kry.co.uk > Your health

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

kry.co.uk > Your health > Metainfo

Your health | KRY

Finding a new lump on your body can be worrying, and it’s easy to let your mind jump to the worst possible outcome. But not every lump is a cause for alarm – most are harmless and can be left alone. 

‘Most lumps are usually nothing to worry about,’ says Dr Roshaan Saloojee, a Kry GP. ‘But sometimes a lump may need treatment or immediate care. You should see a GP if you have concerns about a lump or if it persists for more than 2 weeks.’ 

## Why it’s important to check your body regularly 

‘It’s important to be familiar with your body and examine yourself regularly, so you can spot any new changes or lumps quickly and get advice from a doctor if needed,’ explains Dr Saloojee.

Get into the habit of self-examining your armpits and breasts or testicles and get to know what is and isn’t ‘normal’ for you.’

## What’s the difference between a benign and a cancerous lump? 

Lumps that are benign (non-cancerous) and usually nothing to worry about generally: 

- Are soft
- Are located in the superficial or fat layer of skin 
- Move around when touched 

‘There are some features that make a lump particularly concerning,’ says Dr Saloojee.

Lumps that need checking by a doctor generally:

- Are hard and may be painless
- Don’t move and are fixed to the skin or tissue
- Get larger

## What are the most common causes of a lump?

Lumps and swellings can appear anywhere on your body. Some lumps are specific to one place, while others can occur in many different parts of the body. Common examples include:

- [__Lipoma__](/medical-advice/skin-conditions/lipoma/) – a benign fatty lump that feels smooth, soft and squashy to touch. 
- __Skin tag__ – a small, soft, fleshy growth on the skin. 
- __Cyst__ – a fluid-filled lump under the surface of the skin that moves when you touch it. 
- __Skin abscess__ – a hard, painful lump that may be red and hot to the touch. ‘Skin abscesses usually contain pus and are a sign of infection,’ says Dr Saloojee

## What are the most common places to find a lump?

### 1. Breasts 

It’s important to remember that breast lumps are common in men and women and most aren’t caused by breast cancer. It may be that you’ve got a fibroadenoma – a benign breast lump, which consists of fibrous tissue and glandular tissue. 

It could also be a cyst. ‘Breast cysts are common breast lumps that develop naturally as the breast changes with age due to changes in hormone levels,’ says Dr Saloojee.

__What to watch for__
‘Fibroadenomas are smooth lumps, which can move easily under the skin when pressed,’ says Dr Saloojee. People who have fibrocystic breasts may find it hard to notice a new breast lump. 

‘Breast cysts can feel soft or hard and can vary in size. They’re usually oval or round and can develop quickly anywhere in the breast. Occasionally they can feel uncomfortable and even painful.’

[Breast cancer](/medical-advice/womens-health/breast-cancer/) lumps are often hard and painless (although some may be painful), irregularly shaped and different from your surrounding breast tissue. 

__How often to check__
Get into the habit of [checking your breasts once a month](/your-health/are-you-checking-your-breasts-correctly-a-doctors-guide/) to familiarise yourself with how they normally look and feel.

__When to see a doctor__
Any breast lump should be examined by a doctor. 

### 2. Neck and armpits 

The most common cause of lumps in the neck or armpit are swollen glands (or lymph nodes) known as lymphadenopathy. Swollen glands are often caused by mild infections like [colds](/medical-advice/infections/common-cold/), [sore throats](/medical-advice/infections/sore-throat/) and tonsillitis. Less commonly, glands may swell due to a condition, including rheumatoid arthritis or cancer. 

‘Other neck lumps include a thyroid goitre, which is an abnormal swelling of the thyroid gland,’ explains Dr Saloojee. 

__What to watch for__
Swollen glands feel like tender, painful lumps on either side of the neck, under the jaw or armpit. More serious conditions may cause the glands to become very hard and painless.

A goitre gives you a lump at the front of your neck. ‘The size of a goitre can vary and may move up and down when you swallow,’ says Dr Saloojee.

__How often to check__
Check your neck and armpits around once a month. It’s worth checking them at the same time you do a breast check. 

__When to see a doctor__
Swollen glands usually resolve by themselves within 2 weeks. If they last longer, you should speak to a GP. A doctor can also check whether your thyroid gland is swollen if you think you may have a goitre. 

### 3. Testicles 

‘Lumps and swellings in the testicles can have different causes,’ says Dr Saloojee. ‘They can be harmless lumps, such as fluid-filled cysts or swollen veins called varicoceles. But sometimes they’re a sign of a serious problem such as testicular cancer.’

__What to watch for__
Your testicles should feel firm but not hard, and smooth, without any bumps or lumps. 

Early [signs of testicular cancer](/your-health/testicular-cancer-how-to-spot-the-signs/) may include:

- A hard lump in the testicle
- An enlargement or swelling of the testicle
- A testicle that feels more firm than usual

__How often to check__
It’s a good idea to check your testicles every month, so you’re familiar with their normal shape and size. 

__When to see a doctor__
If you notice any lumps, swellings or other changes, it’s important to get checked by a doctor.

### 4. Groin 

Common causes of a lump in the groin area include swollen glands, an enlarged vein known as a saphena varix, and [sexually transmitted infections](/your-health/10-common-stis-and-their-treaments/) like genital warts. 

‘Hernias can also occur in the groin area. These are lumps caused by internal parts of the body pushing through a weakness in the muscle or tissue wall,’ explains Dr Saloojee. 

__What to watch for__
‘A hernia lump can often be pushed back in or disappears when you lie down. Coughing or straining may also make the lump appear. Occasionally, they can become painful,’ explains Dr Saloojee. 

__How often to check__
It’s worth [checking the lymph nodes](https://www.bad.org.uk/shared/get-file.ashx?id=219&itemtype=document) in your groin once a month. This can be done at the same time as you check other areas of your skin for new lumps and bumps.

__When to see a doctor__
If you have a lump in the groin area, make an appointment with a doctor to check if it’s a hernia.

### 5. Hands and wrists

‘Ganglion cysts are benign lumps that develop along the tendons or joints of your wrists or hands. They can happen in people who have osteoarthritis or who’ve had previous joint or tendon injuries,’ says Dr Saloojee. 

__What to watch for__
‘Ganglion cysts are round or oval and are filled with a jelly-like fluid. They can feel like a small, firm water balloon but are usually compressible,’ explains Dr Saloojee.

__How often to check__
No need to check for this one, as you’ll likely notice when it appears. 

__When to see a doctor__
‘If you notice an unusual lump on your hand, which may or may not cause pain or affect the way you use your hand, you should get it checked out by a GP,’ says Dr Saloojee. 

### 6. Bottom 

A lump around or inside your bottom may be due to [piles (haemorrhoids)](/medical-advice/digestive-problems/piles/). The veins in your bottom can become stretched under pressure, causing them to bulge and swell, creating small, round lumps. This may be caused by straining during bowel movements, constipation or diarrhoea, pregnancy and heavy lifting. 

‘A lump may also be caused by a rectal prolapse, where part of the tissue inside the bottom protrudes out of the anus,’ says Dr Saloojee.

__What to watch for__
Piles inside and around your bottom may cause itching, pain and bright red blood after you poo. 

__How often to check__
You’re likely to notice piles or a rectal prolapse when you go to the toilet or shower, so there’s no need to routinely check. 

__When to see a doctor__
‘Any lump in and around the bottom should be examined by a doctor to exclude anything more serious,’ says Dr Saloojee. 

## When should I get a lump checked?

‘If you’re worried about a lump, or it’s been there for more than 2 weeks, speak to a doctor to get it checked out as soon as possible,’ says Dr Saloojee. 

‘Regularly examining your body is vital because spotting any new lumps quickly can be an important way to catch anything serious early.’

Always see a doctor if you have a lump that: 

- Is growing in size
- Is painful, red or hot
- Is hard and fixed
- Grows back after being removed

‘A doctor will take a history of your symptoms and examine the lump. They may be able to tell you what’s causing it straight away and provide treatment,’ says Dr Saloojee.

‘If there’s uncertainty about the cause or diagnosis, a doctor may refer you for an ultrasound scan to assess the lump or for a biopsy where a small sample of the lump is removed and tested. 

‘For more concerning lumps, a doctor may refer you to a specialist for further investigations.’ 

__This article has been medically approved by Dr Roshaan Saloojee, a Kry GP__

See a GP about a lump under your skin

kry.co.uk > When to worry about a lump under your skin

When to worry about a lump under skin

Lumps are common and can appear anywhere under the skin. But how do you know when to get one checked?

When to worry about a lump under your skin

When to worry about a lump under skin | Kry

General health

General health and seasonal

A key part of any healthy diet is balance – but most of us eat too much sugar. And it’s hard not to because sugar is everywhere, hidden in the foods we eat every day.

According to the World Health Organization (WHO), added sugars should make up no more than 10% of our daily food intake, and reducing this to 5% has significant health benefits.

## What does too much sugar do to your body?

Sugar is found naturally in foods like milk, fruit and vegetables. But this type of sugar isn’t the problem. It’s consuming too many ‘free sugars’ that can cause health issues. Many products that seem relatively healthy, like sauces, soups and yoghurts contain a high amount of added sugars.

Latest research shows that a diet high in added sugars is linked to chronic diseases including obesity, [cardiovascular disease](/medical-advice/cardiovascular-disease/), diabetes and non-alcoholic fatty liver disease. 

## What should my daily sugar intake be?

This is the recommended daily sugar allowance, according to NHS guidance:

- Adults should have no more than 30g of added sugars a day (about 7 sugar cubes)
- Children aged 7-10 should have no more than 24g of added sugars a day (6 sugar cubes)
- Children aged 4-6 should have no more than 19g of added sugars a day (5 sugar cubes)
- There are no guideline limits for children under the age of 4, but it’s recommended that they avoid drinks and food with added sugars

## Reasons to cut down your daily sugar intake

Although there are a number of factors that contribute to poor health, high sugar consumption plays a big part. These are some of the biggest health incentives to eat less sugar.

### Helps prevents obesity and diabetes

When you eat sugar, your body releases insulin, a hormone made by the pancreas that your body uses to process sugar. This leads to a rapid increase in blood glucose. 

When this process is frequent and habitual, it can lead to insulin resistance, which increases your risk of type 2 diabetes. This process can also lead to an [unhealthy BMI](/medical-advice/bmi-calculator/) and weight gain around the abdomen (visceral fat). Weight around the middle is associated with an increased risk of illnesses like heart disease. 

### Protects against chronic inflammation

Sugar stimulates the production of fatty acids in the liver that may lead to inflammation.

Acute inflammation is part of the body’s natural defence mechanism against sickness or injury. Common signs include swelling, pain or a rash. But chronic (slow, long-term) inflammation is when this process continues inside the body. And this leads to a higher risk of cardiovascular disease, [dementia](/medical-advice/neurological-disorders/dementia/), [allergies](/medical-advice/allergies/) and arthritis. 

Reducing your sugar intake lowers your body’s chances of developing this type of inflammation and improving your chances of better long-term health. 

### Helps keep your skin clearer

The inflammation and insulin resistance that can be caused from eating too much sugar can also have an adverse effect on our skin. 

As too much insulin can lead to the production of androgens (male hormones), your skin then produces more sebum (oil), which can trigger a [flare up of acne](/medical-advice/skin-conditions/acne/).

### Improves your mood

While a sweet treat can give you an instant mood boost when you’re feeling low, eating too much sugar can affect your mood in the long-term.

In fact, [research by the British Medical Journal](https://www.bmj.com/content/369/bmj.m2382) shows that a diet high in sugar and processed foods can increase the risk of [depression](/medical-advice/mental-health/depression/). 

By swapping sugary snacks for more wholefoods and complex carbohydrates, you’re giving your body a more sustainable kind of energy. That means fewer cravings, or highs and lows throughout the day.

### Looks after your teeth

Eating too many sugar-rich foods can cause serious tooth decay, especially in children. Tooth decay is now the number one reason for hospital admissions among young children.

While brushing your teeth reduces the impact of dental decay, reducing sugar is a far more effective way of preventing tooth decay.

## How to cut down on sugar effectively in 5 steps

Taking the following steps might seem tricky. But remember, you don’t have to do them all at once. If it feels like too much, start with 1 or 2 of the following steps to gradually reduce your daily sugar intake.

### 1. Get to know food labels

- High sugar foods contain more than 22.5g of total sugars per 100g

- Low sugar foods contain 5g or less of total sugars per 100g

- Look out for hidden added sugars in pasta sauces, salad dressings, ready meals, yoghurts, takeaways, pizzas, savoury sauces and soups  

### 2. Look out for sneaky sugar names

Many food labels list added sugars in different names – but they still have the same effects.

- Cane juice, cane sugar or cane crystals
- Honey
- Dextrose or dextrin
- Fructose or fruit juice concentrate
- Glucose
- Sucrose
- Sugar (palm, raw, beet, brown, invert)
- Syrup (corn, maple, rice, barley, malt)
- Treacle
- Xylose

### 3. Try simple sugar swaps

- Instead of sugar-sweetened, fizzy drinks, opt for water with a squeeze of lemon or lime, or try adding sliced cucumber or strawberries for flavour
- Swap sugary cereal for a bowl of unsweetened porridge oats with a handful of berries
- If you usually eat flavoured yoghurt, plain Greek yoghurt with added fresh fruit is a great alternative 

### 4. Regulate your blood sugar

- Eating small amounts regularly can help [keep your blood sugar levels stable](/your-health/what-you-need-to-know-about-blood-sugar/)
- Choose complex carbohydrates (over refined ones) like brown rice, wholemeal or sourdough bread, quinoa and wholewheat pasta
- Include some protein with every meal, like lean meat, fish, eggs, tofu, chickpeas or lentils

### 5. Choose healthier snacks

- Have healthy snack foods ready for when you get hungry between meals so you’re not reaching for chocolate or sweets. Here are a few suggestions:
- Raw vegetable crudités with hummus
- A handful of berries
- Slices of apple with a teaspoon of nut butter
- 2 oatcakes with hummus or nut butter
- Plain yoghurt with berries, nuts and seeds

## Did you know?

- A 500ml bottle of Coca-Cola contains 13.4 teaspoons of sugar
- A typical 45g chocolate bar contains around 6 teaspoons of sugar  
- One glass of medium white wine contains nearly 2 teaspoons of sugar
- 100ml of sweetened fruit juice contains around 2.5 teaspoons of sugar
- An average sized fruit yoghurt contains over 4 teaspoons of sugar


Speak to a GP about your daily sugar intake

How much sugar should I have each day?

How much sugar should you have per day?

The benefits of cutting down on sugar, and doctor-approved recommendations to help you reduce your daily sugar intake

How much sugar should you have each day? | Kry

Every year, hundreds of people are rushed to hospital after a choking incident, and hundreds more of these will be fatal. The elderly, young children and babies are particularly vulnerable.
‘Food such as grapes and nuts are common things to choke on – or anything else that’s not cut into small pieces,’ says Dr Rhianna McClymont, Lead GP at Kry. ‘Small toy parts, batteries and balloons are examples of other choking hazards for children too.’
‘Choking can be a life threatening situation, but the best thing to do is stay calm, act quickly and follow the recommended first aid advice,’ Dr McClymont explains.

## How should I help someone who’s choking?

A baby, child or adult will start choking and won’t be able to breathe if their airway becomes blocked, either fully or partly. The following advice is the same for adults and children (over 1 years old).

First of all, if their airway is only partly blocked, the person should be able to speak, cry, cough or breathe. You can help by doing the following:

- Encourage them to keep coughing to clear the blockage
- Ask them to spit out the object if it's in their mouth
- Keep your fingers away from their mouth

They'll usually be able to clear the blockage themselves. But if coughing doesn’t work, you need to act quickly and start doing back blows and abdominal thrusts.

When someone is choking and can’t dislodge the blockage by coughing, they won't be able to make any noise, speak or cry. If they don’t get help immediately to start breathing again, they will become unconscious.

![1- 720x377 - what to do if someone is choking](//images.ctfassets.net/h8qzhh7m9m8u/6FaMhzhhvB2iH8iCrXNen6/e8053d6eb4bc35b11c2d696b49fe23e3/1-_720x377_-_what_to_do_if_someone_is_choking-1.jpg)

## How to give back blows

To carry out a back blow on an adult or child over 1 year old:

- Stand behind the person and slightly to one side
- Support their chest with one hand
- Lean them forward so the object blocking their airway will come out of their mouth, rather than moving further down
- Give up to 5 sharp blows between their shoulder blades with the heel of your hand (between your palm and wrist)
- Check if the blockage has cleared
- If not, give up to 5 abdominal thrusts

![1- 720x377 - what to do if someone is choking-1](//images.ctfassets.net/h8qzhh7m9m8u/4G9naRV85126Qz79Ll6wyv/264dbb421c63dcc299b9c33345353fa2/bfeb9378-620c-406a-b9bf-04c8aa231188.jpg)

## How to give abdominal thrusts

Abdominal thrusts should not be given to children under 1 year old or pregnant women.

To carry out an abdominal thrust on an adult or child over 1 year old:

- Stand behind the person
- Place your arms around their waist and bend them forward
- Clench your fist and hold it just above their belly button
- Put your other hand on top of your fist and pull sharply inwards and upwards
- Repeat this movement up to 5 times

If the person's airway is still blocked after trying back blows and abdominal thrusts, get help immediately:

- Call 999 and ask for an ambulance. Let the operator know the person is choking
- Continue with these cycles of 5 back blows and 5 abdominal thrusts until help arrives

If they lose consciousness and aren't breathing, you should start doing CPR (cardiopulmonary resuscitation). The aim of CPR is to pump blood around the person's body when their heart has stopped beating.

Although this can be a scary situation, it’s important to act quickly. We’ve put together a step by step guide on [how to do CPR](/your-health/learn-how-to-do-cpr-a-step-by-step-guide/) to help you stay calm.

__Tips on helping a choking child__

If you can see the object clearly in the child’s mouth, try to remove it. Don't poke blindly or repeatedly with your fingers – as you could make things worse by pushing the object further and making it harder to remove.

If your child is coughing loudly, encourage them to carry on coughing to bring up what they're choking on and don't leave them alone.

But if your child's coughing isn't helping to dislodge the blockage (or they’re not making a noise), shout for help immediately.

If your child's still conscious, but they're either not coughing or their coughing isn't working, start using back blows.

The advice is slightly different for a baby (a child under 1 year old), so if you’re a new parent it’s a good idea to familiarise yourself with what to do in this situation.

__How do I stop a baby from choking?__

__Back blows__

- Sit down and lay your baby face down along your thighs, supporting their head with your hand
- Give up to 5 sharp back blows with the heel of one hand in the middle of the back, between their shoulder blades

__Chest thrusts__

- Lay your baby face up along your thighs
- Find the breastbone and place 2 fingers in the middle
- Give 5 sharp chest thrusts (pushing their chest in and out by about a third)

__Can you get complications from choking?__

‘If you, your child or baby have any of the following symptoms after choking, it’s important to get medical help as soon as you can, either at A&E, an NHS walk-in centre or by a GP,’ says Dr Rhianna McClymont, Lead GP at Kry.

‘They will carry out various checks to make sure there are no complications or injuries.’

- A persistent cough after choking
- Throat still feels blocked
- Pain or discomfort from abdominal thrusts 


kry.co.uk > What to do if someone starts choking > Call out

Speak to a GP about choking

kry.co.uk > Your health > What to do if someone starts choking

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Expert medical advice on how to stop choking in adults, children and babies

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What to do if someone is choking – first aid advice | Kry UK

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Dr Rhianna McClymont

Lead GP at Kry

What to do if someone starts choking

‘Did I lock the car?’ ‘Is the oven definitely off?’ We’ve all had worrying thoughts like these. But if you have [obsessive compulsive disorder (OCD)](/medical-advice/mental-health/obsessive-compulsive-disorder/) the uncertainty could eventually come to dominate your life. 

The progression from normal behaviours into a mental disorder can be subtle. As a result, it’s not uncommon for people to live with OCD for years before they seek therapy. Stigmatisation and common misconceptions can also make living with OCD extremely challenging. 

## What is OCD?
Obsessive compulsive disorder is a mental disorder that manifests itself as [obsessive thoughts and/or compulsive actions](/medical-advice/mental-health/obsessive-compulsive-disorder/). Although people with OCD might recognise their thoughts as being irrational or unpleasant, they can’t help but think them over and over again. 

### Types of obsessive compulsive thoughts (or obsessions)
- Fear – often of something bad happening to a loved one
- Doubt – that you’ve not understood something correctly or done it properly
- Aggressive thoughts – about inflicting violence on someone, for example
- Obsessively ruminating over things – without coming to a solution
- Counting compulsions – where you feel the need to count things that appear in everyday life, like the number of letters in words

Compulsions are when you feel the repeated urge to do certain things. If you resist the compulsion, you might feel afraid or tense. If you carry out the compulsive action, the tension might ease for a short time, which motivates you to perform the action again repeatedly.

In this way, the disorder may gradually extend into multiple areas of your life and severely limit your everyday life. 

### Types of compulsory acts (or compulsions)
- __Compulsive checking__ – like checking several times whether the oven is turned off, whether all the doors and windows are closed or whether important paperwork is where it should be
- __Compulsive hand-washing__ – the need to wash your hands constantly, perhaps due to a fear of germs
- __Compulsive orderliness__ – an uneasy feeling when objects are not symmetrical or arranged according to other rules, like books in height order
- __Touching or tapping compulsion__ – the need to touch certain things or avoid touching them in all circumstances, like door handles
- __Hoarding__ – obsessively collecting things out of fear of accidentally throwing something important away

## What are the most common misconceptions about OCD?

### 1. ‘You can tell if someone has OCD’

Many obsessive compulsive rituals are difficult to hide, like if someone washes their hands 100 times a day or arrives late for work because they need to check and recheck everything before leaving the house. 

In extreme cases, someone might not feel able to leave their home and end up neglecting their work, friends and family because the entire day is taken over by their obsessive compulsions. 

The fact is: Struggling with obsessive compulsive thinking can often go unnoticed. Someone’s friends, family or colleagues may not be aware of or understand the problem. This doesn’t mean that the suffering or pressure is any easier, and those struggling with OCD will often need help and support.

### 2. ‘Stress causes OCD’ 

Compulsive thoughts and actions are often strongest when people are under [stress](/your-health/physical-signs-of-stress-on-the-body/). This is when they’re least able to control the impulse, because the compulsive ritual can sometimes help relieve stress for a short period of time. The coincidence of stress and obsessive compulsive thoughts makes it easy to mistake stress as the cause of OCD. 

__The fact is__: While stress can exacerbate the symptoms of obsessive compulsive disorder, the cause of it usually lies elsewhere. Differences in the brain or life events like trauma can be the cause. Genetics may also come into play – the risk of developing OCD may be higher if a parent or other family member has it. 

### 3. ‘Obsessive compulsive disorder isn’t treatable’

People who suffer from obsessive compulsive disorder are often ashamed of it, and some people believe that they can’t do anything to help it.

__The fact is__: OCD usually responds well to treatment. Combining medicine and behavioural therapy like CBT is often a successful strategy. Through therapy, patients can learn how to better cope with their symptoms and how to manage their compulsions.

## What should I do if I think I – or someone I know – has OCD? 

Taking obsessive compulsive thoughts or actions seriously as a symptom of a psychological disorder is a good start. 

It’s important to remember that if disturbing thoughts come up, suppressing them doesn’t help. Talking to a doctor, considering therapy and joining a self-help group can help you feel less alone and give you access to first-hand help and advice.

## How does therapy help with OCD?

It can be nerve-wracking to reach out for help. Even just the idea of talking about compulsions or obsessive thoughts to a therapist might make you feel anxious. But people usually find it’s worth it – one of the best treatments for OCD is behavioural therapy.

In therapy, you’ll get step-by-step guidance on how to cope with situations that challenge you without giving in to your compulsions. A variety of methods are used in therapy, like exposure, habituation and relaxation techniques. 

## When should I get help from a doctor?

If you’re experiencing compulsive thoughts or actions, speak to someone you trust and seek medical advice – the sooner, the better. A doctor or healthcare professional is a good first point of contact – they can advise you on the treatment options available to you.

__This article has been medically reviewed by Kry doctor, Dr Monika Gratzke.__


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kry.co.uk > Your health > What is OCD – and what are the biggest misconceptions? 

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What is OCD, what are the signs and why do we have so many misconceptions about it? Read our guide for advice on how to seek help if you need it

kry.co.uk > Meta information > What is obsessive compulsive disorder?

What is obsessive compulsive disorder? | Kry 

Mental health

What is OCD – and what are the biggest misconceptions?

It’s no secret that alcohol has a detrimental effect on your body. As well as the hangover that shows up the next morning, alcohol can affect both your physical and mental health. 

In the long term, it can increase your risk of [cancer](/medical-advice/cancer/), [dementia](/medical-advice/neurology/dementia/), heart disease and [stroke](/medical-advice/cardiovascular-diseases/stroke/). There’s also evidence that alcohol can impair your memory and reduce fertility. 

The good news is that cutting back or giving up alcohol comes with [clear benefits to your health](/your-health/6-health-benefits-of-drinking-less/) – often within just 1 week. And with more of us considering going sober than ever before, now’s a great time to be more conscious of your drinking.

## How do I know if my drinking is causing damage to my health?

‘We might not realise that our drinking is problematic because aside from a hangover, you can’t tell what’s going on under the surface until it becomes a problem,’ explains Dr Nikki Ramskill, a Kry GP. ‘If you’re regularly drinking above the recommended 14 units of alcohol a week, the negative effects will reveal themselves over time. 

‘Fortunately, there are lots of ways to reduce your alcohol consumption, including having some drink-free days and reducing your glass size to stay within the advice on safe drinking.’

## How long does alcohol stay in my system? 

When you drink alcohol, it passes rapidly into your bloodstream through the stomach and travels to every part of your body – affecting your brain, liver, kidneys and lungs. 

‘Alcohol will stay in the body for different lengths of time depending on your gender, size, age, how regularly you drink and whether you’ve eaten,’ explains Dr Ramskill. 

‘It takes approximately 1 hour for 1 unit of alcohol to leave your body. So, if you’ve had 8 pints of ordinary strength beer (with each pint being 2 units of alcohol), and stopped drinking at midnight, the alcohol won’t be out of your body until about 4pm the next day. 

‘Once alcohol is in your system, your liver breaks it down, or metabolises it, by producing a special enzyme.’ 

## What happens if I cut down on alcohol? 

If you cut back or stop drinking alcohol, there are plenty of short- and long-term benefits. 

### After 1 week: 

__Your sleep will improve__ 

‘There’s a common misconception that alcohol improves sleep,’ says Dr Ramskill. ‘It may help you drift off, but the effects of alcohol mean you’ll get less restorative REM (rapid eye movement) sleep, which is essential for your health.’

After just 1 week of no alcohol, your REM cycle will likely return to normal. You can expect to feel more rested and notice an improvement in your mood and cognitive function. ‘You may notice that your dreams are more vivid or that you're starting to dream again,’ says Dr Ramskill. 

__Your skin may appear healthier__

‘When the body metabolises alcohol, it releases a by-product called acetaldehyde before it is broken down to a less toxic product and removed from the body,’ says Dr Ramskill. ‘Acetaldehyde is toxic to your bodily tissues. It causes you to become dehydrated and increases your chance of skin breakouts.’

By cutting down on alcohol, you may notice your skin improves, including any issues with redness like rosacea. [One study](https://www.aad.org/news/alcohol-and-rosacea-in-women) found that increased consumption of alcohol is associated with a higher risk of [rosacea](/medical-advice/skin-conditions/rosacea/) in women.

### After 1 month:

__You’ll find it easier to maintain a healthy weight__ 

Alcohol has a high calorie count. Just 1 standard glass of wine has 133 calories, while a pint of beer has 239 – about the same as a Mars bar. ‘Alcohol contains lots of calories that don’t offer any nutritional value. These “empty calories” are converted into fat stores, which you'll notice on your waistline,’ explains Dr Ramskill. 

After 1 month of not drinking as much, your body may start to shed excess fat due to all the calories you save. 

__The damage to your liver will be reversed__

The effects of alcohol can lead to [alcohol-related fatty liver disease](/your-health/how-to-reduce-your-risk-of-fatty-liver-disease/). ‘The liver works hard at eliminating toxins from the body. It also performs lots of other really useful functions to help our body function,’ explains Dr Ramskill. 

‘Your liver needs to work harder to break down alcohol. A [fatty liver](/medical-advice/fatty-liver/) can reduce its ability to perform vital functions, leading you to feel sluggish.’ 

After only 2 weeks of abstaining from alcohol, your [liver starts to regenerate](https://www.nhs.uk/conditions/alcohol-related-liver-disease-arld/treatment/). ‘Within 4-8 weeks your liver may be fully recovered,’ says Dr Ramskill. ‘It just depends on how much you drink and what state it was in to begin with.’ 

__Your mental health may improve__

While alcohol may initially make you feel more confident and less anxious, in the long term it can make you more vulnerable to [mental health conditions](/medical-advice/mental-health/) like depression and anxiety. Alcohol can disrupt the balance of chemicals and processes in your brain and affect your thoughts, feelings and behaviour. 

‘Alcohol is a depressant, so people who already have mental health problems may find that this gets worse,’ says Dr Ramskill.

After 4 weeks, your mood will start to improve and you may notice that you have more resilience to cope with life in general.

### After 1 year:

__Your blood pressure will lower__

Regularly drinking too much alcohol can raise your blood pressure. ‘Having high blood pressure puts you at an increased risk of cardiovascular disease because it puts strain on the heart muscle,’ says Dr Ramskill. [One large genetic study](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31772-0/fulltext) found that even light-to-moderate drinking increases blood pressure and the chances of having a stroke. 

‘Across a year, abstaining from alcohol will lower your blood pressure and reduce your risk of stroke or having a [heart attack](/medical-advice/cardiovascular-diseases/heart-attack/),’ explains Dr Ramskill. 

__Your memory will improve__

Alcohol can affect the function of your hippocampus – the part of your brain that forms and stores memory. ‘Drinking too much can also lead to brain damage and may increase your risk of developing dementia,’ says Dr Ramskill. 

However, research suggests that when you stop drinking, some of the brain damage that long-time alcohol can cause may reverse. 

## How can I cut down on alcohol?

Giving up alcohol can be difficult, but the benefits can make it worth the effort. If you’re finding it challenging, here are some ways to help:

- Stay hydrated by swapping every second drink for water or a soft drink
- Have several drink-free days a week
- Let your family and friends know that you want to cut down to encourage their support
- Go for a drink that’s lower in strength (ABV in %) and opt for a smaller wine glass than usual
- When you’re going out, take a fixed amount of money to spend on alcohol 

## When should I speak to a doctor?

If you’re struggling to reduce your drinking, it’s a good idea to speak to a doctor. It’s also worth [booking an appointment](/gp-appointments-online/) if you experience any of the following: 

- You’re worried about your relationship with alcohol
- Your drinking is causing arguments with family, friends or colleagues
- You can’t say no to alcohol 
- You need to drink more to achieve the same effects
- You’re struggling with sleep

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


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Vaginal dryness is very common. Around 17% of women aged 18-50 and [more than half of post-menopausal women](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459457/) over the age of 51 experience vaginal dryness.

Lower oestrogen is a common trigger of vaginal dryness, and menopause, pregnancy, birth and breastfeeding can all impact oestrogen levels. But there are other causes too, including autoimmune diseases, certain lifestyle choices and medical or surgical treatments.

## What’s vaginal lubrication and why do we need it?

‘Vaginal secretion is created by glands in the cervix to maintain a moist, slightly acidic environment in the vagina,’ says Dr Elisabeth Rosen, a Kry doctor who specialises in gynaecology and obstetrics. 

This secretion helps maintain the right balance of bacteria and prevents infection by flushing out dead cells and unwanted bacteria to clean the vagina. 

‘The secretion changes throughout the menstrual cycle to help or prevent the movement of sperm and to protect the body and a potential pregnancy from infections,’ Dr Rosen says.

‘The lubrication you experience when you’re sexually aroused is different. It’s activated in the Bartholin’s glands right by the vaginal opening. This gland produces secretions all the time, but it’s also activated when you’re sexually aroused to protect the sensitive membrane in the vagina during penetration.’

## What are the symptoms of vaginal dryness?

The most common vaginal dryness symptoms include:

- Vaginal discomfort, tenderness and pain
- Pain during penetration
- Itching in and around the vagina

‘Reduced moisture in the vagina can also upset the balance of vaginal flora – the bacteria living inside the vagina – which can increase the risk of issues like [urinary tract infections](/your-health/utis-your-questions-answered/), vaginitis and [bacterial vaginosis](/medical-advice/womens-health/bacterial-vaginosis/),’ says Dr Rosen. 

## What causes vaginal dryness?

Vaginal dryness has a range of causes, but it’s often linked to the production of hormones like oestrogen and progesterone. The best treatment for dryness depends on what’s causing it, with several different causes:

### 1. Perimenopause and menopause

During [perimenopause](/your-health/7-signs-of-perimenopause-a-doctors-guide/) and menopause, the body produces less oestrogen. This can cause the mucous membranes in the vagina – which are usually moist, elastic and pink – to become increasingly dry and pale. ‘Vaginal dryness during menopause is also called vaginal atrophy,’ explains Dr Rosen. ‘It affects more than 50% of all post-menopausal women.

‘This can cause stinging and itchiness, as well as pain during sex. It can also affect the urinary tract, making you pee more often or leading to recurrent UTIs.’

You might notice vaginal dryness alongside symptoms like irregular bleeding, hot flashes or a change in libido.

Many menopausal women benefit from [hormonal treatment](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)66519-1/fulltext).‘It’s very effective and safe for everyone, unless you’re undergoing treatment for breast cancer,’ says Dr Rosen.

### 2. Childbirth, breastfeeding and the early post-partum stage

‘This isn’t a cause for concern,’ explains Dr Rosen. ‘It’s perfectly natural and will pass. You might also experience missed periods or periods that haven’t returned as  a result of hormones preventing ovulation.

‘Using a water-based lubricant can be a good idea, and if that’s not enough, a doctor may prescribe local oestrogen to use temporarily.’

### 3. Hormonal contraception

‘Vaginal dryness is a common side effect of hormonal contraceptives,’ says Dr Rosen. ‘This is because the body’s production of oestrogen and progesterone, which control the production of vaginal secretion, is replaced by the synthetic hormones in hormonal contraception. 

‘As the synthetic hormones are not the same as the body’s natural hormones, they can’t fully recreate their functions. Most hormonal contraceptives contain quite a high concentration of hormones. 

‘They’re also constant over time, unlike the menstrual cycle’s natural fluctuation. For some people, that’s not a problem at all, but for others it can cause problems like vaginal dryness. Trying a different type of hormonal contraception can help.’

### 4. Antidepressants

The primary role of SSRIs (selective serotonin reuptake inhibitors), a widely used type of antidepressant, is to increase our levels of serotonin – a key hormone that stabilises our mood. 

‘But antidepressants also impact receptors for a neurotransmitter called acetylcholine,’ explains Dr Rosen. ‘This blocks certain involuntary muscle movements and bodily functions, which can lead to vaginal dryness.’ 

If you’re experiencing vaginal dryness, you can speak to a doctor about trying a different type of medication.

### 5. Hysterectomy

Both the cervix and the cells that produce vaginal secretions are often removed during a hysterectomy, and this can cause vaginal dryness.

‘If you’re experiencing these symptoms after having a hysterectomy, talk to a doctor,’ says Dr Rosen. ‘Local oestrogen can help tremendously.’

### 6. Chemotherapy

Additional symptoms: 
Menopause triggered by medicine, also known as iatrogenic menopause or medical menopause

‘Chemotherapy often affects the hormone production of the ovaries,’ says Dr Rosen. ‘This puts the body in a state of chemical menopause.’ 

Speak to a doctor about vaginal dryness symptoms. They may be able to offer solutions during your treatment.

### 7. Over-washing

‘Some people think that it’s necessary to flush out the vagina with water,’ says Dr Rosen. ‘But water has a dehydrating effect. The vagina is very clever and cleans itself – that’s exactly the purpose of the secretions and discharge. It’s completely normal as long as it’s not accompanied by pain, discomfort or a foul smell.

‘Simply wash the vulva gently with water – don’t use soap or other hygiene products.’ 

### 8. Sjögren’s syndrome

‘Sjögren’s syndrome is an autoimmune disease that causes chronic inflammation of the body’s secretion-producing glands, which leads to less secretion production. It can cause a dry mouth, eyes, skin and a dry cough. As a result it can also cause you to have a dry, itchy vagina,’ Dr Rosen explains.

Sjögren’s syndrome is relatively uncommon, affecting far more women than men, especially [from midlife.](https://www.uptodate.com/contents/diagnosis-and-classification-of-sjogrens-syndrome) 

### 9. Diabetes

‘High blood sugar levels can cause damage to the body’s small nerves and blood vessels,’ says Dr Rosen. ‘This can affect the glands in the cervix, resulting in dry mucous membranes.’ Other symptoms of diabetes include increased thirst, needing to pee more often, lack of energy and blurred vision. 

### 10. Not feeling aroused during sex

Sometimes, people experience dryness when they’re simply not aroused.

‘Use a water-based lubricant, or try more foreplay or other alternatives to penetration. I’d advise avoiding latex condoms as well,’ says Dr Rosen. ‘It’s also important to try to explore why you may not be feeling aroused, to avoid developing chronic vaginal pain.’

Read more on what might be the cause of a [low libido](/your-health/8-causes-of-low-libido-a-doctors-guide/). 

### 11. Antihistamines

Antihistamines block your body’s histamine secretion to help relieve a runny nose or watery, itchy eyes. 

‘They can also affect the mucous membrane of the vagina, making it drier than normal,’ Dr Rosen explains.

## When should I speak to a doctor about vaginal dryness?

‘If you’re struggling with any of these symptoms and there isn’t an obvious, temporary cause, like breastfeeding, speak to a doctor,’ advises Dr Rosen.

Never ignore these symptoms:

- Pain during sex that doesn’t go away with increased arousal
- Recurring UTIs
- Recurring thrush or bacterial vaginosis
- Vaginal bleeding that’s unusual and abnormal for you

__This article has been medically approved by Dr Elisabeth Rosen.__


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‘Menopause has always been a disruptive time for women, but as is the case with so many other women’s health issues, it’s been disregarded and under-researched. Now it’s a recognised phenomenon,’ says Dr Elisabeth Rosén, a Kry doctor and gynaecology specialist.

Mental health difficulties during perimenopause and menopause are so widespread that some researchers have proposed a new term to describe them: ‘menopause distress’. The symptoms are described as significant and persistent, yet different enough to other depressive diagnoses to warrant their own label.

‘Around 70% of women experience some sort of mental health impact during menopause,’ says Dr Rosén. ‘But the good news is that these symptoms tend to go away when the body gets used to the new hormone levels.’ There’s also plenty you can do to look after yourself and get professional help.

## What are perimenopause and menopause, and how do I know they’re happening?

Entering menopause happens once you haven’t had a menstrual bleed in 12 months. The average age of menopause is 51. ‘Perimenopause is the time before and around menopause. It starts on average 4 years before menopause, but it can last longer than that,’ Dr Rosén explains.

Menopause happens as a result of a decline in ovarian function, which leads to a change in the production of the female sex hormones oestrogen and progesterone. 

‘The most obvious sign of perimenopause is changing periods – initially shorter and shorter cycles, followed by irregular and heavy bleeds,’ says Dr Rosén. Look out for these symptoms, which are often linked to reduced oestrogen levels:

- Sweating and hot flushes
- Tiredness and insomnia
- Vaginal dryness
- A [decreased libido](/your-health/8-causes-of-low-libido-a-doctors-guide/)
- Psychological symptoms like irritability, low moods, a lack of motivation, aggression, difficulty concentrating and stress
- A relapse of previous psychological illness

## How do perimenopause and menopause impact our mental health?

The exact link between perimenopause and mental stress is yet to be established. ‘We do know that hormonal fluctuations and changing oestrogen levels can affect and interact with the neurotransmitters of the brain, which in turn impacts our mood,’ says Dr Rosén. 

There are two main ways that hormonal changes are thought to have a psychological effect:

### Reduced oestrogen 

Oestrogen affects your mood because of its impact on the levels of serotonin in your brain. ‘Serotonin is a hormone that stabilises your mood and promotes happiness and wellbeing,’ Dr Rosén explains. ‘When the levels of oestrogen go down, so do the levels of serotonin, which explains why you might feel closer to tears, a bit low or even depressed.

‘The oestrogen drop comes in phases, which can make the psychological problems more pronounced. When the body has acclimated to the new hormone levels, your mood tends to stabilise, only to suddenly worsen again the next time the oestrogen drops.’

### Reduced progesterone

The other female sex hormone, progesterone, has a calming effect. ‘Decreasing progesterone levels can lead to sleep issues, low moods, irritability and anxiety,’ says Dr Rosén.

On top of the impact of hormonal changes, many women find that the physical symptoms of menopause have a negative impact on their mood, too. ‘It’s tough to walk around worrying about sudden hot flushes, to not get the sleep you need, to be unable to enjoy sex to the same extent and to get used to a new weight, for instance,’ acknowledges Dr Rosén.

A growing body of research is now pointing to a potential link between vasomotor symptoms in particular – that’s night sweats and hot flushes – and changes in cognition and brain function in menopause. It’s possible that treatment of these physical symptoms could also relieve some of the cognitive difficulties.

## What mental health problems are most common in perimenopause and menopause?

Anxiety, mood swings and depressive symptoms are common problems during this time. ‘The difficulties can be quite pronounced and often seem to appear out of the blue, which can make them more difficult to deal with,’ says Dr Rosén.

Oestrogen doesn’t only impact serotonin levels, it can also affect our cognition. As a result, during perimenopause, it’s common for people to experience:

- Forgetfulness 
- Brain fog
- Brain fatigue
- Difficulty concentrating
- Frustration as a result of the above, which can then negatively impact our mood

You are 2-5 times more likely to experience depressive disorders during perimenopause than during the late premenopausal years. For some, emotional exhaustion can make everyday tasks difficult. 

‘Around 25% of people experience psychological problems they need professional help with, and many find the psychological changes during perimenopause more difficult to manage than the physical symptoms.’

## How might perimenopause and menopause impact our sleep?

‘Many perimenopausal women experience sleep problems, including those who have never had issues with sleep before,’ says Dr Rosén. ‘Changes to oestrogen and progesterone levels impact other hormones that are responsible for regulating your body temperature, which can cause intense night sweats. The hormone changes themselves, as well as anxiety, can also make it difficult to sleep, and it’s not unusual to wake up suddenly in a panic.’

However, these symptoms can often be treated and alleviated, which can not only improve sleep but also prevent mental illnesses that long-term insomnia can contribute to. 

## Are there any other risk factors for mental health issues during menopause?

Midlife is a time when many of us go through life-changing experiences and events. Life stressors and adversity can contribute to mental health difficulties, which is why psychotherapy or cognitive behavioural therapy (CBT) can help. In addition, people who have experienced depression previously are at higher risk during perimenopause.

## What should you do if you’re struggling with your mental health during menopause?

There are many things you can do to improve your chances of a positive menopause transition. Dr Rosén advises the following:

1. [Read up about perimenopause](/your-health/7-signs-of-perimenopause-a-doctors-guide/) so that you’re able to identify symptoms and know what to expect.
2. Try to accept and manage the psychological difficulties – let yourself feel your emotions while also trying to find peace.
3. Identify situations that trigger negative emotions and try to avoid them.
4. Allow yourself to take things more slowly throughout this period of your life, as perimenopausal problems tend to be more difficult to manage if you’re stressed.
5. Exercise regularly. Research shows that physical activity has a positive effect on both physical and mental health during perimenopause. It also releases endorphins and other feel-good hormones.
6. Eat a well-balanced diet. 
7. Use techniques like meditation or yoga to help lower stress levels. 
8. Maintain a good sleep routine, keep the bedroom cool and keep extra bed sheets close by to improve your chances of a good night’s sleep.
9. Tell family and friends how you’re feeling – they can be a huge support during tough times.

## What if I feel like I need professional help?

If these habits don’t relieve your symptoms, reach out for professional help. Depressive symptoms are very common during perimenopause, and a doctor will be able to guide you through your options, including talk therapy, antidepressants, HRT or a combination. 

For many people, a mixed approach is best. While in many countries, HRT is currently only prescribed for night sweats and hot flushes, some recent studies suggest it might also help prevent depression in perimenopause. Options like family therapy can also be helpful. 

‘The physical consequences of reduced hormone levels can’t be reversed, even if HRT may postpone the reduction by a few years, while local oestrogen tends to help with vaginal dryness,’ says Dr Rosén. 

‘But psychological problems tend to ease off and eventually go away when the body has adapted to the new levels of oestrogen.’ 

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

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Acne vulgaris, more commonly known as [acne](/medical-advice/skin-conditions/acne/), is a skin condition that affects most people at some point. It causes spots, oily skin and inflammation that can be hot or painful to touch. 

Every year, 3.5 million visits to the doctors will be made to discuss skin treatment for acne.

## Quick facts:

- In puberty, acne is especially common in teenage boys
- Women can be affected in adulthood due to changing hormones
- Poor hygiene and sexual activity are not causes of acne
- Acne affects the face in 99% of cases, the back in 60% and the chest in 15%

Skin plays a role in our self-perception, so experiencing acne on any level can carry emotional strain and affect self-confidence.

But the good news is, there’s lots that can be done, both in terms of self-help measures and medical treatments.

## What causes acne?

There are sebaceous glands in the skin that are met on the skin’s surface by hair follicles. They produce a fatty substance called sebum, which keeps hair and skin soft.

When we reach puberty, sebum production increases along with the bacterium propionibacterium on the skin. Sometimes sebaceous glands produce more sebum than needed and that’s when acne develops. This is because the excess sebum and skin residue can clog the hair follicle or the sebaceous gland, or because the bacteria enter it, creating an inflammation or infection.

These changes come about because of an upsurge of testosterone and other hormones during puberty and are especially common in teenage boys. The same effects can also become common in women in adulthood, known as [adult acne](/your-health/managing-adult-acne-a-doctors-advice-on-what-really-works/).

## What are the different forms of acne?

Acne vulgaris mostly occurs on the areas of skin where there are more hair follicles found that produce sebum – which is why the face, back and chest are most affected. It can come in different forms.

### Types of spots: Non inflammatory acne

__Whiteheads__ — small bumps that are sebaceous glands where the wall of the hair follicle is closed.

__Blackheads__ — small dark dots that occur when the hair follicle is open and sebum and bacteria there have turned black because of contact with air.

### Types of spots: Inflammatory acne
__Pimples__ — skin pimples appear as red and swollen bumps that can progress to the types below.

__Papules and pustules__ — these can be hardened, clogged pores surrounded by pink skin, that are usually tender to the touch. 
Sometimes an infection under the skin’s surface can lead to painful bumps filled with fluid (called pustules) that are yellow or white in colour.

__Nodules and cysts__ — these can be painful to the touch and look red and inflamed.

## What is post-inflammatory hyperpigmentation? 
Post-inflammatory hyperpigmentation (PIH) appears as a result of damage to the skin, following an inflammatory skin condition like acne vulgaris.

It appears as dark flat spots of discolouration across the face and body. Depending on the person’s skin tone and the level of discolouration, these patches are usually brown or black in colour.

Men and women are equally at risk, and while all skin types can get post-inflammatory hyperpigmentation, it occurs more in people with darker skin tones. 

## Differences between mild acne, moderate acne and severe acne

### Mild acne
White and blackheads mostly, with occasional pimples.

### Moderate acne 
More inflammatory papules and pustules that are less than 5mm in diameter, as well as pimples, blackheads and whiteheads.

### Severe acne 
Nodules and cysts that are more than 5mm diameter (along with all or some of the above). In very severe cases, these may join together and leak fluid onto the skin’s surface.

## Skin treatment for acne

Mild cases of acne can often be treated at home with the help of your pharmacist. For moderate acne that’s not clearing up, talk to a Kry GP about some of the treatments they can offer. In some cases you may be referred to a dermatologist.

### From the pharmacy

For mild acne, over-the-counter products are available that may take up to 8 weeks to make a difference. These include creams that can work on the bacteria causing the skin pimples as well as cleansers, gels and lotions that work on recurring mild acne and may also help prevention.

### From a Kry GP

If your acne has more sore red pustules or papules, or you develop hard lumps under the skin – nodules or cysts – see a GP. They will be able to recommend a course of treatment that is suitable for you. They’ll rule out other conditions that may mimic some features of acne (like [rosacea](/medical-advice/skin-conditions/rosacea/) or a [hair follicle infection](/medical-advice/skin-conditions/folliculitis/)).

Then they can offer a wide range of prescription treatments. These can include prescription creams, topical and oral antibiotics or birth control pills (if you’re not planning on getting pregnant). The latter can help moderate the hormonal action behind the acne.

It’s usually recommended to try any prescribed treatment for around three months. If your acne isn’t clearing up after that, talk to your doctor about changing your treatment.

### From a dermatologist

If acne treatments from your pharmacy and GP are not working, they may refer you to a dermatologist for further treatment.

A specialist dermatologist can also advise you about treatments available for acne scarring (such as post-inflammatory hyperpigmentation).

## What about adult acne?

For women, hormonal changes related to age or lifestyle and changes in the skin – sometimes triggered by stress – can bring on acne. In this case, the same treatments above apply.

Though because skin is less resilient, it may be better to avoid harsh stripping products and choose milder exfoliating lotions to encourage cell turnover (like those containing salicylic acid – see above).

There’s a theoretical chance that antioxidants like vitamin C in skincare may help acne scarring by stimulating collagen production. But we need more recent studies on whether this helps active acne. Using topical vitamin C could help reduce redness that may be associated with adult acne.

If you develop erratic periods, increased bodily or facial hair growth, alopecia (excessive hair loss from the head) alongside the acne, you may have [polycystic](/your-health/severe-period-pain-endometriosis-or-pcos-how-can-you-tell-the-difference/) ovarian syndrome (PCOS). This can be diagnosed by a doctor.

## How to help acne with lifestyle changes

### 1. Don’t over-cleanse 
Spots are not down to poor hygiene, but this is a myth. If you cleanse too aggressively, you may irritate your skin and treatments may sting. Look for non-comedogenic (this means non-pore blocking) products. Ideally wash twice a day with a gentle cleanser that is pH-matched to the skin and use a non-oily moisturiser. Look for oil-free or water-based non-comedogenic make-up. Never pick or squeeze spots.

### 2. Stop smoking 
More spots under the skin surface (acne inversa) occur in smokers. The toxins in cigarettes and vapes and the blood vessel constriction they promote will not be doing skin any favours in general.

### 3. Try to manage your stress 
Stress can exacerbate any skin condition and research has found that, especially in women, high stress levels can increase the severity of acne. You often can’t avoid it, but you can choose to deal with it better. Try yoga, [breathing techniques](/your-health/3-breathing-exercises-a-psychologist-recommends/) and meditation.

### 4. Don‘t wear too much make-up 
Water-based make-up is less likely to block your pores and cause acne breakouts. Always remove make-up before bed.

### 5. Drink plenty of water 
Dehydration does not help any skin or inflammatory condition (including acne) so [keep well hydrated](/your-health/why-is-hydration-so-important-a-doctors-guide/).

### 6. Take care of your gut health 
A nourishing diet for gut health along with good levels of probiotics (that’s healthy bacteria from fermented foods such as sauerkraut, kimchi and natural yogurt) may play a role in healthy skin.

### 7. Get enough vitamin D 
Vitamin D deficiency means we have less protection from inflammation in the body, which may worsen acne. Make sure you get enough sunshine and [vitamin D-rich foods](/your-health/do-i-have-a-vitamin-d-deficiency-symptoms-causes-and-treatments/).

### 8. Eat an anti-inflammatory diet 
We’re beginning to understand the influence of nutrition over the different systems in our bodies, including the skin. Although more research into this area is needed, many studies are now suggesting there’s enough evidence to encourage avoiding high glycaemic index foods like sugary foods and carbohydrates. For good skin health, it is preferable to eat a diet rich in fresh fruits, vegetables, lean meats, fish and seafood.


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