No, the coronavirus vaccine won’t make you infertile

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Dr. Marina Del Rios, from University of Illinois Hospital & Health Sciences System, receives Chicago’s first COVID-19 vaccination from Dr. Nikhila Juvvadi on Tuesday, Dec. 15, 2020, at Loretto Hospital, a 122-bed medical facility in the Austin neighborhood of Chicago. Jose M. Osorio/Chicago Tribune via AP

  • A now-blocked Facebook post that went viral claimed the coronavirus vaccine could cause infertility.
  • It suggested incorrectly that the vaccine teaches the body to attack a protein involved in placental development.
  • In reality, the protein the vaccine spurs the body to make and attack bears little resemblance to the one in the placenta.
  • Although data is still lacking as to how the coronavirus vaccine
  • works in pregnant women, experts expect it to be safe and say that women who are pregnant or of childbearing age should be able to get it if they want.

A post that was circulating on social media falsely claimed that Pfizer’s new coronavirus vaccine could cause infertility in women. The vaccine is “female sterilization,” an image in the post said, incorrectly attributing the myth to the “head of Pfizer research.”

The post, which has since been blocked by Facebook as “false information,” promoted an incorrect idea that the vaccine spurs the immune system to attack both a protein in the coronavirus and also a protein involved in the formation of the placenta – the organ that delivers oxygen and nutrients to the fetus during pregnancy

But experts say there’s no evidence the vaccine could lead to infertility.”Based on the way it’s made, it should be safe,” Dr. Zaher Merhi, an OB-GYN, reproductive endocrinology and infertility specialist, and the founder of Rejuvenating Fertility Center, told Insider.

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Rachel Greenspan/screenshot

The protein the vaccine teaches the body to fend off is not the same as the one involved in placental formation

According to USA Today, the post, written by an unidentifiable author, said: “The vaccine contains a spike protein (see image) called syncytin-1, vital for the formation of the human placenta in women.”

“If the vaccine works so that we form an immune response AGAINST the spike protein, we are also training the female body to attack syncytin-1, which could lead to infertility for an unspecified duration.”

That’s not true. First, the vaccine does not contain syncytin-1, but rather mRNA: genetic instructions that spur the body to produce, and therefore recognize, the unique spike protein that the novel coronavirus uses to latch onto cells.

While it’s true that syncytin-1 and the coronavirus’s spike protein share a small amino acid sequence, they are not interchangeable. “It has been incorrectly suggested that COVID-19 vaccines will cause infertility because of a shared amino acid sequence in the spike protein of SARS-CoV-2 and a placental protein,” Pfizer spokeswoman Jerica Pitts said in an email to the Associated Press. “The sequence, however, is too short to plausibly give rise to autoimmunity.”

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Crystal Cox/Business Insider

The theory also suggests that syncytin-1 is the one and only protein important for placental development, but it’s more complicated than that. A sibling protein, syncytin-2, for instance, helps prevent the mother’s immune system from attacking the fetus.

Plus, the vaccine prompts the body to produce antibodies very similar to the natural ones produced in response to infection. If those antibodies attacked the placenta, we’d to see high rates of placental complications and miscarriages among the more than 44,000 pregnant women who’ve gotten the coronavirus, Dr. Mary Jane Minkin, clinical professor of obstetrics and gynecology at Yale School of Medicine, told USA TODAY.

What’s more, some people have gotten pregnant while participating in clinical trials and receiving a vaccine. These women are still being tracked, but if the vaccine prevented pregnancy, their pregnancies wouldn’t have been possible.

Pregnant women and those who may become pregnant can get the vaccine if they want to

Pregnant women were excluded from clinical trials, so we don’t know the real-world effects of the vaccine in that population. But experts say it should be safe, since the vaccine, like the flu vaccine, does not contain live virus.

The mRNA is “not going to be able to enter the cell of the baby and cause any problem, mechanistically speaking,” Merhi told Business Insider.

As the American College of Obstetricians and Gynecologies (ACOG) says in its advisory about vaccination in pregnant and lactating people, “these vaccines do not enter the nucleus and do not alter human DNA in vaccine recipients. As a result, mRNA vaccines cannot cause any genetic changes.”The organization, along with the Centers for Disease Control and Prevention and the Food and Drug Administration, says pregnant women who want the vaccine should be able to get it.

People who are in prioritized vaccination groups and are actively trying to become pregnant or are contemplating pregnancy should also get vaccinated, ACOG says. There’s no need to delay pregnancy after getting the vaccine, according to the group.

Getting COVID-19 while pregnant puts people at a higher risk of being admitted to the intensive-care unit, needing ventilators or life support, and dying than patients who aren’t pregnant, according to a November CDC report. So Dr. Rahul Gupta, chief medical and health officer at March of Dimes, previously told Insider anyone who could get pregnant should be a top priority for vaccination.

“We’ve got to make sure we make an active effort … to ensure that childbearing-age women, especially minorities, are able to get the vaccine even before they get pregnant,” he said.

Congratulations! Dr. Zaher Merhi and Rejuvenating Fertility Center were featured on News 12 Connecticut

Congratulations! Dr. Zaher Merhi and Rejuvenating Fertility Center were featured on News 12 Connecticut, which aired on November 1, 2020

The segment entitled, “Rejuvenating Fertility Center Grand Opening Westport, ” featured video clips from the grand opening event, showcasing Dr. Merhi cutting the ceremonial ribbon. Dr. Merhi stated, “There are several fertility centers in Connecticut, but all of them use similar protocols, similar medication. What we are doing here is totally different. All these women who were told they could never get pregnant with their own eggs can now come to us so we can help them to conceive. ”

The segment credited Dr. Merhi as the founder of RFC, the first non-conventional IVF center in Connecticut and also mentioned that RFC has two Manhattan locations. 

Please share this placement on your social media channels tagging @sarahhallprinc and @news12ct.

News 12 Connecticut is the exclusive 24-hour local news service dedicated to bringing residents of southwestern Connecticut the best local news and information about their counties, towns, and neighborhoods. The digital website receives over 117,546 unique visitors per month

When you use hand sanitizer every day, this is what really happens

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Bottles of hand sanitizer began flying off the shelves by spring 2020. To prevent the spread of COVID-19, public health authorities such as the U.S. Food and Drug Administration, the Centers for Disease Control and Prevention, and the World Health Organization advised washing hands with soap and water for at least 20 seconds, especially after using the bathroom, before eating, and after coughing, sneezing, or blowing your nose. However, if soap and water are not readily available, the organizations recommend using an alcohol-based hand sanitizer containing at least 60 percent alcohol (aka ethanol).

Hand sanitizers recommended by these leading public health authorities for such purpose are always comprised of some combination of ethyl alcohol, isopropyl alcohol, and hydrogen peroxide. However, not every hand sanitizer sold out there meets the requirements of leading public health authorities. And even if you are using one that does, there are still consequences worth considering — especially if you’re using the stuff on a daily basis. Here’s a look at what really happens when you use hand sanitizer every day, according to the experts.

You’ll kill some germs if you use hand sanitizer every day

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Washing your hands with soap and water helps physically remove many kinds of germs that can linger on your skin, but rubbing hand sanitizer on your hands doesn’t exactly remove all germs, the Centers for Disease Control and Prevention (CDC) revealed. Rather, hand sanitizer kills certain germs upon coming into contact with them. One of the germs that hand sanitizers is known to be effective against is, thankfully, the novel coronavirus. So if you are using hand sanitizer every day, you are, at least theoretically, able to kill any coronavirus germs that have ended up on your hands.

However, to do the job properly, hand sanitizer has to be made of at least 60 percent alcohol. Unfortunately, not all hand sanitizers have this ratio of alcohol. Additionally, hand sanitizer is not a cure-all; it’s not effective at killing every germ out there, according to the CDC.

You could be wasting your money if you use hand sanitizer every day

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“The thing that a lot of people don’t seem to get is that it is not necessary to use hand sanitizer if you’re already washing your hands whenever you should be,” Dr. Leann Poston, an Ohio-based physician,told Health Digest. “Hand sanitizer is recommended as a substitute for hand washing when hand washing is not possible. It is not meant to be an extra precaution on top of hand washing.”

If you’re wondering right about now why hospitals stock up on hand sanitizer and make it available in all examining rooms, it is not because hand sanitizer offers better protection against the spread of germs than soap and water, but rather because hand sanitizer offers the ability to kill germs when hand washing is unavailable. Although you could say it is more efficient than washing with soap and water, it’s not more effective

You might be robbing yourself of the important benefits of soap and water if you use hand sanitizer every day

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When asked if hand sanitizer is effective against COVID-19, the FDA made it abundantly clear that the best way to prevent the spread of infections and decrease the risk of getting sick is by washing your hands with “plain soap and water.” And when they say “plain soap and water,” they mean precisely that. “There is currently no evidence that consumer antiseptic wash products (also known as antibacterial soaps) are any more effective at preventing illness than washing with plain soap and water,” the FDA explained. “In fact, some data suggests that antibacterial ingredients could do more harm than good in the long-term and more research is needed.”

Further, soap and water is capable of removing certain organisms that hand sanitizers are either not consistently effective at killing or those which need to be removed as opposed to killed. These include Clostridioides difficile because it’s impenetrable by alcohol, norovirus because it is enclosed within a protective “capsid” structure, and parasites such as Cryptosporidium because they are actual living organisms. Additionally, hand sanitizers do nothing to remove certain chemicals, pesticides, and heavy metals from the skin.

Hand sanitizer won’t do much for you if you don’t use it correctly

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Just like soap and water, hand sanitizer must be used correctly to be effective, Dr. Leann Poston, an Ohio-based physician, told Health Digest. Correct use means applying enough to the hands to cover all the skin surfaces and then rubbing hands together until they feel dry, which should take around 20 seconds. This happens to be the same amount of time you’d be washing your hands with soap and water, Poston pointed out.

If you wipe off hand sanitizer before it has fully dried, it may not work as well against the germs, according to the CDC. In addition, the CDC cited a number of studies demonstrating that hand sanitizers work best on hands that are otherwise clean or only slightly soiled. This may explain why “hand sanitizers work well in clinical settings like hospitals, where hands come into contact with germs but generally are not heavily soiled or greasy,” the CDC explained. The bottom line, according to Dr. Poston: If your hands are visibly dirty, your best bet is to wash them with soap and water.

Using hand sanitizer every day can rob your skin of good bacteria

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One of the problems with hand sanitizer is that it does not distinguish between bad bacteria and good bacteria. So when you use hand sanitizer, you’re not only killing the germs you want to kill, but you’re also killing the bacteria that naturally lives on your skin and helps you to fight off harmful bacteria, Dr. Giuseppe Aragona, a general practitioner with PrescriptionDoctor.com, told Health Digest.

After many years of study, it is now well understood that good bacteria plays an important role in human health. According to a 2020 study published in the World Journal of Current Medical and Pharmaceutical Research, “excessive” use of hand sanitizer can create an imbalance of good and bad bacteria in the digestive system, potentially leading to inflammatory bowel diseases, obesity, and liver disease. Although it remains to be seen precisely how much is “excessive,” it certainly appears that using hand sanitizer multiple times daily could be heading in that direction.

Using hand sanitizer every day could contribute to the development of superbugs

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You know how your doctor always instructs you to finish an entire course of prescribed antibiotics, even if you feel better sooner? That’s so the antibiotics have the chance to kill all the bacteria, and not just the weakest (and why would we want to leave the strongest bacteria behind?). You’ve likely also heard about “antibiotic resistance,” which results from the overuse of antibiotics. Over time, antibiotics can lead to the development of antibiotic-resistant bacteria. And, unfortunately, antibiotics kill both good and bad bacteria.

These factors together explain why overuse of alcohol-based hand sanitizer can contribute to the development of superbugs that are resistant to antimicrobials. And that’s not just a problem for you. It’s a public health issue, according to one 2020 study. Or as the World Health Organization put it: “Antibiotic resistance is one of the biggest threats to global health, food security, and development today.”

Your hands can become dry if you use hand sanitizer every day

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You’ve probably noticed that using hand sanitizer even one time can leave the skin on your hands feeling more dry than usual. You will probably notice this even more if the antibacterial formula you’ve been using contains more than the minimum recommended amount of alcohol (60 percent). The reason is simple, Dr. Giuseppe Aragona, a general practitioner with PrescriptionDoctor.com, told Health Digest: “It’s because alcohol is drying.”

Furthermore, Dr. Aragona added, “If you use hand sanitizer multiple times daily, you’ll exacerbate the dryness because you are by forcing your skin to absorb a lot of moisture, which stresses and stretches the skin and can lead to dryness on the skin’ surface.” Soap and water are drying too, so if you’re using hand sanitizer on frequent hand washings, you’re setting yourself up for uncomfortably dry skin on your hands.

Using hand sanitizer every day raises your chances of getting certain skin infections

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Having dry skin on your hands is not just uncomfortable, Dr. Leann Poston, an Ohio-based physician, reminded Health Digest — it’s also a setup for infection. Your skin forms a barrier between everything that is inside of your body and the outside world, she explained. When the skin is dry, it is more prone to cracking, and cracked skin offers germs an easy entry point into your body.

“Dry and damaged skin is [a] hotbed for many diseases causing bacteria with increased risk of virus entry into skin,” a study in the journal Science of the Total Environment explained. But it’s not just skin infections you’re risking. Research has shown that overusing sanitizers can, in some cases, increase the risk of systemic viral outbreaks, including norovirus, according to that same study. If you’re going to use hand sanitizer, the American Academy of Dermatology recommends applying “hand cream or ointment immediately after the hand sanitizer dries.”

You risk skin irritation and rashes when using hand sanitizer every day

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If dry skin and the various infections it can lead to aren’t enough to inspire you to taper off a bit from your daily hand sanitizer habit, how about the fact that hand sanitizer can cause skin rashes, blistering, chemical sensitivities, or even allergies? Overuse of hand sanitizer is associated with dermatitis (inflammation of the skin), according to the Florida Skin Center. “Alcohol-based hand sanitizer can disturb the natural pH and barrier of the skin, leaving skin vulnerable to allergens which can penetrate beneath the surface and trigger an autoimmune reaction,” the center revealed.

If you’re thinking it’s because of the harsh chemicals used in hand sanitizers, you’re partly right. The other piece of the puzzle is that some of the inactive ingredients in hand sanitizer can cause skin irritation in some people. These can include phthalates, which are found in added fragrances, as well as natural extracts, such as tea tree oil.

Parents should exercise caution when using hand sanitizer every day

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When used as intended (to kill germs on the skin of the hands), hand sanitizer poses no further risks to children than it poses for adults, according to the FDA. However, the FDA also recommends storing hand sanitizer out of the reach of children and never storing it in anything resembling a beverage or food container. For children under the age of six, hand sanitizer should only be used with adult supervision. This is for a few reasons: to ensure the child is using it properly, to encourage the child not to put their fingers in or near their eyes (which can cause eye irritation), and because hand sanitizer contains high enough levels of alcohol that it can result in alcohol poisoning if ingested by a child. 

“Drinking only a small amount of hand sanitizer can cause alcohol poisoning in children,” the FDA cautioned. “However, there is no need to be concerned if your children eat with or lick their hands after using hand sanitizer.” If your child has ingested hand sanitizer, or if you have reason to believe that might have happened, the FDA advises calling poison control or a medical professional immediately.

Using hand sanitizer every day may be a fire hazard

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If one of the reasons you’re using hand sanitizer daily is that you think of it as nothing more than an alternative to soap, it’s time to consider a major difference between soap and hand sanitizer: Unlike soap, hand sanitizer is flammable, according to the CDC. Accordingly, it’s imperative that it be stored away from flame and heat. In addressing the safest ways to store and dispense hand sanitizer, the CDC reiterates that the percentage of alcohol that should be contained in a hand sanitizer is not only never less than 60 percent, but also never more than 95 percent.

If you’re routinely rubbing hand sanitizer on your hands, you should also know that it doesn’t take much hand sanitizer to react with heat or flame to start a fire. What’s on your hands after applying hand sanitizer can catch fire if exposed to sparks, static electricity, or open flames. To help prevent fires, the CDC recommends rubbing hand sanitizer into hands until they feel completely dry and before continuing on to activities that might involve heat, sparks, static electricity, or flames.

Beware of chemical reactions when using hand sanitizer every day

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Although you may not have given much thought to squeezing some hand sanitizer into your hands, there’s something you should be aware of: Hand sanitizer can react with chemicals in ways you might not have expected. For example, in this study published in 2012 in the Journal of Occupational and Environmental Medicine, farm workers who used hand sanitizer more frequently were found to have more pesticides in their blood than farm workers who were exposed to the same levels of pesticides.

In addition, some chemicals should never be mixed with alcohol. That includes bleach. Bleach and rubbing alcohol, together, form the chemical chloroform — the fumes from which can be damaging to the eyes and skin. And if prolonged contact occurs, damage to the liver, kidneys, and nervous system is also possible. If you’re using hand sanitizer on a daily basis, please do not slather it on before you plan to use any household products that contain bleach.

Your hand sanitizer may contain ingredients banned by the FDA

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The FDA regulates hand sanitizers and has banned certain ingredients from being used in hand sanitizers. One such ingredient is triclosan, a chemical associated with hormone disruption. Fertility expert Dr. Zaher Merhi told Health Digest that this ingredient can impair fertility in both men and women. Another such ingredient is methanol, which is wood alcohol. Methanol should never be used in hand sanitizer because not only is it life-threatening when ingested, but it can also be toxic when absorbed through the skin.

Despite clear rules made by the FDA regarding the ingredients that can and cannot go into hand sanitizer, the FDA announced in August 2020 that it had seen a “sharp increase” in hand sanitizers that claim to contain none of the banned ingredients when, in actuality, they do. Accordingly, the FDA maintains a live database of hand sanitizers that are still using banned ingredients. It’s always a good idea to check this list before purchasing hand sanitizer.

Using hand sanitizer every day may be safe, or it may not

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Even before spring and summer 2020, the FDA had been investigating the longterm risks associated with daily use of hand sanitizers. In April 2019, the FDA made a final determination as to 28 chemicals that should not be included in hand sanitizer. These include triclosan, salicylic acid, and tea tree oil.

At the same time, the FDA acknowledged they still need more data regarding the safety and risks associated with the chemicals that are permitted in hand sanitizer. One of those ingredients is ethyl alcohol, which is the most commonly used ingredient in hand sanitizers, as of this writing, according to Dr. Janet Woodcock, director of the FDA’s Center for Drug Evaluation and Research (via FDA.gov). Another is benzethonium chloride (aka BZK), which, perhaps ironically, is used in some hand sanitizers in order to circumvent the drying effects of alcohol. A 2015 study in the International Journal of Medical Science pointed out that contact dermatitis due to BZK in skin antiseptic has been reported.

Miscarriage Puts Both Partners at Risk of PTSD, Research Shows

Key Takeaways

  • Up to 20% of known pregnancies end in a miscarriage.
  • About 20% of birth-giving partners have post-traumatic stress after the loss of a pregnancy.
  • Nearly 10% of partners who deal with miscarriage suffer from PTSD, but may be more likely to try to hide their feelings.

When it comes to pregnancies and all of the complexities that come along with those experiences, both hospitals and researchers tend to focus primarily on the parent that is giving birth. A study in the October issue of Ultrasound in Obstetrics and Gynecology, however, found that losing a pregnancy at an early stage can lead to post-traumatic stress in both partners.[1]

While the birth-giving partner is more likely to suffer from PTSD following pregnancy loss, the new study showed that non-birthing partners may also experience symptoms, though to a lesser degree.

What Did the Study Show?

This study surveyed 192 couples in the United Kingdom, and within this sample size, all couples were comprised of one man and one woman. Participants were approached in the hospital units designated for early pregnancies; consenting participants completed online surveys one, three, and nine months after early pregnancy loss.[1]

An important step of this process was to determine which participants met the criteria for anxiety, depression, or post-traumatic stress (PTS) following their miscarriages, and the researchers utilized the Hospital Anxiety and Depression Scale (HADS)[2] and Post‐Traumatic Diagnostic Scale (PDS) within the surveys to determine.

There are similarities and differences when it comes to how parents respond to a loss. Both share negative feelings, but due to societal pressures on men and the emphasis placed on the birth parent, the emotional response is often disparate.[3]

“There are multiple noticeable differences in the response of birthing and non-birthing partners to this event,” says Zaher Merhi, MD, OB-GYN, a reproductive endocrinology and infertility specialist and founder of Rejuvenating Fertility Center in Connecticut.

“For starters, non-birthing partners tend to feel the need to be supportive and to give emotionally and physically to the birthing partner, whereas the birthing partners will most likely become more introverted and reclusive. Typically, the non-birthing partner will be inclined to try to ‘fix things’ emotionally and physically for the birthing partner,” he says.

What Is Post-Traumatic Stress?

Post-traumatic stress disorder can occur in individuals that have experienced an unsettling event. Events that cause PTSD symptoms can be isolated or recurring. Symptoms of PTSD are broken down into four categories, including:[4]

The new study found that the most common PTSD symptom occurring in both partners after pregnancy loss was re-experiencing, followed by avoidance and hyperarousal.[1]

Kenda Sutton-El, a birth worker and executive director of Birth in Color in Richmond, VA, has witnessed this during her experience working with couples going through this difficult time. “Non-birthing partners attempt to be strong for the mom because they feel as that is their role, but they will grieve in silence,” she says. “They both become extremely terrified of even trying for another baby.”

The non-birthing partner will be inclined to try to ‘fix things’ emotionally and physically for the birthing partner.

— ZAHER MERHI, MD

Given that all of the non-birthing partners in this study were men, researchers say that the part of issue surrounding PTSD symptoms and the subsequent silence surrounding the condition is that men are less likely to ask for help. “Men are generally less likely to seek support for mental health and may have poorer peer support,” the researchers note.[1]

This can compound and result in poorer health outcomes. “Both partners are likely to experience grief in its different stages, maybe in different sequences and maybe each at his/her own pace,” says Merhi. “Most importantly, each individual should allow the other partner freedom to experience their grief in their own way.”

How Can This Study Be Helpful?

Feelings of Loss For Both Partners Are Normal

Miscarriages are very common within the first trimester of pregnancy, with 10 to 20 percent of known pregnancies ending in a loss.[5] This includes ectopic pregnancies, which occurs in 1–2% of all pregnancies as an embryo implants outside of the uterus and is unable to develop, resulting in pregnancy loss.[6]

While it is common for the non-birthing partner to forego their emotions in an effort to care for the birthing parent, a shared loss means the grief can be shared as well. Keeping lines of communication open as well as seeking out resources can aid in an emotionally difficult situation such as a pregnancy loss.

Loss can drive couples apart, but it can also bring them closer together. There is a closeness and tenderness that can form as people journey through this together.

— TALITHA PHILLIPS

“I recommend seeking counseling help from a professional as soon as possible to help navigate the waves of emotion and pain,” says Talitha Phillips, a certified labor and postpartum doula and CEO of Claris Health in Los Angeles. “It’s important to communicate how the partner as well as other friends and family can help.”

Phillips adds, “This includes the need for physical help and a safe place to talk and process the loss. Loss can drive couples apart, but it can also bring them closer together. There is a closeness and tenderness that can form as people journey through this together.”

Additional Resources are Needed for Both Couples

A 2017 review suggested that research on the effects of pregnancy loss on non-heterosexual and non-cisgender men is lacking, and that understanding how miscarriage affects the mental health of male non-birthing partners across different cultures could lead to better health care outcomes.[7] The new data could serve as evidence that additional considerations and protocols for both parents, regardless of gender or sociocultural context, should be in place for all outcomes of pregnancy.

In addition to mental health providers, seeking out a doula (either for birth or following miscarriage) can assist both partners throughout the journey of conception, birth, or losing a pregnancy, and is a viable option for support.[8]

Potential Next Steps for Couples

Merhi advises:

  • Be sensitive to each other. Talking about other pregnancies may be the non-birthing partner’s way of trying to fix things, however what the birthing partner usually needs is someone to listen and be there.
  • Support your partner. Taking the time to sit with each other, talk, and engage in activities together will help both partners heal faster.
  • Ask for support. Support groups, counselors, and even therapists can be of great help to both partners.
  • Get busy. Keeping yourself busy through this process is important, to decrease the constant thoughts that you have about the miscarriage. One or two new projects are adequate to keep busy while handling this change.
  • Give it time. Give yourself and your partner enough time to fully experience this and come out the other side.

What This Means For You

Miscarriage is a heartbreaking thing to experience, and a difficult issue to discuss. Because of the severe strain on the birthing parents’ body and mind, we oftentimes overlook the non-birth giving partner in the situation. Losing a baby is incredibly difficult, regardless of your role in the situation.

Preparation for all outcomes is necessary for both parents, and can encourage everyone to feel comfortable in sharing their needs post-miscarriage and seek the help they deserve. 

  1. Farren J, Jalmbrant M, Falconieri N, et al. Differences in post‐traumatic stress, anxiety and depression following miscarriage and ectopic pregnancy between women and their partners: a multicenter prospective cohort study. Ultrasound Obstet Gynecol. 2020. doi:10.1002/uog.23147
  2. Stern AF, The Hospital Anxiety and Depression Scale. Occupational Medicine. 2014;64(5):393-394. doi:10.1093/occmed/kqu024
  3. Leis-Newman E. American Psychological Association. Miscarriage and loss. 2012;43(6):56.
  4. National Institute of Mental Health. Post-Traumatic Stress Disorder
  5. Cleveland Clinic. Miscarriage. Updated July 22, 2019.
  6. Panelli DM, Phillips CH, Brady PC. Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review. Fertil Res and Pract. 2015;1:15. doi:10.1186/s40738-015-0008-z
  7. Due C, Chiarolli S, Riggs DW. The impact of pregnancy loss on men’s health and wellbeing: a systematic review. BMC Pregnancy Childbirth. 2017;17(1):380. doi:10.1186/s12884-017-1560-9
  8. Strauss N, Giessler K, McAllister E. How doula care can advance the goals of the affordable care act: a snapshot from new york city. J Perinat Educ. 2015;24(1):8-15. doi:10.1891/1058-1243.24.1.8
  9. Murphy FA, Lipp A, Powles DL. Follow-up for improving psychological well being for women after a miscarriage. Cochrane Database Syst Rev. 2012;(3):CD008679. doi:10.1002/14651858.CD008679.pub2

All-Natural Ways to BALANCE YOUR VULVA’S pH LEVELS

It’s true what they say: our vaginas—and vulvas—are self-cleaning ovens. What that means is that they can regulate invaders, keeping things clean and operational all on their own, but that level of wellness hinges on allowing our good bacteria to thrive and not allowing bad bacteria to take over. It requires diligent awareness of materials and chemicals that grace our nether regions.

Dr. Zaher Merhi, board-certified OB-GYN and fertility expert at New Hope Fertility Center in New York, knows this intimate balance, well, intimately. “The pH of the vulva/vagina is on the acidic spectrum (low pH). The acidity of the vulva/vagina is naturally protective against abnormal bacteria and infections such as yeast.” Yeast has well earned a bad reputation in the land of all things vagina. This is where our situational awareness comes into play.

Airflow

Dr. Merhi suggests avoiding tight clothing for too long, because a bit of normal airflow around the area keeps the good bacteria happy and doesn’t allow things to become overly acidic, or too basic.

Use condoms

In case you missed it (we did not know this), Dr. Merhi let us know that semen is very alkaline, aka a high pH. Unless you’re trying to conceive, try barrier contraception to keep a balanced pH.

Use antibiotics wisely

“Avoid taking unnecessary antibiotics, because they not only kill the bad bacteria but also the good bacteria that are needed to maintain a more acidic vaginal pH level.” We heard it from a doctor, so we know it’s true.

Don’t douche

And no, we aren’t talking about hooking up with your ex (but maybe avoid that, too). “Avoid unnecessary douching, because it can increase the vaginal pH level, but also encourages the growth of harmful bacteria overall.” Like we mentioned earlier, the balanced pH of the vagina keeps things fresh naturally, so douching is not only unnecessary but also counter-productive.

Keep tampons on deck

Obviously, toxic shock syndrome is a major concern if you don’t change your tampons regularly, but Dr. Merhi also explains that “menstrual blood is a basic and can change the pH in the vagina.” Don’t let it just linger there. Because also, ew.

Take probiotics

Obviously, not killing good bacteria was a crucial step in not destroying the beautiful balance, but feeding those goodies is also important, so take a trusted probiotic. Eating yogurt can help because it is a source of bacteria that are important for maintaining a normal pH. Some studies even suggest making a homeopathic cream from yogurt if afflicted by yeast.

Wipe like momma taught ya.

OK, this one is obvious, but somehow we still manage to fudge it up from time to time. No pun intended. Front to back, always. Prevent any bacteria that does not belong around the vulva from entering the vagina, and you’ll avoid any major wars (aka infections) down yonder.

One disclaimer Dr. Merhi mentions is that “natural menopause means less estrogen in the blood, which is important to have normal pH.” For those of us who may be entering that phase in life, our pH could be all over the place. We and Dr. Merhi urge you to ask your OB-GYN about ways to treat that, if necessary.

New Study Raises Concern About Antidepressant Use During Pregnancy

If you’re dealing with depression and anxiety at any point during your pregnancy, know that you’re not alone. A study conducted by the Journal of Obstetrics and Gynecology found that the rate of depression among women who arrive at the hospital to give birth is at an all-time high of more than 28 women per every thousand.

Doctors commonly prescribe antidepressants known as SSRIs, or Selective Serotonin Reuptake Inhibitors to both non-pregnant and pregnant people in an effort to alleviate symptoms of depression and anxiety. In general, most of these drugs are widely used and considered safe during pregnancy.

But a recent study indicates that there may be increased risks to the fetus when SSRIs are used at medium and high doses during the third trimester of pregnancy.

Depression During Pregnancy

Depression, even during pregnancy, is a common and treatable disorder that can be controlled with the use of antidepressant medication. Even if you’ve never experienced depression or anxiety before, if you notice symptoms or feel something isn’t right, it’s always best to speak to your doctor. Never has self-care been more important than now, when you’re about to be responsible for a little person who will rely on you for everything.

So don’t hesitate to bring it up, and if your doctor decides you would benefit from an antidepressant, it’s a good idea to start it sooner rather than later to protect your own mental health. Not sure whether you’re experiencing depression? Below, we’ve listed some of the more common symptoms of depression, as reported by the Centers for Disease Control and Prevention:

  • Having a lasting sad, anxious, or “empty” mood
  • Feelings of hopelessness or pessimism
  • Feelings of guilt, worthlessness, or helplessness
  • Feelings of irritability or restlessness
  • Loss of energy
  • Problems concentrating, recalling details, and making decisions
  • Difficulty falling asleep or sleeping too much
  • Overeating or loss of appetite
  • Suicidal thoughts or suicide attempts
  • Aches or pains that do not get better with treatment

Risks of Using Antidepressants While Pregnant

In recent years, antidepressant use during pregnancy has been considered largely safe, with most antidepressants labeled as Class B or C drugs (both relatively safe during pregnancy).

However, a study published in the June 2020 edition of Pediatrics, the Official Journal of the American Academy of Pediatrics indicated that the risks of fetal respiratory distress and preterm birth are increased with maternal use of antidepressant drugs in the third trimester at high doses.

While that sounds scary, it’s not time to worry quite yet. Rather than uncovering new and unknown risks to the fetus, the study was conducted to examine the prevalence of these outcomes based on dosage and timing of antidepressant use.

Not surprisingly, findings indicated that high doses used during the entire nine months were associated with the greatest risks to an unborn baby. But even then, the risks are low, and this new information shouldn’t change your mind about taking an antidepressant if you really need it.

Zaher Merhi, MD, a board-certified OB-GYN, and fertility expert at New Hope Fertility Center in New York says, “These risks are real, but they should be weighed against the risk of untreated depression in the mother, which could cause a much worse outcome than respiratory distress and potential preterm birth in the fetus.”  

Risks of Perinatal Depression

In a perfect world, you might consider tapering off your antidepressant medication in the months before you start trying to get pregnant. Of course, that’s simply not possible if you want to keep your symptoms at bay.

“In general, women with a history of mental health conditions are likely to experience worsening of symptoms during pregnancy,” says Pavan Madan, MD, a psychiatrist with Community Psychiatry.

Untreated mental health disorders are also known to pose significant risks to mother and the fetus. Women with untreated anxiety may have higher risk of blood pressure problems for the mother, growth restriction for the fetus, and increased complications during labor and the postpartum period.

— PAVAN MADAN, MD

Other risks involve day-to-day struggles, like finding the energy to get through the day, let alone suffer through morning sickness, extreme fatigue, and all of pregnancy’s other not-so-glamorous symptoms.

“A depressed mother may have a hard time taking care of herself. She may be more likely to struggle with lack of energy or inappropriate diet, or in some cases, she may self-medicate with illicit drugs, smoking, or drinking alcohol. These things, of course, can all cause significant harm to her unborn baby—more so than the minute risks of taking antidepressants during pregnancy,” says Merhi.

Treating and Managing Depression During Pregnancy

So how do you decide whether to continue taking your medication or attempt to stop for nine months? There’s no easy answer to this question. Allie Shapiro, a psychologist with Community Psychiatry says the most important consideration is the answer to the question, can I be stable off of medication?

“The answer depends on a number of variables as well as your medication history. The severity of your anxiety often dictates whether or not you should continue medication during pregnancy,” she says. Feel like you can manage without? “Some non-medication therapies include exercise, support groups, yoga, meditation, behavioral therapy, and acupuncture,” suggests Merhi. 

But if it’s simply not possible for you to be at your best without daily use of an antidepressant, you can still mitigate your risk of potential harm to your baby by taking the smallest effective dose and if possible, sticking to only one medication rather than two or more.

In keeping with the findings set forth in the June 2020 study, the lower the dose of medication, the safer it is for the baby. Also, the fewer medications a mother takes, the better it is. It is best to use one medication at a dosage that controls the depression rather than using two or more medications.

— ZAHER MERHI, MD

And if you haven’t yet found a medication you’re happy with, consider switching to an antidepressant that’s considered safer for use during pregnancy. The Mayo Clinic indicates Celexa and Zoloft as two of the safer drugs to try, along with Cymbalta and Effexor.

One that’s not recommended? Paxil, also called Paroxetine. Several studies have found that taking Paxil during the first trimester of pregnancy is associated with an increased risk of congenital heart defects.4 Paxil is particularly difficult to wean off of, so if you’re taking Paxil and considering getting pregnant, work with your doctor early on to assess whether it may be beneficial to change your medication. 

Why everyone needs to know more about menopause — especially now

Recently, and out of necessity, my husband and daughter became more familiar with the symptoms of menopause. As many families sheltering at home are learning, physical and emotional changes can amplify the challenges already inherent in spending so much time together. But, until this time, my family had only a basic understanding of menopause and its symptoms, and no idea how to help.

Traditionally, menopause has been discussed only by women approaching middle age, with few resources for partners and children. Experts say that’s a mistake, because the more openly menopause is talked about, the less stress menopausal people — women, gender-neutral people and transgender men with ovaries may experience symptoms of menopause — will feel as they traverse the physical and emotional changes they’re experiencing. That’s especially important now, with pandemic-associated depression and anxiety potentially exacerbating this difficult part of aging.

After I asked about experiences with menopause in an over-40 women’s Facebook group, Alex Thom, a mom from Toronto, shared her frustrations. She wrote: “These are rough times. We are aging and seeing the effects of that on our bodies — wrinkles, grey hairs, sagging, unexplained weight gain, and a lack of energy. Then we add hormonal changes — remember the teen years when everything felt confusing, awful and scary? Menopause is that, times 100. We question our own feelings, like ‘Am I justifiably upset, or is this just a hormone swing?’ ”

She went on to mention how menopausal symptoms can be compounded by partners who don’t understand, and concerns about jobs, aging parents, or kids whose hormones are also out of control. “How did we get to midlife knowing nothing about what’s next?” she wrote, adding, “And why are we not talking more about all this?”

Research has documented this lack of knowledge about and discussion of menopause, including a 2010 study published in the journal Women’s Health Issues that concluded that there was a gap for women in “information about symptoms and how to cope with/reduce them, how to communicate with providers about their experience, what to expect, and social support.” Ten years later, that gap seems to persist. Why is that, and how can we do better?

What is menopause?

The term “menopause” is commonly used to cover a hormonal process that usually has three phases. “Menopause occurs when a woman has not menstruated for 12 months,” said Dara N. Matseoane-Peterssen, an obstetrician, gynecologist and assistant professor at Columbia University’s Irving Medical Center in New York City. The transition period leading up to that point is called perimenopause and can last several years; symptoms associated with menopause can also occur during that time. Symptoms may be present after the year without periods, too, in the stage called postmenopause. The average age for Americans to reach menopause is 51, but few know that 1 percent of people reach menopause before age 40, according to Zaher Merhi, a gynecologist at New Hope Fertility Center in Manhattan.

[Taking care of yourself during the pandemic, from head to toe]

When ovaries stop releasing eggs to the uterus, they produce and release less of the hormone estrogen, which is important to cholesterol levels and reproductive, bone and skin health. It can also affect the brain (including moods) and body tissues. Decreasing estrogen levels can result in hot flashes, mood swings, depression, anxiety and irregular periods during perimenopause, and those symptoms can continue into the rest of the menopausal process after periods end. The median number of years women experience vasomotor symptoms — hot flashes and night sweats — is 7 1/2 years, according to a study published in the Journal of the American Medical Association in 2015.

Maura C. Brennan, an obstetrician and gynecologist at Advocate Lutheran General Hospital in Park Ridge, Ill., said lesser-known symptoms of the menopausal process include migraines, insomnia, joint aches, stomach issues, fatigue and mental fogginess.  Menopausal people may also experience a variety of symptoms recently collected under the name genitourinary syndrome of menopause, or GSM. These can include vaginal dryness, painful intercourse (due to thinning vaginal walls) and urinary urgency, discomfort or frequent urinary tract infections.

While there are prescription and over-the-counter medicines, treatments — including hormone-replacement therapy — and lifestyle changes to help manage menopausal symptoms, some medicines have risks or side effects, and not all people find relief, which is another reason family support is so important.

Why don’t we know more?

How is it possible that even those who will go through it know so little about what to expect from menopause? It’s partly because the condition has been feared or misunderstood throughout the ages. “Society has a long history — from the ancient Egyptians through the Middle Ages and Renaissance — of women being treated as bewitched, or viewed as men if they had an inability to bear children, and being relegated to the periphery of society,” said Soma Mandal, an internal medicine specialist in Berkeley Heights, N.J., and the author of the book “Dear Menopause I Do Not Fear You!” “Society doesn’t look at aging as a good thing. Unfortunately, menopause is a part of that.”

It’s also no secret that previous generations considered the “change of life” strictly women’s territory — along with periods, pregnancy, giving birth and postpartum physical concerns — and some of that mystery around natural gynecological functions continues today.

The subject hasn’t received the attention it deserves. “The reason partners and kids have been left out of the educational loop about menopause is that menopausal people themselves have been left out of the loop,” Leslie Butterfield, a perinatal psychologist in Seattle, said via email. “There is no ‘information loop’ about menopause,” she added. “Despite the (thankfully) increasing information many women receive about the hormonal, physical, and emotional impacts of pregnancy and postpartum, that type of sharing of knowledge and understanding does not generally extend to include menopause.”

Why should we know more?

While most know that hot flashes and the end of menstrual periods signify the menopausal process, there are also associated mental and physical health risks that are critical to determining an overall health plan. About 30 to 66 percent of menopausal people will experience menopausal depression if they have experienced previous depression, postpartum depression, premenstrual syndrome or premenstrual dysphoric disorder before menopause. Ten to 20 percent of perimenopausal people will experience anxiety and/or depression for the first time.

There are also physical concerns associated with menopause, including increased cholesterol levels, a higher risk of heart disease, osteoporosis, a higher risk of stroke, weight gain and even oral issues.

For these reasons, Mandal and Merhi said, knowledgeable and compassionate families are a key component to a smoother menopausal transition. When family members are aware of both the emotional and physical problems associated with menopause, they can help watch for symptoms, encourage menopausal family members to seek treatment and help establish preventive measures, such as changes in diet and exercise, that are easier to stick to as a family.

2019 study published in the Journal of the North American Menopause Society concluded that “additional training and/or resources for men (e.g. brochures, websites, materials at doctors’ offices) could greatly benefit both menopausal women and their male partners in coping with menopause. Male partners may offer a unique opportunity to further disseminate information regarding menopause and treatment options for bothersome symptoms and improve midlife women’s health and well-being.”

Uchenna Umeh, a San Antonio pediatrician, said education shouldn’t stop with husbands. “If kids know what’s going on with their parents and have empathy for them, our next generation will understand better when it’s their turn,” she said. “It’s particularly important for boys to learn about menopause so they’re supportive to potential future mates.”

How can families help?

What does such support look like? It’s understanding that a menopausal partner or parent “is going through a life-changing experience in their physical body that also affects emotional health, which may also affect self-esteem,” Tola T’Sarumi, a psychiatrist in Boston, wrote in an email. “You cannot always resolve your partner’s issues, but understanding means you can provide physical and emotional support. The most important thing a partner can do is ensure that communication does not break down.”

Umeh says that both children and partners should understand that menopause can cause people to express negative emotions unpredictably, and that families should try not to take it personally. She suggested partners educate themselves, without expecting the menopausal person to be their only teacher, and recommended parents discuss menopause with children at their maturity level. Relating menopause to puberty and its physical and emotional hormonal challenges can help teens and tweens understand, along with answering questions openly and honestly. Doing so can sometimes bring empathy in unexpected ways, as Nina McCollum of Cleveland found out.

I’ve been talking about my perimenopausal and menopausal journey with my partner and my son for a couple of years now,” McCollum said. “I have had tons of hot flashes, and they know all about them and understand my need to suddenly turn on a fan. My son will even get a magazine or book and fan me sometimes.

Given how long this transition can last, attitude and lifestyle shifts are often required from the entire family. Whether it’s doing more around the house to help lower stress or giving a menopausal person time alone for quiet self-reflection, as Mandal suggested, dealing with menopause is less difficult as a team effort.

After three years of communication about menopause with my family, my husband recently stopped complaining when I blasted the air conditioning to soothe my hot flashes and instead simply kept a sweater handy. With communication, knowledge and understanding, I’m learning that menopause doesn’t have to be an exasperating process suffered alone.