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What is
BetaSitosterol?
BetaSitosterol is a plant sterol found in almost every plant. BetaSitosterol is one of the main subcomponents of a group of plant sterols known as
phytosterols. BetaSitosterol - as found in nature - is white and feels "waxy."
BetaSitosterol has a chemical structure that is very similar to cholesterol. High levels of
BetaSitosterol are found naturally in rice bran, wheat germ, corn oils, and soybeans.
BetaSitosterol is the most abundant phytosterol in the diet. BetaSitosterol is also widely distributed in the plant kingdom and found in such botanicals as Serenoa
Repens (saw palmetto), Curcurbita Pepo (pumpkin seed) and Pygeum Africanum. These three botanicals are used in the herbal management of benign prostatic hypertrophy (BPH). There is some belief that
BetaSitosterol plays some role in the possible benefits of these herbs in BPH.
What are plant sterols?
Plant sterols (or phytosterols) are cholesterol-like substances that are naturally present at low levels in many varieties of fruits, vegetables, nuts and cereals.
They can be extracted either from edible vegetable oils such as soybean or sunflower oil, or are obtained from a by-product of the pulping process used for coniferous trees.
Plant sterols are a natural part of the diet. From natural dietary sources, intake of plant sterols is between 0.3-0.6 grams per day, depending on the diet. Vegetarians may consume more plant sterols because of a higher consumption of fruits and vegetables.
Because plant sterols are chemically similar to cholesterol in animals, they have the ability to reduce absorption of dietary cholesterol, when eaten in sufficient quantities.
Table spreads with added plant sterols have been available for several years. Plant sterols may also be added to low-fat varieties of milk and yoghurt and can be incorporated into breakfast cereal.
What amounts of plant sterols are required for a cholesterol-lowering effect?
Plant sterols block the absorption of cholesterol from the intestine, but are not absorbed themselves to any significant extent. A small cholesterol lowering effect can be achieved when plant sterols are consumed in amounts between 1 and 3 grams per day. Plant sterols lower LDL cholesterol levels (bad cholesterol), but do not alter HDL cholesterol levels (good cholesterol) in the blood.
Can eating more plant sterols increase these effects?
A significant body of research has shown that plant sterols are safe even when consumed in amounts well above 3 grams per day. However, there is no increase in the cholesterol lowering effect of plant sterols when eaten in amounts above approximately 3 grams per day.
For a healthy diet, it is important to enjoy a variety of foods every day. A diet low in saturated fats and high in fruits, vegetables and wholegrain cereals is also a good choice when you have concerns about your cholesterol level.
Do plant sterols have other effects?
The safety of consuming up to 3 grams per day of plant sterols is well supported by the scientific evidence.
Because plant sterols lower cholesterol absorption, they can also lower the absorption of some fat-soluble vitamins. In particular, levels of beta-carotene are lowered when plant sterol enriched foods are consumed. Eating additional fruits and vegetables that are rich in beta-carotene may help to minimise this effect. Orange coloured fruits such as apricots, and vegetables such as pumpkin, sweet potato and carrots, as well as dark green leafy vegetables such as spinach and some Asian greens are good sources of beta-carotene.
Are there any health risks from eating plant sterol enriched foods?
People with a rare inherited metabolic disease called sitosterolaemia should restrict consumption of plant sterols. This disease affects a very small proportion of the population (about 1 in 6 million) and is managed under medical supervision. People with sitosterolaemia absorb high levels of plant sterols which can lead to premature atherosclerosis and heart disease.
What if I am taking medication to lower my cholesterol levels?
Plant sterol enriched foods may be consumed safely while you are taking cholesterol lowering drugs. However, plant sterols do not replace cholesterol lowering medication prescribed by your doctor. If you are already on cholesterol lowering medication, consult your doctor for advice about your diet and whether plant sterol enriched foods may provide any additional benefits.
Can children eat plant sterol enriched foods?
Generally there is no need to lower cholesterol levels in children. Plant sterol enriched foods are intended for adults who want to reduce their cholesterol level through changes in their diet.
Manufacturers are required to label their products so that consumers will know that plant sterol enriched foods are intended for adults, not children.
What if I am pregnant?
Plant sterol enriched foods have not been tested specifically in pregnant women. However, knowledge about plant sterols and the way in which they work in the body to reduce absorption of dietary cholesterol does not indicate safety concerns for pregnant or lactating women. Generally speaking, women who are pregnant or breast feeding do not need to be concerned about cholesterol and do not need to consume plant sterol enriched foods.
How will I know how much plant sterols are in a product?
Manufacturers must label plant sterol enriched products with the words ‘plant sterols’, ‘plant sterol esters’ or ‘phytosterol esters’. The label must also include the total amount of plant sterols added in grams per serving of food.
As a general guide, one cup (250ml) is regarded as one serving of low-fat milk, one serving of low-fat yoghurt is an individual punnet up to 200 g, and one serving of a muesli-type cereal is equivalent to about 45 g of cereal.
Are foods with plant sterols permitted in other countries?
In other countries, particularly in Europe, plant sterols are permitted in table spreads, milk, yoghurt and cheese products, some cereal products and spicy sauces, and rye bread (pumpernickel). In the US, plant sterols are also permitted in orange juice.
Menopause
Menopause
is a normal change in a woman's life when her period stops. It is often called
the "change of life." During menopause, a woman's body slowly makes
less of the hormones estrogen and progesterone. This often happens between the
ages of 45 and 55 years old. A woman has reached menopause when she has not had
a period for 12 months in a row, and there are no other causes for this change.
As you near menopause, you may have symptoms from the changes your body is
making. Many women wonder if these changes are normal, and many are confused
about how to treat their symptoms. You can feel better by learning all you can
about menopause, and talking with your doctor about your health and your
symptoms. If you want to treat your symptoms, your doctor can tell you more
about your options and help you make the best treatment choices.
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Every woman's period will stop at menopause. Some women may not have any other symptoms. But as you near menopause, you may have these symptoms:
Changes in your period. The time between periods and the flow from month to month may be different.
Abnormal bleeding or "spotting." This is common as you near menopause. But if your periods have stopped for 12 months in a row, and you still have "spotting," you should talk to your doctor to rule out serious causes, like cancer.
Hot flashes ("hot flushes"). You get warm in the face, neck and chest.
Night sweats and sleeping problems. These may lead to feeling tired, stressed, or tense.
Vaginal changes. The vagina may become dry and thin, and sex and vaginal exams may be painful. You also might get more vaginal infections.
Thinning of your bones. This may lead to loss of height and bone breaks (osteoporosis).
Mood changes. May include mood swings, depression, and irritability.
Urinary problems. You may have leaking, burning or pain when urinating, or leaking when sneezing, coughing, or laughing.
Lack of concentration. You may become forgetful.
Sex drive decreases. You may have less interest in sex and changes in sexual response.
Weight fluctuation. Weight gain or increase in body fat around your waist.
Hair loss or thinning. Hair thinning or loss is a problem for some women.
Depression. Some researchers believe that the decrease in estrogen triggers changes in your brain, causing depression.
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As you near menopause, you may have symptoms from the changes your body is making. Here are some ways to relieve those symptoms.
Hot Flashes. A hot environment, eating or drinking hot or spicy foods, alcohol, or caffeine, and stress can bring on hot flashes. Try to avoid these triggers. Dress in layers and keep a fan in your home or workplace. Regular exercise might also bring relief from hot flashes and other symptoms. Ask your doctor about taking an antidepressant medicine. There is proof that this can be helpful for some women.
Vaginal Dryness. Use an over-the-counter vaginal lubricant. There are also prescription estrogen replacement creams that your doctor might give you. If you have spotting or bleeding while using estrogen creams, you should see your doctor.
Problems Sleeping. One of the best ways to get a good night's sleep is to get at least 30 minutes of physical activity on most days of the week. But avoid a lot of exercise close to bedtime. Also avoid alcohol, caffeine, large meals, and working right before bedtime. You might want to drink something warm, such as herb tea or warm milk, before bedtime. Try to keep your bedroom at a comfortable temperature. Avoid napping during the day and try to go to bed and get up at the same times every day.
Memory problems. Ask your doctor about mental exercises you can do to improve your memory. Try to get enough sleep and be physically active.
Mood swings. Try to get enough sleep and be physically active. Ask your doctor about relaxation exercises you can do. Ask your doctor about taking an antidepressant medicine. There is proof that this can be helpful. Think about going to a support group for women who are going through the same thing as you, or getting counseling to talk through your problems and fears.
Two other common health problems can start to happen at menopause, and you might not even notice.
Osteoporosis. Day in and day out your body is busy breaking down old bone and replacing it with new healthy bone. Estrogen helps control bone loss. So losing estrogen around the time of menopause causes women to begin to lose more bone than is replaced. In time, bones can become weak and break easily. This condition is called osteoporosis.
Heart disease. After menopause, women are more likely to have heart disease. Changes in estrogen levels may be part of the cause. But, so is getting older. As you age, you may develop other problems, like high blood pressure or weight gain, that put you at greater risk for heart disease.
You can use this chart to keep track of menopausal symptoms that bother you. Take it with you when you visit your doctor, so you both can figure out the best way to handle them.
Menopause is only one of several stages in the reproductive life of a women. The whole menopause transition is divided into four main stages known as:
Premature Menopause — menopause that happens before the age of 40, whether it is natural or induced.
Premenopause — refers to the entirety of a woman's life from her first to her last regular menstrual period. It is best defined as a time of "normal" reproductive function in a woman.
Perimenopause — means "around menopause" and is a transitional stage of two to ten years before complete cessation of the menstrual period and is usually experienced by women from 35 to 50 years of age. This stage of menopause is characterized by hormone fluctuations, which cause the typical menopause symptoms, such as hot flashes.
Menopause — represents the end stage of a natural transition in a woman's reproductive life. Menopause is the point at which estrogen and progesterone production decreases permanently to very low levels. The ovaries stop producing eggs and a woman is no longer able to get pregnant naturally.
Postmenopause — refers to a women's time of life after menopause has occurred. It is generally believed that the postmenopausal phase begins when 12 full months have passed since the last menstrual period. From here a woman will be postmenopausal for the rest of her life.
Premature Menopause
Premature Menopause — menopause that happens before the age of 40, whether it is natural or induced.
Premature menopause is menopause that happens before the age of 40 — whether it is natural or induced. Women who enter menopause early get symptoms similar to those of natural menopause, like hot flashes, emotional problems, vaginal dryness, and decreased sex drive. For some women with early menopause, these symptoms are severe. Also, women who have early menopause tend to get weaker bones faster than women who enter menopause later in life. This raises their chances of getting osteoporosis and breaking a bone. Premature menopause can happen for these reasons.
Chromosome defects. Defects in the chromosomes can cause premature menopause. For example, women with Turner's syndrome are born without a second X chromosome or born without part of the chromosome. The ovaries don't form normally, and early menopause results.
Genetics. Women with a family history of premature menopause are more likely to have early menopause themselves.
Autoimmune diseases. The body's immune system, which normally fights off diseases, mistakenly attacks a part of its own reproductive system. This hurts the ovaries and prevents them from making female hormones. Thyroid disease and rheumatoid arthritis are two diseases in which this can happen.
Surgery to Remove the Ovaries. Surgical removal of both ovaries, also called a bilateral oophorectomy, puts a woman into menopause right away. She will no longer have periods, and hormones decline rapidly. She may have menopausal symptoms right away, like hot flashes and diminished sexual desire. Women who have a hysterectomy, but have their ovaries left in place, will not have induced menopause because their ovaries will continue to make hormones. But because their uterus is removed, they no longer have their periods and cannot get pregnant. They might have hot flashes since the surgery can sometimes disturb the blood supply to the ovaries. Later on, they might have natural menopause a year or two earlier than expected.
Chemotherapy or Pelvic Radiation Treatments for Cancer. Cancer chemotherapy or pelvic radiation therapy for reproductive system cancers can cause ovarian damage. Women may stop getting their periods, have fertility problems, or lose their fertility. This can happen right away or take several months. With cancer treatment, the chances of going into menopause depend on the type of chemotherapy used, how much was used, and the age of the woman when she gets treatment. The younger a woman is, the less likely she will go into menopause.
Your doctor will ask you if you've had changes typical of menopause, like hot flashes, irregular periods, sleep problems, and vaginal dryness. Normally, menopause is confirmed when a woman hasn't had her period for 12 months in a row.
However, with certain types of premature menopause, these signs may not be enough for a diagnosis. A blood test that measures follicle-stimulating hormone (FSH) can be done. Your ovaries use this hormone to make estrogen. FSH levels rise when the ovaries stop making estrogen. When FSH levels are higher than normal, you've reached menopause. However, your estrogen levels vary daily, so you may need this test more than once to know for sure.
You may also have a test for levels of estradiol (a type of estrogen) and luetinizing hormone (LH). Estradiol levels fall when the ovaries fail. Levels lower than normal are a sign of menopause. LH is a hormone that triggers ovulation. If you test above normal levels, you've gone through menopause.
Premenopause
Premenopause — refers to the entirety of a woman's life from her first to her last regular menstrual period. It is best defined as a time of "normal" reproductive function in a woman.
Perimenopause
Perimenopause — means "around menopause" and is a transitional stage of two to ten years before complete cessation of the menstrual period and is usually experienced by women from 35 to 50 years of age. This stage of menopause is characterized by hormone fluctuations, which cause the typical menopause symptoms, such as hot flashes.
Perimenopause marks the time when your body begins its move into menopause. It includes the years leading up to menopause — anywhere from two to eight years — plus the first year after your final period. There is no way to tell in advance how long it will last OR how long it will take you to go through it. It's a natural part of aging that signals the ending of your reproductive years.
Perimenopause causes some changes in your body that may not be noticeable. For most women, the discomforts associated with perimenopause are minimal and manageable. Some things you might experience include:
Changes in your menstrual cycle (longer or shorter periods, heavier or lighter periods, or missed periods)
Hot flashes (sudden rush of heat from your chest to your head)
Night sweats (hot flashes that happen while you sleep)
Vaginal dryness
Sleep problems
Mood changes (mood swings, depression, irritability)
Pain during sex
More urinary infections
Urinary incontinence
Less interest in sex
Increase in body fat around your waist
Problems with concentration and memory
By monitoring your menstrual cycle and recording your signs and symptoms for several months, you'll gain a better understanding of the changes occurring during this time. You will also have valuable information to discuss with your doctor.
Oral contraceptives (birth control pills) are often the treatment of choice to relieve perimenopausal symptoms — even if you don't need them for birth control. Today's low-dose pills regulate periods and eliminate or reduce hot flashes, vaginal dryness, and premenstrual syndrome.
Making lifestyle changes may help ease the discomfort of your symptoms and keep you healthy in the long run.
Good nutrition. Because your risk of osteoporosis and heart disease increases at this time, a healthy diet is more important than ever. Adopt a low-fat, high-fiber diet that is rich in fruits, vegetables, and whole grains. Add calcium-rich foods or take a calcium supplement. Avoid alcohol or caffeine, which can trigger hot flashes. If you smoke, try to quit.
Regular exercise. Regular physical activity helps keep your weight down, improves your sleep, strengthens your bones, and elevates your mood. Try to exercise for 30 minutes or more on most days of the week.
Stress reduction. Practiced regularly, stress reduction techniques, such as meditation or yoga — both can help you relax and tolerate your symptoms more easily. The "Stress and Your Health" FAQ can be a good resource as well.
If you're still having periods, even if they are not regular, you can get pregnant. Talk to your doctor about your options for birth control. Keep in mind that methods of birth control, like birth control pills, shots, implants, or diaphragms will not protect you from STDs or HIV. If you use one of these methods, be sure to also use a latex condom or dental dam (used for oral sex) correctly every time you have sexual contact. Be aware that condoms don't provide complete protection against STDs and HIV — the only sure protection is abstinence (not having sex of any kind). But appropriate and consistent use of latex condoms and other barrier methods can help protect you from STDs.
More about Menopause for Men
Menopause is the time in a woman's life when her period stops. It is a normal change in a woman's body. A woman has reached menopause when she has not had a period for 12 months in a row (and there are no other causes, such as pregnancy or illness, for this change). Menopause is sometimes called, "the change of life." Leading up to menopause, a woman’s body slowly makes less and less of the hormones estrogen and progesterone. This change often happens between the ages of 45 and 55 years old.
As you near menopause, you may have symptoms from the changes your body is making. Many women wonder if these changes are normal, and many are confused about how to treat their symptoms. You will feel better by learning all you can about menopause and talking with your doctor about your health and your symptoms. If your symptoms are causing you discomfort or concern, your doctor can teach you about treatment options and help you to make wise treatment choices.
Menopause affects every woman differently. Your only symptom may be your period stopping. You may have other symptoms, too. Many symptoms at this time of life are because of you getting older. But some are due to menopause. Common symptoms of menopause include:
Change in pattern of periods (can be shorter or longer, lighter or heavier, more or less time between periods)
Hot flashes (sometimes called hot flushes), night sweats (sometimes followed by a chill)
Trouble sleeping through the night (with or without night sweats)
Vaginal dryness
Mood swings, feeling crabby, crying spells (probably because of lack of sleep)
Trouble focusing, feeling mixed-up or confused
Hair loss or thinning on your head, more hair growth on your face
When a woman is young, estrogen helps to keep bone strong. When estrogen levels fall at menopause, bones weaken. When bones weaken a lot, the condition is called osteoporosis. Weak bones can break more easily.
Eating a healthy diet and exercising at menopause and beyond are important to feeling your best. Most women do not need any special treatment for menopause. But some women may have menopause symptoms that need treatment. Several treatments are available. It's a good idea to talk about the treatments with your doctor so you can choose what’s best for you. There is no one treatment that is good for all women. Sometimes menopause symptoms go away over time without treatment, but there’s no way to know when.
Hormone therapy (HT) -- If used properly, hormone therapy (once called hormone replacement therapy or HRT) is one way to deal with the more difficult symptoms of menopause. It's the only therapy that is approved by the government for treating more difficult hot flashes and vaginal dryness. Hormone therapy should NOT be used solely to prevent heart or bone disease, stroke, memory loss, or Alzheimer's disease. There are many kinds of hormone therapies so your doctor can suggest what's best for you. As with all treatments, HT has both possible benefits and possible risks; it is important to talk about these issues with your doctor. If you decide to use HT, use the lowest dose that helps and for the shortest time needed. Check with your doctor every 6 months to see if you still need HT. For more information on the benefits and risks of HT, go to http://www.nhlbi.nih.gov/health/women/index.htm.
HT can help with menopause by:
Reducing hot flashes
Treating vaginal dryness
Slowing bone loss
Improving sleep (and thus decrease mood swings)
For some women, HT may increase their chance of:
Blood clots
Heart attack
Stroke
Breast cancer
Gall bladder disease
Women who . . .
Think they are pregnant
Have problems with vaginal bleeding
Have had certain kinds of cancers (such as breast and uterine cancer)
Have had a stroke or heart attack
Have had blood clots
Have liver disease
Have heart disease
HT can also cause these side effects:
Vaginal bleeding
Bloating
Breast tenderness or swelling
Headaches
Mood changes
Nausea
Be sure to see your doctor if you have any of these side effects while using HT.
Some women decide to take herbal or other plant-based products to help relieve hot flashes. Some of the most common ones are:
Soy. Soy contains phytoestrogens (chemicals that are like estrogen). But, there is no proof that soy--or other sources of phytoestrogens--really do make hot flashes better. And the risks of taking soy--mainly soy pills and powders--are not known. The best sources of soy are foods such as tofu, tempeh, soymilk, and soy nuts. These soy products are more likely to work on mild hot flashes.
Other sources of phytoestrogens. These include herbs such as black cohosh, wild yam, dong quai, and valerian root. Again, there is no proof that these herbs (or pills or creams containing these herbs) help with hot flashes.
Products that come from plants may sound like they are safe, but there is no proof they really are. There also is no proof that they are better at helping symptoms of menopause. Make sure to discuss these types of products with your doctor before taking them. You also should tell your doctor about other medicines you are taking, since some plant products can be harmful when combined with other drugs.
This term means different things to different people. It’s really hormones that are just the same as the hormones the body makes. There are several products with hormone like this that are on the market and are well-tested. But some people use this term to mean drugs that are custom-made from a doctor’s order. There is no proof that these custom-made products are better or safer than hormone therapy that’s on the market.
A woman should first talk to her doctor to see what's best for her. The goal is to exercise regularly so you can lower the risk of serious disease (such as heart disease or diabetes), and maintain a healthy weight. This usually takes at least 30 minutes of exercise (such as brisk walking) on most days of the week.
Hot
Flashes. Some women report that eating or drinking hot or spicy
foods, alcohol, or caffeine, feeling stressed, or being in a hot place can
bring on hot flashes. Try to avoid any triggers that bring on your hot
flashes. Dress in layers, and keep a fan in your home or workplace.
Regular exercise might also ease hot flashes, but sometimes exercise can
cause a hot flash. If hot flashes continue and HT is not an option, ask your
doctor about taking an antidepressant or epilepsy medicine. There is proof
that these can relieve hot flashes for some women.
Vaginal
Dryness. A water-based, over-the-counter vaginal lubricant
(like KY® Jelly) can be helpful if sex is painful. A vaginal moisturizer
(also over-the-counter) can provide lubrication and help keep needed
moisture in vaginal tissues. Really bad vaginal dryness may need HT. If
vaginal dryness is the only reason for considering HT, an estrogen product
for the vagina is the best choice. Vaginal estrogen products (creams,
tablet, ring) treat only the vagina.
Problems
Sleeping. One of the best ways to get a good night's sleep is to
get at least 30 minutes of physical activity on most days of the week. But,
don’t exercise close to bedtime. Also avoid large meals, smoking, and
working right before bedtime. Caffeine and alcohol should be avoided after
noon. Drinking something warm before bedtime, such as herbal tea (no
caffeine) or warm milk, might help you to feel sleepy. Keep your bedroom
dark, quiet, and cool, and use your bedroom only for sleeping and sex. Avoid
napping during the day, and try to go to bed and get up at the same times
every day. If you wake during the night and can't get back to sleep, get up
and read until you’re sleepy. Don't just lie there. If hot flashes are the
cause of sleep problems, treating the hot flashes will usually improve
sleep.
Mood
swings. Some women report mood swings or "feeling blue"
as they reach menopause. Women who had mood swings (PMS) before their
periods or post-partum depression after giving birth may have more mood
swings around menopause. These are women who are sensitive to hormone
changes. Often the mood swings will go away with time. If a woman is using
HT for hot flashes or another menopause symptom, sometimes her mood swings
will get better, too. Also, getting enough sleep and staying physically
active will help you to feel your best. Mood swings are not the same as
depression.
Memory problems. As people age, their memory is not as good as it once was. Some women say they have "fuzzy thinking" as they reach menopause. This may be caused by changing hormones and can improve over time. Getting enough sleep and keeping physically active can help. If memory problems are really bad, talk to your doctor right away. This is not caused by menopause.
Sometimes, younger women need a hysterectomy to treat health problems such as endometriosis or cancer. A hysterectomy is an operation to remove a woman's uterus (womb). Often one or both ovaries (the female organs that produce eggs and hormones) are removed at the same time the hysterectomy is done. If you haven’t reached menopause, a hysterectomy will stop your period. But, you will reach menopause only if both ovaries are removed, called surgical menopause. Because surgical menopause is instant menopause, it can cause more severe symptoms than natural menopause (menopause that occurs as part of the natural aging process). You should talk with your doctor about how to best manage these symptoms.
Women who have a hysterectomy but have their ovaries left in place will not reach menopause at the time of surgery because their ovaries will continue to make hormones. But, because the uterus is removed, they will no longer have their periods and they cannot become pregnant. Later on, they might reach natural menopause a year or two earlier than expected.
Sometimes, younger women need a hysterectomy to treat health problems such as endometriosis or cancer. A hysterectomy is an operation to remove a woman’s uterus (womb). Often one or both ovaries (the female organs that produce eggs and hormones) are removed at the same time the hysterectomy is done. If you haven’t reached menopause, a hysterectomy will stop your period. But, you will reach menopause only if both ovaries are removed, called surgical menopause. Because surgical menopause is instant menopause, it can cause more severe symptoms than natural menopause (menopause that occurs as part of the natural aging process). You should talk with your doctor about how to best manage these symptoms.
Women who have a hysterectomy but have their ovaries left in place will not reach menopause at the time of surgery because their ovaries will continue to make hormones. But, because the uterus is removed, they will no longer have their periods and they cannot become pregnant. Later on, they might reach natural menopause a year or two earlier than expected.
Menopause is called "premature" if it happens at or before the age of 40--whether it is natural or brought on by medical means (induced). Some women have premature menopause because of:
Family history (genes)
Medical treatments, such as surgery to remove the ovaries
Cancer treatments, such as chemotherapy or radiation to the pelvic area that damage the ovaries-- although menopause does not always occur
Having premature menopause puts a woman at more risk for osteoporosis later in her life. For women who want to have children, premature menopause can be a source of great distress. Women who still want to become pregnant can talk with their doctors about other ways of having children, such as donor egg programs or adoption.
Postmenopause is the term for all the years beyond menopause. It begins after you have not had a period for 12 months in a row--whether your menopause was natural or medically induced.
Menstruation
Education, Information & Products
When
do girls become young ladies, i.e. start to menstruate?
Many people recognize the transition of a little girl into a young lady when she has her first period. "Menarche" is a young lady's first menstruation, or the date she has her first menstrual period, and when she begins menstruating.
A young lady's first period or menarche usually begins between the ages of 9 and 14, although sometimes as early as 8 and as late as 16. Her first period is also a sign that puberty has begun. For more information about your daughter's puberty, see our article; Puberty: When Your Daughter Becomes a Young Woman.
Special note to Dad's: Your daughter needs your love and support now more than ever. Be involved!! Menstruation and growing up is a normal part of YOUR daughter's life and not something to shy away from. Talk with your daughter about these topics, let her know that you know what she will be experiencing and to feel free to ask you any questions she may have, and that if you don't know the answer(s), that you will find out for her. Don't let your daughter get the answers to her questions from her girlfriends, or other unreliable sources. When she gets her first period, and sees blood coming from her vagina, she may be very frightened. Some girls, who were not prepared by her mother or father for their first period, absolutely thought they were dying. They were scared and afraid. Prepare your daughter, prepare yourself, and have the talk with her!
And when she has her first period, celebrate the day and
make a big deal of it... take her out on a special daughter - daddy
"date" to her favorite restaurant, buy her flowers, take her
shopping.... let her know that you are thrilled about her becoming
a young lady!!
How
old will I be when I stop menstruation?
Women
normally menstruate until they are 45 to 55 years old, when menopause begins.
Menopause is when a female stops menstruation. An operation called a
hysterectomy, which removes some or all of the female reproductive organs, also
stops menstruation.
What
happens during menstruation?
Girls
have thousands of tiny eggs in their ovaries. Each month, or approximately every
21 - 42 days, on average, one of the eggs leaves an ovary and travels through a
fallopian tube. When the egg leaves the ovary, this is called ovulation.
Normally, the ovaries alternate each month, releasing an egg from the left ovary
one month and then releasing an egg from the right ovary the next month.
As
the egg travels in the fallopian tube, a soft spongy lining forms in the uterus.
This lining is mostly made of tiny blood vessels and is called the endometrium.
The lining gives nourishment in case an egg and sperm meet to form an embryo, or
baby, that begins to grow in the uterus.
If
the egg is not joined by a sperm, the endometrium or lining of the uterus is not
needed. It flows out of the vagina. This bleeding is called a period. This whole
cycle is called menstruation.
Menstruation is just one part of the menstrual cycle, in which a
woman's body prepares for pregnancy each month. A cycle is counted from the
first day of one period to the first day of the next. An average cycle is 28
days, but anywhere from 23 to 35 days is normal.
Estrogen and progesterone levels are very low at the beginning of
the cycle. During menstruation, levels of estrogen, made by the ovaries, start
to rise and make the lining of the uterus grow and thicken. In the meantime, an
egg (ovum) in one of the ovaries starts to mature. It is encased in a sac called
the Graafian follicle, which continues to produce estrogen as the egg grows.
At about day 14 of a typical 28-day cycle, the sac bursts and the
egg leaves the ovary, traveling through one of the fallopian tubes to the
uterus. The release of the egg from the ovary is called ovulation. Some women
know when they're ovulating, because at mid-cycle they have some pain--typically
a dull ache on either side of the lower abdomen lasting a few hours. The medical
word for this is mittelschmerz, from the German, meaning middle pain. Some women
also have very light bleeding, or spotting, during ovulation.
After the egg is expelled, the sac--now called a corpus luteum--remains
in the ovary, where it starts producing mainly progesterone. The rising levels
of both estrogen and progesterone help build up the uterine lining to prepare
for pregnancy.
The few days before, during and after ovulation are a woman's
"fertile period"-the time when she can become pregnant.
Because the length of menstrual cycles varies from one person to another,
many woman ovulate earlier or later than day 14.
It's even possible for a woman to ovulate while she still has her period
if that month's cycle is very short. Oftentimes, stress can play a role in this
occurring.
If a woman has sex with a man during this time and conception
occurs (his sperm fertilizes the egg), she becomes pregnant.
The fertilized egg attaches to the uterus, and the corpus luteum
makes all the progesterone needed to keep it implanted and growing until a
placenta (an organ connecting the fetus to the mother) develops. The placenta
then makes hormones and provides nourishment from the mother to the baby.
If an egg is not fertilized that month and the woman doesn't get
pregnant, the corpus luteum stops making hormones and gets reabsorbed in the
ovary. Hormone levels drop again, the lining of the uterus breaks down,
menstruation begins, and the cycle repeats.
In the illustration below, an egg has left an ovary after ovulation and is on its way through a fallopian tube to the uterus.
Most menstrual periods last from three to five days, but anywhere from two to seven days is normal. The amount of blood flow varies, too, but for most women, bleeding starts out light at first, followed by heavier flow for a day or two and then another light day or two. Sanitary pads or tampons, which are made of cotton or another absorbent material, are worn to absorb the blood flow.
Sanitary pads are placed inside the panties; tampons are inserted
into the vagina.
The amount of bleeding varies from woman to woman because
everybody's body has a different way of building up the lining of the uterus.
A lighter flow or heavier flow doesn't mean you can't get pregnant as easily or
you're never going to get pregnant, or that your periods will always stay the
same way. But if you're bleeding excessively-soaking one or more tampons or pads
an hour-you should see a doctor to see if there's a problem."
Teenagers often are concerned if they expel blood clots during
their periods. This is very normal and not dangerous. The menstrual clots are
clumps of pooled blood in the vagina. Sometimes, instead of flowing freely,
blood drains from the uterus and stays in the vagina until there's a change in
position--say, from sitting to standing.
Young
women experiencing their first periods often wonder, "will my periods ever
become “regular?”
When
a girl starts to menstruate, her period may not come on a regular schedule for
several years. Her periods may come three weeks apart, or even months apart.
Why
you need to keep track of my periods.
A
girl should keep a record so she'll know if her period is late. A late period
may be sign of pregnancy or one or medical problems that you should immediately
inform/visit your doctor. Also, your doctor can provide you with better care if
he/she knows about your periods.
How
do I keep track of my periods?
The
first day of your period is called Day 1.
The
period or bleeding usually lasts 3 to 5 days but 7 days is not uncommon.
Ovulation
(when the egg is released) happens 12 to 16 days before your next period starts.
Ovulation, and the days before and after, is the time when you are most likely
to get pregnant.
If
the female does not get pregnant, her period comes and the whole cycle begins
again, with Day 1 starting over again when the next period starts. The
whole cycle usually takes 21 to 36 days, but even 42 days is not unusual for a
cycle.
Will
I get cramps and how bad are they?
Cramps
are a common complaint.
More than half of menstruating women have cramp-like pain during their periods.
The medical term for menstrual pain is dysmenorrhea. Cramps are usually felt in
the pelvic area and lower abdomen, but can radiate to the lower back or down the
legs.
Many girls have cramps severe enough to keep them home from
school. In fact, according to Danforth's Obstetrics and Gynecology,
dysmenorrhea is the most frequent cause of absenteeism from school among younger
women. Women seem to go through phases when cramps are severe, then get better
for several years, and then maybe worsen again. Most women find they have less
menstrual pain after having children.
Cramps are like labor pains. Just as the uterus contracts to open
up the cervix (neck of the uterus) and push out a baby, it contracts to expel
menstrual blood. Often, after several years of menstruating or after childbirth,
the cervical opening enlarges. The uterus doesn't have to contract as much to
discharge the menstrual flow, so there is less cramping.
Menstrual pain may also come from the bleeding process itself.
When the uterine lining separates from the wall, it releases chemicals called
prostaglandins. Prostaglandins cause blood vessels to narrow, impeding the
supply of oxygen to the uterus. Just as the pain of a heart attack comes from
insufficient blood to the muscles of the heart, too little blood to the uterine
muscle might cause the pain of menstrual cramps.
Menstrual pain can have other causes, although these are rare
among teenagers. They include tumors, fallopian tube infection, and
endometriosis, a condition in which fragments of the lining of the uterus become
embedded elsewhere in the body
Cramps
are the actual uterus' contractions. The uterus, which is like a pear-shaped
muscle, helps get rid of the endometrium, or lining of the uterus, since
no baby will be growing inside. These contractions, that sometimes feel
like cramps, are the body's way of shedding, or getting rid the lining of the
uterus, through the vagina, and out of the body, as the lining is no longer
needed that cycle.
What about cramps?
Some girls have cramps during their periods. For most they are mild and can be helped by exercise, a heating pad or aspirin. If there is a lot of pain, very long a heavy periods. or very irregular periods or very irregular periods you should get a checkup.
What
can I do to help with cramps?
Cramps
are usually mild. They can be helped by exercise, warm bath, use of a heating
pad or pain relievers such as aspirin.
If there is a lot of pain, long or "heavy" periods (heavy meaning more
bleeding than normal), which means saturating a tampon or pad in less than 2-3
hours, or if you have irregular periods, you should inform your parents and ask
them to take you to your doctor for a checkup.
Can
I take a bath or shower during my period? What about exercising?
Menstruation
is a very normal part of every girl's life. During your period, you can do
everything you normally do, including daily baths or showers, exercising,
dancing and playing sports are all fine. In fact, you will feel better by
continuing your normal routine, and find that warm baths are a great way to help
with any cramping you may have.
Should
I choose sanitary napkins or tampons for my feminine hygiene choice?
Feminine
hygiene products come in all sorts of types, sizes, shapes, absorbencies, smells
(vulva and vaginal “deodorant” protection – which we recommend NOT using)
and materials.
Sanitary napkins or pads, absorb the blood from your period on the outside of your vagina. Most sanitary napkins are made with adhesive strips that you simply peel off the backing and then they will stick or adhere to your panties or pantyhose.
Can
I still take a bath during my period, or should I take showers instead?
Menstruation is a very normal part of every girl's life. When you get your period, you can continue doing everything you normally do. This includes continuing to take baths or showers. However, some girls may prefer to take showers during the days of their period that bleeding is heavier.
What are sanitary napkins and how do they work?
Sanitary napkins come in different shapes, styles, absorbencies, deodorant, non-deodorant, as well as thin pantiliners for light days and pads, for heavy days of menstrual bleeding. All sanitary napkins, pads and pantiliners are made with removable strips of paper that reveal adhesive tape that is made to stick to your panties. Other pads and pantiliners have wrap-around "wings" that wrap under your panties to keep it from moving or "bunching."
Some young ladies don't like the feeling of sitting on a pad and may choose a tampon and pantiliner on their heavy days.
What are tampons and how do I use them?
Like pads and pantiliners, tampons come in many different brands, sizes, styles, absorbencies and deodorant, perfumed and non-deodorant choices. Also like pads and pantiliners, tampons absorb the menstrual blood, except tampons absorb the menstrual blood inside of the vagina, instead of on the outside. Tampons absorb the blood from your period like a pad or sanitary napkin, but they do so by placing the tampon inside your vagina. Tampons can be used whether or not a girl has had intercourse and tampons cannot get lost inside your body.
Tampons come in different sizes and thicknesses. They come in applicator and non-applicator styles. There are "slim" or "slender" tampons for young ladies who have never had intercourse, or given birth via vaginal delivery. Tampons can be used whether or not a girl has had intercourse. Tampons cannot get lost inside a girl's body. Tampons are shaped so that they can be easily inserted into your vagina and absorb the menstrual blood before the blood comes out onto the pad the monthly period.
Many women prefer to use a tampon to avoid any possible smells that are associated with menstruation, as the menstrual blood that is absorbed by pads and pantiliners, are exposed to the air, and not changing a pad or pantiliner frequently enough, may produce a menstrual smell that some find objectionable.
Tampon Insertion: How do I Insert a Tampon?
Inserting a tampon the first time takes a little practice. It gets easier with each new period. You may want to go to the bathroom or close your bedroom door as you will want some privacy. To insert a tampon, remove your panties, remove the wrapper of the tampon, and get into a comfortable position. Using a mirror may help you find your vagina, and insert the tampon the first few times. The best positions are those that help expand the vaginal walls inside your vagina, to help ease the tampon into place. Some women like a squatting position, others are comfortable sitting on the toilet. In any case, you will want to spread your legs apart, and then using one hand, spread the labia minora, so that you can see or feel the entrance to your vagina. Keeping your legs apart, while keeping your labia minora separated, slowly insert the tampon toward the small of your back. You may need to use a little vaginal lubricant spread on the outside of the tampon for easier insertion. Insert the tampon until the ridges of the tampon applicator come in contact with the entrance to your vagina. Then, slowly insert or press down on the plunger, that pushes the tampon into the correct position inside your vagina. Once a tampon is properly inserted, you shouldn't be able to feel it. Don't worry that the tampon can "fall out" because the walls of your vagina hold it in place. If you can feel the tampon, you are using the wrong size tampon, or may not have inserted the tampon far enough into your vagina. After pushing down on the plunger, and inserting the tampon, remove and discard the applicator, BUT NOT IN THE TOILET, THE TOILET MAY EASILY STOP UP AND THEN FLOOD THE BATHROOM AND HOUSE! Before pulling your panties back up, make sure the string on the end of the tampon remains outside of your vagina, as this is how you remove the tampon, by pulling the tampon string when it's time to change your tampon.
Urinating with a tampon in your vagina is really simple and easy. To urinate, simply go to the bathroom as you normally would, but before you start urinating, move the tampon string to one side of your vulva so that you don't get urine on the tampon removal string. Going to the restroom is also a great time to see if your tampon needs to be changed. One way of determining whether your tampon needs to be changed is by tugging slightly on the string. If your tampon seems to not want to come out, it's probably not time to change your tampon, as it hasn't absorbed enough menstrual fluid, and is more dry, than more wet. If, however, your tampon seems to slide easily, this is an indicator that your tampon is saturated, or has absorbed as much blood as it can hold. Another indicator that it's time to change your tampon is that your vagina is leaking menstrual blood onto your panties.
Removing your tampon is also very easy. When you believe your tampon has absorbed as much menstrual blood as it can hold, it's time to change your tampon. Simply pull on the string of the tampon in your vagina. This will remove the saturated tampon. Then discard the used tampon in the trash - NOT IN THE TOILET! And insert a new tampon.
NEVER SLEEP OVERNIGHT WITH A TAMPON IN YOUR VAGINA AS THIS MAY CAUSE TOXIC SHOCK SYNDROME.
Most tampons come with a plastic or cardboard applicator to make it easier to put them in. Only the tampon remains inside the body.
For women who have had a vaginal birth, they wouldn't use the slender tampons because their vaginas have been enlarged due to vaginal childbirth. If they did use a slender tampon during their period, the slender tampon would not absorb all of the menstrual blood, and she would have leakage of menstrual blood from her vagina.
Adult women who have delivered vaginally, will choose the wider, thicker tampons that are larger than the slender tampons, due to the enlargement of their vaginas.
How often should tampons, pantiliners, pads or alternative feminine hygiene product be changed?
Pads, pantiliners, tampons or other alternative feminine hygiene products should be changed often enough so that there is no unpleasant odor or your clothes do not get stained as the feminine hygiene product cannot hold any additional menstrual blood. Changing tampons, pads, pantiliners, often can help prevent infections. During the heaviest days of your period, you may need to change them every 3-4 hours.
Depending
on how heavy or light your menstrual flow is - which varies during each day of
your period, from light bleeding, to heavy, almost “gushing” bleeding, back
to light bleeding again, heavy – will determine the type(s) of feminine
hygiene product you may use. Some
women start out by using a pantyliner only. While the menstrual flow increases,
they may switch to a pad, and many women find they need to use a pad and a
tampon simultaneously for the best feminine hygiene results.
It
is very common for women to use a pad as "back-up" to a tampon, as a
tampon will leak if it is not changed when it is saturated.
Most
tampons come with a plastic or cardboard applicator to make it easier to put
them inside your vagina. Only the tampon remains inside the body, the
applicator, if you use this type, is dis-carded in the trash can after you
insert it.
NEVER FLUSH A TAMPON DOWN THE TOILET AS THIS
IMPORTANT!
NEVER LEAVE A
TAMPON IN YOUR VAGINA FOR MORE
IMPORTANT!
NEVER USE OR APPLY TALCUM POWDER
Changing
tampons and napkins often can help prevent infections.
What
is
Toxic Shock
Syndrome?
Toxic
shock syndrome is a rare infection that can happen during a woman's period. The
symptoms include a sudden fever of over 101 degrees or more, diarrhea (the
runs), vomiting (throwing up), muscle aches and a sunburn-like rash. If you have
these symptoms during you period, see a doctor right away.
To
help prevent toxic shock syndrome, you should follow these guidelines:
1.
Wash your hands before unwrapping and placing a new tampon in your vagina.
2.
Never use super-absorbent or deodorant tampons.
3.
Change your tampon at least every 4-6 hours (read the tampon manufacturers
information inside the box).
4.
Do not use tampons all the time and switch to a pad for part of each day.
5.
Do not use a birth control sponge or diaphragm during your period. During your
period it is preferable to use other methods such as condoms and/or foam.
Toxic Shock Syndrome (TSS)
What is " Toxic Shock" and Toxic Shock Syndrome?
Toxic
shock syndrome is a rare infection that can happen during a woman's period. The
symptoms include a sudden fever of over 101 degrees or more, diarrhea (the
runs), vomiting (throwing up), muscle aches and a sunburn-like rash. If you have
these symptoms during you period, see a doctor right away.
To
help prevent toxic shock syndrome, you should follow these guidelines:
1.
Wash your hands before unwrapping and placing a new tampon in your vagina.
2.
Never use super-absorbent or deodorant tampons.
3.
Change your tampon at least every 4-6 hours (read the tampon manufacturers
information inside the box).
4.
Do not use tampons all the time and switch to a pad for part of each day.
5.
Do not use a birth control sponge or diaphragm during your period. During your
period it is preferable to use other methods such as condoms and/or foam.
There are allegations that tampons made from rayon, or cotton with rayon, may cause or be a contributing factor to Toxic Shock Syndrome, as well as vaginal dryness or ulcerations of vaginal tissues.
Toxic Shock Syndrome is a rare but potentially fatal disease caused by a bacterial toxin. (Different bacterial toxins may cause Toxic Shock Syndrome, depending on the situation, but most often streptococci and staphylococci are responsible.) The number of reported Toxic Shock Syndrome cases has decreased significantly in recent years.
Approximately half the cases of Toxic Shock Syndrome reported today are associated with tampon use during menstruation, usually in young women.
Toxic Shock Syndrome also occurs in children, men, and non-menstruating women. In 1997, only five confirmed menstrual-related Toxic Shock Syndrome cases were reported, compared with 814 cases in 1980 [according to data from the Centers for Disease Control and Prevention (CDC)].
Although scientists have recognized an association between Toxic Shock Syndrome and tampon use, the exact connection remains unclear. Research conducted by the CDC suggested that use of some high absorbency tampons increased the risk of Toxic Shock Syndrome in menstruating women. A few specific tampon designs and high absorbency tampon materials were also found to have some association with increased risk of Toxic Shock Syndrome. These products and materials are no longer used in tampons sold in the U.S. Tampons made with rayon do not appear to have a higher risk of Toxic Shock Syndrome than cotton tampons of similar absorbency.
Vaginal dryness and ulcerations may occur when women use tampons more absorbent than needed for the amount of their menstrual flow. Ulcerations have also been reported in women using tampons between menstrual periods to try to control excessive vaginal discharge or abnormal bleeding. Women may avoid problems by choosing a tampon with the minimum absorbency needed to control menstrual flow and using tampons only during active menstruation.
To help women compare absorbency from brand to brand, FDA requires that manufacturers measure absorbency using a standard method and describe absorbency on the package using standardized terms. Thus, the terms "junior," "regular," "super," and "super plus," always describe a specific range of tampon absorbency regardless of the brand.
Historical Perspectives Reduced Incidence of Menstrual Toxic-Shock Syndrome -- United States, 1980-1990
In May 1980, investigators reported to CDC 55 cases of toxic-shock syndrome (TSS) (1), a newly recognized illness characterized by high fever, sunburn-like rash, desquamation, hypotension, and abnormalities in multiple organ systems (2). Fifty-two (95%) of the reported cases occurred in women; onset of illness occurred during menstruation in 38 (95%) of the 40 women from whom menstrual history was obtained. National and state-based studies were initiated to determine risk factors for this disease. In addition, CDC established national surveillance to assess the magnitude of illness and follow trends in disease occurrence; 3295 definite cases have been reported since surveillance was established (Figure 1).
In June 1980, a follow-up report described three studies which detected an association between Toxic Shock Syndrome and the use of tampons (3). Case-control studies in Wisconsin and Utah and a national study by CDC indicated that women with Toxic Shock Syndrome were more likely to have used tampons than were controls. The CDC study also found that continuous use of tampons was associated with a higher risk of Toxic Shock Syndrome than was alternating use of tampons and other menstrual products. Subsequent studies established that risk of Toxic Shock Syndrome was substantially greater in women who used Rely brand tampons than in users of other brands and that risk increased with increased tampon absorbency (4-6). In September 1980, Rely tampons were voluntarily withdrawn from the market by the manufacturer.
In 1980, 890 cases of Toxic Shock Syndrome were reported, 812 (91%) of which were associated with menstruation. In 1989, 61 cases of Toxic Shock Syndrome were reported, 45 (74%) of which were menstrual. In 1980, 38 (5%) of 772 women with menstrual Toxic Shock Syndrome died; in 1988 and 1989, there were no deaths among women with menstrual Toxic Shock Syndrome. Reported by: Meningitis and Special Pathogens Br, Div of Bacterial Diseases, Center for Infectious Diseases, CDC.
On July 22, this notice was posted as an MMWR Dispatch on the MMWR website (http://www.cdc.gov/mmwr).
On July 19, 2005, the Food and Drug Administration (FDA) issued a public health advisory regarding the deaths of four women in the United States after medical abortions with Mifeprex® (mifepristone, formerly RU-486; Danco Laboratories, New York, New York) and intravaginal misoprostol (1). Two of these deaths occurred in 2003, one in 2004, and one in 2005. Two of these U.S. cases had clinical illness consistent with toxic shock and had evidence of endometrial infection with Clostridium sordellii, a gram-positive, toxin-forming anaerobic bacteria. In addition, a fatal case of C. sordellii toxic shock syndrome after medical abortion with mifepristone and misoprostol was reported in 2001, in Canada (2). All three cases of C. sordellii infection were notable for lack of fever, and all had refractory hypotension, multiple effusions, hemoconcentration, and a profound leukocytosis. C. sordellii previously has been described as a cause of pregnancy-associated toxic shock syndrome (3).
Investigation by FDA, CDC, and state and local health departments into the two most recently identified U.S. deaths after medical abortion is ongoing. Empiric therapy for patients suspected of having postpartum or postabortion toxic shock syndrome should include antimicrobials with anaerobic activity against Clostridium species. Health-care providers are encouraged to report any cases of postpartum or postabortion toxic shock syndrome to their state or local health department and to CDC at telephone 800-893-0485. Cases potentially associated with of mifepristone or misoprostol should also be reported through the FDA MedWatch system available at http://www.fda.gov/medwatch/index.html or telephone 800-FDA-1088.
Food and Drug Administration. FDA Public Health Advisory: sepsis and medical abortion. Rockville, Marylan: Food and Drug Administration, Center for Drug Evaluation and Research; 205. Available at http://www.fda.gov/cder/drug/advisory/mifeprex.htm.
Sinave C, Le Templier G, Bluin D, Leveille F, Deland E. Toxic shock syndrome due to Clostridium sordellii: a dramatic postpartum and postabortion disease. Clin Infect Dis 2002;35:1441--3.
McGregor JA, Soper DE, Lovell G, Todd JK. Maternal deaths associated with Clostridium sordellii infection. Am J Obstet Gynecol 1989;161:987--95.
Editorial Note: The number of Toxic Shock Syndrome cases reported annually to CDC has decreased substantially in the 10-year period since menstrual Toxic Shock Syndrome was first recognized. Changes in public awareness and diminished attention to Toxic Shock Syndrome in the medical literature might have resulted in reduced diagnosis and reporting. However, reporting of non-menstrual Toxic Shock Syndrome has remained constant during this time while menstrual Toxic Shock Syndrome reporting has decreased.
A multistate active surveillance study in 1986-1987 confirmed the trends detected by national passive surveillance (7). Through active case-finding efforts in an aggregate population of 34 million persons, the rate for menstrual Toxic Shock Syndrome was determined to be 1.0 per 100,000 women 15-44 years of age (7). This rate represented a substantial reduction from rates reported in similar studies in 1980 (6.2 per 100,000 women 12-49 years of age in Wisconsin (8), 9.0 per 100,000 women 12-45 years of age in Minnesota (9), and 12.3 per 100,000 women 12-49 years of age in Utah (10)). Active surveillance also confirmed that the proportion of Toxic Shock Syndrome associated with menstruation had decreased considerably: in 1988, menstrual Toxic Shock Syndrome accounted for 55% of cases detected both by active surveillance (7) and by the passive surveillance system.
A principle reason for the decreased incidence of menstrual Toxic Shock Syndrome may be decreases in the absorbency of tampons. In 1980, when tampon absorbency (in vitro) ranged from 10.3-20.5 g (4), very high absorbency products ( greater than 15.4 g) were used by 42% of tampon users (9). After the association between Toxic Shock Syndrome and absorbency was recognized, manufacturers lowered the absorbency of tampons. In 1982, the Food and Drug Administration (FDA) issued a regulation requiring that tampon package labels advise women to use the lowest absorbency tampons compatible with their needs. By 1983, tampon absorbency ranged from 6.3-17.2 g (6), and the proportion of tampon users using very high absorbency tampons had declined to 18%. By 1986, very high absorbency products were used by only 1% of women who used tampons. Effective March 1990, the FDA instituted standardized absorbency labeling of tampons, which currently range from 6-15 g.
Tampon composition has also changed since 1980. Rely tampons consisted of polyester foam and cross-linked carboxymethylcellulose, a combination that is no longer used in tampons. Polyacrylate-containing tampons were withdrawn from the market in 1985. Current tampons are manufactured from cotton and/or rayon. The unique composition of Rely tampons may have been responsible for the increased risk associated with those products (11); however, the role of current tampon composition as an independent risk factor for Toxic Shock Syndrome is unclear since composition may vary even for a particular brand and style of tampon marketed at a given time.
Other factors may have contributed to decreased reports of menstrual-related Toxic Shock Syndrome. For example, public awareness of the syndrome may cause women to seek medical care earlier in their illness; milder disease may not meet the surveillance case definition of severe multisystem illness. Increased variety in menstrual products and concern related to Toxic Shock Syndrome may have resulted in fewer women using tampons or fewer using tampons continuously.
Current public health efforts to prevent menstrual-related Toxic Shock Syndrome include tampon package labels and package inserts which describe early signs and symptoms of Toxic Shock Syndrome and warn the consumer about the risk associated with tampons. Tampon users are encouraged to select lower absorbency products to further decrease risk of Toxic Shock Syndrome. Standardized absorbency labeling permits consumers to compare absorbency between brands.
The precise mechanism by which Rely tampons increased the risk of Toxic Shock Syndrome is unknown. The increased risk associated with high absorbency tampons is also poorly understood; high absorbency may be a surrogate for another effect. However, the withdrawal of Rely tampons and the subsequent decrease in use of high absorbency tampons correlate with a marked decrease in incidence of menstrual-related Toxic Shock Syndrome. The rapid demonstration of the risk of Rely and high absorbency tampons resulted in prompt public health interventions and substantial reduction in menstrual Toxic Shock Syndrome.
Tampon
Truth's and Tragedies
The Following Information Courtesy of: http://www.tamponalert.org.uk
and
in Memory of Alice Kilvert, who died at the age of 15 due to
Tampon use and Toxic Shock Syndrome
Alice Kilvert, aged 15, died on Tuesday, 26th November 1991 of tampon-related Toxic Shock Syndrome at Trafford General Hospital, Manchester.
Alice's symptoms were initially very mild and did not cause any undue concern. On the Sunday prior to her death she complained of a headache which persisted, but eased with aspirin. During Sunday evening she was able to watch television, but she was sick during the night. Although very pale on Monday morning, she went to school in order to start her mock GCSE exams, but was taken home as she appeared to be developing influenza.. Alice went straight to bed and by tea time she had a slight temperature. At 7pm she was alert enough to talk about the early evening TV she had missed, but by 10pm she seemed vague and confused and a little faint.
The next morning Alice's breathing was shallow and she had a higher temperature, so the emergency doctor was called. The doctor phoned for an ambulance for Alice to be taken to hospital, but when the ambulance staff tested for blood pressure, it was so low it hardly registered. She arrived at hospital at 9am and her condition was diagnosed as either TOXIC SHOCK SYNDROME or meningitis, and treatment began. She was taken into Intensive Care and put onto a ventilator as her breathing was giving cause for concern. However, the strain on her heart brought on two cardiac arrests. She did not recover from the second one and died at 1pm.
More
Stories on Women and Girls who
Died or Were Injured due to Tampon use and
Tampon-induced Toxic Shock Syndrome
1.
KATIE OF NOTTINGHAMSHIRE.
In the summer of 1990, Katie, then aged 15, went on holiday to Devon with her
family. It was a holiday that she'll never forget.
One morning she woke up with a headache and feeling shivery. Her mother thought
that it could be flu and suggested that she should stay in bed. During the day
her symptoms worsened as her temperature rose; she had aching muscles, a stiff
neck and a sore mouth.
By tea time she became breathless and she was so weak that she needed assistance
to go to the toilet. Her parents sent for the doctor, who diagnosed a virus and
prescribed antibiotics. That night Katie's temperature soared to 102 degrees.
The next morning she felt awful and had a severe headache. Her mother noticed a
red rash on her leg. Katie's eyes were pink and sticky and her skin was turning
yellow. The doctor was called again. He took one look at her and called for an
ambulance. She was rushed to hospital.
At the hospital, the doctors performed a lumber puncture to test for meningitis
and took a blood sample to test for glandular fever. Then the doctor discovered
that Katie was menstruating and took a vaginal swab for testing. By now, her
joints were swollen, her mouth was blistered, her liver and kidneys were failing
and her veins and arteries had gone into spasm. She was transferred to Intensive
Care.
The next morning a microbiologist had identified that Katie was suffering from
Toxic Shock Syndrome, brought on by the tampons she had been using. She was
being treated by the right antibiotics, and the doctors said that they would
just have to wait and hope. Katie remained conscious for the three days that she
was in Intensive Care. The pain was excruciating. She was transferred to a ward
and after a week she was strong enough to go home with the aid of a wheelchair.
Katie felt weak for months. Thick layers of skin peeled off her hands and feet.
This was as a result of the blood supply being cut off from her extremities
during her illness. Then her hair started to fall out in clumps. This lasted for
six months, and it has never grown back to its previous thickness. She realized
that her memory wasn't as good and her ability to concentrate had diminished.
Katie remembers being told at school that Toxic Shock Syndrome is caused by
leaving a tampon in too long. Now she knows differently. Any woman or girl who
uses tampons can get TSS. That's why she'll never use tampons again. It might be
rare, but you never know who it mig
