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Health information, articles, news and advice for NHS patients.

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Your health | KRY

The testicles have two basic functions. First, they’re responsible for the production of sperm. Second, they help make testosterone – this is the hormone that helps develop traits like a deep voice and beard growth. 

## How should a testicle feel?
Most men’s testicles are roughly the same size, though one is usually slightly bigger than the other and one may hang lower than the other. 

Testicles should feel smooth, without any lumps or bumps, and firm but not hard. You may feel a soft tube at the back of each testicle called the epididymis. This transports and stores sperm from the testicles. 

It’s important to check your testicles regularly from puberty onwards. It’ll help you get to know what’s normal for you so that you can spot any changes quickly. 

## What are the signs of testicular cancer?
Common signs of testicular cancer include:

- A lump in the testicles
- A change in size or shape of testicles 
- A dull ache or pain
- A feeling of heaviness in the testicles

Testicular cancer is rare – there are several other reasons why the testicles may be painful, like an infection, trauma, inflammation or cysts. 

Testicular cancer is very treatable, but it’s easier to treat when diagnosed early, so make sure you get any symptoms checked by a doctor. 

## How to check for testicular cancer

![22GL448 organic content testicle-check 16x9 40s UK (1)](//videos.ctfassets.net/h8qzhh7m9m8u/2NvqeWRO1HHMCodzI2dwUW/1c984c86cecdc047dd56bf43201b96c0/22GL448_organic_content_testicle-check_16x9_40s_UK__1_.mp4)

The best time to check is during, or immediately after, a warm bath or shower when your scrotum is relaxed. 

1. Cup your testicles in the palm of your hand.

2. Use your fingers and thumb to feel each testicle.

3. Ask yourself these questions:
- Are there any lumps or swellings?
- Do you feel any aches or pains?
- Are there any new differences between your testicles?
- Have they changed in size or shape?

Don't panic if you notice anything unusual, but see a doctor as soon as you can.

## How common is testicular cancer?
Though it’s still rare, testicular cancer is on the rise. It only accounts for 1% of all male cancers, but rates are predicted to [increase by 25% by 2025 in Europe](https://www.sciencedirect.com/science/article/abs/pii/S095980491301054X).

Testicular cancer occurs most frequently in young adult men – it’s the most common cancer in men from age 20-35. Unlike [prostate cancer](/your-health/prostate-cancer-a-doctors-guide/), testicular cancer risk decreases as you get older. 

## What causes testicular cancer?
Though the exact cause is not known, there are factors that can increase your risk — these include:

### 1. An undescended testicle
‘This is where the testicles do not descend from the abdomen into the scrotum by early childhood, and is the most important risk factor,’ says Dr Rhianna McClymont, Lead GP at Kry. 

### 2. Family history
‘If your dad or brother developed testicular cancer, you’re at higher risk,’ Dr McClymont explains.

### 3. Twins
Twins may be at increased risk of developing testicular cancer.

### 4. Height
Men who are taller than average may also be at a higher risk. 

## How is testicular cancer treated?
The best treatment depends on the person and the stage of cancer. It often involves an operation to remove the testicle with cancer – this is called an orchidectomy. 

Removing a testicle doesn’t usually affect your ability to have sex or get someone pregnant. ‘Having an orchidectomy will not prevent erection,’ says Dr McClymont. 

In some cases, your doctor might recommend storing some of your sperm in a ‘sperm bank’ before your treatment.

When it comes to testicular cancer, early detection is key. So make self-checking a habit, and see a doctor if you notice anything that isn’t normal for you.

__This article has been medically approved by Dr Roshaan Saloojee, a Kry GP.__


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Kry.co.uk > Your health > How to check for testicular cancer

How to check for testicular cancer

What are the signs of testicular cancer and how do you check yourself at home? Read our expert advice on why regularly checking your testicles is so important

How to check for testicular cancer | Kry

Men Health

Men's Health

When temperatures soar in spring and summer, many of us head out to make the most of the sun’s rays. But it’s no secret that too much direct sunlight can be dangerous.

‘Getting a healthy dose of sunshine is important for both our mental and physical health, but we should all be aware of taking precautions when spending time in direct sunlight,’ says Dr McClymont.

## Why is sun safety so important?

‘Without the right level of protection, direct sunlight can cause severe sunburn. This can be very painful and lead to more serious side effects, including a greater risk of developing skin cancer,’ Dr Rhianna explains. ‘That’s why it’s essential to follow advice on sun safety.’ 

According to figures from Cancer Research UK, there are around [2,300 melanoma skin cancer deaths](https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/melanoma-skin-cancer) in the UK every year, which is more than 6 each day. 

Although not every case of skin cancer is preventable, [you can reduce your risk of developing it](https://www.nhs.uk/conditions/melanoma-skin-cancer/) by following sun safety advice and avoiding getting sunburned.

## What are UV rays?

Ultraviolet (UV) radiation is a type of energy emitted by the sun and some man-made sources like tanning beds.

There are 3 types of UV rays:
- __UVA:__ longer wavelength rays that penetrate deep into your skin
- __UVB:__ shorter wavelength rays that only reach the outer layer of your skin 
- __UVC:__ rays from the sun that don’t reach the Earth’s surface, but can come from man-made sources like lamps

![What does the UV index mean?](//images.ctfassets.net/h8qzhh7m9m8u/4OZgjdMCM8MgVeMCrCuwg5/c745b7b37aa3b9a130161c07b92c583d/22GL451_organic_content_sun-saftey-chart__1_.png)

## What’s the UV index?

The WHO created the ultraviolet index (UVI)1 to measure the amount of UV rays reaching Earth during the day. The higher the number, the more intense the UV rays. 

You can usually find the UVI for your area in your local weather reports. 
For example, in Paris, the maximum UVI typically ranges from 0-1 in winter, 3-6 in spring, 6-7 in summer and 2-6 in autumn.

## What affects your UV exposure?

- __Geography:__ UV rays are more intense the closer you are to the equator. 
- __Altitude:__ At higher altitudes, there’s less atmosphere to absorb UV rays, so UV radiation is more intense. With every 1,000 metres of altitude, UV levels increase by about 10%.
- __Time of year:__ Summer brings the strongest UV radiation.
- __Time of day:__ UV rays are most intense when the sun is at its highest point in the sky, from around noon to 2pm.
- __Cloud cover:__ In general, clouds weaken your UV exposure – but don’t underestimate a cloudy day. Light cloud cover may actually intensify UV levels because of an effect called scattering.
- __Reflection:__ UV rays bounce off reflective surfaces like snow, sand, pavements and water, adding to your UV radiation exposure. Fresh snow is particularly reflective and can double your UV exposure. 

## Who is most at risk of sunburn?

People of all ages can get sunburn from spending too much time in the sunshine, as this is actually a form of light radiation. When talking about the health of our skin, there are two main types of ultraviolet to be aware of – UV light UVA and UVB. Together, they contribute to the chance of getting sunburn.

Some people are more prone to burning in the sun than others – especially those with moles or paler skin. Redheads are also more vulnerable to the effects of the sun as well as those who work outdoors.

‘Sunburn can be particularly dangerous for babies and small children, and so exposure to the sun should be carefully limited for little ones,’ Dr McClymont adds.

## How to prevent sunburn

- Remember your sunscreen – aim for SPF 50+
- Try to avoid the sun from 11am to 4pm when UV rays are at their strongest
- Make use of shaded spots, but keep in mind that shade from trees, umbrellas and canopies do not offer complete sun protection. To avoid getting sunburn, apply sunscreen even while in the shade
- Wear protective clothing for optimum sun safety, like a wide-brim hat and loose-fitting clothes
- Watch the UV Index (UVI) to plan your time outdoors. The higher the UVI, the more potential for sunburn or skin damage

## What’s the best way to treat sunburn?

‘Sunburn can usually be safely managed at home, but there are a few exceptions. If your sunburn is so severe it’s caused blistered or swollen skin, or you have other symptoms associated with your sunburn like a high temperature, headache, dizziness, nausea or muscle cramps then, it’s best to chat to a GP,’ Dr McClymont advises.

‘It’s also more important to protect sunburned skin while it’s healing, so if you’re already sunburnt, make sure you double up on your sun safety.’
Dr McClymont shares important things to remember when treating sunburn:

- When you get sunburn, your skin is damaged, so the first thing you need to do is stay out of the sun.
- You can calm down your skin and relieve itchy sunburn with a cool shower or bath – but make sure the water isn’t too cold, especially for children.
- Use a soothing moisturiser designed for sensitive skin to give your sunburn relief. There are lots of creams available for mild sunburn over the counter, often containing aloe vera.
- Sunburn, as well as hot weather, can make you prone to dehydration so drink lots of fluids.
- For treating bad sunburn, painkillers and anti-inflammatories like ibuprofen can help give relief.
- If your skin develops a sun blister (filled with clear liquid), leave it alone. They usually burst or leak easily as the skin is fragile, but it’s not a good idea to burst them yourself.
- As sunburned skin or sunburned lips begin to heal, they can often become very itchy, and the top layer of damaged skin begins to peel. Try not to scratch or peel the skin, as this can cause more damage. Simply keep itchy skin hydrated with a moisturiser.

## How to keep children safe from sun damage

It can be hard to keep active children out of the sun, so make sure they’re covered up as much as possible and are aware of the risks – if they’re old enough to understand. As children get older and more independent, it’s a good idea for them to play a part in their own sun safety.

Children’s skin is more delicate than ours, and the more often they burn, the more likely they are to develop skin cancer in later life.

Always use a high factor sunscreen for parts of the body that can’t be covered up. The label should state that it protects against both UVA and UVB rays. For children, it’s best to use at least factor 50 sunscreen for the best protection, and reapply it frequently – at least every two hours, or more often if it washes off.

Babies under 6 months should not be in direct sunlight at all. If small children or babies do get really bad sunburn, they can become very unwell, very quickly. 

Make sure your child gets an urgent medical assessment if you’re worried about their sunburn.

## What are the health benefits of the sun?

Spending time in the sunshine can be good for us too. As well as increasing the level of serotonin in our bodies, known as the ‘happiness hormone’, the sun has plenty of other health benefits.

### Vitamin D

This is the time of year when we can get the most [vitamin D through sunlight.](https://www.nhs.uk/live-well/healthy-body/how-to-get-vitamin-d-from-sunlight/) It helps keep our bones, teeth, muscles and immune system healthy. [Vitamin D supplements](/your-health/vitamins-that-doctors-recommend-taking/) are often recommended by doctors for those who live in less sunny areas, as well as those at risk of [vitamin D deficiency](/your-health/do-i-have-a-vitamin-d-deficiency-symptoms-causes-and-treatments/).

### Better mental health

Getting outside on a nice day can make all the difference to how we feel. Sunshine is closely linked to improved mood, and even clearer thinking, particularly in [people with depression](/medical-advice/mental-health/depression/). Another important reason to make sure we all enjoy the sun safely.

### Improved sleep cycle

It might seem obvious but experiencing sunlight in the daytime helps our bodies know the difference between night and day – and regulate our sleep patterns. This is all part of your 24-hour biological cycle known as the circadian rhythm that plays a big part in nearly all bodily processes.

### Relief from skin conditions

Sunshine in moderation – even as little as 5 minutes – can create visible short-term improvements to certain skin conditions like [acne](/your-health/acne-types-and-their-treatments-help-to-clear-your-skin/), [eczema](/medical-advice/skin-conditions/eczema/) and [psoriasis](/medical-advice/skin-conditions/psoriasis/).

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kry.co.uk > Your health > How to enjoy the sun safely

Treating sunburn

Here’s our expert guide on sun safety and everything you need to know about sunburn.

How to stay safe in the sun and treat sunburn | Kry UK

kry.co.uk > medical reviewer

Rhianna-headshot

Dr Rhianna McClymont

Lead GP, Kry

General health

General health and seasonal

How to enjoy the sun safely

We all have times when we don’t feel good about ourselves or doubt our ability to do things – like when we’re trying something for the first time. Persistently low self-esteem can take a toll on your mental wellbeing, but there are plenty of ways you can boost it.

## What is self-esteem?

Self-esteem is how you feel about yourself, including your strengths and weaknesses. It’s based on your opinions and beliefs about yourself rather than facts.

Self-esteem can involve a wide array of different factors, including:

- How you look
- How you feel
- How you behave
- How you measure your successes or failures

‘Your self-esteem may also be shaped by how you think others perceive you,’ says Kry Psychologist Dag Härdfeldt. ‘Our thoughts are influenced by biases, which aren’t always rational and logical.’ 

Self-esteem may change rapidly, too. ‘It can vary from day to day and even hour to hour,’ says Härdfeldt. ‘When we feel like we’ve succeeded at something, our self-esteem might get a boost. When we feel like we’ve missed the mark, it might take a knock.’ 

Healthy self-esteem means you value yourself and believe you deserve respect from others. It helps you feel positive about yourself and accept your strengths and weaknesses for what they are.

## What’s the difference between self-confidence and self-esteem?

We often use the term self-esteem alongside other terms including self-worth, self-respect and self-confidence. ‘Self-esteem and self-confidence overlap, but they’re different things,’ explains Härdfeldt. 

‘Self-confidence is one part of self-esteem – it’s your belief in your skills and abilities. You can be confident in your ability to succeed in some aspects of life, like finding a partner or doing good work, but you can still have low self-esteem and experience feelings of worthlessness.’

## Why do we need self-esteem?

Self-esteem impacts many aspects of your life, including your mental and physical health, your relationships, the decisions you make and your overall wellbeing. 

Having low self-esteem is associated with mental health issues like [anxiety, depression and suicidal thoughts](https://www.frontiersin.org/articles/10.3389/fpsyt.2019.00698/full)  and with [learning disorders, antisocial behaviour and eating disorders](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5602593/).  

On the other hand, research shows that high self-esteem helps you develop healthy coping skills, make stronger relationships and even perform better at school and work.  

On the other hand, [research](https://pubmed.ncbi.nlm.nih.gov/35357851/) shows that high self-esteem helps you develop healthy coping skills, make stronger relationships and even perform better at school and work.

## What causes low self-esteem? 

Triggers may include: 
- Bullying, abuse or neglect
- Mental or physical health problems
- Losing your job or having trouble finding one
- Relationship problems, divorce or separation
- Criticism from parents or teachers during childhood
- Body image issues 
- Discrimination, including racism and sexism

## What does low self-esteem look like? 

‘Low self-esteem can manifest as a negative emotion,’ says Härdfeldt. ‘For example, children with low self-esteem may be overwhelmed with fear. Some may freeze in panic and withdraw themselves, and some may act out.’ 

For some people, low self-esteem can manifest in negative thought patterns. They may say things like: 

- ‘No one likes me’ 
- ‘I’m a total failure’ 
- ‘This job interview is bound to go badly’

‘People with low self-esteem can get caught in a vicious cycle of negative thinking,’ explains Härdfeldt. While this cycle can be difficult to break, there are things you can do yourself and professional support that can help.

## How can I improve my self-esteem? 

Here are some steps you can take to feel more confident and boost your self-esteem.

### 1. Challenge negative thoughts about yourself 
Identify the negative thoughts and beliefs you have about yourself, then try to challenge them. 

[‘Cognitive distortions](/your-health/5-ways-to-deal-with-negative-thoughts-now/) are thought patterns that cause people to see their reality inaccurately,’ says Härdfeldt. ‘A common one is mind reading. We’ve all assumed that we know what others are thinking – and we’re often wrong. If you have low self-esteem, there’s a good chance you’ve misinterpreted a facial expression or another interaction.’ 

One helpful technique you can make is to try labelling your thoughts instead of yourself. For example, instead of thinking: ‘I’m not smart,’ switch to: ‘I’m having a thought that I’m not smart.’ 

### 2. Talk to yourself like you would to a friend 

‘People with low self-esteem tend to be more critical about their appearance, personality or abilities than they would be about others,’ explains Härdfeldt. For example, if you were disappointed with your performance review at work, you might say to yourself:

- ‘I did so badly today’ 
- ‘I’m worthless’
- ‘Why am I even trying?’

‘One way to tell if you’re being fair to yourself is to imagine yourself using the same language with someone you love,’ says Härdfeldt. In most cases, you’d show them empathy and understanding. It’s important to treat yourself with the same [compassion](/your-health/what-is-self-compassion-and-why-does-it-matter/). 

### 3. Compete with yourself, not others

‘Competition can be a good thing,’ says Härdfeldt. ‘But when you compare yourself to others, it’s easy to focus on other people’s strengths and achievements while forgetting your own.’

Try picking something you’re good at and developing that skill. For example, if you’ve got green fingers, challenge yourself with a new gardening project. If you’re a good runner, train for a race. Competing with yourself and breaking your own personal records is a great technique to boost your self-esteem.

### 4. Practise body neutrality

It’s not always easy to feel positive about your body – instead, try working towards body neutrality. Practise seeing your body in a neutral way, rather than good or bad.

If you find yourself focusing on the way your body looks, try thinking about the way it functions. Appreciate the things your body allows you to do, like see, hear or move around your environment. 

### 5. Try talking therapy 

Talking with a therapist can help you work through the issues you’re facing. It’s a good idea to book an appointment if you’re experiencing any of the following:

- Your self-esteem is interfering with your daily life, including work, studying or relationships
- You’re having persistent negative thoughts that are affecting your ability to focus
- Your self-esteem has led to mental health problems, including anxiety and depression

Cognitive behavioural therapy (CBT) is a type of [talking therapy](/your-health/is-talking-therapy-for-me/) that can help you recognise unhelpful patterns in the way you think or behave and find ways to change them. ‘It’s also important to remember that low self-esteem can be a symptom of underlying disorders, like [anxiety](/medical-advice/mental-health/anxiety/) and depression, which can be treated,’ says Härdfeldt. 

__This article has been medically reviewed by Dag Härdfeldt, Kry Psychologist.__


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Kry.co.uk > Your health > How can I build my self-esteem?

How can I build my self-esteem?

Self-esteem plays an important role in your ability to develop healthy relationships, feel good about yourself and achieve your goals. Discover some simple ways to boost yours from Kry Psychologist Dag Härdfeldt.

How can I build my self-esteem? | Kry

Everyday mental wellbeing

Allergic reactions, and [allergies](/medical-advice/allergies/) in general, are very common. They happen when the body’s immune system overreacts to a substance, which is called an [allergen](https://www.hopkinsmedicine.org/health/conditions-and-diseases/allergies-and-the-immune-system). Our bodies make antibodies that attack the allergen, even though it’s not harmful. 

Allergic reactions can be triggered by airborne allergens like pollen, food and medications. In some cases, the reaction can lead to anaphylaxis. Although rare, anaphylaxis is a serious condition that can be life-threatening if not treated.

## What causes an allergic reaction?

[Allergies are very common](https://acaai.org/allergies/allergic-conditions/food/) and can start at any age. There are hundreds of different triggers that can set off an allergic reaction, but some of the most common ones include:

- __Foods__, especially tree nuts (which include walnuts, almonds and cashews), peanuts, shellfish, fish, wheat, fruit, eggs, dairy and soy
- __Medications__ like penicillin and some painkillers like aspirin or ibuprofen
- __Venom__ from [stings](/your-health/summer-bites-and-stings-a-guide-to-prevention-and-treatment/), from insects like bees or wasps
- __Latex__, a type of rubber found in some rubber gloves and condoms
- __Contrast agents__, which are dyes used in medical scans like X-rays
- __Airborne allergens__ like pollen ([hay fever](/medical-advice/allergies/hay-fever/)), dust mites, animals with fur, and mould

## What are the symptoms of an allergic reaction?

Allergic reaction symptoms can look different for everyone and happen anywhere in the body. Some common [symptoms](https://www.uptodate.com/contents/anaphylaxis-symptoms-and-diagnosis-beyond-the-basics#H1) of a severe allergic reaction include:

- Itching, hives or skin flushing
- Red or itchy eyes
- Swelling of the tongue or throat
- Difficulty breathing, chest tightness or wheezing
- A feeling of the throat closing
- Diarrhoea
- Dizziness or fainting
- A rapid, slow or irregular heartbeat
- Low blood pressure
- Nausea or vomiting
- Confusion and anxiety

It’s important to act fast if someone is experiencing an allergic reaction. ‘An allergic reaction can start within minutes but can occur anywhere between 20 minutes and 2 hours after exposure to the allergen,’ says Dr Ramskill. ‘Allergic reaction symptoms can be mild at first, but quickly worsen.’

## What happens to your body during an allergic reaction?

An allergic reaction happens when your body’s immune system mistakes something harmless for something dangerous.

‘When you have an allergy, your immune system overreacts, treating the allergen as a harmful virus or bacteria and producing antibodies to fight against it,’ explains Dr Ramskill. 

‘When you’re exposed to the allergen again, these antibodies trigger a rush of chemicals, like histamine, from your immune system into your bloodstream. This can cause your body to go into anaphylactic shock.

‘When in your blood, the chemicals can cause allergy symptoms throughout the whole body. If your airways narrow, you might have difficulty breathing, which can be very dangerous.’

## What should I do if someone is having a severe allergic reaction (anaphylaxis)?

‘Anaphylaxis is a medical emergency. It can be very serious if not treated quickly,’ says Dr Ramskill.

If you, or someone else, is having a severe allergic reaction, here’s [what to do](https://www.uptodate.com/contents/anaphylaxis-treatment-and-prevention-of-recurrences-beyond-the-basics). 

1. __Use an adrenaline auto-injector__. If the person has one of these, look for instructions on the side of the injector before using it. Epinephrine (the medicine in auto-injectors) is the most effective treatment for anaphylaxis, and it works best when given as soon as possible.

2. __Call 999 or emergency medical services__. Ask for an ambulance and tell the operator the person has anaphylaxis. Always call an ambulance, even if the person is starting to feel better. Symptoms can return a few hours after the initial attack, sometimes catching people off guard.

3. __Lie the person down and raise their legs__. If they’re having difficulty breathing, sit them up straight until their breathing improves. If they’re pregnant, lie them down on their left side.

4. __Remove the cause (if possible)__. For example, as long as it doesn’t put the person in further danger, you could try to remove the stinger from the skin after a bee sting.

5. __Give another adrenaline auto-injection__ if their symptoms don’t improve after 5 to 15 minutes.

6. __Start CPR if it’s needed__. If the person’s breathing or heart stops, immediately start CPR until help arrives.

7. __Keep track of what’s happened__. Tell the paramedics or hospital staff what medication you’ve given to someone. Make sure you tell them if there’s no auto-injector available.

‘Most cases are mild, but any anaphylaxis has the potential to become life-threatening,’ says Dr Ramskill. ‘Anaphylaxis develops rapidly, usually reaching peak severity within 5 to 30 minutes – though in rare cases, it may last for several days.’ 

## How can I prevent a severe allergic reaction?

There are steps you can take to minimise your risk of anaphylaxis:

### 1. Carry an auto-injector 
‘If you’re at risk of anaphylaxis, always keep 2 (in date) auto-injector pens with you. Tell friends and family where they are and teach them how to use them,’ says Dr Ramskill.

### 2. Avoid the allergen as much as you can
If you have a food allergy, avoid those foods, read food labels and take extra care when eating out. If you get allergic reactions to insect bites or stings, do your best to steer clear of areas where bugs live, wear loose-fitting long-sleeved tops and trousers and use insect repellent.

### 3. Wear ID
Dr Ramskill suggests that people at risk of anaphylaxis wear a medical identification bracelet or tag. In an emergency, it will let others know you have allergies, helping you get the right treatment quickly.

### 4. Track your symptoms
For less severe allergic reactions, keep a diary to help you link your allergy to the symptoms. You might notice sneezing, a runny nose and itchy eyes after grass has been cut or an allergic reaction rash might come up after you wear latex gloves. ‘Sometimes you may be referred to an allergy clinic to help identify what you may be allergic to,’ says Dr Ramskill. 

__This article has been medically reviewed by Dr Nikki Ramskill, a Kry GP.__


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Kry.co.uk > Your health > What to do if someone has a severe allergic reaction 

What to do if someone has a severe allergic reaction 

Allergic reactions can be dangerous if not treated quickly. Learn how to identify a severe allergic reaction and what you should do if someone is having one.

What to do if someone has an allergic reaction | Kry

Kry.co.uk > Womens health hub > Banner

Menopause is the time when your ovaries stop releasing eggs and you stop having periods. The experience is different for everyone, and it’s usually a gradual change that happens over a few years, giving you time to adapt and seek support for symptoms along the way. 

![22GL331 organic menopause some timeline UK v2](//images.ctfassets.net/h8qzhh7m9m8u/7INZokymAOBSu72jthPiXv/3eb8e28df96c2b993474357a7bc15745/22GL331_organic_menopause_some_timeline_UK_v1.png)

## What’s perimenopause and how do I know it’s happening?

Perimenopause is the time period leading up to menopause. ‘The first sign is usually a change to your menstrual cycle,’ says Dr Elisabeth Rosén, a Kry doctor who specialises in gynaecology and obstetrics. ‘Usually, your menstrual cycle starts to shorten, then it becomes more [irregular, often with heavier, longer bleeds.’](/your-health/what-causes-heavy-or-irregular-periods-a-doctors-guide/)

Perimenopause happens when your ovaries begin to stop working. They start making fewer and lower quality eggs and follicles (sacs filled with fluid that hold an egg). 

### Changes to your menstrual cycle
‘Your cycle becomes shorter because the amount of progesterone you produce decreases, which makes the lining of your uterus shed sooner,’ explains Dr Rosén. ‘Eventually, the few eggs that remain struggle to mature every month, but your body keeps making hormones to regulate your ovaries, leading to irregular and longer bleeds.’

### Hormonal changes
As your body produces lower levels of oestrogen and progesterone, it can trigger a range of [perimenopause signs and symptoms](/your-health/7-signs-of-perimenopause-a-doctors-guide/) like hot flushes and vaginal dryness. 

‘Most people experience some mental and physical difficulties throughout this transition. Some only notice them for a year or so, while others can have symptoms for 10 years or more,’ says Dr Rosén.

### Key perimenopausal symptoms
If you’re perimenopausal, you may experience some or all of the following symptoms:

- [Vaginal dryness](/your-health/causes-of-vaginal-dryness/)
- Urinary incontinence
- Recurrent urinary tract infections (UTIs)
- Vaginal bacterial infections
- Hot flushes
- Decreased quality of sleep
- Low mood, depression or panic attacks
- Weight gain

## What age does perimenopause usually start?

The average age that perimenopause starts is [47.5 years](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3285482/) , but it varies depending on ethnicity, genetics and lifestyle factors. Perimenopause lasts an average of 4 years and ends with your [final menstrual period](https://www.uptodate.com/contents/menopause-beyond-the-basics). 

## What is menopause?

Menopause is the time between perimenopause and post-menopause. ‘You’re considered to have reached menopause when it’s been a full year since your last period,’ says Dr Rosén.

‘When your ovaries’ function is so compromised that your hormone levels are no longer enough to build up the lining of your uterus, your periods stop.’ 

## What signals the end of menopause?

Your oestrogen production will continue to decrease for a few years after you reach menopause. Around 5 years after your last period, the levels of oestrogen in your body have reached a constant, very low level, marking the end of menopause and the beginning of post-menopause.

‘You remain post-menopausal for the rest of your life,’ explains Dr Rosén. ‘At this point, a lot of the symptoms of menopause will disappear. Your body learns to regulate its temperature and the hot flushes go away. Most people also feel that their moods stabilise.’

Some changes may remain, like [vaginal dryness](/your-health/causes-of-vaginal-dryness/). ‘This can be painful and itchy, and may make having sex difficult,’ says Dr Rosén. If this is a problem for you, speak to a doctor. 

## What’s the average menopause age?

The average age of
menopause is 51, but anything from the age of 40 to 57 can be normal.

There are a number of factors that can influence when you reach menopause, including:

- The age your mother reached menopause
- Lifestyle habits
- Blood pressure
- BMI
- Sun exposure

There’s also strong evidence that smoking is linked with earlier menopause. ‘Very intense physical activity, a diet high in polyunsaturated fats and high blood pressure are also associated with an earlier menopause age,’ explains Dr Rosén.

[Pregnancy and breastfeeding](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2759124)  may cause later menopause, most likely because they prevent you from ovulating and depleting your supply of eggs.

## What’s considered early menopause?

Early menopause is menopause that begins before the age of 45. This happens in around 5% of women. Around 1% enter menopause before the age of 40, which is called [premature ovarian insufficiency (POI)](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8529948/). 

‘See a doctor if your periods start to get irregular before the age of 40 or they stop completely before the age of 45,’ says Dr Rosén. ‘The symptoms of early menopause, perimenopause and menopause later in life are the same, but for some they can be more pronounced as hormone levels decrease very rapidly.’

The exact cause of POI is often unknown, but it can be genetic or linked to auto-immune conditions like hypothyroidism. ‘It can also be triggered by medical treatments, including cancer treatment such as radiation and chemotherapy,’ says Dr Rosén.

### Do I need to see a doctor about early menopause?

Usually, blood tests aren’t needed to diagnose menopause. But if you’re young, a doctor might want to check your levels of the hormones FSH and LH to help diagnose POI early. 

Oestrogen also protects against heart disease. ‘If you have POI, you might need hormone replacement therapy (HRT) to prevent osteoporosis and lower your risk of heart disease,’ says Dr Rosén. ‘Calcium and vitamin D supplements can help support your bones, too.’

Coming to terms with the fact that you’re no longer fertile can be challenging regardless of your age, but it can be especially difficult if you’re going through early menopause. ‘See your doctor for advice,’ encourages Dr Rosén. ‘Getting answers and understanding what’s happening to your body can be enough, but you might benefit from CBT or another type of talking therapy.’

## When should I see a doctor about menopause symptoms?

It’s perfectly OK to make an appointment with your doctor about your symptoms during menopause. ‘If you’re not feeling well, getting reassurance can really help,’ says Dr Rosén.

Everyone’s experience with menopause is different. If you’re struggling to cope, hormonal treatments like HRT or local oestrogen can be used to treat symptoms like hot flushes that are caused by low levels of oestrogen. 

‘HRT is very safe if it’s started before the age of 60 and not given for more than 5 years. It can also lower your risk of heart disease. For some, it also helps a lot with [psychological symptoms](/your-health/lets-talk-about-menopause-and-mental-health/),’ says Dr Rosén.

It’s also best to speak to a doctor if:
- You’re suffering from vaginal dryness
- You have a period more often than every 3 weeks
- You have very heavy periods or spotting between periods
- You have any bleeding at all after menopause
- You’re struggling with any menopause-related symptoms

__This article has been medically approved by Dr Elisabeth Rosén, a Kry doctor who specialises in gynaecology and obstetrics.__


kry.co.uk  >        article page  >          CTA

Speak to a GP about menopause

Kry.co.uk > Your health > What age will I reach menopause? A doctor’s guide

What age will I reach menopause? A doctor’s guide

What age will you reach menopause and what happens to your body? Read our doctor’s guide and learn what to expect before, during and after the transition

What’s the average age of menopause and perimenopause? | Kry

Most of us don’t give a lot of thought to our nails. But the condition, shape and colour of your nails could be an indicator of your overall health. Healthy nails are generally even in colour and feel smooth to the touch. As we get older, our nails change. They can become [more dull and brittle and grow more slowly](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3038811). 

While most nail changes are completely normal, some can signal health issues. Here’s what to look out for.

![22GL organic content nail-problemes chart UK](//images.ctfassets.net/h8qzhh7m9m8u/6vo6RqEgrqxfuDV934Zpdu/6ff070e6aca66ad3f32a720b98ed4f46/22GL_organic_content_nail-problemes_chart_UK.jpg)

## 1. Your nails have white spots
Small white spots or lines on the nail are most commonly caused by injury or trauma to the nail bed. They will go away as your nail grows out. Common causes include:

- Nail biting and picking
- Manicures or pedicures
- Using acetone nail polish remover
- Accidents where your nail is trapped in a door or window

‘Rarer causes of white spots on the nail may be associated with a fungal nail infection and as a side effect of medication or chemotherapy, ’explains Dr Saloojee. 

## 2. Your nails are yellow

Nail polish often stains nails a subtle yellow. A fungal infection, known as onychomycosis, can also cause yellow nails. This usually affects the toenails, but it can happen to fingernails too. ‘Typically, nail fungus causes the nail to thicken, discolour, split or lift off in some areas,’ says Dr Saloojee. If you think you have a fungal infection, it’s best to speak to a doctor.

‘Yellow discolouration can also be caused by smoking,’ says Dr Saloojee. ‘In rare cases, it may be associated with lung disease, thyroid disease, diabetes or psoriasis.’

To minimise the chance of yellow nails: 
- Wash and moisturise your hands and feet regularly
- Change your socks frequently to avoid toenail infections like [athlete’s foot](/medical-advice/skin-conditions/athletes-foot/)
- Wear shoes in public areas like pools or locker rooms
- If you paint your nails, use a base coat under your polish and choose a nail salon that sterilises tools between each customer

## 3. The skin around your nails is swollen and red

Paronychia is an infection of the skin around your nails. The skin may turn swollen, red, painful and blisters might form.

It usually happens when the skin around the nail is broken, letting bacteria or fungi in. This can happen from biting or picking the skin, manicures, ingrown nails, having your hands in water a lot, or babies sucking their thumb.

Paronychia usually isn’t serious, but in some rare cases the infection can spread and need medical help. 

## 4. Your nails have deep horizontal ridges

Deep grooves or lines that run horizontally across your nail may be a sign that your nail growth has slowed or stopped for a while. This could be caused by a minor injury or illness.

‘Possible causes can include Raynaud’s disease, [diabetes](/medical-advice/autoimmune-diseases/type-1-diabetes/), kidney failure, [thyroid disease](/your-health/thyroid-symptoms-overactive-underactive/) and illnesses that cause a high fever, such as measles, mumps, scarlet fever and [pneumonia](/medical-advice/respiratory-conditions/pneumonia/),’ says Dr Saloojee.

Horizontal ridged lines, also known as Beau’s lines, can also be a sign of a zinc deficiency. 

## 5. Your nails are pitted

Little dents in the surface of your nail, which might look like they’re caused by an ice pick, are called pits. ‘Although pitting can happen for a variety of reasons, it’s often associated with [psoriasis](/medical-advice/skin-conditions/psoriasis/), a skin condition that causes red, dry, scaly patches on your elbows, knees and other parts of your body,’ explains Dr Saloojee. 

Other symptoms related to [nail psoriasis](https://www.aad.org/public/diseases/psoriasis/treatment/genitals/nails) include:
- Brown, yellow or white nail discolouration
- Thickening of the nail
- Changes to the normal shape
- Nails separating from your finger or toe 
- Blood under your nail

## 6. Your nail separates from its nail bed

This condition, known as onycholysis, is a common nail disorder where the nail painlessly lifts from the nail bed. It’s more likely to happen if you have long nails and might be caused by washing your hands a lot or sensitivity to products used during manicures or pedicures. 

‘It can also be caused by a fungal infection, certain medications or health conditions, like psoriasis, iron deficiency and thyroid disease,’ explains Dr Saloojee. 

If your nails are lifting, Dr Saloojee recommends you: 
- Clip the part of the nail that’s separating
- Avoid possible irritants like nail polish
- Use tape to secure the nail to your finger or toe
- Soak your nail in diluted vinegar, which is antimicrobial, to lower your risk of infection

## 7. Your nail has a brown or black stripe

A dark brown or black stripe along your nail is often due to pigmentation of the nails, known as melanonychia. This is more common in people with darker skin tones. 

Splinter haemorrhages can also cause dark lines down your finger or toenails. They might develop after an injury when blood vessels under the nail are damaged and burst.

‘Rarely, but more seriously, a black streak under the nail can be due to melanoma of the nail, which is a type of [skin cancer](/medical-advice/skin-conditions/skin-cancer/),’ says Dr Saloojee. ‘The dark stripe may widen over time, spreading into the cuticle, and the nail may become painful or bleed.’ Speak to a doctor right away if you notice this. 

## 8. Your nails are brittle

Brittle nails are a common problem that can affect anyone. You may have soft, dry or thin nails that break easily and start to split. 

This can be a sign of ageing but can also be caused by long-term exposure to chemicals like nail polish or washing your hands a lot, which can strip your nails of moisture. Other factors that may cause brittle nails include anaemia and thyroid disorders.

## How do I keep my nails healthy?

Taking care of your nails is important, not just because it improves the way they look, but because it can help prevent nail health problems.

### 1. Keep your nails clean and trimmed
Try not to bite, pick or tear your nails or the skin surrounding them.

### 2. Wear gloves
This will protect your fingernails if you regularly use cleaning products, live in cold climates or your hands are often in water. 

### 3. Eat a healthy diet
Include high-protein foods like fish, meat, pulses and nuts. If you eat a varied diet, you shouldn’t require [supplements](/your-health/what-vitamins-should-i-take/) – but people with weak nails may benefit from a nail supplement that contains biotin, B vitamins, zinc and silica. 

### 4. Be gentle with manicures
Use acetone-free nail polish remover and avoid pushing your cuticles back. This can lead to breaks in the skin around the nail bed and cause infections.

## When should I see a doctor? 

If you’re concerned about any nail symptoms, and you’ve tried simple remedies that aren’t working, speak to a doctor. It’s a good idea to book an appointment if:

Your nails have changed colour or shape or fallen off and you don’t know why
The skin surrounding your nails is red, sore, swollen and warm.

__This article was medically reviewed by Dr Roshaan Saloojee, a Kry GP.__


kry.co.uk > Your Health > 8 common nail problems

See a GP about nail problems

22GL organic content nail-problemes 2100x1200

From yellow nails to white marks, discover what the shape, colour and condition of your nails can tell you about your health

kry.co.uk > Your Health > 8 of the most common nail problems

8 of the most common nail problems | Kry

8 common nail problems

For many people, the warmer weather brings more than sunshine and flowers – it’s hay fever season. Here’s a doctor’s guide to hay fever, including the common hay fever triggers and how you can help relieve symptoms at home.

‘Mild allergies like hay fever are common, but it’s important to know when to seek urgent medical care – if you develop difficulty breathing, or have swelling around your lips and tongue, you need to get emergency help straight away,’ says Dr Rhianna McClymont, Lead GP at Kry. 

## What exactly is hay fever? 

Hay fever is a type of allergic rhinitis – irritation and inflammation mainly in the nose and eyes as a response to something that triggers the immune system. In the case of hay fever, it’s an allergy to pollen in the air – tree pollen, grass pollen, and other plants can cause problems.

When we have an [allergic reaction](/medical-advice/allergies/), our body naturally releases chemicals called histamines as part of a natural protective response. Sometimes when we’re exposed to an allergen, like pollen, our body’s response is excessive and makes us feel unwell. Some people are more susceptible to these kinds of allergic response than others – this seems to be down to a combination of lifestyle, genetic and environmental factors. 

Streaming eyes, sneezes and runny noses for many people signals the arrival of hay fever season. Thankfully, we now know more than ever about the small lifestyle changes and simple treatments that help ease these unwelcome seasonal symptoms.

## How can I manage hay fever myself?

Sometimes, simple hay fever home remedies can be really useful for managing symptoms. Here are 5 of our top tips to try at home.

1. __Use over-the-counter treatments__– your local pharmacy is usually a good first port of call for hay fever relief. 
2. __Plan ahead__ – take notice of which days are likely to be worse than others. Dry, windy days when the pollen count is high are particular culprits for causing hay fever, and you can take antihistamines in advance.
3. __Stay indoors__ – some hay fever sufferers might be able to stay indoors with the windows closed on particularly high pollen days, but not everyone’s lifestyle allows for that. Work, school, and life in general can make it tricky to avoid high pollen days. 
4. __Wash clothes (and pets)__ – doing laundry and showering after you’ve been outside on high pollen days can help with signs of hay fever.
5. __Dry clothes indoors__ – hanging laundry on the line will increase the amount of pollen you’re exposed to.

## When is hay fever season?

Hay fever season is usually between around March and September, when plants release pollen as trillions of microscopic particles. 

During this time, the pollen count is sometimes included in [weather forecasts](https://www.metoffice.gov.uk/weather/warnings-and-advice/seasonal-advice/health-wellbeing/pollen/when-is-hayfever-season) – it just means how much pollen is in the air that day. Hay fever usually gets worse as the pollen count gets higher, so hay fever sufferers might choose to avoid going outdoors at those times. 

## What types of pollen affect hay fever, and when?

Every plant releases a different type of pollen – it’s how they reproduce. Some types of pollen are more likely to cause reactions than others, and some people are more sensitive to one type than another.

- __Grass pollen__ - This is the most common trigger for hay fever, and is usually particularly active from May to July in the UK. 
- __Tree pollen__ - This affects people a little earlier in the year, between February and mid-summer. There might even be differences in how each person reacts to different types of trees. 
- __Weed pollen__ - From June to September, hay fever is more likely to be a reaction to weed pollen – common weeds which cause hay fever include dock, nettles, mugwort and ragweed. 
- __Crops__ - Some crops also cause problems around this time of year, particularly oilseed rape just before and around the time of harvest. 

Allergy screening tests your reaction to some different types of pollen separately, which can help plan the times of year to be extra careful about managing hay fever.  

## Common signs of hay fever

Hay fever can make you feel quite unwell, and can mimic the symptoms of other related allergies.

Some of the most common signs of hay fever include:

- Sneezing
- Runny nose
- Swollen, red and sore eyes
- A sore throat 
- Itching 
- Feeling very tired and generally unwell
- Poor sleep

Some people also find that they get headaches and earaches, and hay fever can even affect your sense of taste and smell.

‘Allergic rhinitis can make you feel really miserable, but most symptoms can be well-managed with over-the-counter medications,’ says Dr McClymont. ‘Oral antihistamines, steroid nasal sprays and antihistamine eye drops are all very useful to control the symptoms. For regular sufferers, it’s important to start using these treatments early in the hay fever season for the best result.’

## Who is more at risk of hay fever?

People with [asthma](/medical-advice/respiratory-conditions/asthma/), who also get hay fever, might find that their asthma is worse when hay fever flares up – 80% of people find that hay fever can trigger asthma, and even sometimes cause serious attacks. Carefully managing both conditions is always essential, but especially so for people who find their asthma flares up badly in hay fever season. 

‘Often, people who suffer with hayfever are also more likely to suffer with asthma or eczema - and vice versa. Sufferers may also have a genetic predisposition to hayfever, and so it tends to run in families. If a close family member suffers with it, your risk is higher,’ says Dr McClymont.

## Is hay fever common in children?

Hay fever in children under the age of five is uncommon, but from that age and up, the numbers of children who develop hay fever surges, with around 40% of people affected at some point in their childhood. 

Although it’s not usually thought of as a very serious condition, having bad hay fever can have a huge negative impact on a child’s quality of life, and lead to days off school and missed opportunities to go on trips and days out. The sleeplessness that sometimes accompanies hay fever can be difficult for children to deal with, but usually symptoms can be reasonably well controlled with careful medication management. 

Many people find that their hay fever settles down as they get older – this may be due to changes in our immune response as we age. But somewhere [between 10% and 30% of adults continue to suffer from hayfever](https://www.allergyuk.org/information-and-advice/statistics). 

## How can I treat hay fever in children?

The types and doses of hay fever treatment suitable for children may be different than those for adults, so it’s important to choose the right product for the age group, and always follow the instructions on the box. A pharmacist or GP can give advice if you have any concerns or are having trouble managing hay fever in a child. 

## Should I see a doctor for hay fever treatment?

Hay fever can really impact the way you feel and how well you feel like you can cope with day-to-day life. On a bad day, hay fever can affect your mood, breathing, ability to work and even leave the house. Usually hay fever is manageable, and there are lots of options for treatment and management. 

‘If you’re struggling to manage your symptoms with medications from the pharmacy then it is best to see your GP for further advice,’ advises Dr McClymont. ‘There are stronger medications for hay fever available on prescription, or in severe cases, a GP may refer you to an allergy specialist’. 


kry.co.uk > Your health > Hay fever signs and treatment: your self-help toolkit 

Hay fever signs and treatment: your self-help toolkit 

Hay fever is a common condition affecting at least a quarter of adults. Simple lifestyle changes can relieve symptoms through the hay fever season.

Hay fever treatment and how to relieve your symptoms | Kry UK

IMG 20200730 224911 865[33] (1)

Lead GP at Kry

A doctor's guide to managing the hay fever season

## How can diabetes affect your mental health?

Having diabetes brings with it a number of extra responsibilities and difficulties. These can include dealing with continuous self-monitoring of [blood sugar levels](https://www.livi.co.uk/your-health/what-you-need-to-know-about-blood-sugar/), daily diet planning, making healthy food choices and worries about potential health complications. 

‘The physical symptoms of diabetes can also affect your memory and concentration, exacerbating feelings of anxiety,’ explains Dr Oyefeso, Livi Psychologist – ‘and this is why the condition can be both physically and psychologically draining.’

If this is something you can relate to, you may be experiencing diabetes distress.

## What is diabetes distress?

Around 1 in 5 people with diabetes struggle with diabetes distress. This condition can occur in [Type 1 diabetes](https://www.livi.co.uk/medical-advice/autoimmune-diseases/type-1-diabetes/) or Type 2 diabetes and describes the emotional response brought on by the challenges of living with diabetes – usually involving the emotional burden of self-care, the effect it has on your relationships and anxiety around future implications.

‘These feelings are something everyone with diabetes has to deal with but can vary depending on the diagnosis, treatment or changes to the condition as well as stress in other areas of your life,’ says Dr Oyefeso. ‘Being aware of the signs can help you manage these feelings.’ 

## What are the symptoms of diabetes distress?

Some of the most common feelings of those struggling with diabetes include: 

- Overwhelmed by living with diabetes 
- Anxiety over the success of treatment 
- Feeling alone and isolated 
- Missing medical appointments
- Not checking blood levels regularly

## Is diabetes distress the same as depression?

Diabetes distress is not the same as depression, but many of the symptoms like hopelessness and helplessness can overlap. [Depression](https://www.livi.co.uk/medical-advice/mental-health/depression/) is an illness that can affect how people feel about all aspects of their life, whereas diabetes distress is an emotional response to living with diabetes.

Diabetes distress is likely to lead to feelings of anxiety, frustration and being overwhelmed. It is still very important to manage any signs of diabetes distress, to help prevent these feelings getting worse or developing into depression.

## 6 tips for managing diabetes distress

Here are some of Dr Oyefeso’s top tips for looking after your wellbeing with a chronic condition.

1. __Be aware of your feelings__ – Everyone can feel stressed at times but having to deal with diabetes can add extra pressure. It’s important to notice if these feelings are starting to affect your life and if you need help coping.
2. __Set realistic expectations__ – We can all find it tricky to keep on top of things. If you occasionally forget to check your blood sugar levels, focus on what you can do next time to help you remember.
3. __Don’t be afraid to ask for help__ – It’s important to [let your doctor know if you’re struggling](https://www.livi.co.uk/your-health/how-to-talk-about-your-mental-health-if-youre-struggling/) with your self-care so you can work together to come up with a new plan that works for you better.
4. __Tell your family and friends__ – Talking openly can help offload your stress but also make those around you more aware of what you are going through, and when you might need some help.
5. __Talk to other people with diabetes__ – Speaking to others going through the same thing, perhaps in a support group. Strangers can be hugely reassuring. It can also be an opportunity to learn new ways about managing your diabetes. 
6. __Simplify your care plan__ – To help you feel less overwhelmed, break things down and manage your tasks one at a time. This will help reduce stress and make your days feel more manageable.

## When should I see a therapist?

Living with a chronic condition like diabetes can have a big impact on your physical and mental health. You should seek medical help if:

- Your symptoms are affecting your overall quality of life and have lasted for more than 2 weeks
- You don’t feel comfortable talking to family and friends
- You’re feeling depressed or suicidal

Speak to a therapist about diabetes distress

Livi.co.uk > Your health > Managing your mental health with diabetes

Managing your mental health with diabetes

Diabetes is a chronic condition that can impact your mental health. Read our expert advice on how to look after your wellbeing and manage diabetes distress.

Kry.co.uk > Your health > Managing your mental health with diabetes

 Mental health and diabetes | Kry

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