Menopause

late menopause
late menopause

Sexual problems are more common in postmenopausal women, which suggests that menopause can reduce libido.

The reduced sex drive is often caused by decreased estrogen levels, which can dampen arousal and result in sex being more painful.

In this article, we look at how menopause might affect someone’s sex drive, along with what can be done to improve libido.

Menopause and libido

What is menopause?

Menopause refers to when a woman stops having her period permanently, but it can affect more than a woman’s menstrual cycle.

Menopause can cause physical and emotional changes that impact a woman’s life, including her sex life.

Some symptoms and side effects associated with menopause include:

  • anxiety
  • bladder control issues
  • decreased sex drive and desire (libido)
  • depression
  • difficulty sleeping
  • thinning hair
  • weight gain

Each of these effects can impact a woman’s quality of life and relationship with her partner.

What is libido?

Libido refers to sexual interest and sexual enjoyment.

Some women going through menopause report reduced libido, but the causes vary from person to person.

According to one review, the reported rates of sexual problems in postmenopausal women are between 68 and 86.5 percent.

This range is much higher than in all women in general, which is estimated to be between 25 and 63 percent.

Why does menopause affect libido?

Decreased estrogen levels can result in reduced blood flow to the vagina, which can cause the tissues of the vagina and labia to become thinner. If this happens, they become less sensitive to sexual stimulation.

Decreased blood flow also affects vaginal lubrication and overall arousal. As a result, a woman may not enjoy sex as much and may have difficulty achieving orgasm. Sex may be uncomfortable or even painful.

Fluctuating hormone levels during perimenopause and menopause can also affect a woman’s mental health, which in turn, may cause a decrease in her libido.

Stress can also impact a woman’s libido, as she may be juggling a job, parenting, and be caring for aging parents. The changes in hormone levels a woman may experience during menopause may make her irritable or depressed, so dealing with everyday stress may feel more difficult.

According to an article published in the Journal of Women’s Health, women who have more significant side effects associated with menopause are more likely to report lower libido levels.

Examples of these side effects include hot flashes, depression, anxiety, trouble sleeping, and fatigue.

Other factors that make a woman going through menopause more likely to experience a reduced libido include:

  • history of chronic health conditions, such as heart disease, diabetes, or depression
  • history of smoking
  • engaging in low levels of physical activity

A woman should talk to her doctor about how these conditions could affect her sex drive.

Tips for improving libido

There are several steps a woman can take to increase her libido. These include medical treatments, lifestyle changes, and home remedies.

Medical treatments

middle aged couple enjoying a bike ride
Spending time together on shared hobbies, exercising, and planned dates will help increase a couple’s intamacy.

If a woman experiences changes to her vaginal tissue, such as thinning and dryness, she may wish to consider estrogen therapy.

Prescription estrogen can be applied directly to the vagina in the form of creams, pills, or vaginal rings. These usually contain lower doses of estrogen than regular birth control pills.

Some women may wish to take estrogen pills that contain higher levels of hormones. This treatment, known as hormone replacement therapy, might help reduce symptoms, such as hot flashes and mood changes, but may also carry risks.

A woman thinking about hormone replacement therapy should discuss it with her doctor before starting to take any medication.

One study found that women using hormone therapies reported higher levels of sexual desire compared with women who did not.

Less commonly, a doctor may prescribe testosterone therapy. However, not all women respond to this treatment, and the United States Food and Drug Administration (FDA) do not approve it for treating sexual disorders in women.

A woman may not experience any changes in her sex drive after using estrogen or testosterone therapies.

A woman may also choose to see a therapist who specializes in sexual dysfunction or enhancing sex. Sometimes, couples may want to attend therapy together.

Lifestyle changes

Some women may benefit from using water-soluble lubricants during sex. These can be purchased over-the-counter at most drugstores.

However, women should avoid non-water soluble and silicone-based lubricants, as these can break down condoms used to protect against sexually transmitted infections (STIs).

Increasing physical activity, such as getting 30 minutes or more of exercise on a routine basis, may help reduce menopause-related symptoms, including a low libido. Eating a healthful diet can also enhance a person’s overall sense of well being.

Changing sexual habits

There are many ways a person can foster a sense of intimacy with their partner, including:

  • Changing sexual routines: Try spending extended periods on foreplay, use vibrators or other sex toys to enhance an intimate experience, or engage in sexual activity or touching without the goal of orgasm.
  • Relieving stress together: There are many stress-relieving techniques a couple can do outside of the bedroom to increase intimacy. Examples include going on planned dates together, taking a walk, or spending time doing hobbies together, such as exercise, crafts, or cooking.
  • Practicing masturbation: Spending time alone and exploring what types of touch and sexual stimulation work well for an individual can help them talk to a partner about their needs and preferences. It can also help a person feel more comfortable with sexual activity without the pressure of a partner.

Natural remedies

Some women use natural supplements to try to increase their libido. It is important to keep in mind that the FDA do not regulate herbs and supplements, so women should be sure to choose a reputable brand.

Some natural remedies used to increase libido in women include:

  • black cohosh
  • red clover
  • soy

A woman should discuss these remedies with a doctor before taking them to ensure they will not interact negatively with other prescriptions and supplements she may be taking. Soy contains estrogen, so it may react with other estrogen therapies.

When to see a doctor

A woman should speak to her doctor whenever perimenopause or menopause is having a significant impact on her day-to-day activities, including sexual activity.

Sometimes, a doctor can recommend changes in health habits as well as discuss whether prescription medications may help relieve the symptoms, including a low libido.

Speaking with a doctor can also rule out any other underlying medical conditions that may cause a reduced libido. These conditions include urinary tract infections, uterine prolapse, endometriosis, or pelvic floor dysfunction.

Outlook

While some women do experience a decreased libido in menopause, others do not.

Some women may even experience a heightened libido after menopause. This can be due to reduced stresses over pregnancy and fewer child-rearing responsibilities.

If a woman’s libido is impacted after menopause, she should talk to her doctor about treatments that could enhance her quality of life.

Certain foods and drinks contain compounds that may improve vaginal health and symptoms of vaginal conditions. These include probiotics, prebiotics, and fermented food and beverages.

The vagina uses natural secretions, immune defenses, and “good” bacteria to keep itself healthy. Eating a healthful, balanced diet might also further prevent infections and improve vaginal conditions.

This article discusses what little research there is into the effects of diet on vaginal health, looks at dietary choices for common vaginal conditions, and identifies other ways to improve vaginal health.

People should speak to a doctor before using diet to address any health concerns.

Balancing pH levels

The vagina is a moderately acidic environment with a pH of around 4.5. This acidity helps healthful bacteria to grow and prevents harmful microbes from developing.

Some good bacteria, such as probiotics, may help balance vaginal acidity levels.

Probiotics

Lactobacillus species bacteria is the most dominant type of “good” bacteria found in a healthy vagina.

Research has suggested that Lactobacillus could benefit vaginal health in the following ways:

  • regulating the microflora in the vagina
  • improving the vagina’s acidity levels
  • stopping harmful microbes from attaching to the vaginal tissues
  • working with the body’s immune system

2016 study indicated that using vaginal Lactobacillus supplements after taking antibiotics hindered bacteria growth in people with bacterial vaginosis (BV), and significantly reduced vaginal pH.

2015 review study found “no significant evidence” that probiotics were more beneficial than using a placebo or no treatment. However, the authors noted that due to a lack of evidence, “a benefit cannot be ruled out.”

Probiotic supplements are available, but some nutritionists recommend getting them from fermented foods and drinks, such as:

  • yogurt and kefir
  • kimchi and sauerkraut
  • pickles
  • tempeh
  • kombucha

Prebiotics

Prebiotic compounds may also help stabilize vaginal pH by promoting the growth of healthy bacterial populations. Foods rich in prebiotics include:

  • leeks and onions
  • asparagus and Jerusalem artichoke
  • garlic
  • whole wheat products
  • oats
  • soybeans
  • bananas

It is important to note that prebiotics can worsen bowel conditions, such as irritable bowel syndrome (IBS).

Preventing UTIs

Urinary tract infections (UTIs) occur when bacteria enter parts of the urethra, bladder, or kidneys, causing symptoms such as burning or pain during urination and bad smelling or cloudy urine. According to the Urology Care Foundation, about 60% of women will experience a UTI at some point.

Drinking lots of fluids might help prevent a UTI.

Cranberry juice

According to the Urology Care Foundation, drinking cranberry juice or taking cranberry tablets may prevent UTIs from developing.

Research supports this idea — in a 2016 study, researchers found that drinking 8 ounces (oz), or 240 milliliters (ml) of a 27% cranberry juice drink each day for 24 weeks lowered the rate of UTIs in adult women who had recently had a UTI.

Cranberries are rich in antibacterial compounds that kill bacteria. These include antioxidants and organic acids, such as:

  • proanthocyanidins and anthocyanins
  • organic and phenolic acids
  • vitamin C
  • flavanols and flavonols

Research into diet and UTIs has mainly focused on cranberries, but many fruits, especially citrus fruits and berries, are also rich in antioxidants and may have similar effects.

Reducing candida infections

Candida infections, or yeast infections, are the second most common cause of vaginitis, or vaginal inflammation.

There is no scientific proof that any foods can reduce candida infections. However, some foods contain ingredients that the fungus uses to grow. These ingredients include refined sugar, preservatives, yeasts, fungi, allergens, and trace antibiotics. People may benefit from avoiding these foods.

Researchers are studying the possible benefits of natural remedies with antifungal, anti-inflammatory, or antioxidant properties for candida infection, including tea tree oil, coconut oil, and garlic.

Other ways to improve vaginal health

Regularly eating a healthful, balanced diet that contains fermented products with probiotics and prebiotics can improve vaginal health.

Following some of these lifestyle habits might also help:

  • cleaning the genital region with mild, unscented soap before rinsing well and patting dry daily or as needed during menstruation
  • wiping from front to back
  • using antibiotics appropriately and only when necessary
  • reducing sweat around the vagina
  • exercising regularly
  • maintaining a healthy weight
  • staying hydrating
  • reducing stress
  • wearing loose-fitting cotton underwear

Avoiding or limiting things that can imbalance the body’s systems or irritate the vagina can help, such as:

  • douching
  • holding in urine or rushing urination
  • personal care products with dyes, flavors, or fragrances
  • spermicidal foam or diaphragms
  • tight pants or underwear
  • smoking
  • prolonged exposure to moisture
  • alcohol
  • processed or heavily refined foods
  • foods or drinks with artificial hormones

Summary

Many nutrients contribute to vaginal health. Eating a healthful, nutrient-rich diet can improve all body systems.

Certain nutrients, antioxidants, and probiotics may have particular benefits for vaginal health. However, researchers need to do more studies to work out which nutrients help boost vaginal health and prevent vaginal infections.

Fish Oil supplements could make men’s testicles bigger and boost their sperm count, a study claims.Men who took the pills, which contain omega-3 fatty acids, were found to have testicles 1.5ml larger and to ejaculate 0.64ml more sperm, on average.The men, who had an average age of 18, were included as regular supplement-takers if they had consumed fish oil for at least 60 out of the past 90 days. Larger testicles and more sperm creation are linked to higher testosterone levels and better fertility, although the study did not test how fertile the men were.

The research was published in the journal JAMA Network Open, by the American Medical Association. The experiment was described by scientists as ‘well-conducted’ and ‘insightful’ but it was clear that it did not prove fish oil makes men more fertile. Researchers from the University of Southern Denmark did their study using 1,679 young Danish men going through military fitness testing.

In Denmark military service is mandatory for all healthy men over the age of 18, so the men in the study were not yet soldiers. Each of the men was screened for Sexually Transmitted Infections (STIs), had physical exams, gave sperm samples and then answered questions about their diets and lifestyles. If someone was considered a regular fish oil supplement user, the research found, they produced millions more sperm in an average ejaculation.

The researchers wrote in their paper: “Fish oil supplements were associated … with higher semen volume and total sperm count, and larger testicular size.”Ninety-eight men in the study said they took fish oil supplements regularly, while another 95 took vitamin D or C supplements. Men in the fish oil group were less likely to have fertility problems, which were judged against the World Health Organization’s low sperm count limit of 39 million sperm per ml of semen.

The scientists found that 12.4 percent of the men who took fish oil supplements (12 out of 98) had sperm counts below the World Health Organisation’s (WHO’s) measure. This compared to 17.2 percent (192 out of 1,125) men who took no supplements. And the longer someone had been taking supplements for, the more sperm they were likely to produce.

The researchers added that, based on a model fit and healthy 19-year-old: “Total sperm count was 147million for men with no supplement intake, 159million for men with other supplement intakes, 168million for men with fish oil supplement intake on fewer than 60 days, and 184million for men with fish oil supplement intake on 60 or more days.”

The study did not give exact measurements for men’s testicle volume or sperm volumes – they only compared the two groups. And the scientists could not explain why – if it was true – the fish oil improved sperm quality.It was also not clear whether increased sperm volume was caused by – or caused – the change in testicle size. Scientists not involved with the research said the study had been well-conducted but it didn’t say how much fish oil the men took.

And nor did it reveal the men’s diets, which may have shown they were getting omega-3 from other sources such as fresh fish.Professor Sheena Lewis, reproductive medicine expert at Queen’s University, Belfast, said: “This is a large well-designed study and the association between fish oil intake and improved semen quality is compelling.

“However, the study focuses on healthy young men; mostly with sperm counts already in the fertile range.“There is no evidence from this study that infertile men with low sperm counts benefit from fish oil.”Dr. Frankie Phillips, of the British Dietetic Association, said missing information about the men’s diets did make the study’s results less convincing.She added: “Antioxidants, including vitamin C, selenium and vitamin A, as well as zinc and omega-3 fats all have a role in the production of healthy sperm.

“There is much focus on the diets of women who are trying to conceive, ensuring that they are in the best possible position to achieve a healthy pregnancy, but diet might also be a factor involved in men’s reproductive health.“Omega-3 is present in a both animal and plant derived foods, but oily fish stands out as an excellent source of long chain omega-3, and the UK population currently consume way below the recommended ‘at least one portion of oily fish per week”.

“So including omega-3 is already part of current dietary recommendations – this study on its own can’t prove that upping omega-3 will itself improve testicular function.”Also, according to researchers, women who have sex every week may have a lower chance of an early menopause. University College London experts asked nearly 3,000 women – who were tracked for 10 years – about how often they had sex. Women of any age who had sex each week were less likely to have been through the menopause, compared to those who did so less than once a month.

For example, those who had regular sex were 28 percent less likely to have entered the menopause at age 51, compared to their counterparts. Sexual activity included full-blown intercourse, oral sex, touching and caressing, or self-stimulation. Scientists said if a woman is not having sex and there is no chance of pregnancy, the body ‘chooses’ to stop investing energy into ovulation.

Instead, their bodies may decide to invest energy elsewhere, such as in looking after grandchildren. The theory, known as the grandmother hypothesis, says the menopause evolved to help mothers have more children. It suggests that grandmothers would aid their offspring to have more of their own children by caring for the existing grandchildren. A woman’s immune function is hampered during ovulation, making the body more susceptible to disease.

And so if a pregnancy is unlikely because of a lack of sexual activity, the body would divert its focus from a costly process to aiding existing relatives. The menopause is when a woman stops having periods and is no longer able to get pregnant naturally. The process is a natural part of ageing and usually occurs among women between 45 and 55. Researchers used data collected from 2,936 women who took part in the Study of Women’s Health Across the Nation (SWAN) in the United States (U.S.).

The women, an average age of 45 at the start of the study in 1996, were asked if and how often they had had sex in the past six months. They were also asked whether they had oral sex, sexual touching, or engaged in self-stimulation in the last six months. The researchers found that the most frequent pattern of sexual activity was weekly (64 percent). None of the women who took part had already entered the menopause, but 46 per cent were starting to experience symptoms (known as peri-menopause). Fifty-four per cent were pre-menopausal, meaning they had not yet displayed any symptoms and were still having their periods.

Interviews were carried out both when the women first took part and then ten years later. Women who had sex weekly were less likely to experience the menopause, compared to those who had sex lass than monthly. And women who had sex monthly were less likely to experience menopause at any given age, compared to those who had sex less than monthly. Prof. Ruth Mace, who co-authored the study, said: “The menopause is, of course, an inevitability for women, and there is no behavioural intervention that will prevent reproductive cessation.“Nonetheless, these results are an initial indication that menopause timing may be adaptive in response to the likelihood of becoming pregnant.”

How can a man’s diet affect his fertility?
The body must get all the chemicals it needs from the diet, meaning what you eat controls your health. Certain foods can improve – or worsen – a man’s fertility. The general rule is that a healthy, balanced diet is better for fertility than one too high in sugar or fat.

Fruits and vegetables are good
Fruit and veg are rich in nutrients such as vitamins C and A, polyphenols, magnesium, folate and fiber, which act as antioxidants in the body. Research has suggested a direct association between the production of reactive oxygen species in sperm cells and intake of antioxidants, which help to reduce this damage by neutralizing them.

Eat foods rich in zinc, selenium and vitamin C
Zinc can be found in foods such as meat, cheese, shellfish wholegrain cereals and nuts. Inadequate intakes of zinc in the diet have been linked to low sperm count and reduced testosterone levels. Selenium can be found in foods such as brazil nuts, fish, poultry and eggs. This mineral is required for normal sperm production and development and men should aim to get 55mcg per day. Vitamin C is thought to help prevent sperm cells clumping together (common with infertility) and men should aim to get 80mg per day.

Limit dairy foods
Intake of dairy foods in association with sperm production is somewhat controversial but the theory goes that as around 75 per cent of the milk we consume comes from pregnant cows, there may be a high level of naturally occurring oestrogens, which could affect sperm production.

Limit meat intake
Although not fully proven, it has been suggested that meat and processed meats may impact on fertility in men by way of xenobiotics (mainly xenestrogens) used in the farming process. Over-exposure to these compounds, which have estrogenic effects in the body, may play a role in the decline of sperm quality in men.

Avoid excessive amounts of sugar
Excessive intake of sugary foods may lead to overweight and obesity, driving insulin resistance, which may negatively influence sperm quality as a result of inflammation and oxidative stress. Diets high in sugar can also lead to blood sugar imbalances, which may disrupt the hypothalamic-pituitary-testicular axis impacting on sperm production.
*Culled from Daily Mail UK

Adnexal masses are lumps that occur in the adnexa of the uterus, which includes the uterus, ovaries, and fallopian tubes. They have several possible causes, which can be gynecological or nongynecological.

An adnexal mass could be:

  • an ovarian cyst
  • an ectopic pregnancy
  • a benign tumor
  • a malignant tumor

A family doctor can usually manage benign masses. However, prepubescent and postmenopausal individuals will need to see a gynecologist or oncologist.

Malignant adnexal masses require treatment from a specialist.

In this article, we discuss the characteristics of adnexal masses. We also review how doctors diagnose and treat adnexal them.

Symptoms

People report different symptoms, depending on the cause of the adnexal mass.

People with an adnexal mass may report:

  • severe lower abdominal or pelvic pain that is usually on one side
  • abnormal bleeding from the uterus
  • pain during sexual intercourse
  • worsening pain during a period
  • painful periods
  • abnormally heavy bleeding during periods
  • abdominal symptoms, including a feeling of fullness, bloating, constipation, difficulty eating, increased abdominal size, indigestion, nausea, and vomiting
  • urinary urgency, frequency, or incontinence
  • weight loss
  • lack of energy
  • fatigue
  • fever
  • vaginal discharge

Different causes of adnexal masses may have similar symptoms, so doctors usually conduct further investigations to determine the exact cause.

Once the doctor has worked out the cause of the adnexal mass, they can recommend treatment and management.

Causes

Adnexal masses include a variety of different conditions that range in severity from benign growths to malignant tumors.

The cause of adnexal masses could be gynecological or nongynecological.

Some of the causes of adnexal masses include:

  • Ectopic pregnancy: A pregnancy where the fertilized egg implants somewhere outside the uterus.
  • Endometrioma: A benign cyst on the ovary that contains thick, old blood that appears brown.
  • Leiomyoma: A benign gynecological tumor, also known as a fibroid.
  • Ovarian cancer: These tumors of the ovary may be ovarian epithelial cancers that begin in the cells on the surface of the ovary or malignant germ cell cancers that begin in the eggs.
  • Pelvic inflammatory disease: Inflammation of the upper genital tract, which includes the uterus, fallopian tubes, and ovaries. It occurs due to an infection.
  • Tubo-ovarian abscess: An infectious adnexal mass that forms because of pelvic inflammatory disease.
  • Ovarian torsion: A gynecological emergency involving a complete or partial rotation of the tissue that supports the ovary, which cuts off blood flow to the ovary.

Diagnosis

A doctor may diagnose an adnexal mass by:

  • taking a complete medical history
  • asking questions about symptoms
  • conducting a physical examination
  • obtaining blood samples

Most of the time, people will need a transvaginal ultrasound to allow doctors to evaluate the characteristics of an adnexal mass.

Females who have had a positive pregnancy test result and report abdominal or pelvic pain and vaginal bleeding might have an ectopic pregnancy. An ovarian torsion causes sudden, severe pain with nausea and vomiting. Immediate medical attention is necessary to treat both an ectopic pregnancy and ovarian torsion.

People with pelvic inflammatory disease or a tubo-ovarian abscess may experience gradual pelvic pain with nausea and vaginal bleeding.

Early ovarian cancer may sometimes present with nonspecific symptoms. Sometimes, doctors may only detect cancer when the tumor has become malignant.

Malignant tumors may have one or several of the following characteristics:

  • a solid component of the tumor
  • parts of the tumor have thick divisions larger than 2–3 centimeters separating them
  • they are present on both sides of the reproductive tract
  • the presence of fluid filled lumps

Treatment

A doctor will choose the most appropriate treatment depending on the cause of the adnexal mass. Women with an ectopic pregnancy will have to end their pregnancy. A doctor may choose one of the following procedures:

  • the administration of a single or two-dose intramuscular methotrexate
  • laparoscopic surgery
  • a salpingostomy or salpingectomy, which are surgical procedures involving the fallopian tubes

Doctors have not yet determined the optimal management of an endometrioma, according to a study that featured in Obstetrical & Gynecological Survey.

Currently, the possible treatments for an endometrioma include:

  • watchful waiting
  • medical therapy
  • surgical intervention
  • inducing ovulation and using assisted reproductive technology in females with infertility

People with pelvic inflammatory disease will require courses of intravenous antibiotics, which may include:

  • cefotetan (Cefotan)
  • cefoxitin (Mefoxin)
  • clindamycin (Cleocin)

Some people can receive treatment outside of the hospital setting with oral doxycycline (Vibramycin) and intramuscular ceftriaxone (Rocephin) or another third generation cephalosporin antibiotic. In some cases, doctors will need to add oral metronidazole (Flagyl).

In the past, tubo-ovarian abscesses required surgical removal of the uterus, ovaries, and fallopian tubes. However, doctors can now prescribe broad-spectrum antibiotics. A person with a ruptured tubo-ovarian abscess may still require surgery.

Ovarian torsion is a gynecological emergency. The only treatment is surgery to prevent severe damage to the ovaries and fallopian tubes.

People with leiomyomas or fibroids may receive hormonal treatments or nonsteroidal anti-inflammatory drugs to control the symptoms. Once a person stops taking medication, the symptoms may return, and the fibroids may continue to grow. Surgery is the most successful treatment for fibroids.

The treatment options for ovarian cancer include surgery, chemotherapy, and targeted therapy. Oncologists will consider the following factors before recommending a treatment plan:

  • the type of ovarian cancer and how much cancer is present
  • the stage and grade of the cancer
  • whether the person has a buildup of fluid in the abdomen causing swelling
  • whether surgery can remove the whole tumor
  • genetic changes
  • the person’s age and general health status
  • whether it is a new diagnosis, or if cancer has come back

Risk factors

Risk factors depend on the cause of the adnexal mass. Females with ovarian masses have an increased risk of developing ovarian torsion. More than 80% of females with ovarian torsion have masses of 5 cm or larger.

Doctors diagnose fibroids in about 70% of white females and more than 80% of black females by the age of 50 years. Other factors may increase a person’s risk of developing fibroids, such as:

  • starting periods early in life
  • using oral contraceptives before 16 years of age
  • an increase in body mass index (BMI)

Ovarian cancer can run in families. People with a family history of ovarian cancer may have an increased risk of developing ovarian cancer. Other risk factors include:

  • inherited genetic changes
  • hereditary nonpolyposis colorectal cancer
  • endometriosis
  • postmenopausal hormonal therapy
  • obesity
  • tall height

The likelihood of developing cancer also tends to increase with age.

Summary

Adnexal masses are lumps that doctors may find in the adnexal of the uterus, which is the part of the body that houses the uterus, ovaries, and fallopian tubes. Not all masses are cancerous, and they do not all require treatment.

Different types of adnexal mass can share many of the same symptoms. As a result, doctors need to collect a full medical history and data from physical examinations, blood tests, and medical imaging, including transvaginal ultrasounds.

Doctors need to pinpoint the location and cause of an adnexal mass to determine the appropriate management and treatment.

The muscles, ligaments, and tissues of the pelvic floor support the bladder, rectum, and sexual organs. When the supportive structures weaken or become especially tight, doctors describe it as pelvic floor dysfunction. It is a common health issue.

When a person has pelvic floor dysfunction, the organs in the pelvis may drop. They often press down on the bladder or rectum, causing a leakage of urine or stool. Or, a person with this condition may have trouble urinating or passing stool.

Keep reading to learn more about pelvic floor dysfunction — including the symptoms, treatments, and some exercises that may help.

What is pelvic floor dysfunction?

The pelvic floor is made up of muscles, ligaments, and tissues that surround the pelvic bone. The muscles attach to the front, back, and sides of the bone, as well as to the lowest part of the spine, called the sacrum.

The function of the pelvic floor is to support the organs in the pelvis, which can include the:

  • bladder
  • rectum
  • urethra
  • uterus
  • vagina
  • prostate

People with pelvic floor dysfunction may have weak or especially tight pelvic floor muscles.

When the muscles tighten, or spasm, people may have trouble urinating or passing stool. When they weaken, the organs within the pelvis may drop and press down on the rectum and bladder.

The table below outlines several common types of pelvic floor dysfunction.

Type of pelvic floor dysfunctionDescription
Obstructed defecationThis occurs when stool enters the rectum, but the body cannot fully evacuate the bowels.
RectoceleThis involves tissue from the rectum protruding into the vagina. Stool may get caught in this pocket, forming a bulge in the vagina.
Pelvic organ prolapseThis refers to the pelvic floor stretching and the pelvic organs dropping as a result of age, childbirth, or a collagen disorder.
Paradoxical puborectalis contractionThis involves a pelvic floor muscle called the puborectalis contracting. When it happens, trying to pass stool may feel like pushing against a closed door.
Levator syndromeThis involves the pelvic floor muscles spasming after bowel movements. It can cause lasting dull pain or achy pressure high in the rectum.
CoccygodyniaThis refers to pain in the tailbone that worsens during and after bowel movements.
Proctalgia fugaxThis involves painful spasms of the rectum and muscles in the pelvic floor.
Pudendal neuralgiaThis refers to irritation or damage to the pudendal nerves, which help the pelvis function.
UrethroceleThis refers to the urethra pressing into the vagina.
EnteroceleThis involves the small intestine descending and pushing into the vagina, forming a bulge.
CystoceleThis involves the bladder dropping and pushing into the vagina.
Uterine prolapseThis refers to the uterus descending and pushing into the vagina.

Symptoms

Pelvic floor dysfunction can cause a variety of symptoms, and some can interfere with daily life.

Depending on the type of pelvic floor dysfunction, a person may experience:

  • pelvic pain
  • pressure
  • a bulge somewhere in the lower pelvic region
  • stress urinary incontinence, which involves a small amount of urine leaking from the body due to an activity such as coughing
  • involuntary leakage of stool
  • incomplete urination
  • bowel movement dysfunction
  • pain during sexual intercourse

Also, some people who see their doctors about bladder overactivity find that pelvic floor dysfunction is responsible.

Causes

Many issues can cause the structures of the pelvic floor to weaken, including:

  • age
  • systemic diseases
  • lasting health issues that cause increased pressure in the abdomen and pelvis, such as a chronic cough
  • pregnancy
  • trauma during delivery
  • multiple deliveries
  • large babies
  • operative delivery

Research indicates that stress urinary incontinence, pelvic organ prolapse, or both occur in about half of all women who have given birth. These issues are closely associated with birth-related injury to the pelvic floor muscles.

The pelvic floor muscles can also stretch naturally with age. Stress urinary incontinence and pelvic organ prolapse become more common with increasing age in females, for example.

Collagen disorders can also affect the muscles’ ability to support the pelvic organs.

Meanwhile, coccygodynia usually stems from trauma to the tailbone, such as from a fall. That said, in about one-third of people with the condition, the cause of coccygodynia is unknown. The pain can make having a bowel movement difficult.

Exercises

Doctors recommend pelvic floor exercises in various situations.

They may particularly benefit pregnant women because the pelvic floor muscles can stretch and weaken during labor. Strengthening these muscles may help prevent incontinence after the baby is born. Some doctors recommend that women who wish to become pregnant start the exercises ahead of time.

Males can also benefit from pelvic floor exercises, though the dysfunction is more common in females. In males, these exercises can help prevent pelvic organ prolapse and urinary incontinence and improve sexual intercourse.

To exercise these muscles, a person should be sitting comfortably. Then, they should attempt to squeeze their pelvic muscles without holding their breath.

It is important to isolate the correct muscles without tightening those of the stomach, buttocks, or and thighs.

Doctors recommend that females aim to do 10 long squeezes — holding each for 10 seconds — followed by 10 short squeezes. However, initially, it may be a good idea to practice holding a squeeze for a few seconds at a time.

By practicing frequently, a person should be able to add more contractions to their routine week by week. It is important to do this gradually and to avoid overworking the muscles.

Within a few months, a person may notice a reduction in their symptoms. Even if symptoms resolve completely, a person should continue strengthening these muscles.

There are physical therapists who specialize in pelvic floor dysfunction. A person may find that consulting one of these professionals leads to a better outcome.

Treatment

Doctors determine the cause of pelvic floor dysfunction before recommending treatment because different types of dysfunction require different approaches.

The purpose of treatment is to relieve or reduce symptoms and improve the person’s quality of life. For some people, a combination of treatment methods works best.

Doctors may recommend:

  • Dietary changes: For example, eating more fiber, drinking more fluids, and taking certain medications can make bowel movements easier.
  • Laxatives: Taking a daily laxative may help people with pelvic floor dysfunction pass stool, but it is important to consult a healthcare provider first because not all laxatives are equally effective.
  • Pain relief: Some people require injections of pain relief or anti-inflammatory medication to relieve their symptoms.
  • Biofeedback: This involves electrical stimulation, ultrasound therapy, or massage of the pelvic floor muscles to help improve rectal sensation and muscle contraction.
  • Pessary: A doctor or nurse inserts a pessary into the vagina to support prolapsed organs. This type of device can help treat various symptoms of pelvic floor dysfunction, either as an alternative to surgery or while a person awaits surgery.
  • Surgery: When prolapse interferes with daily activities, a doctor may recommend surgery. Large rectoceles also require surgery if the person experiences symptoms.

Stem cell therapies

Researchers behind a 2016 study investigated whether a stem cell-based therapy could resolve pelvic floor dysfunction in rats.

The researchers engineered the stem cells to produce and release elastin and collagen into the pelvic floor and injected them into rats with pelvic floor dysfunction.

The elastin and collagen promoted the repair of pelvic floor structures and decreased signs of stress urinary incontinence.

In a final component of the study, the researchers developed stem cells that blocked a factor that stops the production of elastin. This promoted increased production and release of elastin into the pelvic floor.

With further studies, researchers may find that similar therapies are effective in humans.

When to see a doctor

Anyone who experiences painful bowel movements, difficulty urinating or passing stool, pelvic pain, or pain during sexual intercourse should speak with a doctor.

An unusual bulge in the lower pelvic region may also be a reason to see a doctor, though a bulge alone may not be a cause for concern.

People with pelvic floor dysfunction have plenty of treatment options. While the topic may be uncomfortable to bring up with a doctor, it is important to seek professional advice about these symptoms.

While some family doctors may not be familiar with pelvic floor dysfunction, specialists such as colorectal doctors, urologists, and gynecologists can help diagnose the issue and recommend the best course of action.

Summary

Pelvic floor dysfunction can affect anyone, but pregnant women have the highest risk.

The various types of pelvic floor dysfunction stem from different causes, and a doctor must identify the underlying issue before developing a treatment plan.

Exercises can help some people with pelvic floor dysfunction. Depending on the cause, a doctor may also recommend dietary changes, medication, a pessary, biofeedback, or surgery.

Uterine fibroids are noncancerous growths that grow in the wall of the uterus. When fibroids cause heavy bleeding or painful symptoms, and other treatments are ineffective, a doctor may recommend surgery.

Fibroids are common, but it is challenging for doctors to determine what percentage of people have them, as not everyone experiences symptoms. According to various estimates, fibroids may affect between 20% and 80% of the female population under the age of 50 years.

Although fibroids can sometimes grow to the size of a grapefruit or even larger, they are often very small. Many people with fibroids are unaware that they have them. People with asymptomatic fibroids do not require surgery or other treatments.

However, other people experience abdominal pain, pressure, bloating, pain during sex, frequent urination, and heavy or painful periods. These individuals may require surgery.

In this article, learn more about surgery for fibroids, including the types, risks, and what to expect.

Types

There are several different surgical approaches to treating fibroids. The types of surgery that a person can have will depend on the location of the fibroid.

A doctor will usually recommend more conservative options, such as medication, before considering surgery.

In cases where medication and other treatments do not work, surgical options include the following:

Myomectomy

Myomectomy is a surgical procedure that removes fibroids. Depending on the location of these growths, a surgeon may also have to remove other tissue in the process. Surgeons offer different myomectomy techniques.

The traditional technique is quite invasive as it uses a relatively large cut. This incision may go from the bellybutton to the bikini line or run horizontally along the bikini line. Some surgeons also perform laparoscopic surgeries, which use smaller incisions but require more skill.

Although a myomectomy preserves the uterus, women who wish to become pregnant should speak to a doctor about the possible complications. Those with very large or deeply embedded fibroids may only be able to have cesarean deliveries after this procedure.

New fibroids may develop after a myomectomy, which means that it is not a permanent solution for everyone.

Radiofrequency ablation procedure

Radiofrequency ablation destroys fibroids using either an electric current, a laser, cold therapy, or ultrasound. It requires only a small incision.

However, it can cause dangerous pregnancy complications, such as scarring and infection, so doctors do not recommend it for those who are planning future pregnancies.

Radiofrequency ablation may be a good option for people considering a hysterectomy who want a less invasive procedure.

Endometrial ablation

Endometrial ablation does not remove fibroids, but it can help relieve heavy bleeding.

During endometrial ablation, a surgeon uses a range of techniques — which may include heat, electric current, freezing, lasers, or wire — to destroy the lining of the uterus. These techniques reduce or stop heavy bleeding.

This procedure is less invasive than some other surgical options. Sometimes, doctors can even perform it on an outpatient basis in their office.

This procedure may prevent women from being able to get pregnant in the future, so it is not a good option for those who would still like to have children.

Fibroid or artery embolization

A doctor can locate the blood vessels that feed into the fibroid and disrupt their blood supply. During this procedure, they will insert a tube into blood vessels that supply the fibroid and then inject tiny particles that block the fibroid’s blood supply. The lack of blood shrinks the fibroids.

Doctors can do this procedure on an inpatient or outpatient basis, and recovery is usually fairly straightforward. Fibroids do not typically grow back after embolization.

While pregnancy is sometimes possible after fibroid embolization, doctors do not know enough about the risks. Therefore, they do not recommend this procedure for women who wish to get pregnant.

Magnetic resonance-guided focused ultrasound surgery

In magnetic resonance-guided focused ultrasound (MRgFUS), a doctor uses an ultrasound to heat and destroy fibroids.

This procedure can target the individual fibroids and avoid affecting the surrounding healthy tissue. A doctor will do an MRI scan to determine whether a person is a suitable candidate for MRgFUS. They may not recommend MRgFUS if the fibroids are too large or too close to any bones or the bowel.

MRgFUS may be a good option for women who plan to get pregnant, as it leaves the uterus intact. However, more data is necessary to confirm its safety for these individuals.

Hysterectomy

A hysterectomy is a surgery to remove the uterus and, sometimes, the ovaries. A hysterectomy permanently eliminates uterine fibroids.

This procedure is not an option for anyone planning a future pregnancy, as it removes the womb. Some people opt to leave the ovaries in place so that they continue producing estrogen.

A surgeon may be able to perform a laparoscopic hysterectomy, which uses several small incisions and a tiny camera to help the surgeon see inside the abdomen. An open hysterectomy requires a large incision between the bellybutton and the bikini line.

Another option is a vaginal hysterectomy, which is the approach that most people prefer. In this procedure, a surgeon will remove the uterus through the vagina.

A vaginal hysterectomy may not be possible if the uterus or fibroid is too large to fit through the vagina.

Individuals who undergo an open hysterectomy may have a longer recovery time. Doctors usually recommend a hysterectomy only for those whose fibroids are very large or significantly interfere with their quality of life.

People who have other reproductive health issues, such as endometriosis, may find that a hysterectomy provides significant relief from fibroids and other symptoms.

Morcellation

Morcellation is a procedure that reduces the size of fibroids so that a surgeon can remove them through a tiny incision in the abdomen. A doctor may use morcellation during a myomectomy, hysterectomy, or other surgery.

However, the Food and Drug Administration (FDA) caution that morcellation carries significant risks.

While fibroids are not cancerous, uterine cancer is more common in people having fibroid surgery than experts previously thought.

It can also be difficult to tell the difference between a fibroid and a type of cancer that looks the same. According to the FDA, morcellation may inadvertently spread cancer that resembles a fibroid.

Is surgery necessary?

Not everyone with fibroids needs treatment. In most cases, there is no reason to treat fibroids that cause no symptoms.

Some people with fibroids can treat symptoms successfully with medication, including hormonal birth control pills. Others alleviate fibroid symptoms by using pain relievers and other management strategies.

Before considering surgery, people can ask a doctor about other treatment options. The doctor should also provide clear details about the risks and benefits of each surgical procedure.

Fibroids can shrink or disappear after menopause, so people nearing menopause whose symptoms are not severe may wish to postpone treatment.

Benefits

The benefits of surgery depend on the type of surgery and can vary from person to person. For example, there is no chance that the fibroids will grow back after a hysterectomy. However, they may regrow following other procedures.

Some potential benefits include:

  • reduced bleeding
  • relief from pain or pressure
  • removal of fibroids
  • the potential that fibroids will either not grow as large or not regrow at all

Risks

Most people who have fibroid removal surgery have no serious complications, but they may experience pain or bleeding following surgery and will need time to recover.

However, a small number of people do face serious complications. The specific complications and their likelihood depend on the type of surgery that a person chooses, but they can include:

  • anesthesia-related risks
  • infections
  • heavy bleeding
  • failed surgery
  • regrowth of fibroids
  • damage to the uterus or other surrounding organs
  • in the case of morcellation, spreading cancer

How does fibroid surgery affect fertility?

The effects of fibroid surgery on fertility depend on the type of surgery. A hysterectomy or endometrial ablation usually makes pregnancy impossible.

Some procedures that may affect fertility but will not necessarily prevent pregnancy include:

  • morcellation
  • embolization
  • radiofrequency ablation

A myomectomy does not typically affect fertility. However, any surgery on the uterus can potentially damage the reproductive organs and affect future pregnancies.

Recovery

Most fibroid removal surgeries require general anesthesia. A person may need to stay overnight in the hospital, so the hospital staff may advise them to bring an overnight bag.

Invasive surgeries, such as a hysterectomy or a nonlaparoscopic myomectomy, typically have the longest recovery time.

A person can try the following to help ease recovery:

  • asking a doctor about the specific recovery timeline for the chosen surgery
  • asking a doctor about laparoscopic procedures and talking to a specialist with experience in minimally invasive surgery
  • following the doctor’s self-care and recovery instructions
  • getting help from a loved one in the days following surgery

Other treatment options

In most cases, a doctor will recommend trying other treatments before pursuing surgery.

Treatments for fibroids include:

  • Birth control pills. Hormonal contraceptives may slow fibroid growth and prevent heavy, painful periods.
  • Pain medication. Prescription and over-the-counter pain relievers may help with fibroid pain, especially period-related fibroid pain.
  • Iron supplements. For people with heavy bleeding that causes anemia, iron supplements may help.
  • Gonadotropin-releasing hormone agonists (GnRH). These drugs may help shrink fibroids. Some doctors recommend them prior to surgery to make fibroid removal easier.

Summary

Surgery can be lifechanging for people whose fibroids interfere with their quality of life, as it can improve many aspects of their health.

All surgeries present some risks, however, so it is vital to explore all treatment options. A doctor can provide advice on which surgeries might be appropriate. A person may also wish to consider seeking a second opinion before agreeing to surgery.

Regular vaginal discharge is a sign of a healthy female reproductive system. Normal vaginal discharge contains a mixture of cervical mucus, vaginal fluid, dead cells, and bacteria.

Females may experience heavy vaginal discharge from arousal or during ovulation. However, excessive vaginal discharge that smells bad or looks unusual can indicate an underlying condition.

This articles discusses why someone may have heavy vaginal discharge and what they can do about it.

1. Arousal

Sexual arousal triggers several physical responses in the body. Arousal increases blood flow in the genitals. As a result, the blood vessels enlarge, which pushes fluid to the surface of the vaginal walls.

Arousal fluid is clear and watery with a slippery texture. This fluid helps lubricate the vagina during sex.

Other signs of female arousal include:

  • increased heart rate and breathing
  • flushing of the face, neck, and chest
  • swelling of the breasts
  • erect nipples

2. Ovulation

Cervical fluid is a gel-like liquid that contains proteins, carbohydrates, and amino acids. The texture and amount of cervical fluid both change throughout a female’s menstrual cycle.

For example, after menstruation, cervical fluid has a thick, mucus-like texture. It can be cloudy, white, or yellow.

Estrogen levels increase closer to ovulation. This causes the cervical fluid to become clear and slippery, similar to that of raw egg whites.

Cervical fluid discharge increases during the days leading up to ovulation and decreases after ovulation. Females may have no discharge for a few days after their period.

3. Hormonal imbalances

Hormonal imbalances related to stress, diet, or underlying medical conditions can cause heavier vaginal discharge.

Polycystic ovary syndrome (PCOS), for example, refers to a set of symptoms that occur as a result of hormonal imbalances. According to the Centers for Disease Control and Prevention (CDC), PCOS affects up to 5 million females in the United States.

Those with PCOS have higher levels of male hormones called androgens. Increased androgen levels can:

  • change the amount or texture of cervical fluid
  • cause irregular periods
  • prevent ovulation

Not everyone with PCOS will have increased vaginal discharge. Paying attention to other PCOS symptoms may help someone identify and seek treatment for the condition faster.

Some other symptoms of PCOS to look out for include:

  • fewer than eight periods in 1 year, or periods that occur every roughly 21 days
  • excess facial and body hair
  • thinning hair or hair loss
  • acne on the face and body
  • weight gain
  • darkening of the skin on the neck, groin, or breasts
  • skin tags on the armpits or neck

Hormonal birth control, such as birth control pills and intrauterine devices, can also cause increased vaginal discharge, especially during the first few months of use.

Excess vaginal discharge and other symptoms, such as spotting and cramping, usually resolve once the body adjusts to the hormonal birth control.

4. Vaginitis

Vaginitis refers to inflammation of the vagina, which can occur from an infection or irritation due to factors such as douches, lubricants, and ill-fitting clothing.

Vaginitis can cause thick vaginal discharge that may be white, gray, yellow, or green.

Other symptoms of vaginitis include:

  • foul vaginal odor
  • an itching or burning sensation in the genital area
  • redness or inflammation of the vagina
  • pain or discomfort when urinating
  • pain during sexual intercourse

5. Bacterial vaginosis

Bacterial vaginosis is a condition that results from an overgrowth of bacteria in the vagina. This vaginal infection is the most common among females aged 15–44 years.

The exact cause of bacterial vaginosis remains unclear. Females can develop bacterial vaginosis after sexual intercourse. However, this condition is not a sexually transmitted infection (STI).

According to the Office on Women’s Health, those who have bacterial vaginosis may notice a milky or gray-colored vaginal discharge. Some also report a strong, fishy vaginal odor, especially after sexual intercourse.

Bacterial vaginosis can also cause:

  • discomfort when urinating
  • painful burning or itching in the vagina
  • irritation of the skin around the vagina

6. Yeast infection

Vaginal yeast infections result from an overgrowth of the Candida fungus. Females of all ages can develop a vaginal yeast infection, and nearly 70% will have a yeast infection at some point in their lives.

The most common symptom of a vaginal yeast infection is an intense itching in the vagina and vulva.

Vaginal yeast infections can also cause an odorless vaginal discharge that looks similar to cottage cheese.

Vaginal yeast infections are treatable at home using over-the-counter antifungal ointments. Symptoms should improve within a few days. However, severe infections can last longer and may require medical treatment.

7. Trichomoniasis

Trichomoniasis is an STI caused by a parasite. Females can develop trichomoniasis after having sex with someone who has the parasite.

Although most people who have trichomoniasis do not experience symptoms, some may have an itching or burning sensation in the genital area.

Trichomoniasis infections can also cause excess vaginal discharge that has a foul or fishy odor and a white, yellow, or green color. It may also be thinner than usual.

What is healthy discharge?

Healthy vaginal discharge varies from person to person. It also changes throughout their menstrual cycle.

In general, healthy vaginal discharge can appear thin and watery or thick and cloudy. Clear, white, or off-white vaginal discharge is also perfectly normal.

Some females may have brown, red, or black vaginal discharge at the end of their menstrual periods if their vaginal discharge still contains blood from the uterus.

Natural hormonal changes during ovulation can cause an increase in vaginal discharge, which should return to normal after ovulation.

When to see a doctor

It is not always necessary to see a doctor about excessive vaginal discharge. However, a female may want to consider seeing their doctor if their vaginal discharge has an abnormal appearance.

Yellow, green, gray, or foul-smelling vaginal discharge could indicate an infection. Other reasons to see a doctor include:

  • itching or burning near the genitals
  • discomfort or pain when urinating
  • discomfort or pain during sexual intercourse

Possible treatment options

Treating excess vaginal discharge depends on the underlying cause.

People can reduce symptoms of vaginitis by avoiding the source of irritation. Doctors can treat bacterial vaginosis and yeast infections using antibiotics or antifungals.

Doctors can also treat trichomoniasis using antibiotics. The CDC recommend that females wait 7–10 days after receiving treatment before having sex.

Treatment for PCOS varies depending on the individual. A doctor may recommend a combination of lifestyle changes and medications to help people manage their symptoms and regulate their hormone levels.

Maintaining a healthy body weight and eating a varied diet low in added sugars may also help improve some symptoms of PCOS. Birth control pills that contain estrogen or progestin can help balance out excess levels of androgens.

Tips for managing heavy vaginal discharge

Even healthy vaginal discharge can cause discomfort at times. Here are some tips for managing heavy vaginal discharge:

  • Wear panty liners. However, be sure not to let them become too moist, as this can increase the risk of urinary tract infections and vaginitis.
  • Choose breathable underwear made from natural fibers such as cotton.
  • Avoid wearing tight pants.
  • Avoid using hygiene products that contain added fragrances, coloring agents, or other harsh chemicals.
  • Keep the genital area clean and dry.
  • Wipe from the front to the back when using the bathroom.

Outlook

Excess vaginal discharge can occur as a result of arousal, ovulation, or infections. Normal vaginal discharge ranges in color from clear or milky to white.

The consistency of vaginal discharge also varies from thin and watery to thick and sticky. Generally, healthy vaginal discharge should be relatively odorless.

A female can speak with a healthcare professional if they notice any symptoms of an infection. Some symptoms to look out for include:

  • yellow, green, or gray vaginal discharge
  • foul-smelling vaginal discharge
  • discharge that looks similar to cottage cheese
  • itching or burning in or near the genitals

Doctors can easily treat most vaginal infections using antimicrobial medications. Depending on the severity of the infection, people may see their symptoms improving within a few days to weeks.

Lower abdominal pain is pain that occurs below a person’s belly button. Bloating refers to a feeling of pressure or fullness in the abdomen, or a visibly distended abdomen. Sometimes, these symptoms occur together.

Though occasional lower abdominal pain and bloating are common, a person should speak to their doctor if it becomes a regular occurrence. In some cases, this combination of symptoms may indicate an underlying issue that requires medical treatment.

Keep reading for more information on some of the more common causes of abdominal pain and bloating. We also outline various treatment options for this combination of symptoms.

Causes of both abdominal pain and bloating

There are several causes of combined lower abdominal pain (LAP) and bloating. Some relatively harmless, or benign, causes include:

  • consumption of high fat foods
  • swallowing too much air
  • stress

In some cases, LAP and bloating can occur as a result of an underlying medical condition, such as:

  • constipation
  • food intolerances, such as lactose or gluten intolerance
  • gastroesophageal reflux disease (GERD), although this more commonly causes upper abdominal pain-gastroenteritis, which is inflammation of the gastrointestinal (GI) tract that causes vomiting and diarrhoea
  • diverticulitis, which is inflammation or infection of part of the large intestine
  • ileus, which is a condition that slows the function of the small and large intestine
  • delayed stomach emptying, or gastroparesis, which is a complication of diabetes mellitus
  • intestinal obstruction
  • inflammatory bowel disease (Crohn’s disease or ulcerative colitis)

Other conditions that can cause LAP and bloating are specific to females. These include:

  • menstrual pain
  • endometriosis
  • ovarian cysts
  • pelvic inflammatory disease (PID)
  • pregnancy
  • ectopic pregnancy

LAP and bloating can also be due to conditions that do not necessarily affect the stomach, intestines, or reproductive organs. These conditions include;

  • drug allergies
  • side effects of certain medications
  • hernia
  • cystitis, or infection of the urinary tract infection
  • appendicitis, or inflammation of the appendix
  • kidney stones

When to see a doctor

If the cause of LAP and bloating is relatively benign, symptoms should go away within a few hours to days.

A person should see a doctor if:

  • their symptoms last longer than a few days
  • their symptoms begin to interfere with their daily life
  • they are pregnant and are unsure of the cause of LAP and bloating

People should seek immediate medical attention if vomiting or the inability to pass gas occur alongside LAP and bloating.

People who experience LAP and bloating along with one or more of the following symptoms should seek emergency medical attention:

  • sudden worsening of pain
  • fever
  • unusual vaginal discharge
  • bloody stool
  • unexplained weight loss
  • severe nausea and vomiting

Diagnosis

To make a diagnosis, a doctor will begin by carrying out a physical examination. An initial examination will involve applying pressure to the abdomen. This will help the doctor to check the location of pain and to feel for any abnormalities.

A doctor will also make a note of the person’s medical history, and any other symptoms they experience. They may also ask whether there is anything that triggers the pain or makes it worse.

Diagnostic tests, such as urine, blood, or stool tests, may also be necessary. These can help to identify signs of infection or other underlying conditions.

In some cases, a doctor may order one of the following imaging tests to check for abnormalities in the abdomen:

  • ultrasound
  • X-ray
  • CT or MRI

If the imaging tests come back normal, a doctor may perform a colonoscopy for a closer look inside the intestines.

Treatment

The following are some general home treatment options that may help to alleviate symptoms of LAP and bloating:

  • increasing fluid intake
  • exercising to help alleviate gas and bloating
  • taking over-the-counter (OTC) pain medications
  • taking OTC antacids

If home treatments do not work, a person should speak to their doctor about other treatment options. These will vary, depending on the cause of LAP and bloating. However, some examples include:

  • prescription medications to treat pain and bloating
  • antibiotics to help treat a bacterial infection
  • emergency surgery to remove a ruptured appendix

Prevention

There are some steps a person can take to help alleviate LAP and bloating. Two key steps include quitting smoking and avoiding trigger foods.

The following are examples of foods that may cause or contribute to LAP and bloating:

  • high fat foods
  • certain plant-based foods, such as cabbage, lentils, and beans
  • dairy products if a person is lactose intolerant
  • carbonated drinks
  • beer
  • chewing gum
  • hard candy

Also, people may benefit from increasing their intake of high fiber foods such as fruits, vegetables, and whole grains. This will help to prevent constipation and associated bloating.

If an underlying condition is the cause of LAP and bloating, then treating the condition should help to alleviate these symptoms.

Outlook

There are many potential causes of lower abdominal pain and bloating. Some causes are relatively benign and easy to treat, while others may be more serious.

Occasional lower abdominal pain and bloating are usually not a cause for concern. However, people should see a doctor if their symptoms worsen, last more than a few days, or disrupt their daily activities.

People who experience additional symptoms, such as vomiting, fever, or blood in the stool, should seek emergency medical attention.

In some cases, people can prevent lower abdominal pain and bloating by avoiding foods that may trigger these symptoms.

The majority of people can donate blood. However, those who use nicotine products, cannabis products, or both may wonder whether or not they can donate blood.

Hospitals and health clinics use donated blood to treat various medical conditions. According to the World Health Organization (WHO), the number of blood donations collected around the world per year exceeds 117.4 millionTrusted Source.

Blood donations can help with:

  • serious injuries
  • surgery
  • anemia
  • cancer
  • chronic illnesses

Read on to learn more about how different ways of using cigarettes, cannabis, and other drugs can affect a person’s ability to donate blood.

Nicotine

If a person smokes cigarettes or vapes, it does not disqualify them from donating blood.

However, both tobacco cigarettes and electronic cigarettes (e-cigarettes) contain harmful chemicals that may affect a person’s blood.

The American Lung Association claim that a burning cigarette produces more than 7,000 chemicals, including carbon monoxide, ammonia, and arsenic. Several of these chemicals are toxic, and 69 of them can cause cancer.

In addition to nicotine, e-cigarettes may contain the following harmful substances:

  • propylene glycol, which is present in paint solvents, antifreeze, and some foods (as an additive)
  • acetaldehyde, which is a toxic product of ethanol alcohol
  • formaldehyde, which is a chemical preservative present in disinfectants, glue, and plywood
  • diacetyl, which is a flavoring agent that tastes like butter
  • heavy metals, including nickel and lead
  • benzene, which is a chemical compound present in car exhaust

Currently, minimal information exists regarding the exact effects of vaping on blood donations. One thing to keep in mind is the fact that both vaping and smoking cigarettes can increase blood pressure.

According to American Red Cross guidelines, people can donate blood as long as their blood pressure is between 90/50 millimeters of mercury (mm Hg) and 80/100 mm Hg.

In one 2018 studyTrusted Source, researchers compared blood donations from people who smoke with donations from people who do not smoke. They concluded that smoking cigarettes does not affect the overall quality of the donated blood.

However, the researchers did note that the donations from the people who smoke had higher concentrations of carboxyhemoglobin (COHb) in the red blood cells. COHb forms when red blood cells come into contact with carbon monoxide, significantly reducing the amount of oxygen that red blood cells can carry.

Based on these findings, the researchers recommend that people avoid smoking for 12 hoursTrusted Source before donating blood.

Cannabis

Like smoking cigarettes and vaping, smoking cannabis does not disqualify a person from donating blood.

Current scientific researchTrusted Source suggests that cannabis use can negatively impact the cardiovascular system by:

  • increasing blood pressure and heart rate
  • narrowing the blood vessels
  • causing inflammation in the vessel walls
  • promoting blood clots

However, these potential adverse health effects should not impact the quality of any donated blood.

That being said, Vitalant — a nonprofit blood service provider — explain that people must not be under the influence of recreational drugs or alcohol at the time of donation.

Other drugs

According to the American Red Cross, people with a history of recreational intravenous drug use are not eligible to donate blood. This requirement helps prevent the spread of HIV and hepatitis.

It is important to note that this is not the case for people who have used drugs in other ways, such as by smoking them or taking them orally. The American Red Cross and other blood donation companies do not specify drug use as an excluding factor.

However, a person does need to make sure that substances such as nicotine and cannabis are not in their system when donating blood.

Excluding factors

To donate blood, the general requirement is that a person should be at least 17 years old. A person can be 16 years old, but they must have a legal guardian’s consent.

Other factors that may disqualify a person from giving blood include:

  • feeling sick or having cold or flu symptoms
  • using intravenous drugs not prescribed by a licensed doctor
  • having an active infection
  • having HIV or testing positive for hepatitis B or C
  • having uncontrolled diabetes
  • having a blood clotting disorder
  • having ever had the Ebola virus
  • having blood cancers, such as leukemia or lymphoma
  • having received a blood transfusion within the past 12 months
  • having a heart rate below 50 beats per minute (BPM) or above 100 BPM
  • having recently traveled to a foreign country
  • being pregnant, or having given birth within the past 6 weeks

Read more about the advantages and disadvantages of donating blood here.

Summary

Although smoking cigarettes, vaping, and using cannabis will not disqualify a person from donating blood, they should refrain from smoking for at least 2 hoursTrusted Source before and after donating blood.

A person may feel lightheaded or weak after giving blood, and smoking can exacerbate these symptoms. It is a good idea to avoid smoking until these symptoms go away.

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late menopause
late menopause
New research, published in the journal Neurology, suggests that a late menopause onset may benefit the memory skills of senior women later in life.

A new study led by Diana Kuh, from University College London in the United Kingdom, asks whether the age at which a woman gets her menopause influences her memory performance years later.

She and her colleagues were prompted in their research by existing studies that seemed to suggest that an older age at menopause — coupled with a longer reproductive life — are linked with better cognitive performance years later.

However, as the study authors explain, those studies did not use a particularly large sample, and neither did they benefit from a group of age-homogeneous participants.

So, Kuh and team set out to rectify this by looking at birth cohort studies. They investigated the data of 1,315 women using the Medical Research Council National Survey of Health and Development in the U.K.

Menopause and memory: Studying the link

As a part of the survey, the women had been clinically followed since birth — that is, since March 1946 — and had at least one cognitive evaluation as adults. Furthermore, the survey included questions about their age at menopause and other aspects of their reproductive health.

At ages 43, 53, 60–64, and 69, the study participants were asked to take verbal memory tests as well as tests for their cognitive processing speed.

The memory assessment consisted of a task in which the participants were asked to recall as many items as possible from a list of 15, and to do so three times. The maximum score achievable in this task was 45 (they scored one point for each word).

Also, the survey included information on whether the women were taking hormone replacement therapy, whether they had had any surgery such as a hysterectomy, their cognitive ability as children, and a few other social factors, such as level of education and their occupation.

All of these factors were accounted for by the researchers in their analysis.

Late menopause may benefit verbal memory

The study revealed that, on average, participants remembered 25.8 words at age 43, a number that declined to 23.3 words by age 69.

But women whose menopause occurred naturally and later in life had higher scores, being able to recall an additional 0.09 words per year. This correlation was not affected by the use of hormone replacement therapy.

Kuh comments on the findings, saying, “The difference in verbal memory scores for a 10-year difference in the start of menopause was small — recalling only one additional word, but it’s possible that this benefit could translate to a reduced risk of dementia years later.”

However, she adds, “More research and follow-up are needed to determine whether that is the case.”

By contrast, no similar correlation between age and memory was noted among women who had surgery-induced menopause. Also, the researchers found no correlation between the age of menopause onset and the women’s information-processing capabilities.

Speculating on the possible mechanisms behind the findings, Kuh says, “This difference [between memory skills and processing speed] may be due to the estrogen receptor role, which regulates the gene that codes brain-derived neurotrophic factor.”

The brain-derived neurotrophic factor, she continues, “helps to solidify memory formation and storage.” Kuh and her colleagues conclude:

Our findings suggest lifelong hormonal processes, not just short-term fluctuations during the menopause transition, may be associated with verbal memory, consistent with evidence from a variety of neurobiological studies.”