Diastasis Recti: 5 Things You Should Know So It Doesn’t Happen to You

Yep, that’s me and my three kids.

Two on the outside and one still in my uterus. And no, I don’t have Diastasis recti anymore. I just have a small umbilical hernia that made my “inny” turn to an “outy” for about nine and a half months. No band-aid in the world was going to hold that back. I had Diastasis during my pregnancy, but I don’t have it now, 2 years later.

How did I get rid of Diastasis Recti? Let’s get right into it.justyn-warner-532058 small

First, if you don’t know me by now, I love to run the numbers. If you could hear how many of my patients are asking about Diastasis lately, you would think that it affects 100% of pregnant women. It doesn’t, at least not longterm. And while we are on the subject, let’s practice saying it so that you can ask about it with confidence.

DIE-UH-STAY-SIS. You got it. (You know how I feel about the pronunciation of medical terms.)

Diastasis recti (the full name is actually Diastasis recti abdominis or DRA) is around a 2-centimeter separation of the rectus abdominis muscles. The rectus muscles are the “abs”. Pictured below, they are the ones that give you the “pack” that you have, or in my case, want.

Rectus_abdominis mod

As the uterus grows in pregnancy, those muscles can separate. At 35-weeks pregnant, the prevalence of this degree of muscle separation is 100%. By the 6-month post-delivery mark, only about 39% or women have it. That number isn’t small, but it isn’t the majority.

So what do the 39% do to get their abs back? Well first, what is the problem with Diastasis? Some may get uncomfortable hernias that result from this separation. Some are even born with it and need surgical correction to keep the abdominal contents contained. The problem is often cosmetic though. 18424159_10209329163812249_2213968896285513287_n

Some may experience core weakness after childbirth and if not corrected, can find themselves having difficulty lifting objects and having back pain. In that case, the problem isn’t necessarily the Diastasis. The core weakness is the problem. It is VERY NECESSARY to do proper exercises to not worsen the separation, but still strengthen the abs.

If you suspect that you have persistent Diastasis after about the 8-week mark after having your baby, first do this: Lie flat on your back and do a half crunch. If you can fit 2 fingerbreadths between your abs, you may have it. The actual process for diagnosis is more technical than that, but this works for at-home use. Those most likely to be affected are women who carried twins or other multiples, women who have larger babies, women who are over 35 years old,

Here are my 5 Must-Knows.

  1. Pregnancy does not irreparably damage your abs. Even women who have c-sections can come back to flat mid-section. We do not cut the ab muscles during c-sections either. That is a common misconception. Your glory days can come again.

    lq-n5xbg1rs-marcos-moraes
    There is no treatment during pregnancy. Wait until at least 6 weeks postpartum to try any of these exercises.
  2. Don’t do crunches. They can worsen the separation. Do these exercises if you think you have Diastasis recti:
    1. Core contraction – In a seated position, place both hands on abdominal muscles. Take small controlled breaths. Slowly contract the abdominal muscles, pulling them straight back towards the spine. Hold the contraction for 30 seconds, while maintaining the controlled breathing. Complete 10 repetitions.[9]
    2. Seated squeeze – Again in a seated position, place one hand above the belly button, and the other below the belly button. With controlled breaths, with a mid-way starting point, pull the abdominals back toward the spine, hold for 2 seconds and return to the mid-way point. Complete 100 repetitions.[9]
    3. Head lift – In a lying down position, knees bent at 90° angle, feet flat, slowly lift the head, chin toward your chest, (concentrate on isolation of the abdominals to prevent hip-flexors from being engaged),[6] slowly contract abdominals toward floor, hold for two seconds, lower head to starting position for 2 seconds. Complete 10 repetitions.[9]
    4. Upright push-up – A stand-up push-up against the wall, with feet together arms-length away from wall, place hands flat against the wall, contract abdominal muscles toward spine, lean body towards wall, with elbows bent downward close to body, pull abdominal muscles in further, with controlled breathing. Release muscles as you push back to starting position. Complete 20 repetitions.[9]
    5. Squat against the wall – Also known as a seated squat, stand with back against the wall, feet out in front of body, slowly lower body to a seated position so knees are bent at a 90° angle, contracting abs toward spine as you raise body back to standing position. Optionally, this exercise can also be done using an exercise ball placed against the wall and the lower back. Complete 20 repetitions.[9]
    6. Squat with squeeze – A variation to the “squat against the wall” is to place a small resistance ball between the knees, and squeeze the ball while lowering the body to the seated position. Complete 20 repetitions.[9]
  3. Don’t make the mistake of making the call too soon. If you don’t have pain and you are still trying to lose the baby bump, give it time. Your mid-section took 9 months to get to that size. The 6-week snapback is not a realistic expectation for many, no matter what Instagram and Pinterest say. lol

    Planks
    Planks are good, and we do Sculpsure in my office- laser fat removal. loopobgyn.com
  4. Keep your bowels moving well. Constipation may not worsen Diastasis, but it won’t make it better either. Excessive regular bearing down for bowel movements has other health implications that are worth avoiding. (Check out my post about that too.)
  5. If you are worried that it isn’t improving, ask your doctor about it. Physical therapy may be an option, and in extreme circumstances, surgery. Don’t be afraid to ask.

At the end of the day, know that your abs will go through changes due to pregnancy.  Stay optimistic that you can be beach-ready again if you so desire.

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Don’t forget to subscribe to always know when we’re busting myths and dropping science at The Gyneco-(b)Logic.

Photo by Justyn Warner on Unsplash; Photo by Form on Unsplash

References: https://www.ncbi.nlm.nih.gov/pubmed/25282439 https://www.ncbi.nlm.nih.gov/pubmed/2968609

 

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Early Pregnancy Test Is Positive: Do’s and Don’ts from the Doctors

It’s your first trimester. Let the takeover begin!

Dos and Don’ts in pregnancy

Practicing as an OB/Gyn I’ve come to realize almost everyone is afraid of pregnant women. Other medical specialties don’t want to take care of them, employers are afraid of imminent labor during working hours, husbands don’t want to upset them, generally a population surrounded by this shield of protection from the outside world. This has created a sense of mystery and confusion around the pregnant woman, and often they come in completely lost on what they can and cannot do. In general, I tell pregnant women to do whatever they want. There are a few things to avoid, and we will get into that here, but otherwise they should sleep when they can, eat what they crave, and avoid all housework (haha).

Fish/ seafood:

The big concern with fish and seafood is the level of mercury because it can lead to birth defects. Fish that are generally safer in pregnancy: shrimp, salmon, catfish, canned light tuna (***not albacore) and sardines. Fish that are NOT safe because of the levels of mercury are shark, swordfish, king mackerel or tilefish. Also, raw fish should be avoided because of risks of bacteria and food poisoning, so make sure the fish is cooked. I generally tell people to eat fish in moderation (ie limiting intake to 6 ounces a week)

FullSizeRender 18Caffeine:  

Ahhh coffee… How to survive without this wonderous nectar? So, good news is you do not have to out all caffeine. However it is important to limit it. One cup of caffeine (coffee, tea, soda, red bull (ok don’t drink red bull)) in safe.

Listeriosis:

This is a bacteria that usually causes a mild illness, but in pregnant women can make you very ill. Foods to avoid in this category are unpasteurized milk or cheese made from said milk (is feta, queso blanco, queso fresco, camembert, brie), deli meat (unless they are served steaming hot), pates or meat spreads and refrigerated smoked seafood. Remember, nothing raw or uncooked. Everything should be cooked before consuming in pregnancy!

Exercise:

Moderate exercise is not only safe in pregnancy, it is recommended. Whatever exercise you were doing before pregnancy should be modified and continued. Your heart rate should not exceed 120 bpm for greater than 20 mins in any period of cardiac exertion.

Saunas/ Hot tubs:

This is one of the few don’ts in pregnancy. Your body temperature gets too high when submerged in hot water and it is unsafe in pregnancy. Soaking your feet or legs is ok, but that’s it.

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Photo by Leio McLaren on Unsplash

Travel:

The big restrictions when it comes to travel is the time in which you choose to go. The last trimester (especially after 34 weeks) should be avoided because not only is it uncomfortable, but the risks of labor are of course, the greatest. Early in pregnancy travel is safe, as long as you get up and walk every 2-3 hours for 10/15 mins and drink plenty of fluids. One big thing to consider is that Zika is STILL a very real thing. Please please please do NOT travel to Zika infested areas if you are considering getting pregnant or are pregnant. The CDC is constantly updating their site with countries to avoid.

Cats:

You don’t have to avoid cuddling with your feline friends, but you should NOT change the litter box for the duration of pregnancy.

This is not an inclusive list, and as always all concerns should be discussed with your obstetrician as they know you and your medical history best. Happy pregnancy!

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Does Birth Control Cause Breast Cancer? Well, it’s complicated…

In December 2017, the New England Journal of Medicine released this statement:

“Women who use hormonal [contraceptives] for more than a year are at a 20 percent higher risk for breast cancer, [though] the overall risk remains low,” and is called “safe and effective.”

What in the world is that supposed to mean, Doc?

Is it safe? Or are my breasts gonna kill me? Well I, Dr. Wendy, am here to run the numbers. For the longest time we believed that breast cancer risks were pretty much unaffected by birth control. This post will cover these important and life-altering topics:

  • What is Cancer?
  • What types of cancer risks are reduced by birth control?
  • What factors can increase cancer risk?
  • What does birth control do to breast cancer risk?

What is Cancer?

ian-dooley-298769 smallI was in medical school before I really understood what cancer was, so I thought it deserved an explanation. (This section is an excerpt from my book, It Smells Just Like Popcorn, fyi.) Cancer is not an alien beast that finds its way into your body. Cancer, generally speaking, is caused by rogue cells of your own body. Our whole body is composed of cells, tiny building blocks with specific functions that work together. When a few cells decide to do their own thing, it is like a mutiny. I recently watched Guardians of the Galaxy 2. *Spoiler alert*

When Yondu’s crew was overthrown by Taserface, they killed all of the loyal crew mates by tossing them off of the ship into the vacuum of space. Taserface was like a cancer, turning the formerly good crewmates against Yondu.

If we keep with the cancer analogy, what would have then happened is the newly corrupted crew members would have started multiplying and forming new corrupt crew members like that agent in the black suit with the earpiece in the Matrix. Eventually those crew members would multiply beyond capacity, use up all of the resources, food and water on the ship, and everyone would die. The way that chemotherapy works is that it targets the cells that replicate quickly. Cells that rapidly divide and multiply use certain building blocks that chemotherapy and radiation can target and attack. Hair follicles have rapidly dividing cells, which is why people lose their hair during chemotherapy.

What types of cancer risks are reduced by birth control?

chuttersnap-233105 smallRegarding Ovarian Cancer risk, “Oral contraceptive use has consistently been found to be associated with a reduced risk of ovarian cancer. In a 1992 analysis of 20 studies, researchers found that the longer a woman used oral contraceptives the more her risk of ovarian cancer decreased. The risk decreased by 10 to 12 percent after 1 year of use and by approximately 50 percent after 5 years of use (4).” The protective effect of oral contraceptive use persisted more than 10 years after pill use was discontinued. (Source: the CDC.)

Regarding uterine cancer risk: “Women who use oral contraceptives have been shown to have a reduced risk of endometrial cancer. This protective effect increases with the length of time oral contraceptives are used and continues for many years after a woman stops using oral contraceptives (11).”

Regarding cervical cancer risk: Results were inconsistent. “Virtually all cervical cancers are caused by persistent infection with high-risk, or oncogenic, types of HPV, and the association of cervical cancer with oral contraceptive use is likely to be indirect. The hormones in oral contraceptives may change the susceptibility of cervical cells to HPV infection, affect their ability to clear the infection, or make it easier for HPV infection to cause changes that progress to cervical cancer.” (Cancer.gov) Then the American Association for Cancer Research (AACR), said their wasn’t an evidence-based association between cervical cancer and oral contraceptives because studies lacked the proper controls.

Regarding colon cancer risk: Per AACR, “We found that the risk of colorectal cancer was significantly decreased for women who have ever used oral contraceptives compared with women who have never used oral contraceptives.”

What factors can increase cancer risk?

josh-applegate-162067 smallDid you know Catholic nuns have a significantly higher risks of developing breast, ovarian and uterine cancer? Birth control is forbidden and these women never have babies. They just ovulate (release eggs and have menstrual cycles), and ovulate, and ovulate. Along those same lines, women experiencing their first period before age 12 years have a slightly higher risk of breast cancer than those who were older than 15 at menarche.5 Similarly, the risk of breast cancer is increased by 17% for every 5-year delay in menopause.6 Bilateral oophorectomy (removal of the ovaries) before age 40 years led to a 45% reduced risk of breast cancer compared with women with a natural menopause at ages 50—54 years.5 The point is not to have your ovaries remove without a reason. The point is to understand that prolonged uninhibited ovulation has health risks too.

Why is that? The increased number of cycles between menarche (the first ever period) and menopause leads to increased risk of ovarian and uterine cancers. My analogy here is that of an engine that never stops running. Eventually it will be more likely to malfunction and break than an engine that you turn off and give a break every so often. Pregnancy and birth control provide that break or change for your ovaries and uterus.

What does birth control do to breast cancer risk?

nss2erzqwgw-freestocks-orgAs I quoted earlier: “Women who use hormonal [contraceptives] for more than a year are at a 20 percent higher risk for breast cancer, [though] the overall risk remains low,” and is called “safe and effective.” The 20 percent translates to about ONE MORE case of breast cancer a year for every 7,700 women.”

The New York Times (12/6, Rabin, Subscription Publication) calls it “a small but significant increase in the risk for breast cancer. […] While the increase for a 20-year-old means that her risk of breast cancer is still ‘less than one-tenth of 1 percent,’ but for a 40-year-old, it means a change from 1 in 69 to 1 in 57.”

Bloomberg News (12/6, Lauerman) reports that while it was thought that “newer birth control drugs” would reduce the risk, “it turns out they didn’t.” The study found that “the longer they take them, the greater the chance they will develop breast cancer,” thought, it adds, the risk is “somewhat offset by reduced risks of cancer – of the ovaries, endometrium, and digestive system”

What are the take home messages here?

Birth control has it’s risks, but also many advantages. Nothing that we do is perfect or without risks, including homeopathic remedies. As you read above, even not using birth control EVER has its risks (#nunlife). I never advise a woman to start birth control without a reason. Good reasons include heavy periods, painful periods, strong ovarian cancer risk, and let’s not forget, pregnancy prevention. The latest breast cancer risk data is a tough pill to swallow (#punlife), but I think that as long as we all understand the risks and look out for any signs of trouble, birth control use is not wrong or reckless.

Thank you for reading this piece. Take a moment and cruise the site. There a are a lot of pearls and laughs through out. Subscribe, post, tweet, snap and share away.

You may not know this, but I am no stranger to shameless plugs. The cancer excerpt from above is from my book that I have linked there and below. Also for healthy eating and nutrition tips from another amazing M.D., check out TheDocsKitchen.com.

Also check me out at dreverywoman.com for more about me, my YouTube channel, my Podcast, The Gyn Project, and more.

Be Healthy, 2018!

 

Birth control can improve your life! Here are 5 ways

With all the controversy surrounding birth control these days, especially thanks to the extremely old school and right wing leaders in politics, I thought it would be a good idea to review some of the non-contraceptive benefits of birth control, and why it is important to be aware of these benefits when visiting your gynecologist. For a review on the types of birth control, take a peek at You should have a period. Your period shouldn’t have you!

Period issues: One of the most common uses for birth control besides preventing

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Surgery (life) is challenging enough without having to worry about changing your feminine product! Photo by Piron Guillaume on Unsplash

pregnancy is helping to lessen women’s symptoms during her menses. Some women deal with heavy bleeding during their period, which can leave them fatigued and worn out (not to mention it’s so distracting having to worry about changing a pad or tampon every few hours—surgeons, am I right???) and eventually lead to anemia. Independent of bleeding, cramping and pelvic pain can also be debilitating during menses. Birth control is one of the best ways to reduce bleeding and pain. There are so many options out there, and it’s very rare that we can’t find one that doesn’t work.

Headaches: During a normal menstrual cycle, there is a natural rise and fall of estrogen

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Photo by Mickael Gresset on Unsplash

and progesterone. When it’s time to have a period, these hormones drop into their lowest state. This abrupt withdrawal of hormones can lead to menstrual migraines. If you are someone that suffers from migraines, I recommend tracking their timing. If you notice an association with your menses, it may be time to discuss these issues with your gynecologist instead of your neurologist. (Important side note: Women who have migraines with an aura should NOT be on estrogen therapy. It is very important to let your physician know if you have these. Women who use estrogen and have migraines with aura are at an increased risk for stroke.)

Mood changes: In addition to headaches, the withdrawal of estrogen and progesterone especially the week before your menses can lead to some feelings of irritability, anger, overall not feeling like yourself. Birth control can help temper some of these changes because without the fluctuating hormones, our mood tends to stabilize.

Acne: In addition to estrogen and progesterone, we also have testosterone that naturally occurs in our system. Testosterone is what causes acne, male pattern baldness, and forgetting to put the toilet seat down at night (lol jk!). For some women, controlling testosterone levels can help reduce acne. Birth control helps by essentially binding the testosterone so it isn’t free in the blood stream to wreak havoc on our skin.

Ovarian cysts: Every month our ovaries grow a little follicle on them, which fills with fluid and an egg. This cyst then ruptures and releases the fluid and egg (the process known as ovulation) into the abdomen to be picked up into the tube, and then either shed during menses or combined with sperm to make a baby.

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Photo by Michał Grosicki on Unsplash

Review the anatomy of the lady parts here Lady Bits Exposed: Why Knowing Your Anatomy Matters.  Although most of the time these cysts are small and pain free, some women create large cysts, or have cysts that fill with fluid and blood, and upon rupturing can be extremely painful. If you are experiencing lower abdominal pain and cramping two weeks before your cycle that knocks you out and is fairly predictable in timing, birth control can absolutely help prevent ovulation and reduce the pain and discomfort associated with this.

Cancer: Women that experience abnormal menstrual cycles have an increased risk of endometrial cancer because of abnormal and unopposed estrogen exposure. Birth control regulates these hormones, reducing the risk of cancer in high risk women. It has also been shown to reduce the risk of ovarian cancer, especially in those women that have a family history of breast or ovarian cancer. The less ovulatory cycles a woman experiences means the lower her risk of cancer. For an overview on female cancers and their warning signs, Is this normal? Or is WebMD right??

This is by no means a comprehensive list of the benefits of birth control. Besides allowing women to choose when conception happens for them Stop, The Love You Save May Be Your Own: Birth control and other options for preventing pregnancy until you’re ready, the various forms of birth control can really improve your quality of life if you are dealing with issues associated with the fluctuations of hormones. Remember to speak to your physician about any concerns you have, as well as medications you are already taking.

How Do I Know If I Have Fibroids? Diagnosis and Treatment explained

These little fibrous balls of excess are the cause of more ultrasound conversations about incidental findings than anything else in my practice. Women with no symptoms but an enlarged uterus noted on exam, or pressure and/or heavy bleeding, are the all too common recipients of this diagnosis.

This one is near and dear to my own heart because my own fibroids were diagnosed when I was but a lowly medical student. I went in for a routine Pap test and Gyne exam. My doctor said that he felt something in my pelvis. Sure enough it was a 4-centimeter fibroid, about the size of a plum.

Sidebar: Have you ever noticed that gynecologists love to describe body parts with fruit or sports? “Her uterus was the size of a grapefruit.” “The cyst on her ovary was the size of a softball.” It is easier to relate to women with objects rather than just measurements. I just find it kind of funny sometimes when I get to the apricot level and I think, man, I’m going through a lot to find a food to describe this mass.

Double sidebar: My Doc that diagnosed my fibroids was a man. Male OB/GYNs can sometimes feel like a dying breed because women often seem to prefer to see women for their lady issues. No judgement there, but don’t discount the fellas, ladies. Male OB/GYNs went through the same training and are just as knowledgeable as we are. The more seasoned guys also have experience on their side. I just had to make that point because one of my partners is a man. He has a strong following of patients, but newbies to the practice sometimes question seeing him. Don’t. You won’t be sorry.

We re-enter my person fibroid journey when I was pregnant with my eldest son. My dominant fibroid (yes, there were multiple, and no that is not a thing but for the purposes of this story my dominant fibroid was the largest one), was about 10 centimeters- about the size of a softball. Keep in mind, the head of a baby at term is about 10 centimeters from one side to the other. My co-residents used to refer to it as my second baby head because you could even feel it from the outside. After I had my son, it shrank in size dramatically and didn’t bother me. I was always on birth control methods that caused me to not have a period, and I believed that that helped to stabilize growth.

Castile Soap and Natural Cleaning

How I Feel About Treating Fibroids

Fibroids generally don’t bother me as the physician and provider, unless they bother the woman who I am caring for. Women with fibroids who don’t have heavy bleeding or massive uteruses that are causing uncomfortable bladder or bowel symptoms, can keep them as far as I am concerned. As with any rule, there are always exceptions.

The three exceptions to my “But these fibroids aren’t bothering me” rule, are scenarios involving desired pregnancy, those where bleeding is so heavy and abundant that anemia is a concern, and the situations where the fibroids are growing rapidly in size. When pregnancy is desired, it is possible to achieve pregnancy when fibroids are in place (guilty as charged). However, if a person is deviating from the expected or standard time that it should take to get pregnant, fibroids can be possibly removed to improve the fertility rates. If heavy bleeding is causing anemia, iron supplementation and sometimes removal may need to be discussed. If the size of the uterus is changing rapidly within 6 months to a year, removal of fibroids may be in order to make sure cancer isn’t present.

If you don’t know me by now, check out and subscribe to my YouTube channel. You won’t regret it.

Feature Photo by Markus Spiske on Unsplash

For more from Dr. Wendy, visit http://dreverywoman.com/.

The Chesticles. (aka My breasts are hurting and I don’t know why!!)

Ahhhh. The breasts. They create the hourglass figure. They are mystical to members of the opposite sex and they are the reason that 1 out of 8 women have to deal with cancer. Here’s a list of 5 reasons on why your breasts may hurt or feel uncomfortable, especially once pregnancy has been ruled out.

But remember, always discuss all concerns with your physician. Breasts don’t read the textbooks and there are always, always exceptions to the rule.

Why Do My Breasts Hurt?

1) Anxiety

Breast pain or discomfort can be a cause of anxiety for almost all women.

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Get measured! Fun fact: I’ve been measured before and 3 saleswomen at the same department store gave me 3 different measurements!! Find out what feels best. Photo by Jennifer Burk on UnSplash

2) Ill-Fitting Bra

One of the most common things I encounter in practice is women who come in with breast pain that is on both sides, pretty consistent, happens more towards the end of the day, and dull in nature. The first thing I ask is how old are your bras? And the second, have you had any weight changes since you purchased said undergarments? Even 5 pounds of weight fluctuation can make a big impact in your cup and bra size, and not getting fitted every 18-24 months can mean wearing outdated and ill-fitting bras, which can then lead to breast pain.

3) Hormonal

If breast pain is not consistent one of the easiest things to do is keep track of your pain and discomfort in a calendar. If there’s a pattern to it then there could be a component of hormonal changes making breast pain more pronounced. Around ovulation (which falls around day 14 in a traditional 28-day cycle) the breasts can be more engorged and tender than normal. An easy fix to this is to start a hormonal contraceptive.

4) Referred Pain

There are a lot of nerves, muscles, bones and vital organs that live in the

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She’s not ignoring her heart! Photo by Eric Ward on Unsplash

chest. It’s important to do a mental refresh of activities in the last few days that may have been different from routine. New exercises? Change in activity ( i.e. moving, spring cleaning), even driving more than normal?

Another important thing for women to be conscious of is that the heart is a common cause of chest pain, that can be confused with breast pain. Pressure, pulling, left arm pain, tightness or shortness of breath should be evaluated by a physician.

5) Diet/ Lifestyle

Although it hasn’t been proven, there is some association between caffeine intake, alcohol intake, tobacco use and increased frequency of non-cyclic breast pain. Keeping a food diary that chronicles diet with breast pain can help shed some light on things that may be triggering pain.

Final Thoughts

This is by NO MEANS an inclusive list on why your breasts may hurt! Breast changes, pain, skin changes around or on the breast, discharge, or really any differences should be addressed and evaluated by a physician. It can be overwhelming or scary to acknowledge a breast concern, but it’s always better to get it checked out. A workup generally includes a mammogram or ultrasound. Sometimes it is necessary to have a biopsy done, and again as scary as this is, it’s better to have a definitive answer to a clinical concern.

October is Breast Cancer Awareness month. Take a moment to check in and do your self-breast exam. If anything feels off or different, make an appointment! Healthy breasts are happy breasts 🙂

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Oranges?? Yes. There’s a skin change called “peau d’orange” that means the “skin of an orange” that can happen on the surface of the breast and should be checked out! Also Vitamin C is good for you fam. Photo credit: Keilidh Ewan on UnSplash