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What is hypothyroidism?

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Hypothyroidism is when the thyroid gland does not produce enough thyroid hormones to meet the needs of the body. The thyroid is underactive.

The opposite is hyperthyroidism, where the thyroid produces too much thyroid hormone. However, the link between hyperthyroidism and hypothyroidism is complex, and one can lead to the other, in certain circumstances.

Thyroid hormones regulate metabolism, or the way the body uses energy. If thyroxine levels are low, many of the body’s functions slow down.

About 4.6 percent of the population aged 12 years and above in the United States has hypothyroidism.

The thyroid gland is found in the front of the neck below the larynx, or voice box, and has two lobes, one on each side of the windpipe.

It is an endocrine gland, made up of special cells that make hormones. Hormones are chemical messengers that relay information to the organs and tissues of the body, controlling processes such as metabolism, growth, and mood.

The production of thyroid hormones is regulated by thyroid-stimulating hormone (TSH), which is made by the pituitary gland.

This, in turn, is regulated by the hypothalamus, a region of the brain. TSH ensures that enough thyroid hormones are made to meet the needs of the body.

Fast facts on hypothyroidism

  • The thyroid gland produces two thyroid hormones, TS3 and TS4.
  • These hormones regulate the body’s metabolism.
  • The most common cause of hypothyroidism in the U.S. is Hashimoto’s disease.
  • Symptoms of hypothyroidism include fatigue, cold intolerance, and joint and muscle pain.


Hypothyroidism refers to the underproduction of hormones in the thyroid gland. It has a wide range of symptoms.

Thyroid hormones affect multiple organ systems, so the symptoms of hypothyroidism are wide-ranging and diverse.

The thyroid creates two thyroid hormones, triiodothyronine (T3) and thyroxine (T4). These regulate metabolism, and they also affect the following functions:

  • brain development
  • breathing
  • heart and nervous system functions
  • body temperature
  • muscle strength
  • skin dryness
  • menstrual cycles
  • weight
  • cholesterol levels

Symptoms of hypothyroidism commonly include, but are not limited to:

  • fatigue
  • weight gain
  • cold intolerance
  • slowed heart rate, movements, and speech
  • joint and muscle pain, cramps, and weakness
  • constipation
  • dry skin
  • thin, brittle hair or fingernails
  • decreased sweating
  • pins and needles
  • heavy periods, or menorrhagia
  • weakness
  • high cholesterol
  • puffy face, feet, and hands
  • insomnia
  • balance and co-ordination issues
  • loss of libido
  • recurrent urinary and respiratory tract infections
  • anemia
  • depression

If left untreated, the following symptoms can manifest:

  • hoarseness
  • puffiness in the face
  • thinned or missing eyebrows
  • slow heart rate
  • hearing loss

If it develops in children or teenagers, the signs and symptoms are generally the same as adults.

However, they may also experience:

  • poor growth
  • delayed development of teeth
  • poor mental development
  • delayed puberty

Hypothyroidism develops slowly. Symptoms may go unnoticed for a long time, and they may be vague and general.

Symptoms vary a great deal between individuals, and they are shared by other conditions. The only way to obtain a concrete diagnosis is through a blood test.


Treatment for hypothyroidism focuses on supplementing the thyroid hormone. At present, doctors cannot cure hypothyroidism but they can help people to control it in most cases.

Synthetic thyroxine

To replenish levels, doctors usually prescribe synthetic thyroxine, a medication that is identical to the T4 hormone. Doctors may recommend taking this in the morning before eating each day.

Dosage is determined by the patient’s history, symptoms, and current TSH level. Doctors will regularly monitor the patient’s blood to determine if the dosage of synthetic T4 needs to be adjusted.

Regular monitoring will be required, but the frequency of blood tests will likely decrease over time.

Iodine and nutrition

Iodine is an essential mineral for thyroid function. Iodine deficiency is one of the most common causes of goiter development, or abnormal enlargement of the thyroid gland.

Maintaining adequate iodine intake is important for most people, but those with autoimmune thyroid disease can be particularly sensitive to the effects of iodine, meaning that it can trigger or worsen hypothyroidism.

They should inform their doctor if they are sensitive to the effects of iodine.

People with hypothyroidism should discuss any major dietary changes with their doctor, especially when starting a high fiber diet, or eating lots of soy or cruciferous vegetables.

Diet can affect the way in which the body absorbs thyroid medication.

During pregnancy, iodine requirements increase. Using iodized salt in the diet and taking prenatal vitamins can maintain the required levels of iodine.

Iodine supplements are available for purchase online.

Hypothyroidism can normally be managed appropriately by following the advice of a qualified healthcare practitioner. With appropriate treatment, thyroid hormone levels should return to normal.

In most cases, medications for hypothyroidism will need to be taken for the rest of the patient’s life.


There is no way to prevent hypothyroidism, but people who may have a higher risk of thyroid problems, for example, women during pregnancy, should check with their doctor about the need for additional iodine.

Screening is not recommended for those who do not have symptoms, unless they have the following risk factors:

  • a history of autoimmune disease
  • previous radiation treatment to the head or neck
  • a goiter
  • family history of thyroid problems
  • use of medications known to affect thyroid function

These people can be tested for early signs of the condition. If tests are positive, they can take measures to prevent the disease from progressing.

There is no evidence that a particular diet will prevent hypothyroidism, and there is no way to prevent hypothyroidism unless you live in a region with low iodine levels in the diet, for example, some parts of Southeast Asia and Africa.


No specific diet is recommended for hypothyroidism, but individuals should follow a varied, well-balanced diet that is not high in fat or sodium.

In addition, those with autoimmune Hashimoto’s may benefit from following a gluten-free diet. Research suggests a linkTrusted Source between celiac disease and autoimmune thyroid disease, and both have inflammatory components. Avoiding gluten may help in nonceliac autoimmune diseases, but it is important to speak to a doctor first before cutting out foods that contain gluten.

Other foods and nutrients may be hazardous, especially if consumed in large quantities.

These include:

  • soya, as it can affect thyroxine absorption
  • iodine, found in kelp and other seaweeds, and in supplements, including some multivitamins
  • iron supplements, as they can affect thyroxine absorption
  • cruciferous vegetables, such as cauliflower, kale, and cabbage may contribute to a goiter, but only in very large amounts

Consuming additional iodine can interfere with the balance involved in treatment. If hyperthyroidism develops, iodine can be hazardous.

Any changes to diet or supplementation should be discussed with a doctor.


Hypothyroidism can occur if the thyroid gland fails to work properly, or if the thyroid gland is not stimulated properly by the hypothalamus or pituitary gland.

Hashimoto’s thyroiditis

The most common cause of hypothyroidism in the U.S. is Hashimoto’s thyroiditis, also known as chronic lymphocytic thyroiditis or autoimmune thyroiditis.

Hashimoto’s thyroiditis is an autoimmune disease, a disorder in which the immune system attacks the body’s own cells and organs.

The condition causes the immune system to attack the thyroid gland, leading to inflammation and interfering with its ability to produceTrusted Source thyroid hormones.


Thyroiditis is an inflammation of the thyroid gland. It causes thyroid hormones to leak into the blood, raising their overall levels and leading to hyperthyroidism. After 1 to 2 months, this may develop into hypothyroidism.

Thyroiditis can be caused by viral or bacterial infection, an autoimmune condition or following pregnancy.

Congenital hypothyroidism

In cases of congenital hypothyroidism, the thyroid gland does not function properly from birth.

This can lead to physical and mental growth problems, but early treatment can prevent these complications. Most newborns in the U.S. are screened for hypothyroidism.

Thyroid surgery and treatment as causes of hypothyroidism

Hypothyroidism after thyroid surgery.
Hypothyroidism can occur after part of the thyroid is removed during surgery.

Thyroid treatment and surgery can lead to hypothyroidism.

Several conditions such as hyperthyroidism, goiters, thyroid nodules, and thyroid cancer can be treated by partially or fully removing the thyroid gland. This may result in hypothyroidism.

Radiation treatment of the thyroid can also lead to hypothyroidism. Radioactive iodine is a common treatment for hyperthyroidism. It works by destroying the cells of the thyroid gland and decreasing the production of T4.

Radiation is also used to treat people with head and neck cancers, Hodgkin’s disease, and other lymphomas, which can lead to damage of the thyroid gland.


A number of drugs can interfere with thyroid hormone production. These include amiodarone, interferon alpha, interleukin-2, lithium, and tyrosine kinase inhibitors.

Pituitary gland abnormalities

If the pituitary gland stops functioning properly, the thyroid gland may not produce the correct amount of thyroid hormone.

Pituitary tumors or pituitary surgery can affect the function of the pituitary gland, and this can adversely affect the thyroid gland.

Sheehan’s syndrome is a condition that involves damage to the pituitary gland.

If a woman loses a life-threatening amount of blood or has severely low blood pressure during or after childbirth, the gland can be damaged, causing it to under-produce pituitary hormones.

Iodine imbalance

Iodine is needed for the production of the thyroid hormones, but the level must be balanced. Too much or too little iodine can lead to hypothyroidism or hyperthyroidism.MEDICAL NEWS TODAY NEWSLETTERKnowledge is power. Get our free daily newsletter.

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Natural remedies

Some natural remedies are proposed for hypothyroidism, but it is important to speak to a doctor first, because the treatment for thyroid problems must be delicately balanced.

Selenium: People with some types of thyroid problem may benefit from taking selenium, but this should only be used after discussing it with a doctor. Researchers note that “either the deficiency or the excess of this micronutrient may be associated with adverse outcomes.” Selenium supplements that are not recommended by a health professional could be hazardous.

Vitamin D: A deficiency has been linked with severity of disease in Hashimoto’s. Supplementation may be necessary to reach beneficial vitamin D blood levels above 50 ng / dL.

Probiotics: Some people with hypothyroidism may have changes in the small intestine, where bacteria from the colon spread into the small intestine where they are not normally located, known as small intestine bacterial overgrowth (SIBO).

In one studyTrusted Source, 40 patients had abnormal results on a glucose breath test. After taking the probiotic Bacillus clausii for one month, the test result for 19 participants was normal. Both antibiotics and probiotics have been shown effective for SIBO.

Additionally, for those with autoimmune and inflammatory thyroid conditions, supplements such as turmeric (containing at least 500 mg curcumin) and omega-3s may help to improve inflammation.


Doctors usually carry out a physical examination, take a medical history, and sent to a laboratory for analysis.

The most common blood test is the TSH test. This detects the amounts of TSH in the blood.

If the TSH reading is above normal, the patient may have hypothyroidism. If TSH levels are below normal, the patient may have hyperthyroidism or hypothyroidism.

The T3, T4, and thyroid autoantibody tests are additional blood tests used to confirm the diagnosis or determine its cause.

The doctor may run a complete thyroid panel, testing levels of T3 and T4, TSH, and thyroid autoantibodies in order to fully establish the health and activity of the thyroid gland.

There may also be tests to check cholesterol levels, liver enzymes, prolactin, and sodium.

Risk factors

Apart from some disorders and medications, other risk factors include:

People have a greater risk of developing a thyroid disorder if they have conditions such as Turner syndrome or autoimmune diseases like lupus or rheumatoid arthritis.

The risk of hypothyroidism is higher in people with a family history of thyroid disease and those aged over 60 years.

It most commonly affects women from middle age onward, but it can occur at any age.

During and after pregnancy

Hypothyroidism pregnancy
Pregnancy can be a cause of hypothyroidism.

Increased demands on metabolism during pregnancy results in increased demands on the thyroid.

In one study, 85 percent of women who are pregnant and taking thyroid hormone replacement needed an additional intake of 47 percent on average, during pregnancy.

If hypothyroidism occurs during pregnancy, it is usually due to Hashimoto’s thyroiditis. This condition affects between 3 and 5 out of every 1,000Trusted Source women during pregnancy.

Uncontrolled hypothyroidism increases the risk of miscarriage, preterm delivery, and a rise in blood pressure during late pregnancy, or preeclampsia.

It can also affect brain development and growth rates.

Last medically reviewed on January 2, 2018

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Medically reviewed by Natalie Butler, R.D., L.D. — Written by James McIntosh on January 2, 2018

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Can transgender women have a period?

Transgender women may undergo gender-affirming treatment, such as hormone therapy. As a side effect of hormone therapy, they may experience symptoms similar to those of premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD).

While some symptoms of PMS and PMDD are physical, others are emotional or psychological.

In this article, we discuss whether trans women can experience symptoms similar to those of PMS. We also look at the symptoms that can result from hormone therapy and provide tips on how to track them.

Is it possible?

A person lying down who may be experiencing period-like symptoms.
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The United Kingdom’s National Health Service (NHS) states that a period is the part of the menstrual cycle in which blood, comprising uterine lining, leaves the body. People who do not have ovaries and a uterus do not experience periods.

However, PMS and PMDD are terms that refer to the physical and emotional symptoms that people may experience before their period begins. These conditions occur due to fluctuations in hormones.

The symptoms of PMDD are similar to those of PMS but are more severe.

Learn more about how PMDD and PMS differ here.

Transgender women can transition in a variety of ways. One way that a person may transition is through the use of gender-affirming hormone therapy.

Transgender women who undergo hormone therapy may take oral, transdermal, or injectable versions of estrogen. They may also use anti-androgens, such as progesterone.

The anti-androgen that healthcare professionals most commonly prescribe is spironolactone, although they may also prescribe progesterone.

Hormone therapy for transgender women aims to help alleviate gender dysphoria in several ways, includingTrusted Source:

  • changing how the body distributes fat
  • promoting breast growth
  • reducing male pattern hair growth

Estrogen can affect the body in various ways, and transgender women may experience several side effectsTrusted Source while taking supplemental estrogen. Progesterone can also cause side effects.

Although researchers have not studied this area of trans health, the International Association for Premenstrual Disorders (IAPD) notes that the hormones may cause symptoms similar to those of PMDD.

Therefore, while transgender women will not experience the bleeding part of the menstrual cycle, they can experience other PMDD-like symptoms, such as sore breasts, rapid mood shifts, and irritability.

How do trans women experience PMS-like symptoms?

Anecdotal evidence suggests that transgender women experience PMS- or PMDD-like symptoms at the same time each month. However, researchers have not studied this area of transgender health.

The IAPD suggests that some transgender women may be more sensitive to estrogen hormones than others. This increased sensitivity may lead to PMDD-like symptoms.

Emotional and psychological experiences

Some transgender women report emotional and psychological symptoms similar to those of PMS.

The Office on Women’s Health note that these symptoms can include:

  • irritability
  • tiredness
  • sleeping too much or too little
  • appetite changes
  • anxiety
  • rapid changes in mood
  • loss of interest in sex

Both progesterone and estrogenTrusted Source can cause irritability and rapid mood shifts. Estrogen injections can also cause other symptoms, including anxiety, because they lead to high, fluctuating levels of estrogen.

Physical experiences

The possible physical symptoms of PMS in women include:

  • swollen or tender breasts
  • bloating
  • cramping
  • headaches
  • gastrointestinal symptoms, such as nausea
  • appetite changes

Some transgender women may experienceTrusted Source some of these symptoms, including headaches and swollen, tender breasts, as a result of hormone therapy.

Tips for tracking PMS-like symptoms

Trans women can track their symptoms in several ways, the most simple of which is to keep a diary. People can note down which symptoms they experience when, which may help them discover any patterns.

Another option is to use a period-tracking app. Several free and inclusive apps allow people to input a variety of symptoms. After a few cycles, the app can begin to estimate when a person will experience symptoms.

It is important to discuss any adverse symptoms or changes with a healthcare professional. Tracking their symptoms may help people determine what is usual for them and what is not.MEDICAL NEWS TODAY NEWSLETTERKnowledge is power. Get our free daily newsletter.

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How to be an ally

There are many ways to be an ally to people who are transgender.

Do not make assumptions about a person’s gender or sexual orientation

People should only use the pronouns that an individual uses when introducing themselves. Anyone who is not sure should ask the person rather than risk misgendering them.

It is also important to remember that people who are transgender can be heterosexual, gay, lesbian, or bisexual or have another romantic or sexual orientation.

People should not assume that those who are transgender automatically have a certain sexual orientation.

Do not ask a person what their ‘real name’ is

Many people who are transgender change their name to one that reflects who they are, rather than using the name that they received at birth. It is important to use the name that the person introduces themselves with unless they say otherwise.

People should also avoid asking a person who is transgender what their “real name” is. This question implies that the name they have given is not who they are, invalidating them.

Learn more about deadnaming here.

Do not assume a person has to transition in a certain way to be transgender

People may transition in different ways. Some people may transition socially, whereas others may transition with the help of gender-affirming procedures, such as hormones and surgery.

It is important never to say that a person is not transgender because they have not transitioned using a certain method.

Similarly, people should never ask a person who is transgender what genitals they have or ask invasive questions about their sex life. These questions are generally inappropriate to ask anyone, and transgender people are no exception.

Advocate for inclusivity

It is important to advocate for inclusivity as an ally. Working with and listening to those who are transgender can help people come up with suggestions to make schools, workplaces, and other areas more inclusive.

Be open to education

Allies do not know everything there is to know about people who are transgender. They should always be open to learning more from transgender people, who will have more knowledge than them of certain topics.

An ally should never assume that they know more about trans health and trans life than a person who is transgender.


Transgender women may experience physical, emotional, and psychological symptoms similar to those of PMS if they use hormone therapy. Hormone therapy can have multiple side effects, such as breast tenderness and rapid changes in mood.

People can track their symptoms in a variety of ways. Doing this may help them recognize when certain symptoms are unusual for them.

Last medically reviewed on April 27, 2021

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FEEDBACK:Medically reviewed by Emelia Arquilla, DO — Written by Veronica Zambon — Updated on May 13, 2021

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Hormonal acne: What you need to know

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Hormonal acne is usually known simply as acne. Another term for the skin condition is acne vulgaris.

It is sometimes called hormonal acne because of the way the skin problem develops in response to hormonal changes, and especially a rise in androgens, such as testosterone.

The rise in androgen levels can trigger a processTrusted Source of higher sebum production, changes in skin cell activity, inflammation, and colonization of the hair follicles by a bacteria known as Propionibacterium acnes (P. acnes). This can lead to acne.

Acne lesions or zits of varying severity typically affect the face and upper body. Acne is a common and treatable condition.

What is acne?

Mild acne
Mild acne affects many people during adolescence, and it can persist through adulthood.

Acne is a condition of the skin.

It happens when the body makes excess sebum, an oil that stops the skin from drying out, and this clumps together with dead skin cells in a pore. Where the clogging occurs, an acne lesion or zit can form.

The lesions in the skin formed by acne include comedones, which can be open or closed plugs that form at the base of hairs.

Other types of lesion include:

  • papules
  • pustules
  • nodules
  • cysts

These four types of lesions, of increasing size and severity, form when bacteria become involved with the plugs. The bacteria cause an inflammatory response from the immune system.

Acne is the most common skin condition in the United States. The American Academy of Dermatology (AAD) estimate that at any one time, there may be as many as 50 million people in the United States who have acne.

What is hormonal acne?

Hormonal acne is not a term used in medical research or by doctors, but it may be used on the internet, in glossy magazines, or by people selling natural remedies.

This article assumes hormonal acne simply to mean acne. One reason people may call it hormonal acne is to link it to the fact that it is most common in teenagers going through the hormonal changes of puberty.


Acne symptoms can include:

Whiteheads and blackheads are not inflamed and do not cause pain or swelling. If they become inflamed, they can become cysts or pustules. Inflamed lesions can be painful, sore, and red. The lesion and the area around it may be raised.

Lesions often appear on the:

  • face
  • neck
  • back
  • shoulders
  • chest

They are more likely to appearTrusted Source on the forehead than the other parts of the face, such as the cheeks, because sebum levels are higher in this area.

Depression can be a complication of acne, because of the impact on self esteem.

Acne is thought to affect 80 percentTrusted Source of people between the ages of 11 and 30 years, and especially from 14 to 19 years. Some people continue to experience acne after the age of 30 years.

During pregnancy and around menopause, hormonal changes can again cause acne to affect women.


There are four main factors behind the formation of acne lesions. Hormones are one major factor, which may be why some people call it hormonal acne.

The four components of acne involve the units at the base of hairs in the skin:

1. Production of the hormone testosterone rises during puberty. This causes greasy skin because it increases production of sebum, the oily substance secreted at the base of hairs to protect and lubricate the skin

2. The hair follicles become blocked, forming comedones or “clogged pores.” The overproduction of skin cells that would usually be pushed up and lost from the surface also adds to this process.

3. The comedones can be made worse by bacterial infection.

4. The immune system reacts to the bacteria, resulting in inflammation.

Not all acne is inflammatory. Simple comedones — blackheads and whiteheads — may not be inflamed. Pimples called papules, pustules, nodules, and cysts — in order of rising severity — are inflamed.

The role of hormones in acne formation

Acne may be known as hormonal acne because one major causative factor is the hormone testosterone.

Testosterone levels go up in the teenage years as part of puberty. This causes male development in boys and gives muscle and bone strength in girls.

The hormone also has the effect of increasing sebum production at the base of hairs. This is because the glands that secrete the oil are sensitive to testosterone.

Other hormones play a part in acne, too. For women, hormonal changes relating to pregnancy or the menstrual cycle can also trigger acne. Falling estrogen levels may increase the risk of acne around menopause.

The role of progesterone remains unclear.

Conditions that affect hormone levels, for example polycystic ovary syndrome (PCOS) can triggerTrusted Source acne.

Acne in menopause

According to the AAD, growing numbers of women are reporting acne beyond their teenage years and into their 30s, 40s, and 50s. Most cases of adult female acne are mild to moderate.

Most adult female acne is persistent, continuing on from puberty after the age of 24 years, but between 20 and 40 percentTrusted Source of cases start after puberty.

It is not clear why this is so, but some life changes can cause a flare-up.

Hormonal fluctuations can lead to acne in pregnancy and around the time of menopause.

Researchers note that women who experience acne around menopause usually have androgen levels within the normal range, but falling estrogen levels.

It may be this imbalance that gives rise to acne flares. As hormone reach a “tipping point,” the new hormonal ratios lead to additional stimulation of the sebaceous glands, triggering outbreaks.

Severity of acne

Severe acne
Severe acne is when inflammation occurs and there are many lesions. Medication may be prescribed.

Acne can be mild, moderate, or severe.

Existing classfications suggest that:

Mild acne involves mostly blackheads and whiteheads and does not usually need any help from doctors. There are fewer than 20 comedones, or 15 inflammatory lesions, or a total of 30 lesions.

Moderate acne involves both inflamed and non-inflamed lesions, some of which may leave scars. Tthere are 20 to 100 comedones, or 15 to 50 inflammatory lesions, or a total of 30 to 125 total lesions

Severe acne features widespread inflamed lesions. It can impact both appearance and self-esteem, and it can cause scars.

All forms of acne can be distressing.

Even mild acne can affect a person’s self esteem. This is not only due to its appearance, but also the fact that it often affects young people when they begin developing relationships.

Myths about what causes acne

There are many myths about the causes of acne.

There is no evidence that any of the following cause acne:

  • poor hygiene
  • chocolate and other diet factors, including nuts or greasy foods
  • masturbation or sex

Some research has found weak links between acne and milk products – and especially skim milk.

There is also evidence linking acne with diets that contain lots of foods with a high glycemic index. These include simple carbohydrates, found in white bread, chips, and white potatoes, and sugary drinks.

These foods can increase blood sugar levels, and this may have an impact on hormone levels that then impact the risk of developing acne.MEDICAL NEWS TODAY NEWSLETTERKnowledge is power. Get our free daily newsletter.

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Natural treatment

Herbal medicines are examples of complementary and alternative treatments for acne. These are usually harmless, but there is a Examples used include tea tree oil and clove basil.

Practical tips for people with acne

Self-care advice for acne may help with the problem, or avoid making it worse.

Avoid picking spots
People should avoid picking or touching spots, but wash the skin gently twice a day.

Tips include:

  • gentle daily washing no more than twice a day and after sweating
  • using mild soaps or cleansers and warm water, not hot water
  • not using harsh or exfoliating scrubs
  • avoiding scrubbing, picking, or scraping pimples, as doing so can make them worse and can cause inflammation
  • people should avoid makeup, or use water-based cosmetics that are marked as non-comedogenic sparingly
  • where possible, avoiding environments with high humidity that cause excessive sweating

Over-washing is not good for acne.

Too much washing and scrubbing can remove oil from the skin and irritate it more. The skin can respond by producing more oil and so worsening the acne.


Acne is treated according to severity. Mild acne can be treated with over-the-counter products as well as with medicines offered by doctors.

There is no quick-fix treatment for acne. All treatments take weeks to show effect.

Over-the-counter treatment

Mild acne treatments available without prescription include antibacterial skin cleansers. There is no evidence that acne is caused by poor hygiene, however.

Benzoyl peroxide is a topical drug available over-the-counter that may help. Other non-prescription drugs are available but with less evidence for good effect.

While using medications to treat acne, people should avoid direct sunlight and tanning beds, as the skin may be more sensitive to UV light at this time.

Various products for treating acne are available for purchase online.

Treatment for moderate and severe acne

Doctors can help people whose acne involves more severe pimples that may lead to scarring.

Moderate acne may be treated with oral antibiotics. Examples are:

  • tetracycline
  • minocycline
  • erythromycin
  • doxycycline

Antibiotics for acne typically need to be continued for 3 months for full results. Topical antibiotics as well as the oral antibiotics may be prescribed as well.

Women with moderate acne who do not respond to oral antibiotics may be prescribedTrusted Source anti-androgen hormone therapy or birth control medication.


Severe acne may require prescription treatment, for example, the drug isotretinoin.

This is an oral treatment that needs to be taken for 16 to 20 weeks. It is very effective against severe acne, but it has side effects, and its use has to be monitored.

It is crucial not to use isotretinoin if you are planning on becoming pregnant or if you are or could be pregnant, as there is a risk to the unborn child.

Women must have a pregnancy test before starting the medication and use reliable contraceptives before and during its use.

Sexually active women of childbearing age must use two forms of contraception before, during, and after treatment with isotretinoin.

People with severe acne who need to use isotretinoin must be referred to a dermatologist who is registered with the U.S. Food and Drug Administration (FDA) monitoring program for the drug.

Cystic acne and triamcinolone

The most severe form of acne is cystic acne, which may be treated with a corticosteroid injection called triamcinolone. This injection into the lesion aims to reduce scarring caused by the inflammation.

Other procedures

A dermatologist may recommend or use one or a combination of the following:

  • lasers and light therapy
  • chemical peels
  • drainage and extraction to remove a cyst

An injection with medication can decrease the size of a large cyst if there is a need to do so quickly.

Hormonal therapy for adult women with acne

Treatment for acne in adult women is the same as for other people. Further options include hormone therapy.

These include the contraceptive pill as it can help to clear acne in women. Those approved by the FDA contain ethinyl estradiol.

An oral contraceptive can be used alone or with an anti-androgen medication.

Oral contraceptive pills should not be used by those with certain health conditions.

These include:

As with isotretinoin, those using hormonal therapies will need regular monitoring to ensure the safety of the treatment.

When to see a doctor

A doctor who specializes in skin conditions called a dermatologist needs to be seen for severe acne.

People are advised to see a doctor and perhaps a specialist dermatologist if:

  • they have a lot of acne
  • there are severe lesions
  • there is a risk of scarring
  • acne could affect pigmentation

If the presence of acne affects a person’s daily functioning, they should also seek help.


Is it a good idea to use a chemical peel as a treatment for acne?


Chemical peels are effective in the treatment of acne but are best when used alongside other treatments as well.

Multiple treatment modalities are typically best and most effective in the treatment of acne, as rarely is there a single treatment that will completely rid an individual of acne.

Medium to deep peels are especially helpful with scarring that is caused by acne.

Last medically reviewed on July 23, 2018

 19 sourcescollapsed


Medically reviewed by Cynthia Cobb, DNP, APRN, WHNP-BC, FAANP — Written by Markus MacGill on July 23, 2018

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How fibroids affect Black women

Uterine fibroids are noncancerous growths that develop in or around the uterus. They can affect females of any age or ethnicity, but in the United States, they are more common among Black females than white females across all age groups.

This information comes from an article in Seminars in Reproductive MedicineTrusted Source.

On average, fibroids also affect Black females more severely than white females, with higher rates of severe symptoms and hysterectomy. Black women are also more likely to develop fibroids at a younger age.

This article will discuss how common fibroids are in Black females and the potential causes for this. We will also look at the symptoms, diagnosis, and treatment of fibroids.

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more

How common are fibroids in Black females?

A woman sat in a doctor's office on a bed in a blue hospital gown, waiting to discuss fibroids with a doctor..
Jose Luis Pelaez/Getty Images

In the U.S., the incidence of uterine fibroids Trusted Sourcein Black females is up to 3 times greater than among white females.

Compared with white females of similar socioeconomic status, Black females also tend to develop fibroids:

  • at a younger age – 5.3 years younger, on average
  • in greater numbers
  • of larger size
  • that cause more severe disease
  • that grow more quickly, in females aged 45 or older
  • that do not decline in growth rate with age

There are also differences in treatment and health outcomes. For example, compared with white females, Black females:

  • undergo surgical treatment at a younger age
  • receive more invasive treatment from doctors
  • have higher rates of recurrence after treatment

Black females also experience more significant outcomes for their reproductive health, including being 2.4 timesTrusted Source more likely to have a hysterectomy, which means a person can no longer get pregnant.

Learn more about recovery after a hysterectomy here.

Why are fibroids more common in Black females?

There is no firm evidence that explains why fibroids affect Black females more often and more severely than white females. This is partly because researchers are not sure what exactly causes fibroids in anyone.

There is also a lack of research on how and why fibroids develop in people of color and why invasive surgery is more common.

Researchers have suggested that the following factors may play a role in the prevalence and severity of fibroids among Black females:

Family history

Fibroids appear to be more likelyTrusted Source if a person has close relatives who also develop them. This is true regardless of race, ethnicity, or nationality.

However, there are currently no studies that have identified a genetic component in the development of fibroids in any group.

Diet and nutrition

ResearchersTrusted Source believe there may be a link between nutritionbody weight, and fibroids. People with a higher body weight may be more likely to develop them.

According to the American Psychological Association, obesity is more common among Black people in the U.S. than other groups, which could explain the higher prevalence of fibroids in Black females.

The higher rates of obesity in Black communities result from health inequity and socioeconomic inequality, which systemic racism perpetuates.

On average, predominantly Black neighborhoods have less access to fresh and healthy food or affordable, safe spaces for exercise.

Vitamin D deficiency

Some studiesTrusted Source have found a correlation between vitamin D deficiency and higher rates of fibroids. This may affect people with darker skin more than people with lighter skin because they have more melanin in their skin. Higher levels of melanin prevent the skin from synthesizing as much vitamin D from sunlight.

Taking vitamin D supplements may have a protective effect against fibroids.

Learn about vitamin D deficiency here.

Difficulty accessing healthcare

Systemic racism also makes it more difficult for marginalized groups to access quality healthcare and health insurance.

This can make seeking treatment for fibroids expensive, stressful, or in some cases, less effective, as people in rural areas may not have accessTrusted Source to the same treatments.

People in this position may avoid seeking help or wait until symptoms have become severe before reporting them.

Black females can also have difficulty getting appropriate healthcare once they do speak to a doctor. For example, a 2016 study revealed that many medical students believed in false biological differences between races, including a false perception that Black people feel less pain than white people.

This, along with other explicit or implicit biases, could explain why doctors seem more likely to recommend invasive procedures in Black females with fibroids.

Learn more about racism in healthcare.

Perceptions about periods

Heavy periods and pelvic pain are common fibroid symptoms. Individuals and healthcare professionals sometimes overlook these symptoms or believe they are a normal part of menstruation. As a result, many females do not seek treatment for fibroids for over 3 yearsTrusted Source.

2015 surveyTrusted Source on the impact that fibroids have on mental health found that half of the 60 participants felt helpless because they thought they had no control over it. Nearly 62% of the participants were African American.

Learn more about period pain and its broader impact.

Can hair relaxers cause fibroids?

There is evidence to suggest that the use of hair relaxers increases the risk of uterine fibroids.

The 1997–2009 Black Women’s Health Study assessed hair relaxer use in more than 23,000 females. Throughout the study, the researchers found a positive trendTrusted Source between hair relaxer use and fibroids.

Fibroids were more likely in participants who:

  • used hair relaxers more frequently
  • used hair relaxers long-term
  • experienced more burns on the scalp

Learn about Black hair care here.


Not everyone with fibroids experiences symptoms. When symptoms do occur, they may include:

Around 25–50% of people with fibroids will experience symptoms, and they can have a significant impact on quality of life. A national survey revealed that 28%Trusted Source of participants reported missing work due to their symptoms and that almost a quarter believed that their symptoms stopped them from reaching their full potential.

Learn more about fibroid symptoms here.

Risk factors

In addition to the factors that may particularly affect Black females, other risk factors can increase the chances of developing fibroids. These include:

  • being aged 30–40
  • beginning periods at a younger age
  • drinking alcohol

In the Black Women’s Health StudyTrusted Source, researchers noted that alcohol, particularly beer, had associations with fibroids. However, smoking cigarettes and consuming caffeine did not appear to affect the risk.

Learn about moderate drinking and how it affects the body here.


The main method of diagnosis for fibroids is an ultrasound of the uterus, either through the stomach (transabdominal) or the vagina (transvaginal). Sometimes, a doctor may recommend other imaging tests and techniques, such as:

  • a sonohysterography, which uses a saline solution to enlarge the uterine cavity before an ultrasound
  • a hysterosalpingography, which uses dye to emphasize the uterus and fallopian tubes on an x-ray
  • hysteroscopy, which involves the insertion of a small telescope and light through the cervix into the uterus
  • laparoscopy, which is similar to a hysteroscopy but involves an incision below the navel to enable the surgeon to view any fibroids that are on the outside of the uterus

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There are many different treatment options for uterine fibroids. Options include:

The “watchful waiting” approach

If fibroids are not causing symptoms or only cause mild symptoms, a person may not need any treatment. A doctor may recommend waiting to see how the fibroids progress. Sometimes, they shrink with age.


Medications that may help reduce the symptoms of fibroids include:

GnRH agonists can stop the menstrual cycle and shrink fibroids, but they have side effects. Doctors typically only prescribe them short-term.

Learn more about period symptoms that you should not ignore here.

Noninvasive or minimally invasive procedures

Several noninvasive or minimally-invasive treatment options exist for uterine fibroids. All carry the risk of the fibroids returning. Some may also affect fertility.

Therefore, individuals should talk with their doctor to determine which option is best for them. Options include:

  • endometrial ablation
  • hysteroscopic myomectomy
  • laparoscopic or robotic myomectomy
  • laparoscopic radiofrequency ablation (Lap-RFA)
  • MRI-guided focused ultrasound surgery (FUS)
  • uterine artery embolization

Learn more about fibroid surgery here.

Surgical procedures

Traditional surgical procedures include:

  • abdominal myomectomy, where the surgeon removes the fibroids during open surgery
  • hysterectomy, which removes the uterus

An abdominal myomectomy can cause scarring, which can potentially affect fertility. If a person does become pregnant following this procedure, they may have to deliver via a Caesarean section.

A hysterectomy would result in someone no longer being able to get pregnant.

Learn more about fibroids and pregnancy here.

When to seek help

People experiencing pelvic pain or pressure, long or heavy periods, or difficulty urinating should speak with a doctor if they can. People do not have to live with these symptoms, as treatments are available to improve their quality of life.

However, Black females may find it more challenging to find a doctor who understands how fibroids affect people of color and who will treat the condition appropriately.

Some Black people may feel more comfortable speaking with a female doctor, a Black doctor, or both.

The Association of Black Women Physicians offers a search function on their website to help people find a doctor from the National Medical Association. People can also ask friends and family for recommendations.

People can also consider seeking support if fibroids are having an impact on their mental health. Organizations that specialize in mental health services and information for Black people include:

Learn how racism affects mental and physical health here.


Fibroids are more common among Black females than among other groups. Scientists are not sure why, as the cause of fibroids is unknown, and many factors appear to affect their development. However, it seems likely that health inequity is a key factor.

Last medically reviewed on April 27, 2021

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Medically reviewed by Valinda Riggins Nwadike, MD, MPH — Written by Jayne Leonard on April 27, 2021

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What to know about narcolepsy with cataplexy

Narcolepsy with cataplexy, now known as type 1 narcolepsy, is a chronic neurological disorder that affects a person’s sleep-wake cycle and involves muscle weakness.

The condition can cause a person to feel sleepy throughout their waking hours, even if they had a good sleep and woke up feeling well-rested.

This article discusses the causes and symptoms of narcolepsy with cataplexy, as well as some of the treatment options.

What is narcolepsy? 

Close up of eyes suffering from narcolepsy.
Nilesh Das/EyeEm/Getty Images

The National Institute of Neurological Disorders and Stroke (NINDS) describes narcolepsy as “a chronic neurological disorder that affects the brain’s ability to control sleep-wake cycles.”

People with narcolepsy may frequently feel tired, even after feeling well-rested on waking. They may also have interrupted sleep, in which they wake several times.

During a person’s waking hours, episodes of sleepiness can last for between a few seconds and several minutes.

Without treatment, the condition can disrupt cognitive, social, and psychological development or function. It can also cause a person’s social, school, or work life to suffer.

Learn more about narcolepsy here.

What is cataplexy?

The National Organization for Rare Diseases (NORD) uses the term cataplexy to refer to a sudden, extreme muscle weakness. Cataplexy is one of three symptoms commonly associated with narcolepsy.

The other common symptoms are a specific hallucination that occurs just before falling asleep or immediately after waking and a brief period of paralysis on waking up.

The Narcolepsy Network adds that cataplexy causes a sudden loss of muscle tone — either throughout the body or in certain muscles — in response to a strong emotion. When it affects the whole body, it can cause the person to collapse.

The NINDS explains that there are two major types of narcolepsy: type 1 and type 2. Doctors used to refer to type 1 narcolepsy as narcolepsy with cataplexy and to type 2 narcolepsy as narcolepsy without cataplexy.

Although the names of these types have changed, doctors still define the type of narcolepsy by whether or not a person experiences muscle weakness in addition to sleepiness.

Learn more about cataplexy here.

Causes of narcolepsy with cataplexy

ResearchTrusted Source has shown that the most likely cause of type 1 narcolepsy is insufficient hypocretin in the brain.

Hypocretin is one of several hormones that affect the wake-sleep cycle. Although researchers need to carry out additional studies to build their understanding of the exact role of hypocretin, they have noted that an insufficiency or lack of hypocretin is common among people with narcolepsy.

The NINDS adds that additional risk factors for narcolepsy may include:

  • a family history of the disorder
  • hypocretin loss due to an autoimmune issue in which the immune system attacks the cells that produce the hormone
  • a brain tumor or injury



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If a person presents with chronic excessive sleepiness and cataplexy, the doctor is likely to suspect type 1 narcolepsy.

Doctors can only diagnose narcolepsy in people who experience periods of excessive sleepiness during waking hours for at least 3 monthsTrusted Source.

An additional criterion is a mean sleep latency of less than 8 minutes and two or more early rapid eye movement (REM) sleep periods on a multiple sleep latency test. In some cases, a doctor may also order a lumbar puncture, or spinal tap, which can reveal a low cerebrospinal fluid hypocretin level.


Narcolepsy with cataplexy can present with symptoms similar to those of other, unrelated health conditions.

Narcolepsy can affect people differently in terms of symptom severity. The NORD states that symptoms may come on slowly, appearing one at a time over the course of several years. The symptoms are often mild initially and gradually build in intensity.

Excessive sleepiness is typically the first symptom that a person will experience. However, over time, a person may experience varying symptoms — the severity of which can keep changing. Common symptoms include:

  • periods of tiredness, low energy, or drowsiness
  • an irresistible urge to sleep, known as a “sleep attack”
  • the inability to resist sleeping
  • a sudden loss of muscle strength or tone
  • disrupted sleep

As the condition gets worse, the symptoms can interfere with a person’s regular activities. They may fall asleep during an activity and stay asleep for a few seconds to a few minutes.

The NINDS adds that other symptoms can include:

  • hallucinations — either before falling asleep or during sleep paralysis — that can be unsettling and involve the vision and other senses
  • sleep paralysis
  • insomnia
  • fragmented sleep patterns
  • automatic behaviors, where a person will continue doing an activity without conscious awareness, resulting in impaired performance

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According to a 2016 studyTrusted Source, treatment for both types of narcolepsy generally focuses on treating a person’s symptoms. Some recent therapies that doctors use to treat narcolepsy include:

  • modafinil (Provigil) and armodafinil (Nuvigil) for sleepiness
  • antidepressants for cataplexy, which include selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors (SSRIs and SNRIs)
  • sodium oxybate (Xyrem) for both sleepiness and muscle tone
  • stimulants, such as methylphenidate (Ritalin), dextroamphetamine (Adderall), and amphetamine (Evekeo)

The study authors note the need for further sleep studies involving people undergoing treatment to understand the effectiveness of these treatment options.

The NINDS notes that some people may find certain strategies helpful in managing the symptoms. These include:

  • taking strategic naps lasting approximately 20 minutes
  • avoiding heavy meals, alcohol, or caffeine right before bed
  • quitting smoking, if a smoker
  • keeping a consistent sleep schedule
  • taking time to relax before bed

When to contact a doctor

Anyone experiencing symptoms of narcolepsy should speak with a doctor. They may be able to recommend additional testing to check for underlying conditions or may test for narcolepsy.

A person undergoing treatment for narcolepsy may need monitoring for treatment effectiveness. It is important to report new or worsening symptoms to the treating doctor.


Narcolepsy with cataplexy occurs when a person frequently experiences excessive sleepiness during their waking hours.

The condition is now commonly called type 1 narcolepsy.

Although the exact cause is still not clear, a lack of the hormone hypocretin is likely why a person experiences the disorder.

Treatments tend to focus on reducing symptom severity and providing a better quality of life. A person can also take steps at home to manage their symptoms.

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