An intrauterine device (IUD) is a form of birth control. It prevents pregnancy either by damaging or killing a man’s sperm or blocking it from entering a woman’s uterus. An IUD is a small, T-shaped device with a string attached to the end. The purpose of the string is to help you or your doctor make sure that the IUD is still in place. It also is how a doctor removes the device.

There are 2 types of IUDs available in the United States: hormonal and non-hormonal. ParaGard is the non-hormonal option. It has copper rings, or coils, that alter the chemicals in your uterine fluid to kill sperm. You should not use ParaGard if you are allergic to copper. Hormonal options include Mirena, Kyleena, Liletta, and Skyla. These release progestin hormones to thicken your cervical mucus and stop ovulation.

Path to improved health

Your primary care or women’s doctor can insert an IUD. They can insert ParaGard at any time during your menstrual cycle. Hormonal IUDs should be inserted in the first 7 days of your cycle. The procedure is quick and done in the doctor’s office. The doctor puts a small plastic tube with the IUD into your vagina. You may have pain or cramping during this process. Discomfort can last several hours or days. Most doctors suggest that you have someone else drive you home from the appointment.

IUDs start working immediately. You can have sex, exercise, and use tampons. An IUD is effective for 3 to 12 years, depending on the type. Your doctor can remove it at any time.

Call your doctor right away if you have the following symptoms or problems. They will check your IUD and may remove or replace it.

• You can’t find the string
• You can feel the IUD
• Your IUD comes loose or falls out
• You have a fever or chills
• You have abnormal blood, fluid, or odor coming from your vagina

Things to consider

You should not use an IUD if you have abnormal vaginal bleeding. Cancer of the cervix or uterus or the AIDS infection prevent IUD use as well. You shouldn’t use an IUD if you are pregnant or want to become pregnant. You can, however, get an IUD immediately after giving birth. The best time for the doctor to insert it is after delivery of the baby and placenta.

IUDs do not protect you from sexually transmitted diseases or infections (STDs or STIs). To reduce your risk of getting an STD, use a condom when you have sex. IUDs can affect your menstrual cycle. At first, you may have pain, cramping, or spotting (light bleeding) between periods. This can last for 3 to 6 months. Hormonal IUDs can cause your periods to be irregular. They may also cause you to miss periods. Copper IUDs can cause worse cramps and bleeding during your period.

The benefits of IUDs include:

• Pregnancy prevention success rate of 99% when used properly
• Use of 3 to 12 years, depending on the type
• Can be removed by your doctor at any time
• Convenience
• Safe for women who just gave birth and/or are breastfeeding
• Cannot be felt during sex
• Low risk of side effects

Risks are uncommon, but include:

• Injury to the uterus when the IUD is being inserted
• Increased risk of pelvic inflammatory disease if you have an STD
• Chance of getting pregnant, in which case your doctor should remove the IUD (If you become pregnant, the risk of miscarriage and health problems for you and the baby increase.)
• Chance of an ectopic pregnancy (This occurs when an egg fertilizes outside of your uterus. It is rare but can be harmful for a woman.)

Questions to ask your doctor

• How do I know which IUD is right for me, or if I should use another form of birth control?
• Are there any other health conditions that prevent me from using an IUD?
• Does my age play a factor in which type and brand of IUD I get?
• Does my insurance cover an IUD?
• How often do I need to check my IUD, either by a doctor or myself?
• What happens after an IUD expires?

Resources

American Academy of Family Physicians: Birth Control Options

Centers for Disease Control and Prevention: Intrauterine Contraception

National Institutes of Health, MedlinePlus: Intrauterine Devices (IUD)

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Your rotator cuff is made up of multiple muscles and tendons. These attach the bones of your shoulder and form a protective shield. They help power and stabilize your arm and shoulder movements. It is common to overuse your rotator cuff. When this happens, you can have tendinitis or a tear in one or more of the tendons or muscles. This can cause pain, stiffness, weakness, and further damage.

Rotator cuff exercises are important to prevent and treat injuries. They help strengthen your muscles and improve flexibility. Follow the recommended movements below.

Path to improved health

Before you begin, you should assess your current range of motion. This will help to keep track of your progress. A doctor or physical trainer can assist you with this.

You should warm up your arms and shoulders first. This can consist of basic stretches:

• Stretch 1: Cross your right arm straight across your chest to the left. Grip your upper right arm with your left hand. Hold for 30 seconds and then switch sides.
• Stretch 2: Lift your right arm up overhead then bend it behind your neck. Grip your right elbow with your left hand and gently pull your elbow back so that your hand can get closer to the base of your neck. Hold for 30 seconds and switch sides.
• Stretch 3: Stand with your feet slightly apart for the pendulum stretch. Bend forward at the waist and let your arms hang straight down. Keep your arm and shoulder muscles relaxed and move your chest back and forth slowly to allow your arms to swing slowly back and forth. Do this for about 30 seconds.
• Stretch 4: Start in a standing position with your feet slightly apart. Place the end of a rolled-up towel in your right hand. Lift your right arm overhead and cross it behind your back. With your left arm, reach around behind your back and underneath to grab the bottom of the towel. Hold for 30 seconds and switch sides. Repeat 3 times. Over time, try to decrease the amount of space between your hands on the towel. Eventually, you may be able to remove the towel and hold onto your hands. The closer together your hands are, the better your shoulder flexibility.
• Stretch 5: Stand with your right side against a wall. Lift your right arm along the wall behind you to 90°. Turn your palm inward and hold for 30 seconds. Turn your palm outward and hold for 30 seconds. Switch sides.

Then, you can move on to the strengthening exercises:

• Exercise 1: Lie on your right side on a table or bed. Your right arm should be extended overhead with your head resting on your arm. Place a rolled-up towel under your right armpit. Lift your left arm to shoulder height with your elbow bent 90°. Your left forearm should be forward with your palm facing down. Keep your left elbow in place and raise your left forearm. (Your arm motion should be going up.) Hold for 2 to 3 seconds and return to your starting position. Repeat and switch sides.
• Exercise 2: Lie on your right side on a table or bed. Your right arm should be extended overhead with your head resting on your arm. Place a rolled-up towel under your right armpit. With your left arm at your side, bend your elbow 90°. Your left forearm should be forward with your palm facing down. Keep your left elbow touching your side and raise your left forearm until it’s level with your shoulder. (Your arm motion should be going out, away from your body.) Hold for 2 to 3 seconds and return to your starting position. Repeat and switch sides.
• Exercise 3: Lie on your right side on a table or bed. Your right arm should be extended overhead with your head resting on your arm. Place a rolled-up towel under your right armpit. With your left arm at your side, bend your elbow 90°. Your left forearm should be forward with your palm facing down. Keep your left shoulder in place and raise your left arm in line with your shoulder, about 45°. Your elbow should still be bent. Hold for 2 to 3 seconds and return to your starting position. Repeat and switch sides.

Things to consider

Having good shoulder posture can help prevent shoulder pain. Many people with shoulder pain often lift or hunch their shoulder forward. Work on improving your posture if you find yourself slumping or hunching. Throughout the day, focus on bringing your shoulder or shoulder blade down and holding there.

Another exercise is to stand against the wall with the back of your head, shoulders, legs, and heels touching the wall. Notice if your painful shoulder blade doesn’t touch the wall completely. Keep trying that position throughout the day.

There are other options for the strengthening exercises. You can do them standing up. You can use hand weights or a resistance band to make the stretches more difficult. For each exercise, you should do 20 to 30 reps, 3 to 5 times a week.

Keep your range of motion small at the beginning and increase it over time. If you choose to use weights, start small and increase a little each week. Perform the exercises slowly. Jerky movements can cause pain or damage. Be careful if you have an injury or have had surgery on your rotator cuff.

You should be able to feel the stretches and exercises. However, they should not be painful. If you feel any pain, stop and talk to your doctor or physical therapist. You can ice your shoulder for up to 20 minutes. It’s best to use a plastic bag filled with ice cubes instead of a gel pack.

Questions to ask your doctor

• What should I do if the exercises cause pain?
• How long do I need to do these exercises?
• Are there any other exercises I should do?

Resources

American Academy of Family Physicians: Shoulder Pain

Men’s Fitness, Injury Free: The Best Rotator Cuff Exercises

National Institutes of Health, MedlinePlus: Rotator Cuff Exercises

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What is abnormal uterine bleeding?

Abnormal uterine bleeding is any heavy or unusual bleeding from the uterus (through your vagina). It can occur at any time during your monthly cycle, including during your normal menstrual period. Bleeding after sex or post-menopause would also be considered abnormal.

Symptoms of abnormal uterine bleeding

Vaginal bleeding between periods is one symptom of abnormal uterine bleeding. Having extremely heavy bleeding during your period can also be considered abnormal uterine bleeding. Very heavy bleeding during a period and/or bleeding that lasts more than 7 days is called menorrhagia. For example, women may bleed enough to soak through 1 or more tampons or sanitary pads every hour.

What causes abnormal uterine bleeding?

A variety of things can cause abnormal uterine bleeding. In most women, abnormal uterine bleeding is caused by a hormonal imbalance. When hormones are the problem, doctors refer to this as dysfunctional uterine bleeding (DUB). Abnormal bleeding caused by hormonal imbalance is more common in teenagers or in women who are approaching menopause.

Other common causes of abnormal uterine bleeding are pregnancy, polycystic ovary syndrome (PCOS), or growths in the uterus. These are called polyps or fibroids and can range from small to large growths. Less common causes include an infection, liver, kidney, or thyroid disease, a bleeding disorder, or cancer of the uterus or cervix.

Abnormal uterine bleeding can occur at any age, but the cause usually depends on your age.

Teens, 20s, and 30s

A common cause of abnormal bleeding in teenagers and young adults is pregnancy. Abnormal bleeding can occur in the first few months of a normal pregnancy. Some birth control pills or intrauterine devices (IUDs) can also cause abnormal bleeding.

Abnormal uterine bleeding during a menstrual cycle can occur when your body does not release an egg from your ovaries (called ovulation) as it should. This is common for teenagers who have just started getting their periods. This creates a hormonal imbalance in which the estrogen in your body makes the lining of your uterus (called the endometrium) grow until it gets too thick. When your body gets rid of this lining during your period, the bleeding will be very heavy. A hormonal imbalance may also cause your body not to know when to shed the lining. This can cause irregular bleeding (“spotting”) between your periods.

40s and early 50s

In the years before menopause and when menopause begins, it is common to have months when you don’t ovulate. This can cause abnormal uterine bleeding, including heavy periods and lighter, irregular bleeding. Thickening of the uterine lining is another cause of bleeding in your 40s and 50s. This thickening can be a warning of uterine cancer. You need to talk to your doctor if you have abnormal uterine bleeding and are in this age group. It may be a normal part of getting older, but it’s important to make sure uterine cancer isn’t the cause.

Post-menopause

Hormone replacement therapy is a common cause of uterine bleeding after menopause. Other causes include endometrial and uterine cancer. These cancers are more common in older people than in younger people. But cancer is not always the cause of abnormal uterine bleeding. Many other problems can cause bleeding after menopause. For this reason, it’s important to talk to your doctor if you have any bleeding after menopause.

How is abnormal uterine bleeding diagnosed?

The tests your doctor orders may depend on your age. If you could be pregnant, your doctor will order a pregnancy test. If your bleeding is heavy, your doctor may want to order a blood test. This will make sure you don’t have a low blood count from the blood loss, which could lead to iron deficiency and anemia.

An ultrasound exam of your pelvic area shows both the uterus and the ovaries. It may also show the cause of your bleeding.

Your doctor may want to do an endometrial biopsy. This is a test of the uterine lining. It’s done by putting a thin plastic tube (called a catheter) into your uterus. Your doctor will use the catheter to remove a tiny piece of the uterine lining. They will send that lining sample to the lab for testing. The test will show if you have cancer or a change in the cells. A biopsy can be done in the doctor’s office and causes only mild pain.

Another test is a hysteroscopy. A thin tube with a tiny camera in it is put into your uterus. The camera lets your doctor see the inside of your uterus. If anything abnormal shows up, your doctor can collect tissue for a biopsy.

Can abnormal uterine bleeding be prevented or avoided?

Most causes of abnormal uterine bleeding are not preventable. However, if a hormonal imbalance is caused by being overweight, losing weight could help. Your weight affects your hormone production. Maintaining a healthy weight can help prevent abnormal uterine bleeding in some cases.

Abnormal uterine bleeding treatment

There are several treatment options for abnormal bleeding. Your treatment will depend on the cause of your bleeding, your age, and whether you want to get pregnant in the future. Your doctor will help you decide which treatment is right for you. If your doctor decides that a hormone imbalance is causing your abnormal bleeding, you and your doctor may decide to wait and see if the bleeding improves on its own.

Some treatment options include the following:

Birth control pills. Birth control pills contain hormones that can stop the lining of your uterus from getting too thick. They also can help keep your menstrual cycle regular and reduce cramping. Some types of birth control pills, especially the progestin-only pill (also called the “mini-pill”), can cause abnormal bleeding. Let your doctor know if the pill you’re taking doesn’t control your abnormal bleeding.

Intrauterine device (IUD). Your doctor may suggest an IUD. An IUD is a small, plastic device that your doctor inserts into your uterus through your vagina to prevent pregnancy. One type of IUD releases hormones. This type can significantly reduce abnormal bleeding. Like birth control pills, sometimes IUDs can be the cause of abnormal bleeding. Tell your doctor if this happens to you.

Dilation and curettage (D&C). A D&C is a procedure in which the opening of your cervix is stretched so that a surgical tool can be put into your uterus. Your doctor uses this tool to scrape away the lining of your uterus. The removed lining is checked in a lab for abnormal tissue. A D&C is done under general anesthesia (while you’re in a sleep-like state).

If you’re having heavy bleeding, your doctor may perform a D&C both to find out the cause and treat the bleeding. The D&C itself often makes heavy bleeding stop. Your doctor will decide if this procedure is necessary.

Hysterectomy. This type of surgery removes the uterus. If you have a hysterectomy, you won’t have any more periods and you won’t be able to get pregnant. A hysterectomy is major surgery that requires general anesthesia and a hospital stay. It may require a long recovery period. Talk to your doctor about the risks and benefits of a hysterectomy.

Endometrial ablation. This is a surgical procedure that destroys the lining of the uterus. Unlike a hysterectomy, it does not remove the uterus. Endometrial ablation may stop all menstrual bleeding. However, some people will have light menstrual bleeding or spotting after endometrial ablation. In rare cases, you may still have regular menstrual periods after the procedure. After endometrial ablation, you should still use some form of birth control even though, in most cases, pregnancy is not likely after the procedure.

Your doctor can do endometrial ablation in several different ways. Newer endometrial ablation techniques do not require general anesthesia or a hospital stay. The recovery time after this procedure is shorter than the recovery time after a hysterectomy.

Living with abnormal uterine bleeding

Abnormal uterine bleeding can impact your life in a negative way. Not being able to predict when bleeding will begin can cause you to be anxious all the time. Also, heavy menstrual bleeding may limit your daily activities during your period. For some people, it even prevents them from leaving the house.

If you have heavy menstrual bleeding, try taking ibuprofen (brand names: Advil, Motrin) during your period (or a few days before you expect your period). Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs can help reduce pain and cramping.

You also should be sure to get enough iron in your diet. Your doctor may prescribe an iron supplement to ensure that you don’t become anemic.

Questions to ask your doctor:

• What is the likely cause of my abnormal uterine bleeding?
• Is my condition serious? Am I at risk for any other health problems?
• Based on the cause, what treatment options do you recommend?
• What are the risks and benefits of this treatment?
• Will the treatment affect my chances of getting pregnant in the future?

Resources

Centers for Disease Control and Prevention: Heavy Menstrual Bleeding

National Institutes of Health, MedlinePlus: Abnormal Uterine Bleeding

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When you digest food, your body changes most of the food you eat into glucose (a form of sugar). Insulin allows this glucose to enter all the cells of your body and be used as energy. When you have diabetes, your body doesn’t make enough insulin or can’t use it properly. Because of this, the glucose builds up in your blood instead of moving into the cells. Too much glucose in the blood and not enough in your cells can lead to serious health problems.

All people who have type 1 diabetes and some who have type 2 diabetes need to take insulin. It helps control their blood sugar levels. The goal is to keep your blood sugar level in a normal range as much as possible. Insulin is usually taken by injection (a shot). It can also be taken using an insulin pen or an insulin pump.

Path to improved health

How often will I need to take insulin?

You and your doctor will develop a schedule that is right for you. Most people who have diabetes and take insulin need at least 2 insulin shots a day for good blood sugar control. Some people need 3 or 4 shots a day.

Do I need to monitor my blood sugar level?

Yes. Monitoring and controlling your blood sugar is key to preventing the complications of diabetes. If you don’t already monitor your blood sugar level, you will need to learn how. Checking your blood sugar involves pricking your finger to get a small drop of blood that you put on a test strip. You then insert the strip into a machine called a glucose meter. The results will tell you whether your blood sugar is in a healthy range

There are newer devices that can monitor your blood sugar without pricking your finger. Some of these work by wearing a sensor on your arm or abdomen. The sensor will read your glucose levels from fluids just underneath your skin. The information is then transmitted to a reader or an app on your phone.

Your doctor will help you decide which method is best for you.

When should I take insulin?

You and your doctor should discuss when and how you will take your insulin. Each person’s treatment is different. Some people who use regular insulin take it 30 to 60 minutes before a meal. Some people who use rapid-acting insulin take it just before they eat.

Types of insulin:

• Rapid-acting insulin (such as insulin lispro, insulin aspart, and insulin glulisine) starts working in about 15 minutes. It lasts for 3 to 5 hours.
• Short-acting insulin (such as regular insulin) starts working in 30 to 60 minutes and lasts 5 to 8 hours.
• Intermediate-acting insulin (such as insulin NPH) starts working in 1 to 3 hours and lasts 12 to 16 hours.
• Long-acting insulin (such as insulin glargine and insulin detemir) starts working in about 1 hour and lasts 20 to 26 hours.
• Premixed insulin is a combination of 2 types of insulin (usually a rapid- or short-acting insulin and an intermediate-acting insulin).

What is rapid-acting insulin? How can it help control my blood sugar level?

Rapid-acting insulin starts working more quickly than other types of insulin. It begins working within 15 minutes and leaves your body after 3 to 5 hours.

To keep your blood sugar level steady throughout the day, your doctor may also prescribe a longer-acting insulin. Or they may prescribe another drug for you to take each day in addition to rapid-acting insulin.

When do I take rapid-acting insulin?

You should inject rapid-acting insulin no more than 15 minutes before you eat. Your doctor will tell you how much insulin to inject. Remember, you should not wait more than 15 minutes to eat after you take this insulin shot.

Rapid-acting insulin can be more convenient to take than regular insulin. With regular insulin, you inject the insulin and then wait 30 to 60 minutes before eating. Many people find it hard to time their meals around regular insulin injections. Sometimes they end up eating too soon or too late. Then they don’t achieve the best blood sugar control. Since rapid-acting insulin is taken so close to mealtime, it may help you control your blood sugar more effectively.

Can I mix rapid-acting insulin with other types of insulin?

You can mix a rapid-acting insulin with an intermediate-acting insulin, according to your doctor’s instructions. Rapid-acting insulin should always be drawn into the syringe first. This will keep the intermediate-acting insulin from getting into the rapid-acting insulin bottle. After mixing rapid-acting insulin in the same syringe with an intermediate-acting insulin, you must inject the mixture under your skin within 15 minutes. Remember to eat within 15 minutes after the injection.

How do I prepare the correct dose of insulin?

You may take insulin using a syringe that you fill from a vial or using a dosing pen that contains the insulin. If your rapid-acting insulin comes in a pen, your doctor or their office staff can show you how to use it correctly. Follow the directions carefully.

• Wash your hands.
• Take the plastic cover off the new insulin bottle. Wipe the top of the bottle with a cotton swab that you have dipped in alcohol. It’s best for rapid-acting insulin to be at room temperature before you inject it.
• Pull back the plunger of the syringe. This draws air into the syringe equal to the dose of insulin that you are taking. Then put the syringe needle through the rubber top of the insulin bottle. Inject air into the bottle by pushing the syringe plunger forward. Then turn the bottle upside down.
• Make sure that the tip of the needle is in the insulin. Pull back on the syringe plunger to draw the correct dose of insulin into the syringe. The dose of insulin is measured in units.
• Make sure there are no air bubbles in the syringe before you take the needle out of the insulin bottle. Air bubbles can cut down the amount of insulin that you get in your injection. If air bubbles are present, hold the syringe and the bottle straight up in one hand, tap the syringe with your other hand and let the air bubbles float to the top. Push on the plunger of the syringe to move the air bubbles back into the insulin bottle. Then withdraw the correct insulin dose by pulling back on the plunger.
• Clean your skin with cotton dipped in alcohol. Grab a fold of skin and inject the insulin at a 90-degree angle. (If you’re thin, you may need to pinch the skin and inject the insulin at a 45-degree angle.) When the needle is in your skin, you don’t need to draw back the syringe plunger to check for blood.

Where do I inject the insulin?

Insulin is injected just under the skin. Your doctor or their office staff will show you how and where to give an insulin injection. The usual places to inject insulin are the upper arm, the front and side parts of the thighs, and the abdomen. Don’t inject insulin closer than 2 inches from your belly button.

To keep your skin from thickening, try not to inject the insulin in the same place over and over. Instead, rotate injection places.

Things to consider

If you’re going to use rapid-acting insulin, you need to be aware of insulin reactions and how to treat them. Rapid-acting insulin begins to work very quickly. So while you and your doctor are working to find the right dosage of this insulin, you may have some insulin reactions.

Hypoglycemia is a condition in which the level of sugar in your blood is too low. If you use insulin, your blood sugar level can get too low if you exercise more than usual or if you don’t eat enough. It also can get too low if you don’t eat on time or if you take too much insulin. Most people who take insulin have insulin reactions at some time. Signs of an insulin reaction and hypoglycemia include the following:

• Feeling very tired
• Yawning frequently
• Being unable to speak or think clearly
• Losing muscle coordination
• Sweating
• Twitching
• Having a seizure
• Suddenly feeling like you’re going to pass out
• Becoming very pale
• Losing consciousness

People who have diabetes should carry at least 15 grams of a fast-acting carbohydrate with them at all times in case of hypoglycemia or an insulin reaction. The following are examples of quick sources of energy that can relieve the symptoms of an insulin reaction:

• Non-diet soda: ½ to ¾ cup
• Fruit juice: ½ cup
• Fruit: 2 tablespoons of raisins
• Milk: 1 cup
• Candy: 5 Lifesavers
• Glucose tablets: 3 tablets (5 grams each)

If you don’t feel better 15 minutes after having a fast-acting carbohydrate, or if monitoring shows that your blood sugar level is still too low, have another 15 grams of a fast-acting carbohydrate.

Teach your friends, work colleagues, and family members how to treat hypoglycemia, because sometimes you may need their help. Also, keep a supply of glucagon on hand. Glucagon comes in a kit with a powder and a liquid that you must mix and then inject. It will raise your blood sugar level. If you are unconscious, or you can’t eat or drink, another person can give you a shot of glucagon. Talk to your doctor to learn when and how to use glucagon.

You need to check your blood sugar level regularly using a blood glucose monitor. Your doctor or their office staff can teach you how to use the monitor. You’ll need to write down each measurement and show this record to your doctor. They will use this information to decide how much insulin is right for you.

Blood sugar measurements can vary depending on your lifestyle. Stress levels, how often you exercise, and how fast your body absorbs food can affect measurements. Hormonal changes related to puberty, menstrual cycles, and pregnancy can, too. Illness, traveling, or a change in your routine may mean that you have to monitor your blood sugar level more often.

Questions for your doctor

• Do I need insulin to control my type of diabetes?
• What type of insulin should I take?
• How often do I need to check my blood sugar?
• How can I know how much insulin to take?
• What if insulin doesn’t seem to lower my blood sugar?
• What should I do to keep my insulin from getting too low overnight?

Resources

National Institutes of Health, MedlinePlus: Insulin Injection

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