Category: Treatments And Advice

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.

Contact dermatitis is a type of eczema triggered by contact with a particular substance.

Eczema is the name for a group of conditions that cause skin to become dry and irritated.

Contact dermatitis usually improves or clears up completely if the substance causing the problem is identified and avoided. Treatments are also available to help ease the symptoms.

Symptoms of contact dermatitis

Contact dermatitis causes the skin to become itchy, blistered, dry and cracked.

Lighter skin can become red, and darker skin can become dark brown, purple or grey.

This reaction usually occurs within a few hours or days of exposure to an irritant or allergen.

Symptoms can affect any part of the body but most commonly the hands and face.

Read about symptoms of contact dermatitis

When to see a pharmacist

Speak to a pharmacist if your contact dermatitis is troubling you.

They can recommend treatments such as emollients (moisturisers), which you rub on your skin to stop it becoming dry.

Find a pharmacy

When to see a GP

See a GP if you have persistent, recurrent or severe symptoms of contact dermatitis. They can try to identify the cause and suggest appropriate treatments.

A GP may refer you to  a doctor who specialises in treating skin conditions (dermatologist) for further tests if:

• the substance causing your contact dermatitis cannot be identified
• your symptoms are not responding to treatment

Read about diagnosing contact dermatitis

Causes of contact dermatitis

Contact dermatitis can be caused by:

• an irritant – a substance that directly damages the outer layer of skin
• an allergen – a substance that causes the immune system to respond in a way that affects the skin

Contact dermatitis is most commonly caused by irritants such as soaps and detergents, solvents or regular contact with water.

Read about causes of contact dermatitis

Treating contact dermatitis

If you can successfully avoid the irritants or allergens that trigger your symptoms, your skin will eventually clear up.

However, as this is not always possible, you may also be advised to use:

• emollients – moisturisers applied to the skin to stop it becoming dry
• topical corticosteroids – steroid ointments and creams applied to the skin to relieve severe symptoms

If you have a severe episode of contact dermatitis and it covers a large area of your skin, a doctor may prescribe oral corticosteroids, but this is rare.

Read about treating contact dermatitis

Preventing contact dermatitis

The best way to prevent contact dermatitis is to avoid contact with the allergens or irritants that cause your symptoms.

If you cannot avoid contact, you can take steps to reduce the risk of the allergens or irritants causing symptoms, including:

• cleaning your skin – if you come into contact with an allergen or irritant, rinse the affected skin with warm water and an emollient as soon as possible
• using gloves to protect your hands – but take them off every now and again, as sweating can make any symptoms worse; you may find it useful to wear cotton gloves underneath rubber gloves if the rubber also irritates you
• changing products that irritate your skin – check the ingredients on make-up or soap to make sure it does not contain any irritants or allergens; in some cases, you may need to contact the manufacturer or check online to get this information
• applying emollients frequently and in large amounts – these keep your skin hydrated and help protect it from allergens and irritants; you could also use emollient soap substitutes rather than regular bar or liquid soaps, which can dry out your skin

Other types of eczema

Other types of eczema include:

• atopic eczema (also called atopic dermatitis) – the most common type of eczema; it often runs in families and is linked to other conditions, such as asthma and hay fever
• discoid eczema – circular or oval patches of eczema on the skin
• varicose eczema – this most often affects the lower legs; it’s caused by problems with the flow of blood through the leg veins

Contact dermatitis occurs when your skin reacts to a particular substance.

This can be either:

• an irritant – a substance that directly damages the outer layer of skin
• an allergen – a substance that causes your immune system to respond in a way that affects the skin

Irritant contact dermatitis

Irritant contact dermatitis may be caused by frequent exposure to a weak irritant, such as soap or detergent. It may also develop if you’ve been in contact with a stronger irritant for a short while.

You’re at an increased risk of irritant contact dermatitis if you also have atopic eczema, which is the most common form of eczema. 

Common irritants include:

• soaps and detergents
• antiseptics and antibacterials
• perfumes and preservatives in toiletries or cosmetics
• solvents
• oils used in machines 
• disinfectants
• acids and alkalis
• cement
• powders, dust and soil
• water – especially hard, chalky water or heavily chlorinated water
• many plants – such as Ranunculus, spurge, Boraginaceae and mustards

If you already have irritant contact dermatitis symptoms, they can be made worse by heat, cold, friction (rubbing against the irritant) and low humidity (dry air).

Exposure at work 

You may be more at risk of irritant contact dermatitis if you work with irritants as part of your job, or if your job involves a lot of wet work.

If you develop the condition because of a substance you work with, it may be referred to as occupational irritant dermatitis.

This type of dermatitis is more common in certain occupations, including:

• agricultural workers
• beauticians and hairdressers
• chemical workers
• cleaners
• construction workers
• cooks and caterers
• metal and electronics workers
• health and social care workers
• machine operators
• mechanics and vehicle assemblers

Allergic contact dermatitis

The first time you come into contact with an allergen, your body becomes sensitised to it, but does not react to it. It’s only when you’re exposed to the substance again that your immune system reacts and causes the skin to become red and itchy.

Allergens that commonly cause allergic contact dermatitis include:

• cosmetic ingredients – such as preservatives, fragrances, hair dye and nail varnish hardeners
• metals – such as nickel or cobalt in jewellery
• some topical medicines (medicines applied directly to the skin) – including topical corticosteroids, in rare cases
• rubber – including latex, a type of naturally occurring rubber 
• textiles – particularly the dyes and resins that are contained in them
• strong glues – such as epoxy resin adhesives
• some plants – such as chrysanthemums, sunflowers, daffodils, tulips and primula

If the substance causing your contact dermatitis can be identified and avoided, your symptoms should improve and may even clear up completely.

There are a number of treatments to help ease your symptoms if it’s not possible for you to avoid the substance causing them.

A pharmacist will be able to recommend treatments like emollients (moisturisers), which you rub on your skin to stop it becoming dry.

Find your nearest pharmacy

Avoiding the cause

One of the most important steps in treating contact dermatitis is identifying and avoiding the allergens or irritants that affect you. If you can successfully avoid or reduce your exposure to the cause, you should not experience any symptoms.

It’s not always easy to avoid irritants or allergens that affect you, but a pharmacist, GP or dermatologist (skin specialist) can suggest ways to minimise your contact with things that trigger your condition.

If you’re exposed to irritants as part of your job, wear protective clothing to minimise any contact. Tell your employer about your condition, so they can help you avoid the causes as much as possible.

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 eczema.

Choice of emollient

Several different emollients are available. 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 can be quite greasy, but they 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.

Creams and lotions tend to be more suitable for inflamed (swollen) areas of skin. Ointments are more suitable for areas of dry skin that are not inflamed.

If you’ve 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, your pharmacist can recommend another product.

How to use emollients

Use your emollient frequently and in large amounts. Many people find it helpful to keep separate supplies of emollients at work or school.

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
• for very dry skin, apply the emollient 2 to 4 times a day, or as prescribed by a doctor 
• after a bath or shower, gently dry the skin and then immediately apply the emollient while the skin is still moist 

If you’re exposed to irritants at work that cause your contact dermatitis, make sure you apply emollients regularly during and after work.

Do not share emollients with other people.

Side effects

Occasionally, some emollients can irritate the skin. If you have contact dermatitis, your skin will be sensitive and can sometimes react to certain ingredients, such as perfume in over-the-counter emollients.

If your skin reacts to the emollient, stop using it and speak to your pharmacist, who may be able to recommend an alternative product.

Be aware that some emollients contain paraffin and can be a fire hazard, so should not be used near a naked flame. Emollients added to bath water can make your bath very slippery, so take care getting in and out of the bath.

Topical corticosteroids

Contact dermatitis can cause lighter skin to become red, and darker skin to become dark brown, purple or grey.

If your skin is also sore and inflamed, a GP may prescribe a topical corticosteroid (a cream or ointment applied directly to your skin) that can quickly reduce the inflammation.

When used as instructed by a pharmacist or doctor, corticosteroids are a safe and effective treatment for contact dermatitis.

Choice of topical corticosteroid

Different strengths of topical corticosteroids can be prescribed, depending on the severity of your contact dermatitis and where the affected skin is.

You may be prescribed:

• a stronger cream for short-term use for severe contact dermatitis
• a weaker cream if the eczema is mild
• a weaker cream for use on your face, genitals or in the creases of your joints (such as your elbows), as your skin is thinner in these areas
• a stronger cream to use on your palms and the soles of your feet, as the skin is thicker here

How to use topical corticosteroids

When using corticosteroids, apply the treatment in a thin layer to all the affected areas. Unless instructed otherwise by your doctor, follow the directions on the patient information leaflet that comes with your medicine. This will give details of how much to apply.

During an episode of severe contact dermatitis, do not apply the corticosteroid more than twice a day. Most people only have to apply it once a day.

You should apply your emollient first and wait around 30 minutes before applying the topical corticosteroid.

The medicine will usually start to have an effect within a few days. Speak to a GP if you’ve been using a topical corticosteroid and your symptoms have not improved.

Side effects

Topical corticosteroids may cause a mild, short-lived burning or stinging sensation as you apply them. In some cases, they may also cause:

• thinning of the skin
• changes in skin colour
• acne (spots)
• increased hair growth

Most of these side effects will improve once treatment stops.

Generally, using a stronger topical corticosteroid or using a large amount of topical corticosteroid increases your risk of getting side effects. You should use the weakest and smallest amount possible to control your symptoms.

Steroid tablets

If you have a severe episode of contact dermatitis and it covers a large area of your skin, a doctor may prescribe corticosteroid tablets.

If steroid tablets are taken often or for a long time, they can cause a number of side effects, such as:

• high blood pressure (hypertension)  
• osteoporosis (brittle bones)
• diabetes

For this reason, a doctor is unlikely to prescribe repeat courses of corticosteroid tablets without referring you to a specialist.

Further treatments

If the treatments prescribed by a GP are not successfully controlling your symptoms, they may refer you for assessment and treatment by a dermatologist.

Further treatments that may be available from a dermatologist include:

• phototherapy – where the affected area of skin is exposed to ultraviolet (UV) light to help improve its appearance
• immunosuppressant therapy – medicines that reduce inflammation by suppressing your immune system
• alitretinoin – capsules licensed for severe eczema affecting the hands

Complementary therapies

Some people may choose to use complementary therapies for contact dermatitis, such as food supplements or herbal remedies, but there is often a lack of evidence to show they are effective in treating the condition.

If you are thinking about using a complementary therapy, speak to a GP first to make sure the therapy is safe for you to use. You should continue to use any other treatments prescribed by a GP.

Insomnia means you regularly have problems sleeping. It usually gets better by changing your sleeping habits.

Check if you have insomnia

You have insomnia if you regularly:

• find it hard to go to sleep
• wake up several times during the night
• lie awake at night
• wake up early and cannot go back to sleep
• still feel tired after waking up
• find it hard to nap during the day even though you’re tired
• feel tired and irritable during the day
• find it difficult to concentrate during the day because you’re tired

You can have these symptoms for months, sometimes years.

Do you have a sleep problem?

Most people experience problems with sleep in their life. In fact, it’s thought that a third of Brits will have episodes of insomnia at some point.

The causes can include physical conditions, psychological conditions (such as depression or anxiety) or a combination of both.

Sleep self-assessment

How much sleep you need

Everyone needs different amounts of sleep.

On average, we need:

• adults: 7 to 9 hours
• children: 9 to 13 hours
• toddlers and babies: 12 to 17 hours

You probably do not get enough sleep if you’re constantly tired during the day.

What causes insomnia

The most common causes are:

• stress, anxiety or depression
• noise
• a room that’s too hot or cold
• uncomfortable beds
• alcohol, caffeine or nicotine
• recreational drugs like cocaine or ecstasy
• jet lag
• shift work

How you can treat insomnia yourself

Insomnia usually gets better by changing your sleeping habits.

Do

• go to bed and wake up at the same time every day – only go to bed when you feel tired
• relax at least 1 hour before bed – for example, take a bath or read a book
• make sure your bedroom is dark and quiet – use thick curtains, blinds, an eye mask or ear plugs
• exercise regularly during the day
• make sure your mattress, pillows and covers are comfortable

Don’t

• do not smoke or drink alcohol, tea or coffee at least 6 hours before going to bed
• do not eat a big meal late at night
• do not exercise at least 4 hours before bed
• do not watch television or use devices right before going to bed – the bright light makes you more awake
• do not nap during the day
• do not drive when you feel sleepy
• do not sleep in after a bad night’s sleep – stick to your regular sleeping hours instead

How a pharmacist can help with insomnia

You can get sleeping aids from a pharmacy. But they will not get rid of your insomnia and they have many side effects.

Sleeping aids can often make you drowsy the next day. You might find it hard to get things done.

You should not drive the day after taking them.

See a GP if:

• changing your sleeping habits has not worked
• you have had trouble sleeping for months
• your insomnia is affecting your daily life in a way that makes it hard for you to cope

Treatment from a GP

A GP will try to find out what’s causing your insomnia so you get the right treatment.

Sometimes you’ll be referred to a therapist for cognitive behavioural therapy (CBT).

This can help you change the thoughts and behaviours that keep you from sleeping.

GPs now rarely prescribe sleeping pills to treat insomnia. Sleeping pills can have serious side effects and you can become dependent on them.

Sleeping pills are only prescribed for a few days, or weeks at the most, if:

• your insomnia is very bad
• other treatments have not worked

THE MORNING AFTER PILL

Support, guidance and medication for women seeking emergency contraceptive treatment

Like condoms and other forms of contraception, the morning after pill is an effective method for reducing the risk of pregnancy as a result of sexual intercourse.

There are two kinds of emergency contraception. The first of these is the morning after pill, otherwise known as the emergency contraceptive pill (Levonelle or ellaOne). The other is the intrauterine device (IUD or coil).

DID YOU KNOW?

You are not alone in considering emergency contraception. Recent figures suggest that as many as one in five UK women between 18 and 35 take the morning after pill at least once a year.

WHAT DOES THE MORNING AFTER PILL DO?

The morning after pill is a form of emergency hormonal contraception (EHC) taken to prevent pregnancy after unprotected sex. It is an emergency contraception which is commonly taken if contraception wasn’t used during sexual intercourse, or if the method of contraception failed (e.g. a split condom). Guidelines state that the morning after pill should be taken as quickly as possible after having unprotected sex for it to be most effective.

While the morning after pill is an effective way of preventing pregnancy it should only be taken as an emergency rather than a regular contraceptive method. It is also important to note that neither the morning after pill or an IUD will help to prevent sexually transmitted diseases or infections.

WHEN TO TAKE THE MORNING AFTER PILL

The earlier the morning after pill is taken after intercourse, the more effective it is when it comes to preventing pregnancy. Different forms of the emergency contraceptive pill can be taken for different lengths of time after sex. For example, Levonelle must be taken within 72 hours (3 days) of sex in order to prevent pregnancy. It does not interfere with your regular method of contraception. However, the longer you wait the less effective the pill becomes. Alternatively, elleOne can be taken up to 120 hours after sex (5 days) to prevent pregnancy.

MORNING AFTER PILL EFFECTIVENESS

The morning after pill is an effective post-coital method of protection against pregnancy, especially if taken within 12 hours after intercourse has taken place. Both Levonelle and ellaOne are proven to be effective in significantly reducing the risk of pregnancy from unprotected or not-fully protected sex.

Levonelle is known to be most effective when taken within 12 hours of sexual intercourse. Studies have found that it can prevent up to 95% of pregnancies when taken within 24 hours. ellaOne can be used up to 5 days after sex and, unlike Levonelle, it has a 95% chance of success throughout the 5-day window.

SIDE EFFECTS OF THE MORNING AFTER PILL

Contrary to common misconception, there are very rarely serious or long-term side effects relating to the morning after pill. However, like all medication it carries a small risk of mild side effects that usually resolve themselves on their own in a short space of time.

These side effects can include:

• Stomach ache
• Headache
• Nausea
• Changes to your next period – it may be earlier, later or more painful than usual
• Vomiting. You should seek medical attention if you are sick within 2–3 hours of taken the morning after pill.

You should also seek medical attention if:

• Your next period is more than 7 days late
• You think you may be pregnant
• Your period is shorter or considerably lighter than usual
• You have a sudden sense of pain in your lower tummy. This could be a sign of an extremely rare condition known as ectopic pregnancy, when a fertilised egg may have implanted outside the womb.

WHERE CAN I GET THE MORNING AFTER PILL?

Some women worry about how to obtain the morning after pill, but in reality there are many different ways to access emergency contraception.

People often get confused about the nature of the morning after pill. The morning after pill is not designed as a medication to terminate pregnancies nor does it affect the chance of a woman conceiving in the future. Speaking to a qualified pharmacist is often the best way to get the right information and to fully understand the nature of this medication.

 Daman Bhamra, Express Pharmacy

Emergency contraception can be obtained in person at contraception clinics, sexual health clinics, NHS walk-in centres, pharmacies, and certain GPs, young people’s clinics and accident and emergency departments (A&E).

You can also order the morning after pill online from trusted sources like Express Pharmacy, if you are aged 16 or older. This is a good way to access the medication discreetly without having to worry about travelling to a clinic or doctor’s surgery. It also allows you to access the medication in advance if you know you will need it in the near future, such as if you are going on holiday.

MORNING AFTER PILL BREASTFEEDING

The morning after pill is considered compatible with breastfeeding, so it can be used by women who are currently nursing. Combination morning after pills contain both oestrogen and progestin. Higher levels of oestrogen in particular have been linked to a lower milk supply in nursing new mothers. As consequence of this, there may be a slight drop in milk supply for a few days after taking the morning after pill. However, milk supply should rebound within a matter of days.

DIFFERENT MORNING AFTER PILLS: WHICH ONE IS RIGHT FOR ME?

If you are considering taking emergency contraception in the form of an oral pill, there are two main options to choose from. As discussed briefly earlier, these are Levonelle and ellaOne. Both of these options are considered highly effective post-coital contraceptive measures for the prevention of pregnancy.

LEVONELLE

Levonelle is the trade name of the treatment levonorgestrel, which was first licensed for use in the UK in 2004. It has been developed as an effective emergency contraceptive pill which can be taken orally within 72 hours of unprotected sex. It becomes less effective the longer you wait to take it after intercourse. It works by stopping the ovaries from releasing an egg and preventing sperm from fertilising any egg which may have been released.

ELLAONE

ellaOne is the trade name of the treatment ulipristal acetate; a prescription only medication which was launched in the UK and licensed for use throughout Europe. It comes in the form of a single oral tablet that can be taken up to 120 hours after sex as a means of inhibiting or delaying ovulation, therefore preventing pregnancy. It can be taken with or without food.

HOW MUCH IS THE MORNING AFTER PILL?

The cost of emergency contraception varies depending on the medication you choose. For up to date pricing on the prescription medications stocked here at Express Pharmacy, visit the ellaOne or Levonelle pages.

SHOULD I CONSIDER AN IUD?

An IUD (intrauterine device) is an alternative form of emergency contraception. It is a small, T-shaped plastic and copper device which is inserted directly into the womb by a doctor or nurse. The release of copper inhibits the processes that lead to pregnancy and can protect you for between 5 and 10 years. As such, the IUD is a long-term method of contraception with a 99% effectiveness rate. However, it can increase the flow, length and severity of your period for several months after insertion, and it does not protect against STIs.