9 Schizophrenia Facts to Know, Because It’s Way Too Misunderstood

If you aren’t super familiar with schizophrenia, you might associate the condition with movies like A Beautiful Mind or episodes of Law & Order. But schizophrenia is a complex, widely misunderstood condition, and pop culture references to the disorder don’t always (or even usually) get it right. Here’s what you actually need to know about schizophrenia.

1. Yes, schizophrenia is a mental health disorder that can cause symptoms such as delusions, but there’s more to it than that.

According to the National Institute of Mental Health (NIMH), you can think of the symptoms of schizophrenia in three major buckets: positive, negative, and cognitive.

Positive symptoms encompass psychotic behaviors you don’t typically see in people without disorders like schizophrenia. They include:

  • Hallucinations
  • Delusions
  • Unusual thought processes
  • Unusual body movements

Negative symptoms are ones that indicate a lack of feelings and behaviors you would see in many people without schizophrenia, such as:

  • “Flat affect,” which is basically when someone doesn’t express the level of emotions you’d expect
  • Taking less pleasure in life
  • Problems starting and sticking with activities
  • Diminished speaking

Cognitive symptoms have to do with memory and thinking. They include:

  • Problems understanding information and using it to make decisions
  • A hard time concentrating
  • Trouble with “working memory” (being able to use information right after learning it)

2. Experts aren’t totally sure what causes schizophrenia, but it’s thought to be a combination of factors such as genes and brain chemistry.

People often point solely to factors like family dynamics as the origin of schizophrenia, Ananda Pandurangi, Ph.D., director of the Schizophrenia and Electroconvulsive Therapy programs at Virginia Commonwealth University’s Department of Psychiatry, tells SELF. “This is totally inaccurate,” Pandurangi says.

According to the NIMH, the condition is largely genetic; multiple genes might increase a person’s risk of developing schizophrenia. An imbalance in neurotransmitters such as dopamine and glutamate might also make a person more susceptible to this mental health condition. In addition, people with schizophrenia experience brain changes such as reduced gray matter. (Gray matter is brain tissue that helps with processing information, according to the National Institute of Neurological Disorders and Stroke.) Experts are still investigating to what extent this decrease in gray matter is involved with schizophrenia’s onset and trajectory.

Finally, components like mind-altering drug use as a teenager or young adult, prenatal exposure to viruses that can affect brain development, prenatal malnutrition, and psychosocial factors (meaning psychological and social issues such as childhood trauma) can also play a role. The takeaway: No single environmental or behavioral factor leads to schizophrenia.

3. Men are more likely to develop schizophrenia than women.

Of the 23 million or so people worldwide who have schizophrenia, the World Health Organization estimates that 12 million are men and 9 million are women. Experts aren’t sure of exactly why this is, though they have some theories. One is that higher levels of hormones such as estrogen in women may help prevent imbalances in neurotransmitters like dopamine and glutamate that are implicated in schizophrenia. There’s also the idea that sex chromosomes may be a factor, though that’s still up for debate.

Not only are men more likely than women to develop schizophrenia, the two groups might experience the condition differently. For example, symptoms of schizophrenia generally emerge between the ages of 16 and 30, but they typically begin in the early to mid-20s for men and the late-20s for women, according to the Mayo Clinic. (The later onset in women may be related to lower estrogen levels as women age.)

It also appears as though men and women can experience schizophrenia differently. For instance, men with schizophrenia tend to have more of those negative symptoms while women are more inclined to have mood-related symptoms, a 2010 paper in International Review of Psychiatry explains. This may be due in part to neurotransmitters acting differently in people of different sexes.

4. People with schizophrenia are not inherently violent or criminals, no matter what you’ve heard.

“Most people with schizophrenia are not violent,” Prakash Masand M.D., a psychiatrist and founder of the Centers of Psychiatric Excellence, tells SELF. It’s true that a person with untreated schizophrenia may be more likely than someone without schizophrenia to commit a violent crime, and people with schizophrenia are largely overrepresented in prison populations, Dr. Masand notes. But this is about correlation, not causation: Having schizophrenia doesn’t inherently make a person dangerous.

A 2014 study in Law and Human Behavior found that out of 429 violent and non-violent crimes committed by people with mental illnesses, only 4 percent were directly related to schizophrenia-induced psychosis. (Three percent were directly related to depression, and 10 percent to bipolar disorder.) Other elements—mainly general risk factors for crime, regardless of a person’s mental health status—tended to weigh much more heavily, such as poverty, substance abuse, homelessness, and unemployment. Another issue is that people with schizophrenia are often unable to access the mental health treatment they need, as explained in this 2015 paper in Crime Psychology Review, which is not so much about schizophrenia as it is barriers to health care.

Furthermore, a 2011 study in Schizophrenia Bulletin noted that people with schizophrenia may be up to 14 times more likely to be victims of violent crimes than to be arrested for committing them.

“This is for a few reasons,” Aimee Daramus, Psy.D., a licensed clinical psychologist at Behavioral Health Associates in Chicago, Illinois, tells SELF. “[People with schizophrenia] are often attacked by people who are afraid of their eccentric behavior, such as talking, singing, or shouting at their hallucinations. People with schizophrenia also have high rates of homelessness, which puts them at risk of violence. And because they’re often focused on their internal world of hallucinations and delusions, they often aren’t paying attention to their surroundings.”

5. Schizophrenia is not the same thing as bipolar disorder or dissociative identity disorder.

The word “schizophrenia” came from the Greek “skhizein,” meaning “to split,” and “phren,” which translates to “mind,” the Oxford English Dictionary explains. But this literal meaning can cause confusion, so people may conflate schizophrenia with bipolar disorder or dissociative identity disorder.

Bipolar disorder, which is sometimes called manic depression, is a mental health condition characterized by extreme mood swings between highs (mania) and lows (depression), according to the Mayo Clinic. People with bipolar disorder may experience psychosis—one of the main components of schizophrenia—but it’s not common. And while schizophrenia can cause mood swings, that’s not a primary symptom.

There are also differences between schizophrenia and dissociative identity disorder (previously referred to as multiple personality disorder). Per the Mayo Clinic, people with dissociative identity disorder (DID) alternate between multiple identities and may feel like there are many voices inside their head vying for control. While schizophrenia can also cause delusions and hallucinations, they don’t necessarily revolve around various personalities the way they do with DID.

Here’s another way to think about it, if it helps: The “split” in schizophrenia refers to a split from reality during times of psychosis, not a split in identities or the split between extremely high and low moods.

6. People who have schizophrenia may be at a higher risk of other health issues, including premature death.

Individuals with schizophrenia can be more vulnerable to issues such as cardiovascular disease, diabetes, and smoking-related lung disease, according to the NIMH, which notes that under-detection and under-treatment of these conditions in those with schizophrenia can lead to death. People with schizophrenia are also more likely to die by suicide. Due to these factors, people living with schizophrenia are unfortunately at a higher overall risk of premature mortality (dying at an early age) than the general population, according to the NIMH.

7. There’s no definitive diagnostic test for schizophrenia, so doctors will typically take a multi-pronged approach.

The fifth and most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which experts use as a blueprint for identifying different mental health conditions, lays out exactly what doctors should look for when it comes to schizophrenia. Diagnosis isn’t just about the symptoms, but also things like how long they last (a person must have at least two positive or negative symptoms for at least a month) and how they affect a person’s life, such as making it tough to maintain work, relationships, and self-care.

It’s also about ruling out other influences that can cause schizophrenia-esque symptoms, such as bipolar disorder and substance use. To do this, doctors might perform a physical exam, do drug and alcohol screenings, and conduct psychiatric evaluations to assess symptoms like delusions and hallucinations, the Mayo Clinic explains.

8. There’s not yet a cure for schizophrenia, but the available treatments make it possible to manage the condition.

The majority of people with schizophrenia can function well and have fulfilling lives if they undergo the recommended treatments to diminish or eliminate symptoms, Pandurangi says.

A lifelong regimen of antipsychotic medications is an essential part of managing schizophrenia, according to the Mayo Clinic. It seems as though the drugs, which come in pill or liquid form, might change the brain’s levels of dopamine in a way that lessens symptoms. It can take weeks to see a difference, though, and like drugs for many other mental health conditions, trial and error might be necessary to find the right course of treatment. Antipsychotics may also cause side effects such as tardive dyskinesia (a disorder that induces repetitive and involuntary movements), although newer ones generally come with fewer serious side reactions, the Mayo Clinic notes. Some people may also require antidepressants or anti-anxiety medication.

Therapy is another central component of schizophrenia treatment, along with other psychosocial methods. These methods can include training to help bolster people’s social skills so they can more fully participate in life, along with programs to help people with schizophrenia find and maintain employment. This type of lifestyle support is important for many people with the condition, the Mayo Clinic explains.

Research also suggests that electroconvulsive therapy (ECT) may be helpful for schizophrenia that isn’t responding well to other treatments. ECT has the potential to change a person’s brain chemistry by using an electric current to bring on short, painless seizures. A 2018 review of literature in Current Opinion in Psychiatry concluded that ECT is a promising potential treatment that warrants more research.

Beyond that, sometimes people with schizophrenia need short-term hospitalization to prevent them from harming themselves or others or allow professionals to assess how treatment is going.

9. Individuals with schizophrenia still face stigma surrounding their mental illness, and it’s on all of us not to add to it.

It’s normal to be nervous about things you don’t understand. But now that you do have a primer on schizophrenia, it’s hopefully a bit easier to recognize that people with this condition don’t deserve its often terrifying, violent portrayal. “Persons with schizophrenia are like anyone else,” Pandurangi says. “They are suffering an internal neurological chaos…and need an understanding and caring approach.”

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Here’s What Cardiologists Say About the Apple Watch’s New Heart Monitoring Features

On Wednesday, Apple unveiled the next generation of the Apple Watch—and it has some notable new features. Like many new tech roll-outs, the watch is thinner and faster than watches that came before it, but the updated version also has several unique options for tracking a person’s heart health.

Previous Apple Watches have always had a heart monitor, but the new version can perform an electrocardiogram (also known as EKG or ECG), a test that measures the electrical activity of your heartbeat. What’s more, the new Apple Watch’s ECG feature is FDA-cleared to detect atrial fibrillation (an irregular heart rate that increases your risk for stroke and heart failure) and to give users notifications that their heartbeat is irregular. The watch also notes when a person’s heart rate is too low.

Users will be required to go through education through an app before they can unlock the ECG feature. Additionally, the FDA says in the approvals that, although the ECG feature can “determine the presence” of an atrial fibrillation, neither feature should be used for the purposes of diagnosis or is intended to “replace traditional methods of diagnosis or treatment.” The features are also not intended to be used by people under age 22 or by people who have had previous atrial fibrillations or other arrhythmias.

There is another ECG-enabled device that’s received FDA clearance. It’s called AliveCor’s Kardiaband device, and it’s a watch band and app that works with the Apple Watch. (However, it’s not built into the watch itself like the new feature.) AliveCor also makes a personal ECG monitor called KardiaMobile that can be used with your phone.

The Apple Watch’s ECG and the ability to detect atrial fibrillation (an irregular heart rate that increases your risk for stroke and heart failure) will launch later this year, while the feature that detects a too-low heart rate will launch later this month with the Watch OS 5.

The Apple Watch’s ECG feature is different from an ECG you’d get at your doctor’s office in a few key ways.

Typically, your doctor will want you to have an ECG when you have irregularities in your heart (called arrhythmia), chest pain, structural problems with your heart’s chambers, a previous heart attack, or ongoing heart disease treatment like a pacemaker, the Mayo Clinic says. But your doctor will also likely want to run an ECG if you have heart palpitations, a rapid pulse, shortness of breath, have been dizzy or confused, or are having weakness, fatigue, or a drop in your ability to exercise.

But standard ECGs (which are done at your doctor’s office) can only tell your doctor what’s going on if you’re actually having symptoms while it’s being conducted. So, for instance, if you’ve been having heart palpitations but feel just fine when you’re undergoing the ECG, it’s probably not going to detect anything, Shephal Doshi, M.D., director of cardiac electrophysiology and pacing at Providence Saint John’s Health Center in Santa Monica, Calif., tells SELF.

That’s why your doctor may want you to use a different type of heart monitoring device that you can wear more consistently—such as a Holter monitor that straps onto your chest—to try to figure out what’s going on, the Mayo Clinic says. This is where the Apple Watch’s ECG might be helpful, Dr. Doshi says: If it’s accurate, it can help your doctor pinpoint your heartbeat’s electrical activity at the time you report feeling symptoms.

This seems great in theory, but doctors are a little wary.

“It seems like a wonderful idea and I’m sure there are some potential upsides to it,” Micah Eimer, M.D., a cardiologist and medical director for the Northwestern Medicine Glenview and Deerfield Outpatient Centers, tells SELF. But Dr. Eimer worries “a lot” about the potential for false positives, or indications that something is wrong when it isn’t.

For instance, while having a low heart rate (below 60 beats per minute) can be a sign of a heart issue, thyroid disorder, sleep apnea, or a side effect of high blood pressure medications, in many cases, it’s totally harmless—especially if you’re a serious athlete.

Long-distance runners, for example, are prone to having lower heart rates (bradycardia), Dr. Doshi says. If you’re not an athlete, having a watch that detects bradycardia could tip you off that something isn’t right with your heart and prompt you to seek care, Dr. Doshi says. But it could also give you a false positive and freak you out for no reason.

Additionally, things that are normal and known to be normal to cardiologists could be alarming to an Apple Watch user, like the fact that your heart rate can drop down to 30 or 40 beats per minute when you’re sleeping (which would apparently trigger an alert). That, and other false positives, may lead to people rushing to the ER and flooding the medical system when they don’t need to, he says.

The ECG you’d get at your doctor’s office gathers information from 12 areas of your heart, the Mayo Clinic explains. But the Apple Watch only gives you one ECG reading, according to the FDA’s approval letter, similar to a Lead I ECG (essentially one part of the standard 12-part ECG). But it’s hard to say how accurate the watch heart data will be compared to medical-grade monitors that doctors use until more information (and research) about the Watch’s new capability is available.

“In theory, it will provide the ability to monitor patients in real time but we don’t yet understand how accurate this signal will be,” Dr. Doshi says. “In the past, devices like that have not been so accurate.”

There’s also the question of what to do with all the data. All of the data collected can be sent to your doctor in a PDF, Apple says in a press release. While that can be helpful in some situations, it can also be really tricky, Dr. Doshi says. “Who is going to be analyzing that data, and is there going to be proper follow-up?” he questions. “We use medical grade monitors all the time and they generate a lot of data. A lot of that is noise and can be very tricky even for trained users to figure out what’s real and what’s not.”

Some overzealous users may also overload their doctor with excess information (as Dr. Doshi is already seeing with AliveCor users). “There are some patients who start sending you EKGs every 30 minutes, which can become a challenge. That can cause a huge data dump,” Dr. Doshi says.

Finally, Dr. Eimer is concerned that a patient may have unusual symptoms, like chest pain, but write them off because their watch says they’re OK. “The doesn’t mean they’re actually OK,” he says. “Having chest pain may or may not cause an abnormal EKG. It’s a lot more complicated than it appears.”

Still, experts see some possible benefits to wearing a device like this.

If you have an irregular heart beat, a history of heart disease or heart attack, or a pacemaker, the Apple Watch’s ECG could potentially provide helpful information for your doctor—especially if you’re having symptoms outside of the doctor’s office. But any symptoms you experience would still require a visit to the doctor’s office to sort out, and would likely involve more traditional testing.

Dr. Elmer also says some people may see a doctor for abnormal readings who wouldn’t otherwise have sought care. He sees one or two patients a year who found that their heart rates were off thanks to a consumer heart monitoring device and ended up learning they had an atrial fibrillation or other issue. “That’s a big win, a big save,” he says. But that’s obviously not common.

Also, some patients require continuous heart rate monitoring, which is currently performed with a device implanted under a patient’s skin, Dr. Doshi explains. So, if the Apple Watch is accurate, it presents an opportunity for continuous heart rate monitoring that’s less invasive.

So, although doctors aren’t exactly recommending that patients go out and buy one of these, they say there’s potential—provided it works well and people use it correctly and with common sense. “If you’re having heart problems, go to your doctor,” Dr. Eimer says. “Watches may serve a very narrow purpose, but they certainly don’t tell the whole story when it comes to your heart.”

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10-Minute Butt and Core Pilates Workout You Can Do in Your Living Room

It’s hard to overstate how important a strong core and strong glutes are. As a fitness editor and certified trainer, I find myself harping on both of these things quite often—whether I’m talking about how a strong butt can help improve your running or how focusing on your core can be useful for relieving lower back pain. Both of these major muscle groups play a huge role in the majority of our movements, so the stronger they are, the more efficiently you can move.

When it comes to working both the glutes and core, Pilates is a great option. The low-intensity workout focuses on small, controlled movements that target specific muscles. “Focusing on that control helps isolate the muscles being targeted and lets you work them deeper, which is what makes Pilates so good and effective for working the core and butt,” Manuela Sanchez, certified Pilates instructor at Club Pilates in Brooklyn, tells SELF.

She adds that the mind-body focus of Pilates—it’s meant to be done in a precise, slow, focused manner—is beneficial. When you’re thinking about the muscles you’re working (what trainers often call “minding your muscle), it can help you better engage them.

Sanchez suggests doing the below circuit before a run or a high-intensity workout to get your core and glutes fired up and primed to work “before going into a more complex routine.” The workout below should take you 10 minutes max, and if you want to do it twice, that’s fine too. You can also just do it on its own a few times a week to do some extra core- and glute-strengthening work that will help keep you stable and strong for your other workouts.

Demoing the moves is Sonja Herbert, a New York–based writer, classically trained Pilates instructor, and founder of Black Girl Pilates.

The Workout

Moves

  • The One Hundred — 5 reps
  • Articulated Bridging — 8 reps
  • Single-Leg Bridge — 8 reps each side
  • Criss-Cross — 30 reps, alternating sides
  • Leg Circles — 20 reps each side

Directions

Do all five exercises, for the set amount of reps. Try to rest as little as possible in between each one. If you want a longer workout, repeat the entire circuit a second time.

Here’s how to do each move:

J. Crew Has Lots of Cozy Fall Sweaters On Sale for Under $50

One of my favorite parts about the fall season is that its brisk temperatures give me an excuse to break out my favorite sweaters. While we’re still a little ways away from the full return of the turtleneck, a stylish sweater offers an easy and cozy wardrobe transition into cooler months. Right now, J. Crew is making fall dressing even easier with awesome markdowns on shoes, clothing, and accessories—some for up to 75 percent off their original prices.

I like to think of this sale as my fairy fashion godmother sprinkling my wallet with extra savings, plus some awesome outfit inspiration for the next couple of months. Who needs a jacket when you have a drawer full of sweaters just waiting to be worn? Ahead, check out all the chic and comfortable sweaters J. Crew has on deep discount just in time for the weather change.

Here’s Why You Are So Freaking Dry When You Get Off a Plane

Why is it that we always feel like we’ve spent a week in the desert after we get off a plane? We’re talking dry eyeballs, a parched mouth, alligator skin, the works. We talked to doctors about what the hell is up with this post-plane dryness, plus how to combat it before, during, and after your flight.

The low humidity in airplanes can cause skin dryness, along with discomfort in sensitive areas like your eyes, mouth, and nose.

Mini science lesson: Humidity is the amount of water vapor that’s in the air. The humidity you’re normally exposed to varies depending on where you live and the weather conditions, but the World Health Organization (WHO) points out that the humidity in most homes is typically over 30 percent. The humidity on airplanes is way lower than that, usually less than 20 percent.

Low humidity can mess with your skin’s ability to retain moisture, making it feel dried out after a while, Joshua Zeichner, M.D., a New York City–based board-certified dermatologist and director of cosmetic and clinical research in dermatology at Mount Sinai Medical Center, tells SELF.

As for your eyes, they rely on a moisturizing tear film to function properly and keep you comfortable, the National Eye Institute (NEI) explains. When you’re in a low-humidity environment, you keep on making that tear film like normal, but the dry environment makes them evaporate more quickly than they otherwise would, Alex Nixon, O.D., assistant clinical professor of optometry at The Ohio State University, tells SELF. This can lead to symptoms like the obvious dryness, plus irritation, stinging, sensitivity to light, and more. Also, if you’re spending the flight watching that teeny TV on the seatback in front of you, working on your laptop, or reading, you’re probably blinking less than you typically would. This also saps your eyeballs of moisture because blinking spreads that important tear film across your eyes.

With your mouth and nose, it really comes down to the lack of humidity and dehydration, Omid Mehdizadeh, M.D., an otolaryngologist at Providence Saint John’s Health Center in Santa Monica, California, tells SELF. Like your eyes, all the lovely moisture that’s naturally in your mouth and nose can evaporate more quickly in a low-humidity environment, he says. Couple that with the fact that you may not be drinking as much on the flight (either because you only drink when the beverage cart comes around or to avoid constant trips to the bathroom), and you’re just setting yourself up for a case of dry mouth and nose, Michael Zimring, M.D., director of the Center for Wilderness and Travel Medicine at Mercy Medical Center and co-author of the book Healthy Travel, tells SELF.

There are a few things you can do to avoid feeling like a living, breathing piece of beef jerky after every flight.

Obviously, everyone has different areas that tend to feel dried out after a flight, and you may not need to do all of these. Still, experts say they can really, really help.

1. Slather on a ton of thick moisturizer. Thick ointments and creams are more effective than thinner lotions at adding moisture to your skin, according to the American Academy of Dermatology (AAD). If you want to get even more specific, look for something that contains mineral, olive, or jojoba oil to lock in moisture, the AAD says. Lactic acid, urea, hyaluronic acid, dimethicone, glycerin, lanolin, and shea butter are also good options.

While you can start applying your cream mid-flight, it’s actually better to get started before that. “The more hydrated your skin is before boarding the plane, the better foundation you have to start off with when you are flying,” Dr. Zeichner says. Continue moisturizing as necessary post-flight until your skin feels normal again.

2. Swap your contacts for glasses. “It is best to avoid contact lens wear if possible on the airplane,” Dr. Nixon says. Even in a normal, perfectly humid environment, contact lenses can mess with your tear film and make your eyes feel dry, the Mayo Clinic says. (Contact lenses block the amount of nourishing oxygen your eyes can receive, plus they’re foreign objects, which can be irritating all on its own.) When you’re in a low-humidity zone like a plane, that drying effect can be even worse.

Also keep in mind that many people sleep on flights, and sleeping in your contacts is just going to dry out your eyeballs even more, Dr. Nixon says. (And potentially compromise your eye health by making you more vulnerable to infection.) “Glasses are the way to go for comfort and safety on board,” he says.

If wearing glasses is just not an option, definitely pack some rewetting drops in your bag and use them liberally during the flight, Dr. Nixon says. Make sure to get drops that don’t promise to relieve redness, since those can cause an aggravating rebound effect that just makes your eyes redder.

3. Use a salt spray in your nose. Saline nasal sprays can help add moisture to your nasal passages when you’re in a low-humidity place like an airplane cabin, Dr. Mehdizadeh says. Just use a few squirts in each nostril to keep your nose feeling OK, and keep on doing it if you start drying out.

4. Hydrate before your flight, and keep it up when you’re on board. In a perfect world, you’d consume about 11.5 cups of fluid a day, per the Mayo Clinic. (That includes liquids you get from drinks like coffee and foods you eat.) But life happens, and sometimes it’s hard to meet that goal. Still, it’s especially important to make sure you’re well-hydrated before you get on a plane, Dr. Zimring says. One easy way to tell? When you’re hydrated, your pee is clear or pale yellow.

The work doesn’t stop once you board: Dr. Zimring recommends trying to have a small bottle of water every hour or two during your flight, depending on what you (and your bladder) can handle.

5. Drink mainly water instead of caffeinated or alcoholic beverages. The plane’s low humidity itself won’t dehydrate you, but what you drink can certainly contribute. That’s why the WHO recommends that you don’t go overboard with caffeine and alcohol when you fly (especially on long hauls). These substances have a diuretic effect (meaning they make you pee more), and that can eventually make you dehydrated if you’re not replacing those fluids.

That doesn’t mean you have to completely shun the good stuff on the beverage cart. If you want to have a cocktail, that’s OK. “Just follow it with plenty of water,” Dr. Zimring says.

6. Whip out a sheet mask midflight. OK, sure, this may look a little silly, but…sheet masks can be really hydrating for your skin, Dr. Zeichner says. “A sheet mask is a great option for the airplane because it is at the same time effective, easy to use, and portable,” he points out. Every sheet mask is different, but you can simply clean your face in the bathroom, follow the mask’s directions, and then chuck it in the trash when you’re done. Voilà.

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How to Give Oral Sex to Someone With a Vagina: 7 Things You Need to Do

Are you a bit confused on how exactly to make your partner get off with oral sex? No worries. You’re not the only one with questions on how to properly go down on a vulva. There simply isn’t enough accurate information out there. You’ll find everything from bad fingering advice to untested ideas about using your tongue like a helicopter blade or spelling out the alphabet.

How do you know if they’re into it? How do you know what they like? What do you even do down there? As a certified sex coach and educator, I’ve heard all of these questions. The answers (and more) ahead.

1. Talk. Encouragement will get you everywhere.

Let your partner know how much you like being between their legs. They need to hear it come out of your mouth (see what I did there?).

Unfortunately, most of what we hear about oral sex has to do with penises, so it’s not surprising that those of us with vaginas often have trouble allowing ourselves to be serviced and giving into pleasure. It is not something we’ve been taught to expect. As a result, we often have trouble orgasming during oral sex if we feel we are taking too long, that you don’t want to be down there, that we’re asking for too much, etc.

Tell your partner you love going down on them. Encourage them to relax and breathe into it. Let them know you’re going to be down there all night if need be and you couldn’t be more delighted. The more chill they feel, the more likely they are to get where they want to be: in Orgasmland.

While you’re down there, make some noise. This isn’t the library. They want to know you’re enjoying yourself, too.

2. Keep it consistent (and choose a steady rhythm).

When in doubt, stay consistent and stay on the clitoris. The clitoris has over 8,000 nerve endings and the majority of those nerves are clustered in the exposed bud-like glans (the part you can see at the tippy top of the vulva).

If you’re with a new partner or aren’t feeling totally confident in your skills, pick a move and stick to it. You can try running your tongue back and forth over the clitoris, up and down, in clockwise circles, or in a figure eight motion. Whatever it is, do it until they come.

If they’re not responding positively (E.G. “Yes! Just like that!”), try a different pattern.

3. Pay attention to their body.

If you’re wondering if your partner is enjoying themselves, pay attention to their body. Are they moving their hips into your face? Are they moaning? Keep these things in mind. If your partner is lying on the bed like a limp starfish, perhaps you should reassess what you’re doing.

Their body will tell you much of what you need to know. If you’re still not sure if they’re liking your moves…

4. Ask for direction.

Inquiring about their needs is not unsexy. It’s hot to want to please your partner. If you want to know what they like, ask. They’ll be more than happy to tell you which moves they like best. After all, we’re all here to come, right?

If they’re not sure what they like, take time to explore their body and encourage them to inform you if something feels particularly good. Remember, every single vulva-owning human is different. We don’t all want the same things.

5. Try adding penetration.

Penetration of a finger or toy can be awesome during oral sex, but it isn’t for everyone. What I’ve found works best of all is to ask! Some people love penetration, some prefer external stimulation only, others want a combination. Don’t be afraid to try all three types of stimulation to find what works.

If your partner isn’t sure whether they like penetration, give it a go—with their permission. Start with one finger, hooking it in a rocking horse or “come hither” motion. This will give you access to the G-spot area, behind the pubic bone.

You can give this a try first, and then add back in your mouth. Gently sliding a finger or two (or a toy—read on) in an out of the vagina while running circles over the clitoris can be highly stimulating. This does take some multitasking! If you want to try internal stimulation on its own, but aren’t sure what to do with your mouth, try talking dirty or kissing your partner’s chest and breasts.

Always remember to pay attention to your partner’s body. If you’re unsure about how it’s going, again, just ask. If they’re feeling it, you can move to two or three fingers.

6. Maybe get a toy in on the action.

There are two main ways I suggest clients and readers incorporate toys into oral sex: penetration with a G-spot wand or a vibrator on the clitoris.

When using a wand for penetration, focus on the G-spot. These toys are specifically designed for this purpose, curving upward for the perfect reach. Massage the G-spot while using your tongue on the clitoris.

With a vibrator on the external glans clitoris (the part you can see!), massage in the same consistent motion you use with your tongue. You can use your mouth as well! Try penetration with the tongue or gently stimulate the very bottom of the vaginal opening. This area contains many pleasurable nerve endings.

7. Check in after sex.

Once playtime is over, check in. Aftercare is an important part of any sexual experience. We have many raw emotions after sex. Talking, cuddling, and discussing everything that transpired will help get you both in the right headspace. No matter the nature of your relationship, whether casual or long-term, your partner deserves respect and to have their needs met. Everyone needs emotional care.

Ask what was working for them and what they enjoyed most. This will help you improve your skills for next time. Sexual play always includes learning and growing.

Gigi Engle is a certified sex coach, educator, and writer living in Chicago. Follow her on Twitter and Instagram @GigiEngle.

Repeat vaccination is safe for most kids with mild to moderate reactions

Children who experience some type of adverse event following initial immunization have a low rate of recurrent reactions to subsequent vaccinations, reports a study in The Pediatric Infectious Disease Journal, the official journal of The European Society for Paediatric Infectious Diseases.

“Most patients with a history of mild or moderate adverse events following immunization [AEFI] can be safely reimmunized,” write Gaston De Serres, MD, of Laval University, Quebec, and colleagues. Although recurrent AEFIs can sometimes occur after repeat doses of vaccine, this study suggests that the risk of recurrent AEFIs after re-vaccination is relatively low, especially when the previous reaction was mild or moderate.

Safety of Repeat Vaccination after Initial Reactions — ‘Passive Surveillance’ Data

In Quebec, healthcare professionals are legally required to report any “unusual or severe” AEFI related to a “passive surveillance” system similar to the Vaccine Adverse Event Reporting System (VAERS) used in the United States. The analysis included 5,600 patients with AEFIs reported to Quebec’s passive surveillance database from 1998 through 2016, all of whom required further doses of the vaccine to which they reacted. (The analysis excluded seasonal influenza vaccine, which changes from year to year.)

Of 1,731 patients with available follow-up data, 1,350 patients were re-vaccinated: a rate of 78 percent. Most of the re-vaccinated children were under two years old; about one-half of the AEFIs were allergic-like reactions.

Sixteen percent of patients experienced some type of recurrent AEFI after re-vaccination. In more than 80 percent of cases, the recurrent reaction was no more severe than the initial reaction. The researchers analyzed potential risk factors for recurrent reactions, including:

  • Patient Characteristics. Children under age 2 were more likely to be re-vaccinated and less likely to have recurrent reactions, compared to older patients. Recurrence risk was similar for males and females.
  • Type of AEFI. Recurrence rate was similar for patients with most types of initial AEFIs. The risk was highest (67 percent) for patients with large local reactions with “extensive limb swelling.” For patients who had allergic-type reactions, the recurrence rate was 12 percent. Severe allergic events (anaphylaxis) were very rare after re-vaccination.
  • Severity of AEFI. Patients with more severe initial AEFIs were less likely to be re-vaccinated: only 60 percent of children with severe reactions were re-vaccinated, compared to 80 percent of those with less-severe reactions. Within this selected group, patients with severe AEFIs were less likely to have recurrences: eight versus 17 percent.
  • Type of Vaccine. The recurrence rate did not differ significantly for different types of vaccines. The re-vaccination rate was highest (90 percent) for children with AEFIs to diphtheria-tetanus-pertussis vaccines.

Prior to this study, there have been limited data on the safety of reimmunizing patients who had a prior AEFI. The study is one of the largest to estimate the rate of recurrent AEFIs by type of reaction and type of vaccine — key information for healthcare providers and parents/caregivers making decisions about further immunization. The results support the safety of continued vaccination especially when the previous reaction was mild or moderate.

The study provides helpful information on the risk of recurrent reactions to specific vaccines and in patients with different types of initial reactions. Dr. De Serres and coauthors suggest that vaccine adverse event passive surveillance systems could be adapted to include “systematic and standardized follow-up” to provide more complete information on recurrence risk and other outcomes for children with AEFIs .

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Materials provided by Wolters Kluwer Health. Note: Content may be edited for style and length.

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