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THOUGHT FOR THE DAY...

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The Secret to Soft, Glowing Skin

Think exfoliating products are just a sales gimmick? Dermatologists say they really do help you get a healthy glow on. Read on to learn how to make the most of a scrub… Drugstore beauty aisles are full of products claiming to exfoliate skin, but many women don’t know how and when to scrub. Or what it actually does for complexions. Turns out, it’s a key way to keep skin soft and glowing. Especially as we age. Here’s why exfoliating helps: The top tier of skin (the epidermis) is made of layers of dead, flattened cells. Over roughly four weeks, these move from the bottom of the epidermis to its surface, where they naturally fall off, exposing newer, fresher-looking skin underneath. But as we age, our body’s ability to shed dead cells slows, leaving skin looking dull. That’s why kids have a rosy radiance and many adults don’t. By removing the topmost layer, exfoliating speeds up the skin’s shedding process, says New York City-based dermatologist Doris Day, M.D., author of Forget the Facelift (Avery). But exfoliating too often or using the wrong products may dry out or irritate skin. So how do you make sure you don’t rub skin the wrong way? Read on for the dermatologists’ top do’s and don’ts. Do know what exfoliating does for your skin. A gentle scrubbing offers more than a temporary rosiness and softer, smoother skin. Over the long term, regular exfoliation “can visibly minimize pores and rejuvenate the skin’s surface,” says Patricia Wexler, M.D., associate clinical professor of dermatology at Mount Sinai College of Medicine in New York. Exposing fresher cells evens out texture and tone – including acne scars – and unclogs pores. And it makes pigmentation and fine lines less noticeable, because you’re removing some discolored, sun-damaged skin. Exfoliating can also boost penetration of other skin products – those that moisturize or fight wrinkles, acne and discoloration. It also makes self-tanners look more natural and last longer. Don’t think all exfoliants are created equal. Exfoliants fall into two categories: physical and chemical. To understand their differences, imagine a sink of dirty pots and pans. Both a scouring pad and dish soap will clean them, but in different ways. Physical exfoliants (also called mechanical exfoliants) use gritty materials – beads, grainy scrubs, loofahs and even shaving – to send dead skin packing. Chemical, or liquid, exfoliants use a mild acid to dissolve the “glue” that binds dead cells to the skin’s surface, Day says. These include beta hydroxy acids (salicylic is one) and alpha hydroxy acids, such as glycolic and lactic. Which is best for you? It depends on your skin type. If you have extremely dry, sensitive or acne-prone skin, choose chemical exfoliants over grainy scrubs. The latter can be too abrasive, leaving skin inflamed and irritated. Salicylic acid is particularly good for acne sufferers because “it exfoliates the surface layer of dead skin cells and cleanses away acne-forming bacteria,” Day says. And whatever your skin type, use physical scrubs with ground fruit pits, nuts or shells only on your body, not your face. These may sound safe because they’re made with natural ingredients, but they can tear delicate facial skin with their harsh, jagged edges, exacerbating acne and other skin conditions. Do know when to exfoliate. All skin types benefit from a good scrubbing, Wexler says. “I advise all my clients to exfoliate regularly, no matter their skin condition – whether aging, acne-prone or sensitive – for optimum cell renewal and a glowing complexion,” she says. But how often you exfoliate depends on your skin type. If your face is oily, exfoliate at least once a week. Women with drier, more sensitive skin should stick to only once a week or every two weeks, Day advises. Body parts like knees, elbows, ankles and feet can be rubbed and scrubbed every other day. That’s because skin is thicker in these areas and can tolerate more friction. Plus, dead, dry skin cells tend to pile up there. But don't scrub if you have an active infection, cold sore, sunburn, extremely dry skin, redness or inflammation for any reason. Let skin heal before exfoliating or you may worsen the conditions. Don’t overdo exfoliation. While a little can make a big difference in your complexion, over-exfoliating can damage skin, aggravating acne or increasing dryness. That’s because dead surface cells retain moisture, “so constantly removing this protective layer keeps it from staying hydrated,” says Manhattan based-dermatologist Paul Jarrod Frank, M.D., associate professor of dermatology at New York University Medical Center. You’ve gone too far “if skin bleeds, stings or burns after exfoliating. That’s a sign “you've over-stripped the outer layer of skin,” Day says. Another common problem: Using too many exfoliants at once. It’s an easy mistake. How many times have you washed your face with a physical exfoliant (like a loofah or grainy scrub) and then applied a chemical exfoliant (a skin cream with alpha-hydroxy-acids)? Do know how to exfoliate. Pretty much every body part can be exfoliated, but here are tips to make it more effective. On your face, use a light hand and apply exfoliant to damp skin – it causes too much friction on dry skin. Exfoliate your lips with a toothbrush, washcloth or an exfoliant made for lips to remove dry flakes and boost blood circulation. Dry brush the rest of your body three times a week before stepping in the shower, advises Susan Ciminelli, owner of the Susan Ciminelli Day Spa in New York City and author of The Ciminelli Solution: A Seven-Day Plan for Radiant Skin (William Morrow). Use a natural-bristle body brush, loofah sponge or loofah gloves (all available at a health food store and some drugstores); they’re not as harsh than synthetic versions. Start at your feet, using gentle, circular, counter-clockwise motions, and work your way up legs to the torso, chest and arms. Don’t assume you have to use expensive products. Physical and chemical exfoliants are sold in a variety of price ranges at drugstores and department stores. In fact, you might have all the ingredients for an effective scrub right in your kitchen. “Oatmeal is one of my favorite ingredients because it’s gentle in abrading off the upper layers of skin cells,” Day says. “It’s excellent for all skin types, including acne-prone and sensitive skin.” Here are two do-it-yourself scrubs Day recommends: Oatmeal-Aloe Vera Facial Scrub 1/2 cup coarsely ground, raw oatmeal 1/4 cup organic honey 1 teaspoon extra-virgin olive oil 1 teaspoon aloe vera gel 2 teaspoons water 1. Mix all ingredients in a small bowl. Apply to face and neck with gentle, circular strokes for about a minute. Rinse with lukewarm tap water or wipe off with a warm, damp washcloth. Finish with a splash of cold tap water to tighten pores, and pat dry. Oatmeal-Salt Body Scrub 1/2 cup sea salt 1/4 cup ground, uncooked oatmeal 6 tablespoons flaxseed oil 1 tablespoon extra-virgin olive oil 8 drops geranium oil 1. Mix all ingredients in a small bowl. Massage over your body and feet in the bath or shower for a few minutes. Finish with a rinse of cool water and pat skin dry. Do care for skin after exfoliating. Because exfoliating makes other products penetrate better, be careful with lotions and potions that you apply afterward. If your skin gets too sensitive to them after exfoliating, apply them on days you don’t scrub. If you have skin dry skin, apply moisturizer immediately after exfoliating so it really soaks in. Headed outside? Freshly exfoliated skin is more sun-sensitive – because you’re removing the epidermis’ top layer – which increases the risk of sun damage and sunburn. Be extra vigilant about avoiding the sun and using a broad-spectrum sunscreen (that protects against ultraviolet A and B rays) daily. Michele Bender writes frequently on skin care for Lifescript. For more information, visit our Skin Heath Center. Are You Skin-Care Savvy? The skin is a living, breathing organ, and what you don't know about taking care of it could keep your complexion from looking fantastic. If your skin-care knowledge could barely fill a pillbox, you need a refresher course. Do you know how to put your best face forward?

Decoding Your Health Test Results Get the 411 On 9 Critical Medical Tests

Your doctor ordered a blood test. But do you understand the numbers? Or if you’re bordering on a heart attack, diabetes or underactive thyroid? We asked the experts to explain these critical medical test results – and what they say about your health... You look and feel great, but are you really in optimal health? Routine medical tests can tell you – if you know how to interpret the results. “A person who understands the significance of tests and results is better able to make decisions about their care,” says cardiologist Janet Wright, M.D. Read on to find out which tests you need, what’s being measured and the next steps to take if you don’t ace the exam. 1. Blood Pressure Blood pressure is simply a measurement of the force of blood pushing against artery walls as your heart pumps blood through the body. Your doctor will read off two numbers. The top, or systolic, is the pressure that occurs when your heart beats. The bottom, or diastolic, measures pressure when your ticker rests between beats. If your blood pressure is higher than normal, you have hypertension, which “damages arteries, leading to strokes, kidney failure, blindness and heart attacks,” Dr. Wright says. What’s optimal for your health: 120/80 mmHg. (That stands for millimeters of mercury, which is used to measure blood pressure.) What’s not: A top number over 140 or a bottom number higher than 90 indicate high blood pressure. A systolic number of 120-139 or a diastolic of 80-89 suggests pre-hypertension, which means you’re likely to end up with high blood pressure if you don’t exercise more or change your diet. Some people have low blood pressure, but this is a problem only if it causes fainting or dizziness. 2. Cholesterol The body needs some of this waxy, fatty substance to help it make hormones and vitamin D, for example. But too much cholesterol can accumulate on your arterial walls and “lead to heart attacks and strokes,” Dr. Wright says. You have a tougher time managing cholesterol levels if you have diabetes, leading to a condition called diabetic hyperlipidosis. Your body produces two kinds of cholesterol: HDL, or “high-density lipoprotein,” is good for you because it helps keep arteries clear. The higher this number, the lower your risk of heart disease. Bad cholesterol, or LDL or “low-density lipoprotein,” can build up in arteries and form plaque, a hard substance that can slow or block blood flow. Two other types of bad cholesterol, triglycerides and Lp(a) cholesterol, also contribute to arterial plaque buildup. Learn how to lower your cholesterol levels. What’s optimal for your health: Total blood cholesterol should be below 200 mg/dL (which means milligrams per deciliter of blood). HDL should be over 50 for women LDL, less than 100 is optimal; 100-129 is near-optimal What’s not: Total blood cholesterol of 200-239 is borderline high; over 240 is high. HDL: below 50 for women LDL: 130-159 is borderline high; 160-189 is high; 190 or above is very high 3. C-Reactive Protein (CRP) Your liver produces this protein, and levels rise when arteries are inflamed or swollen. It’s a sign of cardiovascular disease. A test called the hs-CRP (highly sensitive C-Reactive Protein) measures how much CRP is in your blood. / People with high levels have twice the risk of heart attacks than those with low levels, according to the American Heart Association. What’s optimal for your health: An hs-CRP level of less than 1.0 mg/L (milligrams per liter) indicates low risk; 1.0 to 3.0 mg/L means average risk. What’s not: An hs-CRP level more than 3.0 mg/L indicates a high risk. CRP levels too high? Get doctor-recommended tips for a healthy heart. 4. Thyroid Stimulating Hormone (TSH) This simple blood test will tell you if your body is producing enough THS. The hormone is produced by the pituitary gland to help control hormones produced by the thyroid, a butterfly-shaped gland in the lower part of your neck just above the collarbone. The thyroid controls many body processes, including bowel function, energy level and menstruation. An underactive thyroid slows metabolism, creating hypothyroidism. Symptoms include unexplained weight gain, decreased appetite, feeling too cold, oversleeping, constipation, hair loss, reduced sex drive, infertility, depression and excessive fatigue. An overactive thyroid speeds up your metabolism, a condition called hyperthyroidism. Symptoms include unexplained weight loss, increased appetite, feeling too hot, sleeping troubles, pounding heartbeat, diarrhea and feeling wound-up. “Your TSH will be elevated as it tries to push your gland to produce more thyroid hormone,” says Laura C. Knobel, M.D., a family physician in Walpole, Mass., and a member of the Board of Directors of the American Academy of Family Physicians. “If too much thyroid hormone is being produced, your TSH will be very low, or not even detected.” What’s optimal for your health: TSH from 0.4 to 4.0 mIU/L (milli-international units per liter) What’s not: Over 4.0 mIU/L indicates hypothyroidism. Under 0.4 means hyperthyroidism. 5. Blood Sugar A blood glucose test can indicate if your body is processing blood sugars properly and whether you're at risk for diabetes, one of the leading causes of disability and death in the U.S. When you eat, food is converted into blood sugar. In healthy people, a hormone called insulin, which is secreted by the pancreas, ushers glucose into cells throughout your body so it can fuel growth, cell repair and other functions. In some people, insulin doesn’t do its job, either because the pancreas, a gland behind the stomach, doesn’t make enough or because the body is resistant to it. The result: Too much glucose stays in the blood and diabetes develops. Over time, excess blood sugar can damage blood vessels, heart, kidneys, eyes and nerves. Three medical tests measure blood sugar levels: Hemoglobin A1C, fasting plasma glucose test (FPG) and oral glucose tolerance test (OGTT). Most doctors will do an FPG or OGTT, but the hemoglobin A1C is considered the most reliable. “It [shows] how high blood sugars have been over the last three months,” Dr. Knobel says. Find out how to prevent diabetes. What’s optimal for your health: An A1C under 5.7%, an FPG under 100 mg/dL or OGTT below 140 mg/dL What’s not: An A1 from 5.7%-6.4% indicates pre-diabetes; over 6.4% is considered diabetes. FPG: 100-125 mg/dL indicates pre-diabetes; over 125 indicates diabetes OGTT: 140-200 mean pre-diabetes; over 200 is diabetes 6. Bone Mineral Density (BMD) Doctors use bone mineral density tests to gauge skeletal health. The denser your bones, the stronger they are. But when they lose calcium (their primary substance) because of aging, poor diet, lack of exercise or a genetic predisposition, they become less dense, resulting in osteoporosis. Similar to an X-ray, a BMD test measures bone density against that of a healthy 30-year-old woman. The comparison is used to determine a T-score. A score of zero means your bones are equal to that of a healthy 30-year-old. Higher numbers indicate stronger bones; lower indicates weaker ones. With a BMD test, you may also get a Z-score, comparing your bone density to women your age. A Z-score is a less accurate way to diagnose osteoporosis, but it can tell your doctor if you’re starting to lose calcium. Find out how to build your bones. What’s optimal for your health: A T-score of minus 1 to plus 1 and a Z-score above minus 2 is normal. What’s not: T-scores from minus 1 to minus 2.5 indicate low bone density — a condition known as osteopenia. A T-score lower than minus 2.5 indicates osteoporosis. Z-scores below minus 2 require more testing. Here are two other non-lab health tests that offer clues to your well-being: 7. Body Mass Index (BMI) Doctors use BMI to determine if – and by how much – you're over- or underweight. It's calculated with weight and height. Isn't weight enough of an indicator? Not according to Erin E. Tracy, M.D., an obstetrician/gynecologist at Massachusetts General Hospital. “BMI is more accurate,” she says. Here’s why: Consider two women who each weigh 140 pounds. If one is 4 feet, 8 inches, and the other is 5 feet, 8 inches, the first woman with a BMI of 31.4 would be considered obese. The second? Her BMI of just 21.3 would be healthy. As your BMI goes up, so does your risk for several conditions, including diabetes, high blood pressure and cardiovascular disease. To figure out your BMI easily, use this calculator. What’s optimal for your health: A BMI of 18.5 -24.9. What’s not: An underweight BMI (less than 18.5 inches) means you’re probably not eating enough and not getting the nutrients your body needs, increasing your risk of anemia, osteoporosis and menstrual problems. Overweight: 25-29.9. Obese: 30 or over. 8. Waist Circumference This critical number tells you how much fat you have in your abdominal area. Nobody wants a flabby belly, but having one isn’t only about looks. Too much belly fat – also known as visceral fat – threatens your health. It surrounds your abdominal organs and secretes hormones that raise your risk of heart disease, cancer and diabetes. “Waist circumference is a better indicator of obesity than BMI since it measures central obesity, or the fat that accumulates around the middle section of the body,” Dr. Knobel says. Even normal-weight women need to watch their waistlines. Studies – including the Harvard School of Public Health’s Nurses’ Health Study, which followed 238,000 nurses – have found that women with excess waist fat die younger from cancer or heart disease than those with smaller middles, even if they're not overweight. You can do this one at home: Put the tape snugly around your waist around your belly button – and don’t hold your stomach in. What’s optimal for your health: Under 35 inches for women What’s not: Anything higher Will You See Your 80th Birthday? What is your life expectancy? Can you rely on good genetics to keep you thriving through the years, or do you need to do more to raise your odds of living longer?

Don’t Let Depression Destroy Your Relationship

If you’re depressed, you could be dragging your mate to the dumps with you. Here are 5 common symptoms that wreck relationships – and expert advice on how to get love back on track… When you’re in a relationship and feeling depressed, two people suffer. Karen S., a business executive in her late 20s, had been with her boyfriend eight months when she fell into a funk. She no longer enjoyed her favorite activities, preferring to spend weekends sleeping in and watching TV. Her boyfriend missed the fun-loving, outgoing woman he’d fallen for. Their sex life was nonexistent. He thought she wasn’t interested in him anymore. A few months later, Karen's doctor diagnosed her with depression. She eventually got the help she needed, but it was too late - the relationship didn’t survive. That doesn’t surprise Miami marriage and family therapist Lisa Paz, Ph.D. “Depression makes the non-depressed partner feel helpless and confused,” she says. “[Faced with] silence, withdrawal, and no sex or desire to do anything, partners think this is the turn the relationship is taking – that this is the way it’s always going to be.” Depression isn’t just occasional sadness. It’s a collection of symptoms, including irritability, fatigue, difficulty concentrating, changes in appetite or sleep patterns, feelings of worthlessness or helplessness, a loss of enjoyment in your usual activities, and sometimes suicidal thoughts. If you experience five or more symptoms for at least two weeks, you could have clinical depression, also known as major depression. It’s a serious condition you should have evaluated by a doctor or mental-health professional immediately, for the sake of your own well-being and your relationship. “Getting treatment and taking positive steps toward helping yourself are some of the best things you can do for you - and your relationship,” says Andrea Bonior, Ph.D., a professor of psychology at Georgetown University. “Working on getting better and assuring your partner that you’re on that path can go a long way.” To rekindle the romance, we’ve outlined five classic symptoms of depression that erode a relationship. Plus, we asked therapists for their best strategies to help you and your partner survive depression together. 1. Your sex drive tanks. When your mood plummets, it usually takes libido with it, says Paz. Since sex is often the glue that bonds couples, and your guy doesn't get why you haven't been intimate lately, he may think you’re not attracted to him or don’t love him anymore. What you can do: Explain that it really is you, not him. And that while your desire has evaporated, it’s not a reflection of your feelings for him. If your doctor recommends antidepressants, ask if you can take medication that will alleviate symptoms without dulling your sex drive even more. “Many antidepressants can exacerbate low desire,” says marriage, family and sex therapist Stephen Betchen, DSW, LMFT, author of Magnetic Partners: Discover How the Hidden Conflict That Once Attracted You to Each Other Is Driving You Apart (Tantor Media). One that doesn’t: bupropion (Wellbutrin). What your partner can do for you: Focus on being close without any expectations about the outcome. “I tell couples to create a situation where it’s not about sex, but physical intimacy,” Bonior says. “Some couples end up cuddling on the couch. Others have sex anyway.” 2. You squabble more. Are you nagging more, or acting short-tempered, impatient and cynical, which leads to fights? “People think depression is about being tearful all the time, but it also comes out as irritability and negativity,” Bonior says. What you can do: Acknowledge that your mood is affecting your behavior. And give him permission to remove himself from the fight, says Bonior. “Some couples work out a script in advance so they have a plan to extricate themselves from arising conflicts.” What your partner can do for you: Though it’s common for the depressed person to pick on a partner, he doesn’t have to take the bait, says Betchen. Instead, he should look for ways to diffuse situations before they blow up. A good start, says Bonior, is saying something like: We’re fighting a lot more. Let’s try to understand what’s going on here. Also, he needs to realize he’s not responsible for making you better. “It’s very common for the nondepressed partner to get angry and frustrated with the person who’s depressed because they haven’t been able to fix or cure them,” Betchen says. “You can help, but don't try to take on the doctor role.” 3. You’re isolating yourself. Depression makes you want to withdraw into your own island of despair. You might be ashamed you can’t pull yourself out of the funk. Or if you don’t have the energy to connect with your partner, you might drop out until you feel better. “There’s an emotional checkout with depression,” Paz says. “You’re not present in anything but your darkness.” What you can do: If you can’t talk face-to-face, send emails or leave notes for your partner that say I love you, Thanks for your patience, Bear with me, You’re the best. “That way you can stay connected on some level,” Paz says. What your partner can do for you: Stay nearby, so you can both feel close even if you’re not interacting. “Showing you’re supportive but not smothering is the best act of love in this tough time,” Paz says. 4. You don’t want to go out. When you don’t feel like doing anything, it’s tempting to curl up on the couch and order takeout. While that may be all you can manage, eventually even the most devoted partner will get cabin fever and resent your diminishing social life. “Part of depression is being turned off to things you used to be enthusiastic about,” Bonior says. Giving up hobbies and not keeping up with friendships hurts relationships. “To the partner, it can seem like the person they knew isn’t there anymore,” she says. What you can do: Find an activity outside the house that brings you joy. Gardening, yoga, talking a walk, listening to music, laughing with a friend. “That’s a lifeline. Even if it’s just an hour, it can make you feel better for that time,” Bonior says. What your partner can do for you: Look for opportunities to take you out even for a short time. A midday movie could be a good choice. “This requires minimal conversation – which can be exhausting – and you don’t have to get dressed up,” Paz says. And if you’ve been considering getting a dog, now’s the time: Walking and caring for a pet will get you out of the house and can lift you out of your funk. It worked for a client of psychologist Stephanie Newman, Ph.D., of the Psychoanalytic Institute at New York University Medical Center. When she wouldn’t leave the house, her partner got them a dog. “Having something to love changes your perspective a bit. The dog can break through the loneliness and isolation,” she says. 5. You’re letting yourself go. Maybe you don’t notice – or care – that you haven’t changed out of your pajamas for days. “When you’re depressed, everything feels overwhelming," Paz says. "You feel like you can’t do all of it, so why do any of it?” Without understanding why you’re gaining weight, not doing your hair or putting on nice clothes, your partner could interpret your lack of effort as disinterest in the relationship. “He wonders why she doesn’t want to look nice for him anymore,” Bonior says. What you can do: Instead of getting overwhelmed by the process, take baby steps. “Go minute by minute,” Paz says. “Ask yourself, 'Can I get to the bathroom and just brush my teeth?' Then 'Can I get in the shower now?' If it becomes too much, sit down or get back in bed.” And cut yourself some slack occasionally. “Give yourself permission to wear a sweatsuit and go without makeup,” Paz suggests. “When you don’t force yourself to rally, it often frees you up to feel like you can rally because you don’t have the pressure.” What your partner can do for you: Convey support, not criticism. Suggesting that you jump in the shower because it’s been a while since you touched soap and water: criticism. Preparing a soothing bath filled with your favorite scented oils and offering to wash your hair: supportive. Also, some comfy, yet fashionable clothes, such as yoga pants, would make a great feel-good gift, suggests Paz. Of course, all these tips can be modified if your partner’s the one who’s depressed and you’re struggling to cope. Either way, dealing with the situation now can create an even better relationship once the fog lifts. “Couples that navigate the really tough times are usually stronger,” Betchen says. “They feel that they can conquer just about anything.”

Treating Uterine Fibroids: Key Questions Answered

Are uterine fibroids cancerous? Do they affect fertility? Which treatment is right for you? Read on as experts answer your top questions… Your period is so heavy, you avoid leaving the house a few days each month. Sex is painful. And you’re spotting regularly. The likely diagnosis – uterine tumors called uterine fibroids – is scary. But it’s common: As many as 80% of women develop a uterine fibroid tumor in their lifetimes, says Michele Curtis, M.D., a professor of obstetrics and gynecology at the University of Texas in Houston. Symptoms vary: Some women have excessive bleeding, pelvic pressure and pain. Others notice nothing. Only 25% of women have tumors that require treatment, which can range from simple birth control pills to a life-altering hysterectomy to remove the uterus. To find out how fibroids affect your body and the best ways to treat them, we asked gynecologists these key questions: 1. How did I get uterine fibroids? Doctors don’t know what causes these tumors – sometimes called leiomyomas or myomas – but there’s a strong genetic link. You’re three times more likely to develop fibroids if your mother had one, according to the National Women’s Health Information Center (NWHIC). They’re also more common among obese and/or African-American women. Research suggests the hormones estrogen and progesterone, which stimulate the uterine lining in preparation for pregnancy, also play a role in fibroid growth. Fibroid tissue contains more estrogen than normal uterine cells, and fibroids seem to be fueled by the presence of these hormones. When a woman enters menopause, and her estrogen levels decrease, fibroids shrink. Estrogen doesn’t cause fibroids, but it does feed them. 2. Can they become cancerous? It’s extremely rare – less than one in 1,000 fibroids is cancerous, according to the NWHIC. If they begin to grow rapidly, they’re more likely to be cancerous. Your gynecologist will track them through a routine manual pelvic exam or by ordering an annual ultrasound. Questionable tumors will be removed and tested for malignancy. 3. What other factors determine severity? Depending on its location, a small tumor can cause more problems than a larger one. For example, a 1-centimeter fibroid in the uterine cavity that’s causing profuse menstrual bleeding would require treatment, says Serene Srouji, M.D., of Boston’s Brigham and Women’s Hospital. But a 7-centimeter tumor in the outer wall that isn’t causing discomfort wouldn’t. 4. Do all fibroids need treatment? “There are no specific treatment guidelines in terms of size, location or number of fibroids,” Dr. Srouji says. “These decisions depend on symptoms.” If you don’t have any symptoms – such as heavy menstrual bleeding, pain during sex, frequent urination, constipation and abdominal bloating – fibroids don’t require treatment. If your fibroids are asymptomatic, they won’t cause other health problems, Dr. Curtis says. 5. Why do fibroids make my periods heavier? If the fibroid is inside the uterus, it increases growth of endometrial tissue that’s normally shed during menstruation, says Pasquale Patrizio, M.D., director of the Yale Fertility Center. 6. Can heavy bleeding cause other problems? Sometimes it can lead to iron loss and anemia. Iron makes hemoglobin, the protein that turns blood red and allows it to carry oxygen throughout your body. With a deficiency, you can feel weak, cold, dizzy and irritable. If iron-deficiency anemia is suspected, your doctor should check iron levels in your blood. Low levels are treated with iron supplements to improve strength. 7. Can fibroids affect my ability to have children? Fibroids alone rarely cause infertility, Dr. Curtis says. If they do, it’s often because of their location. A fibroid in the uterine wall can distort the uterus and prevent an embryo from implanting, resulting in first-trimester miscarriages. Or it can block or distort the fallopian tubes so the sperm and egg can’t get through. Removing the fibroid will fix both problems. 8. Do I need to have fibroids removed to become pregnant? Not necessarily. “If a woman [who wants to become pregnant] is diagnosed with a fibroid, we tell her to try getting pregnant,” Dr. Curtis says. “If she can’t, or if she has repeated miscarriages after a year, we may recommend removing the fibroid.” If you get pregnant and the fibroid is obstructing the cervix, your doctor may recommend a Cesarean delivery. 9. Do I need surgery to remove my fibroids? If your symptoms are limited to heavy bleeding, birth control pills or a progesterone intrauterine device (IUD) can reduce your flow. So can other less-invasive procedures, like endometrial ablation. But these aren’t recommended for women who want to get pregnant because they change the uterine lining: Uterine artery embolization (UAE). This procedure is commonly done when excessive menstrual bleeding (menorrhagia) is the primary symptom and the surgical risk is judged unacceptable or the patient declines surgery, Dr. Curtis says. A radiologist inserts a catheter tube through a small groin incision, then finds and catheterizes uterine arteries and inserts small, nonradioactive particles. These form a clot to stop blood flow to the fibroid, making it shrink. (There’s radiation from the imaging used to guide the radiologist during the procedure. It’s comparable to two chest CT scans.) Many women are hospitalized for 1-2 days after this procedure for pain, Dr. Curtis says. You may feel severe cramps lasting more than six hours at a time. While the procedure is considered safe, it’s not known if the radiation exposure causes any long-term effects. Endometrial ablation. This technique works for only fibroids in the uterine lining. Gynecologists use heat, cold or high-energy radiofrequencies to burn, scar or remove the uterine lining, destroying fibroids in that area and reducing menstrual bleeding. It’s usually done as an outpatient procedure, and women recover in 1-2 days. Some side effects, such as cramping, nausea and vaginal discharge, can last a week or two. 10. What are options to preserve my fertility? Your gynecologist can perform a myomectomy, an operation to remove the fibroids. This is often done through a minimally invasive abdominal incision, such as a laparoscopy, in which a thin instrument is inserted into the abdominal wall. In some cases, it’s possible to insert an instrument (known as a hysteroscope) through the vagina into the uterus to shave down the fibroid. This is an option when fibroids are just underneath the uterine lining and there aren’t many in the uterus’ muscle wall. Because the fibroid isn’t fully removed with this procedure, and they’re fueled by estrogen, it’s likely to grow back within 3-5 years if you’re still menstruating. 11. Will this get rid of severe symptoms? If symptoms are severe or the fibroid is large, your gynecologist may prescribe gonadotropin-releasing hormone (Gn-RH) agonists. These drugs mimic menopause, reducing the amount of estrogen in the body. “Estrogen is fibroid food,” Dr. Patrizio says. “They shrink in its absence.” That’s why fibroids shrink when women enter menopause naturally. This treatment can shrink large fibroids so they’re easier to remove. It will also stop bleeding so an anemic woman can gain back strength before surgery. Gn-RH agonists can’t be used alone for more than 6 months, however, because side effects include bone loss, which can lead to osteoporosis. Other side effects are similar to those of menopause, including hot flashes and vaginal dryness. 12. Is there a way to get rid of fibroids permanently? A hysterectomy – surgery to remove the uterus – is the only permanent solution. If you have persistent problems and don’t plan to get pregnant, ask your gynecologist whether it’s right for you. 13. What are my options for a hysterectomy? You have several choices, all of which are covered by most health insurance plans. Recovery time is 4-6 weeks: Vaginal hysterectomy: The uterus is removed through the vagina. This isn’t an option if your uterus is enlarged or there’s scarring from previous surgeries. If that’s the case, you’ll have to have one of the options below. Abdominal hysterectomy: An incision, either vertical or horizontal, is made in the abdominal wall. This option may be necessary if the uterus is large. Laparoscopic hysterectomy: A thin, lighted tube with a camera is inserted through small abdominal incisions. This surgery takes longer than abdominal surgery, requiring more time under general anesthesia, but you’re left with a smaller scar. 14. Are there new treatments being developed? Magnetic resonance-guided focused ultrasound ablation was approved by the Food and Drug Administration in 2004 and is available at some large teaching hospitals. This outpatient technique – with local anesthesia and a sedative – is typically used to treat uterine-wall fibroids that are larger than 3 centimeters. Because it’s expensive, not covered by insurance (the other treatments mentioned are) and isn’t suitable unless your fibroids are large, it’s not available at most hospitals. Single-treatment sessions last about three hours, and about 50% of women require a second-treatment session within 12 months, Dr. Curtis says. “But patients are able to return to normal daily activities the day after the procedure,” she adds. 15. How does this treatment work? A radiologist uses magnetic resonance imaging (MRI) to locate the tumor and a highly focused ultrasound heat beam to kill and remove fibroid cells. It can be painful, but most patients return to their regular activities the next day. Because this procedure destroys some uterine tissue, it could hurt fertility, so doctors don’t recommend it for women who want to become pregnant. Although the beam is targeted, it also can damage nearby tissue, so it’s not recommended for fibroids near other organs, such as the bowel. Because this procedure is so new, there aren’t any long-term studies of risks and benefits. 16. If I have my fibroids surgically removed, are they gone for good? Those fibroids won’t grow back – but new ones can. Within five years of fibroid removal, about 50% of women develop new tumors, Dr. Srouji says. But because they differ in size and location, they might not require the same treatment. Consult your doctor if you think you’re experiencing fibroids.

Need Low Back Pain Treatment? Just Say ‘Om’ 6 Yoga Exercises for Chronic Back Pain

Is your aching back making even the simplest movement difficult and painful? Yoga – offering pain relief through stretching, strengthening and de-stressing – is a great low back pain treatment. Here are 6 gentle ways to use yoga for back pain. The key? Go slowly and breathe deeply... Chronic back pain may be partly in your head. "Back pain is a classic mind-body problem,” says Vijay Vad, M.D., sports medicine specialist at the Hospital for Special Surgery in New York City, author of Back Rx (Gotham), and host of the PBS special "Stop Back Pain." That's why it’s so hard to get lower back pain relief through conventional medicine – typically a combination of physical therapy, anti-inflammatory medications and/or narcotics. It's also what makes yoga, which uses deep breathing to reduce stress, such a powerful back-healing tool. "For every 10 people I treat for chronic back pain, only one or two of them have a purely physical issue, such as a damaged disk, pinched nerve or spasming muscle," Dr. Vad says. Besides those two, he adds, a couple more have a purely psychological issue, such as stress, triggering their chronic low back pain, and the rest have a combination of the two. Yoga can work on all three, according to a 2009 randomized control study at West Virginia University. Researchers found that bi-weekly yoga sessions resulted in significant reductions in pain, use of pain medication, functional disability, and depression – and these benefits lasted up to six months after classes ended. To use yoga to treat your back pain, Dr. Vad recommends doing the following six exercises three times a week for 15-20 minutes, breathing deeply – so that the belly expands with each inhale – as you do them. "Exercise and deep breathing increase blood flow, delivering oxygen and nutrients to discs, which helps them heal," Dr. Vad says. Consult your physician before starting and expect soreness in the first 2-3 weeks. That's because the muscles in your back have likely been frozen in a perpetual spasm, and these exercises call on those muscles to release and start working again. Don't walk in to any yoga class during a flare-up and expect to keep up with a vigorous sequence of poses. But by week 8, you should see noticeable lower back pain relief, Dr. Vad says. "If you stick to it, the long-term benefits far outweigh the early discomfort," he says. The first week, start by doing any three of the following poses in each of your sessions, making sure to incorporate the two reclined poses included here. The second week, do all six poses in each session. Try to hold each stretch for 5-7 breaths, breathing slowly and fully through the nose. Lower back pain relief pose #1: Lumbar Rotation with Leg Crossed What it does: Stretches the outer leg and muscles that support the lower spine. How to do it: Lie on your back with legs straight and arms outstretched in a T. Slowly bend your left leg and drag the left foot along the floor until it rests next to your right knee. Inhale and allow your left knee to fall across your body to the right. With each exhale, let gravity pull your left knee closer to the floor. Hold for 4-6 more breaths. Return to the starting position, then repeat with the right leg bent. Lower back pain relief pose #2: Seated Forward Bend with Straight Legs What it does: Stretches the hamstrings and lower back muscles. How to do it: Sit on the floor with legs outstretched. Inhale and lengthen and lift up the spine gently. Exhale and bend forward at the hips, reaching fingers toward your toes. Hold 4-6 more breaths, gradually reaching your fingers closer to your toes. Only go as far as feels comfortable. Return to sitting up straight on an inhale. Lower back pain relief pose #3: Seated Twist with One Knee Bent What it does: Stretches the outer hip and muscles that support the lower and middle spine. How to do it: Sit on the floor with both legs straight. Bend the right knee and place your right foot on the floor outside the left knee. Place your right hand on the floor behind your right hip for support. Inhale and lift the spine tall. Exhale and rotate your torso to the right, placing your left elbow on the outside of your right knee. Place your right hand on the floor for a deeper twist. Turn your head to look over your right shoulder. Hold 4-6 breaths. Return to the starting position, then switch legs and twist to the left. Lower back pain relief pose #4: Seated Bound Angle What it does: Stretches the hips and inner thighs. How to do it: Sit upright with both legs straight. Bend both knees and bring the soles of your feet together. Gently grasp your ankles with your hands. Inhale and lift the chest. Exhale and round forward over the legs. Hold 4-6 more breaths. Return to sitting on an inhale. Lower back pain relief pose #5: Cross-Legged Seated Forward Bend What it does: Stretches the hips and lower back. How to do it: Sit on the floor in a comfortable cross-legged position. Inhale and lift up your spine tall. Exhale and fold your torso forward over your hips, walking your hands out as far as you can comfortably reach. Keep your spine extended to minimize hunching the shoulders. Hold 4-6 more breaths. Inhale to return to the starting position. Change the cross of your legs so that the opposite leg is in front and repeat. Lower back pain relief pose #6: Reclined No. 4 Stretch What it does: Stretches the outer hips and hamstrings. How to do it: Lie on your back with both knees bent, feet on the floor. Rest your right ankle on your left knee as you inhale. Grasp the back of your left thigh and gently draw the left knee in toward your chest as you exhale. Hold 4-6 more breaths, then repeat with the left ankle resting on the right knee. How Bad Is Your Back Pain?