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Signs of a late period: How Late Can a Period Be Before You Know You’re Pregnant?


Menstrual Period – Missed or Late

Is this your child’s symptom?

  • Late or missed menstrual period
  • Late period: 5 or more days late compared to normal menstrual cycle
  • Missed period: no menstrual flow for more than 6 weeks
  • Teen not using any birth control that stops periods. These products include birth control shots, implants, and IUDs with hormones.

Normal Cause of a Missed Period during the First Year

  • Skipping periods is common during the first 1 to 2 years after they start. This is due to not releasing an egg each month.
  • This is most likely the cause if less than 2 years since the first period
  • Has missed periods in the past or has had only 1 or 2 periods
  • Otherwise healthy
  • No signs of pregnancy such as breast tenderness, breast swelling or nausea

Common Cause of a Missed Period after the First Year

  • Pregnancy is the most common cause

Other Causes

  • Stress
  • Dieting, extreme exercise and weight loss
  • Polycystic ovarian disease
  • Endocrine disorders
  • Birth control products like birth control shots, implants, and some IUDs

Home Urine Pregnancy Tests

  • Home urine pregnancy tests do not cost very much. They are easy to use. Most drugstores sell these tests. No prescription is needed.
  • Urine pregnancy tests are very accurate. They can turn positive as early as the first week after a missed period.
  • It is best to do the pregnancy test first thing in the morning. Reason: hormone levels are higher in the morning urine.
  • Sometimes, a home test is negative even if you think you might be pregnant. In this case, repeat the test. Do the repeat test in 3-5 days. You can also go to a doctor’s office for testing.
  • A pregnancy testing fact sheet can be found at www.womenshealth.gov. Search “pregnancy tests.”

When to Call for Menstrual Period – Missed or Late

Call Doctor or Seek Care Now

  • Your teen looks or acts very sick
  • You think your teen needs to be seen, and the problem is urgent

Contact Doctor During Office Hours

  • Home pregnancy test is positive
  • You want a pregnancy test done in the office
  • Sexual intercourse (had sex) within the last 3 months
  • Recent breast swelling, weight gain or nausea
  • Teen acts sick
  • Has missed 2 or more periods and prior periods were regular
  • Recent weight loss
  • Excessive exercise suspected as cause of no periods
  • First period started less than 1 year ago and has missed 4 or more periods
  • Age 15 or older and periods have not started
  • Cause is unknown (not recent onset of menstrual periods or recent stress)
  • You think your teen needs to be seen, but the problem is not urgent
  • You have other questions or concerns

Self Care at Home

  • Pregnancy suspected or possible
  • First period started less than 1 year ago and has missed 3 periods or less
  • Recent stress (such as starting at a new school, break-up) causing late period

Seattle Children’s Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

Care Advice

Pregnancy Suspected or Possible

  1. What You Should Know About Late Periods if Having Sex:
    • Menstrual periods stop when a woman becomes pregnant.
    • A woman with a missed or late period should think about pregnancy.
    • Here is some care advice that should help.
  2. Pregnancy Test, When in Doubt:
    • If there is a chance that you might be pregnant, use a urine pregnancy test.
    • You can buy a pregnancy test at any drugstore.
    • It works best first thing in the morning.
    • Follow all package instructions.
  3. Call Your Doctor If:
    • You have trouble with the home pregnancy test
    • Pregnancy test is positive
    • Misses 2 periods and pregnancy test is negative
    • Your teen develops any serious symptoms

First Period Started Less than 1 Year Ago

  1. What You Should Know About First Periods in Young Teens:
    • Skipping periods is common during the first 1 or 2 years after they start.
    • It doesn’t mean anything serious or cause any harm.
    • A girl can normally go up to 6 months between the first and second periods.
    • Also, a girl can go up to 4 months between the second and third periods.
    • Normal irregular periods can go on for 2 years.
  2. Call Your Doctor If:
    • Misses 4 periods
    • New symptoms suggest pregnancy (such as morning sickness)
    • You have other questions

Recent Stress Causing Late Period

  1. What You Should Know about Stress and Late Menstrual Periods:
    • Stress can disrupt normal menstrual cycles.
    • Try to help your daughter deal with the stress by talking about it.
    • Also, try to avoid or decrease stressors.
    • If this does not help, seek help from a counselor.
  2. Call Your Doctor If:
    • Misses 2 periods
    • Your daughter needs help coping with stress
    • New symptoms suggest pregnancy (such as morning sickness)
    • You have other questions

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 05/30/2021

Last Revised: 03/11/2021

Copyright 2000-2021. Schmitt Pediatric Guidelines LLC.

9 Early Signs of Pregnancy (Before Your Missed Period)

Missing your period is not always the first sign that you’re pregnant. Several symptoms can indicate pregnancy before you are due for your period. If you’re trying to conceive, look for these early signs of pregnancy a week or two before you expect your period.

1. Morning Sickness

Morning sickness is notoriously incorrectly named. As most pregnant women can tell you, it can happen at any time. It is also a common early sign of pregnancy before you miss your period. A few weeks after conception, your body produces more estrogen and progesterone, causing nausea or vomiting. According to the American College of Obstetricians and Gynecologists (ACOG), morning sickness subsides after the first trimester for some women, while others have it throughout the entire pregnancy.

2. Fatigue

Sometimes we all feel a little tired and rundown if we’re not taking care of ourselves properly. However, one of the most common early signs of pregnancy is extreme fatigue or exhaustion. Activities that never phased you before may tire you out, and you might want to sleep a lot even if you have gotten 7-9 hours already. The body is producing more blood to support the developing baby, which can cause fatigue and increase your need for nutrients. These symptoms usually last through the first trimester and can be alleviated by resting, eating a nutrient-rich diet, and drinking plenty of fluids.

3. Breast Changes

In the first few weeks of pregnancy, your breasts may become heavy, tender, swollen, or tender. Some women experience this symptom before their period, so it can be confused with PMS. However, one thing that happens during the early weeks of pregnancy that does not occur during a regular menstrual cycle might tip you off. If your areolas – the circles of pigmented skin surrounding the nipples – may darken or even become enlarged.

4. Spotting

Some women experience spotting as an early sign of pregnancy. Small amounts of light pink or brownish blood may appear a week or so before your period is due. This type of spotting is called implantation bleeding. As the fertilized egg attaches to the uterine lining, it can cause irritation and light bleeding. Sometimes this is mistaken as a period, but spotting is usually much lighter than a regular period. 

5. Cramping

Another sign of early pregnancy that can be confused with PMS or a regular period is cramping. During pregnancy, blood flow increases all over the body. Increased blood flow in the uterus can cause cramping. These cramps are usually mild, but if they become severe enough to affect your daily routine, you should see your doctor. Many women experience similar cramping right before their regular menstrual period, but it’s a common early symptom of pregnancy. So, if you have cramps (or the spotting mentioned above), don’t give up hope that you’re pregnant just yet.

6. Changes in Food Preference

Strange food cravings are a staple cliche in TV and films about pregnant women. However, that stereotype is rooted in reality. Many pregnant women develop cravings or aversions to food a few weeks after conception. You might find yourself wanting to eat things you don’t usually eat. Your favorite foods might suddenly make you nauseous. Or you may lose your appetite altogether.

7. Sensitivity to Smells

For some women, pregnancy makes their sense of smell go into overdrive. Exaggerated reactions to certain smells can tie into morning sickness and food preference. Scents that are not very strong to other people can be pungent and unpleasant to a pregnant woman.

8. Frequent Urination

A baby pressing on the bladder in the third trimester is not the only thing that causes frequent urination during pregnancy. After conception, your kidneys start working harder to filter the increased blood flow, resulting in the urge to urinate more frequently. This symptom can start right before your missed period.

9. Light Headedness

During the first weeks of pregnancy, you might feel dizzy or light-headed at times. After you get pregnant, your blood vessels dilate to prepare for the increased blood flow, which lowers blood pressure and creates that feeling of lightheadedness.

At City of Oaks Midwifery, we believe in caring for the whole woman in all stages of her life. If you are experiencing early signs of pregnancy or have other concerns about your health, call (919) 351-8253 to make an appointment at our Raleigh, NC midwifery practice.


How do I know if I’m pregnant, or just late?

You’ve ovulated and had sex, you might be noticing some possible early pregnancy symptoms, and your period should be coming soon or has already passed. Could you be pregnant, or is this more likely a late period? It’s hard to know for sure.

The science behind symptoms

Pregnant or not, your body starts releasing progesterone after you ovulate. This hormone keeps getting released and is at its highest point around five to seven days after ovulation. If a woman is pregnant, her body continues to produce progesterone in high amounts to help sustain the pregnancy. If she’s not pregnant, her progesterone levels decrease, and she’ll start her menstrual period.

Thanks also to progesterone, the symptoms of early pregnancy and your period are nearly identical. Cramps, fatigue, dizziness, breast tenderness – all early signs of pregnancy, but also possible signs of your period coming.

What about light spotting a week after ovulation? It could indicate implantation bleeding, but most women don’t experience this symptom and spotting can happen for other reasons.

What about nausea? This symptom is typically attributed to hCG, the pregnancy hormone, but it can be caused by other things, too (including PMS).

In the weeks between ovulation and a pregnancy test, many women “symptom spot”; that is, they take note of certain physical symptoms and think that they are definitely signs of early pregnancy. Is symptom spotting so wrong? Absolutely not, and it can even be kind of fun, as long as you know that only a blood test can tell you for sure if you’re pregnant.

Is there anything I can look for?

Probably the most reliable physical symptom of early pregnancy is a missed period. Noticing that your breasts are getting increasingly sore, or experiencing symptoms that you don’t usually get around the time of your period, are also signs that you could be pregnant. But again, a blood test will be the best way to know for sure.

Final thoughts: things to keep in mind

The bottom line is that without a blood test, it’s nearly impossible to know for sure whether you’re pregnant or experiencing a late period. Even home pregnancy tests can sometimes give a false negative, if taken too early, so it’s really smart to wait to take a test until or after your expected period.

If you’re paying attention to your symptoms, just know that it can get a little stressful for some women. So if you find yourself symptom spotting, try to be aware of how often you do it, and how you feel – does it distract you or stress you out? If it starts to get emotionally taxing for you, look for ways to stop paying attention to your symptoms.

Finally, make sure you’ve scheduled a pregnancy blood test, and keep taking your prenatal vitamins! Whether it’s sooner or later, when you get that BFP, you’ll be glad you did!

  • Mayo Clinic Staff. “Home pregnancy tests: Can you trust the results?” MayoClinic. Mayo Foundation for Medical Education and Research, Dec 2015. Web. Accessed 8/3/17. Available at http://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/home-pregnancy-tests/art-20047940.
  • Lori A Bastian, Haywood Brown. “Clinical manifestations and diagnosis of early pregnancy.” UptoDate. UptoDate Inc., Jul 2017. Web. Accessed 8/3/17. Available at https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-early-pregnancy?source=search_result&search=waiting%20for%20pregnancy%20test&selectedTitle=1~150.
  • “Morning Sickness: Nausea and Vomiting of Pregnancy.” ACOG. FAQ126 from the American College of Obstetricans and Gynecologists, Dec 2015. Web. Accessed 8/3/17. Available at https://www.acog.org/Patients/FAQs/Morning-Sickness-Nausea-and-Vomiting-of-Pregnancy. 

21 Early Signs & Symptoms of Pregnancy Before Missed Period

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A missed period is definitely the most obvious sign of pregnancy, but it isn’t the only sign of pregnancy. An egg fertilises and implants in the uterus wall, well before you miss your period. Essentially, you are pregnant the moment the implantation happens. When you are a few days or weeks into pregnancy, the body begins to give indications about pregnancy, even before the menstrual date. The symptoms of pregnancy generally appear during the first week of conception. However, an excited and anxious expectant mother can fail to notice them. Is there a way to know that you are pregnant even before you miss your period? Yes, there are! Read on, to find out.

Video: 10 Early Pregnancy Symptoms Before Missed Period

Signs and Symptoms of Pregnancy Before a Missed Period

A pregnancy test is undoubtedly the most accurate way to assess if you are pregnant. However, experiencing a few common symptoms could reveal those first signs of pregnancy, much before a missed period. Here is a list of some early symptoms of pregnancy, which could help gauge if you are pregnant, prior to the agonizing wait to take the tests.

1. Cramps

Menstrual cramps are an early and evident sign of pregnancy. You may experience light or mild cramping if you’re pregnant. These cramps will feel similar to the ones you experience before your periods, but they will be in your lower stomach or lower back.

2. Elevated Basal Body Temperature

Often more accurate than the rest of the symptoms, basal body temperature (your body temperature at complete rest) should be monitored for months to figure out a noticeable change. Prior to ovulation, the body temperature increases and comes back to normal after your period cycle. However, during pregnancy, the basal body temperature tends to stay elevated throughout. This is due to high levels of progesterone during pregnancy, which causes basal body temperature to rise. If your body temperature has been on the rise for over 20 days post-ovulation, it marks the onset of a new journey.

3. Sore, Tender, and Heavy Breasts

Sore, tender, heavy breasts or darker areolas are noticeable pregnancy symptoms, a week before missed period. With rising oestrogen levels after conception, women feel sore, full, and experience acute pain in the breasts. Nipples begin to look darker and feel itchy, tingly or prickly. Then again, these symptoms are not very different from pre-menstrual breast signs, but they will last after you have missed your period too.

4. Exhaustion and Fatigue

Hormonal changes leave you feeling tired and fatigued all the time. Exhaustion and sleepiness are early signs of being pregnant. It is normal to feel tired after doing even small chores during pregnancy. Progesterone levels are to be blamed for an increased tendency to sleep and it will last through the entire first trimester. The body also starts producing more blood to support the growing foetus, which results in increased exhaustion. This can be countered with a healthy diet, rich in minerals, vitamins, iron, and plenty of fluids.

5. Nausea

Nausea or vomiting, a very common symptom, often called ‘morning sickness‘, is a prominent symptom and could indicate that you are pregnant. You might start feeling uneasy and may experience nausea, 4-6 weeks after conception. Due to a rise in the levels of oestrogen and progesterone, you could wake up every day and feel the need to vomit. Nausea need not necessarily happen in the morning. It could appear anytime, last throughout the day, and stick around through all the trimesters. About 80% of pregnant women are afflicted with nausea in the initial weeks of pregnancy before a missed period. The severity of morning sickness or nausea symptoms vary in different women, but 50% of pregnant women feel nauseated within six weeks of pregnancy or even earlier.

6. Food Cravings, Aversions, and Sensitivity to Smells

Pregnancy hormones play a major role in making you crave your favourite food and may also cause an aversion to certain smells. Sudden and heightened sensitivity to smells, pungent tastes, and food aversions, occur during the initial weeks after conception and may or may not last through the entire pregnancy. Some mothers-to-be even lose their appetite before they miss their periods.

7. Bloating and a Feeling of Tightness

One of the most commonly experienced symptoms of pregnancy before a missed period is bloating or stomach twinges and pulls. These are a result of an increase in progesterone. The increased level of hormones impedes digestion, trapping gas in the intestines. A protruding stomach could tighten clothes around the waistline and result in discomfort. Bloating could also lead to unpleasant farts and burps. Healthy eating and controlled portions of food intake could help in dealing with any discomfort.

8. Urge to Urinate

The frequent urge to urinate is another prominent sign of pregnancy. This tendency will only increase through your pregnancy, when the growing uterus starts pushing the bladder. With hormonal changes and extra production of blood, frequent urination is a common symptom that will last through the entire pregnancy. Kidneys work overtime to filter blood, thereby causing an urge to urinate often. Almost all pregnant women experience this urge, which is one of the earliest signs of pregnancy. It starts occurring closer to when your periods are due.

9. Mood Swings

Changes in hormones can make you either feel upbeat or very low. Another early sign before you miss your period, mood swings work in mysterious ways, and will have you sobbing over the smallest or trivial issues. The imbalance in hormones affects the neurotransmitters in the brain, causing enhanced spells of emotions, ranging from anger to sudden emotional outbursts. Take some time to relax and rest, if you don’t feel normal.

10. Dizziness

Dizziness and a feeling of lightheadedness is an early symptom of pregnancy, which occurs in several expecting mothers. Blood vessels dilate, thereby causing a reduction in blood pressure, which leads to a feeling of dizziness and imbalance. The symptom lasts during the first trimester and gradually decreases in the other phases. However, if dizziness is accompanied by vaginal bleeding and abdominal pain, you should consult a doctor at the earliest.

11. Constipation

The progesterone hormone tends to constipate bowels and if you find yourself unable to poop, it could be an early sign of pregnancy. Bowel movements harden due to the spurt in hormones and reduce the pace at which food passes through the digestive system. If you feel constipated for over a week after you have missed a period, you should consider taking a pregnancy test.

12. Headache

Headaches are the most common premenstrual symptom. However, with conception, oestrogen and progesterone hormones work overtime to prepare the uterus for the baby. The hormones cause a dip in blood sugar levels, causing headaches, as the brain cells struggle to keep pace with low levels of sugar supply.

13. Aches and Pains

Hormones do the task of making space for the new life inside you, and this impacts the ligaments, which need to stretch. Stretching of ligaments and joints could result in pain in the spinal area before you miss your period.

14. Strange Taste in the Mouth

Hormones could play strange games during pregnancy, and you may find yourself having a strange awkward taste in your mouth, also called Dysgeusia. You could feel like you have swallowed some unsavoury metal. This metallic taste could well be an early sign to tell you that you have started your journey to motherhood. The symptom generally disappears after the first trimester, but could last longer in some women.

15. Excessive Thirst or Ravenous Pecking Tendencies

Don’t be surprised if you find yourself downing gallons of water. An increase in blood volume could make you feel excessively thirsty, even before you miss your period. You may also tend to feel hungry all the time, with the surge in hormones during pregnancy.

16. Cervical Mucus Change

An increase in cervical mucus is an early detector of pregnancy. After conception, the cervical mucus will appear thicker and creamier, and will stay that way till you have missed your period. You may also experience a stinging feeling when you pee, or itchiness and soreness around your vagina.

17. Shortness of Breath

Shortness of breath could be an early sign of pregnancy, since the body starts requiring more oxygen and blood to breathe for two lives. This continues throughout all trimesters with the baby growing. Slowly increasing the need for more oxygen and nutrition, as days pass.

18. Drooling or Salivating

Although not a very common symptom, some women do produce excess saliva before they miss their period. This condition, primarily known as ptyalis gradidarum, is related to morning sickness and heartburn. Nausea pangs build up extra liquid in the mouth, resulting in drooling.

19. Hot Flashes

A very common occurrence when your periods are due or even when menopause sets in, hot flashes could also be an early indication of pregnancy. If you experience frequent flushes of heat that last several seconds or minutes, there may be a good chance of you being pregnant.

20. Spots, Acne, and Bumps

An occasional occurrence of pimples and zits is common during the premenstrual phase. Sudden sprouts could be the result of an increase in hormone levels after conception. Well, the opposite could happen too. Pregnancy could reverse the occurrence of acne before your period and it could be a sign that a baby is on the way.

21. Bizarre Dreams

Vivid dreams could be prevalent during the early weeks of pregnancy even before you have missed your period. A peculiar pregnancy symptom, many women experience strange feelings a week or two after conception. Pregnancy hormones work in a baffling manner causing inexplicable dreams and illusions in an expectant mother.

How Soon Can You Experience Pregnancy Symptoms Before a Missed Period?

The occurrence of symptoms varies from woman to woman. Tender breasts, nausea, fatigue, sleepiness, sensitivity to smell, and bloating are commonly experienced symptoms, which start to surface about a week or ten days before your period is scheduled to arrive. The tendency to urinate frequently, generally occurs a few days before the period. Other symptoms like vaginal discharge, change in colour of cervical mucus, darkened areolas take some time to make their appearance, and need to be closely monitored.

Causes of a Period Delay

Period delays could be caused by several factors. There could be a chance that you are pregnant. However hormonal changes, weight gain, weight loss, medication, eating disorders stress, polycystic ovary syndrome, thyroid, birth control pills, or drug use could cause a delay in periods too.

What Is the Difference Between PMS and Pregnancy Symptoms?

Pregnancy symptoms and the effects of premenstrual syndrome (PMS) are very similar, and hence, you need to wait a little longer to confirm your pregnancy. A constant elevated basal body temperature, creamy vaginal discharge, and darkening areolas are some consistent signs of conception. However, none of them is foolproof, and the only way to confirm if you are pregnant or not is by taking a pregnancy test. This symptoms can give you an inkling of pregnancy, prompting you to take a test.

Is It Possible to Miss a Period and Not Be Pregnant?

A missed period does not necessarily mean that you’re pregnant. There could be several reasons for a delayed period, such as hormonal changes or stress, and until a pregnancy test confirms it, a missed period cannot be assumed a sign of pregnancy.

Is It Possible to Be Pregnant and Get Your Period?

It is not uncommon for newly expectant mothers to experience bleeding during the early stages of pregnancy. Implantation bleeding occurs 6 to 12 days after conception. It is possible to have light spotting, medium pink or light brown discharge that lasts for a few hours or a few days.  However, if you have an irregular period cycle, spotting could be a mid-cycle glitch, leading to your monthly periods. To confirm that you are pregnant, head to the nearest pharmacist and grab a home pregnancy kit or visit your gynaecologist for a definite answer.

How Long Should You Wait to Take a Home Pregnancy Test?

Early pregnancy symptoms show up weeks before your period, but an average waiting period of two weeks is recommended from the date of ovulation, to take a home pregnancy test. Human Chorionic Gonadotropin (hCG) is a placenta-produced hormone that enters the urine, once an embryo is implanted in the uterus. This takes place about 6 to 12 days after fertilisation.  hCG levels are picked up by the test, only closer to when periods are due. The ideal time to take a home pregnancy test is a week after your periods are due. There are 90% chances of an accurate result when the test is taken after the due date for the period has passed.

When Does One Start Experiencing Pregnancy Symptoms?

The earliest pregnancy symptoms are revealed 6 to 14 days after conception. Once you have sex during the ovulation period, the body starts preparing itself for the growing foetus. After fertilisation, the embryo implants itself to the uterine wall. You get pregnant around ten days before your periods are due. That is when you start experiencing the early signs of pregnancy such as fatigue, nausea, and tiredness. However, the pregnancy test gives the best results only after a week or two of a missed period, as the level of pregnancy hormone in the urine is up to a reasonable level by then.

Are Home Pregnancy Tests a Foolproof Indicator of Pregnancy?

During pregnancy, the body produces human chorionic gonadotropin (hCG), which can be detected in the urine. A Home Pregnancy Test checks for the presence of this hormone and declares a positive or negative result. While most home pregnancy tests are considered accurate, it is also dependent on the brand of pregnancy test you choose, as well as the timing of the test. Each pregnancy test brand recognises varying amounts of hCG in the urine. Moreover, hCG levels are low during the initial stages, and gradually increase as the pregnancy progresses. In many instances, you may take the test too early or use a less accurate test, prompting a negative result even when you may be pregnant, also called a false negative result. In some cases, certain drugs, medication, or proteins in the body may cause a false positive result. Hence, it is always best to confirm pregnancy by a doctor, via a blood test.

Symptoms and stages of pregnancy have never known to be common among all women. Some symptoms you experience may be due to a medical condition which you may not be aware of. The symptoms listed above do not necessarily confirm a pregnancy. The indicators mentioned above are just signs to watch out for, if you are planning to start a family. It is also possible to not go through any of these symptoms and still be pregnant with perfectly normal baby. Pregnancy can be confirmed only when you miss your periods, or by a pregnancy test kit, and in all cases, by a blood test conducted by a certified health practitioner.

Also Read:

Pregnancy Symptoms After Missed Period
Pregnancy Symptoms You Should Never Ignore
Weird Early Pregnancy Symptoms
Positive Pregnancy Test But No Symptom

8 Early Signs of Pregnancy: Before a Missed Period

Before a missed period, it’s possible to have a few symptoms that are early pregnancy signs, such as painful breasts, nausea, cramps or light abdominal pain, and excessive tiredness without an obvious cause. However, these symptoms may also show that your period is almost coming.

To check whether the symptoms are in fact indicators of pregnancy, it is important for you to go to a gynecologist and do urine and blood tests to identify whether she has the pregnancy hormone beta-hCG.

Some of the following symptoms may appear before a late period and can be signs of pregnancy:

  1. Breast pain;
  2. Darkening areolas;
  3. Pink vaginal discharge;
  4. Swelling and abdominal pain;
  5. Excessive tiredness for no obvious reason;
  6. Increased need to urinate;
  7. Constipation;
  8. Nausea

These symptoms can also happen before a period, so they are not definite pregnancy signs. If these symptoms appear, the best thing to do is to wait for the missed period and then do a pregnancy test.

How to know if you are pregnant 

In order for you to be more certain that the symptoms you have mean that you are pregnant, it’s important to pay attention to your ovulation, as then you will be able to check the probability of having had ovulation and fertilization by the sperm. 

In addition, to know if your symptoms are pregnancy-related, it’s important that you visit a gynecologist and do tests that identify the beta-HCG hormone, as HCG levels are higher in pregnancy.

You can also do a pregnancy test you can buy at a drugstore, but be sure to only do it from the first day after the period is late, through a urine sample. If the result is negative but you keep having pregnancy symptoms, we recommend that you do the test again after three and five days, as different pregnancy tests have different levels of sensitivity.

Usually, a doctor will recommend a blood test to confirm a pregnancy, as it can indicate whether the woman is pregnant and what pregnancy week she is on, according to the beta-HCG levels that circulate in the blood. This test can be done 12 days after the fertile period, even before the period comes.

To find out what the fertile period is, and thus know when it is possible to do a blood test, just insert the data in the calculator below:

Signs Your Period Is Coming

Getting your period is a normal part of growing up. During your period, a little bit of blood comes out of your vagina for a few days. Here’s the deal on periods, cramps, and PMS.

What do I need to know about my period?

Menstruation (also known as having your period) is when blood from your uterus drips out of your vagina for a few days every month. You start getting your period during puberty, usually when you’re around 12-15 years old.

Your menstrual cycle is what makes your period come every month. It’s controlled by hormones in your body. The purpose of the menstrual cycle is to help your body get ready for pregnancy. Your menstrual cycle = the time from the 1st day of your period to the 1st day of your next period.  Learn more about how your menstrual cycle works.

Most people get their period every 21-35 days — around once a month (that’s why periods are sometimes called “that time of the month”). The bleeding lasts for 2-7 days — it’s different for everyone. Your period might not always come at the same time each month, especially when you first start getting it. It can take a few years for your period to settle into it’s natural rhythm, and some people never get regular periods throughout their lives.

Missing your period can be a sign of pregnancy if you’ve had penis-in-vagina sex without using birth control. But there are other reasons your period might be late, too. Learn more about what to do if you miss your period.

There are lots of ways to deal with the blood that comes out of your vagina when you have your period. You can use pads, tampons, period underwear, or a menstrual cup to collect the blood, so it doesn’t get on your clothes. Learn more about using tampons, period underwear, pads, and cups.

Some people get cramps or other symptoms before and/or during their period — this is called PMS. Luckily, there are things you can do to feel better if your period is painful or uncomfortable. You can also track your period using our app, to help get a better idea of when your period is coming and what side effects to expect. 

Getting your period is a healthy part of growing up. Periods don’t have to stop you from going to school, doing sports, swimming, or hanging out with your friends — you can do all your normal activities during your period. And you’re the only person who’ll know that you’re having your period.

How do I deal with PMS and cramps?

PMS stands for Premenstrual Syndrome. It’s when the hormones that control your menstrual cycle cause changes in your body and emotions around the time of your period.

Some of the most common PMS symptoms are:

  • Cramps (pain in your lower belly or lower back)

  • Bloating (when your belly feels puffy)

  • Breakouts (getting pimples)

  • Sore breasts

  • Feeling tired

  • Mood swings (when your emotions change quickly or you feel sad, angry, or anxious)

Some people get PMS every time they have their periods. Others only get PMS every once in awhile. You may have all or just some PMS symptoms. And some people don’t get PMS at all. Learn more about PMS.

Cramps are one of the most common symptoms to have before/during your period. They can be super painful, or just a little annoying. You can calm cramps by taking pain medicine (like ibuprofen). Putting a heating pad where it hurts, taking a hot bath, exercising, or stretching your body can also help. Learn more about how to deal with cramps.

Certain types of birth control — like the pill, shot, implant, and IUD — can help with PMS and other period problems. If your PMS is so bad that it’s hard to do normal activities during your period, talk to an adult you trust or your family doctor. You can also call your local Planned Parenthood health center. You shouldn’t have to suffer every month, and they can help you find the cause and get treatment.

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Irregular or Absent Periods – Your Period

It is not uncommon to occasionally miss a period, or for periods to become irregular from time to time. Under some circumstances, periods can even stop altogether. Sometimes these irregularities are due to normal changes, and are not cause for concern. Other times, they are a sign that something is going on, and a call to your doctor is warranted.

Why did I miss a period?

Missing a period is not uncommon, and most of the time, it is not a cause for concern.  Some of the reasons you might miss a period include:

Normal lifecycle changes

There are a number of changes that happen in the female lifecycle that can result in a skipped period. All of these are normal reasons to miss a period and are not cause for concern.

For example:


The most common reason for a missed period is pregnancy. If this is a possibility, take a home pregnancy test to see if this is the cause of your missed period. If you skip a period and then have one the next month at the expected time, it’s possible that a non-viable pregnancy occurred, and the period is actually an early miscarriage.


Breastfeeding can suppress your period, depending on how frequently you are nursing. You may get a period while breastfeeding, and then not have another one for several months or more, particularly if your baby is nursing exclusively. You can ovulate before you get your period, so it’s important to use birth control during this time, if you don’t want to get pregnant.


A skipped period may be a sign that you are entering menopause and your periods are beginning to become less regular, especially if you are experiencing other symptoms of menopause (e.g., hot flashes). If you are 45 or older, there is a good chance this is the cause of a missed period.


Both psychological and physiological stress can cause a missed period. If you are going through a difficult period of life (e.g., moving, new job, loss of a loved one), or experience a physical trauma (e.g., surgery, illness) it is not unusual to miss a period. There are many things you can do to help manage your mental stress levels. Talking to a trusted friend or family member about what you are going through can help. Carving out small blocks of time for activities that help you relax, such as exercise, yoga, painting, or reading can also help. If you are finding your stress very hard to manage, talking to a therapist with expertise in cognitive behavioural therapy can help you change some of your thinking patterns and learn to cope better.

Weight loss

Excessive exercise and rapid weight loss can result in a missed period. If your caloric intake is very low, the hormones that cause ovulation to happen are suppressed. If you are underweight, a dietitian can help you plan your dietary intake to promote weight gain.

If you are struggling with an eating disorder, there is help out there. Counseling, support groups, self-help strategies, and support from a team of health care providers such as a dietitian, psychiatrist, and your family doctor can all be part of recovery. There are also medications that can help. Contact your doctor or the Canadian Mental Health Association to find resources in your area.

Birth control

If you take the birth control pill continuously without taking a seven day break where the pills do not contain hormones (or you don’t take a pill at all), you will miss a period. Similarly, if you are using the birth control shot, patch, vaginal ring (without removal for the seven day break) or have a progestin IUD, you will likely have few or absent periods.

Hormonal changes

Hormonal changes can also result in missing periods. The most common causes of hormone changes are polycystic ovarian syndrome, pituitary tumours , and thyroid disorders.


Some medications that can cause a missed period include antidepressants, antipsychotic drugs, chemotherapy agents, and steroids.

Why am I not getting my period at all?

The medical term for absent periods is ‘amenorrhea’, and is considered to occur when a woman who has previously had normal periods stops menstruating for six months or more. Many of the causes of amenorrhea are the same as those for a skipped period. Your period can be absent for a number of reasons:


The most common reason to not get your period is because you are pregnant. A home pregnancy test can quickly tell you if that is the reason.


Most women stop getting their periods in their late 40s or early 50s. The average age is 51 years old.


If you breastfeed frequently, including at night-time, you may not get a period for many months. Be aware that you will ovulate prior to getting your period back, so birth control is important if you are not ready to be pregnant again.


While a sudden stressful life event can result in a single missed period, ongoing, high level stress and anxiety can cause your period to stop altogether. Managing stress though self-care, counselling, changing your life circumstances, medication, or other strategies can help you return to having normal periods.

Weight loss

Ongoing, dramatic weight loss, from low intake, excessive exercise, gastric bypass surgery, or eating disorders such as anorexia or bulimia can stop your period. This happens because the hormones required for ovulation are not produced.


At a BMI of less than 18, you may experience the absence of periods. The exact weight and body fat levels that result in amenorrhea differs from person to person.


Obese women are more likely to have absent periods or infrequent periods. This is due to hormonal changes associated with obesity, such as increased insulin, increased testosterone, and insulin resistance. Obesity is also associated with polycystic ovary syndrome (PCOS), which impacts the menstrual cycle and can cause periods to stop (or can cause heavy menstrual bleeding).

High levels of prolactin

Prolactin is a hormone that is produced by the pituitary gland, located in the brain, which stimulates breast development and the production of milk. If you are not pregnant or nursing but have high levels of prolactin, you may not be ovulating, and therefore may not menstruate.

Asherman’s syndrome

This is a very rare condition where scar tissue is present inside the uterus. It typically develops after surgery (for example dilatation and curettage), or after an infection of the uterus. The scar tissue is usually removed surgically.

Absent uterus

Although it is very rare, there is a rare congenital syndrome called Mayer-Rokitansky-Kuster-Hauser syndrome where the uterus and upper vagina are absent at birth, although ovaries and fallopian tubes are present. No menstruation occurs due to the lack of uterus.

If you have had a hysterectomy, no menstrual periods will occur.

Premature ovarian failure

This condition is marked by the depletion of follicles in the ovaries before the age of 40. It leads to early menopause and the absence of periods, and the loss of fertility.

Pituitary tumours

A pituitary tumour is an abnormal growth of cells that originates in the pituitary gland, located in the brain. Control of the body’s hormones is regulated by the pituitary gland. It secretes a wide variety of hormones, including growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, luteinizing hormone , follicle-stimulating hormone , and prolactin. Depending on where in the pituitary gland the tumour is growing, production of any of these hormones can be impacted.

Pituitary tumours are almost always benign. There is a very wide range of symptoms that can be caused by a pituitary tumour, depending on its location and what type of hormone(s) the tumour is producing. They can exert a wide range of effects on menstruation, and can cause periods to become irregular or stop altogether.

90,000 Death Spiral. Can we predict the time of our demise?

  • Colin Barras
  • BBC Earth

Photo by Simon Colmer naturepl.com

Scientists already know how to predict the date of death in flies, the observer found out

BBC Earth . When will it come to a person?

Death is inevitable – but is it predictable? Some scholars believe so.

According to them, in the course of experiments with fruit flies, a new and very special phase of the life cycle was revealed, which is a harbinger of the approaching end.

This phase is called the death spiral. According to scientists, there can also be a similar stage in people’s lives.

Even some 25 years ago, biologists believed that life is divided into only two main phases – childhood and adulthood.

This division is clear to everyone. Childhood is characterized by rapid growth and development until puberty. During this period, the likelihood of death is low.

Adult life begins after puberty.At the beginning of this period, the probability of death is low – this is the time of the heyday of vitality and the ability to bear children.

But over time, the body begins to age and wear out. Every year the probability of death increases – slowly at first, and then faster and faster.

In the early 1990s, scientists realized that life was not limited to these two periods, and identified the third phase of the life cycle, which reaches the oldest members of society – “late life”.

Late years of life differ from the adult period by a special mortality schedule.The annual increase in the likelihood of death, characteristic of adult life, does not work at this stage.

While a 60-year-old has a much higher probability of dying soon than a 50-year-old, then a 90-year-old and a 100-year-old have almost identical rates.

“The mortality rate is leveling off and reaching a plateau,” explains Lawrence Mueller, a research assistant at the University of California, Irvine (USA).

Why the mortality graph behaves this way is unclear to this day – scientists have still not been able to come to a consensus on this issue.

Photo author, Thinkstock

Photo caption,

As a child, we grow rapidly, and the likelihood of natural death is extremely low

While studying this problem, Mueller, together with his colleague Michael Rose, began to look for signs that other biological indicators other than mortality.

“We were interested in the question of whether reproductive function or female fertility, that is, a woman’s ability to bear children, does not follow the same pattern,” he explained.

They began to investigate this problem with biologists’ favorite guinea pigs, the fruit fly population.

“We took 2828 females and put each in a separate tube with two males,” says Müller. “Every day, we moved the females into new tubes and counted how many eggs they had laid. So we continued until all the females died. “.

Photo by Solvin Zankl naturepl.com

Photo caption,

Counting flies is boring, but useful

Drosophila usually live for several weeks.“It was a very big experiment,” says Mueller.

And very tiring: moving so many tiny flies every day and counting their even tinier eggs can get tired quickly.

Rose’s graduate Kasandra Rauser and several dozen students took on these difficult tasks.

After all this work, the results at first seemed discouraging. No clear leveling of the fertility level was observed in the late period of flies’ life.

In fact, upon closer inspection, scientists have discovered that something completely different is happening.

“I noticed that females who were nearing death had a different fertility rate than other females of the same age who I knew from the database had a few more weeks to live,” Mueller recalls.

Simply put, in the last two weeks before death, the fly’s fertility rate – the number of eggs laid during the day – dropped dramatically.

Photo author, Thinkstock

Photo caption,

When the body enters the death spiral, the end is near

But even more remarkable, the decline in fertility occurred regardless of the fly’s age at the time of death.(Roughly speaking, the fly’s body felt the approach not of old age, but of death – at any age – Red .).

If an aged Drosophila, which lived 60 days, was nearing its end, its fertility level dropped sharply – but the same sharp decrease in the number of eggs was observed in a fly at the age of 15 days, which was destined to die young.

This period turned out to be universal – a new, fourth phase, different from childhood, adulthood or later years of life.Mueller and Rose called it the death spiral.

The discovery was made in 2007, and since then scientists have been looking for further evidence of the death spiral.

For example, in 2012, they found that male fruit flies show a similar decline in reproductive potential in the days immediately preceding death.

This time a graduate of the Faculty of Biology Parvin Shahrestani led the permanent collection of data.

“As the male ages, the ability of the male to fertilize the female gets worse,” says Müller.“But shortly before the death of a male – regardless of whether he is young or old – his reproductive function is much weaker than that of males of the same age, who still have a few weeks to live.”

And more recently, in 2016, Müller and Rose analyzed data from a series of experiments conducted independently by scientists from four different laboratories.

The purpose of the experiments was to study the lifespan and fertility rate of fruit flies.

According to Müller, this combined database also provided evidence of the death spiral at work.

Photo by Solvin Zankl naturepl.com

Photo caption,

Some changes in the fruit flies clearly indicate that death is approaching

Regardless of their age, two weeks before death, female fruit flies show a sharp decline in fertility.

Scientists and their colleagues have even found that it is possible to some extent to predict whether a fly will die on a particular day – solely based on its fertility data over the previous three days and without any other information, including its age. …

“About 80% of the time, we accurately predicted the date of death,” says Müller.

Rose and Müller are not the only scientists to see a relationship between fertility and death.

University of Minnesota Researcher (USA) James Curtsinger conducts his own experiments on the aging and death of fruit flies.

The results of his research were published in 2016 and also showed a decrease in fertility on the eve of imminent death, which is broadly in line with the findings of Mueller and Rose.

Importantly, Kertinger also found that fertility declined as death approached regardless of age: both relatively young and old flies fit into the same pattern.

However, Kertsinger’s work differs from that of Mueller and Rose in a number of important details.

First, he does not consider the results obtained as evidence of the existence of a separate and universal fourth phase of life – he is not convinced that such a decline in fertility is observed in humans or other species that differ from flies in a number of biological parameters.

In addition, in his opinion, the term “death spiral” is overly vague and ambiguous.

Photo author, Reynermedia CC by 2.0

Photo caption,

Do we still have to discover new stages of life?

He has developed his own terminology, which he believes will be more suitable for biologists.

“When I was twenty I was researching sex ratio, after forty I took up the science of aging, and now that I’m sixty-five I’m working on a new biological concept that I call retirement,” he says.

“Retirement” is easy to spot in female fruit flies. This stage begins on the day when the mature female will not be able to lay any eggs.

To understand the meaning of this day, you need to understand a little about the physiology of female fruit flies.

“A fly is 2.5 millimeters long, while a Drosophila egg is only half a millimeter,” explains Kertsinger. “During her life, a female lays about 1200 eggs – if laid out in one line, it will be about half a meter.”

In other words, the female Drosophila is a kind of egg-laying machine.This is almost the only thing that worries her in this life.

And if a fly has not laid a single egg in the whole day – even if the next day it resumes this work of its life – it means that something is wrong with it.

Kertsinger makes a comparison with a car running out of gasoline. The engine can start tapping several kilometers before complete failure, but this first knock tells the driver that the situation has become critical.

Photo by Bernard Castlelein naturepl.com

Photo caption,

Motherhood is not a gift for the body

In addition, based on the results of his research, Kertsinger came to several conclusions that Mueller and Rose did not have.

He realized that at the very end of the retirement period, when the level of fertility is low and death is very close, the mortality rate in flies is equalized in the same way as in the later period of life.

“This is a completely new observation,” he says. “The leveling off in mortality is not just a sign of old age, it can occur in middle and young age.”

The current general consensus is that the leveling off in mortality is associated with age, but Kertsinger says these new results show that both the leveling off of mortality and death itself are more likely to be associated with fertility.

Perhaps this observation will force biologists to rethink theories of aging.

However, Kertsinger is still struggling with one question: what exactly explains such a close relationship between fertility and death? “We have no answer to this question,” he admits.

However, according to James Keiry of the University of California, Davis, USA, this phenomenon may simply reflect a well-known concept: offspring goes to parents – especially mothers – at a high cost.

Photo by Edwin Giesbers naturepl.com

Photo caption,

Reproduction can affect life expectancy

For example, mothers with many children can develop dental diseases.

More than ten years ago, Keiri and his colleagues showed that changing the reproductive systems of mice can influence their lifespan.

Aged female mice were placed on the operating table and their worn out ovaries were replaced with new ones taken from younger females. After such an operation, the old mice lived much longer than expected.

“We have seen a number of signs indicating that mice with new ovaries had healthier hearts and fewer heart diseases than those who did not have this operation,” explains the scientist.

If Kertsinger is not sure that people experience a “retirement” before dying, then, according to Mueller, there is evidence that those of us who will soon die of natural causes fall into a death spiral.

“Interesting research has been done in a nursing home in Denmark that may be relevant to illustrate this concept,” he says.

In a group of 90-year-old volunteers, scientists conducted a series of tests aimed at assessing their strength, coordination and mental alertness.

A few years later, they contacted the nursing home again to find out who of the study participants had died and who was still alive.

Photo by Jared Tarbell CC by 2.0

Photo caption,

It would be best to stay healthy until death

“People who died during this period, in general, were among those who performed worse on the tests,” explains Müller. decline in physiological capabilities “.

What interests him most is the idea that studying fruit flies will help identify strategies to delay the onset of the death cycle – so that it begins a few days, rather than a few weeks before death.

The scientist hopes that his work will provide new clues to understanding how to prevent the period of deterioration in health before death, which can be slow and prolonged.

“That would be a really valuable result – shortening the death spiral so that people can stay healthy until they die,” he says.

Information about Alzheimer’s disease (for patients and their loved ones)

Many people can at least once in their life encounter a situation when their memory and attention are not in such good condition as they would like.The condition is often transient and usually accompanies stress, anxiety, depression, or sleep disturbances.

With age, people are more likely to encounter memory problems. This can be both a natural manifestation of aging and a sign of illness. In most cases, age-related changes do not cause serious problems in daily life. If constant forgetting begins to interfere with a person’s daily life, and he cannot cope with previously performed actions, this may be a manifestation of dementia.

Dementia is a progressive deterioration in memory, mental ability and ability to cope with daily activities, which leads to a state where a person cannot cope without assistance.
There are several causes of dementia, and the most common cause is Alzheimer’s.

Alzheimer’s is a chronic disease of the nervous system that was first described by Dr. Alois Alzheimer in 1906.The disease got its name from his name. The disease causes slow neuronal damage and brain tissue death. Due to the disease, memory, mental abilities gradually deteriorate, and the ability to cope with daily activities decreases.

Other causes of dementia include, for example, recurrent cerebrovascular disorder (vascular dementia), degeneration of the frontal and temporal lobes (frontotemporal dementia), and long-term Parkinson’s disease.

Occasionally, severe renal or hepatic impairment, thyroid insufficiency, tumors or brain injury result in decreased mental performance. If a doctor suspects that a person with memory impairments has the aforementioned diseases, they may carry out the necessary tests and examinations to rule out these diseases.

The diagnosis of Alzheimer’s disease cannot be confirmed by a blood test. Decreased brain volume can be seen on examination of the brain.

Due to the aging of the population, the incidence of Alzheimer’s disease is also increasing.Therefore, it is very important to raise public awareness of this disease. Treatment for Alzheimer’s disease can help slow the progression of the disease, so it is very important to see your doctor as early as possible.

The Patient Manual in your hand is intended for Alzheimer’s patients and their loved ones, as well as all other interested parties. The purpose of the guide is to help people with Alzheimer’s and their loved ones understand the nature of the disease, diagnose it and find suitable solutions if problems arise.A holistic knowledge of the disease helps to recognize the disease as early as possible, and thanks to this we can better understand the patient’s problems and provide him with effective assistance.

Acetylcholine is a transport substance through which communication between brain cells occurs. Alzheimer’s disease causes a lack of acetylcholine in the brain.

Dementia is a worsening impairment of memory, mental ability and ability to cope with daily activities, which leads to a condition that a person needs assistance.

Guardianship is a legal relationship in which the court appoints a guardian to a person with limited legal capacity (ward) to protect his personal and property rights of a person and to carry out specific actions prescribed by law and provided by the court for the protection and well-being of persons.

G Lutamate is a transport substance through which communication occurs between brain cells. Alzheimer’s disease is caused by excessive release of glutamate in the brain.

Primary caregiver primary caregiver

Capability – the ability of a person to independently make existing transactions. The presence of legal capacity implies that a person can adequately understand the meaning of his actions.

Brief Test Mental Status is a screening test used to diagnose dementia and assess the severity of the disease.

  • If your memory and skills are impaired, contact your family doctor. If you notice these changes in a loved one, help him go to the family doctor’s appointment. Stay with him at the doctor’s appointment to help describe the changes, if needed.
  • Call your family doctor right away if problems come on suddenly and progress over days, weeks, or months.If necessary, the family doctor will cooperate with a neurologist and / or psychiatrist and / or geriatrician.
  • Tests and blood tests, as well as computed tomography and magnetic resonance imaging, are done to determine the cause of memory problems.
  • Alzheimer’s diagnosis begins with treatment that helps maintain the ability to cope with daily activities and slows down the development of memory impairment. Treatment of the disease with drugs is not possible.
  • If you experience hallucinations (eg, seeing ghosts), mood swings, anxiety attacks, aggressive behavior, seek the help of your family doctor or psychiatrist.Mental and behavioral disorders are common in patients with Alzheimer’s disease. They can be associated with a medical condition, but they can also be caused by insufficient treatment for other comorbid conditions. Conduct disorders significantly impair the ability to cope with daily activities.
  • Memory and behavioral problems make it difficult to relate to family members and loved ones and complicate daily life. People with memory impairments should have a loved one who can help them in their daily work, as well as in solving legal issues.Financial, property and property issues must be resolved even when the person with Alzheimer’s is still capable of working.
  • Alzheimer’s disease affects memory, spatial orientation, thinking and reaction speed. Therefore, driving a car becomes difficult, and to ensure traffic safety, it is necessary to restrict driving rights.
  • A person with Alzheimer’s may be impaired in their ability to critically assess their actions. Track the ability of people with Alzheimer’s to drive and operate household appliances.If he cannot perform these types of activities at the proper safe level, then they must be abandoned.
  • Alzheimer’s is a severe and progressive disease and caring for such patients is physically and emotionally exhausting for those who are close to them. Understanding the nature of the disease and learning how to care in a new environment will help avoid burnout. It is recommended that you seek help from a clinical psychologist or psychotherapist.
  • Useful reading material on this topic can be found at the end of this guide.

The triggering mechanisms for Alzheimer’s are not yet fully understood. Early-onset Alzheimer’s disease may first appear before age 65 and may be hereditary. If you have relatives with Alzheimer’s and have questions about the inheritance of the disease, it is recommended that you consult with a geneticist.

Late-onset Alzheimer’s is much more common than early-onset Alzheimer’s.It is not known why some people develop Alzheimer’s disease while others have clear thinking for the rest of their lives. The factors of heredity and the environment, as well as the way of life, probably play a role. The most well-defined risk factor is age. Smoking and depression in middle age are also cited as contributing risk factors. Moderate physical activity, healthy eating and communication are known to have good effects on both mental and physical health, but they do not protect against the development of Alzheimer’s disease.

Changes characteristic of Alzheimer’s disease occur in the brain tissue for decades before the onset of symptoms of the disease. Abnormal proteins deposited in the brain tissue (amyloid and tau proteins) disrupt the functioning of nerve cells, which ultimately leads to the death of the nervous tissue (atrophy).

Memory impairment is the most common symptom of Alzheimer’s disease. At first, it can be difficult to distinguish from normal age-related ones (for example, difficulty remembering names and faces).In case of illness, small details begin to be forgotten: keys and documents are lost, when leaving the house they forget to close it, when cooking, dishes with food are forgotten on the stove or the gas tap remains open, for a long time the recipes used for dishes begin to get confused during cooking and the taste of food becomes narrower not the same as before, the actions associated with putting the house in order are no longer successful, etc. (see Figure 1).

People with a high level of education and those involved in mental work may have the first signs of the disease later, because their brain is better able to cope with changes in it.The manifestation of the disease is individual for each person. Some early stage people may find it difficult to find words, recognize faces and objects, find the right path in a familiar place, understand and make decisions, and memory impairment can occur later.

Figure 1. Changes associated with Alzheimer’s disease

Depending on the severity of the disease, its course can be divided into periods: at the onset of the disease, mild dementia develops, then moderate memory impairment develops, and in the later period of the disease it is already severe dementia (see.Annex 1).

At the onset of the disease , a person often notices his own problems. During this period, a person can understand his condition, he can independently seek help and cope with most of his daily activities. This period should be the best time to diagnose the disease.

  • When memory impairment and forgetfulness worsen, a person may repeat the same story, ask the same questions, forget the answers, forget dates, promises, and obligations (such as paying bills).When you go to the store, you forget to buy the necessary things.
  • It may happen that a person starts to be careless with money and buys unnecessary things instead of necessary ones.
  • Household skills are forgotten and take longer to complete (for example, it becomes more difficult to cope with cooking, cleaning, repairing and building, washing clothes, the quality of the actions performed deteriorates and the result becomes more and more simplified each time).
  • The patient can no longer learn new activities (for example, using a new telephone, opening a new door lock, etc.).
  • Indifference and loss of interests often arise, the desire to clean the house and visit friends is lost.
  • Self-care is getting worse – the previously always well-groomed hairstyle and tasteful clothing are becoming more and more casual.

It may happen that a person initially tries to hide his problems from others.

As the disease progresses , the capacity for critical assessment and attention are further reduced, and memory impairment begins to be more pronounced. People with Alzheimer’s disease forget the date, day of the week, and year, their address, and where they are currently. In most cases, patients do not notice changes around and in themselves, although sometimes there may be moments of clarification, when the understanding is clearer.

  • Difficulties in recognizing familiar, objects and places appear.They are often confused in familiar places.
  • It becomes more difficult to act in new situations, anxiety arises.
  • The time estimate may decrease / disappear.
  • The person finds it increasingly difficult to cope with daily activities, it takes more time (for example, paying bills and dealing with money, preparing food, dressing, eating, going to the toilet).
  • Mental and behavioral disorders (suspicion, hiding things, aggression, screaming) may also occur.
  • The ability to recognize loved ones gradually decreases. The daily rhythm is disturbed, sleep disorders are formed. Often a person is more active in the evenings and at night, when he calls and wanders.

In the later stages of the disease , the ability of people to speak and understand speech is so impaired that they cannot express themselves or understand the meaning of others. The more important is non-verbal communication with loved ones – tone of voice, facial expression, gestures. All previous skills of a person disappear, and he can no longer get out of bed, dress, walk, go to the toilet or eat.

In case of memory and mental impairment, as well as impairment of usually well-performed skills, it is recommended to first consult a family doctor (see Figure 2). If possible, the patient needs to come to the doctor with a loved one, who will help describe the changes as an outside observer, this will help confirm the diagnosis. The patient himself may underestimate some of the problems or forget to share them with the doctor. The doctor may ask a loved one to complete a questionnaire about the patient’s behavior and daily activity over the past six months.

Tell your family doctor:

  • What is the main problem that causes you to see a doctor?
  • How long does it take for these problems to appear?
  • What was the first sign that something was wrong?
  • How has human behavior changed?
  • How much does he need outside help in everyday life?
  • Does he have any mood swings, thoughts of suicide, joy, aggressive behavior?
  • Are there any comorbidities and what medications, including dietary supplements, are they taking?
  • How and at what age did family members develop dementia?

The family doctor assesses the memory disorder using a test (for example, using a brief mental health examination).Mini Mental State Examination, MMSE). The test assesses the ability to navigate in space and time, attention and memory, as well as the ability to plan the activities necessary for the task. The maximum number of points in the test is 30; a result of 24 or less will indicate dementia. To analyze the results, the doctor takes into account the patient’s educational level, language proficiency and other possible factors affecting the level of task performance (for example, hearing and visual impairments).The test can determine the severity of dementia (mild, moderate, severe) (see Appendix 1).

Testing is not enough to diagnose Alzheimer’s disease. The test also does not provide information about the causes of memory impairment. This will require additional surveys.

A blood test can be used to investigate whether memory problems are caused by any other medical conditions, such as low thyroid function, anemia (anemia), vitamin deficiencies, infectious diseases (such as borreliosis, syphilis, AIDS) and dr.With proper treatment of the above diseases, memory impairments can recede to one degree or another.

If necessary, the family doctor will refer the patient to an appointment with a specialist dealing with memory impairments (neurologist, psychiatrist, geriatrician).

A patient with suspected Alzheimer’s disease undergoes a general head examination (computed tomography or magnetic resonance imaging) to rule out other brain diseases (eg, brain tumor, chronic hemorrhage, hydrocephalus).

If the diagnosis remains unclear, the physician may refer the patient for a neuropsychological evaluation by a clinical psychologist. Tests carried out during the examination will help determine exactly which type of memory impairment is present in the patient. Neuropsychological evaluation is only good for patients with mild dementia and early-onset patients. For patients in advanced stages of the disease, the tests can be overwhelming and tedious.

Figure 2. Patient collaboration with specialists from different fields

Treatment of Alzheimer’s disease slows its progression. The earlier the disease is detected and treatment is started, the longer the patient’s ability to cope with daily activities remains. This allows loved ones and caregivers more time to adapt to the changing lifestyle and think through the most important issues that inevitably arise at the end of life.

Alzheimer’s disease progresses slowly.The late stage of the disease is formed over an average of five to ten years. This condition is considered an end-of-life stage that cannot be cured and life prolongation by various medical procedures is not considered ethically acceptable.

Since the cause of the disease is unclear, it cannot be prevented. A good, varied diet, moderate physical activity, social activity, mental work and hobbies (for example, theater, solving crossword puzzles, dancing, fishing, hiking, traveling, mushroom picking, etc.)) are good for mental and physical health and help reduce the risk of Alzheimer’s. Research has not proven that the use of vitamins and nutritional supplements helps prevent the onset of the disease.

Patients are encouraged to eat a variety of wholesome foods (see Figure 3). They don’t have to adhere to any special diet. In the food pyramid, you can see which foods and in what quantity are recommended to be eaten.

Figure 3. Food pyramid (for more details visit http://toitumine.ee/ru/kak-pravilno-pitatsya/rekomendatsii-v-oblasti-pitaniya-i-piramida-%20pitaniya)

Patients with Alzheimer’s disease often have a risk of weight loss. They may forget about eating and not notice the feeling of hunger. Reduced appetite can be reduced by decreased physical activity, certain medications, and decreased sense of smell and taste. The reason for this may be poorly installed prostheses, as well as the fact that patients do not recognize food, etc.Thus, patients can lose too much weight and lose muscle mass, which, in turn, increases the risk of falling and other diseases. Therefore, it is recommended to eat protein-rich foods and prevent weight loss. Protein supplements (protein powders or drinks) sold in pharmacies and eating smaller meals more often can help with decreased appetite. Adequate fluid intake is also important.

On the other hand, there are cases of excessive appetite due to loss / decrease in the feeling of satiety.Some people with Alzheimer’s are eating too much sweets. Patients should try to eat a full and varied diet, and have small snacks between meals. At the same time, excessive restriction of food can cause anxiety and irritation in the patient.

As Alzheimer’s disease progresses, sufferers are no longer able to use kitchen utensils and prepare food on their own due to the gradual decline of skills. Pre-cooked meals and meal reminders can help here.It is best to have a joint meal. In the case of swallowing disorders, food can be pre-crushed or divided into small pieces, it is better to thicken the drinks.

There are two types of treatment options for patients with memory impairments: supportive therapies and medication (see Figure 4). In both cases, the goal is to improve the quality of life of the patient and his loved ones, to maintain the existing level of skills and as long as possible to maintain the same level of ability to cope with everyday affairs.

Figure 4. Treatment of Alzheimer’s disease

Supportive therapies

Among the possible treatments for Alzheimer’s disease, the importance of different types of creative activity is especially noted. Constant communication and activity slows down the worsening of speech, attention and behavior disorders. A person with Alzheimer’s thinks more slowly and may not understand more complex speech. During the conversation, you need to be patient, not to be irritated by the patient’s repetitive questions, or his inappropriate or “childish” statements.It is advisable to speak slowly and in simple phrases, to avoid command, heightened or irritated tone of speech.

Patients with moderate to moderate memory impairment are advised to play games, take care of the garden or pets, music, art or aroma therapy, food preparation and other stimulating activities. Versatile physical activity improves gait speed, body strength, muscle strength, balance, state of mind and promotes better ability to cope with daily activities.

Listening to your favorite familiar music can evoke positive emotions and memories and thus have a good effect on your mood and quality of life. It doesn’t matter what kind of music you listen to – the most important thing is that a person liked it!

It is important to continue pursuing your hobbies. If a person has played any musical instrument before, you need to continue playing it. This is a good way to stimulate your brain and keep you in a good mood. The above activities are simple and suitable for both patients and their loved ones.


Medicines can help preserve memory and slow down the disappearance of existing skills. The process of the death of nerve cells that occurs as a result of the disease cannot be influenced by drugs.

Acetylcholine plays an important role in the memory function, which is responsible for communication between nerve cells. Alzheimer’s disease is caused by a lack of acetylcholine in the brain. In the initial stage of the disease, treatment is usually started with donepezil, which stops the breakdown of acetylcholine.At the beginning of treatment, side effects can sometimes appear – a feeling of nausea, vomiting, diarrhea, dizziness, weight loss, slowing of the heart rate and short-term loss of consciousness. To reduce side effects, treatment is started with small doses and usually the side effects disappear within the first month. After that, the dose of the medicine can be increased.

For patients with severe Alzheimer’s disease, memantine is the first choice and can be combined with donepezil.It is not known exactly how memantine helps to maintain acquired skills. However, it was found that in the case of Alzheimer’s disease in patients in the brain there is an excessive release of the transport substance glutamate, which destroys nerve cells. Memantine balances the action of glutamate and possibly thus slows down the destruction of nerve cells. The most common side effect of memantine is a drowsy, inhibited state. Less commonly, illusions or aggressive behavior may appear.All side effects must be reported to the doctor and then decide on the further use of the medication.

Donepezil and / or memantine are not effective in all cases. As the disease progresses, the effectiveness of drugs decreases. Therefore, the doctor should regularly assess the course of the disease, the effect of drugs and their side effects.

Donepezil and memantine are the names of the active ingredients of the preparations. Medicines containing these active ingredients are sold under different brand names, but their effectiveness is the same.

Mental and behavioral disorders are common in Alzheimer’s patients. They can be as follows:

  • irritability
  • aggressiveness
  • mood swings
  • apathy
  • unreasonable, excessive feeling of fear
  • anxiety
  • suspicion (suspicion that someone wishes the patient ill, and intentionally harms in any way)
  • Sleep disorders (difficulty falling asleep, violation of the daily routine, night walks)

The above problems may indicate some other medical condition or that the patient feels insecure in some circumstances.Mental and behavioral disorders can be part of Alzheimer’s disease and their incidence may increase as the disease progresses.

It is important to understand that a person with Alzheimer’s is not behaving so deliberately, but it is caused by their disease!

A person with Alzheimer’s disease does not always know how to talk about their problems, so it is important to understand what exactly bothers or annoys him. Sometimes it can be a fever or a feeling of pain. Other times, the path to the toilet is forgotten or the skill of eating a sandwich or using a fork is lost.Failure can cause too many people around or other people’s expectations of the patient. With the progression of the disease, it is more and more difficult to explain their desires and feelings to other people, the right words are not found, and the patient cannot find solutions to his problems. All of these can act as annoying and depressing factors.

At calm the patient down and speak with him in a friendly tone, rather slowly and in short phrases . Give him time to respond, as illness usually slows down the thinking process.Irritability towards the patient can piss him off, and it may take some time to re-establish the relationship of trust.

If you experience mental and behavioral disorders, contact your family doctor to try to find out the causes of the problem. Not all disorders require the use of medications, sometimes it is enough to change the behavior of loved ones or a caregiver (you can calm the patient, divert thoughts to another area, involve in a feasible type of activity, etc.)

Sometimes the cause of behavior change can be unmet basic needs – inadequate nutrition and water intake: too little or too much communication with loved ones, fatigue and / or sleep disturbances, noise and other environmental factors, pain or other feeling of discomfort in the body.

Sometimes the patient can be aggressive, present a danger to himself and others. In some cases, depression may occur, due to which everyday affairs may remain unfulfilled, a person becomes apathetic, speaks of the meaninglessness of life, and loses hope.In such cases, be sure to consult a psychiatrist. Living with people with Alzheimer’s can be exhausting and cumbersome. Some days can be harder than others. Caring for the sick should not fall on the shoulders of just one family member.

To support the caregiver:

  • Be in touch with him, ask him how he copes with leaving and how to help him. For example, if you are planning to go to a mall, ask if you need to buy something for it.Ask if you can help him with housekeeping (cooking, gardening).
  • Give him the opportunity to continue pursuing his hobbies and interests. Sometimes a few hours are enough for him to be able to do his own business or just relax.
  • Be a sympathetic and sympathetic listener. You don’t always have to give advice, but give people the opportunity to talk about their problems or everyday work.
  • Read as much as you can about Alzheimer’s.This way you can better help and support both the patient himself and his family members.

Alzheimer’s disease worsens the treatment of underlying chronic conditions and vice versa. At the beginning of the disease, the patient is shown treatment procedures that improve the quality of life, for example, surgery to remove cataracts, surgical treatment of broken ribs, dental treatment, oral care, purchasing a hearing aid or glasses.

Regular monitoring and treatment of other chronic diseases is important, as cardiovascular insufficiency or fluctuations in blood sugar levels impair the normal nutrition of nerve cells.In the treatment of chronic diseases, it is necessary to monitor the safe use of drugs to prevent overdose and reduce the dosage of drugs due to memory impairment.

The question of stopping treatment with pills to maintain existing skills and quality of life is decided individually, taking into account the wishes of the patient. If the patient himself can no longer decide, then the wishes of his loved ones are taken into account, while the patient’s well-being must be taken into account. For example, if a patient refuses to take medications or it cannot be guaranteed that they will be used safely, then it would be wise to discontinue such treatment.If the patient has another serious illness in addition to Alzheimer’s disease, then taking medications can cause additional inconvenience, since it does not improve the quality of life and does not prolong life.

Also, treatment is completed if the disease progresses to such a level when the patient needs outside help in all actions, he himself cannot get out of bed, cannot walk and refuses to eat and drink.

As the disease progresses, it becomes increasingly important to treat that alleviate suffering (palliative care).Its goal is to make the patient feel as comfortable as possible and free him from suffering. The goal of patient care is her well-being. Well-being is ensured, among other things, by taking care of hygiene. If a person is constantly in bed and cannot change his position on his own, you need to help him do this every three hours – this way you can prevent the occurrence of bedsores. Make sure that no part of your body is pressed against a hard surface – this will interfere with the blood supply and contribute to the formation of pressure sores.Dry skin requires creams; dry mouth requires moisturizing. Pain relievers may be needed. If a person can no longer swallow on their own, then there is no need to prolong his suffering and switch to feeding through a vein or tube. The body at this stage dies out and no longer absorbs nutrients and does not produce energy.

Memory and mental impairment, as well as communication problems, cause problems with daily activities.Over time, the problems worsen, this process occurs in different ways in different patients. It is influenced by the type of activity that the patient was engaged in before, the level of his education, personality traits, previous lifestyle and the course of the disease.

It is important for those close to you or guardians to educate themselves as early as possible with the necessary business issues, legal and monetary obligations. If the patient is still independent, you can monitor whether he is paying bills correctly or helping him with a trip to the store.It is important to maintain a friendly and trusting relationship.

For people with memory impairments, attention and the ability to critically assess their activities gradually fade away. At some point, he can no longer correctly assess the risks, so important things remain unfulfilled (unpaid bills, uncleaned house) or dangerous situations arise (the gas valve is forgotten in an open state, working tools are inaccurately used, carelessness when crossing the street).

Progressive disorders of the patient’s memory and behavior can cause severe stress for caregivers and family members, especially in a state when the patient himself is no longer able to understand the problem.With this in mind, loved ones need to organize help and care for the patient. If family members are unable to care for the sick on their own, then help should be sought from available social services: home care, day care centers, nursing homes, or other support systems. For more information, contact your local government social worker.

If family members are home-based caregivers, assistive devices (such as diapers, function beds, wheelchairs or walking frames) can be used to simplify day-to-day procedures.Assistive products can be bought or rented from stores selling goods for the disabled. For rental or discount purchases, the attending physician or family doctor must issue a certificate for obtaining a personal assistive device card and notification of the need for a particular assistive device. More information can be obtained from family doctors, social workers and companies selling aids.

If a person with Alzheimer’s can no longer cope on their own and relatives cannot care for them, then a safe place to live for the person can be found in a care facility.You can ask your social worker for information about care facilities. If the patient is outside his home, you can try to make the environment similar to home, so that he recognizes familiar objects, for example, his photographs of his adolescence are suitable for this, etc. An adapted environment can reduce the anxiety of patients with dementia and improve their behavior.

Restricted legal capacity

The ideal option is a situation when a person with Alzheimer’s disease, even before the disease or at its initial stage, takes the necessary measures and signs powers of attorney to manage their concluded contracts, finances and property.As the disease progresses, he can no longer make clear decisions and fulfill his obligations. Thus, misuse of the patient’s financial resources can also occur – for example, when neighbors, relatives or strangers, in relation to whom the patient suddenly becomes very trusting, lure out of the patient for money, housing or other property. Sometimes the patient may have contracts that need to be monitored and followed. Relatives have the opportunity through the court to limit the legal capacity of a person suffering from Alzheimer’s disease, and / or appoint a certain guardian to carry out legal transactions, as well as to protect their interests, rights and property.You can request information from a local government social worker or court clerks. Local self-government bodies deal with issues of guardianship of people who have no relatives.

Driving a motor vehicle

Alzheimer’s dementia syndrome is a severe mental disorder that limits the right to drive.

People with memory impairments do not believe and often do not notice that their ability to drive and other acquired skills are beginning to decline.People with mild memory impairments usually cope with driving in familiar territory, but their loved ones should regularly assess the situation and restrict access to the car if necessary. The family doctor must issue a health certificate to obtain a driving license for a person with memory impairments for a shorter than usual period of time (for example, 3-6 months or a year). Each time the certificate needs to be renewed, the applicant’s condition is assessed again and, if necessary, he is referred for a neuropsychological examination.Sometimes test drives can be carried out to assess driving skills and ability to drive a car.

The right to drive of people with Alzheimer’s is restricted by the road traffic law.

Weapon proficiency

Possession of a weapon requires a weapons permit, which is regulated in Estonia by the Arms Act. A medical certificate is required to issue a weapon permit. Alzheimer’s dementia syndrome is a severe mental disorder that is a contraindication to obtaining and renewing a gun license.Loved ones should restrict access to weapons for people with Alzheimer’s, as they can be dangerous to themselves and to others.

  • Agree with family members about who will be the primary caregiver and how the care burden will be distributed.
  • You should try to maintain a trusting relationship with the patient and regularly monitor his condition and behavior.
  • Go to the doctor with the patient, if necessary, and in other places.
  • Pay attention to changes in the patient’s condition, regularly remove objects from his environment that have become dangerous for him, and create a favorable environment for him around the ward.
  • Monitor your medication intake. Medicine boxes can be a good help, in which you can put pills according to the order of taking for each day. Some pharmacies offer repackaging of medicines. This will give the patient and caregivers a clearer picture of the medication they are taking.Sometimes it can help to recount the tablets available in the package of the medicine.
  • Remind the patient to eat. Patients often forget to find and take food from the refrigerator on their own. Eat together if possible and make sure the person is able to cope with warming food or using kitchen appliances. For safety reasons, check if household appliances are turned off after use.
  • Try to create a clear plan of the day for the patient and help him to form from it the observed regimen, routine.Post the day plan in a prominent place in your home, such as on the refrigerator door. When providing the necessary physical, mental and social activity, diet, personal care and collective activities (this can be a joint viewing of photographs and recalling events captured on them, joint meals, reading books, etc.), always take into account the patient’s real capabilities and his wishes …
  • Track who the person with Alzheimer’s is in contact with. A person with Alzheimer’s can be easily suggestible and gullible towards strangers, so it can be easily used.His trust can also be abused by acquaintances.
  • Try to avoid conflicts. The patient can use his own behavior for his own purposes, relatives, mistreat them, manipulate. In case of problems, consult a social worker.
  • Do not bring alcohol into your home or share with someone who is sick. Drinking alcohol causes conflicts and behavioral disorders, as well as misunderstandings with relatives and friends.
  • If someone close to the sick person feels that they need professional help with mental health issues, then it is better to find an opportunity to consult on this topic.Detailed information can be obtained from your doctor or go to thematic sites on the Internet.
  • People with Alzheimer’s are better off calling more often, reminding them of the day’s to-do’s, and checking to see if they’ve done it. Daily activities can be facilitated by placing labels on the doors. Emphasize the need for self-care, the importance of communicating with friends and family, and, if necessary, how to get help.

Additional information on the Internet in Estonian:

Other materials and publications:

  • “Käsiraamat dementsete haigete hooldajale”, Ülla Linnamägi, Mark Braschinsky, Kai Saks, Eve Võrk, Terje Lääts.Iloprint, 2008.
  • Eesti toitumis- ja liikumissoovitused, 2015, kättesaadav: www.tai.ee.
  • Juhtimisõiguse ja relvalubade alane seadusandlus, kättesaadav: www.riigiteataja.ee.
  • “Elu dementsusega”, Angela Caughey. Petrone Print, 2017.
  • “Siiski veel Alice”, Lisa Genova. Kunst, 2016
  • “Loomulik vananemine ja dementsus”, Anna Follestad. TEA Kirjastus, 2016
  • „Mul on Alzheimer. Minu isa lugu “, Stella Braam.Tammerraamat, 2008.

Additional information on the Internet in English:

  • Alzheimer’s Disease Association, website: www.alz.org.
  • Alzheimer’s Disease Association of Great Britain, website: www.alzheimers.org.uk.

Additional information on the Internet in Russian:

Further information on the Internet in German:

Points Severity Need for subsequent tests Legal capacity
25-30 Questionable clinical importance

If clinical signs are found, new tests may be helpful

Normal / Clinical decline may be present
20-24 Light

May be useful for assessing the scale of the deficit and its severity

Significant decline, may require assistance and monitoring


Moderate May be useful

Clear reduction, may require assistance around the clock

0-9 Heavy Most likely testing is not possible

Severe violations, needs constant 24/7 assistance

  1. Prince, M., Anders, W., Guerchet, M., Ali, G., Wu, Y., Prina, M. World Alzheimer Report 2015. The Global Impact of Dementia [Internet]. Alzheimer’s Disease International; 2015. Available from: http://www.worldalzreport2015.org
  2. Tanna, S. Alzheimer Disease and other Dementias Background Paper 6.11 [Internet]. 2013. Available from: http: //www.who. int / medicines / areas / priority_medicines / BP6_11Alzheimer.pdf
  3. Hort, J., O’Brien, J. T., Gainotti, G., Pirttila, T., Popescu, B.O., Rektorova, I., et al. EFNS guidelines for the diagnosis and management of Alzheimer’s disease. Eur J Neurol. 2010 Oct; 17 (10): 1236–48.
  4. Bruni, A. C., Conidi, M. E., Bernardi, L. Genetics in degenerative dementia: current status and applicability. Alzheimer Dis Assoc Disord. 2014 Sep; 28 (3): 199–205.
  5. Linnamägi, Ü. Alzheimeri tõve riskiteguritest. Eesti Arst. 2014; 93 (2): 90-4.
  6. Alzheimer’s Disease Fact Sheet [Internet].National Institute on Aging. [cited 2017 Sep 1]. Available from: https://www.nia.nih.gov/health/alzheimers-disease-fact-sheet
  7. Kryscio, R. J., Abner, E. L., Caban-Holt, A., Lovell, M., Goodman, P., Darke, A. K., et al . Association of Antioxidant Supplement Use and Dementia in the Prevention of Alzheimer’s Disease by Vitamin E and Selenium Trial (PREADViSE). JAMA Neurol. 2017 May 1; 74 (5): 567-73.
  8. Charemboon, T., Jaisin, K. Ginkgo biloba for prevention of dementia: a systematic review and meta-analysis.J Med Assoc Thail Chotmaihet Thangphaet. 2015 May; 98 (5): 508-13.
  9. Olazarán, J., Reisberg, B., Clare, L., Cruz, I., Peña-Casanova, J., Del Ser, T., et al. Nonpharmacological therapies in Alzheimer’s disease: a systematic review of efficacy. Dement Geriatr Cogn Disord. 2010; 30 (2): 161–78.
  10. APA Work Group on Alzheimer’s Disease and other Dementias. Rabins, P. V., Blacker, D., Rovner, B. W., Rummans, T., Schneider, L. S., et al . American Psychiatric Association practice guideline for the treatment of patients with Alzheimer’s disease and other dementias.Second edition. Am J Psychiatry. 2007 Dec; 164 (12 Suppl): 5-56.
  11. Segal-Gidan, F., Cherry, D., Jones, R., Williams, B., Hewett, L., Chodosh, J., et al . Alzheimer’s disease management guideline: update 2008. Alzheimers Dement J Alzheimers Assoc. 2011 May; 7 (3): e51-9.
  12. Liiklusseadus. Riigi Teataja (internet). Kättesaadav: https://www.riigiteataja.ee/akt/117032011021?leiaKehtiv
  13. “Soetamisloa ja relvaloa taotleja tervisekontrolli kord, loa andmist välistavate tervisehäirete loetelu ning tervisetõendi sisu ja vormi nõuded”.Riigi Teataja (internet). Kättesaadav: https://www.riigiteataja.ee/akt/126032015012?leiaKehtiv
  14. Alzheimeri assotsiatsiooni koduleht. Kättesaadav: https://www.alz.org/care/alzheimers-food-eating.asp
  15. Eesti toitumis- ja liikumissoovitused. Kättesaadav: https://intra.tai.ee//images/prints/documents/14


  16. Linnamägi, Ü., et al. Dementsuse Estonian ravi- tegevus- ja diagnostikajuhend.2006. Kättesaadav: http://www.enns.ee/Ravijuhendid/Dementsuse_ravijuhend.pdf
  17. Tahlhauser, C. J., et al . Alzheimer’s disease: rapid and slow progression. J R Soc Interface. 2012. Jan 7; 9 (66): 119-126.
  18. Toidupüramiid. Kättesaadav: http://tervisliktoitumine.ee/toidupuramiid-on-tervisliku-toitumise-alus/; http://toitumine.ee/ru/kak-pravilno-pitatsya/rekomendatsii-v-%20oblasti-pitaniya-i-piramida-pitaniya
  19. Folstein, M.F. et al .“Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research. 1975: 189-198.

90,000 Puberty delay

Sexual development – the process of maturation of the hypothalamic-pituitary-gonadal system (HHGS), characterized by the appearance of secondary sexual characteristics and the production of mature germ cells, as well as the formation of physical, functional and psychological processes in the child’s body.

Currently, puberty for children of the European population in 95% of cases occurs in the age range from 8 to 13 years in girls and from 9 to 14 years in boys.

Doctors say about delayed sexual development in girls when a girl after 15-16 years old has underdevelopment of secondary sexual characteristics and rare irregular menstruation. If a girl over 16 years old has neither menstruation nor secondary sexual characteristics, then we are talking not about a delay, but about the absence of sexual development.Delayed puberty in boys is considered to be the absence of signs of puberty after 14 years of age or the timely onset of puberty, but with an abnormal course.


  • Genetic abnormalities.
  • Brain injury.
  • Previous viral infections: encephalitis or meningitis.
  • Neuroses, stress, poor nutrition.
  • Overweight or underweight.
  • Anorexia nervosa.



  • Infantile physique.
  • Long limbs.
  • The thighs are often wider than the shoulders.
  • Deposition of subcutaneous fat on the chest, waist, lower abdomen.
  • High children’s voice.
  • Child’s penis.
  • Shyness, weakness of will, apathy, withdrawal from the team.
  • Rapid fatigability.


  • Low stature.
  • Ovarian underdevelopment on ultrasound.
  • Short neck with pterygoid folds.
  • “Old lady” face.
  • Barrel-shaped or flat chest.
  • Widely spaced, underdeveloped nipples.
  • O-shaped curvature of the arms.
  • X-shaped curvature of the legs.
  • Lymphatic edema of the hands and feet.

For the diagnosis of the disease, consultation and examination by an endocrinologist, laboratory and instrumental diagnostics are required.Additionally, a cytogenetic study may be prescribed, as well as an ultrasound scan to detect abnormalities of the vagina, uterus and ovaries (for girls) and scrotal organs (for boys).


  • Prevention of complications during pregnancy.
  • Timely treatment of infectious diseases accompanied by prolonged intoxication and depletion of the body.
  • Prevention of late rickets.
  • Timely detection and treatment of a number of endocrine diseases.
  • Preventive examinations by a gynecologist.

More about pediatric endocrinology at the YugMed clinic

90,000 signs, symptoms and causes. How to identify a frozen pregnancy. Clinic Ak. Grishchenko


Not always a long-awaited and such a desired pregnancy ends with the birth of a baby. Sometimes women find out that the pregnancy has stopped. Unfortunately, this problem is not uncommon. According to statistics, in about 15% of cases, the planned babies “freeze” in the womb for one reason or another.


What is it?

Frozen is a pregnancy that initially met all medical standards, but at a certain period suddenly stopped developing. The cessation of progress in the development of the fetus leads to its death, but it remains in the uterine cavity. For this reason, such a pathology is called a failed miscarriage.

In fact, at the very beginning, everything happens, as in a normal pregnancy – the egg is fertilized, enters the uterus and implanted for further development, but it stops at one point.This pathology also includes the syndrome of “empty ovum”. It represents the development of membranes in which the embryo is absent. With this syndrome, a pregnancy test is positive, as well as an analysis for hCG.

Dangerous Timing: When Can It Happen?

Fetal development can stop at any time up to 28 weeks (in rare cases, developmental cessation may occur later), but the greatest likelihood of such a pathology occurs in the first trimester.There are also several periods with the highest risks of a missed pregnancy, these include the following periods:

  • 3-4 weeks;
  • 8-10 weeks;
  • 16-18 weeks.

It is these terms that most often become critical for pregnancy.

What causes a frozen pregnancy?

Even doctors do not always manage to find out with certainty why a frozen pregnancy happened. In modern medicine, there are a number of reasons that can cause this pathology.All of them are divided into several large groups:

  • Genetic pathologies . It is these reasons that most often provoke an arrest in fetal development. Abnormal genes or the presence of an extra chromosome in the embryo can cause the development of many defects that are incompatible with life, which leads to termination of pregnancy. Often, genetic pathologies cause pregnancy to stop at the eighth to tenth week.
  • Infection .A frozen pregnancy can also often happen due to the presence of infectious diseases, since during the period of bearing a child, a woman experiences a rather serious decline in her immune defense. TORCH infections are considered especially dangerous for this period, which include rubella, cytomegalovirus, herpes and toxoplasmosis. The greatest danger to the fetus is the first “encounter” of a mother with an infection in an already pregnant state. Therefore, when registering, pregnant women are strongly advised to be screened for these types of infections.Even seemingly simple and common diseases such as influenza or ARVI can cause pathology, especially in the early stages, when vital organs are being formed in the fetus. The infection can act directly on the fetus, causing various types of abnormalities, or on the membranes, which leads to a significant lack of oxygen or nutrients to the fetus.
  • Hormonal disorders . Hormonal balance is extremely important for the normal bearing of a baby.Therefore, with a lack of progesterone or an excess of male hormones (androgens), the likelihood of miscarriage increases significantly. Any hormonal disruptions are recommended to be treated even before pregnancy.
  • Antiphospholipid syndrome . Because of them, the formation of placental vessels or their blockage may decrease, which leads to a violation of the fetus receiving the necessary nutrition.
  • Teratozoospermia . This reason for a frozen pregnancy is associated with pathologies in the semen of a man.With teratozoospermia, sperm have an irregular structure, therefore fertilization with such a cell leads to abnormalities in the development of the embryo.
  • Lifestyle . The presence of bad habits, as well as the lifestyle while carrying a child (and the planning period) can also negatively affect the development of the embryo, provoking its fading. Alcohol consumption, smoking, stress, occupational hazards, daily routine, sedentary lifestyle, unbalanced diet – all these are considered negative factors for pregnancy.
  • Other factors. Fading of pregnancy can also occur due to a sharp change in climate, a history of abortions (especially if there were several of them).

In some cases, several reasons can be detected at once, which could lead to the fading of pregnancy.

How do doctors define a frozen pregnancy?

At each examination of a pregnant woman, the gynecologist determines the size of the uterus, therefore, if they do not correspond to the current date, the specialist may suspect fetal fading.But such a diagnosis is made only after an ultrasound examination. In rare cases, ultrasound is not performed – if a woman has turned to a doctor late and the body has already been intoxicated due to fetal death.

Signs and Symptoms

Symptoms of a frozen pregnancy are the same in any trimester. The main signs that may indicate such a pathology are:

  • vaginal discharge with blood impurities;
  • general weakness, chills, fever;
  • drawing pains in the lower abdomen;
  • cessation of swelling and soreness of the mammary glands;
  • abrupt disappearance of manifestations of toxicosis;
  • absence of fetal movements (with pathology in the second trimester).

Despite the existence of characteristic symptoms of pathology, often the cessation of fetal development remains unnoticed, since the basal temperature can remain within 37 degrees, and the hCG level remains high for several more weeks. In this case, a woman finds out about the problem only at the next appointment with a doctor or a scheduled ultrasound scan.

How to recover from a frozen pregnancy?

In the event of such a pathology, it is imperative to remove the dead embryo from the uterine cavity, if this did not happen naturally.For this, cleaning is carried out, with the help of which all particles of the membranes are removed from the uterus. Both scraping and vacuum can be used. If the fading occurs very early, doctors may offer medical abortion, which is somewhat more benign for the woman, including psychologically.

Doctors recommend abstaining from the next pregnancy for six months (as recommended by the World Health Organization). This time is enough to restore the body after the incident.Therefore, during this time, women are advised to take oral contraceptives, which minimize the likelihood of conception, as well as normalize hormonal levels.

During recovery, it is also recommended to lead the most healthy and active lifestyle, take care of a balanced diet and intake of vitamin complexes. A woman definitely needs psychological support, and if she endured the incident especially hard, she may need the help of specialists – a psychologist or psychiatrist.This will help you get back to normal and prepare for your next pregnancy.

What tests should I take after?

Before getting pregnant after a frozen pregnancy, it is necessary to exclude the possibility of a recurrence of the incident. Treatment should be appropriate for the problem that caused the pathology. Therefore, it is extremely important to undergo a complete examination, which will help determine what is the reason for the fetal development fading. Based on the results of the examination, doctors prescribe treatment in accordance with the detected diseases.

It is recommended to undergo an examination after the woman’s menstrual cycle is restored (it usually takes about 30 days after cleaning). But both spouses should be tested. Full examination includes:

  • genetic testing of spouses;
  • analyzes for TORCH infections;
  • study of hormonal levels;
  • blood coagulogram;
  • Gynecological ultrasound;
  • spermogram;
  • immunograms.

Such a survey is usually sufficient to determine the causes of a missed pregnancy, both in the early and late stages.The attending physician may order additional tests if necessary. All these examinations can be performed at the IVF and infertility treatment clinic of Academician V.I. Grishchenko.

A frozen pregnancy is not a sentence – in 90% of cases, after the occurrence of such a pathology, the spouses in the near future become happy parents of healthy babies. The main thing is to undergo a complete examination and eliminate the cause of the pathology. And if necessary, you can undergo the procedure of artificial insemination (IVF).

Answers from specialists in the field of reproductive medicine, fertility, and women’s health about whether cleaning is mandatory for a frozen pregnancy.

On the Internet, the question is often asked: “Is it necessary to do curettage for a frozen pregnancy (ST)?”

We asked this question to our doctors:

Paraschuk Valentin Yurievich

Chief Physician of the Clinic of Academician Grishchenko, obstetrician-gynecologist, reproductologist.

Good afternoon.If the pregnancy froze at an early stage and there are no signs that it is going to resolve itself, that is, there is no bleeding, then it is advisable to evacuate the contents of the uterine cavity, that is, to do curettage. If pregnancy seeks to resolve itself, then it can come out on its own. And then scraping is not required, you can just look at the ultrasound as soon as the discharge ends, that there are no inclusions in the uterine cavity, that there are no elements of the ovum left in the uterine cavity.

Another situation, when the pregnancy froze and you really need to evacuate the contents, and then there are alternative ways, sometimes the so-called “medical abortion” is offered, this is such a term. And it is more correct to do scraping, or a vacuum, if the time permits. Because, sometimes, after these very drug-induced abortions of pregnancy, you have to do curettage, but already after complications. Because the entire contents of the uterine cavity do not always come out completely, and now inflammation joins, this is a big trauma for the uterus, this is already a more conditionally urgent condition, and it is better not to allow it to reach it.Therefore, it is better to do a moderate, without severe injury and without complications curettage on time, than to do it as a necessary measure. When it is already clear that this is a frozen pregnancy, you can discuss tactics, but it is important to really understand when it is, what are such dangerous or alarming signals.

The main complaint is that if the uterus is already frozen and is trying to get rid of pregnancy, then it is bloody discharge, that is, the pregnancy is already rejected. But it happens that she freezes and the patient knows absolutely nothing about it, and become a find at a later date, when she is informed that the fertilized egg does not correspond in size, that she stopped earlier and this is impossible to suspect in any way.Therefore, if there are pains, pulling pains in the lower abdomen, bloody discharge, you should definitely consult a doctor. Firstly, because it is not a fact that it is frozen. Or maybe this is the threat of pregnancy fading, and you can contact in time, respond in time, stop the process and save the pregnancy. And if she really froze, then react in time and get rid of the fetal egg that has already stopped in development, without allowing any complications. In any case, if pain or bloody discharge occurs during pregnancy, at any time this is an indication to consult a doctor.There should be no pain, there should be no blood.

Alipova Elena Konstantinovna

Obstetrician-gynecologist, reproductologist, doctor of ultrasound diagnostics.

The unconditional question is that a frozen pregnancy should be removed from the uterus. That is, non-developing tissues, they are the source of the inflammatory process in the first place, and these tissues should be removed as soon as possible. The best method is still scraping.

As for not deleting at all, this is not even discussed. You can talk a little about medical abortion, but in my opinion, it also has no right to exist with a frozen pregnancy. First, because everything has to be done:

  • fast;
  • as carefully as possible.

And The main thing is that scraping products, concept products, as they say now, can be sent in this case for genetic research .And this, with a frozen pregnancy, is very important because, well, what happened happened, and everyone is interested in the question of why it happened. Genetic study of abortive material helps in about 80% of cases to answer the question of what actually happened. If genetics is to blame – this is one conversation, if from a genetic point of view everything is in order – additional examinations will be directed in a different direction.

Lutskiy Andrey Sergeevich

Obstetrician-gynecologist, fertility specialist.

Hello. Today we will talk about a frozen pregnancy. There are surgical methods, these are curettage, vacuum aspiration and hysteroscopic removal of the ovum, and medical methods, the so-called “medical abortion” . Medical methods of termination of pregnancy are indicated for women who have already had pregnancies in the past and have had natural childbirth. This is due to the fact that the cervix of such women is slightly open and during induction, artificial induction of uterine contractions, a complete spontaneous abortion occurs, no remnants remain in the uterine cavity.If the girl is nulliparous, then medical abortion often causes complications. Not everything comes out of the uterine cavity. Parts of the membranes, clots remain, and, let’s say, a delay of these parts occurs and there may be an inflammatory process, as a result of which, in the future, surgical intervention is required – scraping or vacuum aspiration. The method of terminating a frozen pregnancy is chosen by the attending physician based on these data. In our clinic, we often encounter a frozen pregnancy in those women who want to give birth to their child.And to understand the genetics of the fetus, we often recommend hysteroscopic removal or vacuum aspiration of the ovum.

Labuznaya Yulia Vladimirovna

Obstetrician-gynecologist of the Department of Operative Gynecology, doctor of the cervical pathology office

Hello. Today I will try to answer the most frequently asked questions regarding missed pregnancies. Perhaps I’ll start with such a skating rink: – “Is it necessary to do a vacuum aspiration of the contents of the uterine cavity, that is, evacuation of a frozen pregnancy, in case of a diagnosis of an undeveloped pregnancy?” And so let’s deal with the concept. Non-developing pregnancy is a pathological condition in which the pregnancy freezes, but spontaneous expulsion from the uterine cavity does not occur. At the same time, the woman herself does not immediately understand what happened to her. The first signs of a frozen pregnancy can appear 2-3 weeks after the incident. The fetal egg, which is located in the uterine cavity, undergoes various pathological changes, adversely affecting the endometrium, thereby causing an inflammatory process called “endometritis”.

If a woman decides to wait for the spontaneous expulsion of a frozen pregnancy from the uterine cavity – what happens? The endometrium tries to reject the frozen ovum, but the inflammatory processes taking place in this endometrium slow down this process, and the process can last from several days to several weeks. That absolutely definitely negatively affects the endometrium and contributes to the development of the inflammatory process further. There is an act that the fertilized egg from the uterine cavity, as it were, came out, but not completely.Some part of it remained. From this part, a placental polyp is often formed. The presence of a placental polyp in the uterine cavity does not contribute to the onset of subsequent pregnancy. Before the onset, planning a subsequent pregnancy, such a pali must be removed. In addition, the presence of the ovum in the uterine cavity for four weeks or more significantly increases the risk of bleeding. Therefore, the optimal solution to such a question, in the presence of a frozen pregnancy in the patient, is a vacuum aspiration of the contents of the uterine cavity with the appointment of subsequent anti-inflammatory therapy.

The second question is errors in the diagnosis of “undeveloped pregnancy”. For example, at 5-6 weeks, ultrasound examination, in order to avoid such errors, is carried out by at least two specialists. If there are no clear criteria for a non-developing pregnancy, the patient is recommended to repeat this study after 3-7 days. Again, to avoid mistakes. In addition, in parallel, the task of such an analysis as the analysis of human chorionic gonadotropin in the blood is mandatory.If pregnancy develops, respectively, hCG will increase, if the pregnancy is still frozen, then hCG will either fall or not grow at all. If the gestation period is 7-8 weeks, then according to this ultrasound examination, there will be no heart rate of the embryo. In addition, there will be a discrepancy between the size of the ovum and the gestational age. With a gestation period of 9-12 weeks, in addition to the absence of a heart rate and a discrepancy between the gestational age and the size of the ovum, there will also be no movement of the embryo.It should always be remembered that every woman has the right to look closely at an ultrasound scan in a few days for an accurate diagnosis, to control human chorionic gonadotropin, in fact, in order to avoid mistakes in the diagnosis of “undeveloped pregnancy”.

Answers to frequently asked and discussed questions on forums:

✅ Can an ultrasound scan mistakenly show a frozen pregnancy?

The misdiagnosis of “undeveloped pregnancy” occurs in the early stages.In our clinic, in order to avoid such mistakes, ultrasound scans are performed by at least two specialists in 5-6 weeks. If there are no clear criteria for a non-developing pregnancy, then the patient is recommended to do a second examination after 3-7 days. And on a second study, it may turn out that the frozen pregnancy turned out to be normal.

✅ With a frozen pregnancy, can you do without cleaning?

If a frozen pregnancy seeks to resolve itself, then it can come out on its own, and then scraping (cleaning) is not required.As soon as the discharge ends, it is necessary to check by ultrasound that there are no elements of the ovum left in the uterine cavity. If the pregnancy froze at an early stage and there are no signs that it is going to self-resolve, that is, there is no bleeding, then it is advisable to do curettage.

✅ Frozen pregnancy – cleaning or pills?

Medical methods of termination of pregnancy are indicated for women who have already had pregnancies and had natural childbirth in the past.But it is more correct to do scraping, or a vacuum, if the time permits. Because, sometimes, after medical interruptions of pregnancy, you also have to do curettage, but in fact of complications. Because the contents of the uterine cavity do not always come out completely, and inflammation is added, and this is a big trauma for the uterus and it is better not to allow this. Therefore, it is better to do a moderate, without severe injury and without complications curettage on time, than to do it as a necessary measure. And most importantly, scraping products can be sent for genetic research to identify the causes of fetal development freezing.

✅ Can there be a missed pregnancy without symptoms?

It so happens that the pregnancy freezes, and the patient knows absolutely nothing about it, and this is revealed at a later date, when she is informed that the fertilized egg does not correspond in size, that the pregnancy stopped earlier, but this, unfortunately, is it is impossible to suspect in advance. The first signs of a missed pregnancy can appear 2-3 weeks after the incident. This is bloody discharge or pulling pains in the lower abdomen.With these symptoms, you should definitely consult a doctor.

✅ How long to wait for a miscarriage in case of a frozen pregnancy?

If a woman decides to wait for the spontaneous expulsion of an undeveloped pregnancy – what happens? The endometrium tries to reject the frozen ovum, but the inflammatory processes taking place in this endometrium slow down this process, and the process can last from several days to several weeks. What negatively affects the endometrium and contributes to the development of the inflammatory process “endometritis”.It so happens that the ovum does not come out completely, leaving some part in the uterine cavity, from which a placental polyp is often formed, which prevents the onset of subsequent pregnancy.


A ship to heaven: the main features of Gothic architecture

The Goths are ancient Germanic tribes who, at the beginning of the new era, settled throughout Europe. “Gothic” in the highly spiritual era of the Renaissance began to scornfully call everything barbaric, “low”.But at the same time, almost any Gothic cathedral always makes a stunning impression, and it cannot be called “low” in any sense. The press service of the Glavgosexpertiza of Russia talks about the features of Gothic architecture.

The date of her birth is known for sure – it is 1144. Then Abbot Suger, adviser to the French kings Louis VI and Louis VII, having lost his influence at court after the latter’s death, decided to rebuild the basilica of the Abbey of Saint-Denis in the northern suburbs of Paris.He “canceled” the spherical dome, ordered to build not round, but pointed arches and buttresses – vertical structures that represent a protruding part of the wall. The buttresses took on the horizontal thrust from the vaults, and since then they have become an indispensable element of Gothic architecture, just like the round rose window on the facade.

Suger built a strange angular cathedral for a reason, he was guided by a beautiful concept: the church is a ship that takes believers to heaven, so the outlines of the temple resembled masts and blown sails.”Fashion” for a new architectural style during the XIII century spread throughout France, and then – in Germany, Spain, England, northern and eastern Europe.

Architects quickly improved a new method of construction, which was radically different from the previous one used in the construction of buildings in the Romanesque style (which, by the way, was also the most important stage in the development of medieval architecture). In general, I must say that Gothic architecture is the pinnacle of engineering thought of that time.Take at least the fact that now the pressure of the masonry was not distributed along the entire perimeter, as it was before, but concentrated at certain points. Accordingly, in other parts of the building, this load was minimal, which made it possible to build light “airy” buildings.

If Romanesque churches have thick, solid walls, then Gothic churches seem to have none at all, these buildings consist of solid windows. Unlike the semicircular Romanesque apses and chapels, the Gothic ones are faceted: it was more convenient to make huge windows in cathedrals, it was easier to install them on a flat rather than a rounded wall.In addition, the shape of the walls of Gothic cathedrals is associated with the shape of the vaults.

Recall that in the Romanesque church, the supporting structures are the walls, and in the Gothic church – the pillars: they support the vaults that soar above the heads of the parishioners at an unimaginable height, reaching more than 50 meters. The Gothic vault is a frame, and the structure on which it rests (the very rows of pillars tied with arches) is also a frame. A huge piece of the wall could be cut between the pillars, replacing it with a window.So, by its construction, the Gothic cathedral resembles a giant stone greenhouse. The already mentioned massive buttresses, which took on the expansion pressure from the vaults, were located outside the building. And if the outwardly Gothic cathedral is a fairly solid structure, then its inner space is as cleaned as possible – it is light, filled with air and light.

In the Middle Ages, the cathedral was the main building of the city. And, of course, the tallest: some Gothic churches are higher in height than the pyramid of Cheops.Cathedrals were intended not only for church services: lessons for children were held here, beggars found shelter here, sometimes the city government sat under the church vaults and theatrical performances were played. It is known that when archaeologists conduct excavations of ancient cities, they determine their population by how many places the local theater was designed for. The same principle can be applied to Gothic cathedrals: when designing them, the architects calculated the dimensions of the building so that it could accommodate all the inhabitants of the city under their vaults.

Gothic architecture is divided into three types – as the style develops.

Early or lancet Gothic, which is not quite Gothic yet but rather a hybrid with the Romanesque style, developed between 1140 and 1250. This period is characterized by powerful walls, majestic portals and high arches. A typical example of the style is Notre Dame Cathedral, built in 1160.

The period of high or mature Gothic is about 200 years old – from 1194 to 1400.At this time, the frame structure of cathedrals becomes more complicated, the number of stained-glass windows and sculptures increases, buildings become taller and more airy, and their roofs are made “openwork”. The best example of this period is the famous cathedral in Reims, where all French monarchs were crowned. By the way, Marc Chagall made several late stained glass windows for the cathedral.

Late or fiery Gothic covers the period from 1350 to 1550.At this time, great attention was paid to the external decoration of cathedrals. They are covered with a huge number of decorative details, so from a distance it seems as if the building is engulfed in flames. First of all, the flaming Gothic is the Milan Cathedral. Other famous examples of the style are the beautiful cathedral in Seville, where the remains of Christopher Columbus are located, the graceful and sophisticated cathedral of St. Anna in Vilnius; cathedral of st. Stephen’s Church in Vienna, which, although it was founded at the beginning of the 12th century during the early Gothic, acquired its present “flaming” appearance at the beginning of the 16th century.

Concise Gothic Dictionary

Arkbutan – an external stone semi-arch that transmits the horizontal thrust force from the vaults to the support pillar-buttress located behind the walls of the building. You can learn more about this and other structures from the previous material prepared by the Press Service of the Glavgosexpertiza of Russia.

Wimperg – a high, pointed decorative pediment that completes the portals and window openings of Gothic buildings.

Gargoyles – stone or metal gutter outlets, made in the form of grotesque characters. It is difficult to find two identical gargoyles in the design of a Gothic cathedral. And if gargoyles play a completely functional role – they drain rainwater from the walls of the cathedral, then chimeras, which can also be seen in abundance on the facades of many cathedrals, are exclusively decorative elements, and their images are symbolic.

Ribs – protruding ribs of the frame cross vault.It was they who made it possible to lighten the vault, reduce its vertical pressure and lateral strut and, accordingly, expand the window openings.

Pinnacle – decorative lance-shaped turret. They were often crowned with buttresses and towers, as well as pillars of walls.

Triforium is a low decorative gallery located in the thickness of the wall above the arches separating the side naves from the middle.

Rose – A large, stained-glass window in a stone frame on the main facade of the cathedral.The Gothic “rose” comes from the Roman oculus, a round hole (usually in the ceiling of a building) made to let light and air through. The most famous oculus is located in the Roman Pantheon. The rose window is dismembered by a figured binding into parts in the form of a blossoming flower. At the beginning of the development of the style, the drawing of the rose was quite simple, and in the late Gothic era it became extremely intricate. Amiens, Chartres, Rouen and Orleans cathedrals in France are famous for the most beautiful “roses”.

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Rehabilitation after removal of uterine fibroids

Removing a fibroid (a benign tumor) is a complex operation, and once it is completed, you cannot simply return to your normal life. The next stage is rehabilitation. There are several stages:

  1. Early postoperative: it begins immediately after the completion of the operation and ends when the patient leaves the hospital.
  2. Late postoperative: This rehabilitation period lasts approximately two months after discharge.
  3. Remote: This recovery period begins two months after discharge and lasts until the patient is fully recovered, the exact timing depending on the patient’s condition.

Consequences and complications of the postoperative period

Any surgical intervention is stressful for the body. Its consequences depend on the age, weight, general health of the patient, methods and quality of treatment and other factors, but a number of the most frequent complications are distinguished depending on the period of rehabilitation.


  1. Complications after anesthesia: a sharp rise or fall in temperature, constant temperature measurements, vomiting, tongue sinking, arrhythmia.
  2. Inflammatory processes: infection or dehiscence of sutures, edema, redness, purulent discharge, peritonitis as a result of inflammation.
  3. Circulatory disorders: thrombosis, internal and external bleeding, hematomas, hematometers, etc.
  4. Painful sensations: any damage to the integrity of the tissues is accompanied by a painful symptom.Rehabilitation after surgery to remove uterine fibroids minimizes pain. Discomfort often occurs when urinating. This is considered normal, but still requires treatment.
  5. Disorders of urination and fecal discharge, intestinal obstruction, etc. The surgical effect affects the metabolism and leads to various adverse consequences.
  6. Pneumonia usually caused by prolonged bed rest.

Usually, these consequences and complications are characteristic of all surgical interventions, and not only for this particular disease.


  1. Disorders of the intestines.
  2. Hernias.
  3. Depression. The state of depression is caused by emotional exhaustion associated with an unpleasant diagnosis and subsequent treatment. Mood is influenced by changes in lifestyle, thoughts of infertility, the presence of scars (they remain if an abdominal operation was performed, there are practically no traces during a laparoscopic operation), etc.

During the late period, the main healing processes are completed.Significant complications are rare.


  1. Re-development of the disease: This is usually due to the fact that the doctor did not eliminate the cause of the tumor formation or did not take into account other factors, for example, hormone levels.
  2. Climax: Hormonal changes cause various reactions in the body, including an early onset of menopause.
  3. Osteoporosis: Disease and subsequent surgery adversely affect calcium levels in the body.Its deficiency leads to increased bone fragility.
  4. vagina, urinary incontinence, as well as diseases caused by non-observance of personal hygiene rules, doctor’s recommendations and infection.
  5. Transformation of benign cells into malignant ones: special attention should be paid to the condition of the mammary glands, as they are most at risk.
  6. Depression and other psychological problems.

Complications can be identified not only at a doctor’s appointment. Increased body temperature, uncharacteristic discharge, burning sensation in the genital area and other changes are a reason to visit a specialist.

Recovery after surgery to remove uterine fibroids allows you to minimize negative consequences.

How to speed up the healing process after removal of uterine fibroids

When a woman is faced with the removal of fibroids, recovery from even minimally invasive surgery can take up to 3 months.A number of procedures allow you to speed up this process, make it more comfortable and quickly return to your usual way of life, it is also important to follow the basic recommendations of a specialist. As a rule, the doctor voices them to each patient personally, but there are a number of universal tips:

  • Observe contraception: pregnancy is not permissible for a year, but this period may last longer, depending on individual health indicators.It is optimal if the contraceptive methods are selected by the doctor.
  • Refuse thermal procedures: visiting the solarium, baths, beach, seaside, etc. is prohibited.
  • Eat right: Food should be easy to digest. It is impossible to use fixing food, it is worth giving preference to soups, cereals, etc. After discharge from the hospital, you can add fruits, raw or baked vegetables, fish, lean meat to the diet. And it is recommended to completely abandon fatty, fried, viscous foods, carbohydrates, alcoholic beverages and coffee.
  • Observe the regime of the day: it is worth including in it a full sleep, daily walks, moderate physical activity (morning exercises, exercise therapy).
  • Get rid of bad habits: smoking, stress, lack of sleep, etc. are prohibited.
  • And, of course, do not forget about regular examination by a doctor, even if there are no signs of complications.

    Recovery after removal of uterine fibroids: methods

    1. Drug therapy. Removal of fibroids does not pass without leaving a trace for the body. Depending on the patient’s condition, the doctor selects medications. Usually these are pain relief drugs, strengthening immunity, helping to replenish blood loss, as well as drugs to prevent blood clots. To restore hormonal levels and as a means of preventing relapse, the doctor individually selects hormonal drugs.
    2. Physiotherapy. A number of procedures, for example, CMT, lymphatic drainage massage, ultrasound and magnetic therapy, improve blood circulation and accelerate tissue regeneration processes, help to avoid problems associated with changes in hormonal levels, early menopause, are a means of preventing adhesions, edema of the lower extremities, urinary disorders, etc.
    3. Physiotherapy exercises. Moderate physical activity under the supervision of a specialist allows you to strengthen the immune system, restore muscle tone. The optimal sports are gymnastics and regular walks, but any water sports will have to be abandoned. Kegel exercises can help you cope with urinary incontinence. Respiratory gymnastics helps to avoid adhesions and accelerate recovery.
    4. Psychotherapy. Women often experience depression caused by infertility after surgery to remove uterine fibroids.Rehabilitation in this case is impossible without psychotherapy. The doctor helps to restore the emotional state, overcome depression.

    General rules for recovery from myomectomy

    Rehabilitation after removal of uterine fibroids is associated with a number of limitations. For example, at first, bed rest is shown: you cannot walk, stand for a long time. Thermal procedures and sunbathing are prohibited. You also can not be in the cold: hypothermia negatively affects the body.It is contraindicated to lift weights (more than 2 kg for the first time and more than 10 kg after discharge), overexertion (this includes daily household chores and exercise). It is worth abstaining from sexual activity for about two months after the operation, pregnancy is unacceptable for about a year. It is important to eliminate stress, emotional overload. For 1-2 months, you should not use tampons, only pads, until the sutures are completely healed, you should not go to the pool or swim in water bodies. In case of constipation, you need to see a doctor or solve the problem yourself.It is not recommended to use synthetic and too tight underwear, clothes should not squeeze or chafe the skin.

    What not to do after abdominal surgery to remove fibroids

    Patients are interested in what can and cannot be done after surgery to remove uterine fibroids. Rehabilitation usually consists of the procedures and guidelines described above. The main thing is to obey the doctor and take care of your health. The early period is considered the most important: a number of restrictions are caused by the fact that the wound has not yet healed completely and there is a risk that the stitches will come apart.For this reason, you should not overstrain, loads are allowed, but they should be moderate. It is recommended to take a shower instead of a bath to avoid getting an infection.

    How long does it take to recover after removal of uterine fibroids

    It is difficult to determine in advance how long the rehabilitation will take, since this parameter depends on many conditions: from the patient’s age to the method of treatment. For example, the early postoperative period after hysterectomy is 10-14 days, and recovery after laparoscopy of uterine fibroids usually does not exceed 5 days.The late and distant periods also differ from each other in duration.

    In addition to the type of intervention, the period determines the age, general health of the woman and the quality of the selected treatment. It usually takes about a year to fully recover in the absence of major complications.

    Removal of fibroids: rehabilitation after surgery in the center “Wellbeing”

    The health, well-being and mood of our patients is our main value.That is why we provide them with all the conditions to achieve the desired results. Our center employs professional doctors who regularly improve their qualifications. We adhere to an individual multidisciplinary approach: all procedures are selected depending on the health indicators of each individual patient, not only rehabilitologists, but also doctors of other narrow specialties are involved in decision-making. This is the only way we can choose the optimal course of procedures. Our center is equipped with modern simulators and devices that have proven their effectiveness.Friendly atmosphere, cozy rooms make you feel comfortable. A good mood and a positive attitude play an important role in recovery, therefore we have created a pleasant microclimate, and professional psychotherapists with extensive practical experience work with patients.

    Adentia of teeth – causes and treatment of adentia

    Complete or partial absence of teeth in dentistry is called adentia. This pathology can be congenital (an anomaly in the development of the dentition) or acquired.The disease is characterized by a violation of the continuity of the dentition. The person cannot chew, speak normally, and is uncomfortable with the cosmetic defect in the smile. His diction and articulation deteriorate, the gastrointestinal tract works worse.

    Both complete and partial adentia are dangerous because, due to the loss of teeth, deformation of the facial skeleton, diseases of the temporomandibular joint (TMJ) are possible.

    Types of pathology

    In dentistry, edentulousness is considered as a primary or secondary defect in the dentition.

    • Complete congenital adentia is extremely rare, in about 1% of cases.
    • Partial secondary adentia is diagnosed in 45–75% of cases.
    • Also edentulous occurs in 25% of people over 60 years of age.

    Depending on the causes and time of the onset of the pathology, dentists, as mentioned above, distinguish between congenital and secondary tooth loss, as well as adentia of temporary and permanent rows. True adentia is the absence of a tooth germ, and when adjacent crowns merge and the timing of their eruption is delayed, dentists speak of false adentia.

    Taking into account the number of missing teeth, partial and complete adentia stands out. The first assumes a lack of up to 10 units of the dentition, as a rule, of the upper lateral incisors, second premolars and third molars. In the absence of more than 10 teeth, doctors diagnose multiple adentia.


    The main and only cause of adentia is the absence or death of tooth rudiments. Primary pathology can be caused by heredity or provoked by various harmful factors that act during the formation of the dental plate of the fetus.

    Complete congenital adentia is extremely rare. Formed due to ectodermal dysplasia. In this case, along with the absence of teeth in patients, there is underdevelopment of hair, skin, nails, as well as sebaceous and sweat glands, lenses of the eyes, and nerves.

    Among other common causes of pathology, the following are distinguished:

    • Disorder of mineral metabolism during intrauterine development of the fetus against the background of diseases of the mother during pregnancy;
    • diseases in early childhood;
    • heredity;
    • disruption of the endocrine system;
    • disruptions in the development of ectoderm – the outer germ layer of the embryo;
    • treatment of concomitant diseases, including malignant neoplasms;
    • chemotherapy, treatment with ionizing radiation;
    • osteomyelitis and other purulent inflammations of the jaws.

    Untreated caries, pulpitis, periodontitis, dental injuries, phlegmon, abscesses, illiterate provision of dental or orthopedic care, as well as other pathologies of teeth and gums can be the causes of secondary loss of teeth during life.


    Adentia leads to a variety of physical and aesthetic complications:

    • in the area of ​​the absence of a tooth, the unloaded bone gradually atrophies;
    • the face may become asymmetrical, the lip closure is disturbed, the chin and nasolabial folds deepen.The position of the corners of the mouth often changes, they begin to sink;
    • , underdevelopment of the jaws occurs. It is expressed the more strongly, the more teeth are missing, various dentoalveolar deformities appear;
    • with multiple adentia of the lower jaw, its strong protrusion, deep bite is observed;
    • with anomalies of the upper jaw, the lower dentition begins to overlap the upper one;

    Underdevelopment of the jaws is not observed in all cases, and far from all children and adults it is expressed in the same way.However, in all cases, adentia leads to negative changes in appearance.

    With complete or multiple adentia, the bite is formed incorrectly, the function of oral digestion is impaired. Food is poorly chopped, and the patient is forced to refuse many tasty dishes. Do not forget that with this pathology, a person’s self-esteem decreases, he begins to worry about the fact that outwardly he looks unattractive, withdraws into himself and rarely makes contact with people.

    Adentia of the upper jaw

    The upper jaw is more often the lower one undergoes various kinds of anomalies.As a rule, patients have symmetrical hypodentia of two teeth. And since the front teeth are involved in sound production and form the purity of pronunciation, this type of deformation is the most noticeable. The patient’s speech becomes lisping, indistinct, the smile “creeps away”, saliva splashes.

    Adentia of the lower jaw

    The lower jaw has a small prosthetic bed, therefore, with adentia, the tongue begins to take the place of the lower teeth. As a result, the patient’s diction significantly changes, his health worsens.

    Diagnostics and treatment

    To diagnose the disease, the dentist needs a detailed examination of the patient’s oral cavity. The doctor asks the patient a number of points:

    • causes and timing of tooth loss;
    • information about past illnesses;
    • data on the dentures previously used by the patient.

    During the examination, the dentist notes the asymmetry of the face, the severity of the chin and nasolabial folds, the degree of decrease in the height of the lower part of the face, the presence of jam, the nature of the lips closing, the topography of the transitional fold, the degree of mouth opening, the nature of the ratio of the jaws.The specialist also determines the presence of crunching in the joints, pain during movement of the lower jaw and diagnoses the degree of atrophy of the alveolar processes.

    Examination necessarily includes palpation of the oral cavity and radiography of the TMJ. Based on the data obtained, the doctor determines the further tactics of treatment (prosthetics), selects the appropriate type of prosthesis for the patient, the impression material.

    Treatment of adentia in children

    It is important for parents to understand that the treatment of children who have pathological loss of teeth must be carried out without fail.For example, in the absence of milk teeth in the anterior and lateral segments of a child, in adolescence, the row may not form correctly.

    Typical for children edentulous:

    • delay in changing permanent teeth;
    • asymmetric dentition;
    • unilateral preservation of milk teeth;
    • non-prolapse of the deciduous tooth and its fusion with a depression in the jawbone.

    If at least one of these signs is found, the child must be shown to the orthodontist.

    The choice of an orthopedic design depends on the type of pathology and the state of the oral cavity of a small patient. For children, fixed bridges are most often installed – cantilever or sliding. To fix the structure, crowns are mounted. Children respond well to prosthetics and normally adapt to new designs.

    Small patients can also be fitted with bridges, but such constructions are more suitable in the period of late replacement and permanent occlusion.The most successful designs are considered to be sliding bridges. The only drawback of such a system is the formation of a gap when the structure is expanded and food gets into it.

    Bridges are sometimes installed for prophylactic purposes in order to preserve space in the dentition.

    During the period of early removable and temporary bite, removable plate prostheses are used, which do not retard the growth of jaw bones.

    Treatment of adentia in adults

    Adult patients are offered various types of removable and fixed prostheses.Prosthetics on implants, installation of bridges on four implants and other prosthetics options at the patient’s choice are possible. Depending on the state of his dentition, financial capabilities and wishes, dentists, as a rule, offer several treatment options to choose from.

    When choosing a treatment method, it is important to understand the features of each design. The doctor, based on the state of the patient’s oral cavity, offers him a choice of several options for prosthetics.

    Removable dentures

    Partial or full dentures should be replaced every 1.5–2 years. Therefore, even with a complete loss of teeth, dentists offer an alternative type of implant-supported prosthetics.

    Clasp prostheses

    Dentures on a metal frame, on which an acrylic base is installed, and artificial teeth on it. This solution makes it possible to significantly lighten the design of the prosthesis, make it thinner and more comfortable.


    In case of partial edentulousness, the installation of bridges is possible.The non-removable structure is fixed on the adjacent non-grinded teeth.

    Implant-supported prosthetics

    Prosthetics based on implants is considered the most reliable and aesthetic way to restore the dentition. The main advantages of this type of bone implantation include:

    • long service life of the structure;
    • aesthetic appearance;
    • no need to turn adjacent teeth.

    A dental prosthesis installed on implants completely replaces missing teeth and fulfills a functional and aesthetic task.

    Prevention of adentia

    The best prevention is competent, timely oral care. Regular cleaning of teeth and gums, preventive examinations at the dentist twice a year, giving up bad habits, switching to a balanced diet – all this will help keep teeth healthy and strong for as long as possible.

    If you or your child has this condition, do not delay your visit to the dentist. Experienced therapists, orthopedists and implantologists of STOMA clinics will help to solve the problem of partial or complete absence of teeth: they will select a comfortable and aesthetic prosthesis that will significantly improve the quality of life, make you more self-confident and more beautiful.