kry.co.uk > Your health

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

kry.co.uk > Your health > Metainfo

Your health | KRY

Many people experience feelings of [anxiety](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30381-6/fulltext) from time to time. But for some, anxiety can go beyond feeling fearful and worried, causing physical symptoms like chest pain.  

## What are the symptoms of anxiety?

It’s not always easy to recognise the difference between anxiety-related chest pain and pain from something like a [heart attack](https://www.livi.co.uk/medical-advice/cardiovascular-diseases/heart-attack/) or [angina](https://www.livi.co.uk/medical-advice/cardiovascular-diseases/angina/). ‘Everyone will experience anxiety differently, and there’s a wide range of [psychological and physical symptoms](https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/feelings-and-symptoms/anxiety-fear-panic/) you might feel,’ says Dr Roshaan Saloojee, a Livi GP.  

Some [psychological symptoms of anxiety](https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/feelings-and-symptoms/anxiety-fear-panic/) include:
- Feelings of panic or fear
- Feeling tense or always on edge
- Racing thoughts you can’t control
- Difficulty concentrating
- Irritability

Physical symptoms of anxiety can include:
- Sweating or hot flushes
- A fast heartbeat (or sometimes [palpitations](https://www.livi.co.uk/your-health/why-is-my-heart-racing-when-i-am-reasting-the-facts-about-heart-palpitations/))
- Feeling dizzy or lightheaded
- Shortness of breath
- A dry mouth
- Stomach ache
- Feeling sick

## How does anxiety cause chest pain?

Anxiety is a normal reaction to real or imagined danger. When you’re worried, scared or stressed, you enter ‘[fight or flight](https://journals.lww.com/hrpjournal/Fulltext/2015/07000/Fear_and_the_Defense_Cascade__Clinical.3.aspx)’ mode.  This is your body’s way of preparing you to fight against, or run away from, something that could hurt you.

‘The fight or flight reaction automatically triggers the release of stress hormones like adrenaline,’ says Dr Saloojee. ‘This causes your blood pressure to spike, your heart rate to increase and your breathing to become quick and shallow.’

Like any muscle, the harder your heart works, the more strained and stressed it becomes. ‘You might feel palpitations, spasms and chest pain from muscle tension,’ says Dr Saloojee.  ‘The lack of oxygen and increased heart rate can also cause other symptoms like [dizziness and shortness of breath](https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms).’ 

## What does chest pain from anxiety feel like?

When it comes to the symptoms of anxiety, everyone has a different experience, and anxiety chest pain is the same. However, there are some common patterns to how it feels and how long it lasts.

Chest pain from anxiety can include:
- A sharp or stabbing pain that stays in the chest area
- Tightness
- Pressure
- Burning 
- A dull ache
- Twitching in the chest

For some people, the anxiety can intensify into a [panic attack](https://www.livi.co.uk/medical-advice/mental-health/panic-disorder/), causing tight chest pain along with emotional distress.

‘Anxiety chest pain usually comes on quickly and goes away quickly,’ Dr Saloojee says. ‘You will typically start to feel better after around 10 minutes.  For a while afterwards, some people might feel some soreness or an ache in their chest because of the muscle contractions.’

## What’s the difference between anxiety chest pain and a heart attack?

Chest pain from anxiety can sometimes be confused with other problems, like a heart attack. 

‘In comparison with anxiety chest pain, pain from a heart attack will worsen with activity and last longer (more than 20 minutes),’ says Dr Saloojee. 

‘[Heart attack chest pain](https://www.cdc.gov/heartdisease/heart_attack.htm) often feels like a squeezing, heavy or intense pressure on the chest.  It can spread to other parts of the body, like the arms, shoulders, back and jaw. You may also experience sweating, nausea, coughing or wheezing.’

Over time, you might start to recognise when chest pain is due to anxiety. But if you’re ever worried that your chest pain is something more serious, seek medical help.

## How can I stop anxiety chest pain?

The best treatment for your chest pain will depend on what’s causing it. If your chest pain is caused by anxiety, the best course of action is to treat the underlying cause. 

### 1. Try a breathing exercise
‘Practise taking deep and slow breaths, or try a specific [breathing exercise](https://www.livi.co.uk/your-health/3-breathing-exercises-a-psychologist-recommends/), like diaphragmatic breathing,’ says Dr Saloojee. ‘Effective deep breathing can help to control your breath, reduce your heart rate and stop an anxiety attack before it gets worse.’

### 2. Use relaxation techniques
Techniques like meditation or visualising a safe place can also help calm you down. They can help reduce racing anxious thoughts, relaxing the brain and body. There are lots of apps and websites that can guide you through different meditation techniques.

### 3. Keep active
Lifestyle changes have been shown to help manage anxiety, too. Regular exercise can reduce muscle tension and release chemicals like serotonin that make you feel happier and more relaxed. 

### 4. Prioritise sleep
Getting enough[ good quality sleep](https://www.livi.co.uk/your-health/how-to-sleep-better/) can also reduce feelings of anxiety. Aim for a regular bedtime routine and 7-9 hours of sleep a night. Also try to cut down on caffeine and alcohol consumption, which can increase anxiety if consumed in excess. 

## When do I need to seek help for chest pain?

‘Chest pain shouldn’t be ignored,’ warns Dr Saloojee. ‘If you’re experiencing chest pain, it’s important to speak to your doctor, especially if it’s persistent and interfering with your daily life.

‘Even if your chest pain is anxiety related, it’s important to exclude a heart problem to ensure you get the right treatment. To do this, your doctor will take a history of your symptoms and may perform a few simple tests like a blood test or ECG.’

If your anxiety is becoming too difficult to manage by yourself, there are treatments to help. Speak to your GP who may refer you for [talking therapies](https://www.livi.co.uk/your-health/how-to-talk-about-your-mental-health-if-youre-struggling/) like cognitive behavioural therapy (CBT). There are also medications that may help manage the symptoms of anxiety.

__This article has been medically reviewed by Dr Roshaan Saloojee, a Livi GP.__


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See a GP about anxiety

Livi.co.uk > Your health > Can anxiety cause chest pain? 

Can anxiety cause chest pain? 

Anxiety can sometimes cause chest pain, which can be confused with heart problems. Learn about the link between anxiety and chest pain and the help available.

Kry.co.uk > Your health > Can anxiety cause chest pain? 

Can anxiety cause chest pain? | Kry

Kry.co.uk > Womens health hub > Banner

[Attention deficit hyperactivity disorder](https://www.livi.co.uk/medical-advice/learning-disabilities/attention-deficit-hyperactivity-disorder-adhd/) (ADHD) was previously thought to be up to [9 times more common](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3827008/#B3) in boys than girls.  [Recent research](https://link.springer.com/article/10.1007/s00787-018-1211-3) suggests that although more boys get an official diagnosis, it’s not necessarily less common in girls. 

## What is ADHD?

ADHD is a condition that affects how you behave and function. ‘It’s a neurodevelopmental condition, but it may be more helpful to think of it as a day-to-day challenge in functioning that starts in childhood,’ says Livi psychologist Jessica Almqvist. 

ADHD is a spectrum disorder, which means it can cause mild to moderate symptoms. ‘It causes you to have trouble concentrating and focusing. Many people also have problems regulating energy levels – sometimes you have lots and sometimes too little.’

## Are ADHD symptoms different for males and females? 

A common perception is that people with ADHD are hyperactive and disruptive. These symptoms, which are easy to spot, happen to be more common in young boys with ADHD.

‘Women and girls experience ADHD differently, which may explain why they often don’t get a diagnosis until later – if at all,’ says Almqvist. ‘As research accumulates, we’re seeing that many more girls, ethnic minorities and adults of both sexes have ADHD than we’ve previously assumed.’

ADHD has a lot of similar symptoms for males and females, but there can also be some key differences. 

[Symptoms of ADHD](https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd) fall into 3 categories:

- __Attention__ – having trouble concentrating
- __Activity levels__ – being hyperactive, like fidgeting or talking a lot
- __Self-control__ – acting impulsively without considering the consequences

Women and girls often experience attention-related symptoms, like being distracted and withdrawn. Men and boys are more likely to be hyperactive and impulsive.

![Screen Shot 2022-04-20 at 13.02.20](//images.ctfassets.net/h8qzhh7m9m8u/XKeMdkrhGNjcZK4N7TGfm/5075de7c4271dd1dfc072a581c9026d6/Screen_Shot_2022-04-20_at_13.04.23.png)

## Why is ADHD missed in women and girls? 

Women and girls tend to have more internalised symptoms, which are usually less disruptive than the typical symptoms in boys. 

Women and girls may also develop coping mechanisms that allow them to mask their symptoms better than boys. ‘They often get diagnosed in their teens because that’s when it starts getting hard to cover up the symptoms,’ says Almqvist. 

## How does ADHD look and feel for girls? 

The way ADHD symptoms appear on the outside and the way you feel inside might be different. Looking at both sides of the story can help us better understand the symptoms. 

### 1. Problems concentrating 

#### How it can look:
- Not listening or zoning out 
- Being indecisive
- Shyness
- Starting things but not finishing them

#### How it can feel:
- Like your head is full of thoughts or noise 
- Like some distractions are hard to tune out
- As if your social batteries are often drained 

### 2. Challenges with energy levels

#### How it can look: 
- Being unpredictable or chaotic 
- Suddenly withdrawing 
- Being restless or fidgety 

#### How it can feel:
- Not having the right amount of energy at the right time
- Getting ‘hyper-fixated’ or engrossed in one thing for hours 
- Having to hide being too energetic
- Burning out quickly 

### 3. Being impulsive

#### How it can look:
- Risky behaviour
- Bingeing on food or alcohol 
- Lack of self-control

#### How it can feel:
- Like boredom is unbearable 
- Getting strong urges you can’t control 

### 4. Low motivation

#### How it can look:
- Putting off chores or homework 
- Not caring about certain things 
- Only wanting to do ‘fun’ activities

#### How it can feel:
- Feeling stuck or overwhelmed when starting projects 
- Worrying that you’re ‘lazy’
- Having sudden bursts of motivation to ‘fix’ everything

### 5. Social challenges 

#### How it can look:
- Shyness or disinterest in friendships 
- Being argumentative or easily frustrated 
- Verbal or physical aggression

#### How it can feel:
- Like you’re different from others
- Often feeling ashamed, embarrassed or guilty
- Fearing rejection and trying to please people 
- People getting frustrated with you or feeling let down by you

### 6. Cognitive skills 

#### How it can look:
- Saying ‘I don’t know’ a lot 
- Not remembering important plans or information
- Getting frustrated with difficult tasks 

#### How it can feel:
- Getting overwhelmed by lots of information or steps
- Like you can’t trust your memory
- Falling behind even when you work hard

### 7. Anxiety or depression 

#### How it can look:
- Becoming irritated or tearful easily
- Withdrawing and isolating  

#### How it can feel:
- Feeling nervous or tense
- Getting headaches or a [pounding heart ](https://www.livi.co.uk/your-health/why-is-my-heart-racing-when-i-am-reasting-the-facts-about-heart-palpitations/)
- Not being able to sleep or sleeping too much
- Like you don’t enjoy things any more
- A sense of hopelessness

‘From the outside, many ADHD symptoms could be confused with personality traits, as well as other conditions like anxiety,’ says Almqvist. ‘Ask yourself if it’s a recent problem or if you’ve struggled since childhood. How much has it affected your relationships, work or mental health?

‘If your friends or family tell you that you’re too forgetful or don’t listen, it can hurt – but it may be a sign to seek help,’ says Jessica. ‘Sometimes other people spot patterns that we fail to see ourselves.’

## Why is it important to get an ADHD diagnosis? 

‘It’s really important to get a diagnosis for ADHD – not just so you can access support and treatment but for practical reasons,’ emphasises Almqvist. 

If ADHD isn’t diagnosed and treated properly, girls will be at risk of the same negative consequences as boys, like struggling at work or school. ‘A diagnosis can open the door to help in school or workplaces. It can take time to get a diagnosis, but it’s worth it.’ 

## What should I do if I think I have ADHD? 

Make an appointment to speak to a doctor if:

- You or your friends or family recognise the signs of ADHD in yourself
- You aren’t able to stick to routines even when you feel okay
- Your symptoms impact your daily life and you’re struggling to cope  

A doctor can help figure out what’s causing your symptoms. They might refer you to a specialist for testing or give you practical advice to help you cope. 

__This article has been medically reviewed by Jessica Almqvist, licensed psychologist at Livi.__


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Speak to a GP about ADHD

Livi.co.uk > Your health > Understanding ADHD in women and girls

Understanding ADHD in women and girls

Women and girls are less likely to be diagnosed with ADHD and often have less obvious symptoms. Read a psychologist’s advice on what signs to look for

Kry.co.uk > Your health > Understanding ADHD in women and girls

Understanding ADHD in women and girls | Kry

## What is talking therapy?

Talking therapy is a treatment that involves talking to a trained professional about your thoughts, feelings and behaviour. It provides a safe space to speak about something you’re struggling with, whether you’ve been going through a crisis or feeling low.

‘Talking therapy works differently depending on the type of treatment you choose and the challenges you’re experiencing,’ says Henrik Altréus, licensed psychologist and CBT psychotherapist at Kry. 

It might be in person, in a group, online, over the phone, with your family or with your partner.

## What can talking therapy help with?

Talking therapy can help you make sense of things and understand yourself better. It can also help you recognise unhelpful patterns in the way you think or behave and find ways to change them. 

You might consider talking therapy if you’re:

- Feeling low or depressed
- Feeling anxious
- Having panic attacks
- Feeling stressed
- [Having trouble sleeping](/your-health/how-to-sleep-better/)
- Experiencing [negative thoughts](/your-health/5-ways-to-deal-with-negative-thoughts-now/)
- Coping with difficult life events, like [grief](/your-health/a-therapists-advice-for-coping-with-grief-in-your-own-way/) over the loss of a loved one or a break-up

Talking therapy can help you cope with [health problems](https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/nhs-talking-therapies/) like diabetes, cancer, chronic pain or irritable bowel syndrome (IBS). It can also help with [phobias](/your-health/5-phobias-cbt-can-help-with/), eating disorders and addiction.

## Who is talking therapy for?

‘Talking therapy is for people who need support coping with a challenging life situation or a mental health problem,’ says Altréus. ‘It can also help support your personal development.’

Talking therapy can seem like a last resort, but you don’t have to be going through a crisis to try it. 

‘For some people, talking can be a healing process in itself,’ says Altréus. ‘Others might need a structured method and effective strategies to try.’

## What are the different types of talking therapy?

There are many different types of talking therapy. ‘For every type, language is used as the main tool to help you describe, evaluate and restructure the way you think about personal problems,’ says Altréus. 

### 1. Cognitive behavioural therapy (CBT)
CBT is one of the most well-researched types of talking therapy. It’s based on the idea that your thoughts influence your feelings and behaviours. It combines 2 types of therapy:

- __Cognitive therapy__: looking at the way you think
- __Behaviour therapy__: looking at the way you act

Often considered the most effective form of psychological therapy, CBT can help with a range of problems, including depression, anxiety and stress-related issues like insomnia. 

‘It teaches you strategies for working with your emotions, relationship problems, negative thinking patterns like self-criticism and much more,’ says Altréus. 

### 2. Psychodynamic therapy (PDT) 
PDT is about understanding how your unconscious thoughts affect your behaviours. ‘PDT is particularly useful for addressing issues related to childhood difficulties and [personality disorders](/medical-advice/mental-health/personality-disorder/),’ says Altréus. 

### 3. Interpersonal therapy (IPT)
‘IPT focuses on improving relationships with important people in your life,’ explains Altréus. It’s based on the idea that strong relationships with your family, partner or friends can support your mental health. 

### 4. Family therapy
If your family is going through a tough time, family therapy can be worth a try. ‘Family therapy helps family members or couples to deal with crises, resolve relationship problems and cope with difficult life situations,’ explains Altréus. 

## How does online talking therapy work? 

[Research](https://pubmed.ncbi.nlm.nih.gov/35070186/) shows that digital talking therapy like iCBT can be as beneficial as in-person therapy. It’s also convenient, since you don’t have to travel to an appointment. Some of us might feel more at ease if we’re at home or somewhere we feel safe. 

Digital therapy is usually done over a video call to help it feel as similar as possible to talking in person. ‘Good relationships can still be made in distance psychological therapy,’ says Altréus.

‘Digital talking therapy is suitable for mild to moderate mental health problems, such as depression, anxiety and stress.’

## How can I get talking therapy?

You don’t need to have any kind of diagnosis to try talking therapy. Speaking to a GP is a helpful first step to deciding which type of talking therapy to try.

__This article has been medically reviewed by Henrik Altréus, licensed psychologist and CBT psychotherapist at Kry.__


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Kry.co.uk > Your health > is talking therapy for me?

22GL293 organic talking-therapy 2100x1200

Talking is a powerful tool. Find out what you should know about talking therapy, including how it works, the different types and what it can help you with. 

Kry.co.uk > Your health > What is talking therapy?

Is talking therapy for me? | Kry

Is talking therapy for me?

The thought of speaking to a doctor about sensitive issues can make anyone nervous. Whether you’ve noticed unusual body odour, you want to discuss issues around sex or you’ve been feeling low, a doctor is there to help with even the most nerve-wracking symptoms.

‘Opening up can be tough, but living with an issue that’s bothering you is worse,’ says Dr Roshaan Saloojee, a Kry GP. ‘A doctor is there to listen and address any problem you may have, big or small.’ 

Remember that doctors aren’t there to pass judgement and no question is out of bounds when it comes to your health. Being honest about your symptoms or how you’re feeling will help the doctor find ways to support you – whether that’s through treatment, medication, therapy or referral to a specialist. 

Here are 8 simple tips to help you feel ready to share how you’re feeling.

## 1. Make notes in advance

Sometimes it’s easier to organise your thoughts before speaking to a doctor, especially if there are a few different things you’d like to discuss. 

Writing down your symptoms, experiences or questions before can help you remember important details you might otherwise forget during your appointment. Having notes to refer to can also help to reduce any anxiety. If you’re still feeling nervous, you can also share your notes with your doctor.

## 2. Try a digital appointment

If you’re experiencing symptoms and worried about discussing them face-to-face, you could try a digital appointment from home as a first port of call. You might find it easier to talk openly in a familiar space where you feel safe. 

## 3. Educate yourself

Some people like to read up on the topic they’re worried about before their appointment. There’s no need to know all the medical terminology, but it can help give you some useful language to describe how you’re feeling.

Searching for symptoms online can be confusing and even frightening, so stick to reputable sources like the NHS or [Kry’s medical advice hub](/medical-advice/), which is reviewed by medical experts.

## 4. Practise beforehand

If you find yourself feeling self-conscious or struggling to talk about your concerns, try practising at home or in a safe space. Often hearing your words out loud can help you feel more confident. 

## 5. Be as specific as you can 

Don’t feel like you need to know exactly what’s going on with your body or the reason why. Just being specific about the timeline and sharing details of your symptoms can help your doctor understand what’s going on. 

For example:

- ‘This past month, there have been a few times when I couldn’t control my bladder’
- ‘For the past 2 months, I’ve felt a sharp pain when having sex’
- ‘I’ve lost interest in the things that I used to find fun and I’m struggling to wake up in the morning’

The more information your doctor has, the better equipped they’ll be to help you.

## 6. Ask questions

Doctor’s appointments can be overwhelming and sometimes a doctor can present a lot of information quite quickly. Remember that it’s okay to ask questions as you need to understand your doctor’s advice.

It’s also okay to ask them to clarify any medical terms you’re not familiar with. Try repeating the information back to them to help you absorb it. 

## 7. Let the doctor know you’re feeling nervous

Sharing that you’re feeling anxious can help the doctor understand that you may need more time to speak about your concern. Simply addressing the awkwardness by getting it out in the open can help reduce those feelings. Some phrases you could try include:

- ‘This is embarrassing/difficult for me to speak about’
- ‘I haven’t spoken to anyone about this before’
- ‘I’m feeling nervous – bear with me while I explain’ 

## 8. Remember the appointment is completely confidential

‘We respect our patient’s privacy, and the consultation room – whether digital or in-person – is a place where you can share your problem with the confidence that it will be kept confidential,’ says Dr Saloojee. ‘Our job is to put you at ease and make it a comfortable environment for you to discuss your health problems.’ 

## How do I know when to speak to a doctor?

If you have any symptoms that you’re worried about, it’s usually best to address them with a doctor as soon as possible. Some health issues that are important to address as soon as symptoms appear include:

- Digestive or[ poo-related issues](/your-health/10-things-your-poo-can-tell-you-about-your-health/)
- Mental health issues, such as [depression](/medical-advice/mental-health/depression/), [grief](/your-health/a-therapists-advice-for-coping-with-grief-in-your-own-way/) and [anxiety](/your-health/need-help-for-anxiety-here-are-your-questions-answered/)
- [Lumps](/your-health/when-to-worry-about-lump-under-skin/) or rashes around your bottom, breasts, groin or vagina
- [Lack of bladder control](/your-health/urinary-incontinence-a-guide-to-coping-with-a-leaky-bladder/)
- Symptoms of sexually transmitted infections (STIs)
- Sexual dysfunction like [premature ejaculation](/your-health/erection-problems-a-doctors-guide-to-getting-help/) or [erectile dysfunction ](/your-health/erection-problems-a-doctors-guide-to-getting-help/)
- Perimenopausal or menopausal symptoms 
- Losing hair
- Body odours, excessive sweating or bad breath

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


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Kry.co.uk > Your health > 8 tips for talking about uncomfortable topics at a doctor’s appointment

22GL288 uncomfortable topics 1600x900

Worried about discussing sensitive issues with a doctor? Read our guide on how to prepare for your doctor’s appointment and tackle any awkwardness

How to talk about uncomfortable topics during a doctor’s appointment | Kry

8 tips for talking about uncomfortable topics with a doctor 

Ever noticed how your flow changes colours throughout your period? Paying attention to the colour of your period blood can reveal a lot about your overall health and where you are in your [menstrual cycle](/your-health/your-menstrual-cycle-explained/).

Getting to know what’s normal (and what’s not) for your cycle is essential. It means you can identify any changes – like colours you don’t recognise, the duration of your period or unexplained spotting – and seek medical advice if necessary. 

## Why does period blood change in colour?

It’s completely normal for your menstrual blood to change colour during your period or even from month to month. The amount of blood you lose varies (like most aspects of your monthly cycle), but it’s usually about [2-3 tablespoons](https://www.cdc.gov/ncbddd/blooddisorders/women/menorrhagia.html) throughout your whole period. 

The colour of your menstrual blood can vary from bright red to dark brown or even black. The colour changes depending on how long the blood takes to leave your body,’ says Dr Rosén. 

![2100x3067 Chart PeriodBlood](//images.ctfassets.net/h8qzhh7m9m8u/3LmKosel5vNtv2E2CCYXdu/7f5eb46f14108a816c065b6197a3244c/2100x3067_Chart_PeriodBlood.png)

## What do different period colours mean? 

### 1. Bright red
Your blood will usually be bright red on the heaviest days of your period when you have a steady flow of fresh blood. It’s often brighter in colour because it passes out of your body at a faster rate – meaning it has little time to oxidise and go darker. 

‘Some people experience bright-red blood throughout their period, but in most cases, the blood will go from a bright red to a darker colour,’ says Dr Rosén. 

#### Heavy periods 
Blood clots usually occur during the heaviest days of your menstrual flow and are bright or dark red. ‘Blood clots are due to heavy bleeding, where the blood flow is faster and heavier than the body can process, leading to the formation of clots,’ Dr Rosén explains.

‘Menstrual clots are normal – but they can also be a sign that you have heavy periods (menorrhagia).’

You should see a doctor if: 

- Your periods are always heavy
- You feel dizzy, tired or short of breath during your period 
- You have stomach pains accompanied by heavy bleeding
- Your period lasts more than 7 days
- You need to change your tampon or pad every 1 or 2 hours
- Your blood clots are larger than 2.5cm (about the size of a 10p coin)

### 2. Dark red 
Dark red blood is very common, especially first thing in the morning. This is because after you’ve been lying down for a while, the blood has oxidised inside your uterus before coming out. 

Other possible reasons for dark red period blood include: 

#### Nearing the end of your cycle 
You may also notice dark red blood at the end of your period (or at the very beginning) when the blood is moving at a slower pace and has more time to oxidise. 

#### Postpartum bleeding 
After childbirth, your [vaginal discharge](/your-health/is-my-vaginal-discharge-healthy-a-doctors-guide/) (also called lochia) will be a dark red colour. ‘Lochia behaves just like menstrual bleeding – immediately after birth, when the bleeding is at its heaviest, it’s usually bright red and then becomes darker as the flow decreases,’ Dr Rosén says.

If you’re breastfeeding, the bleeding may be redder and heavier due to hormones causing your uterus to contract.

### 3. Dark brown or black
Dark brown or black blood is just older blood. Like with dark red blood, you may see brown or black blood at the very beginning or end of your cycle when blood is taking longer to leave your body.

Brown discharge or spotting during pregnancy can indicate a miscarriage or an ectopic pregnancy, which is when the fertilised egg implants itself outside the uterus, usually in one of the fallopian tubes.
If you’re bleeding heavily and you’re in a lot of pain, it’s important to speak to a midwife or doctor immediately for further investigation.

### 4. Light pink
Pink blood is likely due to your cervical fluid mixing with your period blood and lightening the colour – you may notice this on days when your flow is light, like at the end of your period. 

Other possible reasons for pink blood include: 

#### Anaemia 
Anaemia, a condition caused by low iron levels, can also cause pink period blood. ‘Iron is what gives the blood its red colour, and blood may become lighter if iron is low,’ explains Dr Rosén. 

#### Spotting 
‘Light blood loss either during or in between periods is called spotting. While this can be any colour, it can sometimes be light-pink due to the lighter nature of the bleeding’ explains Dr Rosén. 

Several factors can cause spotting, including:

- Ovulation 
- A tear to the vaginal wall during sex
- Sexually transmitted infections, like chlamydia
- Hormonal contraceptives
- [Polycystic ovary syndrome (PCOS)](/your-health/severe-period-pain-endometriosis-or-pcos-how-can-you-tell-the-difference/)
- [Fibroids](/medical-advice/gynaecology/fibroids/) or polyps (non-cancerous growths in the womb)
- Cancers of the cervix, uterus, vulva or vagina

If you experience any spotting between periods, speak to a doctor. 

#### Low oestrogen
Pink vaginal discharge could also signal low oestrogen levels – and it could be a sign of [perimenopause](/your-health/7-signs-of-perimenopause-a-doctors-guide/). ‘Low oestrogen levels may lead to pink discharge at different points of your cycle, and not necessarily when you'd expect a period,’ explains Dr Rosén. 

‘Oestrogen helps to stabilise the uterine lining. If there’s not enough oestrogen, the lining may break down and shed irregularly, leading to spotting.’ 

### 5. Orange

Orange menstrual fluid may be a result of your menstrual blood mixing with cervical fluid. 

‘Orange period blood or discharge may also be a sign of an infection, like [bacterial vaginosis](/medical-advice/womens-health/bacterial-vaginosis/). Or a sexually transmitted infection, such as trichomoniasis, which is caused by a parasite,’ says Dr Rosén.

‘If you have orange blood, check for other symptoms of an infection, like vaginal itching, an unusual smell or discomfort.’

### 6. Grey

Grey period blood is usually a sign of an infection, like bacterial vaginosis. ‘It may be harder to identify this blood colour, so I would recommend you look out for other signs of infection, such as a foul-smelling vaginal odour, a burning sensation when you pee and itching in and around the vagina.’

Bacterial vaginosis is usually treated with antibiotics, so it’s important you speak to a doctor. 

If you have grey discharge accompanied by blood clots or tissue, there’s a possibility that you’re having a miscarriage. You may experience other symptoms of [miscarriage](https://www.nhs.uk/conditions/miscarriage/symptoms/), including cramping and pain in your lower tummy. 

## When should I see a doctor about my period blood colour? 

If you’re worried about any unusual discharge, it’s always good to see a doctor. As well as the colour of your period blood, watch out for changes in the length, texture, heaviness and consistency of your flow. 

You should make an appointment with a doctor if:

- You experience new or unusual discharge 
- You have irregular periods that change in length and heaviness from one month to the next
- You experience bleeding after menopause
- You miss 3 or more periods
- You experience thick grey vaginal discharge 
- You have itching in or around the vagina 
- You have a fever with an unusual discharge 

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


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What does your period blood colour mean? 

## Quick facts

- Omega-3 oils (found in oily fish like salmon and mackerel) could have anti-inflammatory effects on joints
- Eating a Mediterranean-style diet — rich in oily fish, wholegrains and vegetables — can also be helpful.
- Regular exercise is considered the most effective, non-drug treatment for reducing osteoarthritis pain

When the temperature drops, many peoples find that their hands, knees, feet, back hips can feel stiff, tender, sore or ‘creaky’. For those with osteoarthritis – the most common form of arthritis – joints can also feel painful and inflamed.

## What is arthritis?

There are two types of arthritis — osteoarthritis, which is more common and usually age-related, and rheumatoid arthritis which can affect people of any age.

‘Osteoarthritis is often referred to as the “wear and tear” arthritis,’ says Dr Rhianna McClymont, Lead GP at Kry. ‘It’s caused by the protective cartilage inside joints, which acts as a ‘shock absorber’, becoming damaged and wearing down. This causes pain and sweling, which is normally most severe when moving the joint.’

Rheumatoid arthritis (RA) on the other hand, is an auto-immune condition in which the immune system starts to attack the joints. Although it’s far less common, RA can affect anyone, including the very young, and the earlier you seek medical help for it, the better the outcome. RA causes prolonged pain in the joints, including stiffness and swelling. It commonly affects the small joints of the fingers and toes, the wrists, elbows, shoulders and knees and the neck and jaw.

## How is arthritis diagnosed?

If you have pain that gets worse the more you use your joints, a stiffness that’s not there in the mornings, or any of the symptoms above, talk to a doctor.

## Here’s what can help winter arthritis pain:

### 1. Maintain a healthy weight

‘If you are obese, and therefore carrying extra weight, that puts extra strain on the joints and can exacerbate osteoarthritis,’ says Dr McClymont. ‘Regular exercise and a healthy diet plan to maintain a healthy weight and BMI are ideal.’

There’s strong evidence that losing weight can improve your overall health and physical function and this applies to those with osteoarthritis. Losing just 10% of your weight — if you are overweight or obese — can lead to significant improvement in symptoms of osteoporosis and pain relief.

A Kry doctor can help you with a plan toward achieving a healthy weight.

### 2. Eat a joint-friendly diet

Experts recommend that those with osteoarthritis aim to eat at least 1 portion of oily fish, like salmon or mackerel a week. The omega-3 oils found within the fish have anti-inflammatory properties that may help those suffering with this condition.

[A Mediterranean-style diet](/medical-advice/infections/) that includes healthy oils, nuts and wholegrains may also help. One study found that patients with osteoarthritis had a significant reduction in pain after switching to a wholefoods, plant-based diet. Patients in the study also lost weight without counting calories or limiting portion.

### 3. Cut down on pro-inflammatory foods

Some foods are believed to be pro-inflammatory for joints, which means they could make symptoms worse. These include omega-6 polyunsaturated fats found in corn, sunflower and safflower oils, as well as saturated fats found in animal pruducts. It may be helpful to remove as much fat from meat as possible before you cook and replace omega-6 fats with oils and spreads rich in mono-unsaturated fats like rapeseed and olive oils.

### 4. prioritise exercise

Research shows that people with osteoarthritis can benefit from exercise, though they may be concerned about their pain getting worse. In fact, exercise is considered the most effective, non-drug treatment for reducing pain and improving movement for patients with osteoarthritis. Brisk walking, swimming, jogging, yoga and strength-training are all beneficial. The weekly recommendation for aerobic exercise is 150 minutes of moderate intensity or 75 minutes of vigorous intensity exercise a week.

### 5. Keep your joints warm

‘Keeping joints warm may help alleviate pain as warmth relaxes muscles and reduces stiffness,’ says Dr Clymont.

Warm showers and baths, heating pads, electric blankets and covering joints with gloves or even wrapping hands around hot drinks can all help with keeping your pain at bay in winter.

### 6. Talk to a doctor about your pain

It’s important to have a dialogue going with a doctor about how your arthritis is affected and your pain levels.

There are different pain-relief medicines you can take for osteoarthritis, depending on the severity of the condition and other health concerns.


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Dr Rhianna McClymont

Lead GP at Kry

7 ways to help arthritis pain in winter

Staring at the ceiling, tossing and turning in bed or randomly wide awake at 3am? Having trouble sleeping is common. A global sleep review found that [up to one-third](https://www.nature.com/articles/s41562-020-00965-x.epdf) of us struggle to get the recommended 7 hours of sleep each night. 

The pandemic has also impacted our sleep, with [recent research](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744844/) showing that the majority of us are getting poorer quality sleep than before Covid-19.

So, what can we do to sleep better? 

## Why is sleep so important?

‘Good sleep is essential for your body and mind to function properly,’ says Dr Saloojee. ‘It’s as important as regular exercise and a healthy diet. Sleep helps us to feel alert and refreshed and can help us[ maintain a healthy weight](/your-health/5-things-you-need-to-know-about-sustainable-and-healthy-weight-loss-according-to-a-doctor/) and stave off diseases. 

‘In contrast, poor sleep has negative effects on the body and can lead to reduced concentration, weight gain and an increased risk of problems such as heart disease, obesity and diabetes. Chronic sleep problems can also negatively impact our mood and mental health.’ 

[Trouble sleeping](/your-health/5-sleep-problems-to-discuss-with-a-doctor/) is linked to a wide range of factors, from mental health problems like depression to shift work and [stress](/your-health/3-ways-stress-can-disturb-your-sleep/). 

This is why it’s important to explore the particular reasons for your own sleep problems – especially if it lasts more than a couple of months.

## How much sleep do I need?

‘Most adults need between 7-9 hours of sleep at night to function optimally,’ says Dr Saloojee. ‘Children need even more.’

Getting a good night’s sleep is vital, so it’s worth taking seriously and prioritising your sleep as much as you can.

## What are some common sleep problems?

- Difficulty falling asleep
- Waking up at night and having trouble falling back asleep
- Waking up early in the morning

[Sleep problems](/your-health/5-sleep-problems-to-discuss-with-a-doctor/) can also include night terrors, nightmares and walking or talking in your sleep. All these things can also disrupt the quality of your sleep.

Sleeping poorly and[ being tired](/your-health/why-am-i-always-tired/) during the day can sometimes make us feel anxious around bedtime, which, in turn, can make it even harder to fall asleep. This can create a negative spiral where you associate sleep with stress rather than rest.

If this is the case for you, it’s important to work on reducing your stress levels – either with self-care or by speaking to a doctor or therapist.

## What is deep sleep and how do I get more of it?

‘When we fall asleep, our bodies follow a sleep cycle that is divided into 4 stages,’ says Dr Saloojee. ‘Deep sleep is known as the most physically restorative stage of sleep.’ 

‘The first 3 stages are all called non-rapid eye movement (NREM) sleep and the fourth stage is called rapid eye movement (REM) sleep.’

![Sleeopcycle table](//images.ctfassets.net/h8qzhh7m9m8u/jMrYx0959I0CCMJdg0PeM/a8787c14f4130cb44c8b9144144a86bc/Sleeopcycle_table.png)

### Stage 1 NREM – lightest sleep
This is when your body is beginning to relax and you’re falling asleep. You might experience slow, rolling eye movements, sudden jerks or muscle spasms. At this stage, you can wake up easily

### Stage 2 NREM – light sleep
This stage is a period of light sleep before you enter deeper sleep. Your heartbeat slows and your body temperature begins to drop. Stage 2 usually lasts the longest of the 4 stages.

### Stage 3 NREM – deep sleep
Stage 3 is the period of deep, restorative sleep that helps you feel more refreshed the next day. Your heartbeat and breathing are at their lowest rate. It’s much harder for you to be woken up at this time.

### Stage 4 REM – deepest sleep
The last stage is REM sleep, the deepest stage of sleep. It first happens about 90 minutes after you’ve fallen asleep. Your eyes move rapidly from side to side behind your eyelids, your heart rate increases and your brain becomes more active. This is when most of your dreaming occurs.

Each sleep cycle lasts 90-120 minutes and will repeat several times during the night until you wake up. NREM usually makes up 80% of each cycle. 

‘Having good sleep hygiene – or a regular sleep routine – can help improve the quality of your sleep and increase the deeper NREM sleep that helps you feel refreshed the next day,’ says Dr Saloojee.

## How can I sleep better?

Dr Saloojee recommends these tips for a good bedtime routine and getting better, deeper sleep:

### During the day 

- __Keep your sleep routine as consistent as possible__
Our internal body clock regulates our sleep cycle, controlling when we feel tired or alert. The clock operates on a 24-hour cycle, known as the circadian rhythm. 

Keeping a consistent sleep and wake time, even on weekends, will help keep your circadian rhythm on track. 

- __Spend time outdoors__
Getting some sun (or artificial bright light) during the day helps keep our circadian rhythm healthy. Research has shown that daily light exposure increases sleep quality and duration at night, too.

### During the evening

- __Be mindful of caffeine__
Try to avoid caffeine in the late afternoon and evening. Caffeine stimulates your nervous system and keeps you alert, which you don’t want at night. Caffeine levels in your body can remain elevated for 6-8 hours and can significantly impact your sleep quality.

- __Watch your [alcohol intake](/your-health/what-does-alcohol-do-to-your-body/)__
Drinking can also negatively affect your sleep. [Research](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751071/) has shown that while alcohol can make you sleepy at first, it may interrupt your sleep later at night and in the early morning. Drinking has also been linked to [snoring](/your-health/how-to-stop-snoring/).

- __Turn down the lights__
Avoid too much light – including blue light from your TV, phone and laptop – in the evening as this can trick your circadian rhythm into thinking it’s still daytime. This in turn reduces hormones like melatonin, which helps you relax and sleep well. 

- __Wind down before bedtime__
Relaxing in the evening will help to lower your stress levels and potentially prevent a racing mind before bed. Take a bath or shower, read a book, listen to music, try meditation or do some [breathing relaxation](/your-health/3-breathing-exercises-a-psychologist-recommends/) techniques.

### Just before bed
- __Increase your chance of uninterrupted sleep__
If you live with a snorer or know the daylight wakes you early, small changes can make a big difference. Make sure your bedroom is dark and quiet – use thick curtains, blinds or an eye mask and earplugs. 

### When you wake up
- __Keep a sleep diary__
Make a note of when you sleep badly and when you sleep well. This will help you identify potential triggers or factors and will be useful if you talk to a doctor.

## What if my sleeplessness is becoming a long-term problem?

If you’re regularly having problems sleeping, you may have insomnia. 

Speak to a doctor if:

- You’ve already tried some simple lifestyle solutions 
- Your insomnia has lasted a few months or more
- Your sleeping problems are making it hard to cope with your daily life

A doctor will be able to help identify and advise on the possible causes of your insomnia and give guidance on good sleep hygiene. They may refer you for talking therapy like cognitive behavioural therapy (CBT), which may help uncover the underlying reasons you’re having trouble sleeping.  

In rare situations, a doctor may prescribe medication. In the case of chronic sleep disorders, you may be referred for an investigation in a sleep laboratory. This might include an in-depth analysis and monitoring of your sleep.

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


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 How to sleep better 

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Everyday mental wellbeing

As the invasion of Ukraine continues, we’re exposed to even more upsetting images. Children may be feeling worried and asking tricky questions about the war. To help you respond and offer them reassurance, here’s some specialist advice from a child psychologist.*

A child who has previously been exposed to war is likely to feel differently to a child without that experience. All we can do as adults is do our best to give the child the level of reassurance they need. But don’t assume that your child feels scared just because you do. 

## How do I talk to my child about what’s happening in Ukraine?
‘Children come from different backgrounds and see the world from different perspectives. This will determine how worried the child will be about the current situation,’ explains Martin Forster, child psychologist at Kry.

‘It’s usually best to let your child ask questions, rather than you reporting the facts to them. Asking your child what they already know is a good place to start,’ he says. 

Have they discussed the conflict in school? Have they heard things from their friends or seen something on social media? What are your child’s thoughts about all this? 
If you – the child’s parent/guardian – are feeling extremely anxious about the situation, it may be a good idea to let another adult talk to the child, as anxiety can spread easily.

## What else can help with my child who’s worrying?
It can help to stay up-to-date with information from the government. But remember it’s fine to have a break from the news and not know all the answers. If your child asks a difficult question that you can’t answer, be honest and promise to find out.

‘Obviously, it’s a bad idea to show or tell young children very frightening things,’ Martin says. ‘But it’s also important to answer your child’s questions honestly, rather than try to convince them that everything’s fine. This may make them feel that you’re not taking their fears seriously. Your child may even suspect that you’re trying to hide the truth, which might make them feel even more scared.

You could suggest watching CBBC Newsround with them, as this is news content especially made for children. And could help dispel any fake news they have seen on social media. You should assure your child that not everything they read on social media is true. And ask them to come to you instead if they have any questions.

## What’s the best way to reassure my child?
It’s always worth reiterating the importance of honesty. Give straight and simple answers to your child’s questions, and validate their concerns – for example, it’s completely okay to feel worried, and you’re also very disappointed and scared by the conflict.

But it’s not always helpful to talk in depth about the situation. Some children may be overwhelmed by anxiety and ask question after question, hoping to feel calmer. In these cases, it may be better to not talk about the war at all, as each answer only relieves the child’s anxiety temporarily. 

If you have a child who’s very scared by what’s happening, it may be a good idea to take a break from the news altogether. Suggest some fun activities, restrict your family’s use of social media, and don’t keep the radio or TV on in the background.

‘Many children are wondering if the war might spread to their country. Young children may find it very difficult to assess risks, so it’s usually better to reply with something like: no, Russia isn’t interested in our country,’ suggests Martin.

‘Or for older children you could say – that while the risk may be small, our military leaders always need to be ready to defend our country because that’s their job.’

__This article has been medically reviewed by Martin Forster, child psychologist at Kry.__


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