenopausal Women of Different Socioeconomic Backgrounds. J South Asian Feder Menopause Soc 2019;7(1):8–13.

[6] ACOG Committee Opinion No. 734: The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding. Obstet Gynecol. 2018 May;131(5):e124-e129.

[7] Jadoon S, et al. Postmenopausal Bleeding - A Strong Indicator of Endometrial Carcinoma. Pak Armed Forces Med J 2019; 69 (2): 368-72

[8] Perveen, S., Azhar, M. S., Shah, F., Mahmood, F., & Mahmood, U. (2022). Association of postmenopausal bleeding with endometrial carcinoma. Pakistan Journal of Medical and Health Sciences, 16(3), 103–105.

Iqra Mazhar

This article or video has been viewed by many visitors, and is popular.

I’m Hot. It’s Not Summer, It’s Just Menopause

<a href="https://www.merisehat.pk/disease/menopause">Menopause</a> marks the evident end of regular menstrual cycles. The term can depict any progressions one goes through nearing the end of menstruation, or what one may experience closely after it, indicating the completion of your reproductive years and stages.&nbsp; 
&nbsp;

Menopause and perimenopause can cause side effects like nervousness, mood swings, mind haze, hot flushes, and irregular periods. These side effects can begin a long time before the end of the menstrual cycle and continue a while later. Menopause and perimenopause side effects can hugely affect the individual&rsquo;s life, including social interactions and work. However, there are multiple ways that can help you deal with these side effects. Several medications, for instance, can help replace the missing or reduced chemicals associated with menopause and help ease the unavoidable signs and symptoms.

&nbsp;

Understanding menopause and how to deal with its symptoms

Menopause is a natural process that all menstruating women must go through. It may occur due to one of the following reasons: 
&nbsp;

<ul>
	<li>Natural Menopause: During their 40s, most women observe changes to their regular cycles. The cycles may become longer or more limited, heavier or lighter, more frequent or with much significant dry spells, until the ovaries stop producing eggs and menopause commences. This occurs, on average, by the age of 51 years<a href="#accordion">[1]</a>. 
	&nbsp;</li>
	<li>Surgical Procedures: Surgical procedures such as oophorectomy or removal of ovaries are also associated with causing menopause. The ovaries are responsible for producing hormones, including estrogen and progesterone that control, monitor, and synchronize the monthly menstrual cycle. Thus, medical procedures to remove the ovaries cause early and prompt menopause. The monthly periods halt, and the person goes through the various menopausal signs and symptoms<a href="#accordion">[1]</a>. 
	&nbsp;</li>
	<li>Chemotherapy Or Radiation Therapy: These disease treatments can affect menopause by causing side effects such as hot flashes during or not long after the course of treatment. Following chemotherapy, the stop to the monthly cycle (and fertility) is not necessarily irreversible or long-lasting, so contraceptive measures might be needed<a href="#accordion">[1]</a>. 
	&nbsp;</li>
	<li>Primary Ovarian Insufficiency: Early menopause might result from the inadequate production of reproductive hormones by the ovaries, a condition called primary ovarian insufficiency. It can result from hereditary elements or immune system illness. Hormone treatment is regularly suggested until the normal period of menopause to safeguard the cerebrum, heart, and bones<a href="#accordion">[2]</a>.&nbsp;</li>
</ul>

&nbsp;

Menopause is not easily self-diagnosed and missing a period for more than three months is a concerning state. The most common symptoms of menopause include: 
&nbsp;

<ul>
	<li>Hot Flashes</li>
	<li>Insomnia</li>
	<li>Vaginal Dryness</li>
	<li>Urinary Incontinence</li>
	<li>Mood Changes 
	&nbsp;</li>
</ul>

An individual may experience one or more symptoms and should consult medical healthcare providers to confirm the suspicion of menopause. They will monitor and examine your symptoms to guide you towards an efficient treatment.&nbsp; 
&nbsp;

While certain lifestyle changes and drugs may forestall menopause, it is a natural and inevitable process every menstruating woman must go through. However, certain measures may help alleviate its symptoms.

&nbsp;

<h5>1. Hot Flashes</h5>

Hot flashes are the most prevalent symptoms of menopause. It is the unexpected sensation of warmth in the chest area, but is normally experienced with a greater sensation over the face, neck, and chest. Your skin can blush, as though you are becoming embarrassed. A hot flash can likewise cause extreme perspiration. Assuming you lose a lot of body heat, you can feel chills a short time later. Night sweats are hot flashes that occur at night<a href="#accordion">[3]</a>. 
&nbsp;

Phytoestrogens naturally occur in plants and certain food sources. Research suggests that these substances can, to some extent, reverse the hormonal imbalance associated with menopause<a href="#accordion">[4]</a>. Soy-based food varieties contain elevated degrees of phytoestrogens, so eating loads of tofu is recommended to decrease the overwhelming effects of hot flashes. Moreover, it is highly recommended to stay away from food triggers that can make you sweat as they increase your basal temperature. These include hot drinks, spicy food, and liquor. And remember to stay hydrated! 
&nbsp;

Exercise likewise facilitates the discomfort of hot flashes by bringing down levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Try to get at least 20 minutes of physical activity, three times each week. As per the National Center for Complementary and Integrative Health, acupuncture can also help reduce hot flashes in postmenopausal women<a href="#accordion">[5]</a>. 
&nbsp;

<h5>2. Insomnia</h5>

During menopause, it appears as though you are constantly drained and exhausted. To exacerbate the situation, hot flashes and various other side effects disrupt a person&rsquo;s sleep. Having a consistent sleep routine helps individuals to get the necessary amount of rest, especially during menopause when they are fatigued. To adhere to a timetable, set up your brain and body for rest by fostering a soothing bedtime ritual that starts around a similar time each night. For instance, clean up, listen to calming music, read a book, or do different exercises that help you relax. These practices indicate to your body that it&rsquo;s almost time to sleep. Thus, helping you to nod off with ease. 
&nbsp;

Once you get in bed, abstain from staring at the TV, using your laptop, or checking your phone. The blue light from gleaming electronic screens smothers your body&#39;s development of melatonin, a hormone that affects sleep. Moreover, try to abstain from working, eating, and having a serious conversation with anyone especially your spouse once you have settled into your bedroom. Reinforcing the relationship between your bed and rest might assist you with clearing your brain at bedtime. Ensure you are in a comfortable atmosphere by adjusting the temperature of the AC or heater, and getting a new fluffier pillow. If you live in a metropolitan city, get ear plugs so that the noises outside do not disturb you, and drink a cup of chamomile tea before going to bed.&nbsp; 
&nbsp;

<h5>3. Vaginal Dryness</h5>

The vagina might become dry, or irritated because of menopause and perimenopause. A GP can prescribe estrogen medicines that can be placed into the vagina, in the form of a tablet, cream, or ring. This multifaceted treatment can also help alleviate any urinary side effects of menopause and perimenopause, such as urinary incontinence. These vaginal estrogen medicines cannot enter the circulatory system and just have a local effect. Moreover, they do not have a rigid time frame and can be used throughout the post-menopause stage. Discontinuing the use of the product might bring back the unpleasant symptoms. There have not been any recorded repercussions, therefore, vaginal estrogen is safe to be used with hormone replacement therapy (HRT)<a href="#accordion">[6]</a>. 
&nbsp;

Over-the-counter vaginal lubricants are recommended to address vaginal dryness experienced during intercourse. These items lower the frictional erosion associated with vaginal dryness and prevent any sexual discomfort. It should be noted that only water-soluble lubricants are recommended as the counterpart oil-soluble items, for example, Vaseline increases discomfort and make the situation more complex. Reach out for products intended for the vagina; keep away from hand creams and moisturizers containing alcohol or those that are scented. These can disturb the vaginal tissue and disrupt the vaginal pH<a href="#accordion">[7]</a>.&nbsp;&nbsp; 
&nbsp;

<h5>4. Urinary Incontinence&nbsp;</h5>

While it is characterized as the constant and uncontrollable urge to urinate, most individuals would agree that urinary incontinence is an unwanted disturbance. Fortunately, there are systems to assist with various types of incontinence without drugs or medical procedures. Ensure you are drinking satisfactory water to keep urine diluted. This can be confirmed if the urine is clear or has a light-yellow hue. Keep away from food varieties or refreshments with a high acid or caffeine content, as that can disturb the bladder lining. These include grapefruits, oranges, tomatoes, coffee, and caffeine-containing sodas. Likewise, attempt Kegel exercises to reinforce your pelvic floor muscles and diminish incontinence episodes<a href="#accordion">[7].</a>&nbsp; 
&nbsp;

<h5>5. Mood Changes</h5>

Discussing your mood swings with a healthcare professional can assist you with recognizing the reason, gauging the probability of depression, and settling on the most suitable mediation. For depression, treatment would be different as your doctor might prescribe drugs that alter the chemical imbalance associated with menopause. Normally, these medications take half a month to bring about any noticeable improvement. A few antidepressants have, likewise, been found to treat hot flashes.&nbsp;Antidepressants work best when combined with therapy or psychotherapy. 
&nbsp;

When you reach menopause, you might anxiously wait to transition to post-menopause. This is the period after menopause. However, that does not guarantee complete liberty from discomforting menopausal symptoms. 
&nbsp;

There is no conclusive timetable for when menopausal symptoms begin and end. Your experience generally depends on hereditary qualities. Figuring out how to adapt to your symptoms can bring you long stretches of solace as you progress to the next chapter of your life. 
&nbsp;

While there are no treatments to reverse menopause, an individual can make certain changes in their lifestyle to alleviate the persisting symptoms: 
&nbsp;

<ul>
	<li>Stay hydrated and wear light clothes to avoid intense hot flashes. Also, keep away from spicy food and hot beverages.</li>
	<li>Try to include physical fitness and exercise into your routine to help with hot flashes and insomnia.</li>
	<li>Do not be fickle with your sleep routine. Adhere to a consistent cycle, even on weekends, to get uninterrupted sleep.</li>
	<li>Schedule an appointment with a counselor or therapist to address mood changes in a comfortable and safe environment.</li>
	<li>Engage yourself in social gatherings to increase serotonin.</li>
	<li>Try Kegel exercises to strengthen pelvic bone muscles and reduce the recurrence of urinary incontinence.</li>
</ul>

&nbsp;

[1].Mayo Clinic. (2022). Menopause.

[2].Welt, C. (2020, September 8). Clinical manifestations and diagnosis of spontaneous primary ovarian insufficiency (premature ovarian failure).

[3].Santen, R. J., Loprinzi, C. L., & Casper, R. F. (2020, Feburary 18). Menopausal hot flashes.

[4].Chen, M. N., Lin, C. C., & Liu, C. F. (2014). Efficacy of phytoestrogens for menopausal symptoms: a meta-analysis and systematic review. Climacteric, Vol 18(2), 260-269.

[5].Mudd, L., & Shurtleff, D. (2017, May). Menopausal Symptoms: In Depth. Retrieved from National Center for Complementary and Integrative Health: https://www.nccih.nih.gov/health/menopausal-symptoms-in-depth#hed3

[6].NHS. (2022, May 7). Menopause. Retrieved from NHS

[7].NAMS. (2022). Five Solutions for Menopause Symptoms. Retrieved from The North American Menopause Society:

Zarlish Kazmi

AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

Debunking Myths About COVID-19 & Anti-Malarial Drugs

A pandemic is often a cause of panic, and rightly so, as things are often difficult to make sense of at the start or even in the middle. The looming threat of a deadly illness can lead to irrational fears among people. As expected, the <a href="https://www.merisehat.pk/disease/covid-19">COVID-19 pandemic</a> also gave birth to some strange fears across the world. These ranged from thinking 5G networks cause <a href="https://www.merisehat.pk/disease/covid-19">COVID-19</a> to drinking disinfectants as a preventive measure. There has also been a lot of misinformation about coronavirus treatments. While some have touted eating garlic to be lifesaving, others have stuck to drinking camel urine.

According to the World Health Organization (WHO), as of 19th May, the world has reported more than 520 million COVID-19 cases and 6 million deaths<a href="#accordion">[1]</a>. Although the first COVID-19 case emerged in November 2019, Pakistan did not report a case until February 2020<a href="#accordion">[2]</a>. However, the fear of an outbreak had already gripped the country way before the detection of the first case. Soon enough, people were sharing various home remedies and myths about the novel coronavirus. Moreover, the pandemic also led to the prescription and use of unauthorized drugs for the treatment of COVID-19. These included antibiotics and antimalarial drugs, among others.&nbsp;

&nbsp;

Understanding The Dangers Of Unsubstantiated COVID Treatments

At the start of the pandemic, scientists conducted multiple studies in hopes to find a cure for the novel coronavirus. They investigated existing drugs such as ivermectin, anti-viral drugs, and antimalarial medications chloroquine and hydroxychloroquine as experimental therapies for COVID-19. Short on time, many doctors also began prescribing these drugs to COVID patients, without any conclusive scientific evidence of their effectiveness.&nbsp;

To make matters worse, the then U.S President, Donald J. Trump admitted to taking the antimalarial hydroxychloroquine as a preventive strategy. Many of Trump&#39;s advisers and doctors supported his decision. The statement was backed by a French trial that had demonstrated a decrease in viral load after just 6 days of treatment with hydroxychloroquine<a href="#accordion">[3]</a>. However, many experts labeled the results from the small-scale study anecdotal and insufficient.&nbsp;

As a result of the drug demonstrating anti-viral effects in experimental models, the U.S. Food and Drug Administration (FDA) further granted both chloroquine and hydroxychloroquine emergency use authorization early in the pandemic. And researchers around the world began conducting large clinical trials to evaluate the drug&#39;s safety and effectiveness against COVID-19. However, many of the trials had to be stopped in the middle due to the drug&#39;s adverse effects on participants. Moreover, many failed to show a significant benefit compared to a placebo group. In a study done among rheumatoid arthritis patients, researchers found a similar incidence of COVID-19 among both groups: 0.89% in hydroxychloroquine users and 0.62% in non-users<a href="#accordion">[4]</a>. Thus, showing that the antimalarial drug does not provide protection against the novel coronavirus.&nbsp;

As a result of the negative results in multiple trials, the FDA later revoked its emergency use authorization for chloroquine and hydroxychloroquine<a href="#accordion">[5]</a>. According to the regulatory body, the benefits no longer outweighed the risks associated with drug use. Thus, resulting in a reversal of the decision.&nbsp;

Despite the evidence, several countries such as Brazil, Pakistan, and India continued administering the antimalarial. Pakistan even banned exports of the drugs to have more available for the treatment of COVID-19. However, the increased prescription and self-medication of the drug resulted in a shortage for those that truly needed them.

&nbsp;

Both chloroquine and hydroxychloroquine are used for the treatment of malaria. Chloroquine works by preventing the malarial parasite from multiplying within the red blood cells. There was a time when it was hailed as a highly effective drug and was widely used to treat malaria. However, over the years, malaria strains have developed resistance to the drug. Therefore, in areas with chloroquine resistance, doctors usually prescribe other antimalarials such as mefloquine or atovaquone.&nbsp;&nbsp;

Hydroxychloroquine is a safer and more soluble metabolite of chloroquine. Both are used for treating or preventing malaria. However, due to their immunosuppressive effects, they are also FDA-approved for treating autoimmune conditions, such as lupus and rheumatoid arthritis.

The most common side effects of using antimalarial drugs are headache, nausea, diarrhea, itchiness, hives, double vision, anxiety, and hair discoloration. Although both are fairly safe, long-term use of these drugs can lead to retinal toxicity, heart toxicity, and even death. Moreover, in COVID-19 patients, antimalarial drugs have been shown to exert severe cardiac side effects. These include disturbances in the heart&#39;s rhythm and, in certain cases, sudden death.&nbsp;

&nbsp;

Chloroquine and hydroxychloroquine are not the only antimalarial drugs that people have used to treat COVID-19. Many have also experimented with the Artemisia plant in the form of herbal teas or supplements to cure the viral disease.&nbsp;

One of the commonly used antimalarial drugs, artemisinin-based combination therapies (ACTs) are produced from extracts of the Artemisia plant. However, no study has found the drug or the plant to exert a positive effect against COVID-19. The WHO has also found no evidence of the plant&#39;s effectiveness against the novel coronavirus.&nbsp;

One antimalarial drug, atovaquone, has shown anti-viral activity in a lab study. Atovaquone is an effective antimalarial drug used in combination with proguanil. Sold under the brand name Malarone, the medication is highly effective in treating chloroquine-resistant malaria. Moreover, atovaquone is also used to treat toxoplasmosis and mild pneumocystis pneumonia infections. Due to the drug&#39;s anti-viral effects against viruses such as Zika and dengue, scientists conducted a laboratory study investigating its effect on infected human lung cells.

The study not only demonstrated the drug&#39;s ability to prevent coronavirus replication in cells but also its effectiveness against various coronavirus variants<a href="#accordion">[6]</a>. Based on these results, researchers are now conducting clinical trials of atovaquone for COVID-19 treatment.

&nbsp;

The start of the COVID-19 pandemic led to scientists scrambling for a cure or breakthrough in the treatment of the novel coronavirus. Since developing new treatments can take a lot of time, researchers turned to drug repurposing. This involves investigating new uses for existing drugs. The strategy is often employed for its time and cost-effectiveness, especially in times like the pandemic.&nbsp;

During the COVID-19 pandemic, researchers repurposed various drugs such as remdesivir, ivermectin, steroids, antidepressants, vitamin C and D, Zinc, and even immunosuppressants. While this led to several safe and effective coronavirus treatments, it also helped establish which drugs don&#39;t work.&nbsp;

Antimalarial drugs, such as chloroquine and hydroxychloroquine, are among the treatment options that did not show a favorable profile against COVID-19. Although, at the start of the pandemic, many countries adopted the drugs without any validated scientific evidence. Antimalarial use was further exacerbated when the then U.S. President Donald J. Trump reported using hydroxychloroquine as a precautionary step. Despite the lack of evidence, people rushed to get their hands on a prescription for the medicine. Moreover, the increased demand led to pharmaceutical companies putting all their resources into increasing drug production. This diverted attention from the production of important pandemic supplies, like face masks, ventilators, and gowns. Experts have criticized people for hoarding these medications and causing shortages for those suffering from malaria, lupus, or rheumatoid arthritis. Moreover, recent trials and studies have proven hydroxychloroquine and chloroquine as ineffective against COVID-19. Many have also related severe side effects to the drug&#39;s use.&nbsp;

Therefore, the WHO urges people to not self-medicate with these or any drugs that have not been backed by any health regulatory body. Moreover, physicians are advised to refrain from administering such treatments to COVID-19 patients.

In conclusion, prevention is the best strategy against COVID-19. Washing hands, maintaining social distancing, and wearing a mask continue to be the best precautionary steps for preventing COVID-19.

&nbsp;

Key points

<ul></ul><ul><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">The COVID-19 pandemic began in November of 2019 and has infected more than 520 million people across the world.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">The pandemic gave rise to several myths and theories about the spread and treatment of COVID-19. From eating garlic to drinking disinfectants, people have done some rather outlandish things to protect themselves.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">One such myth surrounded the use of antimalarial drugs to treat COVID-19. Early in the pandemic, several scientists also supported the theory, citing successful result from small scale in-vitro studies.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">As the use of chloroquine and hydroxychloroquine increased worldwide, it also led to the development of severe side effects among COVID-19 patients.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Multiple trials also investigated the effects of these drugs on the novel coronavirus. However, none could demonstrate any benefits. Moreover, many clinical trials ended halfway due to the occurrence of severe cardiac side effects among trial patients taking hydroxychloroquine.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Other than chloroquine and hydroxychloroquine, people have also explored the Artemisia plant for its anti-viral properties. The plant's extracts are used for making artemisinin-based combination therapies (ACTs) for malaria. However, studies have not found the plant to have anti-COVID activity.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">So far, atovaquone is the only antimalarial that has shown anti-viral properties against COVID-infected lung cells. The laboratory study is now being converted into a clinical trial to help scientists better understand the drug's mechanism of action and safety.&nbsp;</li></ul>

[1] WHO, 2022. WHO Coronavirus (COVID-19) Dashboard. [Online].

[2] Habib, M. & Abbas, M., 2021. Facing the Threat of COVID-19 in Pakistan: A Nation’s Dilemma. Value in Health Regional Issues, Volume 24, pp. 90-95.

[3] Gautret, P. et al., 2020. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. International Journal of Antimicrobial Agents.

[4] Favalli, E. G. et al., 2020. Role of antimalarials in COVID-19: observational data from a cohort of rheumatic patients. Annals of the Rheumatic Disease, 80(5).

[5] FDA, 2020. Coronavirus (COVID-19) Update: FDA Revokes Emergency Use Authorization for Chloroquine and Hydroxychloroquine. [Online].

[6] Carter-Timofte, E. M. et al., 2021. Antiviral Potential of the Antimicrobial Drug Atovaquone against SARS-CoV-2 and Emerging Variants of Concern. ACS Infectious Diseases, 7(11), pp. 3034-3051.

Humza Khizer

14 Labor Induction Myths Debunked

There are a wide range of reasons why it might be essential to induce labor. Most frequently, it&rsquo;s because the delivery is overdue or there are some kinds of pregnancy problems. Despite the fact that in 2017, 43.1% of women expecting their first child had their labor induced, the process is still seen as an emergency intervention and hence requires understanding<a href="#accordion">[1]</a>.

&nbsp;

According to NHS Maternity Statistics, the rate of induction of labor in England has climbed from 21% (March 2010) to 34% (March 2021)<a href="#accordion">[2]</a>. Under the guidance of a skilled gynecologist, labor induction is a safe procedure.

&nbsp;

This article will shed light on various myths and pertinent facts about elective or natural labor.&nbsp; 
&nbsp;

Understanding Myths Surrounding Labor Induction

<h5>Myth #1: Acupuncture Helps Induce Labor</h5>

Fact: <a href="https://merisehat.pk/article/is-acupuncture-the-right-choice-for-you">Acupuncture</a> indeed has a noble past, and many individuals speak of its claimed advantages. Generally, acupuncture has no negative effects as long as it is administered by a trained professional who observes standard medical safety procedures. There isn&#39;t much information available, though, about this technique&#39;s efficacy in inducing labor. 
&nbsp;

<h5>Myth #2: Eating Spicy Food Induces Labor</h5>

Fact: Well, spicy food does not directly contribute to induction. It&rsquo;s an old wives&#39; tale &ndash; since spicy food triggers diarrhea or otherwise excites intestines, it might in turn result in uterine contractions.

&nbsp;

A word of caution is needed here: This isn&#39;t an authorized way to induce labor. It&#39;s not a good idea to induce diarrhea because it might lead to dehydration. There&rsquo;s also a possibility of having a severe case of heartburn. 
&nbsp;

<h5>Myth #3: Sex Induces Labor</h5>

Fact: Yes, in some circumstances, it might be helpful. Semen contains a minor quantity of prostaglandins, which are hormones that encourage cervical ripening. This coupled with female orgasms can bring on uterine contractions and the release of oxytocin, (sometimes referred to as the &quot;love hormone&quot;) during sex. However, experiencing a few contractions post sex doesn&#39;t mean it&rsquo;ll lead to regular contractions or a full-fledged labor.

&nbsp;

Moreover, several smaller studies suggest that having intercourse might not necessarily influence how quickly a pregnant woman goes into labor.

&nbsp;

A pregnant person may be hopeful that this strategy will succeed for a variety of reasons. However, it&#39;s vital to remember that not all pregnant women can have safe sex. If the doctor&rsquo;s advised against it and asked to maintain pelvic rest due to a placenta previa or another pregnancy problem, then the pregnant woman should refrain from having intercourse. 
&nbsp;

<h5>Myth #4: Walking or Exercising Induces Labor</h5>

Fact: This is not likely because walking has little effect on prostaglandin release. The idea behind walking is that gravity, balance changes, and movement can assist in lowering the baby into the pelvis and accelerating labor. However, while studies suggest that walking is an excellent form of exercise for expectant mothers, there is no evidence of its role in inducing labor.&nbsp;

&nbsp;

Regular walks help expecting mothers to feel good about themselves, assist them in getting the baby into the proper position for delivery, as well as enable them to develop strength for childbirth throughout their pregnancy (not just at the end!). Walking, or at the very least, staying upright whenever feasible, has been reported to speed up labor after it has begun. 
&nbsp;

<h5>Myth #5: Pineapple Induces Labor</h5>

Fact: NO. Pineapple contains a protein-breaking enzyme called bromelain, which makes it a crucial component of numerous meat tenderizers.

&nbsp;

Bromelain is thought to break down the tissue in the cervix and soften it in order to prepare for delivery. This is the reason why it&rsquo;s used in labor induction. However, there is no solid scientific proof for this hypothesis.

&nbsp;

Although bromelain may be effective on meat, the human body does not respond well to it. Additionally, pineapple may induce heartburn during pregnancy. 
&nbsp;

<h5>Myth #6: It&rsquo;s Better To Wait till 41+ Weeks Than Opt For Elective Induction</h5>

Fact: False. The recent guidelines by&nbsp; NICE (National Institute for Health Care and Excellence) states that there is an increasing body of evidence that pregnancies that reach, or pass, 41 weeks are associated with a small increase in the risk of stillbirth and perinatal death and that induction of labor reduces this risk<a href="#accordion">[3]</a>. 
&nbsp;

<h5>Myth #7: Nipple Stimulation Induces Labor</h5>

Fact: Nipple stimulation releases oxytocin, which might result in contractions, and anything that initiates labor would help, even when it is not directly related to dilatation.

&nbsp;

Before attempting nipple stimulation, always consult a doctor. When carrying a high-risk pregnancy, it should be avoided because prolonged and intense nipple stimulation can cause stress to the fetus.&nbsp;

&nbsp;

There are three options for nipple stimulation: manually, with a breast pump, or with a spouse. Just be careful not to overdo it; only massage one breast at a time for 5 minutes each. 
&nbsp;

<h5>Myth #8: Eating Dates Helps&nbsp;</h5>

Fact: Yes, frequent consumption of dates provides the body with a good amount of nourishment. Dates possess the hormone potuchin, which serves to bind the uterus and its muscles in an effort to lessen postpartum bleeding. And then, there is the hormone oxytocin, which can encourage uterine muscular contractions to speed up labor<a href="#accordion">[4]</a>. However, please exercise moderation when it comes to food consumption. Please consult your doctor to know the safe amount of dates to consume. 
&nbsp;

<h5>Myth #9: Castor Oil Induces Labor</h5>

Fact: No, and it&#39;s not advised. Castor oil can produce diarrhea and cramping in the intestines, which may make the uterus &quot;irritable&quot; . The cervix does not dilate as a result of these cramps, but these cramps can be exceedingly uncomfortable for the patients.

&nbsp;

Additionally, castor oil might induce feces release in an unborn child (meconium). Meconium can be consumed prior to birth when it combines with amniotic fluid. In rare cases, it might lead to pneumonia in the newborn. Please refrain from attempting castor oil! 
&nbsp;

<h5>Myth #10: Herbal Teas And Cohosh Induce Labor</h5>

Fact: It&#39;s untrue! Medical studies to support the safety of these products for mothers have not been conducted. Cohosh is one plant that contains phytoestrogens, which increases the risk of clotting in pregnant women and, therefore, should be avoided.

&nbsp;

Gamma-linolenic acid or GLA, which is a precursor to prostaglandins, is found in evening primrose oil. It is said to aid in &quot;ripening the cervix.&quot; Although there is no medical proof that it is effective, there is also no evidence that it is hazardous. However, it is best to avoid it.&nbsp;&nbsp; 
&nbsp;

<h5>Myth #11: A Second Labor Is Less Painful and Easy</h5>

Fact: It&#39;s true that successive labors tend to be shorter because the previous birth already stretched the cervix, pelvic floor muscles, and birth canal. But even if they last a shorter time, the discomfort is still there. 
&nbsp;

<h5>Myth #12: A C-Section Is Necessary In Case Of Twins</h5>

Fact: A vaginal birth is entirely conceivable if there are no problems; it&rsquo;s true despite the fact that more than half of all twin births in the UK occur via Cesarean. A vaginal birth ought to be achievable if the first twin is lying head-down. 
&nbsp;

<h5>Myth #13: Full Moon Helps Ease Labor Induction</h5>

Fact: According to an urban legend, more women have labor around full moons. There is absolutely no evidence to support the claim.&nbsp; Despite the absence of proof, many midwives still believe they will have a busy shift around the full moon! 
&nbsp;

<h5>Myth #14: Elective Induction Reduces Labor Time&nbsp;</h5>

Fact: The duration of labor varies from woman to woman and from pregnancy to pregnancy, but induced labor, which is started by using artificial hormones to trigger uterine contractions, can last for a few hours to a few days. It can take longer for first-time mothers or those less than 37 weeks pregnant. Before beginning the induction process, it is impossible to predict how the body will react to the medications being utilized. 
&nbsp;

Although it usually takes less time, labor induction can occasionally last 2-3 days. It takes longer if it's the first pregnancy. Eat very little -before visiting the hospital. Keep in mind that the medications used to induce labor may cause stomach discomfort and very severe contractions. Inform the doctor in case the pain is unbearable. Most of the time, a successful labor induction results in vaginal delivery. Don’t rely on myths. Just go along with the doctor's suggestions.

<ul><li>When the doctor administers medication or punctures the water to initiate labor, this process is referred to as inducing labor (also known as labor induction).</li><li>Only medical needs should justify inducing labor. The best course of action is to wait for labor to begin naturally if the pregnancy has been a healthy one.</li><li>Ask about delaying labor induction until at least 39 weeks if the doctor advises, so the baby has time to grow within the womb.</li><li>Never believe in myths without any medical research evidence.</li></ul>

[1] Can I. Induction of Labour.

[2] Wilkes E, Gamble J, Adam G, Creedy DK. Reforming maternity services in Australia: Outcomes of a private practice midwifery service. Midwifery. 2015;31(10):935–40.

[3] guideline NG207 N. Inducing labour. 2021;

[4] Kuswati K, Handayani R. Effect of Dates Consumption On Bleeding, Duration, And Types of Labor. J Midwifery. 2019;4(1):85–91.

Neelam Asad

First Period? No Worries, We Got You Covered

Menarche &ndash; first menstrual period &ndash; is a normal phenomenon for girls. It is significant because it implies growth, both physically and socially.&nbsp; 
&nbsp;

Menstruation is the &quot;periodic discharge of blood from the uterus.&quot; It may or may not occur as a monthly cycle and continues for the entirety of the women&rsquo;s active reproductive life&quot;<a href="#accordion">[1]</a>. 
&nbsp;

Periods can be very challenging to manage, regardless of how long you have had them; but they are especially difficult the first time when you are totally unprepared for them.&nbsp; 
&nbsp;

In this article, you&#39;ll find everything you need to know about your periods &ndash; from finding the right menstrual products, including napkins and tampons, to managing pains and preserving stained clothes.&nbsp; 
&nbsp;

Puberty is the main cause of menstruation. This is the stage when the girl&rsquo;s body becomes capable of reproduction. The estrogen (female hormone) levels increase in the female body due to the beginning of the menstrual cycle, which plays an important role in the thickening of the endometrium or the inner lining of the uterus.&nbsp; 
&nbsp;

The main purpose of the endometrium lining is to aid a fertilized egg during pregnancy. In case the sperm does not fertilize the ovum (egg), the thickened lining is broken down by your body&#39;s natural mechanism and pushed out of your uterus in the form of periods. 
 
&nbsp;

<h5>When Will I Get My First Period? 
&nbsp;</h5>

Girls start menstruating when they reach the age of puberty, between the ages of 12 and 13<a href="#accordion">[2]</a>. Typically, menstruation takes place 2 years after the development of your breasts. 
&nbsp;

<h5>What Symptoms Should I Look For? 
&nbsp;</h5>

Some girls would not experience any symptoms. Their periods start abruptly and without warning. Other girls experience some symptoms in the days preceding their periods, otherwise known as Premenstrual Syndrome (PMS).&nbsp; 
&nbsp;

Symptoms of PMS include:

<ul>
	<li>Skin problems</li>
	<li>Abdominal bloating and pain</li>
	<li>Breast tenderness</li>
	<li>Pain in the lower back</li>
	<li>Constipation</li>
	<li>Diarrhea</li>
	<li>Fatigue</li>
	<li>Mood swings, feeling sensitive or irritable</li>
	<li>Food craving, especially sweets</li>
	<li>Transparent or white discharge from the vagina 
	&nbsp;</li>
</ul>

To avoid being caught unprepared when your period starts, you should start keeping a &quot;<a href="https://merisehat.pk/article/a-guide-to-period-products">period kit</a>&quot; in your bag as soon as you reach that age and feel that your body&rsquo;s changing. This kit should include: 
&nbsp;

<ul>
	<li>A pair of clean underwear</li>
	<li>Pad, menstrual cup, or tampon</li>
	<li>Cleaning wipes</li>
	<li>Over-the-counter pain relievers, such as ibuprofen 
	&nbsp;</li>
</ul>

<h5>What Should You Do For Your First Period? 
&nbsp;</h5>

Try not to panic if your menstruation has begun and you don&#39;t have anything to utilize for the blood. Until you can obtain a good pad or tampon, you can make a temporary pad out of toilet paper to tide you over. 
&nbsp;

A quick tutorial: 
&nbsp;

1. Fold the layers of a long piece of toilet paper (at least 10 squares) over one another.

2. Place this on your underwear where the napkin would be placed &mdash; down the central part of your underwear, along the piece of fabric between your legs (known as the gusset).

3. Use a second toilet paper to wrap the pad and your underwear repeatedly. This will help keep the tissue in its place.

4. Finish the wrap by tucking the tissue&#39;s end into the top. Now, you have a temporary pad that you can easily manage and remove.&nbsp;

You might think of asking your teacher /school nurse/ friends for a pad if you are at your school. It&rsquo;s nothing to feel ashamed or embarrassed about.&nbsp; 
&nbsp;

Understanding How to Deal With the First Menstrual Cycle

Your first period would continue for a few days. It takes some time for your period to become regular and consistent. Usually, periods last between 2-7 days every month when they become regular.&nbsp; How Much Blood Will Be Lost From Your Body? The first few periods are considered typically light compared to those later in your life and only bring a few patches of red-brown blood throughout the week.Once the hormones have stabilized, your cycle will follow a schedule that will be more predictable. However, it is possible to experience a strong flow in the first few months and it's not always a problem if the bleeding is heavier. But, if you believe you are bleeding too much, you need to inform your parents or consult the school nurse.You can also tell any adult whom you trust if you:<ul><li>Have to replace/change your sanitary napkin and tampon every couple of hours.&nbsp;</li><li>Feel giddy</li><li>Feel dizzy</li><li>Feel heart palpitation</li><li>A period of bleeding that lasts more than 7 days.&nbsp; </li></ul>You might need to be taken to the gynecologist by your guardian to discuss your signs. The doctor can also prescribe some medicines to help you with your symptoms.&nbsp;

In this section of the article, several menstrual products have been outlined. Your choice of product depends on a variety of factors such as flow, pain, comfort etc. It is important to bear in mind that your preferred option might change down the line.&nbsp; 
&nbsp;

<h5>Period Underwear</h5>

The concept of period underwear is quite recent. The only difference between it and conventional underwear is that it is made of a unique fabric that absorbs menstrual blood and keeps it inside the fabric. 
&nbsp;

Period underwear caters to all girls and women, i.e. they have different levels of absorbency of blood. If your first period is light, you might be able to rely solely on these. But, if you feel it&rsquo;s a heavy flow, then period underwear is a great backup; it&rsquo;s pretty helpful in preventing accidental leakage.&nbsp; 
&nbsp;

There are numerous brands available, but they all function similarly. Choose one according to your flow and comfort. 
&nbsp;

<h5>Sanitary Napkins And Panty Liners</h5>

Rectangular pieces of absorbent material that you can stick on the inside your underwear are called sanitary napkins. Every pad has a sticky strip on the underside, allowing for the pad to remain attached to your underwear. Some pads may include &quot;wings&quot; on the sides that you drape over the borders of your underwear. This aids in keeping the pad in position and also prevents leakage. 
&nbsp;

There are many different sizes of pads. Each size is specifically designed to accommodate various degrees of blood flow. The amount of blood a pad can absorb varies depending on its size and is usually indicated on the box/cover 
&nbsp;

You&#39;ll most probably use different sizes of pads within one cycle for example at the start of the cycle, you will need more absorbent pads since the flow is heavy, while towards the end of the cycle a lighter absorption pad would be adequate due to less flow.&nbsp;&nbsp; 
&nbsp;

Most women prefer using pads at night compared to tampons as it is easier to change and if left overnight will not cause any health related issues.&nbsp; 
&nbsp;

At the start of your cycle, you will notice some spotting. To prevent staining your underwear due to spotting, you can use panty liners. These are thinner and more compact. They can also be used towards the end of your periods when your bleeding could be sporadic.&nbsp; 
&nbsp;

<h5>Tampons</h5>

Tampons are menstruation products that are tube-shaped and absorbent. They are placed within the vagina to soak up menstruation blood before it gets to your underwear. 
&nbsp;

Applicator tubes made of cardboard or plastic are often sold with tampons. These tubes have been made to aid you in inserting the tampon into your vagina. A string is on one end of every tampon to help you remove it easily.&nbsp; 
&nbsp;

Tampons are available in various sizes and levels of absorbency. Beware of scented tampons, though, as your vagina might become irritated by fragrance. 
&nbsp;

When it&#39;s time to insert the tampon, carefully press it inside your vaginal canal until only the string is left exposed.&nbsp; If your tampon has an applicator, gently pull it out by holding onto the tube. You should let the tampon stay in your vagina so that it&#39;ll absorb the blood.&nbsp; 
&nbsp;

When it is time to take it out of the vagina, just pull the string till the tampon is free.&nbsp; 
&nbsp;

Please make sure to change your tampon every 4 to 6 hours, but no longer than 8 hours. If left for 8 hours, the risk of infections and&nbsp; irritation increases. You also risk developing Toxic shock syndrome (TSS), although it&#39;s rare but it always better to be safe than sorry&nbsp; 
&nbsp;

<h5>Menstrual Cups</h5>

If you are uncomfortable using pads or tampons, another option is menstrual cups. Cups are inserted into the vagina, similarly to tampons, where they collect blood before it leaves the body. 
&nbsp;

Cups normally come in two size options &mdash; small or large &mdash; generally based on the female&#39;s age and previous delivery experience, their menstrual flow, and cervix height. 
&nbsp;

The smaller variant will probably be more convenient, easy to use and more comfortable for you to insert. You should receive step-by-step instructions for your product, but you can also refer to a guide to insertion and removal.&nbsp; 
&nbsp;

One major advantage of these cups over pads or tampons is that they can be washed and used repeatedly. This implies that you only need to remove the cup, clean it, and reinstall it when it&#39;s time to replace it. 
&nbsp;

The lifespan of reusable cups ranges from 6 months to 10 years with proper maintenance depending upon the type of brand and manufacturer of it. In other words, menstrual cups are not only safe and effective, they also save you money and are eco-friendly.&nbsp; 
&nbsp;

No, not always! Before we get into the details, know that it can happen to anyone. 
&nbsp;

When you start your period, you&#39;ll be learning about how much blood will be shed from your body, the amount your menstrual item can absorb, and when your flow seems to be at its heaviest. 
&nbsp;

Keep a few cleaning wipes in your bag if you can. They can help you remove the stain until you can thoroughly wash the fabric.&nbsp; 
&nbsp;

As a temporary solution, you can tie a jacket around your waist to hide the stain&nbsp; 
&nbsp;

Try this technique to remove the stain when you reach home: 
&nbsp;

1. Soak the stained fabric in cold water as soon as possible. Do not use warm water because that would set the stain and make it impossible to get out.&nbsp;

2. Spray a stain remover if it is available. Be sure to soak the affected region thoroughly. Let it sit for the amount of time labeled on the product&#39;s packaging.&nbsp;

3. If you don&#39;t have a stain remover on hand or wish to use two different methods to make it more effective, you can rub a bar soap or dab some liquid soap into the stain-affected region to build up a thin lather.&nbsp;

4. Wash and repeat the process till the stain washes out.

5. Wash your pants in the washing machine if the stain is not completely removed. Just be certain to use cold water rather than warm.&nbsp;

6. Air dry the washed clothes since the dryer&#39;s heat has the potential to set the stain permanently.&nbsp; 
&nbsp;

<h5>Can Other People Tell That I&rsquo;m On My Period?</h5>

Not at all! You don&rsquo;t have a different appearance or fragrance. Someone could smell the blood only if you leave your napkin or period underwear on for a longer period than advised. 
&nbsp;

You should not use scented menstrual products as they can aggravate your vulva.&nbsp; 
&nbsp;

Wash your vaginal area with lukewarm water if you are worried about body odor. Another great alternative is use of baby wipes to clean your intimate regions during periods. 
&nbsp;

<h5>Can I Still Swim And Play Sports?</h5>

Swimming and other physical activities are allowed during your period. It may also have the potential to lessen cramps.&nbsp; 
&nbsp;

Choose a tampon or a menstrual cup to stop leakage in the water when you intend to swim.&nbsp; 
&nbsp;

For the majority of activities, pads or period underwear can be used.&nbsp; 
&nbsp;

<h5>What Can I Do About Cramps?</h5>

Cramps are, without a doubt, uncomfortable. But think about it this way: your body needs periods &ndash; and, therefore, cramps &ndash; to remove the uterine lining. 
&nbsp;

To feel better:

<ul>
	<li>Follow the directions on the label or advice of medical healthcare professionals for use of&nbsp; over-the-counter pain relievers such as ibuprofen.&nbsp;</li>
	<li>Put a heating pad or heating wrap as a source of heat on your lower back or stomach.</li>
	<li>Take a warm bath. 
	&nbsp;</li>
</ul>

Speak to an adult if your cramps are worsening and you feel sick and unable to get out of bed or do routine activities. In some instances, excruciating cramping could signify an underlying illness like endometriosis so don&rsquo;t ignore or take it lightly and consult a gynecologist&nbsp; . 
&nbsp;

<h5>Other Symptoms I Might Have ?&nbsp;</h5>

Besides cramps, you might also experience the following symptoms:

<ul>
	<li>Acne</li>
	<li>Abdominal bloating</li>
	<li>Sore breasts</li>
	<li>Back pain</li>
	<li>Constipation</li>
	<li>Diarrhea</li>
	<li>Fatigue</li>
	<li>Feeling sensitive or irritable</li>
	<li>Food cravings 
	&nbsp;</li>
</ul>

All these symptoms don&#39;t necessarily need to be present when you have your period. They appear or disappear depending upon the hormonal swings.&nbsp; 
&nbsp;

<h5>How Frequently will I Get It?</h5>

The period is basically one part of the menstrual cycle. This implies that your period will follow a more regular pattern over time.&nbsp; 
&nbsp;

Typically, a menstrual cycle lasts for 28 days. But it can be around 21-45 days, which is also normal.&nbsp; 
&nbsp;

Menstruation may not start consistently for about 6 years following your first period. This is because your body has to learn how to control the release of your reproductive hormones.&nbsp; 
&nbsp;

<h5>How Can I Predict When It Will Come?</h5>

It would take a few years for your periods to develop a regular pattern. But you can keep a track of your symptoms, which would prove useful in spotting patterns and getting (mentally) ready for your period till it arrives.&nbsp; 
&nbsp;

This record can also be used to discuss severe pains with the nurse or other healthcare professionals.&nbsp; 
&nbsp;

You can use signs or code words to aid you in symbolizing the start and end of your period if you don&#39;t want people to know what you are tracking. You can maintain it on paper or on a phone. Or you can download an app. Fitbit, for instance, has a tracking option; others like Flo Period &amp; Ovulation Tracker, Clue Period Tracker &amp; Calendar, and Eve Period Tracker App work, too. 
&nbsp;

<h5>Will I Have Periods Forever?</h5>

You won&#39;t have periods for your entire life, but you&#39;ll have them until menopause. The onset of menopause is directly related to the level of hormones that triggered your menarche i.e. Menopause occurs when these hormones start to decrease in your body. 
&nbsp;

Usually, menopause starts between the ages of 45 and 55. But it&rsquo;s not just the age factor; your period may stop/ become irregular due to stress and other medical conditions as well. Talk to your healthcare professional about when you miss a period. 
&nbsp;

Meanwhile, there&rsquo;s the option of hormonal birth control if you want to stop your periods for health reasons/ travel purposes. Again, it&rsquo;s better to get in touch with your doctor first regarding it.&nbsp; 
&nbsp;

You will not have any periods during pregnancy. In case you experience any bleeding or spotting during pregnancy, please consult your doctor immediately. 
&nbsp;

<h5>Can I Get Pregnant After Menstruation?</h5>

The brief answer? Yes. When the semen comes in touch with the vagina, pregnancy is a possibility. Although the start of a period is mostly considered to mark the start of your reproductive years, it is possible to conceive before your period.&nbsp; 
&nbsp;

Hormones determine everything. In some circumstances, your body may secrete ovulation-inducing chemicals before the start of menstruation. Getting pregnant is conceivable even if you have intercourse during your menstruation.&nbsp; 
&nbsp;

Ultimately, it depends on where you are in your cycle. If you want to prevent pregnancy, you can use any of the contraceptive methods suggested by your doctor.&nbsp; 
&nbsp;

Talk to a responsible adult or visit a doctor if: 
&nbsp;

<ul>
	<li>By the age of 15, you have not begun your period.&nbsp;</li>
	<li>It&#39;s been almost 2 years since you have had your periods and they are still irregular.&nbsp;</li>
	<li>Bleeding occurs in between your periods.&nbsp;</li>
	<li>You are in excruciating pain and unable to carry out routine tasks.&nbsp;</li>
	<li>You must replace your pad or tampon every 1-2 hours as you experience heavy intense bleeding.&nbsp;</li>
	<li>You experience periods longer than 7 days.&nbsp; 
	&nbsp;</li>
</ul>

Make sure you&rsquo;ve kept a record of when your last period began and ended, when did the erratic bleeding start, or any other signs you experienced during your cycle. 
&nbsp;

Women in low- and middle-income countries frequently lack access to medical information, particularly regarding menstruation-related hygienic concerns. Lack of formal guidance from the schools, cultural resistance to using alternate menstruation products, a lack of economic resources, and inadequate water and sanitation infrastructure make this natural process difficult for young girls.&nbsp; 
&nbsp;

As a result, a biological process that naturally dignifies women and girls becomes a source of embarrassment and frustration. Such societal stigmas and beliefs make post pubescent girls more susceptible to engaging in unsanitary behaviors that result in various diseases, including those of the reproductive and urinary systems. 
&nbsp;

Hence, this article aims to provide a comprehensive guide to educate young girls about safe menstrual health.&nbsp; 
&nbsp;

<ul>
	<li>It might be challenging for a parent or guardian to know how to help a child during their first period.</li>
	<li>Every woman goes through the period as part of her regular cycle.</li>
	<li>The guardian should keep it factual. Don&rsquo;t let your menstrual past, whether it&#39;s been positive or negative, influence how you think and eventually affect how your daughter feels about menstruation.</li>
	<li>There are various menstruation product options to help you with the process.</li>
	<li>Make a period kit with some underwear, stain remover, and menstrual supplies that they can conveniently put in a locker or backpack.</li>
</ul>

[1] Fingerson, L. (2012). Girls in power: Gender, body, and menstruation in adolescence. SUNY Press.

[2] Marques P, Madeira T, Gama A. Menstrual cycle among adolescents: girls' awareness and influence of age at menarche and overweight. Rev Paul Pediatr. 2022;40:e2020494. Published 2022 Jan 5. doi:10.1590/1984-0462/2022/40/2020494

How Your Menstrual Cycle Affects Your Mental Health

Our mental health is closely linked to the reproductive cycle that our body undergoes every month. Researchers believe this is linked to the hormonal changes that we go through. Rising and falling to varying levels through the month, oestrogen and progesterone impact neurotransmitters in our brain. This impacts a range of emotional and neural parameters, such as energy levels, appetite, and<a href="https://merisehat.pk/article/are-you-sleeping-on-your-sleep-cycle"> sleep cycle</a>. 
&nbsp;

The Menstrual Cycle

Our menstrual cycle starts with the first day of menstruation, when oestrogen and progesterone are at their lowest in our bodies. Both hormones begin to rise the day after menstruation ends and peak right before ovulation. 
&nbsp;

During the luteal phase between ovulation and menstruation, oestrogen and progesterone begin to drop. They rise again during this period, to a lesser degree, and begin to fall once again reaching their lowest levels during menstruation. This entire cycle unfolds over approximately a month. 
&nbsp;

The luteal phase lasts approximately two weeks before our periods, but this may be longer and shorter for some women. It is during this period that most women begin to experience symptoms of premenstrual syndrome (PMS) or, it&rsquo;s more severe version, premenstrual dysphoric disorder (PMDD). 
&nbsp;

The drastic rise and fall of oestrogen and progesterone impacts the release of two major neurotransmitters &mdash; serotonin and dopamine. Research has shown that lower levels of oestrogen correlates to lower levels of serotonin in particular. Both chemicals have varying functions but generally impact our mood, motivation, and energy. When they are present in low quantities in our nervous system, it can lead to sadness, anxiety, sleep problems, and food cravings. 
&nbsp;

Physical symptoms of PMS and PMDD include:

<ul>
	<li>bloating </li>
	<li>skin breakouts </li>
	<li>cramps </li>
	<li>headaches </li>
	<li>joint and muscle pains </li>
	<li>tender breasts </li>
	<li>nausea </li>
	<li>trouble sleeping </li>
	<li>changes in appetite 
	&nbsp;</li>
</ul>

Mental health symptoms include:

<ul>
	<li>feelings of sadness </li>
	<li>anxiety </li>
	<li>feeling overwhelmed </li>
	<li>emotional vulnerability </li>
	<li>rapidly changing moods</li>
	<li>irritability and stress </li>
	<li>fatigue 
	&nbsp;</li>
</ul>

In the two weeks leading up to our period, the emotional symptoms of PMS can manifest in a number of ways. We may find ourselves crying easily. Criticism may hurt more than usual. The smallest triggers may impact us strongly. Life around us could seem overwhelming, or even empty. We may want to withdraw into solitude. Social gatherings might lose their appeal and we could feel aloof from the people around us. 
&nbsp;

Some of us may want to indulge in unhealthy foods while others might lose their appetites. Sexually intimacy may not appeal to us as much but we might want more affection than usual. We may feel a usually strong dislike of our bodies and be harsh with ourselves. We could become angrier and more easily stressed by situations that would not trigger us usually. As motivation dips, everyday tasks could seem tedious. We might want to slack on work or be unable to focus on it. Everything around us might seem to be going wrong. We could start questioning aspects of our career and relationships. 
&nbsp;
<quillbot-extension-portal></quillbot-extension-portal>

Lifestyle Habits

Symptoms of PMS can be managed by adopting certain lifestyle habits. Tracking your cycle is the first step you can take towards this. If you are aware of the emotional and physical impact of your cycle, you can plan accordingly. In the weeks leading up to your period, you could schedule some extra down time for yourself. You can ensure that you don&rsquo;t have any big or stressful tasks planned. This frees you up to tend to yourself, self-reflecting and doing activities that give you joy and don&rsquo;t require too much effort. This would be a good time to perhaps book a massage, or take a restorative yoga class. 
&nbsp;

<ul>
	<li>Well-Balanced Diet: Eating a well-balanced diet throughout the month may enable your body to cope better with the hormonal changes it undergoes. Eat as many whole foods as possible while avoiding processed foods in excess. Ensure that your diet is rich in protein, essential fats, and fibres. Micronutrients like vitamins and minerals will also help balance your hormones. During your period, it&rsquo;s important to continue such a diet and resist the temptation to indulge excessively in sugar and starchy carbs. Avoid smoking, as well as caffeine and alcohol as these may exacerbate symptoms. 
	&nbsp;</li>
	<li>Exercise: Supplement your diet with regular movement. These can be anything from daily walks to weightlifting sessions. Exercise helps our bodies function optimally. During our periods, movement can be particularly helpful. Apart from the endorphin rush, it can help ground us in the bodies and the present, giving us respite from our feelings and thoughts. 
	&nbsp;</li>
	<li>Getting Enough Sleep: Maintain a regular sleeping routine throughout the month. Try to sleep and wake up at the same time as consistently as possible. During our periods, we may experience increased fatigue while also having a hard time sleeping at night. Creating a calming routing and environment may counter this. Dim the lights in your house at night, turn off devices and screens. Explore different ways to help yourself wind down before bedtime. Take a hot shower, go for a walk before bed, read a book, journal, or listen to some soothing music. Essential oils like lavender can also help you fall asleep. 
	&nbsp;</li>
</ul>

Commonly cited research states that 90 percent of menstruating women experience at least one symptom of PMS. Some women are more sensitive to hormonal changes than others. They may experience stronger symptoms, even if their hormones don&rsquo;t fluctuate more than what is considered average. This may be due to a number of factors. Genetics could determine how sensitive we are to hormonal changes. Women with a history of trauma or mental health struggles may also be more likely to experience mental health symptoms. Since there is so much variation in our individual cycles, PMS can look different for everyone. 
&nbsp;

Sometimes, symptoms of PMS may begin to feel too severe or impact your life and wellbeing. Using over-the-counter medicines and lifestyle habits may not relieve them. In this case, it&rsquo;s advisable to see a healthcare professional. About 10 percent of women may also be diagnosed with PMDD if their symptoms are particularly intense and consistent. 
&nbsp;

A number of factors could indicate the necessity of professional healthcare. Your relationships may start suffering. You could find yourself picking fights that have a lasting impact on your relationships. Increasingly, you may start withdrawing from others and isolating yourself. You could start neglecting necessary tasks at work to the point that your career begins to suffer. Your inner voice may become overwhelmingly critical, tipping you to the point of self-loathing. 
&nbsp;

Anxiety attacks may become common and you might find yourself experiencing heart palpitations and breathing difficulties too often. Feelings of depression and anger may become very intense, making you want to harm yourself or others. In very severe cases, suicidal thoughts might become very loud. 
&nbsp;

Untreated PMDD could lead to acute depression, constant anxiety, causing extreme emotional distress and irreparable damage to your life. Medical help can be crucial in alleviating your symptoms. A doctor can treat you in a number of ways, from hormonal therapy to psychotherapy. 
&nbsp;

Ayesha Binte Rashid

Debunking Myths Of Kidney Stones

<a href="https://www.merisehat.pk/disease/kidney-stones-66">Kidney stones</a> are notorious for being one of the most painful and difficult ailments an individual can be diagnosed with. And they are becoming more prevalent. Today over half of all urology patients in Pakistan have a kidney stone and 3-5% of the population is at risk of developing a kidney stone at some point in their lives[1]. Diet, an abundance of body weight, and certain ailments and medications are among the leading reasons for kidney stones. From the kidneys to the bladder, any segment of the urinary tract can be hindered by renal stones. 
&nbsp;

Although a common occurrence, there are a ton of myths and misinterpretations surrounding kidney stones, their causes, and ways to prevent their formation. 
&nbsp;

Potential causes include drinking too little water, excessively working out, weight reduction surgery, obesity, or eating salty or sugary food. In certain individuals, diseases and family ancestry may also play a role. Moreover, consuming an excess of fructose (present in table sugar and high fructose corn syrup) corresponds to a growing chance of fostering a kidney stone<a href="#accordion">[2]</a>. 
&nbsp;

There are four main kinds of kidney stones: 
&nbsp;

<ul>
	<li>Calcium Stones: Calcium stones are the most common type of kidney stones<a href="#accordion">[3]</a>.&nbsp;Calcium oxalate stones are formed due to calcium mixing with the oxalate present in urine. Consuming oxalate-rich foods such as spinach, peanuts, and chocolates can increase one&rsquo;s risk of these stones. On the other hand, calcium phosphate stones are less prevalent than oxalate ones. They are typically caused by hyperparathyroidism, renal tubular acidosis, and urinary tract diseases<a href="#accordion">[4]</a>. 
	&nbsp;</li>
	<li>Uric Acid Stones: Uric acid stones are often associated with diabetes, body weight fluctuations, and several metabolic disorders. These stones are formed due to excessively acidic urine<a href="#accordion">[3]</a>. 
	&nbsp;</li>
	<li>Struvite Stones: The most well-known reason for struvite stones is urinary tract infections (UTIs) that lead to urine pH imbalances These stones can be significantly large and cause urinary obstruction<a href="#accordion">[3]</a>. 
	&nbsp;</li>
	<li>Cystine Stones: This is the least common type of kidney stone. It occurs in people with cystinuria, a genetic condition that results in increased levels of the amino acid cystine in the urine.&nbsp; 
	&nbsp;</li>
</ul>

&nbsp;

Understanding kidney stones and some common myths

Have you ever received unsolicited medical advice from a neighbour? A friend? Or maybe an aunt with no blood relation to you?&nbsp; Technically, anyone but a medical practitioner? Then you have stumbled upon the right page. If there is anything desis love more than chai it is reliance on pseudo-helpful home remedies and ancestral healing concoctions. And why should kidney stones be any different? Here, we have listed the top 5 myths about kidney stones, believing which would do you more harm than good: 
&nbsp;

<h5>1. Toss Out Dairy</h5>

It has been misconstrued that you need to opt for non-milk options and adapt to a dairy-free life as research suggests otherwise. The calcium in milk is essential for several bodily functions such as blood clotting, assisting muscular contractions, regulating healthy heart contractions and relaxations, nerve functioning, strong bones and teeth, and, most of all, preventing kidney stones<a href="#accordion">[5]</a>. 
&nbsp;

Many individuals dread calcium since calcium consumption has been linked to the formation of kidney stones, yet the reality of the situation could not be further from such a restrictive diet. If there is a possibility that your calcium intake is excessively low, you are in fact in danger of increasingly absorbing oxalate, a typical compound we eat in numerous food sources. Excessive retention of oxalate can prompt additional oxalate in your urine and that can give rise to calcium oxalate stones. 
&nbsp;

<h5>2. Like A Stomachache</h5>

We trace the origin of this myth to just a lack of knowledge of anatomy, where any region of the abdomen below the chest and above the legs has been coiled under the umbrella term stomach. While you will experience incredible levels of discomfort and sharp pain in your lower abdominal region, it will feel more like a spasm. At the point when you have spasms, your stomach muscles flex with incomparable force and intensity which causes serious pain. As the stone travels through the urinary tract, the pain might differ in levels of intensity. Kidney stones can cause a tightening of muscles, and for certain individuals, the stabbing sensation of pain is like that experienced in menstrual cramps. To rule out the dismissing excuse of a stomachache, keep an eye out for other symptoms of kidney stones, which include nausea, discomfort while urinating, and a pungent smell of urine<a href="#accordion">[5]</a>. 
&nbsp;

<h5>3. Kidney Stone Is Always Painful</h5>

Kidney stones are defined as hard sediments of minerals within the urinary tract that obstructs the path of urine, cause infection, and bring a mammoth of pain. However, they are not always bearers of pain, especially when they are in the initial stages of formation. Other symptoms might indicate the formation of a kidney stone such as blood while urinating, severe nausea, and uncontrollable vomiting. 
&nbsp;

A type of kidney stone termed &lsquo;Silent Stone&rsquo; fails to exhibit characteristic kidney stone symptoms and is diagnosed by an imaging test or a routine checkup. In Pakistan, the results of a study in a urology department found that 3% of all urology patients suffered from silent kidney stones<a href="#reference" target="_blank">1</a>. Therefore, routine visits to a GP are necessary to catch any unprecedented discovery and receive timely treatment before the development of any complications. 
&nbsp;

<h5>4. Cranberry Juice Is The Elixir Of All</h5>

Cranberry juice is a perfectly viable option and beverage for when you have a urinary tract infection or as a preventive measure to forestall one. It thickens and solidifies your urine, which drains the contaminated substances out and wards off the probability of having it again. However, if you have a kidney stone, it exacerbates the issue. Cranberry contains high measures of oxalate, which is a primary mineral found in kidney stones. Therefore, if you want to get rid of kidney stones, skip the cranberry juice. 
&nbsp;

With regards to halting kidney stones, lemon juice is a far better alternative to cranberry juice. Citrus refreshments have been associated with an increment of citrate levels in urine, which can limit and restrict stone development. Nonetheless, research shows the amount you drink has a lot more prominent effect than what you drink. You must hydrate yourself sufficiently with 100 ounces of liquids daily - anything that those liquids might be - to keep the kidneys flushed out and the abundance and prevalence of stone-forming salts lower. 
&nbsp;

<h5>5. Sodas Cause Kidney Stones</h5>

As an organization dedicated to garnering public attention towards medical illnesses, we feel obligated to suggest avoiding sodas and fizzy beverages as their high sugar and preservative concentrations can cause several complications. But, as morally honest fact bearers, we must admit that soft drinks are not the sole contributors to kidney stones. The truth of the matter is phosphoric acid is the main culprit. The ingredient is commonly found in dark-colored soft drinks. The other issue with soda is that it is an infamous diuretic because of the addition of caffeine. This raises the normal concentration of salt in your urine, which advances kidney stones<a href="#accordion">[6]</a>. So, if you choose to consume a soft drink, compensate the ounces with an equivalent measure of water and you will diminish that concentration. Then again, you could stay away from soft drinks through and through and replace them with better options. 
&nbsp;

<h4>"A high Heart rate variability is a an important indicator of good health. Head on over to our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan </a>and check your heart rate variability today!" </h4>

The only conclusion that can be drawn from busting several myths is another myth that the internet knows it all. While many verified health blogs and revered medical journals will supply you with an influx of information, it is important to realize that each body is different. For any disease or illness or even kidney stones, always consult a doctor, a urologist, and a certified dietician who can guide you, assist you, and support you with reasonable and sustainable solutions. 
&nbsp;

Tip of the day: Be old school and book that appointment ASAP. 
&nbsp;

This article gathered to debunk some of the most common myths surrounding kidney stones that patients have heard from their acquaintances or on the internet. With the intent to inform rather than offend the key takeaways from this article are:

<ul>
	<li>There are four types of kidney stones: calcium stones, uric acid stones, struvite stones, and cystine stones.</li>
	<li>The body should not be deprived of calcium as its deficiency can lead to kidney stones.</li>
	<li>Kidney stones are not always painful and can be silent.</li>
	<li>Kidney stones cause a more severe pain than a stomachache.</li>
	<li>Kidney stones cannot be cured with cranberry juice; opt for lemon juice instead.</li>
	<li>Stay hydrated!&nbsp; 
	&nbsp;</li>
</ul>

[1].Buchholz, N., Abbas, F., Khan, R., Talati, J., Afzal, M., & Rizvi, I. (2003). The Prevalence of Silent Kidney Stones - an Ultrasonographic Screening Study. Journal of the Pakistan Medical Association, Vol 53, 1-5.

[2].National Kidney Foundation. (2022). Kidney Stones. Retrieved from National Kidney Foundation:

[3].U.S. Department of Health and Human Services. (n.d.). Definition & Facts for Kidney Stones. National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved July 28, 2022,

[4].Loughlin, K. R. (2019, May 17). What causes kidney stones (and what to do). Retrieved from Harvard Medical School:

[5].Urology Specialists of Georgia. (2022). Debunking 3 Common Kidney Stone Myths. Retrieved from Urology Specialists of Georgia:

[6].Uribarri, J., Oh, M. S., & Carroll, H. J. (1989). The First Kidney Stone. Annals of internal medicine, 111(12), 1006–1009.

If you belong to the latter group, then chances are that once you got over the dying part and gathered the courage to speak to a family member, they informed you of your body&#39;s natural function and likely a few additional pieces of information regarding menses. As per results from a recent study, only 28% of women in Karachi, Pakistan had adequate menstrual health knowledge prior to their first <a href="https://www.merisehat.pk/article/natural-remedies-to-help-regulate-your-periods">period</a>.<a href="#accordion">[1]</a> 
&nbsp;

Understanding Myths Associated With Menstruation

Almost 50% of Pakistan&#39;s population is composed of females.<a href="#accordion">[2]</a>&nbsp;Despite the high prevalence of females, awareness of women&#39;s health issues is limited. There is an unfortunate stigmatization of menstruation in low-income countries, for e.g., sanitary napkins are often sold in brown paper bags and menstrual concerns are not a widely discussed topic. This stigmatization of menstruation and lack of awareness leads to the spread of incorrect practices and knowledge among women. This could be a source of concern as these practices can later have harmful implications on the lives of women and girls.&nbsp;

Every woman has been likely exposed to several myths and superstitions pertaining to periods. The following article will help to shed light on some of these myths.&nbsp; 
&nbsp;

<ul dir="ltr">
	<li>
	<h5>No Baths Allowed</h5>
	</li>
</ul>

A multi-center study conducted on menstrual hygiene practices among Pakistani girls reported that 39% of girls avoid bathing during menstruation.<a href="#accordion">[3]</a>The most common reason for avoiding taking a bath is that it can cause an irregular flow.<a href="#accordion">[1]</a>&nbsp;However, such practices can affect one&#39;s hygiene and predispose girls to reproductive tract infections. Moreover, research has pointed out that there is no link between irregular flow and bathing during menstruation. Instead, warm baths are often encouraged to help relieve painful menstrual cramps in women.<a href="#accordion">[4]</a>&nbsp; 
&nbsp;

<ul dir="ltr">
	<li>
	<h5>Don&#39;t Eat The Pickle</h5>
	</li>
</ul>

Cold water, pickles, eggs, and milk are just some of the food items various cultures advise against consuming during menstruation. Approximately 50% of Pakistani girls report avoiding &#39;cold foods&#39;(e.g., yogurt, ice cream) as they fear that it will stop their periods and increase the chances of blood clots.<a href="#accordion">[3]</a>&nbsp;Similarly, &#39; hot foods&#39; (e.g., liver, eggs, dry fruits) are also avoided for fear of menstrual irregularities. However, there is a lack of scientific evidence linking cold or hot food to menstrual cycle abnormalities.&nbsp; 
&nbsp;

<ul dir="ltr">
	<li>
	<h5>Avoid Exercising</h5>
	</li>
</ul>

Among the general population in Karachi, approximately 53% of women restrict physical activity during menstruation to avoid heavy periods.<a href="#accordion">[1]</a>&nbsp;Walking, sitting, and lifting weights are some of the commonly avoided physical activities among girls and women. However, research shows that aerobic exercise can be beneficial for painful menstrual cramps.<a href="#accordion">[5]</a> 
&nbsp;

In many low- and middle-income countries, periods are considered impure and a process of dirty or impure blood leaving the body. This is likely due to a lack of education regarding reproductive health. Young adolescent girls are often too shy or scared to discuss menstrual issues with their mothers. Moreover, a majority of adult women are also not aware of the physiology of menstruation or good hygiene practices. As a result, there is a high prevalence of misinformation among girls and women. Almost 70% of Pakistani university-going girls believe the source of bleeding in menstruation to be the vagina instead of the uterus.<a href="#accordion">[3]</a>

Therefore, there is a need for the introduction of regular menstrual education awareness programs in schools and universities. Furthermore, primary care physicians should be aware of the common myths and misconceptions regarding menstrual health in a population. Health education campaigns on a community level can ultimately help destigmatize reproductive health issues.&nbsp; 
&nbsp;

<ul>
</ul>

<ul>
	<li>Menstruation is a natural phenomenon in a woman&#39;s life that is often stigmatized in various cultures.</li>
	<li>A lack of awareness has led to the development of various myths and practices regarding menstruation. The most common of which is avoidance of taking a bath during periods, not eating certain foods, and avoiding exercise.</li>
	<li>Community-based health education programs can help destigmatize menstruation and propagate correct information and practices among girls and women.</li>
</ul>

[1] Ali, S. A. et al., 2020. Perceptions, Practices, and Challenges Regarding Menstrual Hygiene Among Women in Karachi, Pakistan: A Comparison Between General Population and Healthcare Workers. Cureus, 12(8).

[2] Pakistan Bureau of Statistics, n.d. Census 2017. [Online].

[3] Mansoor, H. et al., 2020. Menstrual knowledge and practices of Pakistani girls: A multicenter, cross-sectional study. Heliyon, 6(1).

[4] Jo, J. & Lee, S. H., 2018. Heat therapy for primary dysmenorrhea: A systematic review and meta-analysis of its effects on pain relief and quality of life. Scientific Reports, Volume 8.

[5] Dehnavi, Z. M., Jafarnejad, F. & Kamali, Z., 2018. The Effect of aerobic exercise on primary dysmenorrhea: A clinical trial study. Journal of Education and Health Promotion, 7(3).