Your Guide to Finding an LGBTQ-Friendly Doctor

Once, at a medical appointment, I saw a nurse who seemed unable to wrap his head around the fact that I was sexually active but not on birth control. I wasn’t sleeping with cisgender men at the time; I didn’t need pregnancy protection. Even though I explained this, he prodded me with more questions about my sexual orientation than needles to draw my blood.

I’m a queer, white, cis woman with access to money, transportation, insurance, and other resources that allow me immense privilege. I’ve still had trouble finding doctors and other medical professionals who act as LGBTQ+ allies. To me, a medical LGBTQ+ ally is well-versed in the correct language to describe my sexuality, doesn’t automatically assume I’m straight just because I’m femme, doesn’t say or do offensive things when I correct them, is committed to understanding how my sexuality might influence my health, and generally treats me with respect.

The National Institute on Minority Health and Health Disparities has identified the LGBTQ+ community as a “health disparity population” due, in part, to our lowered health care access. Unfortunately, some of this comes down to LGBTQ+ patients avoiding medical treatment due to past discrimination and fear of stigma. When LGBTQ+ people belong to other marginalized groups, such as being a person of color or having a disability, it only becomes more difficult to find accessible, non-biased care.

It shouldn’t be this hard. Not only because access to affordable, quality health care should be a human right, but also because LGBTQ+ people are at greater risk for a variety of health threats. These include depression, suicide, substance abuse, breast cancer, heart disease, and HIV/AIDS, depending on the specific community in question.

Unfortunately, even the health care we do get sometimes falls miles short of the compassionate, dignified sort we should receive.

Finding decent and affordable health care in America is a challenge for many people, regardless of their gender identity or sexual orientation. Being LGBTQ+ can just make it harder.

Outdated misconceptions about gender identity and sexual orientation have no place in medicine, but they can run rampant. Liz M., 33, a queer, disabled, and non-binary person, tells SELF of “the nurse practitioner who asked ‘how I became a lesbian’ while her hands were inside my intimate parts.”

Even with the best of intentions, medical professionals can make assumptions that lead to mistakes. Leah J., 21, is a non-binary LGBTQ+ speaker and activist with polycystic ovary syndrome (PCOS), a hormonal disorder that is traditionally seen as a condition that only affects women. “Navigating [seeing] an ob/gyn as a non-binary person is very difficult,” Leah tells SELF, explaining that people in doctor’s offices have misgendered them. Leah also has yet to see an intake form that offers “non-binary” as a gender option (or provides space to write in an answer), they add. Then there’s the thorny matter of how medical professionals talk about Leah’s condition, which causes the body to make an excess of testosterone. “I’ll grow extra hair on my face. My voice might be lower. [Doctors have assumed] it’s something I want to fix, that I want to change,” Leah says.

Sometimes it simply comes down to medical professionals’ lack of familiarity with the specific health issues at play for their LGBTQ+ patients. After a dental procedure left me with bloody gums, I asked my dentist and ob/gyn if there was an increased risk of STI transmission during oral sex on people with vaginas. Both doctors fumbled over their words, leaving me without a clear answer.

So, how does the LGBTQ+ community find a safe space to seek medical treatment free from judgment, assumption, and in the worst cases, harassment and even assault?

There are various resources out there for LGBTQ+ people to find supportive primary, sexual, and mental health care.

Here are a few places to start:

  • The Human Rights Campaign’s 2018 Healthcare Equality Index (HEI) surveyed 626 medical facilities across the nation to see which provide patient-oriented care for LGBTQ+ people. (The survey evaluated areas such as staff training in LGBTQ+ services, domestic partner benefits, and patient/employment non-discrimination.)

The HEI designated 418 of those facilities as “LGBTQ Healthcare Equality Leaders” because they scored 100 points, indicating that they’ve made a concerted effort to publicly fight for and provide inclusive care. An additional 95 facilities got “Top Performer” because they received 80 to 95 points.

You can look through the full report to learn about the survey and see how various health centers and hospitals performed. The Human Rights Campaign also has a searchable database of 1,656 facilities they’ve scored (including those from past years and some that have never participated at all). Here’s a map laying out where those facilities are, too.

  • Another great resource is the GLMA (Gay and Lesbian Medical Association) provider directory, Bruce Olmscheid, a primary care provider at One Medical, tells SELF. The providers in the directory have agreed to certain affirmations listed on GLMA’s website, such as: “I welcome lesbian, gay, bisexual, and transgender individuals and families into my practice and offer all health services to patients on an equal basis, regardless of sexual orientation, gender identity, marital status, and other non-medically relevant factors.”

  • Planned Parenthood has long been fighting the battle to provide affordable sexual and reproductive health care for all. On their LGBT Services page, they explicitly state their commitment to delivering quality care no matter a person’s gender identity or sexual orientation. Of course, while this policy is excellent, Planned Parenthood has many health centers. The level at which staff reflects the written policy can vary from location to location. With that in mind, you can find a local center here.

  • GBLT Near Me has a database of local resources for LGBTQ+ people, including health-related ones.

  • This great Twitter thread serendipitously went viral as I was writing this story. The person behind the account, Dill Werner, notes that you might be able to find therapy services through your local LGBTQ+ center, your state’s Pride website, or by specifically Googling your location and the words “gender clinic.”

  • One Medical of New York City put me in touch with an LGBTQ+ general practitioner with quickness and ease. One Medical is a primary care brand that offers services in eight metropolitan regions: Boston, Chicago, Los Angeles, New York, Phoenix, San Francisco, Seattle, and Washington, D.C. Enter your location here to find nearby offices.

“You can use the website to find One Medical doctors who specialize in LGBTQ+ care,” a One Medical representative tells SELF via email. If you click “Primary Care Team” at the top of the site, you’ll see a dropdown labeled “Interests” with an “LGBT Care” option. (One thing to note: One Medical is a concierge service with a membership of $199 a year, although the fee is not mandatory, so you can ask your local office about waiving it.)

  • If you’re in New York City, Manhattan Alternative is a network of sex-positive health care providers committed to affirming the experiences of LGBTQ+ people, along with those in gender non-conforming, kink, poly, and consensually non-monogamous communities. If you’re not in NYC, try searching for a few of those keywords and your city, like “sex-positive therapist in Washington, D.C.”

  • You can also try Googling “gay doctor” or “LGBTQ+ doctor” in your area, Dr. Olmscheid says.

  • This isn’t specifically about doctors, but we’d be remiss to leave it out: If you or someone you know is LGBTQ+ and having a mental health emergency, organizations like The Trevor Project offer crisis intervention and suicide prevention specifically for LGBTQ+ people. You can reach their 24/7 hotline at 1-866-488-7386. They also have a texting service (text TREVOR to 1-202-304-1200) and an online counseling system. (The texting is available Monday through Friday from 3 P.M. to 10 P.M. ET; the online counseling is available every day of the week at the same times.)

  • Trans Lifeline is another incredibly valuable hotline. It’s run by transgender operators in the United States (1-877-565-8860) and Canada (1-877-330-6366) who are there to listen to and support transgender or questioning callers in crisis. While the hotline is technically open 24/7, operators are specifically guaranteed to be on call from 10 A.M. to 4 A.M. ET every day. (Many are also there to talk off-hours, so don’t let that keep you from calling.)

  • “Leverage your community. Ask friends or colleagues if they’ve had positive experiences with their doctors. It’s important to keep the conversation going,” Dr. Olmscheid says.

Of course, all of this might lead you to a list of doctors who don’t accept your insurance, possibly driving up the cost of your care. In that case, Liz has a strategy for working backwards. “If none of my friends know someone good, I start by going into my insurance page and [seeing] who’s in-network,” Liz says. “Are they publicly or visibly identifiable as someone with at least one marginalized identity? Then they might understand that prejudice, even in medicine, is a thing.”

You might feel all set once you’ve found a doctor. But if you’re still not feeling comfortable, you can try calling the front desk with questions.

“I don’t always feel people who advertise as LGBTQ+-competent [actually] are,” Kelly J. Wise, Ph.D., an NYC-based therapist specializing in sexuality and gender who is trans himself, tells SELF. Doing a bit more digging may help ease your mind.

Leah Torres, M.D., an ob/gyn based in Salt Lake City, advises calling the office to ask questions before booking an appointment. You can try asking if the office sees or attends to LGBTQ+ people, Dr. Torres tells SELF. (Dr. Torres is a SELF columnist.) You can also ask more specifically about their experience with people of your identity if you like. If the receptionist doesn’t have an immediate answer for you and doesn’t seem concerned about getting one (or does, but no one follows up with you), that might tell you something about the care the office provides. (Although sometimes the doctor is great with LGBTQ+ issues, and the staff isn’t as familiar. “One of [medicine’s] pitfalls is that the office staff isn’t always trained,” Dr. Torres says. “Having a staff that’s able to set aside their own assumption and bias is important.”)

You can also look through the office’s reviews on resources such as Yelp and ZocDoc. Even if there aren’t any pertaining to LGBTQ+ people in particular, you may get a better feel for how they treat people in the potentially vulnerable spot of trying to look after their health.
Finally, consider looking into what sorts of community events the office has participated in, the charitable contributions they’ve made, and the social media presences of the office and the specific provider you might see.

Once you’re face-to-face with your doctor, their allyship (or lack thereof) might become clear pretty quickly.

Your doctor’s office should be a safe space to explain anything they need to know in order to take excellent care of you, including various aspects of your identity. When they ask what brought you in to see them, that’s a great time to lead with something like, “I have sex with other women, and I’m here for STI testing,” or “I’m dealing with some stress because I’m non-binary, and the people in my office refuse to use my proper pronouns.”

But remember that the onus is really on the doctor to navigate the situation properly, not you, Dr. Wise says. Here are some signs they’re committed to doing so:

  • They ask what your pronouns are, or if you tell them before they ask, they use the correct ones.
  • If they mess up your pronouns, they apologize.
  • They ask assumption-free questions such as, “Are you in a relationship?” rather than, “Do you have a husband?”
  • They also don’t assume things after you express your identity, such as thinking you’re there for STI testing just because you are bisexual.
  • If their body language and/or facial expression change when you mention your identity, it’s only in affirming ways, such as nodding and smiling.
  • They admit when they don’t have the answers. “You don’t want the person who is like, ‘I know everything’. You want someone who knows when they have to ask a colleague,” Dr. Torres says. As an example, Dr. Torres, who doesn’t have many transgender patients, tells those undergoing hormone therapy that she will discuss their care with an endocrinologist.

What if a doctor screws up and doesn’t apologize or otherwise doesn’t offer compassionate, comprehensive care?

“Our medical system hasn’t caught up with how evolved our gender and sexual identities are,” Leah says. “A lot of people just aren’t educated.”

If your medical provider does do something that makes you uncomfortable, you might freeze up and not know how to respond. That’s OK. However, if you feel safe enough, try to advocate for yourself in that moment, Dr. Wise says. You can try correcting them by saying something like, “I actually don’t date men” or, “As I mentioned, my pronouns are ‘they/them.’” Depending on how comfortable you feel being direct, you can also straight up say something like, “That was extremely unprofessional.”

If you don’t feel you’re in a position to speak up but you want to leave, do or say what you need to in order to get out of there. Maybe it’s exiting the room instead of changing into a dressing gown and proceeding with an exam, or even pretending you got a text and need to attend to work immediately. Whatever you need to do is valid.

However you respond in the moment, writing a Yelp and/or Zocdoc review after your appointment or sharing your experience on social media is really up to you. You might feel compelled to warn other LGBTQ+ patients, Dr. Wise says, but only do this if you really feel OK with it—it’s not a requirement. (Especially if you’re concerned it might out you before you’re ready.) Dr. Torres also notes that you can file a complaint with the office or hospital’s human resources department. Another option: Get in touch with your state’s medical board to report the episode.

As you can see, there are plenty of options at your disposal if you want to spread the word about a medical professional who isn’t an LGBTQ+ ally. But if all you want to do is move on and find a provider who treats you with the care you deserve, that’s perfectly fine, too.

Related:

Dietary fiber reduces brain inflammation during aging

As mammals age, immune cells in the brain known as microglia become chronically inflamed. In this state, they produce chemicals known to impair cognitive and motor function. That’s one explanation for why memory fades and other brain functions decline during old age. But, according to a new study from the University of Illinois, there may be a remedy to delay the inevitable: dietary fiber.

Dietary fiber promotes the growth of good bacteria in the gut. When these bacteria digest fiber, they produce short-chain-fatty-acids (SCFAs), including butyrate, as byproducts.

“Butyrate is of interest because it has been shown to have anti-inflammatory properties on microglia and improve memory in mice when administered pharmacologically,” says Rodney Johnson, professor and head of the Department of Animal Sciences at U of I, and corresponding author on the Frontiers in Immunology study.

Although positive outcomes of sodium butyrate — the drug form — were seen in previous studies, the mechanism wasn’t clear. The new study reveals, in old mice, that butyrate inhibits production of damaging chemicals by inflamed microglia. One of those chemicals is interleukin-1?, which has been associated with Alzheimer’s disease in humans.

Understanding how sodium butyrate works is a step forward, but the researchers were more interested in knowing whether the same effects could be obtained simply by feeding the mice more fiber.

“People are not likely to consume sodium butyrate directly, due to its noxious odor,” Johnson says. “A practical way to get elevated butyrate is to consume a diet high in soluble fiber.”

The concept takes advantage of the fact that gut bacteria convert fiber into butyrate naturally.

“We know that diet has a major influence on the composition and function of microbes in the gut and that diets high in fiber benefit good microbes, while diets high in fat and protein can have a negative influence on microbial composition and function. Diet, through altering gut microbes, is one way in which it affects disease,” says Jeff Woods, professor in the Department of Kinesiology and Community Health at U of I, and co-author on the study.

Butyrate derived from dietary fiber should have the same benefits in the brain as the drug form, but no one had tested it before. The researchers fed low- and high-fiber diets to groups of young and old mice, then measured the levels of butyrate and other SCFAs in the blood, as well as inflammatory chemicals in the intestine.

“The high-fiber diet elevated butyrate and other SCFAs in the blood both for young and old mice. But only the old mice showed intestinal inflammation on the low-fiber diet,” Johnson says. “It’s interesting that young adults didn’t have that inflammatory response on the same diet. It clearly highlights the vulnerability of being old.”

On the other hand, when old mice consumed the high-fiber diet, their intestinal inflammation was reduced dramatically, showing no difference between the age groups. Johnson concludes, “Dietary fiber can really manipulate the inflammatory environment in the gut.”

The next step was looking at signs of inflammation in the brain. The researchers examined about 50 unique genes in microglia and found the high-fiber diet reduced the inflammatory profile in aged animals.

The researchers did not examine the effects of the diets on cognition and behavior or the precise mechanisms in the gut-brain axis, but they plan to tackle that work in the future as part of a new, almost-$2 million grant from the National Institute on Aging, part of the National Institutes of Health.

Although the study was conducted in mice, Johnson is comfortable extending his findings to humans, if only in a general sense. “What you eat matters. We know that older adults consume 40 percent less dietary fiber than is recommended. Not getting enough fiber could have negative consequences for things you don’t even think about, such as connections to brain health and inflammation in general.”

Diabetes and Menopause: a Twin Challenge

Menopause—and the years leading up to it—may present unique challenges if you have diabetes. But it’s not necessarily a one-two punch. First, learn what to expect. Then consider what to do about it.

Diabetes and menopause: What to expect

Menopause is the phase of life after your periods have stopped and your estrogen levels decline. In some women, menopause can occur as a result of surgery, when the ovaries are removed for other medical reasons.

Diabetes and menopause may team up for varied effects on your body, including:

  • Changes in blood sugar level. The hormones estrogen and progesterone affect how your cells respond to insulin. After menopause, changes in your hormone levels can trigger fluctuations in your blood sugar level. You may notice that your blood sugar level is more variable and less predictable than before. If your blood sugar gets out of control, you have a higher risk of diabetes complications.
  • Weight gain. Some women gain weight during the menopausal transition and after menopause. This can increase the need for insulin or oral diabetes medication.
  • Infections. Even before menopause, high blood sugar levels can contribute to urinary tract and vaginal infections. After menopause—when a drop in estrogen makes it easier for bacteria and yeast to thrive in the urinary tract and vagina—the risk is even higher.
  • Sleep problems. After menopause, hot flashes, and night sweats may keep you up at night. In turn, the sleep deprivation can make it tougher to manage your blood sugar level.
  • Sexual problems. Diabetes can damage the nerves of the cells that line the vagina. This can interfere with arousal and orgasm. Vaginal dryness, a common symptom of menopause, may compound the issue by causing pain during sex.

Diabetes and menopause: What you can do

Menopause can wreak havoc on your diabetes control. But there’s plenty you can do to better manage diabetes and menopause.

  • Make healthy lifestyle choices. Healthy lifestyle choices—such as eating healthy foods and exercising regularly—are the cornerstone of your diabetes treatment plan. Healthy foods and regular physical activity can help you feel your best after menopause, too.

  • Measure your blood sugar frequently. You may need to check your blood sugar level more often than usual during the day, and occasionally during the night. Keep a log of your blood sugar readings and symptoms. Your doctor may use the details to adjust your diabetes treatment plan as needed.

  • Ask your doctor about adjusting your diabetes medications. If your average blood sugar level increases, you may need to increase the dosage of your diabetes medications or begin taking a new medication—especially if you gain weight or reduce your level of physical activity. Likewise, if your average blood sugar level decreases, you may need to reduce the dosage of your diabetes medications.

  • Ask your doctor about cholesterol-lowering medications. If you have diabetes, you’re at increased risk of cardiovascular disease. The risk increases even more when you reach menopause. To reduce the risk, eat healthy foods and exercise regularly. Your doctor may recommend cholesterol-lowering medication if you’re not already taking it.

  • Seek help for menopausal symptoms. If you’re struggling with hot flashes, vaginal dryness, decreased sexual response, or other menopausal symptoms, remember that treatment is available. For example, your doctor may recommend a vaginal lubricant to restore vaginal moisture or vaginal estrogen therapy to correct thinning and inflammation of the vaginal walls (vaginal atrophy). Your doctor may also recommend hormone replacement therapy to alleviate the symptoms if you have no contraindications for this therapy.

    If weight gain is a problem, a registered dietitian can help you revise your meal plans. For some women, hormone therapy may be a good option.

Having diabetes while going through menopause can be a twin challenge. Work closely with your doctor to ease the transition.

Updated: 2017-02-16

Publication Date: 2001-04-02

Here’s Exactly How to Find the Best Birth Control Pill for You

Thanks to the plethora of options at your disposal, choosing the right birth control can feel like you’re blindfolded and trying to pin the tail on the contraceptive donkey. Even if you narrow your focus to just the pill, you still have a lot of possible choices out there. But if you do your homework—and are prepared to possibly engage in some trial and error—you can pinpoint the best birth control pill based on your needs.

First things first, there are two main kinds of birth control pills: ones with estrogen and ones without.

Birth control pills that contain a mixture of estrogen and progestin (combination pills) are the most common type out there.

So, how do combination pills work to keep you pregnancy-free? During your typical menstrual cycle, there’s a hormonal surge that triggers the release of an egg to potentially be fertilized, Justine P. Wu, M.D., a family planning expert and assistant professor in the department of family medicine within the department of obstetrics and gynecology at the University of Michigan, tells SELF.

“[Estrogen] overrides that normal hormonal surge, and because of that, there’s no egg released,” says Dr. Wu, who is also a board chair member of the Association of Reproductive Health Professionals. Progestin does its part by thickening your cervical mucus to make it harder for sperm to move and thinning your uterine lining, which makes it less likely for any egg that does get fertilized to attach to it.

Different brands of combination pills can differ in many ways, including how much estrogen and progestin they contain within each 28-pill pack and how often (if at all) those levels fluctuate throughout the month. There’s also the fact that many, but not all, combination pills have placebos at the end of the month to allow for a withdrawal bleed that simulates your period. We’ll dive into why these distinctions might matter in more detail later, but for right now, just keep in mind that combination pills contain estrogen and progestin and all work in the same way across the board.

Then there are birth control pills without estrogen, which are known as progestin-only pills (also called the minipill). These come in packs of 28 active pills (no placebos) and deliver a steady dose of progestin to thicken your cervical mucus and thin your uterine lining. If you still have enough uterine lining to shed, you may experience a withdrawal bleed (your period) at some point during the month. (It won’t necessarily come in the last week of the pack the way it would with combination pills, since you take these pills every day.)

Research shows that birth control pills are over 99 percent effective at preventing pregnancy—if you use them perfectly.

With perfect use (which means taking them consistently and correctly every single time), research estimates that the birth control pill has a failure rate of 0.3 percent. This indicates that fewer than one woman out of every 100 will get pregnant in the first year of taking birth control pills perfectly. When you incorporate human error (which researchers refer to as “typical use”), the failure rate for birth control pills is thought to be about 9 percent, according to the Centers for Disease Control and Prevention, meaning nine out of every 100 women getting pregnant in the first year of taking the pill this way.

So, what constitutes typical use versus perfect use? Typical use could include taking a pill late or forgetting it completely. This depends somewhat on the type of pill you’re taking and how late you were on that missed dose. If you’re on a combined birth control pill, the instructions for what to do after a missed dose may vary from pill to pill, so check the prescribing information that came with your pill pack for details. With progestin-only pills, perfect use requires you to take the pill within the same three-hour window to be the most effective, according to the American College of Obstetricians and Gynecologists (ACOG).

For context on where the pill falls on the pregnancy-protection spectrum, it’s more effective than internal condoms (which carry a 2 and 18 percent failure rate with perfect and typical use, respectively), provides equivalent protection to the vaginal ring and patch when used typically and perfectly, and isn’t quite as excellent as the hormonal IUD or implant (which both have a failure rate of less than 1 percent, even with typical use).

The right birth control pill for you will depend on some personal factors, so let’s go over some pros and cons of each type.

Pills with estrogen (combination pills)

Pros:

  • They’re a little harder to mess up than progestin-only pills. Because combination pills use two hormones to prevent pregnancy (and at higher levels than in estrogen-free birth control pills), they’re thought to be slightly more effective than the minipill, according to the Mayo Clinic. Because of this, you don’t have to take combined birth control pills at the exact same time every day for them to be effective, whereas you really need to be mindful of this when you’re taking progestin-only pills. Researchers aren’t sure of the exact disparity between efficacy rates here, but it’s still worth noting if you’re someone who can’t always take a pill within the same three-hour window.

  • They can help with PMS. Combination birth control pills’ steadying of your normal estrogen fluctuations means you may experience fewer PMS symptoms like bloating and mood swings, according to the Mayo Clinic.

  • You may experience lighter periods and less painful cramps. This is thanks to combination pills’ progestin, which keeps your uterine lining thinner so there’s less to shed during your period. Your period could even stop altogether. With less uterine lining, you may also produce fewer prostaglandins, which are hormone-like chemicals that make your uterus cramp, leading to period pain. These benefits can be especially useful for people who have conditions that make their periods hellishly painful, like endometriosis.

  • They can help clear up your skin if you have acne. By suppressing your ovulation, combination pills tamp down on the testosterone spikes that often accompany ovulation, Dr. Wu explains. Excessive testosterone production is linked with acne, so curbing your levels can lead to clearer skin.

  • They temporarily prevent you from ovulating, which could be a bonus for some people. Since the estrogen in combination pills suppresses ovulation, they can help if you’re prone to developing uncomfortable ovarian cysts. Ovarian cysts can happen for two ovulation-related reasons: because an ovarian follicle that houses an egg keeps growing when it should instead break open to release said egg, or because the follicle collects fluid after ovulation and continues to grow when it shouldn’t, the Mayo Clinic explains. Sometimes the resulting cyst is completely harmless, but other times it can cause severe pain, particularly if it ruptures or twists your ovary around itself.

The ovulation suppression aspect here can also be helpful if you’re prone to a kind of bizarre, painful phenomenon known as mittelschmerz. It’s basically an abdominal aching or cramping sensation that can happen when a follicle containing an egg stretches your ovary as it grows in preparation for ovulation. It can also happen right as the follicle bursts to release the egg.

  • You may be able to manipulate your period with certain formulations of combined birth control pills. It’s theoretically possible to make your period come earlier by moving up when you take the placebo week of combination pills. Or you can skip your period entirely by skipping the placebo week and immediately starting a new pack of active pills.

Using the pill this way means you’re not using it for its prescribed intent, so you should always talk with your doctor to make sure they’re on board with this before you try it. It can also make you more liable to experience breakthrough bleeding.

  • They may help reduce menstrual migraines if used continuously under a doctor’s supervision. During your menstrual cycle, your levels of estrogen fluctuate. This can trigger menstruation-related migraines in some people, the Mayo Clinic says. “By using the pill continuously and not having the withdrawal bleed, you can suppress those horrible headaches,” Dr. Wu explains.

  • They may reduce your risk of certain cancers. Combination pills come with a reduced risk of endometrial, ovarian, and colorectal cancers. Researchers are still working to understand the nuances of these connections, but it seems as though combination pills suppress rapid growth in endometrial cells, reduce your exposure to naturally occurring hormones tied with ovulation, and lower the amount of bile acids in your blood, according to the National Cancer Institute. These mechanisms are tied with lower risks of endometrial, ovarian, and colorectal cancers, respectively.

To be clear, that’s not to say taking a combination pill means you have zero risk of getting these cancers, but that enough research has been done to show that the pill is associated with lowered incidences of these specific kinds of cancer.

Cons:

It’s possible that these kinds of side effects will decrease with time, so talk to your doctor about how likely it is that yours may stick around. You might just need a different formulation of the pill that has different amounts of estrogen. “Sometimes there’s a lot of troubleshooting,” Raegan McDonald-Mosley, M.D., chief medical officer at Planned Parenthood Federation of America, tells SELF.

  • They don’t provide any protection against STIs or HIV. For the record, this goes for all birth control methods except for internal and external condoms. So, if you’re at risk of getting STIs (like if you’re having sex with more than one partner or don’t know your partner’s STI status), you’ll need to rely on something like a condom or dental dam to better protect yourself during sex, whether or not you’re on the pill.

  • You have to remember to take the pill every single day. If you’re aiming for perfect use (which you really should be, since that’s when you’re most protected against pregnancy), you’ll need to remember to take the pill every day. You can’t “set it and forget it” with the pill as you can with, say, an IUD.

  • They’re not recommended for people who are breastfeeding. If you’re breastfeeding, estrogen may affect your milk supply, according to ACOG, which is why combination pills aren’t advised until at least the fifth week post-delivery.

  • They may actually cause or worsen migraines in some people. Kind of confusing, given that they may make migraines better for some lucky folks. For others, though, taking combination birth control pills is what actually brings about this aggressive head pain, the Mayo Clinic says.

Also, there’s some evidence that taking hormonal contraception (especially those with higher amounts of estrogen) if you have migraines with aura (sensory changes that are typically visual, like seeing flashing lights or zigzags) may increase your risk of stroke. This is a really thorny area that isn’t set in stone, because this contraindication may be based on outdated advice. Here’s more information on that. Bottom line: If you have migraines (especially with aura), you need to be clear about that when discussing contraceptive options with your doctor.

  • They may increase your risk cardiovascular issues like blood clots and stroke, particularly if you have certain risk factors. This is a complex potential drawback, because it sounds terrifying, but there’s a lot going on beneath the surface. First thing to know: The hormones in birth control pills increase the clotting factors in your blood. (This is mainly due to estrogen, but researchers are still investigating if progestin can also have this effect when combined with certain kinds of estrogen.) If your blood clots up in a vein deep inside your legs, it’s called a deep vein thrombosis. This kind of clot can dissolve on its own, but it can also be life-threatening if it breaks off, travels to your lungs, and blocks your airflow. Blood clots can also lead to stroke.

However, Dr. Wu points out: “The risk [of a blood clot] in a woman who is otherwise healthy is incredibly low.” A 2015 study in BMJ that looked at over 50,000 women put the odds of getting a blood clot while not using hormonal birth control at about 0.04 percent, raising it to between 0.06 and 0.18 percent when on the pill, with variations depending on the specific kind of pill in question. That’s why this is mainly only a concern if you have additional blood clot risk factors like being over 35 and smoking. “It’s also something that has to be put into perspective—the risk of a blood clot is higher when you’re pregnant [than when you’re on the pill],” says Dr. Wu. “Preventing pregnancy in and of itself is lower risk.”

  • You may not be a good candidate for combination pills if you have hypertension. This is especially the case if it’s poorly controlled, because the estrogen in them can further raise your blood pressure.

  • They may increase your risk of certain cancers. Some evidence shows that the chances of developing breast and cervical cancers are increased in those who take combination pills. Similarly to the lowered risks of getting specific cancers on the pill, this isn’t to say that if you take the pill, you’re absolutely going to wind up with certain cancers—just that the scientific evidence shows the odds of developing breast and cervical cancer are higher in people who take the pill.

This may be because the estrogen and progestin in the pill prompt the growth of some cancers, like those of the breast that respond to those hormones, according to the National Cancer Institute. When it comes to cervical cancer, the issue may be that birth control pills increase how vulnerable cervical cells are to infection with the strains of human papillomavirus that lead to cervical cancer. However, after you stop the pill, any related increased risk of both of these cancers is thought to decline over time.

  • They aren’t recommended for people who have or have had breast cancer. This is because the hormones in them have the capacity to stoke the growth of cancers that are receptive to hormones.

If you’ve decided on combination birth control pills, you’re still only about halfway there, because there are various formulations on the market.

There are actually a ton of different birth control pills out there with estrogen and progestin. To help you narrow down your options, here are some questions you should consider:

Do you want a monophasic, biphasic, triphasic, or quadriphasic pill?

While these sound more like phases of the moon, they’re really describing the different ways combination pills deliver their hormonal dosages.

Monophasic pills offer the same amount of estrogen and progestin in every active pill.
Biphasic pills contain two different, color-coded hormonal dosages throughout the month’s active pills.
As you’ve probably already guessed, triphasic birth control pills contain three different amounts of active hormones in the pill pack.
Quadriphasic pills deliver four different hormonal dosages.

As a general rule, multiphasic pills are designed in part to mimic the rise and fall of estrogen and progesterone levels during a regular menstrual cycle, thereby potentially reducing birth control side effects. But various research attempts, such as a 2011 review in Cochrane, haven’t found solid evidence of significant advantages to using multiphasic pills. Many experts recommend that people at the very least start their birth control pill journey with monophasic ones, since they’re simplest.

Do you want a very low hormone version?

Low-dose pills generally have 35 or fewer micrograms of estrogen per active tablet, although the lowest available option contains 10 micrograms of the stuff. Even the highest dose pills today aren’t as chock full of estrogen as they once were.

“A lot of women are asking for ‘the low-dose pill,’ and in reality, they’re all low-dose because they’ve dropped the dose of estrogen significantly from what used it to be,” Dr. Wu points out. The first birth control pill, Enovid, hit the market in 1960 and contained 150 micrograms of estrogen. As such, it was associated much more closely with serious complications like cardiovascular issues.

Even with the reduced doses of estrogen, low-dose pills provide the same pregnancy protection as other combination formulas. But that lower dose can change the side effects you experience. You may not have as much breast tenderness, for instance. And it may help with menstrual migraines by delivering a less dramatic drop in hormones during your placebo week. One major drawback, though, is that the lower levels of estrogen can make you more likely to have breakthrough bleeding.

Do you want a conventional or extended cycle pill?

Conventional pill packs typically come with 21 active and seven inactive pills, allowing for a withdrawal bleed at the end of the month. (Even though it’s totally safe to skip your period, you might like that bloody reassurance that you’re not pregnant.)

Extended cycle pills typically come in packs of 84 active pills—taken back-to-back—and 7 inactive pills, the Mayo Clinic explains. These mega pill packs let you theoretically only have a period four times a year—possibly a major win for anyone who suffers from painful period-related conditions, like endometriosis and menstrual migraines, or for those who just doesn’t want to deal with having their period every month. But, much like low-dose pills, this kind of birth control can make you more liable to breakthrough bleeding.

Do you want a pill formulated to combat PMS/PMDD?

If you experience physical and emotional symptoms like bloating, breast tenderness, and mood swings that are hallmarks of premenstrual syndrome (PMS), combination pills may help ease that time of the month. Same goes if you have premenstrual dysphoric disorder (PMDD), which is characterized by extreme moodiness, depression, anxiety, and other severe symptoms. Taking the active birth control pills back-to-back to skip your period (if approved by your doctor) gives you a steady supply of hormones that can reduce PMS and PMDD symptoms, according to the Mayo Clinic.

But there are also oral contraceptives that contain a synthetic version of progesterone called drospirenone that are FDA-approved for the treatment of PMDD (such as Beyaz and Yaz. It seems as though the drospirenone may reduce how susceptible you are to hormone fluctuations that lead to PMDD symptoms, and it also acts as a diuretic, which helps with bloating.

Not sure if combination pills are right for you? Here’s what you need to know about progestin-only pills (aka, the minipill):

Pros:

  • You may experience lighter periods and less painful cramps. Just like with combination pills, the progestin in the minipill keeps your uterine lining thinner so there’s less to shed during your period. Your period could even stop altogether. With less uterine lining, you may also produce fewer prostaglandins, which are hormone-like chemicals that make your uterus cramp, leading to period pain. These benefits can be especially useful for people who have conditions that make their periods hellishly painful, like endometriosis.

  • You can take them while you’re breastfeeding. Unlike estrogen, progestin doesn’t seem to have the potential of messing with your milk supply if you’re breastfeeding, according to ACOG.

  • You can take them if you have hypertension. As opposed to estrogen, progestin shouldn’t raise your blood pressure, so the minipill can be a good option if you have hypertension.

  • Your fertility should return pretty much immediately after you quit progestin-only pills, if that’s of interest to you.

  • You can take them even if you can’t (or don’t want) to take estrogen. If for whatever reason the estrogen in combination birth control pills wasn’t a good fit for you, the progestin-only pill may be a better choice.

Cons:

  • You need to take them within the same three-hour window every single day. With only progestin to lean on (and with lower levels of it than you’ll find in combination pills), you need to be incredibly consistent about taking the minipill around the same time every day, specifically within the same three-hour window. “It’s less forgiving than combined pills, so adherence is really important,” Dr. Wu says.

  • You may experience irregular bleeding or spotting. Due to the low level of hormones, you might experience irregular bleeding on the minipill, Dr. Wu says. This is especially true if you don’t take it precisely as you should, within that three-hour timeframe every day.

  • You can’t mess around with the minipill to influence your period. Screwing with when you take it in any way can boost your chances of unintended pregnancy, since adhering to the dosage schedule is so important.

  • They don’t provide any protection against STIs or HIV. As we mentioned, this goes for all birth control methods except for internal and external condoms. So, if you’re at risk of getting STIs (like if you’re having sex with more than one partner or don’t know your partner’s STI status), you’ll need to rely on something like a condom or dental dam to better protect yourself during sex, whether or not you’re on the pill.

  • Since ovulation suppression isn’t guaranteed with progestin-only pills, you might still release eggs sometimes. If you’re susceptible to mittelschmerz (that ovulation pain) or ovarian cysts, the minipill won’t help the way a combined pill would.

  • You won’t necessarily reap any of combination pills’ benefits that are related to estrogen. Such as clearer skin or reduced risk of certain cancers.

  • Like combination pills, the minipill isn’t a good idea for people who have or have had breast cancer. This is because the progestin in them may help hormone-receptive cancers develop.

  • If you do get pregnant while taking the minipill, you have a slightly higher risk of experiencing an ectopic pregnancy. An ectopic pregnancy is a nonviable pregnancy that occurs when the fertilized egg implants somewhere other than the uterus, usually in a fallopian tube, according to the Mayo Clinic. This risk is higher than with combination pills for a few possible reasons.

It seems as though progestin may reduce the activity of cilia (small hair-like structures) in your fallopian tubes. If you do get pregnant, these cilia are supposed to transport the fertilized egg from your fallopian tube to the uterus, but if that doesn’t happen, it can try to implant in the tube instead. If progestin-only pills reliably suppressed ovulation the way combination pills did, this lowered cilia activity probably wouldn’t matter as much. But since they don’t—and since you don’t have much room for error when taking them—you’re more likely to get pregnant with the minipill, then have the fertilized egg latch on in the wrong place.

Still not sure which pill is right for you? Here’s a checklist of important questions you should discuss with your doctor, which might help you narrow down your options.

Based on the information above, you might already have an idea of which kind of pill you’re interested in trying. If not, go into your doctor’s appointment prepared with questions that can help you suss it out. Here’s some inspiration:

  1. I have [insert any period problems that try to ruin your life here]. Which pill tends to work best for that?
  2. I’m interested in getting my period less often and/or controlling when it comes. What kind of pill do you recommend?
  3. Is there anything in my health history that indicates the pill (especially one with estrogen) may not be right for me?
  4. I’m worried about blood clots and/or stroke. Can we discuss if I have any risk factors that might be red flags?
  5. Is there any point in me taking multiphasic pills, or should I stick with monophasic ones?
  6. I really want to avoid [breakthrough bleeding/sore boobs/some other common birth control pill side effect here]. Which pill is least likely to cause this?
  7. Is there a certain kind of pill that may help my migraines? Or might the pill just make them worse?
  8. I have a family history of [insert a specific kind of cancer here]. What does that mean for my birth control options?
  9. Is there any reason low-dose pills might be better or worse for me?

If you’re realizing the pill isn’t right for you, no worries—there are plenty of other contraceptive options from which you can choose.

They range from IUDs that can hang out in your uterus for years to vaginal rings you swap out every three weeks and so much more. Talk with your ob/gyn to explore what’s available to you based on your health history and needs.

“Make sure you’re aware of your options and are not limited by what your friends are taking, because you saw an ad, or the fact that you’ve only been issued a particular pill by your doctor,” Dr. Wu says. After all, it’s called birth control because the end goal is to command your reproductive future with as much confidence as possible, whatever that looks like for you.

Related:

7 Twist Out Mistakes You’re Probably Making

My hair has been natural, or chemical-free, since about my junior year of college, when I decided to solve the mystery of what my curl pattern actually looked like. I’ve been proudly rocking my tightly wound coils ever since I found out.

Although my hair journey to natural has been rewarding, it definitely hasn’t been effortless (something most natural-haired women can attest to). It has taken a lot of trial and error to figure out which styling methods work best for me. Now I can say with absolute certainty that aside from using the somewhat simple method of a wash-and-go—which literally consists of wetting the hair and letting it air dry—to achieve the perfect curl, a twist out is definitely my go-to.

There are so many variables that can make a difference in the outcome of the twist out style that many long time naturalistas don’t even know. Is my hair fully detangled? Am I using the right products? Where on earth is my satin bonnet?

To help you get a bouncy, frizz-free style every time, we called in hair experts Naté Bova, senior stylist at Warren Tricomi Salon in NYC, and Monique Rodriguez, creator of haircare brand Mielle Organics, for their take on common twist out no-nos.

1. Your hair isn’t fully detangled prior to twisting.

First things first—your hair should be totally free of knots and tangles before starting the process. It’s virtually impossible to separate hair properly into sections to twist without doing so. “It’s best to detangle your hair thoroughly in order to get the best definition,” Rodriguez tells SELF. “Proper detangling will help you prevent breakage, and most importantly detangling plays a role in how well your hairstyle will turn out.” Smooth, tangle-free hair ensures an even coating of product, as well as less time spent crafting your actual twists—your arms will thank you.

2. You’re not using the right products for your hair texture.

Since everyone’s hair texture is different, even among natural hair types, figuring out which products actually work for your hair type is extremely important. If you want soft, fluffier curls after taking down your twists, using a cream-based product is ideal. For more defined curls, Bova recommends using a twisting gel for extra hold, or a product that is a mix of both.

“For the perfect twist out, I recommend finding a cream-based product that has a significant amount of hold in the formula,” Bova says. “Hydratherma Naturals Aloe Curl Enhancing Twisting Cream has exactly that. For a softer finish, I recommend the KeraCare Natural Textures Twist & Define Cream. This formula is enhanced with botanicals and castor oil. I am a huge fan of castor oil.” For those who naturally get more of a fro than defined curls, she recommends the Mizani True Textures Twist and Coil Jelly, which offers a bit more hold so hair can take the shape of twists or knots more effectively.

3. You’re using too much product when twisting.

To be completely transparent, I’m guilty of making this mistake more times than I’d like to admit. Since my hair tends to be a bit on the dryer side, I sometimes overcompensate with extra product to make sure each section is properly saturated. Using too much product can often lead to an unsuccessful twist out or lack of curl, since the hair will likely not dry properly, even overnight.

4. You’re not letting your hair completely dry before untwisting it.

I can’t even begin to describe the number of times I prematurely untwisted my hair, and each time I did, my curls were lackluster at best. Patience is a virtue: It’s paramount that hair is completely dry—that is, that the product you used for your twists has been worked in and settled into the hair—before unraveling them. “It is probably the most important step in the twist out process for hair to be completely dry before moving forward with the ultimate style,” Rodriguez tells SELF. “If you untwist your hair while it is still wet, you could cause frizz and lack definition in your hairstyle.” Once your twists are fully dry, you will have the most definition and your style will also last longer, and Bova agrees. “If you’re not giving the hair a chance to set, the damp hair will not take on the shape desired. Sit under the dryer and watch your favorite show.” If you don’t have a hooded dryer at home, you can also use a regular blow dryer to help get twists as dry as possible.

5. You’re not letting your hair cool down properly.

Even if you’re convinced that your hair is completely dry, you’re doing yourself—and your next selfie for Instagram—a disservice if you don’t let it completely cool down after drying it. Chances are, you’ll likely still have a few damp sections that you didn’t notice. Bova advises letting hair cool for about half an hour or so, then going back under heat for an extra cycle, and finally allowing hair to cool down again to test for any remaining wetness. This will ensure that you’re not untwisting your hair too soon.

6. You’re not re-twisting your hair at night.

It can sometimes be tiring to have to re-twist your curls every night (trust me, I know from experience), but you’ll thank yourself every morning for doing it. This style can quickly lose steam over a couple of days, so re-twisting your curls helps to lock it in for little while longer. “To maintain your twist out for a longer period of time you can either re-twist nightly or try the pineapple—or gathering hair at the top of the head—style. This depends on your hair length,” says Rodriguez. “If you have shorter hair, it may be best to re-twist every night to maintain your hairstyle. If your hair is longer, you can pineapple your hair.” For second or third day curls, Bova recommends Shea Moisture Coconut and Hibiscus Hold and Shine Moisture Mist to revive curls. Expert tip: Spray curls, and re-twist hair before the spray dries.

7. You’re going to sleep without wrapping your hair first.

Even if you want to let your curls drop over time, wrapping your hair with either a satin scarf or bonnet is important to maintaining your style and avoiding frizz. “To maintain your twist out for a longer period of time, I definitely suggest to sleep with a silky scarf tied around your head,” Bova tells SELF. “Your curls will be better contained while you’re laying down.” To stay comfortable throughout the night, she recommends using an Isoken Enofe Faziah bonnet for next-day frizz-free curls.

Calorie counts on restaurant menus have customers ordering less

Bye-bye artichoke dip. Heavyweight appetizers and fatty entrees may not get much love when restaurants list calories on their menus.

In a new study, Cornell University researchers conducted a randomized experiment and found that diners at full service restaurants whose menus listed calories ordered meals with 3 percent fewer calories — about 45 calories less — than those who had menus without calorie information. Customers ordered fewer calories in their appetizer and entree courses, but their dessert and drink orders remained the same.

“Even if you’re an educated person who eats out a lot and is aware of nutrition, there can still be surprising things in these calorie counts,” said co-author John Cawley, professor of policy analysis and management in the College of Human Ecology.

Even the chefs at the restaurants in the study were startled by the high number of calories in some dishes, such as a tomato soup/grilled cheese sandwich combo. “They would have said it was one of the lower-calorie items on the menu,” said co-author Alex Susskind, associate professor of operations, technology and information management at the School of Hotel Administration.

The findings come at a time when most Americans don’t have a precise estimate of how many calories they’re eating, because one-third of their food is prepared outside the home. At the same time, the obesity crisis in America has reached epidemic proportions; the prevalence of obesity in adults has nearly tripled in the past 50 years, to nearly 40 percent of the population in 2016.

In response, many cities, counties and states have passed laws requiring restaurants to include calorie information on their menus. And as of May, it is a nationwide requirement that chain restaurants with 20 or more units post calories on menus and menu boards, as part of the Affordable Care Act of 2010.

To find out how this law affects consumer behavior, the researchers conducted a randomized field experiment in two full-service restaurants. Each party of diners was randomly assigned to either a control group, which received the usual menus, or a treatment group, which got the same menus but with calorie counts next to each item. At the end of the meal, each diner was asked to complete a survey that collected sociodemographic information and attitudes toward diet and exercise. In all, the researchers gathered data from 5,550 diners.

The study also found that diners valued the calorie information. Majorities of both the treatment and control groups supported having calorie labels on menus, and exposure to the calorie counts increased support by nearly 10 percent. “It’s clear that people value this information,” Cawley said.

And there was no downside for restaurants. Their revenue, profit and labor costs were unchanged.

“It’s a cheap policy to put in place, and the fact that there is a reduction in calories ordered makes it appealing,” Cawley said.

The study, “The Impact of Information Disclosure on Consumer Behavior,” was released in August by the National Bureau of Economic Research and co-written with Cawley’s former doctoral advisee Barton Willage, Ph.D., who is now an assistant professor of economics at Louisiana State University.

The work was supported by Cornell’s Institute for the Social Sciences, the Institute for Healthy Futures, the Building Faculty Connections Program and the College of Human Ecology.

Story Source:

Materials provided by Cornell University. Original written by Susan Kelley. Note: Content may be edited for style and length.

Rapper Bow Wow Says He ‘Almost Died’ After Developing an Addiction to Lean

This week, rapper Bow Wow (real name Shad Moss) revealed his own experience with addiction. Bow Wow shared the story of his addiction to lean, a combination of promethazine/codeine-based cough syrup and soft drinks, in a series of tweets on Monday while warning fans to stay away from drugs.

He said that he previously used lean “every day,” and at one point, he was using lean at least seven times a day. “I was addicted until our show in Cincinnati.. I came off [stage] and passed out,” he wrote. Bow Wow said that he woke up in the hospital and started experiencing withdrawal symptoms.

“I never felt a pain like that ever,” he continued. “It was summer but I was walking round with 3 hoodies on because I was so cold.” Bow Wow says he “almost died” from his addiction, adding that his stomach “will never be the same and it hasn’t been” after he stopped using lean.

Medical treatment for this kind of addiction focuses more on the codeine, an opioid painkiller, than the promethazine, which is an antihistamine.

During treatment, “the thing that we would be most concerned about is the codeine,” Michael S. Ziffra, M.D., a psychiatry and substance abuse specialist at Northwestern Memorial Hospital, tells SELF. “People mistakenly think of codeine as being a mild medication, but it is an opioid and an addictive substance.”

On the other hand, “promethazine is pretty similar to Benadryl,” Jamie Alan, Ph.D., Pharm.D., an assistant professor of pharmacology and toxicology at Michigan State University, tells SELF, and may come with side effects such as sedation. That, combined with the effects of codeine, may contribute to the feeling of a stronger high, Alan explains.

Specific treatment for this addiction ultimately depends on the doctor, Brad Lander, Ph.D., a psychologist and clinical director of addiction medicine at The Ohio State University Wexner Medical Center, tells SELF. For some, that might mean using medications such as tramadol, buprenorphine, or methadone to help ease withdrawal symptoms, Dr. Ziffra says. But others may be able to go cold turkey without those medications, Alan says.

Whatever you decide, though, you should definitely do it with the guidance of a medical professional. Trying to navigate withdrawal symptoms on your own can be incredibly unpleasant and even dangerous.

The symptoms someone may experience are similar to those you’d have when withdrawing from any type of opioid, Alan explains.

If you take opioids for an extended period of time, your body adjusts and then reacts when you suddenly stop using them. People going through opioid withdrawal often feel a lot of aches and pains in their muscles, and they may feel anxious, depressed, or irritable and have trouble sleeping, Dr. Ziffra says.

Opioids like codeine are also notorious for causing constipation, Dr. Alan says. When you take the drug away, “your gut is going to kick into overdrive,” she says. This can lead to severe nausea, vomiting, and diarrhea. “You’re not going to die, but you feel like it,” she says.

People who go cold turkey will usually be through the withdrawal period in a few days, Alan says. Those who go off an opioid with medical intervention may have symptoms (which, again, are lessened) for one to two weeks.

Once someone makes it through the withdrawal period, it’s highly recommended they undergo more extensive addiction treatment.

“The amount of treatment really depends on the situation and how much they’ve been using,” Lander says, explaining that not everyone who misuses substances has a diagnosable substance use disorder. But if you’re finding it difficult to quit using a substance despite wanting to, it’s important to get professional attention.

If someone does have a substance use disorder, long-term treatment is crucial, Dr. Ziffra says. “You don’t just want to have someone go through detox—you want to address the underlying issue,” he says. That may mean checking into a residential treatment facility where they can do intensive inpatient therapy. Others may do intensive outpatient therapy where they see a therapist or do group therapy for several hours on a daily basis for a few weeks. If the addiction is less severe, a person may do well with a 12-step program like Narcotics Anonymous, Dr. Ziffra adds.

The withdrawal from codeine can be “intense,” Lander says, but ultimately it’s what happens after the withdrawal that matters most.

Related:

Here’s How to Pick the Best Winter Squash

There’s a lot of beautiful produce in season during autumn, but I always get the most excited for squash. When I finally start to see all its many different varieties crop up, I know it’s time to get my sweaters out and my oven ready. As a gourd obsessive, I know a lot about the veg, including the best ways to clean and cut it (no easy feat!), as well as all the different ways you should be cooking with it. But recently, I realized that there’s one thing about squash that I still don’t know: how to tell the good from the bad when I’m at the supermarket.

Up until now, I’ve always blindly chosen my squash from a big pile of them while praying for the best, but there’s a better, easier, more reliable way to go about doing it, Katy Green, global produce field associate at Whole Foods Market, tells SELF. In fact, it’s so easy to spot a good squash, you’ll wonder why you didn’t know what to look for sooner. Here’s everything you need to know.

When it comes to squash, pumpkins are just the beginning—there are a bunch of different varieties you should definitely know about.

According to Green, pumpkins, butternut, acorn, spaghetti, kabocha, and delicata squash are the most common varieties of the vegetable that you’ll see at the store. Each one is completely different from the last and best suited for different things.

For example, pumpkins may be famous because of pies, but Green says they’re also great in soup, especially Alton Brown’s whole pumpkin soup recipe, which is completely cooked and served in a whole, baked pumpkin. Butternut has a mild flavor that makes it good for lots of things, but she especially recommends roasting it with other fall veggies, like Brussels sprouts and parsnips. Spaghetti squash is thus named because, when you bake it, its insides become stringy and tender, like spaghetti. Acorn squash are small and ideal for stuffing—try baking them, carving out their insides, and filling them with a savory stuffing for Thanksgiving. Delicata are long and their skin is edible, so you don’t need to peel them to enjoy. They’re my personal favorite squash, and I love them simply sliced into rounds and roasted with oil and herbs. Finally, kabocha squash, a popular, Japanese variety of the vegetable, has a rich, buttery texture that makes it perfect for blending into thick, creamy soups and stews. When baked for a long time, its skin is also edible.

No matter which kind of squash you’re shopping for, you should look for the same things

Though each squash is pretty different, you can tell whether or not they’re good by looking for the same things, says Green. In general, you’ll have better luck finding a good squash if you shop for them while they’re in season (which can be anywhere from early September to late February for winter squash). When selecting, she says you should start by feeling the squash—it should be heavy for its size and the exterior texture should be very firm with no soft spots. From there, it’s all about the visuals. It should be free of exterior blemishes and the coloring should be fairly even with some exceptions on the ground spot area (that’s where the squash rested on the soil while it was growing.) If your squash passes all these tests, you’re good to go.

You can’t improve a bad squash after you buy it, but a good squash will last you for a really long time.

Like melons, winter squash don’t continue to develop sugar after they’ve been harvested, Green explains, so you can’t continue to improve its flavor at home the way you can with bananas. The good news is, that’s not something you need to worry about if you used your new squash knowledge to find a good one. In fact, if your squash is good, it can last for months—really! As long as you don’t cut it open, and you store it in a cool dry spot (but not in the refrigerator), “you could even have it for a couple of months before seeing breakdown or decay,” says Green.

Experiment with your squash in these seasonal recipes.

Cheesy Butternut Chickpea Bake

Andrew Purcell; Carrie Purcell

With cheese, this creamy squash bake tastes a lot like mac and cheese. Get the recipe here.

Sheet Pan Chicken Breast With Kabocha and Kale

Andrew Purcell; Carrie Purcell

This sheet pan dinner is a great, simple way to make use of kabocha squash. Get the recipe here.

Spaghetti Squash Carbonara

Chris Tharpe

Even though this recipe is pegged as a low-carb alternative, we’d eat it regardless because it’s just that good. Get the recipe here.

7 Ways to Treat Your Feet During Marathon Training

While training for a marathon, your feet take a major pounding. Many runners forget about their feet in their strengthening and stretching programs, but as every runner knows, those feet will make some noise when there is a problem. And when they’re being stuffed into sneakers and forced to hit the pavement over and over again, problems are likely.

When you break down the gait cycle (the repetitive process of stepping with one foot and then the other) you realize how much your feet actually go through when you run. For starters, running is a one-legged sport—the time spent on one leg during each stride is one of the major distinctions between running and walking. With running, you leap and land with all your bodyweight on one foot. In doing so, the feet transform from soft, malleable landing pads to rigid levers designed to help propel your body forward. (This transformation is known as the Windlass mechanism.)

Since your feet are the only contact point between your body and the ground (let’s hope!), that connection needs to feel good and strong or you, your feet, and your running performance will suffer. So show your feet some love by incorporating some of these seven practices into your routine. After all, they are what will carry you across every finish line—they deserve some TLC.

1. Do some simple toe stretches when your feet feel tight.

The flexor hallucis longus is a muscle that extends from the lower part of your leg all the way to the tip of your big toe. You need your big toe to balance and to help propel you forward when you run. Weakness or repetitive straining of this muscle, can cause it to feel tight or painful. Stretching it out can help ease discomfort.

Try this toe-against-the-wall stretch: Keeping your heel on the floor, line up your big toe against a wall. Gently press your knee toward the wall until you feel a stretch below the base of your toe. Hold for 30 seconds.

Here’s another good one: Get on your hands and knees and curl your toes under you. Then, gently sit down and back until you feel a stretch in your foot and toes.

2. Incorporate toe-strengthening exercises into your daily routine.

Strengthening is a necessary and critical part of marathon training. The feet should be no exception. By strengthening the feet and toes, you can create a more sturdy foundation for your running and improve the propulsion capabilities of your feet while you run. But can you think of a single strength exercise where you specifically target your feet and toes? Didn’t think so.

Try towel scrunches: Start sitting in a chair with your heels on the floor and a towel under one forefoot. Keeping the heel in contact with the floor, use your toes to draw the towel toward you. Try 3 sets of 10 on each foot. For best results, do this five days a week. This exercise targets the foot and toe muscles to help improve mobility, dexterity, and strength in the 33 joints and more than 100 muscles, tendons, and ligaments of each foot.

3. Try self-massage—with ice.

What’s better than ice or massage? Combining the effects of both at the same time! Whether you’re having sharp heel pain or pain across your arch from a tight plantar fascia (a thick band of tissue that runs from the heel to the base of your toes) icing (or cryotherapy) can help reduce acute inflammation and pain.

Try rolling your foot over a frozen water bottle. This allows you to both stretch and ice the plantar fascia. For a more direct effect, freeze a paper cup full of water, then peel the top part of the cup off and apply the ice directly to the painful area making small circles for about one to two minutes. The ice will melt as you do this, so keep a towel nearby for easy cleanup.

4. Make the “legs up the wall” stretch part of your post-run ritual.

When you run, your heart rate goes up, increasing blood flow to the muscles. When you stop running, blood, lymph fluid, and extracellular fluid can pool in your legs and feet, causing swelling and pain. While the gastrocnemius (what’s known as the calf muscle) acts as a muscle pump to return fluid from your feet back up to your heart, it can’t always keep up. Compression garments may help minimize swelling (though evidence on their effectiveness remains mixed.

You can help your body out by lying flat on your back with your legs straight up against a wall. This will help decrease swelling and return blood to your heart. Bonus: You get a great hamstring stretch out of it, too.

5. Roll it out with a lacrosse ball.

If you don’t have the time (or funds) to get regular foot massages, try self-massaging your feet with a lacrosse ball. By stretching and releasing restrictions in the soft tissue of the arch of your foot, you can help ease soreness and prevent inflammation and pain caused by repetitive straining of this fascia. It just feels pretty amazing, too. This dreamy and easy DIY massage is a go-to for many veteran runners—I, personally, keep a ball under my desk at all times specifically for this purpose.

6. Give your feet a stability challenge—sans sneakers.

Imagine your hands are in mittens every day, and then you decide you want to go rock climbing. This isn’t too different from having your feet in cushy, supportive sneakers every day. When you surround the feet with tons of support, they may become weaker because they don’t have to work as hard to do their job. As advanced as running footwear technology has become, our feet are begging to be naked and free so they can adapt to different surfaces and grip onto uneven terrain.

To challenge the feet to work muscles they’re not used to using, I love these Yamuna foot wakers. The spikiness and instability of these balls allows the small bones in your feet to move around in ways that regular footwear and walking on flat surfaces does not. Like working any muscle you’re not used to working, your feet may feel sore or tender the first few times you use these—when I have patients stand on them for the first time, their eyes light up. But after a little while, you’ll get used to them and really appreciate them. After a long run, I usually sneak in a few minutes on these balls before leaving for work.

7. Foam roll your calves.

What happens in your calves does not stay in your calves. That’s because many of the muscles in your calves continue into your feet: The gastrocnemius and soleus (calf muscles) join together to become the achilles tendon, which wraps around your calcaneus (the heel bone) and continues as the plantar fascia. Everything is connected, so sometimes fixing foot pain may require paying attention to muscles above or below the area that’s bothering you. For example, pain in the arch of your foot could be due to tightness or weakness in the tibialis posterior muscle—a calf muscle that supports the arch of the foot and also makes it possible to point your toes (called “plantar flexion”).

Rolling out your calf muscles regularly is a good place to start to relieve any tightness that may be impacting the muscles and tendons down the chain. It’s easy to do: Lie face up with a foam roller under both calves and use your arms to lift your booty up off the floor. Focus on putting your weight, and therefore more pressure, into the calf muscles. Slowly roll up and down the muscles. For increased pressure, press one leg over the other as you roll.

Every runner is different, and what is tight, weak, or dysfunctional in one person will be very different for another person. That means the best remedies will be different, too.

There are plenty of other tricks and tools—compression socks, foot inserts, toe spacers, warm epsom salt soaks, wearing sneakers that are one size too big to accommodate the extra swelling…the list of options goes on. It’s important to listen to your own body and address the areas that are causing you pain or discomfort.

And sometimes, you may need to enlist outside help. If your pain is affecting your ability to walk or run, stop running and schedule an appointment with your doctor or a physical therapist so you can be confident about what to do next. Remember that these tricks and tools aren’t one-size-fits-all solutions—but they are an assortment of options worth trying, and a reminder that relief is out there.

Scientific institutions continue to lag behind the #TimesUp movement

Scientific and medical institutions must fundamentally reconsider how they address sexual harassment in the workplace, three national leaders in gender equity in medicine argue in a Perspective published today in the New England Journal of Medicine.

The viewpoint comes in response to publication of a report by the National Academies of Science, Engineering and Medicine concluding that sexual harassment of women is common across scientific fields and has not abated despite concerns raised by the #TimesUp movement. It also comes amid fresh revelations of sexual misconduct by powerful men in business and entertainment.

The National Academies’ report made 15 key recommendations ranging from fostering a more respectful workforce to improving leadership to passing new laws.

“We really believe in the agenda laid out by the National Academies,” said lead author Esther Choo, M.D., M.P.H., associate professor of emergency medicine in the OHSU School of Medicine in Portland, Oregon. “However, we’re skeptical that medicine is determined to move forward. Institutions are very slow to take action and especially reluctant to act against harassers, particularly those who bring in research and other types of funding.”

The authors argue that the response from institutions has been inadequate to the scale of the problem.

Choo was joined by Jane van Dis, M.D., medical director for business development with the OB Hospitalist Group in Burbank, California; and Dara Kass, M.D., assistant professor of emergency medicine at the Columbia University Medical Center in New York.

They cite several major factors to overcome institutional resistance:

Myopia: Institutions focus on formal complaints, which address only the most egregious cases of overt sexual harassment. Yet there are many instances of sexual harassment that may not meet a threshold which individuals perceive as actionable but can be just as destructive. Sexual harassment encompasses objectification, exclusion or second-class status — that constrain women’s careers and compromise their physical and psychological health.

Money and Power: Academics are allowed to perpetuate sexual harassment for years because of their perceived value to the institution. Institutions should aim for consistent treatment of perpetrators, responding to complaints and taking action, regardless of the harasser’s position and power.

Organizational complicity: Organizations too readily view harassment as an individual problem rather than as a result of institutional permissiveness that enables harassment to happen in the first place.

“Correcting inequities in salary, career advancement and leadership positions requires more global fixes than even those who are deeply committed to eradicating sexual harassment in the workplace may be willing to consider,” they write.

Choo said she remains optimistic.

“We have an opportunity to rise to the challenge,” she said. “I think health care institutions will begin to recognize that providing safe and productive workplaces sets us up to provide the high-quality care our patients expect.”

Story Source:

Materials provided by Oregon Health & Science University. Original written by Erik Robinson. Note: Content may be edited for style and length.