Sara Sampaio Says She Has ‘Gaps’ in Her Eyebrows Due to Trichotillomania

Earlier this month, Instagram launched its new “Questions” feature, allowing users to carry out deeper Q&As than are possible using the simpler “Polls” feature. So much deeper, in fact, that when Victoria’s Secret model Sara Sampaio was recently asked a benign question about her eyebrow maintenance, she gave an honest answer about her trichotillomania and detailed her experiences with the impulse-control disorder, Stylecaster reports.

Last Friday, Sampaio called for questions from her followers since she was “stuck in traffic,” according to screenshots of her Instagram Story captured and reposted by fans.

In response to a question about her brows, Sampaio wrote, “Unfortunately I suffer from trichotillomania and I pull on them!”

“so I have lots of gaps in them, I just use a eyebrow pencil to fill out the gaps!” she said. After apparently receiving an influx of messages from her followers who have also experienced the disorder, Sampaio wrote that she wanted to “talk a little about it.”

Sampaio continued, “Mine started when I was around 15yo! It started with me pulling on my eyelashes and almost quick after it went to me pulling in my eyebrow hair! I no longer pull on my eyelashes and have been pulling on my eyebrows ever since! The episodes are worse under a lot of stress or when I’m not doing anything like watching tv or reading a book!”

Sampaio went on to describe her experience with an impulse-fighting supplement prescribed to her by a doctor, before noting, “Please [before] trying anything talk to your doctor before! But this is my experience! I’m not [ashamed] of it, it’s a part of me.”

She added, “Also i do understand that luckily I have quite the mild form of trichotillomania. Some people pull big chunks of their [actual] hair that could form big patches of no hair on their heads! So always be kind to people, don’t judge. This is [psychological] disorder that people can’t just simply stop! But being understanding and kind goes a long way!”

Trichotillomania is characterized by “a long term urge that results in the pulling out of one’s hair,” as Sampaio explained.

According to the Mayo Clinic, the impulse-control disorder may also manifest in other uncontrollable habits like picking at skin, biting nails, or chewing lips, and can be triggered by both negative, stress-related emotions and more positive, satisfying ones.

As SELF wrote previously, the “gold standard” treatment for the disorder is a specialized type of cognitive behavioral therapy known as habit reversal training. But other tactics, like using an app to track your urges and progress or finding a support group of people who understand what it’s like, can help day to day.


These Spandex Bike Shorts are Almost Too Cute to Sweat In

There’s something about slipping on a stylish pair of spandex bike shorts that makes me feel like I can literally do anything. Hike up a mountain? Challenge accepted. Drop it low to “In My Feelings” at a friend’s house party? Practically a no-brainer, since I’m down to do that all the time anyway. I’m just so in love with the stretch and comfort of these shorts and the freedom they give me, that I’m really tempted to never wear my stuffy jean shorts again.

While I love wearing spandex shorts to the gym instead of leggings, you can also find me pairing mine with a sweatshirt and sneakers a la Princess Diana on any given day of the week. They’re also my ideal choice to wear—with an oversized blazer and heels—when I’m looking to feel fancy at brunch but also want to be comfortable while I’m stuffing my face with delicious french toast.

Since not all bike shorts are created the same, I’ve picked out some of my favorites that can help you look and feel cool even while you sweat—whether it’s from a workout or just because it’s ridiculously hot outside.

Sunscreen users receive less than half the sun protection they think, study finds

Researchers from King’s College London have assessed just how much sun protection people actually receive, based on typical use. It is well known that people don’t receive the full ultraviolet radiation blocking benefit of sunscreen, because they are applying it more thinly than manufacturers recommend. The findings are published in journal Acta Dermato-Venereology.

In the first experiment of its kind, the King’s team assessed the DNA damage in the skin after lowering sunscreen application thickness below 2mg/cm2 — the amount manufacturers use to achieve their SPF rating.

Results showed that sunscreen with a sun protection factor (SPF) of 50, applied in a typical way, would at best provide 40% of the expected protection. The findings have prompted the King’s team to suggest that consumers use a much higher SPF sunscreen than they think necessary, to ensure they’re protected from sun damage.

As part of the research scientists divided a cohort of 16 fair-skinned volunteers into two groups of eight — (three women and five men in each). One group received a single UVR exposure, to simulate sunlight, to areas treated with high SPF sunscreen of varying thickness, ranging from 0.75mg, through 1.3mg up to 2mg/cm2.

The other group received exposures on five consecutive days — to mimic continuous holiday exposure. The amount of UVR exposure was varied during the course of the experiment, in order to replicate the conditions in holiday destinations, such as Tenerife, Florida and Brazil.

Biopsies of the UVR exposed areas of skin showed that, for the group that were repeatedly exposed to UVR, considerable DNA damage was found on the areas that received no sun protection, even though the UVR dose was very low.

Damage was reduced when sunscreen was applied at a thickness of 0.75mg/cm2 and considerably reduced when 2mg/cm2 of sunscreen was applied, even with much higher UVR doses.

Five days of exposure to high dose UVR with the sunscreen at 2mg/cm2 showed significantly less damage than just one day’s low UVR dose exposure without sunscreen across all samples.

Report author, Professor Antony Young from King’s College London said: ‘There is no dispute that sunscreen provides important protection against the cancer causing impact of the sun’s ultra violet rays. However, what this research shows is that the way sunscreen is applied plays an important role in determining how effective it is.

‘Given that most people don’t use sunscreens as tested as tested by manufacturers, it’s better for people to use a much higher SPF than they think is necessary.

Nina Goad of the British Association of Dermatologists said: ‘This research demonstrates why it’s so important to choose an SPF of 30 or more. In theory, an SPF of 15 should be sufficient, but we know that in real-world situations, we need the additional protection offered by a higher SPF.

‘It also shows why we shouldn’t rely on sunscreen alone for sun protection, but we should also use clothing and shade. An extra consideration is that when we apply sunscreen, we are prone to missing patches of skin, as well as applying it too thinly.’

Story Source:

Materials provided by King’s College London. Note: Content may be edited for style and length.

Omega-3s help keep kids out of trouble

Something as simple as a dietary supplement could reduce disruptive, even abusive behavior, according to newly released research by a team led by a UMass Lowell criminal justice professor.

Giving children omega-3 fatty acid supplements reduces disruptive behavior, which in turn had a positive effect on their parents, making them less likely to argue with each other and engage in other verbal abuse, according to Jill Portnoy, an assistant professor in UMass Lowell’s School of Criminology and Justice Studies.

“This is a promising line of research because omega-3 fatty acids are thought to improve brain health in children and adults. There is more to be learned about the benefits, but if we can improve people’s brain health and behavior in the process, that’s a really big plus,” said Portnoy, noting that a recent research review found that omega-3 supplements do not affect cardiovascular health.

The new research, published in the scholarly journal Aggressive Behavior, is just one example of how Portnoy is studying biological and social factors that can help explain and predict impulsive and risky behavior. The goal is to help determine effective ways to intervene before anti-social behavior escalates into crime.

That work takes Portnoy into the heart of the “nature versus nurture” debate — whether people who commit crimes have something in their physiological makeup that predisposes them to doing so or if social factors like abusive family situations lead them to it.

“Of course, it’s both,” she said, but exactly how is still to be determined. “Biology and social environment interact in complex ways that we’re just beginning to figure out. Before we can design effective interventions, we need to do research to understand what’s happening.”

Portnoy is exploring such a connection through another research project that is looking at how a low resting heart rate may lead to anti-social behavior.

“My theory is that a low resting heart rate might be an acquired, adaptive trait: If you are subjected to chronic or frequent stress as a child, you adapt by lowering your heart rate. The lower heart rate protects you by blunting your reaction to stressful events, but it can also lead to stimulation-seeking behavior. In other words, a stressful environment may cause physiological changes that lead to an increase in aggressive and impulsive behavior, in addition to causing the behavior directly,” she said.

Working with a counterpart at the University of Pennsylvania, where she earned her Ph.D. and taught before coming to UMass Lowell, Portnoy studied hundreds of youths in Pittsburgh, where she grew up. The researchers found that the youths with lower resting heart rates were more likely to act out as a form of sensation-seeking, including anti-social behavior, which can be especially problematic for individuals living where there are few options for positive forms of stimulation.

Portnoy, who now lives in Portsmouth, N.H., will continue her research on this topic this fall with the help of a dozen UMass Lowell undergrads who will intern with her on the Health, Stress and Behavior Study, researching the connection between stress, heart rate and behavior.

Through this study, Portnoy and her team will examine what she describes as a continuum of criminal behavior with the goal of finding new ways to prevent it.

“Many people break the law in small ways; for example, by driving a few miles over the speed limit. I’m interested in people who are behaving aggressively but not yet reaching the level of criminal behavior or maybe they’re committing more serious crimes like theft or assault, but haven’t been caught. They’re still exacting a toll on society. And if we want to design more general social interventions, like teaching people healthier ways to adapt to stress, then we shouldn’t just study those who get caught,” said Portnoy.

Story Source:

Materials provided by University of Massachusetts Lowell. Note: Content may be edited for style and length.

Intractable hiccups may be more common than we think

Everyone gets hiccups, but some people suffer intractable hiccups that last longer than a month, according to two Loyola Medicine neurologists.

“Intractable hiccups can occur more often than we realize and present to multiple medical disciplines,” Stasia Rouse, MD, and Matthew Wodziak, MD, wrote in the journal Current Neurology and Neuroscience Reports. Dr. Rouse is chief neurology resident and Dr. Wodziak is an assistant professor in Loyola’s department of neurology.

Hiccups typically occur between four and 60 times a minute. Acute hiccups are common. They start without any specific reason and go away in a few minutes. They often can be stopped by holding the breath or breathing into a paper bag.

Persistent hiccups (lasting longer than two days) and intractable hiccups (lasting longer than a month) generally are associated with underlying medical conditions. They interfere with eating, socializing and sleeping and can significantly impair a patient’s quality of life. The longest recorded case was an Iowa farmer who hiccupped continually for 69 years and nine months, according to the Guinness Book of World Records.

About 4,000 people in the United States are hospitalized each year for hiccups. Ninety-one percent of people who suffer intractable hiccups are men, most of whom are over age 50.

Drs. Rouse and Wodziak describe a hiccup as an involuntary, spasmodic contraction of the diaphragm and sometimes the intercostal muscles (tiny muscles between the ribs). This causes inhalation to be cut short by closure of the glottis (the opening between the vocal chords).

Common hiccup triggers are drinking carbonated drinks or eating a large meal. Anxiety or stress also can trigger hiccups, along with alcohol, spices, smoking or other irritants to the gastrointestinal or respiratory tracts.

Intractable hiccups usually have underlying causes. In one patient, for example, hiccups were traced to arthritis in the sternoclavicular joint (the joint connecting the collar bone to the breast bone). In another patient, hiccups were linked to pulmonary embolisms (blood clots in the lungs). Certain drugs also can trigger hiccups.

In addition to treating the underlying cause, if known, physicians can treat hiccups with various medications, including baclofen, gabapentin, metoclopramide, chlorpromazine and haloperidol, Drs. Rouse and Wodziak wrote. Nerve blocks within or near the phrenic nerve (involved in breathing) also are being studied. Other reported remedies include swallowing granulated sugar, hypnosis and acupuncture.

Hiccup treatments cross multiple disciplines, including neurology, gastroenterology, pulmonology and primary care, Drs. Rouse and Wodziak wrote. There are no formal guidelines for treating intractable hiccups. Many treatments are founded merely on a physician’s own experience or anecdotal evidence.

“There is a lack of good quality evidence to recommend specific treatment for hiccups,” Drs. Rouse and Wodziak wrote.

Story Source:

Materials provided by Loyola University Health System. Note: Content may be edited for style and length.

Averting toxic chats: Computer model predicts when online conversations turn sour

The internet offers the potential for constructive dialogue and cooperation, but online conversations too often degenerate into personal attacks. In hopes that those attacks can be averted, Cornell University researchers have created a model to predict which civil conversations might take a turn and derail.

After analyzing hundreds of exchanges between Wikipedia editors, the researchers developed a computer program that scans for warning signs in the language used by participants at the start of a conversation — such as repeated, direct questioning or use of the word “you” — to predict which initially civil conversations would go awry.

Early exchanges that included greetings, expressions of gratitude, hedges such as “it seems,” and the words “I” and “we” were more likely to remain civil, the study found.

“There are millions of such discussions taking place every day, and you can’t possibly monitor all of them live. A system based on this finding might help human moderators better direct their attention,” said Cristian Danescu-Niculescu-Mizil, assistant professor of information science and co-author of the paper “Conversations Gone Awry: Detecting Early Signs of Conversational Failure.”

“We, as humans, have an intuition of whether a conversation is about to go awry, but it’s often just a suspicion. We can’t do it 100 percent of the time. We wonder if we can build systems to replicate or even go beyond this intuition,” Danescu-Niculescu-Mizil said.

The computer model, which also considered Google’s Perspective, a machine-learning tool for evaluating “toxicity,” was correct around 65 percent of the time. Humans guessed correctly 72 percent of the time.

People can test their own ability to guess which conversations will derail at an online quiz.

The study analyzed 1,270 conversations that began civilly but degenerated into personal attacks, culled from 50 million conversations across 16 million Wikipedia “talk” pages, where editors discuss articles or other issues. They examined exchanges in pairs, comparing each conversation that ended badly with one that succeeded on the same topic, so the results weren’t skewed by sensitive subject matter such as politics.

The paper is co-written with Cornell Ph.D. information science student Justine Zhang; Ph.D. computer science students Jonathan P. Chang, and Yiqing Hua; Lucas Dixon and Nithum Thain of Jigsaw; and Dario Taraborelli of the Wikimedia Foundation.

The researchers hope this model can be used to rescue at-risk conversations and improve online dialogue, rather than for banning specific users or censoring certain topics. Some online posters, such as nonnative English speakers, may not realize they could be perceived as aggressive, and nudges from such a system could help them self-adjust.

“If I have tools that find personal attacks, it’s already too late, because the attack has already happened and people have already seen it,” Chang said. “But if you understand this conversation is going in a bad direction and take action then, that might make the place a little more welcoming.”

Story Source:

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

Unless we spot changes, most life experiences are fabricated from memories

We may not be able to change recent events in our lives, but how well we remember them plays a key role in how our brains model what’s happening in the present and predict what is likely to occur in the future, finds new research in the Journal of Experimental Psychology: General.

“Memory isn’t for trying to remember,” said Jeff Zacks, professor of psychology and brain sciences in Arts & Sciences at Washington University in St. Louis and an author of the study. “It’s for doing better the next time.”

The study, co-authored with Chris Wahlheim of the University of North Carolina at Greensboro (UNCG), brings together several emerging theories of brain function to suggest that the ability to detect changes plays a critical role in how we experience and learn from the world around us.

Known as “Event Memory Retrieval and Comparison Theory” or EMRC, the model builds on previous research by Zacks and colleagues that suggests the brain continually compares sensory input from ongoing experiences against working models of similar past events that it builds from related memories.

When real life does not match the “event model,” prediction errors spike and change detection sets off a cascade of cognitive processing that rewires the brain to strengthen memories for both the older model events and the new experience, the theory contends.

“We provide evidence for a theoretical mechanism that explains how people update their memory representations to facilitate their processing of changes in everyday actions of others,” Wahlheim said. “These findings may eventually illuminate how the processing of everyday changes influences how people guide their own actions.”

In their current study, Zacks and Wahlheim tested the change detection model with experiments that take advantage of the well-documented fact that older adults often have increased difficulty in recalling details of recent events.

Groups of healthy older and younger adults were shown video clips of a woman acting out a series of routine, everyday activities, such as doing dishes or preparing to exercise. One week later, they were shown similar videos in which some event details had been changed.

“When viewers tracked the changes in these variation-on-a-theme videos, they had excellent memory for what happened on each day, but when they failed to notice a change, memory was horrible,” Zacks said.

“These effects may account for some of the problems older adults experience with memory — in these experiments, older adults were less able to track the changes, and this accounted for some of their lower memory performance.”

Previous research by Zacks and others has shown that the brain breaks up the activities of daily life into a hierarchy of distinct smaller events or “chunks,” and that our ability to identify transitions or “boundaries” between these chunks has consequences for how these experiences gets encoded in our memories.

For instance, just walking through a doorway, which the brain perceives as an “event boundary,” has been shown to diminish our recollection for information being processed just before we entered the new room. Thus, we sometimes find ourselves forgetting the reason we entered a room in the first place.

This event-driven model of brain function, known as Event Segmentation Theory (EST), has been gaining credence over the last decade.

Zacks, the author of the book “Flicker: Your Brain on Movies,” has used EST to explain how the brain processes fast-paced movie cuts and other film-making techniques that force viewers to process sensory input in ways evolution could never have predicted.

Event models may be based on previous personal experiences, but might also include perceptions gleaned from conversations with friends or similar situations portrayed in books, movies and television.

Thus, someone’s “event model” for a future wedding day might be based on other weddings attended, past gatherings of family and friends and tidbits gleaned from repeat viewings of the movie, “My Big Fat Greek Wedding.”

Event Memory Retrieval and Comparison Theory takes the event segmentation model a step further by introducing concepts from the “memory-for-change” framework, a theory put forth in recent research by Wahlheim and Larry Jacoby.

Jacoby is a prominent cognitive psychologist known for work on the interplay of consciously controlled versus more automatic influences of memory. He is now a professor emeritus of psychological & brain sciences at Washington University.

Wahlheim completed his PhD and postdoctoral training at Washington University, and now directs the Memory and Cognition Lab as an assistant professor at UNCG.

In recent research, Jacoby and Wahlheim exposed study participants to series of lists that included pairs of related words, including some lists where an originally presented word was paired with a new word.

While seeing the same “trigger” word associated with multiple word pairs has been shown to cause interference in the recall process, Jacoby and Wahlheim found that memory improved when participants both recognized the change during presentation and later remembered that the change had been recognized.

The memory-for-change framework suggests that noticing the change is critical to the creation of a memory trace that ties all these events together, strengthening our memory for the original pairing, the recognition of change and the new pairing.

The current study explores the memory-for-change phenomena in a more naturalistic scenario in which videos of daily activities replace paired-word lists. It also adds a chronological element by suggesting the videos represent activities filmed one week apart.

Findings suggest that establishing time-based connections improves recall because memory for a later event becomes embedded within a trace that includes reminding of an earlier event. Recent events embed earlier events, but not vice versa.

More broadly, these studies provide evidence that a major function of our memory is to help us retrieve relevant experiences and relate them to what is happening in the current environment.

“Our study lends support to the theory that predictions based on old events help us identify changes and encode the new event,” Zacks said. “Memories of recent experiences are valuable because they can be used to predict what will happen next in similar situations and help us do better in dealing with what’s happening now.”

How Olympic Fencer Ibtihaj Muhammad Deals With the Unexpected Physical Symptoms of Anxiety

No one is immune to anxiety and mental health issues, and that includes Olympic fencer Ibtihaj Muhammad, the first American to compete at the Olympics in a hijab. In a new interview with Glamour, Muhammad shared her experience with anxiety, saying that she first started dealing with performance anxiety back in 2014.

“At first, I had no idea what was happening,” Muhammad told Glamour. “The morning of a competition I’d wake up feeling lethargic and sleepy—overwhelmingly so—despite having had a good night’s rest. At game time I’d [go] onto the fencing strip and feel completely detached from reality.” Some common symptoms of anxiety, according to the Mayo Clinic, include feeling nervous or tense, difficulty concentrating, and feeling weak or tired, much like Muhammad described.

Muhammad’s sports psychologist explained to her that her anxiety was manifesting in physical symptoms.

The psychologist also gave her a few mental exercises to try when she feels her anxiety creeping in. “Every morning I’d spend 15 minutes in prayer and meditation, which helped me start my day from a calm, centered place,” she said. “On competition days I’d take another 15 minutes to focus on my breathing and my thoughts. I would repeat to myself over and over, ‘I’m ready. I’m prepared. I’m strong. I’m capable. I’m a champion.’”

When she’s not utilizing her meditation mantras or prayer, Muhammad also revealed her secret anti-anxiety weapon: a pair of blinged headphones that she never leaves the house without. “They’re a way to deter people from talking to me while I get in the zone and also let me listen to my favorite music for extra motivation,” Muhammad told Glamour.

As SELF previously reported, it’s not uncommon for athletes performing at this level to check in with a sports psychologist.

Also called mental skills coaches, these psychologists help athletes manage everything from run-of-the-mill jitters to clinical anxiety. For instance, they might help an athlete come to accept the fact that they’re going to be anxious before a competition rather than trying to ignore it. Or, they might suggest journaling or other mindfulness practices to help athletes ground themselves in the present instead of getting caught up in “what if?” scenarios.

For many of us (including Olympians), dealing with anxiety is totally normal and part of the human experience. However, if you’re experiencing excessive worries or fears that interfere with your daily quality of life, that’s a sign that your anxiety is more severe than normal, and you should reach out to a mental health professional. And remember that those symptoms may manifest physically as well.

Of course, not everyone has access to such quality mental health care. So Muhammad encouraged anyone who may be experiencing mental health issues to reach out to a trusted friend or family member when the going gets tough and to always consider self-care a priority.

“It is not a sign of weakness to seek help when you need it,” she said. “In fact, it’s brave.”


Updated: Ritz Cracker Products Recalled for Possible Salmonella Contamination

Update: Unfortunately, Ritz Crackers aren’t the only delicious snack to be recalled in the U.S. this week. According to a statement from Pepperidge Farm, four varieties of Goldfish crackers—Flavor Blasted Xtra Cheddar, Flavor Blasted Sour Cream & Onion, Goldfish Baked With Whole Grain Xtra Cheddar, and Goldfish Mix Xtra Cheddar + Pretzel—have also been recalled, as the whey powder listed as an ingredient in the crackers may have been contaminated with salmonella.

The products that are affected are only those with specific codes and in specific packaging, so check to make sure your precious crackers are included in the recall before getting rid of them. If it turns out you do have some of the recalled products, don’t eat them—instead, throw them away or return them to where you bought them to get a full refund.

Original report (July 23, 2018):

Snack time is about to get a lot less delicious: 16 types of Ritz Cracker products have been voluntarily recalled over possible contamination with salmonella bacteria, according to a statement from Mondelēz Global LLC.

The products affected by the recall—including several varieties of Ritz Bits cheese cracker sandwiches—all contain whey powder as an ingredient, which the statement explains was recalled by the supplier due to potential salmonella contamination. Although the company hasn’t received any complaints of illnesses associated with the recalled products, it is still warning consumers to avoid eating the recalled products and to discard any of the products they may have purchased as a precaution.

Salmonella symptoms may show up as quickly as 12 hours after you eat something contaminated, SELF reported previously.

According to the Mayo Clinic, those symptoms may include:

  • Vomiting
  • Nausea
  • Diarrhea
  • Abdominal cramps
  • Fever
  • Chills
  • Headache
  • Blood in your stool

Otherwise healthy adults are usually able to recover from a salmonella infection within a week without any special treatment. But young children, elderly adults, and pregnant women may be at risk for more serious complications. Either way, if you think you may have a salmonella infection in connection with the Ritz Cracker situation or any other recall, it’s worth talking to your doctor to confirm the diagnosis and get more information.

And if it seems like more foods are being recalled over concerns like these than in the past, you’re not imagining it. As SELF wrote previously, salmonella is a particularly wily bacteria that can contaminate many different types of food—not just the undercooked meat and raw produce we usually associate with foodborne illnesses.

So, other food safety measures—including safe storage and cooking protocols—are just as important as ever. That means keeping certain ingredients refrigerated until you’re ready to use them, keeping raw produce separate from raw meat and poultry, and, yes, avoiding bringing recalled foods into your home in the first place.


Abortion Procedure: 15 Ways to Prepare for Your Abortion

So, you’re pregnant and you don’t want to be. If you’ve decided that having an abortion is the best option for you, there will be many more questions and considerations ahead of you.

Although it may feel like it right now, you’re not alone—around 650,000 women in the United States get an abortion every year, according to the most recent data available from the Centers for Disease Control and Prevention (CDC). Though this procedure is common, it can also feel shrouded in secrecy, especially when you’re looking for advice on what to expect. According to experts, there are a lot of ways to prepare physically and emotionally for your abortion. Here’s what you can do.

1. Educate yourself about your abortion options and what each one entails.

Nearly one in four people getting abortions choose what’s colloquially known as “the abortion pill,” according to the CDC. This option (also called a medical, chemical, or pill abortion), is only available to people who are at most 10 weeks pregnant. If you’re further along than that, or if you have certain contraindications (like taking blood thinners), you’ll need a surgical abortion, which we’ll detail in a moment.

People often choose to have a medical abortion because it’s less invasive than its surgical counterpart. “It seems less clinical because you’re taking medications that mimic a natural miscarriage,” ob/gyn Sara Imershein, M.D., M.P.H., vice chair of the D.C. section for the American College of Obstetricians & Gynecologists (ACOG), professor at the George Washington University School of Medicine, and board member of the NARAL Pro-Choice America Foundation, tells SELF.

Though there are different ways to have a medical abortion, the most common involves taking two pills, according to the Mayo Clinic. The first is mifepristone, which you’ll either take at the health center providing your abortion or at home. (Whether or not you can take this first pill at home depends on the laws in your state.) Mifepristone prevents an embryo from growing by blocking progesterone, a hormone that typically thickens your uterine lining to support a pregnancy. The second pill is misoprostol (you take this one at home 24 to 48 hours after the first pill), and it induces contractions to empty your uterus.
You’ll experience cramping and bleeding as you pass the pregnancy and the uterine lining that would have supported it, typically for a few hours. You may also deal with symptoms like nausea, vomiting, fever, chills, diarrhea, and a headache, according to the Mayo Clinic. Your specific symptoms can vary based on how far along you are and just on how your body works.

A week to two weeks after the abortion, you’ll need to go into the doctor’s office for a follow-up to ensure all the tissue is out of your uterus. Some estimates show that medical abortions have a success rate (meaning the pregnancy is over and all the necessary tissue was expelled from the uterus) of around 93 to 98 percent, depending on how early you get the abortion, according to the Food and Drug Administration. (The completion rate went down as gestational age increased.) If during your visit your doctor discovers your abortion was incomplete, they may decide to prescribe another dose of misoprostol, or they might discuss with you the possibility of surgical intervention to complete the abortion.

There’s also the option to get a surgical abortion. This procedure takes around five to 20 minutes, and what research has been done shows it can be more effective than medical abortion, with 96 to 100 percent completion rates (although the disparity between medical and surgical abortions seems to be wider when you’re talking about less common forms of medical abortion than the mifepristone and misoprostol combination). This involves removing the fetus and placenta from your uterus through your vagina with a suction device or other medical tools. Depending on factors like the fetus’s gestational age, a surgical abortion is performed under local or general anesthesia.

Many people choose this option because they like the idea that it will be over in a few minutes, Dr. Imershein says. Even with pain medication, you may experience cramping during your surgical abortion, but it typically subsides quickly. You may also experience bleeding, cramping, or spotting for days after a surgical abortion.

Whichever route you’re going, your doctor should thoroughly explain all the important details of what to expect before, during, and after the procedure. That should cover how it works, the side effects you can expect based on specifics like how far along you are or what kind of pain medication you’re getting, potential risks and complications, as well as the clinic’s protocols (like if and when to stop eating or drinking the night before, depending on the kind of anesthesia you’ll have).

2. Remember that abortions are safe medical procedures when performed under the care of a medical professional. They carry fewer risks and complications than childbirth.

Abortion is one of the safest routine medical procedures you can have, especially in the first trimester (which is when over 91 percent of abortions take place).

Fewer than one woman will die for every 100,000 legal abortions performed by a professional, according to the CDC. For perspective, there were 17.3 maternal deaths for every 100,000 live births in 2013, according to the CDC’s most recent pregnancy mortality surveillance statistics. This is in large part because the longer you’re pregnant, the higher your risk for potentially life-threatening complications, according to a 2012 study in Obstetrics and Gynecology, which explains that many of the more dangerous conditions, like preeclampsia (high blood pressure during pregnancy), are most likely to present later in pregnancy.

3. Make sure you’re aware of any abortion legislation in your state that may complicate your experience.

For instance, some states have imposed mandatory waiting periods for medical abortions, meaning you may have to wait anywhere from 18 to 72 hours after a counseling session to actually have your abortion, according to the Guttmacher Institute. Here’s a general overview of what you can expect based on where you live, but it’s always smart to do some extra research beforehand so none of this takes you by surprise. This can be especially important if you have to take off work, travel, or find childcare in order to make an appointment.

Also, depending on your state, understand that your doctor may be required by law to lie to you or give you written materials with false information about abortion. Thirty-five states mandate some form of counseling before a person can receive an abortion, according to the Guttmacher Institute. The information included in that counseling varies by state, but sometimes this means that abortion providers are legally forced to share medically inaccurate information, like that abortion can increase the risk of breast cancer (science doesn’t support this) or that having a safe, legal abortion is likely to impair fertility (again, science does not back this up).

Based on the state in which you live, your doctor may also have to perform an ultrasound and show you the resulting image, offer you the chance to see the image, or describe what the fetus looks like.

4. Try to let go of expectations about how you “should” feel about your abortion.

There is no right way to feel about it. “It’s a really different experience for every person,” Gillian Dean, M.D., senior director of medical services at the Planned Parenthood Federation of America (PPFA), tells SELF.

Dr. Dean says that in her experience, most of the women she’s spoken reported feeling an immense sense of relief afterward. This was the case for Violet L.*, 45, who tells SELF she had an abortion at nine weeks 10 years ago and that it was much less scary and traumatizing than she anticipated.

Research hasn’t found an increased risk of psychological problems in people who terminate their pregnancies, Dr. Imershein says. In fact, seeking an abortion but being unable to access one has been linked with more negative mental health outcomes in the short-term than actually having the procedure, according to a 2017 study in JAMA Psychiatry. (In six months, women in both groups generally had similar mental health, meaning the mental health of the women denied abortions improved over time, and it remained steady for the women who got abortions.)

Conversely, some people do describe feeling heartbroken, ashamed, or the need to grieve after an abortion, Megan Aebi, a full-spectrum pregnancy doula and representative of New York-based volunteer organization The Doula Project, tells SELF. (Full-spectrum doulas are trained to counsel women not only through pregnancy and birth but also through experiences like miscarriages, fetal anomalies, stillbirths, and abortions.)

Whatever your emotions surrounding your abortion, all of them are completely valid. Give yourself permission to experience them without judgment, Aebi says.

Also, remember that even if you’ve had an abortion before, this time won’t necessarily be the same. “A woman can have a very different reaction to an abortion than at a time in her past [because] she’s in a different point of her life,” Dr. Dean says.

5. Remove as much financial stress as possible by figuring out how you’re paying for the abortion.

How much your abortion will cost varies widely depending on a number of factors, including the type you’re getting, how far along you are (they’re usually pricier after the first trimester, Dr. Dean says), the provider you go to, where you live, and your insurance coverage. With that in mind, one 2014 report based on all known abortion-providing facilities in the United States found that the median cost for either a surgical or medical abortion at 10 weeks was around $500.

If you have health insurance, your first step should be calling your insurer to find out if your abortion will be covered. (Many states restrict private insurance and Medicaid from helping with abortion; sometimes there are exceptions, like in cases of life endangerment.) You can also call your local abortion-providing health center to see if they charge less for services depending on your income.

There are also a number of organizations that may be able to help offset some of the financial burden. Check out the National Network of Abortion Funds (NNAF) and the National Abortion Federation Hotline Fund.

6. Tell only the people you actually want to and no one else.

Maybe you feel like shouting from the rooftops that this is the smart, safe, choice for you. Perhaps you’d rather not tell a soul. “When it comes to who you share this with, who you seek support from, and whose experience and advice you solicit and follow, [follow] your gut,” Dr. Dean says.

That might mean not telling your sister, who typically knows everything about your life but is staunchly anti-abortion. Or maybe you know your friend would be supportive, but they’re a total blabbermouth.

If you’re not sure whether or not to tell a friend or relative, Aebi says you can test the waters first by bringing up the topic of abortion. She recommends saying something like, “My friend is getting an abortion and they need a ride,” or, “There’s so much talk about abortion in the news recently,” and gauging their reaction. As with any other major medical decision, this information is entirely your business, and only you should get to decide who to share that with.

7. Stock up on things like food, water, pads, and painkillers for after your abortion.

If you can, you should take off work the day of your abortion procedure, no matter the type (and maybe the day after, if you can swing it, although Dr. Imershein says most people are fine to go back by then). If you’re having a medical abortion, that means you’ll want to schedule your day off for when you take the second pill, not the first, because most people don’t experience any kind of discomfort or bleeding until then, Dr. Dean explains.

During a medical abortion, you may experience nausea and vomiting, but it’s important to stay hydrated even when it feels like you can’t keep anything down, Dr. Dean says. Buy some ginger ale, soup, a sports drink, mint tea, whatever your go-to aids are for a queasy stomach. Aebi also recommends you have some comforting food at home, whatever that looks like for you, so you don’t have to venture out and grab anything if you’re not feeling up to it.

You’ll also definitely want to purchase lots of big pads to soak up and monitor the bleeding, Dr. Dean says. During a medical abortion and after a surgical one, you may experience heavy bleeding, then spotting that can last a few days or weeks. (Or you might have virtually zero bleeding afterward, Dr. Dean says.) If at any point you’re soaking through two or more pads an hour for two hours or more—or if you see clots larger than a lemon—you should call the doctor or the clinic that performed the abortion. Same goes for if you experience a fever or foul-smelling vaginal discharge, both of which could indicate an infection.

If you prefer using tampons, it’s important to know that the advice on whether (and when) they are OK to use in the period following your abortion is mixed. Some doctors say it’s safe immediately, while others advise waiting two weeks. “The idea is that the tampon will hold the blood back while normal vaginal bacteria grow and multiply, increasing a risk of infection,” Dr. Imershein explains. “We encourage people to use whichever method they’re most comfortable with, whether that’s pads, tampons, or a menstrual cup,” Dr. Dean says. Ask your doctor performing your abortion what they recommend.

To help with the cramping, which generally mimics period cramps but can vary in severity based on the person, stick to nonsteroidal anti-inflammatories like ibuprofen instead of drugs like aspirin, which can thin your blood and make you bleed more. You can also try a heating pad, hot water bottle, or Aebi’s cheap DIY option: Heat up some dried rice in the microwave, then put it into a sock to form a warm little pouch.

Even with all this information in mind, be sure to talk to your doctor about what kind of bleeding and cramping you can expect, along with any red flags that should get your attention.

8. Go into the waiting room with tools to distract yourself if you think you’ll need or want them.

Depending on your specific clinic, you may be in the waiting room for hours before your surgical procedure or appointment to begin a medical abortion, Dr. Imershein says. You may also need to wait around for any pain medication to kick in or hang out afterward while it wears off and you rest.

“Make sure that you have things to keep occupied,” Aebi says, whether that’s an engrossing true crime podcast or a calming coloring book. This is also where having a friend on hand may help, which brings us to our next point.

9. Consider bringing along a supportive companion.

Some health centers will require you to bring someone who can take you home after a surgical abortion, Dr. Dean says. This depends on the type of anesthesia you’ll be having. (If it’s general, you’ll definitely need an escort.) If that’s not the case for you, or if you’re doing an at-home medical abortion, having someone at your side is your decision.

If you do choose to have company, pick someone whose presence will lower any potential anxiety, Aebi says: “Make sure that they’re somebody that’s calm and centering and supportive of the decision that you’re making.”

If you can’t find the right companion, there are other options. Some clinics have abortion doulas who are there to support you before, possibly during, and after the experience. Whether it’s a friend or abortion doula, keep in mind that they may not be allowed in the procedure and/or recovery room, Dr. Imershein says. Find out your health center’s policy beforehand so you’re not caught off guard.

Depending on where you live, Dr. Imershein adds, an abortion funding organization may be able to connect you with somebody who can accompany you for however much of the procedure your clinic will permit. Ask your health center for guidance, or check out Radical Doula’s list of local volunteer organizations. Also, some NNAF member organizations provide abortion doula services.

10. Be clear with your companion about what you need from them.

Do you require a ride to and from the health center? Do you want someone to keep you distracted in the waiting room? Lie in bed and watch movies with you while you recover from the procedure or wait for the medication to work? Run to the pharmacy? Rub your back? Figure this out and let them know. “Helping them help you is something you can do to prepare yourself,” Dr. Dean says.

Violet, for example, remembers wishing she had asked a friend to come over while she recovered. “The thing that felt the worst was that afterward I just lay around in my bed by myself,” she says. “It would’ve been nice to have someone there.”

11. Ask your health center if you can bring earbuds to listen to something during a surgical abortion if you think that would be helpful for you.

If you’re going to be awake during a surgical abortion and want relaxation or distraction, listening to something might be helpful. Aebi recommends women seeking a sense of calm download a guided meditation app or curate a playlist of serene songs. Or maybe you’re looking for something more stereotypically empowering, Aebi says, adding, “You can stream Beyoncé before, during, and after your procedure if you want.”

12. As much as you can, mentally prepare yourself for the possibility of interacting with protestors.

The unfortunate reality is that you might come across anti-abortion advocates outside of the health center. They may confront you with disturbing images, ones “not based on the reality of abortion and not medically factual to make you feel uncomfortable and stigmatized,” Dr. Dean says.

Remember that you have the right to choose what happens to your body, and that includes getting an abortion if that’s the best choice for you. Furthermore, these protesters “do not mean that the health care you are going to receive in that health center isn’t of the highest quality, based on medical and scientific evidence, and based on compassion and care,” Dr. Dean says.

Also exercise caution online, where there exist not just trolls condemning people who terminate pregnancies, but anti-abortion sites spreading misleading information or possibly directing you to visit crisis pregnancy centers that hold an anti-abortion stance.
If you’re looking for a supportive online community, Aebi recommends Shout Your Abortion, which bills itself as “a decentralized network of individuals talking about abortion on our own terms and creating space for others to do the same.”

13. Consider talking to a mental health counselor before and/or after your abortion.

Remember, while some people feel relieved or indifferent after their abortions, it’s also possible you’ll feel upset (or a mix of emotions, including sad ones). People more prone to having difficulty coping with an unplanned pregnancy and its termination include (but are not limited to) those with pre-existing mental illnesses like anxiety or depression, Dr. Imershein says.

“If you find yourself in that group, reach out to your health care provider,” Dr. Dean says. If you don’t have a regular therapist, Aebi recommends starting by asking the center where you got your procedure to connect you with resources. Many of them offer free counseling that you can take advantage before or after your abortion (though it may not be immediately after; it could take weeks, Aebi says).

There are various other resources at your disposal. Dr. Imershein points to an organization called All-Options, which has a free national talkline at 1-888-493-0092. The National Abortion Federation also has a hotline at 1-800-772-9100.

14. Think about your birth control plan going forward to prevent another unintended pregnancy.

“It’s great to go from pregnant to protected,” Dr. Dean says. Many abortion providers will encourage women to enact a post-abortion birth control plan. For example, Dr. Dean says, you can typically have an IUD placed on the same day of your surgical abortion or during your follow-up appointment after your medical abortion.

That’s why Dr. Imershein advises doing some research on birth control and talking to friends about their own contraception so you have an idea of what you want to do when it comes up at your appointment. Or, if you think you wound up pregnant because of a mishap with birth control, ask your doctor if that means you should consider a different method instead.

15. Remember, this is your body and your decision.

That means whatever your choice in dealing with an unintended pregnancy, you can change your mind, including right up until the last second of getting an abortion. But even if you know it’s definitely the right move for you, if you’re dealing with anxiety or other difficult emotions surrounding your abortion—or are surprised by your lack of these feelings—it can be easy to lose sight of the factors that went into your choice.

Returning to the reasons behind your choice and the opportunities this abortion is giving you rather than taking away can help keep things in focus. Violet, for instance, badly wanted a baby, but not with the person who got her pregnant. She didn’t end up having children, but still tells SELF she doesn’t regret her decision to have an abortion at all.

If you’re sure you want to have an abortion but have any fears or worries, it might make sense to talk to a counselor who can work through those feelings with you. “It’s really about recognizing that [you’re] making the most caring and loving decision for [yourself] and for your future,” Aebi says.

*Name has been changed.