Category: Treatments And Advice

A dry mouth is rarely a sign of anything serious. There are things you can do to help ease it yourself. See a GP if these don’t work or you also have other symptoms.

Causes of a dry mouth

The main causes of a dry mouth are:

• dehydration – for example, from not drinking enough, sweating a lot or being ill
• medicines – check the leaflet or search for your medicine online to see if dry mouth is a side effect
• breathing through your mouth at night – this can happen if you have a blocked nose or you sleep with your mouth open
• anxiety
• cancer treatment (radiotherapy or chemotherapy)

Sometimes a dry mouth that doesn’t go away may be caused by a condition like diabetes or Sjögren’s syndrome.

How to help ease a dry mouth yourself

Do

• drink plenty of water – take regular sips during the day and keep some water by your bed at night
• suck on ice cubes or ice lollies
• chew sugar-free gum or suck on sugar-free sweets
• use lip balm if your lips are also dry
• brush your teeth twice a day and use alcohol-free mouthwash – you’re more likely to get tooth decay if you have a dry mouth

Don’t

• do not drink lots of alcohol, caffeine (such as tea and coffee) or fizzy drinks
• do not have foods that are acidic (like lemons), spicy, salty or sugary
• do not smoke
• do not stop taking a prescribed medicine without getting medical advice first – even if you think it might be causing your symptoms

A pharmacist can help if you have a dry mouth

Ask a pharmacist about treatments you can buy to help keep your mouth moist.

You can get:

• gels
• sprays
• tablets or lozenges

Not all products are suitable for everyone. Ask a pharmacist for advice about the best one for you.

If your dry mouth might be caused by a blocked nose, a pharmacist may suggest decongestants to unblock it.

Non-urgent advice:

See a GP if:

• your mouth is still dry after trying home or pharmacy treatments for a few weeks
• you have difficulty chewing, swallowing or talking
• your mouth is painful, red or swollen
• you have sore white patches in your mouth
• you think a prescribed medicine might be causing your dry mouth
• you have other symptoms, like needing to pee a lot or dry eyes

They can check what the cause might be and recommend treatment for it.

Most people have indigestion at some point. Usually, it’s not a sign of anything more serious and you can treat it yourself.

How to tell if you have indigestion (dyspepsia)

You can have the following symptoms after eating or drinking:

• heartburn – a painful burning feeling in the chest, often after eating
• feeling full and bloated
• feeling sick
• belching and farting
• bringing up food or bitter tasting fluids

When it’s not indigestion

Stomach ache or back pain are usually not symptoms of indigestion. If you have those you might be constipated.

Indigestion, heartburn and acid reflux – what’s the difference?

Heartburn and acid reflux are the same thing – when acid from your stomach comes up your throat. You’ll have a burning feeling when this happens. This can be a symptom of indigestion.

How you can treat indigestion yourself

There’s usually no need to see a GP about indigestion. There are some things you can do at home.

Do

• cut down on tea, coffee, cola or alcohol
• prop your head and shoulders up in bed – this can stop stomach acid coming up while you sleep
• lose weight if you’re overweight

Don’t

• eat 3 to 4 hours before going to bed
• have rich, spicy or fatty foods
• take ibuprofen or aspirin – this can make indigestion worse
• smoke

A pharmacist can help with indigestion

A pharmacist can recommend medicines that will ease the burning feeling or pain that can come with indigestion.

These medicines make your stomach less acidic. They’re called antacids.

It’s best to take the medicine after eating – they’ll last up to 3 hours on a full stomach. They’ll only last for 20 to 60 minutes on an empty stomach.

Find a pharmacy

Pregnant women: treating indigestion

Pregnant women often get indigestion. It’s very common from 27 weeks onwards.

It can be caused by hormonal changes and the growing baby pressing against the stomach.

A pharmacist can help with uncomfortable feelings or pain. They can recommend the best medicines to use when you’re pregnant.

Non-urgent advice:

See a GP if you:

• keep getting indigestion
• are in bad pain
• are 55 or older
• have lost a lot of weight without meaning to
• have difficulty swallowing (dysphagia)
• keep vomiting
• have iron deficiency anaemia
• feel like you have a lump in your stomach
• have bloody vomit or poo

These symptoms can be a sign of something more serious.

What causes indigestion

The acid in your stomach can irritate the stomach lining or your throat. This causes indigestion and gives you a burning feeling and pain.

Other things that can cause indigestion include:

• medicines
• smoking
• alcohol

Stress can make indigestion worse.

Sunburn is red, hot and sore skin caused by too much sun. It may flake and peel after a few days. You can treat it yourself. It usually gets better within 7 days.

How to ease sunburn yourself

Do

• get out of the sun as soon as possible
• cool your skin with a cool shower, bath or damp towel (take care not to let a baby or young child get too cold)
• apply aftersun cream or spray, like aloe vera
• drink plenty of water to cool down and prevent dehydration
• take painkillers, such as paracetamol or ibuprofen for any pain
• cover sunburnt skin from direct sunlight until skin has fully healed

Don’t

• do not use petroleum jelly on sunburnt skin
• do not put ice or ice packs on sunburnt skin
• do not pop any blisters
• do not scratch or try to remove peeling skin
• do not wear tight-fitting clothes over sunburnt skin

You can ask a pharmacist:

• about the best sunburn treatments
• if you need to see a GP

Non-urgent advice:

See a GP urgently or call NHS 111 if:

• your skin is blistered or swollen
• your temperature is very high, or you feel hot and shivery
• you feel very tired, dizzy and sick
• you have a headache and muscle cramps
• your baby or young child has sunburn

Severe sunburn can lead to heat exhaustion and heat stroke, which can be very serious.

Atopic eczema (atopic dermatitis) is the most common form of eczema, a condition that causes the skin to become itchy, dry and cracked.

Atopic eczema is more common in children, often developing before their first birthday. But it may also develop for the first time in adults.

It’s usually a long-term (chronic) condition, although it can improve significantly, or even clear completely, in some children as they get older.

Symptoms of atopic eczema

Atopic eczema causes the skin to become itchy, dry, cracked and sore.

Some people only have small patches of dry skin, but others may experience widespread inflamed skin all over the body.

Inflamed skin can become red on lighter skin, and darker brown, purple or grey on darker skin. This can also be more difficult to see on darker skin.

Although atopic eczema can affect any part of the body, it most often affects the hands, insides of the elbows, backs of the knees and the face and scalp in children.

People with atopic eczema usually have periods when symptoms are less noticeable, as well as periods when symptoms become more severe (flare-ups).

When to seek medical advice

See a GP if you have symptoms of atopic eczema. They’ll usually be able to diagnose atopic eczema by looking at your skin and asking questions, such as:

• whether the rash is itchy and where it appears
• when the symptoms first began
• whether it comes and goes over time
• whether there’s a history of atopic eczema in your family
• whether you have any other conditions, such as allergies or asthma
• whether something in your diet or lifestyle may be contributing to your symptoms

Typically, to be diagnosed with atopic eczema you should have had an itchy skin condition in the last 12 months and 3 or more of the following:

• visibly irritated red skin in the creases of your skin – such as the insides of your elbows or behind your knees (or on the cheeks, outsides of elbows, or fronts of the knees in children aged 18 months or under) at the time of examination by a health professional
• a history of skin irritation occurring in the same areas mentioned above
• generally dry skin in the last 12 months
• a history of asthma or hay fever – children under 4 must have an immediate relative, such as a parent, brother or sister, who has 1 of these conditions
• the condition started before the age of 2 (this does not apply to children under the age of 4)

Causes of atopic eczema

The exact cause of atopic eczema is unknown, but it’s clear it is not down to one single thing.

Atopic eczema often occurs in people who get allergies. “Atopic” means sensitivity to allergens.

It can run in families, and often develops alongside other conditions, such as asthma and hay fever.

The symptoms of atopic eczema often have certain triggers, such as soaps, detergents, stress and the weather. 

Sometimes food allergies can play a part, especially in young children with severe eczema.

You may be asked to keep a food diary to try to determine whether a specific food makes your symptoms worse.

Allergy tests are not usually needed, although they’re sometimes helpful in identifying whether a food allergy may be triggering symptoms.

Treating atopic eczema

Treatment for atopic eczema can help to relieve the symptoms and many cases improve over time.

But there’s currently no cure and severe eczema often has a significant impact on daily life, which may be difficult to cope with physically and mentally.

There’s also an increased risk of skin infections. 

Many different treatments can be used to control symptoms and manage eczema, including:

• self-care techniques, such as reducing scratching and avoiding triggers
• emollients (moisturising treatments) – used on a daily basis for dry skin 
• topical corticosteroids – used to reduce swelling, redness and itching during flare-ups

Other types of eczema

Eczema is the name for a group of skin conditions that cause dry, irritated skin.

Other types of eczema include:

• discoid eczema – a type of eczema that occurs in circular or oval patches on the skin
• contact dermatitis – a type of eczema that occurs when the body comes into contact with a particular substance
• varicose eczema – a type of eczema that most often affects the lower legs and is caused by problems with the flow of blood through the leg veins
• seborrhoeic eczema – a type of eczema where red, scaly patches develop on the sides of the nose, eyebrows, ears and scalp
• dyshidrotic eczema (pompholyx) – a type of eczema that causes tiny blisters to erupt across the palms of the hands

Atopic eczema is likely to be caused by a combination of things.

People with atopic eczema often have very dry skin because their skin is unable to retain much moisture. This dryness may make the skin more likely to react to certain triggers, causing it to become itchy and sore.

You may be born with an increased likelihood of developing atopic eczema because of the genes you inherit from your parents.

Research has shown children who have 1 or both parents with atopic eczema, or who have other siblings with eczema, are more likely to develop it themselves.

Atopic eczema is not infectious, so it cannot be passed on through close contact.

Eczema triggers

There are a number of things that may trigger your eczema symptoms. These can vary from person to person.

Common triggers include:

• irritants – such as soaps and detergents, including shampoo, washing-up liquid and bubble bath
• environmental factors or allergens – such as cold and dry weather, dampness, and more specific things such as house dust mites, pet fur, pollen and moulds
• food allergies – such as allergies to cows’ milk, eggs, peanuts, soya or wheat
• certain materials worn next to the skin – such as wool and synthetic fabrics
• hormonal changes – women may find their symptoms get worse in the days before their period or during pregnancy
• skin infections

Some people also report their symptoms get worse when the air is dry or dusty, or when they are stressed, sweaty, or too hot or too cold.

If you’re diagnosed with atopic eczema, a GP will work with you to try to identify any triggers for your symptoms.

Treatments for atopic eczema can help to ease the symptoms. There’s no cure, but many children find their symptoms naturally improve as they get older.

The main treatments for atopic eczema are:

• emollients (moisturisers) – used every day to stop the skin becoming dry
• topical corticosteroids – creams and ointments used to reduce swelling and redness during flare-ups

Other treatments include:

• topical pimecrolimus or tacrolimus for eczema in sensitive sites not responding to simpler treatment
• antihistamines for severe itching
• bandages or special body suits to allow the body to heal underneath
• more powerful treatments offered by a dermatologist (skin specialist)

The various treatments for atopic eczema are outlined on this page.

Self care

As well as the treatments mentioned above, there are things you can do yourself to help ease your symptoms and prevent further problems. 

Try to reduce the damage from scratching

Eczema is often itchy, and it can be very tempting to scratch the affected areas of skin.

But scratching usually damages the skin, which can itself cause more eczema to occur.

The skin eventually thickens into leathery areas as a result of chronic scratching.

Deep scratching also causes bleeding and increases the risk of your skin becoming infected or scarred.

Try to reduce scratching whenever possible. You could try gently rubbing your skin with your fingers instead.

If your baby has atopic eczema, anti-scratch mittens may stop them scratching their skin.

Keep your nails short and clean to minimise damage to the skin from unintentional scratching.

Keep your skin covered with light clothing to reduce damage from habitual scratching.

Avoid triggers

A GP will work with you to establish what might trigger the eczema flare-ups, although it may get better or worse for no obvious reason.

Once you know your triggers, you can try to avoid them. 

For example:

• if certain fabrics irritate your skin, avoid wearing these and stick to soft, fine-weave clothing or natural materials such as cotton
• if heat aggravates your eczema, keep the rooms in your home cool, especially the bedroom
• avoid using soaps or detergents that may affect your skin – use soap substitutes instead

Although some people with eczema are allergic to house dust mites, trying to rid your home of them is not recommended as it can be difficult and there’s no clear evidence that it helps.

Read more about preventing allergies

Dietary changes

Some foods, such as eggs and cows’ milk, can trigger eczema symptoms.

But you should not make significant changes to your diet without first speaking to a GP.

It may not be healthy to cut these foods from your diet, especially in young children who need the calcium, calories and protein from these foods.

If a GP suspects a food allergy, you may be referred to a dietitian (a specialist in diet and nutrition).

They can help to work out a way to avoid the food you’re allergic to while ensuring you still get all the nutrition you need.

Alternatively, you may be referred to a hospital specialist, such as an immunologist, dermatologist or paediatrician.

If you’re breastfeeding a baby with atopic eczema, get medical advice before making any changes to your regular diet.

Emollients

Emollients are moisturising treatments applied directly to the skin to reduce water loss and cover it with a protective film.

They’re often used to help manage dry or scaly skin conditions, such as atopic eczema.

In addition to making the skin feel less dry, they may also have a mild anti-inflammatory role and can help reduce the number of flare-ups you have.

If you have mild eczema, talk to a pharmacist for advice on emollients. If you have moderate or severe eczema, talk to a GP.

Choosing an emollient

Several different emollients are available. Talk to a pharmacist for advice on which emollient to use. You may need to try a few to find one that works for you.

You may also be advised to use a mix of emollients, such as:

• an ointment for very dry skin
• a cream or lotion for less dry skin
• an emollient to use instead of soap
• an emollient to use on your face and hands, and a different one to use on your body

The difference between lotions, creams and ointments is the amount of oil they contain.

Ointments contain the most oil so they can be quite greasy, but are the most effective at keeping moisture in the skin.

Lotions contain the least amount of oil so are not greasy, but can be less effective. Creams are somewhere in between.

If you have been using a particular emollient for some time, it may eventually become less effective or may start to irritate your skin.

If this is the case, you may find another product suits you better. You can speak to a pharmacist about other options.

The best emollient is the one you feel happy using every day.

How to use emollients

Use your emollient all the time, even if you’re not experiencing symptoms.

Many people find it helpful to keep separate supplies of emollients at work or school, or a tub in the bathroom and one in a living area.

To apply the emollient:

• use a large amount
• do not rub it in – smooth it into the skin in the same direction the hair grows
• after a bath or shower, gently pat the skin dry and apply the emollient while the skin is still moist to keep the moisture in

You should use an emollient at least twice a day if you can, or more often if you have very dry skin.

During a flare-up, apply generous amounts of emollient more frequently, but remember to treat inflamed skin with a topical corticosteroid as emollients used on their own are not enough to control it.

Do not put your fingers into an emollient pot – use a spoon or pump dispenser instead, as this reduces the risk of infection. And never share your emollient with other people.

Topical corticosteroids

If your skin is sore and inflamed, a GP may prescribe a topical corticosteroid (applied directly to your skin), which can reduce the inflammation within a few days.

Topical corticosteroids can be prescribed in different strengths, depending on the severity of your atopic eczema and the areas of skin affected.

They can be:

• very mild (such as hydrocortisone)
• moderate (such as betamethasone valerate and clobetasone butyrate)
• strong (such as a higher dose of betamethasone valerate and betamethasone diproprionate)
• very strong (such as clobetasol proprionate and diflucortolone valterate)

If you need to use corticosteroids frequently, see a GP regularly so they can check the treatment is working effectively and you’re using the right amount.

How to use topical corticosteroids

Do not be afraid to apply the treatment to affected areas to control your eczema.

Unless instructed otherwise by a doctor, follow the directions on the patient information leaflet that comes with your medicine.

This will give details of how much to apply.

Most people only have to apply it once a day as there’s no evidence there’s any benefit to applying it more often.

When using a topical corticosteroid:

• apply your emollient first and ideally wait around 30 minutes until the emollient has soaked into your skin, or apply the corticosteroid at a different time of day (such as at night)
• apply the recommended amount of the topical corticosteroid to the affected area
• continue to use it until 48 hours after the flare-up has cleared so the inflammation under the skin surface is treated

Occasionally, your doctor may suggest using a topical corticosteroid less frequently, but over a longer period of time. This is designed to help prevent flare-ups.

This is sometimes called weekend treatment, where a person who has already gained control of their eczema uses the topical corticosteroid every weekend on the trouble sites to prevent them becoming active again.

Side effects

Topical corticosteroids may cause a mild stinging sensation for less than a minute as you apply them.

In rare cases, they may also cause:

• thinning of the skin – especially if the strong steroids are used in the wrong places, such as the face, for too long (for example, several weeks)
• changes in skin colour – usually, skin lightening after many months of using very strong steroids, but most lightening after eczema is a “footprint” of old inflammation and nothing to do with treatments
• acne (spots) – especially when used on the face in teenagers
• increased hair growth

Most of these side effects will improve once treatment stops.

Your risk of side effects may be increased if you use a strong topical corticosteroid:

• for many months
• in sensitive areas such as the face, armpits or groin
• in large amounts

You should be prescribed the weakest effective treatment to control your symptoms.

Antihistamines 

Antihistamines are a type of medicine that block the effects of a substance in the blood called histamine.

They can help relieve the itching associated with atopic eczema.

They can either be sedating, which cause drowsiness, or non-sedating.

If you have severe itching, a GP may suggest trying a non-sedating antihistamine.

If itching during a flare-up affects your sleep, a GP may suggest taking a sedating antihistamine.

Sedating antihistamines can cause drowsiness into the following day, so it may be helpful to let your child’s school know they may not be as alert as normal.

Bandages and wet wraps

In some cases, a GP may prescribe medicated bandages, clothing or wet wraps to wear over areas of skin affected by eczema.

These can either be used over emollients or with topical corticosteroids to prevent scratching, allow the skin underneath to heal, and stop the skin drying out.

Corticosteroid tablets

Corticosteroid tablets are rarely used to treat atopic eczema nowadays, but may occasionally be prescribed for short periods of 5 to 7 days to help bring particularly severe flare-ups under control.

Longer courses of treatment are generally avoided because of the risk of potentially serious side effects.

If a GP thinks your condition may be severe enough to benefit from repeated or prolonged treatment with corticosteroid tablets, they’ll probably refer you to a specialist.

Seeing a specialist

In some cases, a GP may refer you to a specialist in treating skin conditions (dermatologist).

You may be referred if:

• a GP is not sure what type of eczema you have
• normal treatment is not controlling your eczema
• your eczema is affecting your daily life
• it’s not clear what’s causing it

A dermatologist may be able to offer the following:

• allergy testing
• a thorough review of your existing treatment – to make sure you’re using enough of the right things at the right times
• topical calcineurin inhibitors – creams and ointments that suppress your immune system, such as pimecrolimus and tacrolimus
• very strong topical corticosteroids
• bandages or wet wraps
• phototherapy – ultraviolet (UV) light that reduces inflammation
• immunosuppressant tablets – to suppress your immune system, such as azathioprine, ciclosporin and methotrexate
• alitretinoin – medicine to treat severe eczema affecting the hands in adults
• dupilumab – a medicine for adults with moderate to severe eczema that may be tried when other treatments have not worked

A dermatologist may also offer additional support to help you use your treatments correctly, such as demonstrations from specialist nurses, and they may be able to refer you for psychological support if you feel you need it.

Complementary therapies

Some people may find complementary therapies such as herbal remedies helpful in treating their eczema, but there’s little evidence to show these remedies are effective.

If you’re thinking about using a complementary therapy, speak to a GP first to ensure the therapy is safe for you to use.

Make sure you continue to use other treatments a GP has prescribed.

Infertility is when a couple cannot get pregnant (conceive) despite having regular unprotected sex.

Around 1 in 7 couples may have difficulty conceiving.

About 84% of couples will conceive naturally within a year if they have regular unprotected sex (every 2 or 3 days).

For couples who have been trying to conceive for more than 3 years without success, the likelihood of getting pregnant naturally within the next year is 1 in 4, or less.

Getting help

Some people get pregnant quickly, but for others it can take longer. It’s a good idea to see a GP if you have not conceived after a year of trying.

Women aged 36 and over, and anyone who’s already aware they may have fertility problems, should see their GP sooner.

They can check for common causes of fertility problems and suggest treatments that could help.

Infertility is usually only diagnosed when a couple have not managed to conceive after a year of trying.

There are 2 types of infertility:

• primary infertility – where someone who’s never conceived a child in the past has difficulty conceiving
• secondary infertility – where someone has had 1 or more pregnancies in the past, but is having difficulty conceiving again

Read more about how infertility is diagnosed.

Treating infertility

Fertility treatments include:

• medical treatment for lack of regular ovulation
• surgical procedures such as treatment for endometriosis, repair of the fallopian tubes, or removal of scarring (adhesions) within the womb or abdominal cavity
• assisted conception such as intrauterine insemination (IUI) or IVF

The treatment offered will depend on what’s causing the fertility problems and what’s available from your local clinical commissioning group (CCG).

Private treatment is also available, but it can be expensive and there’s no guarantee it will be successful.

It’s important to choose a private clinic carefully. You can ask a GP for advice, and should make sure you choose a clinic that’s licensed by the Human Fertilisation and Embryology Authority (HFEA).

Some treatments for infertility, such as IVF, can cause complications.

For example:

• multiple pregnancy – if more than 1 embryo is placed in the womb as part of IVF treatment there’s an increased chance of having twins; this may not seem like a bad thing, but it significantly increases the risk of complications for you and your babies
• ectopic pregnancy – the risk of having an ectopic pregnancy is slightly increased if you have IVF

Read more about how infertility is treated.

What causes infertility?

There are many possible causes of infertility, and fertility problems can affect either partner. But in a quarter of cases it is not possible to identify the cause.

Common causes of infertility include:

• lack of regular ovulation (the monthly release of an egg)
• poor quality semen
• blocked or damaged fallopian tubes
• endometriosis – where tissue that behaves like the lining of the womb (the endometrium) is found outside the womb

Risk factors

There are also several factors that can affect fertility.

These include:

• age – fertility declines with age
• weight – being overweight or obese (having a BMI of 30 or over) reduces fertility; in women, being overweight or severely underweight can affect ovulation
• sexually transmitted infections (STIs) – several STIs, including chlamydia, can affect fertility
• smoking – can affect fertility: smoking (including passive smoking) affects your chance of conceiving and can reduce semen quality; read more about quitting smoking
• alcohol – the safest approach is not to drink alcohol at all to keep risks to your baby to a minimum. Drinking too much alcohol can also affect the quality of sperm (the chief medical officers for the UK recommend adults should drink no more than 14 units of alcohol a week, which should be spread evenly over 3 days or more)
• environmental factors – exposure to certain pesticides, solvents and metals has been shown to affect fertility, particularly in men
• stress – can affect your relationship with your partner and cause a loss of sex drive; in severe cases, stress may also affect ovulation and sperm production

There’s no evidence to suggest caffeinated drinks, such as tea, coffee and colas, are associated with fertility problems.

Infertility can be caused by many different things. For 1 in 4 couples, a cause cannot be identified.

Infertility in women

Infertility is commonly caused by problems with ovulation (the monthly release of an egg from the ovaries).

Some problems stop an egg being released at all, while others prevent an egg being released during some cycles but not others.

Ovulation problems can be a result of:

• polycystic ovary syndrome (PCOS)
• thyroid problems – both an overactive thyroid gland and an underactive thyroid gland can prevent ovulation
• premature ovarian failure – where the ovaries stop working before the age of 40

Scarring from surgery

Pelvic surgery can damage and scar the fallopian tubes, which link the ovaries to the womb.

Cervical surgery can also sometimes cause scarring or shorten the neck of the womb (the cervix).

Cervical mucus problems 

When you’re ovulating, mucus in your cervix becomes thinner so sperm can swim through it more easily. If there’s a problem with the mucus, it can make it harder to conceive.

Fibroids

Non-cancerous growths called fibroids in or around the womb can affect fertility. In some cases, they may prevent a fertilised egg attaching itself in the womb, or they may block a fallopian tube.

Endometriosis

Endometriosis is a condition where small pieces of the womb lining (the endometrium) start growing in other places, such as the ovaries.

This can damage the ovaries or fallopian tubes and cause fertility problems.

Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is an infection of the upper female genital tract, which includes the womb, fallopian tubes and ovaries.

It’s often caused by a sexually transmitted infection (STI). PID can damage and scar the fallopian tubes, making it virtually impossible for an egg to travel down into the womb.

Sterilisation

Some women choose to be sterilised if they do not want to have any more children.

Sterilisation involves blocking the fallopian tubes to make it impossible for an egg to travel to the womb.

It’s rarely reversible – if you do have a sterilisation reversed, you will not necessarily be able to have a child.

Medicines and drugs 

The side effects of some types of medicines and drugs can affect your fertility. These include:

• non-steroidal anti-inflammatory drugs (NSAIDs) – the long-term use or a high dosage of NSAIDs, such as ibuprofen or aspirin, can make it more difficult to conceive
• chemotherapy – medicines used for chemotherapy can sometimes cause ovarian failure, which means your ovaries will no longer be able to function properly
• neuroleptic medicines – antipsychotic medicines, often used to treat psychosis, can sometimes cause missed periods or infertility
• spironolactone – a type of medicine used to treat fluid retention (oedema); fertility should recover around 2 months after you stop taking spironolactone

Illegal drugs, such as marijuana and cocaine, can seriously affect fertility and make ovulation more difficult.

Infertility in men

Semen and sperm

A common cause of infertility in men is poor-quality semen, the fluid containing sperm that’s ejaculated during sex.

Possible reasons for abnormal semen include:

• a lack of sperm – you may have a very low sperm count or no sperm at all
• sperm that are not moving properly – this will make it harder for sperm to swim to the egg
• abnormal sperm – sperm can sometimes be an abnormal shape, making it harder for them to move and fertilise an egg

Many cases of abnormal semen are unexplained.

There’s a link between increased temperature of the scrotum and reduced semen quality, but it’s uncertain whether wearing loose-fitting underwear improves fertility.

Testicles

The testicles produce and store sperm. If they’re damaged, it can seriously affect the quality of your semen.

This can happen as a result of:

• an infection of your testicles
• testicular cancer
• testicular surgery
• a problem with your testicles you were born with (a congenital defect)
• when 1 or both testicles has not descended into the scrotum (the loose sac of skin that contains your testicles (undescended testicles))
• injury to your testicles

Sterilisation

Some men choose to have a vasectomy if they do not want children or any more children.

It involves cutting and sealing off the tubes that carry sperm out of your testicles (the vas deferens) so your semen will no longer contain any sperm.

A vasectomy can be reversed, but reversals are not usually successful.

Ejaculation disorders

Some men experience ejaculation problems that can make it difficult for them to release semen during sex (ejaculate).

Hypogonadism

Hypogonadism is an abnormally low level of testosterone, the male sex hormone involved in making sperm.

It could be caused by a tumour, taking illegal drugs, or Klinefelter syndrome (a rare syndrome involving an extra female chromosome).

Medicines and drugs

Certain types of medicines can sometimes cause infertility problems. These include:

• sulfasalazine – an anti-inflammatory medicine used to treat conditions such as Crohn’s disease and rheumatoid arthritis; sulfasalazine can decrease the number of sperm, but its effects are temporary and your sperm count should return to normal when you stop taking it
• anabolic steroids – are often used illegally to build muscle and improve athletic performance; long-term abuse of anabolic steroids can reduce sperm count and sperm mobility
• chemotherapy – medicines used in chemotherapy can sometimes severely reduce sperm production
• herbal remedies – some herbal remedies, such as root extracts of the Chinese herb Tripterygium wilfordii, can affect the production of sperm or reduce the size of your testicles

Illegal drugs, such as marijuana and cocaine, can also affect semen quality.

Unexplained infertility

In the UK, unexplained infertility accounts for around 1 in 4 cases of infertility. This is when no cause can be identified in either partner.

If a cause for your fertility problems has not been found, talk to your doctor about the next steps.

The National Institute for Health and Care Excellence (NICE) recommends that women with unexplained infertility who have not conceived after 2 years of having regular unprotected sex should be offered IVF treatment.

If you have fertility problems, the treatment you’re offered will depend on what’s causing the problem and what’s available from your local clinical commissioning group (CCG).

Find your local clinical commissioning group (CCG).

There are 3 main types of fertility treatment:

• medicines
• surgical procedures
• assisted conception – including intrauterine insemination (IUI) and in vitro fertilisation (IVF)

Medicines

Common fertility medicines include:

• clomifene – encourages the monthly release of an egg (ovulation) in women who do not ovulate regularly or cannot ovulate at all
• tamoxifen – an alternative to clomifene that may be offered if you have ovulation problems
• metformin – is particularly beneficial for women who have polycystic ovary syndrome (PCOS)
• gonadotrophins – can help stimulate ovulation in women, and may also improve fertility in men
• gonadotrophin-releasing hormone and dopamine agonists – other types of medicine prescribed to encourage ovulation in women

Some of these medicines may cause side effects, such as nausea, vomiting, headaches and hot flushes.

Speak to your doctor for more information about the possible side effects of specific medicines.

Medicine that stimulates the ovaries is not recommended for women with unexplained infertility because it has not been found to increase their chances of getting pregnant.

Surgical procedures

There are several types of surgical procedures that may be used to investigate fertility problems and help with fertility.

Fallopian tube surgery

If your fallopian tubes have become blocked or scarred, you may need surgery to repair them.

Surgery can be used to break up the scar tissue in your fallopian tubes, making it easier for eggs to pass through them.

The success of surgery will depend on the extent of the damage to your fallopian tubes.

Possible complications from tubal surgery include an ectopic pregnancy, which is when the fertilised egg implants outside the womb.

Endometriosis, fibroids and PCOS

Endometriosis is when parts of the womb lining start growing outside the womb.

Laparoscopic surgery is often used to treat endometriosis by destroying or removing fluid-filled sacs called cysts.

It may also be used to remove submucosal fibroids, which are small growths in the womb.

If you have polycystic ovary syndrome (PCOS), a minor surgical procedure called laparoscopic ovarian drilling can be used if ovulation medicine has not worked.

This involves using either heat or a laser to destroy part of the ovary.

Read more about laparoscopy.

Correcting an epididymal blockage and surgery to retrieve sperm

The epididymis is a coil-like structure in the testicles that helps store and transport sperm.

Sometimes the epididymis becomes blocked, preventing sperm from being ejaculated normally. If this is causing infertility, surgery can be used to correct the blockage.

Surgical extraction of sperm may be an option if you:

• have an obstruction that prevents the release of sperm
• were born without the tube that drains the sperm from the testicle (vas deferens)
• have had a vasectomy or a failed vasectomy reversal

Both operations take a few hours and are done under local anaesthetic as outpatient procedures.

You’ll be advised on the same day about the quality of the tissue or sperm collected.

Any sperm will be frozen and placed in storage for use at a later stage.

Assisted conception

Intrauterine insemination (IUI)

Intrauterine insemination (IUI), also known as artificial insemination, involves inserting sperm into the womb via a thin plastic tube passed through the cervix.

Sperm is first collected and washed in a fluid. The best quality specimens (the fastest moving) are selected.

Read more about IUI.

In vitro fertilisation (IVF)

In vitro fertilisation (IVF), is when an egg is fertilised outside the body. Fertility medicine is taken to encourage the ovaries to produce more eggs than usual.

Eggs are removed from the ovaries and fertilised with sperm in a laboratory. A fertilised egg (embryo) is then returned to the womb to grow and develop.

Read more about IVF.

Egg and sperm donation

If you or your partner has an infertility problem, you may be able to receive eggs or sperm from a donor to help you conceive. Treatment with donor eggs is usually done using IVF.

Anyone who registered to donate eggs or sperm after 1 April 2005 can no longer remain anonymous and must provide information about their identity.

This is because a child born as a result of donated eggs or sperm is legally entitled to find out the identity of the donor when they become an adult (at age 18).

Further information

Get more information about fertility treatment options from the Human Fertilisation and Embryology Authority (HFEA) website.

Eligibility for fertility treatment on the NHS

Fertility treatment funded by the NHS varies across the UK. Waiting lists for treatment can be very long in some areas.

The eligibility criteria can also vary. A GP will be able to advise about your eligibility for treatment, or you can contact your local clinical commissioning group (CCG).

If the GP refers you to a specialist for further tests, the NHS will pay for this. All patients have the right to be referred to an NHS clinic for the initial investigation.

Going private

If you have an infertility problem you may want to consider private treatment. This can be expensive, and there’s no guarantee of success.

It’s important to choose a private clinic carefully.

You should find out:

• which clinics are available
• which treatments are offered
• the success rates of treatments
• the length of the waiting list
• the costs

Ask for a personalised, fully costed treatment plan that explains exactly what’s included, such as fees, scans and any necessary medicine.

Choosing a clinic

If you decide to go private, you can ask a GP for advice. Make sure you choose a clinic licensed by the HFEA.

The HFEA is a government organisation that regulates and inspects all UK clinics that provide fertility treatment, including the storage of eggs, sperm or embryos.

Complementary therapy

There’s no evidence to suggest complementary therapies for fertility problems are effective.

The National Institute for Health and Care Excellence (NICE) states further research is needed before such interventions can be recommended.

FACIAL HAIR REMOVAL

Advice, support and treatment for women living with facial hair

DID YOU KNOW?

Female facial hair is extremely common. In fact, around 5-15% of women are currently living with some degree of excess hair.

For many women, obvious or excess facial hair can be a source of both distress and embarrassment. While all women have some degree of facial hair, it is usually light and unnoticeable. For some women however, the hair can be darker or thicker than usual. This can make it more obvious — something many women find upsetting.

Living with unwanted facial hair can cause a significant knock to your self-esteem and confidence, stopping you from socialising and enjoying recreational outings and activities.

Thankfully, for women who are bothered by their facial hair, there are ways to treat it. Read below for more details on the causes of unwanted facial hair, and the proven treatments available.

CAUSES OF UNWANTED FACIAL HAIR

Up to 15% of women are currently living with excess hair[1]. Although unwanted facial hair itself is not dangerous to your health, it can be a sign of an underlying condition. There are several potential causes of unwanted facial hair in women, and understanding these conditions can give you a clearer idea of what kind of treatment is necessary in order to effectively get rid of your unwanted facial hair.

The most common of these possible causes include polycystic ovary syndrome, hirsutism and facial hair as a result of hormone imbalance. Each of these conditions carry a different set of symptoms, but all involve some degree of excess facial hair.

PCOS

PCOS (polycystic ovary syndrome) is a common condition which impacts the way a woman’s ovaries work. It is defined by three main symptoms, which are:

• Polycystic ovaries: the ovaries themselves become enlarged and house many fluid-filled sacs known as follicles. These surround the eggs.
• Irregular periods: meaning your ovaries aren’t regularly releasing eggs.
• Excess androgens: these are high levels of ‘male hormones’ in the body, leading to physical symptoms like excess facial and body hair.

It is not known exactly what causes PCOS but it does tend to run in families. There is also no cure for the condition, though a healthy lifestyle can help combat symptoms, and you can treat symptoms like facial hair individually.

HIRSUTISM

Hirsutism is one of the most common causes of unwanted facial hair in women, as it causes excessive hair growth in certain areas of the body, including the:

• Face
• Neck
• Stomach
• Chest
• Lower back
• Buttocks
• Thighs

Additional symptoms can include oily skin, acne, deep voice and irregular periods. It is caused by excess androgens, which is why these symptoms are similar to some of those found in PCOS. Effective treatment like Vaniqa (see below) can help combat symptoms, while tackling lifestyle factors like obesity can also help as obesity can be a factor in causing the condition. Excess hair growth is more common in women after the menopause.

HORMONE IMBALANCE FACIAL HAIR

Both of the above conditions involve excess levels of androgens, which are male hormones. This reflects the wider point that unwanted facial hair in women is usually a case of hormone imbalance. Testosterone is the most well-known androgen. In men, testosterone is involved in the production of sperm and the deepening of the voice.

All women produce some level of testosterone. However, producing excess levels of testosterone may produce effects like increased sex drive, menstrual cycle changes and excess facial and body hair.

This is partially why conditions like PCOS and hirsutism are more common in women who have experienced the menopause, as this change signals a dramatic shift in hormone balance.

HOW TO REMOVE FACIAL HAIR

Hormone imbalances in women can be difficult to treat. However, there are ways of treating the symptoms of these imbalances, such as unwanted facial hair. This can help women who are bothered by their excess facial hair feel more confident in their appearance, allowing you to enjoy your life without worry or self-consciousness.

FACIAL HAIR REMOVAL TREATMENT

Some women are happy to live with unwanted facial hair, but others wish to be rid of it. Effective hair removal medication does exist in the form of prescription creams. There are also other methods of removal which many people try, including bleaching, waxing, laser hair removal and electrolysis.

Not all of these methods are equal in terms of effectiveness and comfort, however. For example, both laser hair removal and electrolysis can be expensive and require multiple sessions. They can also be painful. We’ve outlined some of the most popular treatment methods below.

FACIAL HAIR REMOVAL CREAM

Facial hair removal cream is one of the most common treatment methods. Creams can cause the hair on the skin’s surface to dissolve, leaving the skin smooth. The effectiveness of this method is largely dependent on the brand chosen, as many products will not be as effective as they claim to be. Others however are proven in their effectiveness. To be safe, it is best to seek out a prescription medication like Vaniqa.

VANIQA

Vaniqa (eflornithine hydrochloride) is a prescription medication that was developed to reduce unwanted facial hair in women. Designed for application to the skin, it is advised that Vaniqa is only used on the face and adjacent areas under the chin of women affected by unwanted hair. It can take around 4-8 weeks for women to see the first signs that this medication is working – based on usage twice a day, at least 8 hours apart. It has been tested in women of multiple ethnicities, and has shown to be an effective treatment method.

Vaniqa works by slowing down the growth of facial hair by interfering with an enzyme in the follicle of the hair during the growth stage of the hair cycle. Without this enzyme the hair is unable to grow further.

FACIAL HAIR BLEACH

Some women may choose to bleach their facial hair rather than removing it. This can make the hair less noticeable by turning darker hairs a lighter shade. The pros of bleaching facial hair are that the process is fast, easy, affordable and can be done at home. However, it is not an effective choice for women seeking a smooth, hairless surface. It also isn’t a long-term solution, as you’ll see the return of the darker hair when it starts to grow. What’s more, it is only fully effective in disguising short, fine hairs.

WAXING FACIAL HAIR

Waxing is a longer-term solution than shaving or bleaching. Like bleaching, it can be done quickly and easily at home. It can also provide that smooth skin surface which many women look for. However, waxing can also be a painful process, and often leads to skin irritation. You’ll also have to regularly wax the skin in order to maintain the results, which can cause longer term irritation.