Practice these daily routines to help with managing depression

Sometimes, it’s easy to be harder on yourself than you’d ever allow or want yourself to be with someone else, especially when you’re dealing with depression. When you feel like this, picking some of the people in your life who you love, and who love you, and trying to talk to yourself the way you’d want someone to talk to those people if they were having a hard time can be a good frame for speaking generously to yourself. Like “fake it till you make it,” the way people speak to themselves inside their heads can have a huge impact of the way they think about themselves, and the way they feel, and can easily turn into feedback loops of bad feelings. Making a point to speak to yourself kindly can help to pull you out of the loop of speaking unkindly to yourself in a way that you internalize and feel worse because of.

Some suggestions for dealing with depression – or even most of them – can feel too simple to make much difference, or so often-repeated that it can feel like they can’t possibly make a difference. It’s true that no single one of these strategies may bring an end to depression, but finding the combination that works for you, in conjunction with the type of treatment that works best with your body chemistry and lifestyle, can make a big difference in helping you start to feel better.

Get it out there

Writing in a journal can offer an outlet for getting emotions out without opening them to any judgement, and can give you a way to keep track of your thoughts and notice any patterns in them. For example, do certain thought-patterns seem to go along with more severe depressive symptoms? That’s good information to have, and so is any strategy you might notices for steering your thoughts in other directions.

For endorphins’ sake

Getting into a regular exercise schedule is one of the most common pieces of advice when it comes to managing depression, and in turn, it’s one of the most dismissed pieces of advice. It’s true that exercise isn’t a magic bullet for depression, but getting outside and moving around on a regular basis has a whole host of benefits that can contribute to starting to feeling better. Between the sun, the change of scenery, the endorphins, and the fresh air, anything from a walk around the block to training for a marathon can be a healthy part of managing depression.

Treatment

Depression is a medical condition, but there’s a lot of stigma around it. Some may mistakenly characterize it as a personal problem, and to be resistant to seeking out treatment from professionals. If depression is negatively affecting your quality of life, seek help. Medication, psychotherapy, or some combination of the two, can have a huge positive impact on your life. Just like with these informal strategies, finding the treatment plan that works well for you can take some trial and error, and figuring out how to be patient with yourself and your medical team will be an important part of the process.

Setting up a pattern

Having a strong routine in your life  can help you demonstrate to yourself what you’re capable of, especially when you’re having an especially hard time. It can help to keep self-care tasks from slipping during difficult episodes, and when depression does become severe enough to interfere with routines, having those routines set up to begin as a control can show how much is changing.

General physical health

A lack of physical health doesn’t cause depression, but it can certainly contribute to it. Making sure to eat a balanced diet, get enough sleep (but notice if you find yourself sleeping more and more often), avoiding alcohol and street drugs can help keep you in your best shape possible to combat depression.

Reach out

Often, during periods of strong depression, spending time with people can be one of the early things that gets cut out. Isolating yourself can create a feedback loop of bad feelings, though, whereas spending time with someone, even if the sound of that feels exhausting, can be a way to get out of your own head a bit. Making a point to reach out to people who feel restful or helpful to you during this time, instead of the people who may ask more from your energy reserves, can help to make social experiences during periods of depression more meaningful and positive.

Fake it till you make it

Sometimes, especially during a spell of depression, putting on a can-do attitude – even if it’s not how you feel – is a great way to get through a difficult or challenging day, from a huge family gathering to coordinating with an electrician or landlord over an unexpected wiring problem in your house, to a normal day of work at a time when you just don’t think you can do it. One of the reasons faking it till you make it works is that putting on an attitude can help to infect you with some of the feelings you’re putting on, but that benefit also comes with a caution. It’s also key for you to know and understand how you’re really feeling. Denial about depression can mean putting off making the changes that can help you feel better.

Other things to consider

Depression can make even the simplest tasks feel more challenging, and managing changes to your life, routine, and comfort zone when you’re experiencing depression can feel like an especially dangerous game. Making changes can help you feel out the shifts in your routine that can better support your changes in mood, attitude, and mental health, though. Dealing with depression means that you may be able to benefit from a certain amount of extra support, but by making changes in your own life, some of that support can come directly from you.

Signs of depression and when to talk to a doctor about it

Most people experience majority of the symptoms of depression at some point in their lives, to one degree or another, and it can be hard to tell which moods and feelings are symptoms of disorders which require treatment. For this reason, many people who do have depression or other mood disorders are diagnosed many years after noticing symptoms, or are never diagnosed or treated at all.

Watch out for these symptoms and signs of depression

There are a wide range of symptoms of depression, and some of them are physical, which can make it easier for some people to figure out how and when to reach out and ask for help. Both physical and emotional symptoms may be signs of depression if they last for two weeks or longer. Physical symptoms of depression include:

• Changes in sleep, whether that’s sleeping more often than usual, or insomnia
• A loss of appetite, or increased craving for food, causing either over- or under-eating
• A loss of sex drive
• Tiredness or lack of energy
• Aches and pains or headaches with no obvious cause

The emotional effects of depression can vary widely, from a consistent level of negative feelings all the way to feeling suicidal or hopeless. Emotional symptoms of depression can include:

• Feelings of sadness, hopelessness or feeling on the edge of tears
• Anger, irritability, or frustration, especially anger or frustration that feels excessive to events
• A loss of interest or pleasure in favorite things or interests
• Slowed thoughts, speaking and movements
• Agitation, twitchiness or restlessness
• Feelings of guilt, inability to let go of past mistakes or blame
• Thoughts of death or suicide

Thoughts of suicide should be treated as a medical emergency and you should go to your local emergency room right away.

Depression can be caused and set off by different things at different times. Sometimes depression is triggered  more by life events and stressors. Other times, it’s more determined by brain chemistry, regardless of life and stressors. Often, it’s some combination of the two. In any case, when depression affects your life, reaching out to a healthcare provider  for treatment and support is one of the best ways to start to work towards recovery.

Talking to your provider

Depression is a serious condition, and not something that one snaps out of by force of will. The earlier treatment starts, the faster and more effectively one can begin to start feeling better.

Primary care providers tend to be the first line of defense against depression. Starting the conversation about your mental health with the healthcare provider you’re the most comfortable with is never a bad idea, but it’s also good to remember that most PCPs don’t specialize in mental health treatment, and mental health providers like psychiatrists can be fantastic resources as you start to figure out what your needs around treatment are.

Your health is important to your body’s ability to function and keep you going daily. Your heart, the center of your cardiovascular system, is crucial in maintaining your overall health. Unfortunately, in the United States, heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups. More than one in three women is living with some form of heart disease.

Taking preventive measures is essential to maintaining good heart function and another act of self-care from which we can all benefit. Below are steps towards preventive care to help support your heart health.

Stay informed and proactive in your healthcare

Preventive care can begin the next time you meet with your healthcare provider. Have a shared discussion about the factors that can contribute to your heart’s health.

• Monitor blood pressure, cholesterol levels, and diabetes screenings to catch any potential problems early.
• Early detection and management of elevated blood pressure, high cholesterol, and diabetes can prevent heart disease or its complications.
• Know your family history of heart disease and discuss it with your healthcare provider to personalize your prevention plan. 
• Follow your healthcare provider’s advice, including taking prescribed medications as directed to manage conditions affecting heart health.

Adopt a heart-healthy diet

Eating nourishes us, gives us energy and generally tastes delicious. Taking a heart-healthy approach to food can provide a better defense against cardiovascular issues.

• Eat plenty of fruits, vegetables, whole grains, and lean proteins to provide essential nutrients for heart health.
• Limit saturated fats, trans fats, cholesterol, sodium, and added sugars to reduce the risk of heart disease.
• Incorporate healthy fats from sources like fish, avocados, nuts, and olive oil, which can help improve blood cholesterol levels.

Maintain a healthy weight

• Balance calorie intake with physical activity to prevent obesity, a significant risk factor for heart disease.
• Be aware of your body mass index (BMI) and waist circumference as healthy weight and risk indicators.

Engage in regular physical activity

Anywhere from 10 to 20 minutes of activity and exercise daily can get your heart pumping and your body moving. And your heart will love it.

• Exercise helps control weight and reduces blood pressure, cholesterol levels, and the risk of type 2 diabetes, all of which are risk factors for heart disease.
• Aim for at least 150 minutes of moderate aerobic exercise or 75 minutes of vigorous exercise per week. 
• Add muscle-strengthening activities two or more days per week as recommended by health authorities to support your heart health.

Avoid smoking and limit alcohol consumption

Cigarette smoking and excessive drinking of alcoholic beverages can lead to many health issues, including certain heart diseases.

• Stopping cessation significantly reduces the risk of heart disease by improving heart function and blood circulation.
• Limit alcohol intake to moderate levels (up to one drink a day for women and up to two drinks a day for men) to avoid high blood pressure and other heart risks that arise due to excessive drinking.

Manage stress

Stress can affect your health in many ways, so look for ways to address and manage it. Managing stress can help reduce behaviors and factors that increase heart disease risk, like high blood pressure and cholesterol levels, physical inactivity, and overeating.

• Engage in stress-reducing activities such as meditation, deep breathing, and physical activity.
• Speak to your healthcare provider about managing your mental health as well as studies show that your mental health can also affect your heart’s function.

Sleep well

Sleep recharges your body, so working towards better sleep is another great way to support healthy heart function.

• Aim for 7-9 hours of quality sleep per night, as poor sleep can increase the risk of high blood pressure, obesity, and diabetes.
• Establish a regular sleep schedule and a relaxing bedtime routine to improve sleep quality.

Taking these preventive measures can significantly reduce the risk of developing heart disease. It’s about creating a balanced lifestyle that supports heart health and overall wellbeing. 

Reviewed by the Ovia Health Clinical Team

Read more

Connective Matters: About Your Heart

Sources

Center for Disease Control (CDC). Prevent Heart Disease. cdc.gov. March 21, 2023 https://www.cdc.gov/heartdisease/prevention.htm#:~:text=Eating%20foods%20high%20in%20fiber,prevent%20or%20help%20control%20diabetes.

American College of Obstetricians and Gynecologists (ACOG). Heart Health for Women. acog.org. https://www.acog.org/womens-health/faqs/heart-health-for-women#:~:text=Lack%20of%20physical%20activity%20can,of%20heart%20disease%20and%20stroke

The Mayo Clinic. “Strategies to prevent heart disease”. www.mayoclinic.org. https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/heart-disease-prevention/art-20046502

Many studies have shown that physical activity is linked with lower breast cancer risk. The American Cancer Society recommends that adults get at least 150 to 300 minutes of moderate-intensity or 75 to 150 minutes of vigorous-intensity activity each week. A combination of these activities spread throughout the week would be ideal.

Avoid or limit alcohol

Alcohol increases risk of breast cancer. Even drinking small amounts of alcohol has been linked with an increase in risk. It is best not to drink alcohol at all. For women who do drink, they should have no more than 1 alcoholic drink a day. A drink is 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits (hard liquor).

Breastfeed if possible

Mothers who breastfed are less likely to get breast cancer. Mothers who breastfed for a lifetime total of more than two years get the most benefit.

Limit hormone therapy

Postmenopausal hormone therapy can increase the risk of breast cancer. If you must take hormones to manage menopausal symptoms, try to use the lowest dose that works for you and for the shortest time.

Know and explore your options

If breast cancer runs in your family, talk to your doctor about considering genetic counseling and testing. Testing will show if you have an inherited gene mutation that increases your risk of breast cancer. If genetic test results show you a gene mutation, you can consider drugs that can lower your risk or surgery.

Reviewed by the Ovia Health Clinical Team

Nerlandes’ Story

Nerlandes Themistocle is a pharmacist and Pharmacy Manager at CVS Caremark, having worked in pharmaceuticals for over 25 years. She is a wife and a mother of two, currently residing in Rhode Island and finds joy with her family, listening to music, dancing, traveling, and exploring new foods. Nelandes Themistocle shares her truth about menopause, from what she experienced to what she wishes she knew about this important part of the reproductive health journey.

Can you tell us a little bit about your menopause experience?

I didn’t experience symptoms or body changes during the perimenopause stage as many others have. All of the symptoms started once my periods stopped very suddenly at the age of 50. What I’ve learned throughout this process and when talking with others is that not everyone experiences menopause in the same ways. Some may experience vaginal dryness, while others may feel more irritable or depressed. No experiences are one and the same.

What symptoms did you experience?

My symptoms were mainly hot flashes and night sweats, as well as trouble sleeping. The hot flashes, however, were pretty severe for me. I’d have to have fans on me at all times at work and when I go to bed.

Were there any other symptoms that caught you by surprise?

The symptom that really caught me by surprise was anxiety. I started to feel anxious about things I normally wouldn’t. For instance, I never felt or experienced anxiousness when it came to my work, especially because I have worked at the same place for years, however, one day I had such an overwhelming experience I had to call my husband. The palpitations were very intense, and this lasted for an entire week. I still feel anxiety from time to time, but I find ways to manage.

Did you feel prepared going into menopause?

Going into menopause is not something any woman can ever be fully prepared for. It took me an entire year to realize that I was going through the change . I definitely was not prepared. I did not have any idea what to expect or even how to identify if I was really experiencing it.

What do you wish more people knew about menopause?

Menopause is not as simple as people think. It is a very complex process that can be long and at times frustrating. The symptoms can last several years after your period stops and can be disruptive to your everyday life. Everyone experiences menopause differently, like I mentioned earlier, no experience is one and the same, so be patient with yourselves.

What do you think is the biggest misconception about menopause?

Menopause is still considered a very sensitive topic. I think that a lot of women struggle with this idea that once they go into menopause, their womanhood is stripped away. They may feel life is going to change forever, and people, including their spouses, will not look at them the same way. I felt that at one point, but my husband still treats me the same. Life may change in some ways, but the most important things don’t. People, not just women, need to be more educated about menopause to help with these feelings.

Is there any message you’d like to give to someone going through or preparing for menopause — maybe someone experiencing the same symptoms as you?

Menopause is not a medical condition but a natural process that will become a part of your life. Our bodies go through a lot of changes during this time, but there are so many ways to manage it. Don’t be afraid of talking about your symptoms; there is absolutely nothing to be ashamed of. Challenge yourself, change your lifestyle, exercise, keep yourself hydrated, lastly and most importantly, seek medical advice or talk to your provider. There are also so many drugs on the market that can help with the symptoms. I have learned to live with it and be happy.

Learn more about menopause

Menopause

Menopause 101

Menopause symptoms

Let’s start with the basics, how often should someone be STI tested? Can you tell us a little more about what exactly to expect?

The guidelines are that everyone who is under 25 and sexually active should be tested at least once a year for gonorrhea and chlamydia. Many STIs can be asymptomatic (particularly in women), so it’s important to make testing part of your annual care. Every annual preventive visit should include a conversation about STIs. Certain people may be at higher risk and require more frequent screening. 

Women 25 years and older with risk factors such as new or multiple sex partners or a sex partner who has an STI should also be tested for gonorrhea and chlamydia every year.

All adults and adolescents from ages 13 to 64 should be tested at least once for HIV.

Everyone who is pregnant should be tested for syphilis, HIV, hepatitis B, and hepatitis C starting early in pregnancy. Those at risk for infection should also be tested for chlamydia and gonorrhea starting early in pregnancy. Repeat testing may be needed in some cases.

Are there other options for testing besides at a primary care visit?

Yes. Urgent care is an option, as are retail health clinics, community clinics and OB/GYN providers. Home tests are also available.

Can you tell us more about specific STIs and how they’re tested for?

Gonorrhea and chlamydia are tested with a urine sample, a cervical sample, or a swab. 

HIV, hepatitis, and syphilis can be tested for with blood tests. 

We’ll test for herpes (HSV1 and HSV2) with a swab of the lesion if you have symptoms. 

What are your recommended best safe sex practices with a new sexual partner?

It’s great if both people can discuss STI testing before they forgo using barrier methods like condoms. This way you know where you’re starting out. 

And what if someone doesn’t feel comfortable having those conversations with a new or more casual partner?

These can be hard conversations, especially early on in a relationship. 

To start off, everyone can empower themselves and at least get testing for themselves. These conversations can certainly sometimes put pressure on relationships about the future of the relationship or expectations around monogamy. If you’re not there yet, that’s a good reason to continue using other methods to protect yourself. Then when you both feel comfortable you can test again. 

What are some common symptoms of STIs to pay attention to? 

Women and people with uteruses will typically experience symptoms like pain with urination, vaginal discharge, and painful bumps or sores. 

Gonorrhea can also infect the throat, this can be asymptomatic or cause a sore throat. 

HIV can look like an acute illness with viral symptoms — think swollen lymph nodes and a fever. These symptoms are often missed because they can be mistaken for another type of virus. 

Can you get an STI from oral sex?

Yes. We commonly see gonorrhea which can present as a very painful sore throat. The good thing is that providers are more informed and educated about this symptom as a potential sign of an STI, so they should be taking a swab and testing. 

Herpes (HSV) is often spread during oral sex as well.

Which STIs are treatable vs. curable?

Gonorrhea, chlamydia, trichomonas, and syphilis are all curable. We give medication and we may recommend a test for cure. HIV, as we know, is a chronic infection, which is treatable and we have great therapies and treatments, but it requires lifelong treatment and monitoring. 

An initial outbreak of HSV is treated with a high dose of an antiviral treatment, which shortens the amount of time a person is symptomatic, and most likely the time they’re infectious as well. And then depending on how often a person has outbreaks, we may recommend that they go on suppressive therapy, which is a daily antiviral medication. This can be a lifelong medication.

After a number of years of being on antiviral medication, most people have very low rates of outbreaks. I say that because when people are told that they have HSV, it can be very upsetting. They might be worried about navigating conversations with sexual partners given some stigma that’s still lingering around HSV. People also worry that they might pass it on if they’re pregnant. But we have great medication that is safe and generally has minimal side effects, so most people can go back to living a normal life. We do recommend that they tell new sexual partners. 

Any tips for how to have these conversations with a partner?

HSV is transmitted through skin contact. And we know that there can be transmission of HSV even when a person doesn’t have an outbreak or an outbreak that’s visible to them. This is particularly true right before they have an outbreak, when there can be a high level of virus. And condoms don’t protect anyone 100%. 

These conversations can be hard with a new casual partner before you have any sexual contact. You might say, “I just wanted to let you know that I tested positive for HSV [X] years ago. I’m on suppressive therapy, which reduces the risk, but I just wanted to let you know.” 

Because it’s such a common virus, many people are in this situation, so hopefully the conversation is met with kindness and appreciation that you disclosed it.

HIV can be a more challenging conversation, but it’s similar in many ways. This is a conversation to have earlier rather than later. In relationships with two people who have discordant HIV infection, the partner who is not HIV positive often chooses to go on PrEP therapy to prevent their chance of being infected. Also, here condoms are very effective, because HIV is not transmitted through the skin. 

There is a lot less stigma than there used to be, but these conversations can be hard.

How long should someone be on suppressive therapy before it kicks in?

Those who are HIV positive need to wait until they’re controlled before having sexual contact. Their HIV specialist or internist will help them manage their treatment plan. 

And for other STIs, how should we think about testing timelines? 

If you were sexually active with a new partner recently, your current testing might not reflect your status. It’s good to get tested when you haven’t been with anyone else for 6 weeks, so waiting until you’re 6 weeks or so into a relationship can make sense. This is because it can take 6 weeks for the body to mount an antibody response to the virus so that it can be detected in blood work. 

Certain STIs have recommendations for follow up — in those cases, we recommend that people get tested for cure to make sure they’re fully treated. If both partners are positive for an STI, both should be treated at the same time and there should be no sexual contact during treatment to prevent transmission back and forth.

Any tips if you don’t feel comfortable talking to your provider about sexual health?

There are on-demand tests that you can use, which can be a great option. You can also email or message your provider to ask for certain tests/labs if you don’t feel you can ask in person. We like to minimize barriers for testing for important health issues.

Read more

• 5 Things you should have learned in sex ed class
• The complete glossary on sexually transmitted infections

When the pregnant person’s life is in danger

Some preexisting health conditions as well as some pregnancy complications can put your pregnancy health and safety at risk. Expert provider can help manage many of these conditions to allow a pregnancy to progress long enough that the baby is viable (able to survive outside of the womb). But some health conditions and pregnancy complications cannot be managed safely long enough to reach this point. Continuing the pregnancy in these cases would mean certain or high likelihood of death, loss of uterus, or other long-term medical complications — like stroke and other permanent disabilities for the parent. 

Recent federal legislation aims to secure abortion rights in all cases when a parent’s life is in danger, but it is in dispute in several states. Even a delay in care in these situations can have devastating short and long-term health impacts. 

Before we explain the conditions and complications you should be aware of, there are some steps you can take before you become pregnant to support your health. 

Understand the laws in your state

Abortion access varies depending on your state — and in many places your pregnancy trimester, your provider, and your age. In some states, if you’re a minor, you’ll need one or both of your parents’ consent. You can find a state by state breakdown here.

Schedule a preconception visit with your provider 

A pre-pregnancy checkup helps your healthcare provider make sure that your body is ready for pregnancy and often includes some health screenings. During this appointment, you can ask your provider any questions you have about your general and fertility health. 

Consider pre-pregnancy carrier screening

You may discuss this at your pre-pregnancy appointment. A carrier screen is a genetic test that can help you understand your risk of having a baby with a genetic disorder. And you can request it before you’re pregnant. Carrier screening is one of many tools to help you go into starting or growing your family with more information about your risks and options. 

Let’s review conditions and complications that can happen during pregnancy. If you experience one of these, then your state abortion laws could impact your care.

Ectopic pregnancy 

Ectopic pregnancies are early pregnancies that implant and grow in the wrong part of the body — outside of the uterus. The most common location of an ectopic pregnancy is in a fallopian tube, but can happen anywhere within the abdomen, including on the liver or bowel. 

Ectopic pregnancies can never result in a healthy pregnancy and lead to severe internal bleeding and death if left to grow. The only medical treatment available is abortion. The earlier these pregnancies are identified by ultrasound, and treated, the safer it is. If you live in a highly restrictive state, it’s important to know how your provider treats this type of situation. Will you have early ultrasounds? Will you have to travel if you need an abortion? Is there a local hospital that has experience navigating the legal difficulties of this situation? 

Severe hypertensive disorders 

Severe hypertensive disorders of pregnancy most commonly occur later in pregnancy. But, when they happen before viability (around 24 weeks), they are incredibly dangerous for parents. If the pregnancy is not ended, it can result in seizure, stroke, bleeding, and death. The only “cure” for these disorders is immediate delivery. There is no known long-term management option to safely allow the pregnancy to reach viability. Especially for parents with any history or high risk of hypertensive disorders, it’s important to discuss an emergency plan with your provider and any possible preventative steps.

Sepsis and bleeding 

Sepsis and bleeding are two other life threatening complications that can happen in early pregnancy where your body starts to miscarry or labor before about 24 weeks. In these situations, a pregnant person can experience their water breaking or heavy bleeding while their baby is still alive. The treatment for these conditions is delivery.

In states that don’t recognize the life of the parent as a valid reason for abortion, this can end in the death of the parent and the fetus. Even delaying care can increase the risk of serious infection (sepsis), need for blood transfusions and surgery, and death. Again, discussing your options with your provider early in pregnancy can help you feel at ease or make a necessary emergency plan.

When the fetus is at-risk or will not survive after birth

Finding out your baby has a complication or severe illness is one of the most devastating pieces of news to receive as a parent. Modern medicine has made enormous strides to treat certain conditions during pregnancy and work miracles for some people. However, there are chromosomal and genetic conditions that make it more likely for a fetus to die during the pregnancy or immediately after birth. There are also complex fetal differences that may survive birth, but not all parents feel they have the capacity to manage medically, emotionally, financially, or physically. Many people choose to end a pregnancy in these circumstances to reduce suffering for everyone and potential medical complications for the pregnant parent. 

The impact of abortion bans and restrictions

The abortion bans in many states do not have exceptions for these situations. These laws can be confusing and cause delays in care of the pregnant person. Knowing your state’s guidelines, and where you can travel to safely get the care you need is essential. In some states, specialized OBGYNs, called MFMs (Maternal Fetal Medicine specialists), will help identify and explain what is happening with your fetus, but they may be limited in discussing options. They may be able to refer you for a virtual appointment with an MFM out of state to have a more open discussion inclusive of more care options. Early genetic testing and counseling can leave more options open in states that only restrict abortion after a certain gestational age. 

If you find yourself in need of support or information after a devastating diagnosis here are some resources to explore: 

• Empty Arms
• Rare Disease information
• Neonatal donation
• Medical Ethics and Decision Making

Reviewed by the Ovia Health Clinical Team

Ovia’s goal is to support the health and wellness of our members throughout their reproductive health journeys. Ovia cannot, however, encourage or discourage the very personal decision of whether to have an abortion or counsel on whether and how an abortion may be performed in a particular case. Abortion may or may not be legal in your state and in your particular personal situation. None of the information made available through Ovia is intended to provide you with legal advice regarding abortion. Ovia may refer you to third-party websites or publications for additional information on reproductive health issues, including abortion. Ovia is not affiliated with these third parties and is not responsible for any information that they make available to you.

The first days

The type of care you will receive and what you can expect after an abortion depends on how far along your pregnancy is and if you plan to have a medical abortion (taking pills) or a surgical abortion. Surgical abortions are also called D&C or D&E. D&C is dilation and curettage, D&E is dilation and evacuation. They are two distinct procedures done depending upon gestation age at the time of termination.

Surgical abortions take place at a hospital or clinic, while the abortion pill can be taken at home (though some people will take part of the treatment with a provider). As you plan, make sure to pick up pads in various absorbencies (including the heaviest flow), Ibuprofen, and a heating pad.

Most people who take pills for an abortion will have 1-2 days of heavy bleeding and cramping. This may be accompanied by nausea, vomiting and/or diarrhea. It’s likely you’ll pass tissue and clots in addition to bleeding during this time.

The day of a surgical abortion, you will need a ride home because the sedation you’ll receive will make it unsafe to drive. Most people feel sleepy and some feel nauseous. A few hours after, most of the sedation will have worn off, and you’ll feel tired and crampy. 

After the first 1-2 days, most recoveries look similar whether you had a medical or surgical abortion. Most people describe bleeding like a period, with cramping that is usually managed well by medications like Ibuprofen and warmth (warm drinks and a heating pad both help). Try to rest for 1-2 days if possible, as lots of activity will generally cause heavier bleeding and cramping. 

Weeks one-two

Expect bleeding to slow down over about 1 week, with some discharge or spotting lasting 1 week more. This discharge can be black, brown, pink or mucousy. Sometimes discharge or spotting can last for a few weeks, although this is less common.

If your abortion was performed later in pregnancy, you may have breast/chest changes — this can range from soreness to severe engorgement and milk production. Wearing a supportive bra and icing your chest will help (so will the Ibuprofen you’re already taking for cramps). Some people also add Cabocreme or cabbage leaves to their care. If you are having pain for more than 1-2 days, reach out to your provider for support. If you can’t talk to your provider, monitor for signs of a breast infection. 

After week two

Many people find their menstrual cycle takes 1-3 months to get back to their normal, though it is possible to ovulate right away (before your next period), so take steps to prevent pregnancy or try again depending on your situation. 

If your abortion happened later in pregnancy, then it’s more common to experience longer amounts of bleeding, discharge and cramping. 

Your emotions

The range of emotions after abortion varies as much as the reasons for needing one. You could be feeling immense relief, sadness or just be ready to move on. Whatever your experience is, your feelings are valid. There are also significant hormonal changes at play, knowing that you can expect some ups and downs can help you prepare for them. 

It may feel taboo to talk about your abortion and — depending on where you live — it may not feel like a safe option. If you’re able, talking to a trusted partner or friend can be validating and can help you process your experience. If you’re unable to talk to someone, writing in a journal or doing other activities like meditation can help.

If you need some more support, there are after-abortion hotlines to call, including https://exhaleprovoice.org/resources/. 

What to avoid after an abortion

Until you stop bleeding, you should generally avoid:

• Tampons or anything else in the vagina (if you took pills, you can use tampons or a menstrual cup after the first few days when you’re sure your bleeding has slowed down)
• Swimming or baths
• Intercourse 
• Vigorous exercise
• Breast/nipple stimulation like touch or warm water (for abortions that happened later in pregnancy)

Your provider may have given you more relaxed instructions, and that’s okay too! Be sure to follow their recommendations and take medication they may have prescribed for you.

Warning signs

Be on the lookout for any of these symptoms, each of which are a reason to call your provider right away.

• Heavy bleeding that soaks through a pad in one hour. If you’ve been very active, try rest and a heating pad to see if this helps slow the flow, but continued heavy bleeding needs attention.
• Fever over 100.3F
• Pain that doesn’t get better with medication, warmth and rest
• Clots larger than a lemon 
• Fainting
• Discharge that smells bad or looks like pus
• Still feeling pregnant 2 weeks after your abortion
• Nausea, vomiting or diarrhea that lasts more than 1-2 days

It’s not common to have a complication after an abortion, but watching for warning signs and getting medical help if needed is important to take care of yourself. 

Make a plan that includes where you’ll get care if you need it and who you can rely on for support and transportation. Remember that if you need to seek urgent care for bleeding, or any of the other warning signs above, you do not need to tell medical providers that you had an abortion. The medical care for complications after an abortion is the same as after a miscarriage. 

Reviewed by the Ovia Health Clinical Team

Read more:

• What is a medical abortion and how to access one
• How to find abortion care

Ovia’s goal is to support the health and wellness of our members throughout their reproductive health journeys. Ovia cannot, however, encourage or discourage the very personal decision of whether to have an abortion or counsel on whether and how an abortion may be performed in a particular case. Abortion may or may not be legal in your state and in your particular personal situation. None of the information made available through Ovia is intended to provide you with legal advice regarding abortion. Ovia may refer you to third-party websites or publications for additional information on reproductive health issues, including abortion. Ovia is not affiliated with these third parties and is not responsible for any information that they make available to you.

What exactly is the abortion pill and how does it work?

The “abortion pill” is a bit of a misnomer as it isn’t a single pill. The most common “abortion pill” is a combination of Oral mifepristone (Mifeprex) and oral misoprostol (Cytotec). The former is used to prevent the embryo from growing, and the latter is used to release the embryo from your body. 

Those who get the abortion pill from a provider will likely take Mifeprex in their provider’s office and the Cytotec later at home. You may be asked to return to your provider’s office after about a week so they can confirm the abortion is complete.

Can I purchase the abortion pill online?

Yes. Some opt to purchase abortion pills from legitimate sources online and take them at home. While this is a safe option for most people, it’s a good idea to take a couple steps to make sure you’re safe: preselect a provider that you can contact if you experience side effects and plan to have someone you trust nearby. 

Additionally, the combination of Oral mifepristone (Mifeprex) and oral misoprostol (Cytotec) is not the right abortion method if you’re experiencing an ectopic pregnancy. If you haven’t had an ultrasound, there is a chance that you could be experiencing an ectopic pregnancy without knowing it. It’s always a good idea to check with your provider if possible before taking any medication. Medical abortion is only an option for those who are less than 10 weeks pregnant. If you’re not sure how far along you are, you’ll also need to check with a provider.

If it’s not possible to check in with a provider, serious side effects to look out for are severe stomach pain, fainting or lightheadedness, or sudden shoulder pain. If you notice these symptoms, go to a hospital right away — they will be able to treat you even if abortion is not legal in your state. 

What are normal side effects?

While side effects can vary from person to person, everyone will experience cramping and bleeding. Some more serious side effects, like nausea, vomiting, chills, headache, and diarrhea are also possible. 

Where can I access a medical abortion?

Through your provider or online from sites like https://www.abortionfinder.org. 

How much does it cost?

The abortion pill can cost several hundred dollars, or much less, depending on where you get it and if your insurance covers it. There are abortion funds that can help you cover the cost — learn more here. 

Are there risks?

There may be legal risks to purchasing and taking the abortion pill, depending on where you live. You can find more information about legal risks here. 

And, as with any medication, there are medical risks and side effects associated with the abortion pill (including those cited above). That said, it is a safe, effective, and FDA approved method.

Reviewed by the Ovia Health Clinical Team

Read more:

• What to expect after an abortion
• How to find abortion care

Sources

• Mayo Clinic Staff. “Medical abortion.” Mayo Clinic. Mayo Clinic. July 29, 2022. https://www.mayoclinic.org/tests-procedures/medical-abortion/about/pac-20394687. 
• Lauren Cross and others. “Medication Abortion Now Accounts for More Than Half of All US Abortions.” The Guttmacher Institute. The Guttmacher Institute. February 24, 2022. https://www.guttmacher.org/article/2022/02/medication-abortion-now-accounts-more-half-all-us-abortions. 
• “How much does the abortion pill cost?” Planned Parenthood. Planned Parenthood. 
• https://www.plannedparenthood.org/learn/abortion/the-abortion-pill/how-much-does-abortion-pill-cost.
• “Second-Trimester Abortion.” American College of Obstetricians and Gynecologists (ACOG). ACOG. June 2013. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2013/06/second-trimester-abortion.

Ovia’s goal is to support the health and wellness of our members throughout their reproductive health journeys. Ovia cannot, however, encourage or discourage the very personal decision of whether to have an abortion or counsel on whether and how an abortion may be performed in a particular case. Abortion may or may not be legal in your state and in your particular personal situation. None of the information made available through Ovia is intended to provide you with legal advice regarding abortion. Ovia may refer you to third-party websites or publications for additional information on reproductive health issues, including abortion. Ovia is not affiliated with these third parties and is not responsible for any information that they make available to you.

While medicine may have expanded fertility options, it can feel like there are so many more decisions to make about when to start a family or how to preserve fertility. If you’re wondering: should I freeze my eggs? you’ve come to the right place. Make sense of egg freezing and why it might be an option to consider.

What Is egg freezing?

Known in official medical circles as mature oocyte cryopreservation (OC), egg freezing is the process by which a doctor takes eggs (oocytes) from your ovaries. These eggs can then be frozen and stored until you decide you’re ready to use them. At that point they are thawed, mixed with sperm in a laboratory, and re-inserted into your uterus (womb) through your cervix, hopefully leading to pregnancy.

Who’s freezing their eggs in the U.S.?

Nationally, the number of egg freezing cycles increases every year. The Center for Disease Control (CDC) reports there were more than 22,000 egg freezing cycles in 2019, up from around 18,000 in 2018 and 14,500 in 2017.

• It’s becoming more common for people under the age of 35 years to preserve their fertility through egg freezing.
• White patients freeze their eggs more than people of color, although more minority groups are freezing their eggs, especially Asian women.
• University-educated or professional people are more likely to pursue elective egg freezing.

Why might you want to freeze your eggs?

People choose to press pause on becoming a parent or growing their family for many reasons. Elective egg freezing is now safer, more affordable, and more common. Some of the reasons people give for choosing electively to freeze their eggs include:

• Not being in a relationship with a partner they want to parent with 
• Wanting to be financially stable before starting a family
• Working in a demanding career where being pregnant could come at a professional cost
• Having access to employer-subsidized egg freezing benefits

Other people may turn to egg freezing because they have a medical condition that threatens their future fertility. One out of five women in one study reported choosing egg freezing because of underlying health conditions. Women and their health care providers may consider egg freezing if they:

• Have a condition impacting fertility such as sickle cell anemia, autoimmune diseases such as lupus, or premature ovarian failure
• Have a cancer diagnosis or other illness and need to receive chemotherapy or radiation that could harm their ovaries

Egg freezing also helps LGBTQ+ people keep their parenting options open. Gender-affirming surgery or medical treatments can limit fertility so some transgender men choose egg freezing before beginning their transition.

When should I freeze my eggs?

According to the American Society of Reproductive Medicine (ASRM), elective egg freezing is most successful for women younger than 38 years. The more eggs you can harvest and freeze, the better your chances for pregnancy down the road. As you get older, it gets harder to harvest enough high-quality eggs. Here’s what the science tells us:

• Egg quality peaks between 16 and 28 years old
• Women in their mid-reproductive years (29 to 37 years old) produce enough high-quality eggs to make egg freezing cost effective
• People who freeze their eggs before age 34 have the highest overall live birth rates.
• One 2015 study found that the biggest difference in live birth rates between people who did and didn’t freeze their eggs was at age 37. At younger ages, the differences in live birth rates in people who did and did not freeze their eggs were smaller.
• There is little benefit (no comparative increase in the number of live births) for women ages 25-30 to freeze their eggs

From a straight biological perspective, the younger you are when you freeze your eggs, the better your chances for good egg quality and number harvested.

Egg freezing and deciding what’s right for you

Decisions about fertility and parenting are individual and personal — egg freezing is no different. It can be helpful to think of egg freezing as an insurance plan rather than a guarantee for a baby. It is a way to increase your chances of being able to be a parent, without being limited by your biological clock or life circumstances. That said, it can be very expensive and so is not a good option for everyone.

Reviewed by the Ovia Health Clinical Team

Read more:

• Egg freezing step by step
• Egg freezing FAQ

Sources 

• Katler QS, Shandley LM, Hipp HS, Kawwass JF. National egg-freezing trends: cycle and patient characteristics with a focus on race/ethnicity. Fertil Steril. 2021 Aug;116(2):528-537. doi: 10.1016/j.fertnstert.2021.02.032. Epub 2021 Mar 30. PMID: 33795141.
• Inhorn MC, Birenbaum-Carmeli D, Birger J, Westphal LM, Doyle J, Gleicher N, Meirow D, Dirnfeld M, Seidman D, Kahane A, Patrizio P. Elective egg freezing and its underlying socio-demography: a binational analysis with global implications. Reprod Biol Endocrinol. 2018 Jul 23;16(1):70. doi: 10.1186/s12958-018-0389-z. PMID: 30037349; PMCID: PMC6056999.
• Mayo Clinic Staff. “Egg Freezing.” Mayo Clinic. Mayo Foundation for Medical Education and Research. April 23, 2021. https://www.mayoclinic.org/tests-procedures/egg-freezing/about/pac-20384556. 

• “Assisted Reproductive Technology (ART) National Data.” Centers for Disease Control and Prevention (CDC). CDC. 2019. https://nccd.cdc.gov/drh_art/rdPage.aspx?rdReport=DRH_ART.ClinicInfo&ClinicId=31&ShowNational=0. 
• Kylie Baldwin, Lorraine Culley, Nicky Hudson & Helene Mitchell (2019) Running out of time: exploring women’s motivations for social egg freezing, Journal of Psychosomatic Obstetrics & Gynecology, 40:2, 166-173, DOI: 10.1080/0167482X.2018.1460352
• Amato, Paula. “Fertility Options for Transgender Persons.” UCSF Transgender Care. University of California, San Francisco. June 17, 2016. https://transcare.ucsf.edu/guidelines/fertility. 
• “Can I Freeze My Eggs to Use Later If I’m Not Sick?” ReproductiveFacts.org. American Society for Reproductive Medicine. 2014. https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/can-i-freeze-my-eggs-to-use-later-if-im-not-sick/. 
• Mesen, Tolga B et al. “Optimal timing for elective egg freezing.” Fertility and sterility vol. 103,6 (2015): 1551-6.e1-4. doi:10.1016/j.fertnstert.2015.03.002