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

kry.co.uk > Your health > Metainfo

Your health | KRY

Hot flushes, night sweats, mood swings and troubles with sleeping are common symptoms of menopause. But these symptoms, among others, may actually start well before you’ve reached menopause.

## What is perimenopause?

Perimenopause marks the first changes you experience when your hormone levels shift. 

‘Menopause itself is defined as exactly 12 months after your last menstrual bleed’ says Dr Elisabeth Rosen, a Kry doctor specialising in gynaecology and obstetrics. ‘Perimenopause, on the other hand, varies hugely from person to person.’

The average age of perimenopause is 47.5 years, but it’s different for everyone. ‘Some people will experience symptoms for a couple of years before their periods stop altogether, but some will have them for a decade.’

## How do I know if I’ve started perimenopause?
‘One of the first signs of perimenopause people notice is that their periods become shorter than normal or they get spotting or heavy bleeding,’ says Dr Rosen. 

‘Progesterone helps the uterine lining stick to the walls of the uterus. When progesterone levels drop, the lining can no longer stick, causing irregular bleeding’.

Another common symptom is heavier periods. When your oestrogen levels are higher than your progesterone levels, your uterine lining builds up. This can result in heavier periods once it sheds.

‘The levels of oestrogen and progesterone continue to decline to extremely low levels, leading to menopause,’ says Dr Rosen.

Here are some other normal signs you’ve begun perimenopause and some tips on how to cope with the change. 

## Common signs of perimenopause

### 1. Hot flushes
Hot flushes are one of the most common symptoms of menopause – up to 80% of women experience them. ‘We don’t really know what causes hot flushes, but they’re related to the hormonal changes that come with the menopause,’ says Dr Rosen.

### 2. Irregular periods
Some people notice their periods changing up to a decade before their actual menopause. ‘You can take a hormonal contraceptive like an IUD or the coil to help control the bleeding,’ says Dr Rosen. ‘It contains a synthetic version of progesterone so will help the uterine lining stick to the uterus wall.’

### 3. Mood swings
Several large studies have shown an increased risk of developing depression during perimenopause. ‘Taking general good care of yourself, getting 8 hours of sleep per night, eating good food and doing regular physical activity is the best treatment,’ says Dr Rosen. 

‘Some people find the changes going on in their body quite challenging, so it’s good to be aware that these symptoms are caused by hormones and not by you or your surroundings.’

### 4. Sleeplessness and fatigue
Many people say they have trouble sleeping as they enter perimenopause, especially during their period. ‘Doing physical exercise, sleep meditations and having regular bedtime habits can help,’ says Dr Rosen. ‘Medication is also available for insomnia, but it’s usually a last resort.’

### 5. Decreased libido and vaginal dryness
‘Part of the problem with a low libido is that decreased levels of sex hormones can lead to vaginal dryness,’ says Dr Rosen. A GP can prescribe a local oestrogen treatment gel or a pessary that can help with oestrogen levels. ‘Because these only treat the local area, they can have fewer side effects than hormonal replacement therapy (HRT), which affects the whole body.’

### 6. Trouble controlling your bladder
The urinary tract contains oestrogen, and as the level of that hormone decreases, people may experience urinary incontinence. ‘Local oestrogen gels or treatments can help alleviate the symptoms but it’s also about prevention, rather than cure,’ says Dr Rosen.

‘Remember to do pelvic floor exercises regularly. But there’s only so much you can do yourself, particularly if you’ve given birth. Many people suffer from urinary incontinence for many years before seeking help because they’re embarrassed. It’s always better to seek help from a doctor sooner rather than later as there’s help available.’

### 7. Night sweats
Breaking out in sweat at night is a menopause symptom that usually begins in perimenopause. Just like hot flushes, the exact cause is not known. 

‘We know that physical exercise can help with night sweats. You should also try keeping your bedroom as cool as you can,’ says Dr Rosen. ‘Cutting down on alcohol or spicy food may also alleviate symptoms. If that doesn’t help and the night sweats are making life difficult, medication may help, so talk to a GP.’

__This article has been reviewed by Dr Elisabeth Rosen, a Kry doctor specialising in gynaecology and obstetrics, and Dr Bryony Henderson, lead GP at Kry.__


kry.co.uk > 7 signs of perimenopause — a doctor’s guide > button

Kry.co.uk > Your health > 7 signs of perimenopause — a doctor’s guide

7 signs of perimenopause — a doctor’s guide

Menopause is a time of change, and some of those changes are years in the making. Here are some signs you’ve entered perimenopause. 

kry.co.uk > Medical Reviewer

Dr Bryony Henderson

Lead GP at Kry

Hormonal health

Many of us speak about metabolism as if it’s a muscle we can flex and control. There are 25,000 global monthly Google searches for ‘how to speed up metabolism’. When really, metabolism is a series of chemical processes that help to keep your whole body functioning.

While some may have a slower or faster metabolism, this doesn’t affect our weight to a huge degree. But it's useful to understand the difference between a healthy metabolism and one that’s off balance to help spot the signs of a potential metabolic disorder. 

Here’s everything you need to know about your metabolism.

## What exactly is metabolism and metabolic rate?
You may have heard the terms metabolism, metabolic rate and basal metabolic rate used interchangeably. They all mean slightly different things, so here’s an overview:

### Metabolism
Metabolism refers to the chemical processes that happen as your body converts food and drink into energy. The process combines calories with oxygen to release energy. This fuels important processes like:

- Breathing
- Regulating your body temperature
- Digesting food
- Producing pee
- Circulating blood
- Repairing damaged tissues
- Managing hormone levels

### Metabolic rate
Metabolic rate is one aspect of the metabolic process – it’s the speed or frequency of your metabolism. The basal metabolic rate (BMR) is the minimum number of calories your body needs to function while resting.

Everyone’s BMR is different, but on average, men need around [2,500 calories](https://www.nhs.uk/common-health-questions/food-and-diet/what-should-my-daily-intake-of-calories-be/#:~:text=Generally%2C%20the%20recommended%20daily%20calorie,women%20and%202%2C500%20for%20men.) and women need around [2,000 calories](https://www.nhs.uk/common-health-questions/food-and-diet/what-should-my-daily-intake-of-calories-be/#:~:text=Generally%2C%20the%20recommended%20daily%20calorie,women%20and%202%2C500%20for%20men.) per day to maintain their weight. 

There are 3 main ways your body burns energy every day: 

- The basal metabolism – the energy your body uses to function while at rest. This includes energy needed to breath, circulate blood and cell production amongst others
- The energy you use to break down food (also known as the thermic effect)
- The energy you use during physical activity

It’s worth remembering that most of the energy you burn is from your resting metabolism – [around 75%](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7357764/).

## What affects your metabolic rate?
The function and speed of your metabolism is affected by lots of different things, and it varies from person to person. The key factors include:

- __Muscle mass__ – people with more muscle mass usually have a faster metabolism
- __Age__ – age doesn't affect metabolism on its own but, with age, muscle mass tends to reduce while diet remains the same
- __Biological sex__ – men usually have a faster metabolic rate because they tend to be large than women
- __Hormone disorders__ – an underactive thyroid for example can cause you to have a slower metabolism
- __Natural body size and fat composition__
- __Genetics__ – scientists are still trying to understand this but we do know that some people are able to develop muscle easier than others

Interestingly, the menstrual cycle also plays a minor role. [Research has found](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7357764/) that some women have a higher metabolic rate during the last half of their menstrual cycle, when the resting metabolic rate for some women is up to 10% higher.

## What’s the difference between a fast and slow metabolism?
People who have a slow metabolism burn fewer calories in a specific time frame than average, while people with a fast metabolism burn more calories in a specific time frame.

## What happens when your metabolism is out of balance?
When your metabolism isn’t functioning healthily it can result in some side effects, including:

- Tiredness and fatigue
- Mood swings
- Feeling depressed
- Feeling very hungry 
- Irregular heartbeat
- Irregular periods

There are also some key metabolic disorders that mean your body can’t process certain nutrients normally. These are usually inherited and mean that either vital products aren’t made, or toxic by-products build up. They’re not affected by lifestyle changes and so usually require medication.

## How does metabolism affect your weight?
Most people think that a sluggish metabolism might be responsible for weight gain, but this is rarely true. 

People with a slow metabolism burn fewer calories while resting. This means that more calories can get stored as body fat. People with a fast metabolism burn more calories while resting, so they can usually eat more without putting on weight. 

However, having a slow metabolism isn’t usually the cause of excess weight gain. Metabolism actually plays a minor role – by far the bigger factors are diet and exercise.

## Is it possible to speed up your metabolism?
‘Speeding up your metabolism’ is a myth. Though there are some lifestyle factors that may speed up your basal metabolic rate just a little, they’re unlikely to make a big difference to your weight. 

Food and drinks like coffee and chilli are said to have this effect, but there’s no concrete evidence. Building more muscle through [exercises like strength or resistance training](/your-health/benefits-of-strength-training/). The more muscle on your body and the less fat, the higher your metabolic rate. However, a higher metabolism will also make you want to eat more.

Drinking water is really important. [Some studies have even shown](https://pubmed.ncbi.nlm.nih.gov/21750519/) that half a litre of water increases metabolism for an hour. 

## How can I maintain a healthy metabolism?
Although there’s no way to ‘reset’ your metabolism, you can help to minimise imbalances by staying well-hydrated, exercising regularly, eating a healthy well-balanced diet and getting enough sleep – all factors that lead to a healthier life in general.

## When should I speak to a doctor about my metabolism?
If you’re concerned about any of the associated symptoms with a fast or slow metabolism above, then speak to a doctor. 

If you have unexplained weight loss or a loss of appetite, seek medical help.

__This article has been medically reviewed by Dr Bryony Henderson.__


Section > Call out > Metabolism CTA

Speak to a GP

Your health > What is metabolism – and why is it important?

What is metabolism?

Your metabolism converts the food you eat into energy for key bodily functions. Having a slow or fast metabolism can affect your weight. Find out how it works. 

Meta information > What is metabolism

What is metabolism and why is it important? | Kry UK

Nutrition

What is your metabolism and why is it important?

Lots of people enjoy anal sex as a regular part of their sex lives. But stubborn taboos mean it’s not always talked about openly or covered in sex education.

Let’s set the record straight – anal sex can be a safe, [healthy](https://www.livi.co.uk/your-health/boost-your-sexual-health/) part of your sex life, as long as you know how to prepare. 

## What is anal sex?
Anal sex is where one partner’s penis enters their partner’s anus. Anal sex or anal play could also refer to any kind of sex act involving the anus, whether it involves hands, a mouth, or a sex toy. 

## Who has anal sex? 
People of all sexes, genders and sexual orientations can and do have anal sex. 

And people are having more of it than ever. [Surveys](https://www.jahonline.org/article/S1054-139X(17)30330-0/fulltext) in the UK found that the percentage of women ages 22-24 who’ve had heterosexual anal sex rose from 17% in 1990 to 34% in 2012. The proportion almost tripled in men of the same age, from 14% to 39%.

## Is anal sex safe?
Anal sex is safe and shouldn’t hurt as long as you and your partner take some care. First of all, make sure you both know the risks so you can lower them. 

The main risks of anal sex include:
- __Pain and bleeding__ – the lining of the anus is thin, so it’s at risk of tearing if it’s put under too much strain. 
- __Sexually transmitted infections (STIs)__ – since the lining of the anus is prone to damage, anal sex has a higher risk of infections than some other types of sex, including [STIs](https://www.livi.co.uk/medical-advice/infections/stis/).
- __Injury__ – the anal sphincter (the muscles around your bottom that control when you poo), can get hurt during sex.
- __Incontinence__ – if you have female anatomy, this puts you at a [higher risk](https://www.bmj.com/company/newsroom/doctors-reluctance-to-discuss-anal-sex-is-letting-down-young-women/) of faecal incontinence, where you can’t control your bowel movements, as a result of anal sex.

Having anal sex after a night out or when you’ve been drinking can also increase some of these risks. So, if you’re just starting out with anal sex, try to limit your alcohol consumption so that you’re more aware and able to take care of yourself. 

## Consent and anal sex
Consent is key for any kind of sexual activity. [Up to a quarter](https://www.bmj.com/company/newsroom/doctors-reluctance-to-discuss-anal-sex-is-letting-down-young-women/) of women who’ve had anal sex said they’d been pressured into having it at least once. 

Talk to your partner about what consent means to you, and always make sure your partner actively consents to sex. No one should be coerced into doing something they don’t want to do and remember that consent can also be taken back at any time. 

## How to have anal sex safely 

All it takes are a few simple steps to make anal sex enjoyable and safe. 

### 1. Open up to your partner/s
Before you have sex, talk to your partner/s about what you want to try and what you don’t want to do. The more open you can be with each other about your desires and boundaries, the better your experience can be. 

### 2. Have a condom ready
Using a condom lowers the risk of STIs. Even if you’re not having vaginal sex, there’s still a risk of pregnancy if semen gets in contact with a vagina, so make sure to have a condom ready to go. 

If you have vaginal sex after anal sex, switch to a new condom. This will stop bacteria from the anus getting into the vagina and causing a [UTI](https://www.livi.co.uk/medical-advice/infections/urinary-tract-infection-uti/). If your hands are involved, give them a good wash too.

### 3. Practise good hygiene
Before you have sex, give your bottom a thorough wash in the shower with soap and water, and make sure to rinse and dry it well. 

Afterwards, try to clean up right away to rinse off any bacteria. You can use a wipe or soap and water to wash your bottom, genitals and any toys you used. Remember to wash or wipe from front to back to reduce the risk of bacteria causing a urine infection. 

### 4. Use lots of lube 
Unlike the vagina, the anus doesn’t have any natural lubrication. Using lube won’t just make the experience more enjoyable, it’ll also help prevent any pain or injuries. 

Any water-based lubricant you can find at a pharmacy will do the trick. Avoid oil-based lubricants, including lotion or moisturisers, because it can cause condoms to break. 

### 5. Go slow 
Pace yourself and start things off slow. Make sure you and your partner are relaxed and aroused before any penetration. Rushing can be [painful](https://www.livi.co.uk/your-health/what-causes-painful-sex-and-pain-after-sex/) at best and cause an injury at worst. 

If you’ve never tried anal sex before, you could try experimenting with some anal play [on your own](https://www.livi.co.uk/your-health/is-masturbation-good-for-you/) first. It might help you figure out what you do and don’t like.

## What’s the bottom line on anal sex? 
When it comes to anal sex, being open with your partner and getting prepped are key. It can be safe and pleasurable as long as you and your partner are both on board, well-educated and well-prepped. 

## When to speak to a doctor 
If you’ve got any bleeding or pain around the anus or are struggling to control when you poo, make an appointment to speak to a doctor. It can feel awkward to talk about anal problems, but they’re more common than you think and a doctor is there to help. 

## What can Livi do to help?
If you’re experiencing pain, bleeding or think you may have injured yourself, a Livi healthcare professional can talk to you about your symptoms and help direct you to the right support or treatment.

__This article has been medically reviewed by Lead Livi GP, Dr Bryony Henderson.__


Section > Call out > Anal sex CTA

Livi.co.uk > Your health > Everything you need to know about anal sex

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Anal sex can be safe, pleasurable, and fun – it just takes a little prep. Here’s what you need to know and do before trying it out.

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Everything you need to know about anal sex | Kry

Sexual health and contraceptives

Sexual health

Everything you need to know about anal sex

### Why should I get tested?

Some STIs, such as chlamydia, can have no symptoms. Yet if left untreated, they can have serious consequences. The good news is they are all treatable by a doctor.

So, to protect yourself, always get tested if you’ve had unprotected sex with a new partner. Using a barrier method such as male or female condoms with a new partner is still the best way to avoid getting an STI.

Here are 10 common STIs (sometimes called STDs), their symptoms, how they are tested and their treatments.

## 1. Chlamydia

### Symptoms
When they do show, in women these might include: pain when urinating; unusual vaginal discharge; pain in the abdomen or pelvis; or, extra sensitivity during sex, bleeding after sex and bleeding between periods. If chlamydia is left untreated, it can lead to pelvic inflammatory disease (PID), which can cause ectopic pregnancy and infertility in women.

Men should look out for pain when urinating, white, cloudy or watery discharge from the tip of the penis, burning or itching in the urethra and pain in the testicles. Left untreated, the infection can cause swelling in the epididymis (the tubes that carry sperm) and the testicles. This might affect fertility. Chlamydia can also affect the throat (although this is rare), rectum (via anal sex) and eyes.

### Testing
Involves a urine or swab test. You can be tested through a local sexual health clinic, a contraceptive clinic or your GP. If you’re under 25 you can get a kit sent to you free via pharmacies and other local venues. [Search for venues near you](https://www.nhs.uk/service-search/other-services/Chlamydia-free-online-tests-for-u-25s/LocationSearch/344).

### Treatment
Antibiotics will be prescribed to treat the infection. You should avoid sex until the infection is gone.

## 2. Gonorrhoea
Gonorrhoea is caused by the bacterium Neisseria gonorrhoeae or gonococcus, which is spread through unprotected vaginal, anal or oral sex, or contact with genital fluid, including sharing sex toys. Less commonly, it can affect the throat or eyes. If passed on during labour, it can cause permanent blindness in a newborn.

### Symptoms
Include a thick green or yellow discharge from the vagina or penis, pain when urinating or lower abdominal/vaginal pain and discomfort. Around 1 in 10 men and more than half of women do not experience any symptoms.

### Testing
Completed by a swab test or can be a urine test in men. If left untreated, gonorrhoea can lead to PID and infertility in women.

### Treatment
Antibiotics will be given to clear the infection. This can either be by injection, a tablet, or a combination of both. 

## 3. Trichomoniasis 
Trichomoniasis is caused by a parasite called Trichomonas vaginalis.

### Symptoms
Usually develop within a month of infection – similar to those of many other STIs, which can make it difficult to diagnose. Up to half of all people will not develop any symptoms, though they can still be infectious.

### Testing
Diagnosed after an examination of the genitals and a sample taken using a swab from the vagina or penis. If the test is positive, it's important that your sexual partner and any other recent partners are also tested and treated.

### Treatment
Unlikely to go away without treatment, but it can be effectively treated with antibiotics (usually metronidazole).

## 4. Genital warts
Caused by human papillomavirus (HPV), a type of virus that infects the skin. There are hundreds of different types of HPV but around 13 of these can cause cancer, including cervical cancer in women. The strain of HPV that causes cervical cancer doesn’t cause genital warts, but it’s still very important to have regular cervical screenings. The best way to avoid becoming infected is to use a condom. 

### Symptoms
Include one or more lumps, bumps or fleshy, cauliflower-like growths around the genitals or anus. There might also be discomfort, itching or bleeding, and changes to the flow of urine.

### Testing
For genital warts, testing is done by a physical examination of the genital area.

### Treatment
May include the application of a prescription cream or liquid over several weeks, or surgery where warts are cut, burnt, lasered or frozen off.

## 5. Genital herpes
Genital herpes is caused by the herpes simplex viruses, HSV-1 and HSV-2. They’re passed on through sexual contact (vagina, penis, anus, mouth). People can pass on the herpes virus when they’re not showing any symptoms.

### Symptoms
Include small, fluid-filled blisters (on the genitals or anus) leaving open sores. These burst and cause severe tingling and itching, burning when urinating and women might have a vaginal discharge. Symptoms may take months or even years to appear after you’ve become infected. These clear up by themselves (usually within 2 weeks) but come back periodically. Recurrent outbreaks are usually milder.

### Testing
Usually carried out by taking a swab of fluid from the affected blisters.  

### Treatment
There is no cure for herpes and it can lie dormant in the body for months or years. You might be prescribed antiviral medicine to stop symptoms worsening. Local anaesthetic ointment and soothing creams might also be prescribed to help alleviate itching and pain. Taking a cool shower or bath might also help.

## 6. Public lice
Pubic lice are tiny insects that live on pubic hair around the penis or vagina. They are spread through close body contact, mostly through sexual contact. Public lice are also referred to as crabs.

### Symptoms
They most often live on pubic hair but can also be found in hair on the chest, armpits, face and eyelashes – but are often too small to see. Other symptoms of pubic lice include:

- Itching that is usually worse at night
- small red or blue spots on your skin (lice bites)
- white/yellow dots attached to your hair (lice eggs)
- dark red or brown spots in your underwear (lice poo)
- crusted or sticky eyelashes, if they're affected

### Testing
A doctor or nurse will check your hair for lice, and specifically your pubic hair. They may use a comb or a magnifying lens and ask about your sexual partners. It is usually suggested to get tested for any other STIs too.

### Treatment
Medicated creams or shampoos will be prescribed to kill the lice. You may need to repeat this again a week later to make sure all the lice have been killed. A follow up appointment may also be needed to check the treatment has worked. Any current or recent sexual partners should also be treated, even if they have no symptoms.

## 7. Scabies
Scabies is a common STI that can affect anyone. It should be treated quickly to prevent it from spreading. Scabies is very infectious but can take up to 8 weeks for visible symptoms to appear.

### Symptoms
Intense itching especially at night and a raised rash or spots. These may look red and are more difficult to see on dark skin (but you can feel them). The rash usually spreads across the body, apart from the head.

### Testing
A GP can advise you whether your symptoms suggest you have scabies and they can prescribe a treatment. A pharmacist can help with this too.

### Treatment
A doctor or pharmacist will recommend a cream or lotion to apply over your whole body. Let them know if you are pregnant or breastfeeding. You'll need to repeat the treatment a week later. Everyone in your home needs to be treated at the same time, even if they do not have symptoms. Any sexual partners within the past 8 weeks should also be treated.

## 8. Syphilis
Syphilis is a chronic infectious disease caused by Treponema pallidum, a type of bacterium. It’s most commonly spread during sex (vaginal, anal or oral) or through close contact with an infected sore. It can be passed on from mother to baby (congenital syphilis) with an increased risk of miscarriage, fetal death and premature birth.

### Symptoms
Usually includes a small, painless sore or ulcer on the vagina, penis, anus, mouth or other area (21 days after incubation). This resolves spontaneously after 1-2 months and is followed after 6-8 weeks by flu-like symptoms – fatigue, headache, fever, joint pains and swollen glands usually a couple of months after being infected. Left untreated, syphilis can spread to the brain and other parts of the body many years after infection.

### Testing
Involves a physical genital examination, a blood test and swab test (if there are any sores).

### Treatment
Includes a penicillin injection or (if you’re allergic to penicillin) a 10-14 day course of antibiotics. If you’ve had syphilis for longer than 2 years or symptoms are more serious, you might need weekly or even daily injections or a longer course of antibiotics (28 days).

## 9. Human papillomavirus (HPV)
HPV is the name of a very common group of viruses affecting the skin. For most people, they do not cause medical problems, but some types can cause genital warts or cancer. There are more than 100 different types of HPV.

### Symptoms
Often there are no symptoms but sometimes the virus can cause painless growths or lumps around your vagina, penis or anus (genital warts).

### Testing
HPV testing is a routine part of [cervical screening](/your-health/what-happens-during-a-cervical-screening-test/) for women. There's currently no blood test for HPV. Cervical screening is offered to all women and people with a cervix aged 25 to 64. This helps protect them against [cervical cancer](/medical-advice/cancer/cervical-cancer/).

### Treatment
There is no treatment for HPV, but most infections do not cause problems and are cleared by your body within 2 years. Treatment is needed if HPV causes medical problems like genital warts or changes to cells in your cervix.

## 10. HIV
Human immunodeficiency virus affects the cells in your immune system and their ability to fight everyday infections and disease. HIV infection is found in body fluids and is most commonly transmitted through sexual contact. It can also be passed on by sharing needles (among drug addicts) and can be passed on from mother to baby.

### Symptoms
Most people experience a short flu-like illness around 2-6 weeks after initial infection. HIV might not cause any symptoms for many years. AIDS (acquired immune deficiency syndrome) describes the potentially life-threatening infections and illnesses that might occur when your immune system is severely damaged by the HIV virus. 

### Testing
For HIV, testing is done by taking a sample of blood or saliva to check for the infection. 

### Treatment
There’s no cure for HIV but there are now effective drug treatments to manage it. These include antiretroviral medicines that work by stopping the virus from replicating itself in the body, allowing the immune system to repair itself. This means people with HIV can usually lead long lives if they take medication.

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Kry.co.uk > Your health > 10 common STIs and their treatments

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Looking after your sexual health is always important – especially as some sexually transmitted infections take time to show up, while others have no symptoms at all

10 common STIs and their treatments

General health

General health and seasonal

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[A recent survey](https://thebms.org.uk/2021/08/the-british-menopause-society-response-to-the-department-of-health-and-social-cares-call-for-evidence-to-help-inform-the-development-of-the-governments-womens-health-strateg/) found that 45% of women felt that menopausal symptoms had a negative impact on their work. But thanks to an increased focus from campaigning groups, charities and the media, more people than ever are starting to talk openly about the menopause.

[Menopause](/medical-advice/endocrine-system/menopause/) doesn’t just affect people who identify as women. It can also affect some transgender men, non-binary people and intersex people.

## What are the stages of menopause?
‘Menopause is the natural ageing process of a woman’s ovaries, affecting their production of oestrogen and progesterone, and eventually causing periods and ovulation to stop,’ explains Dr Rosén. In the UK, the [average age](/your-health/what-age-will-i-reach-menopause-a-doctors-guide/) for a woman to reach the menopause is 51.

Perimenopause is the transition towards menopause which can take several years. The first sign is usually a change to your [menstrual cycle](/your-health/your-menstrual-cycle-explained/) where it starts to become shorter and more irregular, and then becomes heavier with longer bleeds.

Your oestrogen production will continue to decrease for a few years after you reach menopause. Around 5 years after your last period marks the end of menopause and the beginning of post-menopause.

## What are the most common menopause symptoms?
‘Although it can be a slow and gradual process, women may experience a range of mild to severe symptoms’, says Dr Rosén.

‘The decrease in hormone levels will affect the body in many different ways, and be different for every person.’

There are 3 key types of [symptoms caused by menopause](/your-health/7-signs-of-perimenopause-a-doctors-guide/) – changes to your periods, your mental health and your physical health.

Some of the most common [mental health symptoms](/your-health/lets-talk-about-menopause-and-mental-health/) include low mood, [anxiety](/medical-advice/mental-health/anxiety/), [depression](/medical-advice/mental-health/depression/), brain fog and problems with concentration.

Other physical symptoms include hot flushes, problems sleeping, heart palpitations, low libido, vaginal dryness, joint pain and migraines.

## How can menopause affect you at work?
Menopause can have a significant impact on your working life. Sometimes the symptoms of menopause or your working conditions while going through the menopause can affect your concentration, attention to detail or ability to carry out your role properly.

‘Lots of women find managing their menopause symptoms in the workplace challenging – partly because of how difficult it can be to talk openly about menopause at work,’ says Dr Elisabeth Rosén.

The good news is that workplaces are getting better at supporting menopausal women who are the fast-growing demographic at work in the UK.

## How to manage menopause symptoms at work
Opening up about your health to someone at work can feel uncomfortable or awkward. Especially if you don’t feel comfortable talking about personal matters to colleagues.

But the first step to getting help is to speak to your line manager, HR team or occupational health service. The more we talk, the easier the conversations will become.

__1. Keep communicating__
Regular conversations can help to discuss things like flexible working hours, working from home and your work environment (easy access to fresh air, bathroom facilities, cold water etc.) It can be helpful to take notes of your menopausal symptoms as well as how they are affecting you. 

__2. Share your experience__ 
It can be helpful to let others know you’re going through the menopause – either with colleagues you can trust or with external support groups. This can help reduce the stigma and widen your support network. You may also want to prepare for conversations at work by talking it through with a friend or family member. 

__3. Ask about adjustments__ 
There are lots of practical changes that can make a big difference, and you’re entitled to ask for these. For hot flushes, ask about a desk fan or to sit near a window. Ahead of any meetings to discuss your symptoms, have a think about some of these solutions so that your employer knows you’re taking your health and work seriously.

__4. Build in breaks to your day__ 
Give yourself enough rest and quiet time to recharge throughout the day, and make this a priority. Meditation, mindfulness and other relaxation techniques during your break may help to reduce your symptoms too. It’s also important to stick to a regular sleep routine, so that you can properly rest after each working day.

__5. Make the most of technology__ 
You may already do so, but it can help to set yourself digital reminders for important meetings and tasks, or get into the habit of using digital note-taking tools. This technology is a great way to overcome the stress caused by brain fog and other memory-related symptoms. 

__6. Ask about other support__ 
Find out if your employer has a menopause policy or health insurance which can guide you through the support available. For example, can your workstation be more comfortable? In some areas you can access local menopause cafes or online groups to speak to people going through a similar experience.

__7. Take the time you need__ 
If you’re struggling to manage your symptoms, speak to your employer about whether you need to take some time off. Outside of work, as well as treatment like [HRT](/your-health/what-is-hrt/), you should consider making some simple lifestyle changes such as more regular exercise and eating a healthy balanced diet. 

kry.co.uk  > article page >  CTA 

Kry.co.uk > Your health > 7 tips for managing menopause symptoms at work

Woman with fan managing menopausal symptoms at work

Managing menopause symptoms at work

Menopause has lots of mental and physical symptoms that can be challenging to manage at work. We speak to our women’s health expert for her specialist advice.

7 tips for managing menopause symptoms at work

Women Health

Women's Health

Ever landed awkwardly on your ankle playing sport or rolled your ankle while walking? A sprained ankle can be painful. A [mild sprain](/your-health/what-is-a-sprain/) means you’ve overstretched your ligaments – the strong but stretchy bands that hold your bones in place and keep your joint stable. A severe sprain can cause the ligaments to tear. 

It can be difficult to know whether you’ve strained, sprained or broken your ankle. Here’s how to tell what type of injury you might have and how to get the best treatment for the fastest possible recovery.

## First aid tips for an ankle sprain
Even if you don’t know whether it’s a sprain or break, if you twist or jolt your ankle painfully, follow these first steps to prevent further injury and to help with healing in the long-run:

- Avoid putting weight on it if it’s very painful and make sure you rest your ankle
- Sit in a comfortable position with your ankle elevated
- Use a crutch or friend for support
- Place ice or a cold compress on the ankle as soon as you can. It helps if this is done regularly throughout the first few days
- Keep your ankle elevated as much as you can
- Seek medical help if the pain and swelling is severe

## How do I know if I have a sprained ankle?
A sprained ankle will feel painful but it may also start to look swollen and bruised. Your symptoms will depend on how bad your injury is, the initial symptoms might be:

- Pain
- Swelling
- Bruising
- Restricted movement of the ankle
- Difficulty putting weight on your foot or more pain when you do
- Feeling wobbly or unstable when you try to stand on it

## Sprained ankle vs broken ankle – what’s the difference?

A [sprain](/your-health/what-is-a-sprain/) happens when you damage the ligaments in your ankle – either stretching them beyond their limit or tearing them completely. An ankle fracture or break happens when at least one of the bones in your ankle breaks.

There are some key ways to help you identify which your injury might be:

- __Noise__ – a sprain may be silent or in severe cases cause a popping sound. With a fracture, you’ll likely hear a loud crack.
- __Shape__ – swelling can happen with both injuries, but if your ankle looks out of shape or off its usual position, this means it’s most likely broken.
- __Feeling__ – with a sprain, you’ll usually feel pain. If you have numbness or tingling, your ankle is more likely broken.
- __Pain placement__ – if the pain is in the soft part of your ankle, it’s more likely a sprain. If your ankle hurts directly above the ankle bone, you probably have a fracture.

Still not sure? Speak to a doctor. They can properly examine your ankle and identify which injury you have so you can get the best ankle sprain or break treatment. If it’s a bad injury then they may suggest that you have an X-ray to look at the bones in your ankle.

## When should I seek medical help?
You don’t always need medical help for a sprained ankle. You can usually follow some self-care steps at home to aid the healing process, including RICE – Rest, Ice, Compress, Elevate.

If your sprain is very bad, the skin is broken, if your ankle is too painful to stand on or you think the bone might be fractured, seek medical attention as soon as possible. It may be best to go to an urgent treatment centre or minor injury unit where they will help to determine the injury type. You can phone NHS 111 if you’re not sure.

You should also seek medical help if your ankle is still painful or the swelling doesn’t improve after a few days. If you keep spraining your ankle or it feels unstable when you walk on it, make an appointment to see a doctor or physiotherapist, and they can help find you the right support.

## The best self-help steps for a mild sprained ankle
Most minor ankle sprains will get better on their own.  

Try the RICE method for the first 2-3 days:
- __Rest__ - try not to put weight on your ankle as much as possible
- __Ice__ - place an ice pack (or a bag of frozen peas wrapped in a towel) on the ankle joint for about 20 minutes every 2-3 hours
- __Compression__ - use a bandage or ankle support, but be careful not to wrap too tightly
- __Elevation__ - keep your ankle above your heart as much as you can, try propping it up with pillows

You can also try the following:
- Take an anti-inflammatory drug to ease the pain if you’re able to do so
- Try physiotherapy for a moderate sprain or introduce your own exercises to increase the range of motion once the pain and swelling go down.

## The best sprained ankle treatments if the sprain is severe

If your sprain is severe, it’s best to seek medical help as soon as you can. To diagnose the injury, a healthcare professional will likely do an imaging scan to rule out a fracture or to look in more detail at your ligament damage. They may do one of the following:

- X-ray
- MRI
- CT scan
- Ultrasound

You then might need any of the following treatments or methods for a severe ankle sprain:

- __Medication__ – pain relievers and anti-inflammatories recommended by a doctor can help to ease the pain
- __Crutches or a support brace__ – these can help to stabilise the ankle while it heals
- __Physiotherapy__ – once the swelling and pain has reduced, a doctor or physical therapist will be able to recommend exercises to help you build stabilisation and balance
- __Surgery__ - on rare occasions when the injury doesn’t heal or the ankle remains unstable, you may need surgery

## How long does a sprained ankle take to heal?
Most sprained ankles are minor, but your injury – and recovery time – depends on the severity of damage to your ligaments. 

__Grade 1 sprain__ – one or more ligaments in your ankle is overstretched but not torn. You’ll likely see normal range in your foot after a few days, and this type of sprain usually heals within 2 weeks.

__Grade 2 sprain__ – your ligament is partially torn and a doctor may be able to feel the instability when they move your ankle. This can take 6-8 weeks for the swelling to go down and for the injury to heal properly.

__Grade 3 sprain__ – your ligament is completely torn. This can take 3-6 months or longer for you to regain full strength and movement in the foot.

__This article has been medically reviewed by Dr Bryony Henderson, Lead Kry GP.__


kry.co.uk > CTA > Ankle sprain

Speak to a GP about an ankle sprain

kry.co.uk > Your Health > Sprained ankle

Ankle sprain

A sprained ankle can be painful and requires rest and recovery – discover the best ways to manage a sprained ankle.

Meta information > Your Health > Sprained ankle

What to do if you have a sprained ankle | Kry UK

What to do if you have a sprained ankle

Feeling itchy on or around your testicles can simply be caused by sweating in your groin area from lots of walking or being sat in a stuffy office. But there are other medical reasons that cause itching which can be easily treated. 

## What are the causes of itchy testicles?
Although the problem is usually benign, itchy testicles can be caused by a number of different factors.

### Dryness
Dryness is the result of not enough moisture in the skin. The symptoms of skin dryness are quite varied. You may notice peeling skin on the surface layer, a rough appearance, redness or dry patches.

Symptoms of dryness are often associated with itching, a feeling of tightness in the skin and occasionally a painful or burning sensation.

### Irritation
Skin irritation can be caused by several things. In some cases it may be the result of chafing, but it could also be an allergy to a chemical substance such as shower gels, soap, washing powder, fragrance or latex.

### Crabs
Crabs (pediculosis pubis or phtiriasis pubis), also known as pubic lice, are classified as a [sexually transmitted infection (STI)](/your-health/10-common-stis-and-their-treaments/). They are usually transmitted via sexual contact, infested bed linen or clothing. If they’re not treated promptly, crabs can spread to other areas of the body including the eyelashes, chest, face and armpits.

### Maceration
Maceration is extremely common and is caused by excessive sweating ([hyperhidrosis](/your-health/what-causes-excessive-sweating-doctors-guide-to-hyperhidrosis/)) and occurs mainly during the summer months, particularly in sporty or overweight people. Certain clothing like swimwear can also be a cause of maceration.

### Genital thrush
Genital thrush is usually caused by a fungus called candida albicans. This fungus spreads and causes redness associated with itching, and can also cause an intense burning sensation. It can be accompanied by white discharge and a bad smell.

Genital thrush may be confined to the testicles, but can also affect the glands and cause inflammation of the penis (balantis), and even spread to the anal area or thigh.

### Eczema and psoriasis 
Chronic inflammatory skin diseases like [eczema](/medical-advice/skin-conditions/eczema/) and [psoriasis](/medical-advice/skin-conditions/psoriasis/), may be specifically located in the genital area. These diseases are usually long-term but not contagious.

### Scabies
[Scabies](/medical-advice/skin-conditions/scabies/) is a highly contagious disease caused by a tiny parasite called sarcoptes. It penetrates the skin and reproduces there. It’s most often transmitted through direct, close or repeated contact with an infected person.

It’s also considered to be an STI because of potential contamination during sexual intercourse. Scabies-induced itching affects several areas of the body, including male genitals.

## Other symptoms of itchy testicles
Pruritus is an itchy sensation of the skin or mucous membranes, triggering the need to scratch. It can affect any part of the body, including the pubic area in men. Sometimes it can spread to the thighs or anus.

There are multiple symptoms associated with itching, depending on the cause of the itch, and these can vary from one person to another. Some men only experience itching at night. Other symptoms that often accompany itching include:

- Little spots or a rash 
- Redness
- Stinging 
- Flaking of the outer layer of skin
- Dry patches
- Bad smell 
- Pain or a burning sensation 
- Changes in the colour or appearance of the skin 
- Discharge

## What should you do if you have itchy testicles?
If the irritation around the testicles continues and does not go away within a couple of days, or if skin lesions develop, get medical advice from a GP. They can recommend a treatment or refer you to a dermatologist.

The right treatment depends on what’s causing your symptoms. In the case of an STI, a complete check-up should be performed and generally, all sexual partners should seek treatment.


Speak to a GP about itchy testicles

kry.co.uk > Your health > Why are my testicles itchy?

why are my testicles itchy

Itchy testicles are a common problem for men. We take a look at the possible causes and how it can be treated.

Why are my testicles itchy? | Kry

Men Health

Men's Health

Why are my testicles itchy?

[More than 8 in 10 workers](https://www.ons.gov.uk/employmentandlabourmarket/) who worked from home during the Covid-19 pandemic planned to continue with hybrid working. Since then, hybrid working in the UK has risen from 13% in early February 2022 to 24% in May 2022.

We take a look at some of the physical and psychological consequences of working from home for an extended period of time, and the steps you can take to protect and improve your health.

## 1. Loneliness

Working from home offers lots of benefits. You avoid long commutes to and from your place of work and have more time for your family and other interests. But the social aspects of our jobs are very important to some of us.

Working from home for long periods of time can lead to feelings of loneliness and social exclusion. Studies show that involuntary loneliness takes a great toll on our mental health, and may lead to [depression](/medical-advice/mental-health/depression/) and [anxiety](/medical-advice/mental-health/anxiety/). 

### How to feel less lonely working from home

If you mostly work from home, or going to the office to see colleagues is not an option, you can actively look for other ways to ease your loneliness.
Find a coworking space – If you’re a freelancer or don’t have an office, you can rent a desk in a coworking space. Find your nearest coworking space and try working from there a few days a week.

Communicate digitally – Try to stay in touch with colleagues and friends via phone calls, video calls and text messages. While this isn’t the same as meeting face-to-face, it may help you feel less isolated.
Spend more time with friends – Make an effort to spend some extra time socialising with a friend or neighbour, either during your lunch break, evenings or weekends. 

## 2. Muscle stiffness

Working from home often involves long periods of sitting in front of your computer. Some of us may experience muscle stiffness and discomfort after prolonged periods of inactivity. You’ll usually be able to ease this stiffness simply by moving around.

Here are 2 exercises you can do to relieve a stiff neck and shoulders:

### Stretch your neck

- Keeping your shoulders straight and relaxed, gently incline your neck sideways until your ear touches your shoulder
- Hold for 15 to 30 seconds and then gently incline your head to the other side
- Turn your head so that your nose touches your armpit, hold for 15 to 30 seconds and then change sides
- Lower your chin towards your chest while carefully holding the back of your head with both hands 
- Hold for 15 to 30 seconds and repeat these exercises 2 or 3 times

### Roll your shoulders

- Stretch your back so you’re sitting or standing straight and relaxed
- Roll your shoulders upwards, backwards and down
- Repeat this movement up to 10 times

## 3. Excess weight and obesity

Working from home inevitably involves more sitting still. Moving about more and exercising can reduce your risk of excess weight and obesity, low mood and anxiety.

Several conditions are linked to excess weight and obesity, such as [type 2 diabetes](/medical-advice/type-2-diabetes/), [high blood pressure](/medical-advice/cardiovascular-diseases/hypertension/) and other cardiovascular diseases. Arthritis, a common condition that causes pain and inflammation in your joints, is also associated with excess weight and obesity.

### How to manage your weight

There’s a lot you can do to improve your health and maintain a healthy weight:

__Diet__ ‒ eat regular healthy and balanced meals. Remember to eat slowly and mindfully, and stop when you feel full.

__Activity__ ‒ exercise regularly for at least 30 minutes a day and try to include both strength and conditioning training. It’s important to start exercising at a light to moderate level and gradually increase your activity.

__Behaviour__ ‒ identify and embrace the activities or habits that help you maintain a healthy lifestyle.

__Social support__ ‒ tell your friends and family that you’re making a conscious effort to improve your health, and ask for their help and support.

## 4. Piles (haemorrhoids)

You can develop gastrointestinal problems like piles after sitting still for long periods of time. Piles may also be caused by [constipation](/medical-advice/digestive-problems/constipation/), especially if you strain too hard on the toilet. 

If you notice any bleeding after you poo, always speak to a GP. Or if you already know that you have piles, keep them clean and dry, but avoid using soap as this may irritate your skin. There are creams available from the pharmacy to ease the pain, itching and swelling. 

### How to avoid constipation and piles

- [Drink more water](/your-health/why-is-hydration-so-important-a-doctors-guide/) and eat plenty of fibre
- Go to the toilet regularly
- Try and get some exercise each day
- Try over-the-counter medicines that soften your poo

## 5. Skin problems

Dry indoor air can make your skin especially sensitive and sometimes cause skin problems. When your skin is dry, its natural protective barrier has been damaged by the lack of moisture and oils in your skin. 

Typical symptoms include tight, inflamed or flaky skin that itches. Your skin may even crack and bleed. These problems can lead to [eczema](/medical-advice/skin-conditions/eczema/), which may require treatment with emollients and steroid creams.

If your skin tends to be dry, you’ll need to regularly apply moisturising and hydrating products. This helps to restore your skin’s elasticity and protect it from further damage. You can get emollients and moisturising products from the pharmacy.

### How to avoid and treat dry skin

- Regularly moisturise your skin especially after washing
- Don’t scratch as it will make the problem worse and can cause infection
- Stick to shorter showers as water strips your skin of its natural oils
- Avoid harsh soaps and choose products made with natural plant oils
- Use rubber gloves when washing up to protect your hands
- Limit the amount of time you spend in the sun and always apply sunscreen
- Protect your skin against the cold as chilly, dry air is tough on your skin

## 6. Alcohol dependence

For some people, working from home contributes to a lack of routine and social isolation. This can increase your risk of having [problems with alcohol](/medical-advice/mental-health/support-for-addiction/) – especially for people who may have experienced these struggles in the past. 

A temporary high intake of alcohol has an immediate effect on the nerve cells in your brain – it impairs your judgement, your responses, your balance and your memory.

Your muscles and emotions are also harder to control, your sleep is disrupted and you may experience nausea and vomiting. A really high blood alcohol level can lead to unconsciousness and alcohol poisoning which requires urgent care.

### How to spot the warning signs

If you suspect that you have an unhealthy relationship with alcohol, it’s important to seek professional help. Here are some of the signs to look out for:

- You feel a strong craving for alcohol
- You drink more, for longer and more frequently than you intended
- You need to drink more to get the same effect
- You have memory gaps and feel shame about your drinking
- Alcohol has a dominant role in your life to the detriment of everything else
- You’ve tried to cut down on your drinking with no success
- You experience withdrawal symptoms if you don’t drink such as shaking and feeling sick
- You drink in secret or continue drinking to cure a hangover
- You drink to cope with your daily life
- The people around you are concerned you drink too much
- Your drinking is causing you financial problems and/or relationship problems, or making you suicidal
- If you’re struggling to limit or give up drinking, you can get help in several different ways. You can contact your GP, or alcohol support services such as Drinkchat, Drinkline, Alcoholics Anonymous or With You.

## 7. Mental health problems

Spending more time at home without regular social contact can increase low mood, [anxiety](/medical-advice/mental-health/anxiety/), and [depression](/medical-advice/mental-health/depression/) for some of us.

Depression is a state of feeling persistently sad for weeks or months, and losing interest in the things you used to enjoy. Sleeping badly and feelings of lethargy and hopelessness are other common symptoms.

While depression may be triggered by traumatic life events or setbacks, sometimes there’s no obvious cause. Genetic factors and anxiety-related difficulties can make you more susceptible.

### Ways to improve your mental health

__Get some fresh air__ – going outdoors every day helps to boost your mood, as both the light and natural vitamin D are good for you, and give you a much-needed break from work.

__Stay active__ – physical activity makes you more resilient against anxiety and low mood, and can alleviate stress, worrying and sleeping difficulties.
Eat healthily – nourishing food at regular intervals throughout the day helps your body to function better.

__Prioritise sleep__ – good sleeping habits make you less prone to low mood, anxiety and depression.

__Avoid stress__ – make time in your working week for relaxation, mindfulness or an activity that you feel has a positive impact on your stress levels.


Speak to a GP about your mental health

kry.co.uk > Your health > 7 ways working from home affects our health

how working from home affects our health

More of us are adapting to a new hybrid way of working. We take a look at the effects on your physical and mental health of working from home.

7 ways working from home affects our health | Kry

7 ways working from home affects our health

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