Is it safe to take allergy medications during pregnancy?

The allergy medication loratadine (Claritin, others) is currently considered a category B drug. This indicates that animal studies haven't shown any risks to a fetus whose mother takes the drug, and there have been no reports of human reproductive problems associated with the drug. Although category B drugs appear to be safe, they haven't been adequately tested during human pregnancy to offer any guarantees.

In fact, few drugs have actually been proved safe during pregnancy. Drugs typically aren't studied in pregnant women because of the possible effects on the fetus. Until more is known, doctors must make judgments using the best available scientific evidence. It's best to exercise caution before taking allergy medications or any other drugs during pregnancy. Work with your doctor to weigh the severity of your allergy symptoms against the possible risks to your baby from taking allergy medications.

If possible, limit your exposure to anything that triggers your allergy symptoms. This may decrease your need for allergy medications. Also, keep in mind that nasal congestion often gets worse during pregnancy due to hormone changes. This occurs even in women who don't have allergies.

Testosterone therapy in women

Testosterone is one of the hormones that contribute to healthy sexual function in women. Typically, however, testosterone therapy isn't recommended to improve low sex drive. For women, other factors are generally more important in determining sex drive — and much remains unknown about the effects of testosterone therapy in women.

Various factors associated with menopause and aging may contribute to changes in a woman's sexual desire and function. These include decreased estrogen levels, vaginal dryness, medication side effects, chronic health conditions, or the loss of a spouse or partner.

A woman's testosterone level gradually declines with age. Although natural menopause doesn't lead to an abrupt change in testosterone level, surgical menopause — which occurs after removal of the ovaries — can have this effect.

If a woman experiences reduced sex drive, depression and fatigue after removal of the ovaries, estrogen therapy may be recommended. If estrogen therapy isn't effective, low-dose testosterone therapy may be another option. Testosterone therapy may also be considered for postmenopausal women taking estrogen who have a decreased sex drive with no other identifiable causes.

In general, testosterone therapy is prescribed only for women who have sufficient estrogen levels. Typically, testosterone therapy isn't recommended for women who are postmenopausal and can't or choose not to take estrogen. Testosterone therapy isn't appropriate for postmenopausal women who have a history of breast or uterine cancer or those who have cardiovascular or liver disease.

For women, testosterone therapy can be given in the form of a cream or gel, and sometimes it's prescribed as a pill or injection. There have been no long-term studies of the risks and benefits of testosterone therapy in women. The most common side effects of testosterone therapy include acne and excess facial hair. Less common side effects include lowering of the voice, enlargement of the clitoris, liver problems, and mood or personality changes.

If you choose to try testosterone therapy, it's important to carefully monitor your symptoms and any side effects.

How to strengthen pelvic floor muscles - Kegel exercises

Kegel exercises

Kegel exercises strengthen the pelvic floor muscles, which support the uterus, bladder and bowel. If you do Kegel exercises regularly and keep your pelvic floor muscles toned, you may reduce your risk of incontinence and similar problems as you get older. Kegel exercises can also help you control urinary incontinence.

Learning how to perform Kegel exercises properly can be tricky. How do you know whether you're working the correct muscles? Here's a guide to perfecting Kegel exercises.

Kegel exercises: Who can benefit

Many conditions put stress on your pelvic floor muscles:

• Pregnancy
• Childbirth
• Being overweight
• Aging
• A chronic cough
• A genetic predisposition to weak connective tissue

When your pelvic floor muscles weaken, your pelvic organs descend and bulge into your vagina, a condition known as pelvic organ prolapse. The effects of pelvic organ prolapse range from uncomfortable pelvic pressure to leakage of urine or feces. Fortunately, Kegel exercises can strengthen pelvic muscles and delay or maybe even prevent pelvic organ prolapse.

Kegel exercises are recommended especially during pregnancy. Well-toned pelvic floor muscles may make you more comfortable as your due date approaches. You may be less likely to develop urine leakage — common near the end of pregnancy and prone to persist after you've given birth.

Finally, Kegel exercises — along with counseling and sex therapy — may be helpful to women who have persistent problems reaching orgasm.

How to do Kegel exercises

It takes diligence to identify your pelvic floor muscles and learn how to contract and relax them. Here are some pointers:

Find the right muscles
To make sure you know how to contract your pelvic floor muscles, try to stop the flow of urine while you're going to the bathroom. If you succeed, you've got the basic move. Or try another technique: Insert a finger inside your vagina and try to squeeze the surrounding muscles. You should be able to feel your vagina tighten and your pelvic floor move upward. Then relax your muscles and feel your pelvic floor move down to the starting position. As your muscles become stronger — and you become more experienced with the exercises — this movement will be more pronounced.

But don't make a habit of starting and stopping your urine stream. Doing Kegel exercises with a full bladder or while emptying your bladder can actually weaken the muscles. It can also lead to incomplete emptying of the bladder, which increases your risk of a urinary tract infection.

If you're having trouble finding the right muscles, don't be embarrassed to ask for help. Your doctor or other health care provider can give you important feedback so that you learn to isolate and exercise the correct muscles.

Perfect your technique
Once you've identified your pelvic floor muscles, empty your bladder and sit or lie down. Then:

• Contract your pelvic floor muscles.
• Hold the contraction for three seconds then relax for three seconds.
• Repeat 10 times.
• Once you've perfected three-second muscle contractions, try it for four seconds at a time, alternating muscle contractions with a four-second rest period.
• Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.

To get the maximum benefit, focus on tightening only your pelvic floor muscles or isolating your pelvic floor muscles. Be careful not to flex the muscles in your abdomen, thighs or buttocks. Also, try not to hold your breath. Just relax, breathe freely and focus on tightening the muscles around your vagina and rectum.

Repeat three times a day
Perform a set of 10 Kegel exercises three times a day. The exercises will get easier the more often you do them. You might make a practice of fitting in a set every time you do a routine task, such as checking e-mail or commuting to work.

Vary your technique with one of these methods:

• Try sets of mini-Kegels. Count quickly to 10 or 20, contracting and relaxing your pelvic floor muscles each time you say a number.
• Visualize an elevator. Slow down the exercises, gradually contracting and releasing your pelvic floor muscles one at a time. As you contract, visualize an elevator traveling up four floors. At each floor, contract your muscles a little more until you reach maximum contraction at the fourth floor. Hold the contraction and then slowly release the tension as you visualize the elevator returning to the ground floor. Repeat 10 times.

Biofeedback training

If you have trouble doing Kegel exercises, biofeedback training may help. In a biofeedback session, a nurse, therapist or technician will either insert a small monitoring probe into your vagina or place adhesive electrodes on the skin outside your vagina or rectal area. When you contract your pelvic floor muscles, you'll see a measurement on a monitor that lets you know whether you've successfully contracted the right muscles. You'll also be able to see how long you hold the contraction.

Another technique uses electrical stimulation to help you feel the muscles contract. The procedure is painless, although you'll experience a buzzing feeling as a small electrical current is applied to your pelvic floor muscles, making them contract. Once you feel this sensation a few times, you'll probably be able to duplicate the exercise on your own. Because simpler methods work for most women, this technique is rarely used.

When to expect results

If you do your Kegel exercises faithfully, you can expect to see some results, such as less frequent urine leakage, within about eight to 12 weeks. Your improvement may be dramatic — or, at the very least, you may keep your problems from worsening. As with other forms of physical activity, you need to make Kegel exercises a lifelong practice to reap lifelong rewards.

Child abuse

Child abuse takes many forms:

• Physical abuse. Physical child abuse occurs when a child is purposefully injured. Physical abuse can be an act of direct physical harm or an act of omission that leads to injury.
• Sexual abuse. Sexual child abuse is any sexual activity with a child, including fondling, oral-genital contact, intercourse and exposure to child pornography.
• Emotional abuse. Emotional child abuse includes verbal and emotional assault — such as continually belittling or berating a child — as well as isolating, ignoring or rejecting a child.
• Neglect. Child neglect is failure to provide a child adequate food, shelter, affection, supervision or medical care.

Most child abuse is inflicted by someone the child knows and trusts, often a parent or other relative. If you suspect child abuse, either in your own child or a close contact, report the abuse to the proper authorities. Your concern may provide an opportunity for healing.

A child who's being abused may feel guilty, ashamed or confused. He or she may be afraid to tell anyone about the abuse, especially if the abuser is a parent or other loved one. That's why it's vital to watch for red flags, such as:

• Sudden changes in behavior or school performance
• Untreated medical or dental problems
• Unexplained bruises, cuts, burns or other injuries
• Blood in the child's underwear
• Inappropriate sexual behavior for the child's age
• Behavior extremes, from overly aggressive to unusually passive
• Nightmares or unusual fears
• Withdrawal from friends or usual activities
• Low self-esteem
• Poor hygiene
• Frequent absences from school

Sometimes a parent's demeanor or behavior also sends red flags about child abuse. Warning signs include a parent who:

• Shows little concern for the child
• Denies the existence of problems at home or school, or blames the child for the problems
• Refuses offers of help to resolve problems at school
• Consistently blames, belittles or berates the child
• Describes the child with negative terms
• Uses harsh physical discipline or asks teachers to do so
• Demands an inappropriate level of physical or academic performance
• Severely limits the child's contact with other children
• Offers conflicting or unconvincing explanations for a child's injuries, or no explanation at all

Keep in mind that warning signs are just that — warning signs. The presence of warning signs doesn't necessarily mean that a child is being abused.

When to see a doctor
If you're concerned that your child or another child has been abused, seek help immediately. Contact the child's doctor, a local child protective agency or the local police department. Keep in mind that health care professionals are legally required to report all suspected cases of child abuse to state authorities.

Child abuse occurs across all socioeconomic levels and ethnic groups. For parents and other caregivers, factors that may increase the risk of becoming abusive include:

• Low self-esteem
• Poor impulse control
• Depression
• Anxiety
• Marital conflict
• Domestic violence
• Financial stress
• Social isolation
• Alcoholism or other forms of substance abuse
• A history of mistreatment as a child
  

Some children overcome the physical and psychological effects of child abuse, particularly those who have high self-esteem, an optimistic attitude and strong social support. For others, however, child abuse has lifelong consequences. For example, child abuse may lead to:

• Physical disabilities
• Learning disabilities
• Low self-esteem
• Depression
• Difficulty establishing or maintaining relationships
• Challenges with intimacy and trust
• An unhealthy view of parenthood
• Anxiety
• Substance abuse
• Eating disorders
• Post-traumatic stress disorder
• Personality disorders
• Delinquent or violent behavior

You can take simple steps to protect your child from exploitation and child abuse, as well as prevent child abuse in your neighborhood or community. For example:

• Offer your child love and attention. If you feel overwhelmed or out of control, take a break. Don't take out your anger on your child.
• Think supervision. Don't leave young children home alone. In public, keep a close eye on your child. Don't allow your child to go anywhere or accept anything without your permission. When your child is old enough to leave home without parental supervision, encourage your child to hang out with friends rather than alone — and to tell you where he or she is at all times.
• Know your child's caregivers. Check references for baby sitters and other caregivers. Make unannounced visits to observe what's happening.
• Emphasize the importance of saying no. Make sure your child understands that he or she doesn't have to do anything that seems scary or uncomfortable. Encourage your child to leave a threatening or frightening situation immediately and seek help from a trusted adult. If something does happen, encourage your child to talk to you or another trusted adult about the episode. Assure your child that it's OK to talk, and that he or she won't get in trouble.
• Teach your child how to stay safe online. The Internet is a tremendous tool, but it's important to use it safely. Cover ground rules such as not sharing personal information and not responding to inappropriate, hurtful or frightening messages. Don't allow your child to share photos or videos online or arrange to meet an online contact in person without your permission. Consider it a red flag if your child is secretive about his or her online activities.
• Reach out. Meet the families in your neighborhood, including both parents and children. If a friend or neighbor seems to be struggling, offer to baby-sit or help in another way.

If you're concerned that you might abuse your child, seek help immediately. Start with your family doctor. He or she may offer a referral to a parent education class, counseling or a support group for parents. If you're abusing alcohol or drugs, ask your doctor about treatment options. Remember, child abuse is preventable — and often a symptom of a problem that may be treatable. Ask for help today.

Prescription drug abuse

Prescription drug abuse is the use of prescription drugs — most commonly painkillers, sedatives and stimulants — in ways not intended by the prescribing doctor. The definition for prescription drug abuse includes everything from taking a friend's prescription painkiller for your backache to snorting ground-up pills to get high.

According to a 2007 survey conducted for the National Institute on Drug Abuse, prescription drug abuse occurs in more than 15 percent of U.S. high school seniors. The types of drugs most popular for prescription drug abuse are codeine-based painkillers such as oxycodone (OxyContin) and those containing hydrocodone (Vicodin).

Prescription drug abuse rarely happens in people who need commonly abused painkillers, sedatives or stimulants to treat a medical condition. But it can be difficult for a doctor to distinguish between a person who needs a larger dose to control his or her pain and a person who's abusing prescription painkillers.

In general, the following behaviors are warning signs of prescription drug abuse:

• Continually "losing" prescriptions, so more prescriptions must be written
• Seeking prescriptions from more than one doctor
• Taking higher doses despite warnings
• Stealing, forging or selling prescriptions
• Excessive mood swings

Symptoms by type of drug
The most commonly abused prescription drugs are:

• Opioid painkillers, such as oxycodone (OxyContin) and those containing hydrocodone (Vicodin)
• Sedatives and tranquilizers, such as diazepam (Valium) and lorazepam (Ativan)
• Stimulants, such as methylphenidate (Ritalin) — commonly used to treat attention-deficit/hyperactivity disorder (ADHD)

Each category has its own specific symptoms of use or abuse.

Opioid painkillers

• Constipation
• Depression
• Low blood pressure
• Decreased respiration rate
• Confusion

Sedatives and tranquilizers

• Drowsiness
• Confusion
• Unsteady gait
• Impaired judgment
• Involuntary and rapid movement of the eyeball

Stimulants

• Weight loss
• Agitation
• Irritability
• Insomnia
• High blood pressure
• Irregular heartbeat

When to see a doctor
Talk to your doctor if you think anyone in your family, including yourself, may be abusing prescription drugs.

According to the National Institute on Drug Abuse, prescription drug abuse has increased as the drugs have become easier to obtain.

For example, U.S. prescriptions for stimulants — including those taken for ADHD — increased from around 5 million in 1991 to almost 35 million in 2007. Prescriptions for opioid painkillers such as oxycodone (OxyContin) and hydrocodone (Vicodin) increased from 40 million in 1991 to 180 million in 2007.

Most prescriptions are written for people who have a true medical need for these drugs. But many households have a drawer filled with old prescription bottles containing leftover drugs. Because prescription drugs have medical uses, teens often believe they are a safe alternative to street drugs.

In some cases, a doctor's prescription isn't even needed. Some countries don't require prescriptions for opioid painkillers or other commonly abused drugs, so they can be obtained from some Web sites without a prescription.

Because the medications associated with prescription drug abuse activate the brain's reward center, it's easy to become addicted to them. Addicts continue to use their drug of choice even when this use makes their lives worse — just like nicotine addicts continue smoking cigarettes even when it harms their health and they want to quit.

In addition to the risk of addiction, other complications of prescription drug abuse may vary, depending on the drug category.

Opioid painkillers

• Increased risk of choking
• Loss of menstrual periods and fertility
• Slowed breathing rate, potential for breathing to stop

Sedatives and tranquilizers

• Memory problems
• Abnormal temperature regulation
• Overdose can cause coma or death

Stimulants

• Hallucinations
• Seizures or tremors
• Increased risk of stroke

Combining alcohol with prescription drugs, particularly sedatives and tranquilizers, is even more dangerous.

If it were easy to stop abusing prescription drugs, no one would become addicted to them. So don't hesitate to get help in conquering your abuse or addiction. Your doctor may suggest that you be admitted to a residential facility that can provide specialized treatment for your specific problem.

Medications

• Opioid withdrawal. Buprenorphine and methadone may be used to ease the symptoms of withdrawal from opioid painkillers. However, the use of these agents to ease withdrawal from opioid addiction in the absence of pain problems is tightly regulated and subject to very strict guidelines and at times special licensure. Other drugs — including clonidine (Catapres), a medicine primarily used for high blood pressure — can be used to help manage opioid withdrawal symptoms.
• Sedative withdrawal. In general, tapering sedatives can be medically complicated and should be done only after a consultation with a doctor comfortable with assessing and managing these issues. If you've used prescription sedatives for a long time, it may take weeks or even months to slowly taper off them. Mood-stabilizing drugs at critical points in the withdrawal process may help. Symptoms of withdrawal can mimic rebound anxiety, so your choice of doctor is critical in withdrawal from this class of drugs.
• Stimulant withdrawal. There are no approved drugs used for the management of stimulant withdrawal. Treatment typically focuses on relieving withdrawal symptoms — such as sleep, appetite and mood disturbances.

Therapies
Counseling — whether it be individual, group or family counseling — is often useful. In addition to helping determine what factors may have led to the prescription drug abuse, counseling can also help people learn the skills needed to help prevent its recurrence.

To reduce the availability of potentially addictive prescription drugs to teens, adults should secure such medications in a locked cabinet, and dispose of any unused pills properly. The federal government recommends flushing opioid painkillers down the toilet. Other unused medications can be taken out of their original containers, mixed with coffee grounds or with used kitty litter and then disposed of in the trash.

Doctors can reduce the likelihood of prescription drug abuse by taking thorough histories and providing careful follow-up for the people they've prescribed opioid painkillers, sedatives, tranquilizers or stimulants.

Drug manufacturers also are investigating ways in which commonly abused drugs can be made less addictive. The approaches being studied include:

• Controlled-release drugs. Slowing the speed at which drugs enter the brain appears to reduce the effect that the drugs have on the brain's reward center.
• Aversive ingredients. Adding secondary ingredients to drug formulations can provoke unpleasant side effects if the dose is too high, or if the pills are ground up and snorted or injected — a delivery system much more likely to result in addiction.
• Digestive enzymes. Some drugs may eventually require exposure to digestive enzymes to be activated. This would greatly reduce the chances of these pills being taken in any way other than by mouth.