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Is My Baby Drinking Enough Milk?

Is my baby drinking enough milk?

Milk supply myths debunked!

Nicole Parakrama | BSc Hons Molecular Cell Biology, UCL (UK) | 17th April 2021 | <5 minute read

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“Aney why is he crying so much?”…

…“Hungry-da?”…..

Mothers of infants might find this line of questioning familiar!

In our culture, we tend to cajole and bribe our children into eating more, with the goal of making them as chubby as possible. However, when we don’t allow our children to regulate their hunger for themselves, this can lead to unhealthy eating patterns (see this study here) with repercussions all the way into adulthood (some other great longitudinal studies here and here). We do our children a great disservice when we don’t take into account their varying body structures, feeding patterns, and metabolisms when considering when and how often we feed them.

“Aney why is he crying so much?”…

…“Hungry-da?”…..

Mothers of infants might find this line of questioning familiar!

In our culture, we tend to cajole and bribe our children into eating more, with the goal of making them as chubby as possible. 

 This same culture can extend to breastfeeding as well, with negative repercussions as a result! A study conducted by Rodrigo et al among 249 mothers at the Colombo North Teaching Hospital, found that “a family member telling mothers that their milk supply was low had

However, when we don’t allow our children to regulate their hunger for themselves, this can lead to unhealthy eating patterns (see this study here) with repercussions all the way into adulthood (some other great longitudinal studies here and here). We do our children a great disservice when we don’t take into account their varying body structures, feeding patterns, and metabolisms when considering when and how often we feed them. This same culture can extend to breastfeeding as well, with negative repercussions as a result! A study conducted by Rodrigo et al among 249 mothers at the Colombo North Teaching Hospital, found that “a family member telling mothers that their milk supply was low had the most

the most significant impact on Perceived Inadequacy of Milk (PIM)”.  In other words, we can give undue weight to the opinion, however well-intentioned, of someone who is (to put it simply) not the mother of our baby. 

It is not surprising, then, that one of the most Googled questions on breastfeeding is – “How can I tell if my baby is drinking enough milk?”  This is an understandable concern, as we simply cannot see how much milk our baby is taking in at the breast, so we have to guess!  Rest-assured, our babies are very clever at making their needs known – and they will usually drink as much milk as they need.  In turn, our breast tissue will respond over time and produce a supply of milk to match their demands. There ARE instances where concerns are warranted, and supply is low for medical reasons, but this is very often not the case.

This same culture can extend to breastfeeding as well, with negative repercussions as a result! A study conducted by Rodrigo et al among 249 mothers at the Colombo North Teaching Hospital, found that “a family member telling mothers that their milk supply was low had the most significant impact on Perceived Inadequacy of Milk (PIM)”.  In other words, we can give undue weight to the opinion, however well-intentioned, of someone who is (to put it simply) not the mother of our baby. 

It is not surprising, then, that one of the most Googled questions on breastfeeding is – “How can I tell if my baby is drinking enough milk?”  This is an understandable concern, as we simply cannot see how much milk our baby is taking in at the breast, so we have to guess!  Rest-assured, our babies are very clever at making their needs known – and they will usually drink as much milk as they need.  In turn, our breast tissue will respond over time and produce a supply of milk to match their demands. There ARE instances where concerns are warranted, and supply is low for medical reasons, but this is very often not the case.

significant impact on Perceived Inadequacy of Milk (PIM)”. In other words, we can give undue weight to the opinion, however well-intentioned, of someone who is (to put it simply) not the mother of our baby. 

It is not surprising, then, that one of the most Googled questions on breastfeeding is – “How can I tell if my baby is drinking enough milk?” 

This is an understandable concern, as we simply cannot see how much milk our baby is taking in at the breast, so we have to guess!  Rest-assured, our babies are very clever at making their needs known – and they will usually drink as much milk as they need.  In turn, our breast tissue will respond over time and produce a supply of milk to match their demands. There ARE instances where concerns are warranted, and supply is low for medical reasons, but this is very often not the case. 

A longitudinal study by Nielsen et al studied the milk intake of 50 healthy, exclusively breastfed babies over 6 months, and found the milk intake and fulfilment of energy values to be in excess of literature values.

Unfortunately, it is this fear of having a low supply which can become a roadblock in our breastfeeding journeys, far more often than it being an actual medical issue.

At a very high level, the rule of thumb is – if your baby comes off the breast looking relaxed, and if the number of heavy, wet diapers in 24 hours is more than or equal to the number of days old (for newborns up to one week), and 5-6 thereafter, your baby is very likely getting adequate milk (check out this comprehensive presentation by the Sri Lanka College of Pediatricians, particularly slides 41-46).

There are 9 common occurrences that may worry mothers, but which are not necessarily an indication of inadequate milk supply:

1. My baby wants to nurse very frequently

Breast milk is actually digested very efficiently (usually within 1.5-2 hours) and frequent feeding is common as a result.  Some babies are also more ‘sucky’ than others or require more skin contact.

2. My baby suddenly nurses more frequently, or for longer durations

This may be a growth spurt, which usually lasts a few days to a week. Since milk production is supply & demand-based, allowing your baby to feed extra will result in your breasts producing more milk to catch up.

3. My baby suddenly nurses less frequently, or for shorter durations

With age, as your baby gets more efficient at extracting milk, and the size of their little tummy increases, this will happen and is not an indicator of low supply.

4. My baby guzzles down a bottle of milk after nursing

Many babies will take a bottle of milk even after a full breastfeed, due to their suckling reflex, and then fall asleep due to exhaustion rather than satiation.

5. My breasts don’t leak milk, or only leak a little, or have stopped leaking

Leaky breasts have nothing to do with your milk supply adequacy. Leaking often stops once your milk supply has adjusted to your baby’s needs, and/or as the feeds become more predictable.

6. My breasts seem softer, or don’t get engorged anymore

Again this often happens once your milk supply has adjusted to your baby’s needs, and/or as the feeds become more predictable.

7. I don’t feel a let down sensation

Some women may never experience a let down sensation (tingling, pins & needles or a feeling of warmth), or find that it reduces over time. This is not connected to a reduction in supply.

8. I get very little milk when i pump

There are many reasons why this could be… pumping technique, pump type, flange size etc. At the best of times, your baby’s suck will always be more efficient at draining your breasts than the pump can mimic.  Pump output should not be used as a reliable indicator of production.

Hopefully you will find some reassurance if you are in this boat of questioning your supply.  However, if you have already found it in yours or your baby’s best interest to give formula, there is no guilt or shame in that. Breastmilk, while optimal, is not the only way to feed your baby. There are many circumstances where combination feeding (formula + breast milk) or only formula is necessary, and your child will be none the worse for it.  A well-fed baby combined with a happy mother really is the best end result.

How I became ‘The Milk Coach’

When my first child was born, I was quite unprepared for what lay ahead.  Particularly when it came to breastfeeding – I was naïvely expectant that I could just place him onto my chest, and let nature take its course.  What a surprise I was in for!  Cracked nipples from sub-optimal positioning, and my milk taking its own time to come in, led to terrible pain.  This pain became excruciating when my son developed oral thrush which travelled through to my milk ducts.  Fortunately, thanks to a lot of research and some wise mum friends, I was able to power through those awful first few months.  Most crucially, I was able to advocate for myself with health professionals (and I’m thankful for the ones who listened to me when I did!).

This birthed a passion to peer-to-peer counsel, share with and advocate for my fellow Sri Lankan mums, to support them to achieve their breastfeeding goals. To this end I am working to add to a science background (in Molecular Cell Biology) with an accreditation by La Leche League International (LLLI). 

Join the conversation, follow @themilkcoach on Instagram or Facebook.

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How to relieve menstrual cramps

How to relieve menstrual cramps

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Ladies, is it that time of the month? Are we feeling subtle cramps in our stomach, lower back pain, maybe some strange mood swings? Maybe we have to make a trip to the supermarket and buy our monthly stock of pads and tampons. We get it! Your period is here, which means those uncomfortable, painful cramps are here too. We’re here to help ease the burden by giving you some ways you can relieve the pain and discomfort.

What are menstrual cramps?

Period cramps, or dysmenorrhea, refers to the discomfort women feel in their abdomen, lower back and thighs during their menses. Cramping can vary in intensity from woman to woman. Some may feel a slight discomfort and others may feel more severe pains that can affect certain aspects of their life.

What are menstrual cramps?

Period cramps, or dysmenorrhea, refers to the discomfort women feel in their abdomen, lower back and thighs during their menses. Cramping can vary in intensity from woman to woman. Some may feel a slight discomfort and others may feel more severe pains that can affect certain aspects of their life.

Why do period cramps happen in the first place?

During your period, the uterus contracts to help shed its lining. Hormone-like substances (prostaglandins) trigger the contractions which causes pain and inflammation. Higher levels of prostaglandins can lead to more severe menstrual cramps.

Symptoms of menstrual cramps may include:

  • Cramping in the lower abdomen
  • Lower back pain
  • Pain radiating down the legs
  • Nausea
  • Vomiting
  • Diarrhea
  • Fatigue
  • Weakness
  • Fainting
  • Headaches

Symptoms of menstrual cramps may include:

  • Cramping in the lower abdomen
  • Lower back pain
  • Pain radiating down the legs
  • Nausea
  • Vomiting
  • Diarrhea
  • Fatigue
  • Weakness
  • Fainting
  • Headaches

What can you do to relieve the pain from cramps during your menses?

For mild and temporary cramps, some home remedies can provide comfort and relief.
Here are a few things for you to try:

Applying heat to your lower abdomen and lower back can relieve pain. If you don’t have a heating pad or hot water bottle, take a warm bath or use a hot towel.

Applying heat to your lower abdomen and lower back can relieve pain. If you don’t have a heating pad or hot water bottle, take a warm bath or use a hot towel.

Applying heat to your lower abdomen and lower back can relieve pain. If you don’t have a heating pad or hot water bottle, take a warm bath or use a hot towel.

Avoid foods that cause bloating such as fatty foods, alcohol, carbonated drinks, caffeine or salty foods. Instead have some tea with ginger or mint, hot water with lemon or strawberries

Avoid foods that cause bloating such as fatty foods, alcohol, carbonated drinks, caffeine or salty foods. Instead have some tea with ginger or mint, hot water with lemon or strawberries

Avoid foods that cause bloating such as fatty foods, alcohol, carbonated drinks, caffeine or salty foods. Instead have some tea with ginger or mint, hot water with lemon or strawberries

Maintain a consistent diet of minimally processed foods, fiber and plants. Try having more papaya, brown rice, walnuts, almonds, broccoli, fish, leafy green vegetables and flax seeds.

Maintain a consistent diet of minimally processed foods, fiber and plants. Try having more papaya, brown rice, walnuts, almonds, broccoli, fish, leafy green vegetables and flax seeds.

Maintain a consistent diet of minimally processed foods, fiber and plants. Try having more papaya, brown rice, walnuts, almonds, broccoli, fish, leafy green vegetables and flax seeds.

Drink more warm or hot water and eat water-based foods to increase your hydration such as cucumber, watermelon, lettuce and celery.

Drink more warm or hot water and eat water-based foods to increase your hydration such as cucumber, watermelon, lettuce and celery.

Drink more warm or hot water and eat water-based foods to increase your hydration such as cucumber, watermelon, lettuce and celery.

Exercise! Although the last thing we want to do during our menses is work out, exercise releases endorphins which relieves some menstrual cramp pain.

Exercise! Although the last thing we want to do during our menses is work out, exercise releases endorphins which relieves some menstrual cramp pain.

Exercise! Although the last thing we want to do during our menses is work out, exercise releases endorphins which relieves some menstrual cramp pain.

When to see a doctor:

  • If period cramps disrupt your life in some way every month
  • Your symptoms get progressively worse and you are in intense pain every month
  • If you started having severe menstrual cramps after the age of 25

You can speak to a VOG doctor by consulting an Obstetrician or Gynecologist on the oDoc app. GPs and Family Physicians are also available to consult.

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Confused over AstraZeneca news? We break it down in one minute!

Confused over AstraZeneca news? We break it down in one minute!

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AstraZeneca, long regarded as the problem child of the COVID vaccines, is plagued again by negative news. So what’s happened? What does it mean for you?

Short read:

The overall risk of blood clots is ca. 4 for every 1,000,000 people. The benefits of AstraZeneca vaccine outweighs the risks posed by COVID19 and the vaccine itself for over 40s. Anyone who didn’t suffer from clots should receive their second vaccine when offered.

However, as the risks posed by COVID19 to under 30s are lower, alternate vaccines are more prudent for use in this population. This is not out of safety concerns but utmost caution.

Want more details? We break it down into bite sized pieces below:

What’s happened?

In early March 2021, a slew of European countries paused administering the AstraZeneca vaccines after some reports of blood clots began to appear.

As per protocol, all severe adverse effects have to be investigated by the relevant medical authorities. When investigating, authorities look for signs of causation – did A cause B? Or did A and B happen to occur at the same time?

Most often, they do this by analysing the rates of occurrence of the event in the general population (or in the specific demographic) and then compare that to the rate of occurrence in the corresponding vaccinated population.

Here’s a simplified fictional example of what that means:

In the general population, say 1% of people over 50 suffer from heart attacks in a one month time period. In the vaccinated population, if this rate is the same or lower, then the event is deemed to not be caused by the vaccine. But if this rate is higher in the vaccinated population, then further investigations or ending of the vaccine trials or drives are required.

What did the investigations show?

On March 19th, EU & British regulators stated that the benefits of the AstraZeneca vaccine in preventing COVID19 outweighs any risks posed by it. They investigated ca. 30 cases of clots out of the 20,000,000 people who had received the vaccine in the EU & UK.

Following this, Germany, Italy and a number of other countries recommenced their vaccine drives with prudent processes in place.

So what’s the latest news about?

On April 7th, The UK’s major medical body, the MHRA held a press conference in collaboration with the EU’s major medical body, the EMA to discuss their findings.

There was confirmation that blood clots have been identified as a “potential side effect” in “an extremely small number of people” (emphasis added).

For example, in the 40-49 age group, 0.5 harms can be caused for every 100,000 people. This compares to 51.5 ICU entries with COVID19 in the same age group for every 100,000 people.

Most importantly, the benefits of AstraZeneca vaccine was found to far outweigh the risks for the majority of people.

What are the key things to remember about this event?

  1. The vaccine is still safe to administer to the vast majority of people over the age of 30. If you’ve had the first dose and haven’t had the below symptoms, you should take the second dose.
  2. If you have a known blood disorder, speak to your doctor before going for vaccination. 
  3. Anyone who has the below symptoms four days after vaccination should seek prompt medical advice.
  4. Symptoms to look out for include: 
    • new onset of a severe or persistent headache
    • Blurred vision
    • Shortness of breath
    • Chest pain
    • Leg swelling
    • Persistent abdominal pain
    • Unusual skin bruising or pinpoint spots beyond injection site

No medicine or vaccine is without risk. But knowing the destruction caused by COVID19 (even to those that present with no symptoms), it is always a matter of weighing the benefits against the risks. Agencies continue to monitor safety and will continue to act expeditiously when necessary. 

Concerned about clots or any of the above symptoms? Speak to an on demand GP on oDoc within 3 minutes.

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Source

  1. “MHRA issues new advice concluding a possible link between COVID19 vaccine Astrazeneca and extremely rare unlikely to occur blood clots”, MRHA website, April 2021
  2. Under 30s won’t be given Astrazeneca vaccine over “extremely rare” risk of blood clots, ITV, April 2021

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PCOS – breaking the stereotype

PCOS - breaking the stereotype

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There is so much noise around women’s health. Specifically, PCOS and most of it seems to be scientifically incorrect. PCOS is one of the most common endocrine disorders in women, affecting one in four women of reproductive age, which is 25% of the entire female population, so it is only fair to bust the myths around it. Before we debunk the misconceptions, here’s a little about PCOS.

A little about PCOS

Polycystic Ovary Syndrome or PCOS is an endocrine disorder that affects the way a woman’s ovary works. Women who suffer from PCOS either have an irregular period, excess production of male hormone or polycystic ovaries (where there are multiple cysts on the ovary). The excess androgen and cysyts in the ovaries prevent ovaries from releasing eggs every month. However, the exact cause of PCOS is still unknown.

Let’s go on and bust the myths around it because separating myth from fact can help you live a healthier life with PCOS. 

Myth #1: Having polycystic ovary syndrome means you have cysts in your ovaries

This is untrue. The name of the disorder is very misleading. If you have PCOS, it doesn’t mean you have cysts in your ovaries and having cysts in your ovaries doesn’t mean you have PCOS.

To be diagnosed with PCOS, you need to have at least 2 of the following symptoms:

Let’s go on and bust the myths around it because separating myth from fact can help you live a healthier life with PCOS. 

Myth #1: Having polycystic ovary syndrome means you have cysts in your ovaries

This is untrue. The name of the disorder is very misleading. If you have PCOS, it doesn’t mean you have cysts in your ovaries and having cysts in your ovaries doesn’t mean you have PCOS.

To be diagnosed with PCOS, you need to have at least 2 of the following symptoms:

Let’s go on and bust the myths around it because separating myth from fact can help you live a healthier life with PCOS. 

Myth #1: Having polycystic ovary syndrome means you have cysts in your ovaries

This is untrue. The name of the disorder is very misleading. If you have PCOS, it doesn’t mean you have cysts in your ovaries and having cysts in your ovaries doesn’t mean you have PCOS.

To be diagnosed with PCOS, you need to have at least 2 of the following symptoms:

Excess androgen – elevated male hormones levels may result in physical signs, such as excess facial and body hair (hirsutism) and occasionally, severe acne and male-pattern baldness.

Irregular periods – this is when you have less than nine periods a year with more than 35 days in between your periods. 

Multiple cysts in your ovaries – your ovaries can be enlarged with tiny follicles that trap the eggs, preventing them from being released every month, causing the ovaries not to function properly. 

So, having just cysts in your ovaries doesn’t necessarily mean you have PCOS. 

If you have any of the above symptoms and would like to get professional advice, you can consult a gynaecologist from the comfort of your home via oDoc.

Myth #2: You can’t get pregnant if you have PCOS

INCORRECT! YOU CAN GET PREGNANT EVEN IF YOU HAVE PCOS. 

PCOS is a common cause of  infertility due to the irregular release of eggs from the ovaries and the hormonal imbalance which interferes with fertilisation, BUT this isn’t the case for everyone. You can still get pregnant both naturally and after fertility treatment. Many medications can stimulate ovulation which is the leading cause of infertility. Women with PCOS who want to start a family can try different fertility treatments. Have a sit down with your gynaecologist to understand your body and treatment options better.

Myth #2: You can’t get pregnant if you have PCOS

INCORRECT! YOU CAN GET PREGNANT EVEN IF YOU HAVE PCOS.

PCOS is a common cause of  infertility due to the irregular release of eggs from the ovaries and the hormonal imbalance which interferes with fertilisation, 

BUT this isn’t the case for everyone. You can still get pregnant both naturally and after fertility treatment. Many medications can stimulate ovulation which is the leading cause of infertility. Women with PCOS who want to start a family can try different fertility treatments. Have a sit down with your gynaecologist to understand your body and treatment options better.

Myth #2: You can’t get pregnant if you have PCOS

INCORRECT! YOU CAN GET PREGNANT EVEN IF YOU HAVE PCOS. 

PCOS is a common cause of  infertility due to the irregular release of eggs from the ovaries and the hormonal imbalance which interferes with fertilisation, BUT this isn’t the case for everyone. You can still get pregnant both naturally and after fertility treatment. Many medications can stimulate ovulation which is the leading cause of infertility. Women with PCOS who want to start a family can try different fertility treatments. Have a sit down with your gynaecologist to understand your body and treatment options better.

Myth #3: You can only get PCOS if you are obese or overweight

Again, nope. This is not true. PCOS is more common in overweight women than lean women, and obesity can worsen the symptoms, but it can affect women of any body type and size.

One of the causes of PCOS is excess insulin in your body. This happens due to your cells forming a resistance to insulin which causes your blood sugar level to increase, and your body might produce more insulin to tackle it. Excess insulin causes more androgen to be produced, which causes difficulty with ovulation. 

The body’s inability to use insulin properly can lead to weight gain. That’s why getting into the habit of eating healthy and exercising regularly is recommended as part of most women’s treatment plan.

Myth #3: You can only get PCOS if you are obese or overweight

Again, nope. This is not true. PCOS is more common in overweight women than lean women, and obesity can worsen the symptoms, but it can affect women of any body type and size.

One of the causes of PCOS is excess insulin in your body. This happens due to your cells forming a resistance to insulin which causes your blood sugar level to increase, and your body might produce more insulin to tackle it. Excess insulin causes more androgen to be produced, which causes difficulty with ovulation. 

The body’s inability to use insulin properly can lead to weight gain. That’s why getting into the habit of eating healthy and exercising regularly is recommended as part of most women’s treatment plan.

Myth #3: You can only get PCOS if you are obese or overweight

Again, nope. This is not true. PCOS is more common in overweight women than lean women, and obesity can worsen the symptoms, but it can affect women of any body type and size.

One of the causes of PCOS is excess insulin in your body. This happens due to your cells forming a resistance to insulin which causes your blood sugar level to increase, and your body might produce more insulin to tackle it. Excess insulin causes more androgen to be produced, which causes difficulty with ovulation. 

The body’s inability to use insulin properly can lead to weight gain. That’s why getting into the habit of eating healthy and exercising regularly is recommended as part of most women’s treatment plan.

Myth 4: Losing weight is how you get rid of PCOS

Unfortunately, there is no cure for PCOS, so losing weight will not make PCOS go away, but it can help manage many of the symptoms. It is said that 10% reduction in body weight can reduce clinical symtoms by 80-90%. Losing weight will help with balancing the hormones. Lifestyle changes, such as healthy eating and regular exercise, improve the way your body uses insulin and, therefore, regulates your hormone levels better, thus helping your symptoms.

Myth 4: Losing weight is how you get rid of PCOS

Unfortunately, there is no cure for PCOS, so losing weight will not make PCOS go away, but it can help manage many of the symptoms. It is said that 10% reduction in body weight can reduce clinical symtoms by 80-90%. Losing weight will help with balancing the hormones. 

Lifestyle changes, such as healthy eating and regular exercise, improve the way your body uses insulin and, therefore, regulates your hormone levels better, thus helping your symptoms.

Myth 4: Losing weight is how you get rid of PCOS

Unfortunately, there is no cure for PCOS, so losing weight will not make PCOS go away, but it can help manage many of the symptoms. It is said that 10% reduction in body weight can reduce clinical symtoms by 80-90%. Losing weight will help with balancing the hormones. Lifestyle changes, such as healthy eating and regular exercise, improve the way your body uses insulin and, therefore, regulates your hormone levels better, thus helping your symptoms.

Myth 5: Women with PCOS do not need to use contraception

If you are not planning on getting pregnant, then you should always use contraception during sex. As mentioned above, ovulation is irregular when you have PCOS, so you never know when the egg will be released. So if you want to avoid unplanned pregnancies, always use a form of contraception.

Myth 5: Women with PCOS do not need to use contraception

If you are not planning on getting pregnant, then you should always use contraception during sex. As mentioned above, ovulation is irregular when you have PCOS, so you never know when the egg will be released. So if you want to avoid unplanned pregnancies, always use a form of contraception.

Myth 5: Women with PCOS do not need to use contraception

If you are not planning on getting pregnant, then you should always use contraception during sex. As mentioned above, ovulation is irregular when you have PCOS, so you never know when the egg will be released. So if you want to avoid unplanned pregnancies, always use a form of contraception.

Myth 6: Irregular periods = PCOS

No! Having PCOS may mean that you might have irregular periods but there are various other factors which can lead to irregular periods such as stress, extreme dieting and other endocrine disorders. Regular periods range between 3-7 days and occur every 21-35 days. Anything longer than this can be considered irregular. If you are experiencing irregular periods, speak to a doctor to get more information.

Myth 6: Irregular periods = PCOS

No! Having PCOS may mean that you might have irregular periods but there are various other factors which can lead to irregular periods such as stress, extreme dieting and other endocrine disorders. Regular periods range between 3-7 days and occur every 21-35 days. Anything longer than this can be considered irregular. If you are experiencing irregular periods, speak to a doctor to get more information.

Myth 6: Irregular periods = PCOS

No! Having PCOS may mean that you might have irregular periods but there are various other factors which can lead to irregular periods such as stress, extreme dieting and other endocrine disorders. Regular periods range between 3-7 days and occur every 21-35 days. Anything longer than this can be considered irregular. If you are experiencing irregular periods, speak to a doctor to get more information.

These are just a few of the misconceptions about PCOS. If you want more information or are experiencing any of the symptoms mentioned in this blog, please seek medical advice from an SLMC registered gynaecologist or GP via oDoc. Do not self-diagnose or self-treat PCOS. 

Checked by Dr. Haroon Thowfeek and Dr. Mohamed Rishard

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