Health / Sexual & Reproductive Health

If you’re exploring different types of birth control methods, you might know that finding one you jive with can take some trial and error. As you go, consider looking into the birth control implant, which is often referred to by the brand name Nexplanon. It’s a 1.6-inch plastic rod that’s inserted beneath the skin of your upper arm. It pumps out small amounts of progestin, a hormone that prevents your ovaries from releasing eggs and thickens your cervical mucus so sperm can’t swim to the egg, to prevent pregnancy (99% of the time!) for at least three and up to five years. Like IUDs, the main perk of Nexplanon is that it’s long-lasting—once it’s in your body, you can kinda forget about it. As great as birth control pills are, you need to remember to take one at the same time every day. It sounds simple enough, but an estimated 50% of people on the pill forget to take it at least once a month, increasing their risk for unintended pregnancies.1 (As someone who failed miserably at taking the pill on a set schedule, I get it. No alarm or pillbox could help me adhere to my medication regimen.)  With Nexplanon, you don’t have to do anything aside from having the device implanted, then getting it removed or replaced when it expires, or sooner if it’s not working for you. Jill Purdie, MD, a board-certified ob-gyn and medical director at Pediatrix Medical Group in Atlanta, Georgia, tells SELF that Nexplanon is one of the “the most effective reversible contraception [options] available.” Basically anyone who, one, wants birth control, and, two, can tolerate a hormonal option is a good candidate for it, she adds.As is the case with any drug, there are potential side effects that could occur—we’ll get to those in a bit—but most people do just fine after they have the implant placed. Here’s what to expect from the procedure to determine if you want to give Nexplanon a whirl.  How the birth control implant is placedThe implantation process is quick and only takes a few minutes. Dr. Purdie, who’s been performing the procedure for over 15 years, breaks it down: First, an anesthetic will be used to numb the area of your arm where the device will go—which, by the way, is typically the inside of your non-dominant upper arm. Then it’s straight to insertion. The implant will already be pre-loaded into an insertion device, and your doctor will push the tip of the device into your skin until the plastic tube is rooted into the layer of fat just below the skin, explains Dr. Purdie. Then you’re good to go.When you get to your appointment, your health care provider will walk you through this entire process, so if you have any questions upfront, they can answer them right there and then. They’ll also do a urine test to make sure you’re not pregnant, Josie Urbina, MD, an ob-gyn and a complex family planning specialist with the University of California, San Francisco, tells SELF. (You can get the implant placed right after having an abortion or giving birth). Then, it’s on to the procedure. Once the implant’s in place, they’ll wrap your arm in bandages, go over what you can expect in the short- and long-term, and send you on your way. How you might feel after getting the birth control implantYour arm will remain numb for an hour or two after the procedure, though you may start to feel some pain and soreness a few hours later when the anesthetic wears off. Some people will develop a bit of bruising, says Dr. Purdie. The soreness shouldn’t be too bothersome, but if it is, over-the-counter pain medications like acetaminophen or ibuprofen—plus putting some ice on your arm—can help, says Dr. Urbina.

Conversations around menopause have often been swept under the rug or discussed in hushed tones—which is why a number of celebrities are now speaking about what, specifically, menopause looked like for them. CBS This Morning host Gayle King and actor Drew Barrymore talked about their experiences with perimenopause by sharing the first symptoms they noticed in a new segment aired on Wednesday.A little refresher: Perimenopause (which translates to “around menopause”) simply refers to the time menopause starts, and it can strike at different ages. It can start during a person’s 30s, but most people experience it from ages 40 to 44, according to the Mount Sinai Health System.Barrymore, now 48, said this transition changed the frequency of her periods. “I realized that I was in perimenopause when I started having my period every two weeks,” she said. When King, now 68, asked if she was having a heavy flow, Barrymore said, “Yes, like a teenager.”This was the telltale sign for King. “I went to the doctor because—not to get too graphic—but it looked like a crime scene,” she said. She also said she experienced hot flashes. As King explained, “It feels like you’re burning inside. It just feels hot, for me it was just a physical heat. Then you can sometimes have dripping, drenching sweats.” She joked that you can’t control when and where a hot flash will strike. “It can happen at the most inopportune times,” King said. “I’ve been on the red carpet where a photographer will say, ‘Gayle, are you okay?’ I go, ‘It’s just a hot flash,’ and they say, ‘Sorry, sorry, sorry.’ It’s like they’ve said something very bad about you.”This is part of the reason King and Barrymore are trying to start more discussions about what menopause actually feels like. “I’m just glad we’re having this conversation because I didn’t even know the phrase perimenopause [when it started for me],” King said.The pair also talked about the importance of educating all children—not just little girls—about natural bodily processes. “I don’t want little boys going, ‘Ew,’ [when they hear about menopause],” King said. “I don’t want that because it is something we go through. And it’s just male and female—there are differences, and those differences are okay.”Related:

You’re probably well aware of the pill and how it works—but long-acting reversible contraceptives (LARCs), including the birth control implant (a.k.a. Nexplanon), don’t require a daily check on your to-do list.There’s a growing interest in the etonogestrel birth control implant, and its set-it-and-forget-it nature likely plays a role in that. Once the tiny rod is placed in your arm, you don’t have to think about your birth control for years. Couple that with the fact that it’s highly effective at preventing pregnancy, and it’s an attractive contraception option, especially as the right to abortion and other forms of critical reproductive care are threatened in many states across the country.So, how does the birth control implant work? Here’s what you should know if you’re looking to switch to a LARC and want to explore your options. How does the birth control implant work?LARCs, which include the birth control plant and intrauterine devices (IUDs), are the most effective reversible contraceptive methods, according to the American College of Obstetricians and Gynecology (ACOG). LARC methods have a high success rate of preventing pregnancy while they are in place, but they shouldn’t directly impact your return to fertility; once the implant is removed, for example, you can get pregnant quickly if you don’t have other factors affecting your fertility, Christine Greves, MD, an ob-gyn at the Winnie Palmer Hospital for Women and Babies in Orlando, tells SELF. The birth control implant is pretty tiny—it’s just under 2 inches long and is about the size of a matchstick. “Nexplanon is a little rod of a synthetic progesterone [progestin] that goes right under the skin,” Mary Jane Minkin, MD, a clinical professor of obstetrics and gynecology and reproductive sciences at Yale School of Medicine, tells SELF. The implant is inserted into your non-dominant upper arm, where it can stay for up to three years to five years, per the ACOG.1 (Don’t worry, your health care provider should numb the area, so you won’t feel any discomfort during this process.) The way it works is pretty cool: “The implant sends out [progestin] into the bloodstream, which gets to the ovaries to help suppress ovulation,” Dr. Minkin explains. “Also, [progestin] helps keep cervical mucus hostile to sperm—so it helps keep sperm from getting up into the uterus.”Like any form of birth control, the contraceptive implant can come with potential side effects like spotting between periods, longer or shorter bleeding during your period, a heavier or lighter flow, varied amounts of time between periods, or no period at all, according to Planned Parenthood. Other possible side effects include the usual: headaches, breast soreness, and nausea, among others. “As long as you’re okay with the possibility of irregular bleeding…it’s a phenomenal form of birth control,” Dr. Greves says. How effective is the birth control implant at preventing pregnancy?In general, “the implant is a good option for individuals who know they want to delay pregnancy for several years and do not want the hassle of taking a pill every day,” Alexa M. Sassin, MD, an assistant professor of obstetrics and gynecology at Baylor College of Medicine in Houston, tells SELF.

Your doctor should go over your medical history first to get a sense of when you started taking the antidepressants, when you started noticing a change in your sex drive, and different factors that could potentially play a role in your low libido, like stressful life changes, underlying health conditions, or other medications or substances you’re taking, among others.Once they have a better idea of all the pieces that could fit into this puzzle, here are a few steps they may recommend taking if the antidepressants feel like the likely culprit:Give the medication more time first, if you’re open to it.This won’t be doable for everyone, but if you feel like you can ride out certain side effects, including low libido, for a little longer, that’s an option worth considering—especially if the medication you’re taking has stabilized other concerning issues, like a really low mood or unpredictable panic attacks. “Sometimes, it just gets better on its own,” Dr. Streicher says, adding that it can take time for your body to get “used to” a new medication. “When people have been taking medications for a while, their body can simply accommodate over time and sexual desire gets better.” This typically takes anywhere between two and six weeks after starting a new prescription, she notes. If you’re riding it out any longer than that and still working with a lackluster libido, it might be time to try another game plan.Adjust the dose of your antidepressants.If you’re on a high dose of an antidepressant, you may be more likely to experience a lowered sex drive, as well as other side effects, that you may not experience with a lower dose of the same antidepressant, Dr. Streicher says. This is a conversation to have with your doctor—and definitely shouldn’t be something you do on your own. Your doctor initially prescribed your specific dose for a reason, and lowering it on your own may lessen the effectiveness of your medication, she says.Consider switching your antidepressants completely. Remember, some SSRIs seem to have a lower risk of sexual side effects compared to others, but this will ultimately depend on the individual. “Just because someone has a reduced libido on one SSRI doesn’t mean they will have a reduced libido on all SSRIs or other antidepressants,” Dr. Streicher says. All of the experts SELF spoke with say switching to bupropion—which is not an SSRI but still very effective as an antidepressant—is another option. Dr. Minkin says bupropion, in her professional experience, has been “the best antidepressant” to switch a patient to if they’re having libido issues.Again, it’s in your best interest to be open with your prescribing doctor and follow their lead, given they know the ins and outs of your medical history. You should never suddenly stop taking your antidepressants—this can lead to intense anxiety, insomnia, headaches, flu-like symptoms, and a swift return of concerning depression symptoms, among other side effects. Work with your doctor to either adjust the dosage or create a plan to switch your meds safely.

The Office on Women’s Health (OWH) recommends the following guidelines for optimal effectiveness: Take Plan B One-Step or a generic version of Plan B as soon as possible, within three days (72 hours) after unprotected sex. For the two-dose generic version of Plan B, which is called Next Choice, take one pill ASAP within three days and the second pill 12 hours afterward.It’s important to note that emergency contraception is intended to protect against pregnancy after a single act of penetrative penis-in-vagina sex. That means if you have unprotected sex, take Plan B, and then have unprotected sex again, you will need to take Plan B again.Does Plan B have side effects?Plan B and other emergency contraceptive pills are safe ways to prevent pregnancy. “The progesterone-like hormone in these pills is something we’ve used for a long time, and when people have studied what happens in individuals who use several repeat doses, it’s been shown to be safe,” Jessica W. Kiley, MD, MPH, an associate professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine, tells SELF.The potential short-term side effects associated with Plan B usually aren’t any more serious than you might experience during PMS or a stomach bug. Per the OWH, some people may experience headaches, abdominal pain, fatigue, dizziness, nausea, or breast pain. Plan B can also affect the timing of your next period. And, according to Planned Parenthood, “there have been no reports of serious problems out of the millions of people who’ve taken it.”How do I know if Plan B worked?Some spotting can happen after you take an emergency contraceptive pill, and your next period may be irregular. The timing of your next period after taking emergency contraception varies. Andrea Henkel, MD, an obstetrics and gynecology physician at Stanford Children’s Health, tells SELF it’s normal to get your period a bit earlier or later after you take emergency contraception, and that your period may be longer or shorter than normal. “With either, if you are more than a week late, you should take a pregnancy test, because this much of a delay may represent an early pregnancy,” Dr. Henkel says.Can I take Plan B if I take birth control pills?The short answer: yes. Many people use Plan B and other emergency contraception pills as backup forms of protection if they forget to take their daily pill—but you don’t need to double up. “If using your method as prescribed, there is no need to take emergency contraception as a ‘back up,’” Dr. Henkel says. (If you’re on birth control pills and forgot to take them consistently, it might be time to consider a long-acting reversible contraceptive method instead, like the birth control implant or an IUD.)You can also continue using your preferred method of birth control as prescribed after using Plan B. (If you are using Ella, the prescription morning-after pill, then Dr. Henkel advises waiting five days prior to restarting a hormonal contraceptive method, like combination birth control pills, as they may interact with the emergency contraception.)Will Plan B make it hard for me to get pregnant later on?Some people worry that taking Plan B will decrease their chances of getting pregnant intentionally later on, but never fear: Before you google “can Plan B make you infertile,” the answer is definitely not. According to the World Health Organization, “Drugs used for emergency contraception do not harm future fertility,” and there’s also no delay in returning to fertility after using Plan B.So take heart: There’s no need to panic if you’re facing the prospect of unintended pregnancy. Plan B or other emergency contraceptives are safe and effective—and can help you handle what happens next.Related:

Dr. Ahmad has seen many of her own patients take oral contraceptive pills for several years simply because that’s what was recommended and available to them when they first needed birth control. “They just decided to stick with them because it was what their friends were doing and they didn’t consider anything else,” Dr. Ahmad says. “Over time, as they learned about other options, [some of] which don’t require them to take a pill every day, many of them switched.”  Your birth control has failed.A good indication that you need a new birth control method: Your current one has failed you. As in, you were using it and still got pregnant. In some cases, the failure may be due to the inability to take it as recommended; in other cases, failure may occur despite perfect or near-perfect use, Dr. Ahmad says.  Quick reminder—no birth control is 100% effective. For instance, if the pill is used perfectly, it’s 99% effective, but the realistic rate (with “typical use,” or the way that the majority of people actually use it, which can include occasionally missing doses) is more like 91%, according to Planned Parenthood. If you get pregnant while on birth control, have a discussion with your doctor to figure out why it was that the method failed so you can pick a method that’s a better fit for you.Are there any risks of switching birth control methods?In most cases, switching from one birth control method to another doesn’t come with any serious risks. Just make sure your doctor has all your up-to-date health details so that you’re not switching to a method you have a contraindication for. Some side effects, like irregular menstruation, are normal when you switch the kind of birth control you’re taking. They’re simply a case of your body adjusting to the new method, which can take up to six to eight weeks, Samantha M. Dunham, MD, clinical associate professor in the department of obstetrics and gynecology at NYU Langone Health, tells SELF. If you’re still having side effects after a couple of months, talk to your doc.“The biggest downside of switching too often is that different types of birth control have different mechanisms of action and when switching, there may be a period of time that the new method is ineffective,” says Dr. Ahmad. Some forms of birth control work immediately, like the copper IUD, which can even work as an emergency contraceptive if inserted within five days after unprotected sex. Others take longer to become effective, including the pill, ring, implant, and hormonal IUD, depending on when in your cycle you start taking them. While your body adjusts to a new contraceptive and you adjust to a new routine, use a reliable back-up method, such as condoms, to prevent pregnancy, says Dr. Baick. She adds that, depending on your current birth control method and the type you want to switch to, you may need to start using your new birth control before you stop using the old one. The overlap time depends on the particular type of methods in play—your doctor can tell you exactly what you need to do. What to do if you decide to switch birth control methodsBefore switching your birth control, the most important thing is to meet with your doctor to go over your options. “Make sure your physician has your updated medical history and understands what your preferences are in terms of frequency of use, hormones versus no hormones, and permanent versus reversible/temporary,” says Dr. Ahmad. “With that information, you and your provider can identify the best type of birth control for your specific needs and goals.” There’s likely no harm in testing out a new-to-you method to see if it works better for you and your current priorities, says Dr. Dunham. “The best method for you is the one you’re happy using and will use regularly.” If you want to do some research ahead of your appointment with your doctor, Dr. Dunham recommends checking out Bedsider, an online birth control support network intended to help prevent unplanned pregnancies. Finally, keep up with your yearly annual exams to ensure that you’re still using the method that’s best for you, despite any life or health changes that pop up. Just like any other aspect of your overall health, your birth control is worthy of your attention. Even if checking in just confirms that you’re on the right track, that’s great to know, too.Related:

C.P. Hoffman, a senior policy lawyer at the National Center for Transgender Equality, tells SELF that policies denying trans people gender-affirming care are especially dangerous for teenagers already going through the tumult of puberty. “If you think of the general trauma of being a teenager, there’s so much body horror associated with it,” they say. “You’re watching your body develop, [thinking], Okay, this is great. Okay, this is weird.” For trans teenagers, being denied gender-affirming care really doubles down on that feeling. “There’s something that could help you, [but] you’re being told by people in power, ‘Oh, you are mentally disturbed for wanting this,’” Hoffman explains.It’s worth noting, they add, that hormonal therapies are nothing new and are sometimes recommended for cisgender kids. For instance, hormonal interventions may be recommended if a cisgender child starts puberty too soon. “[Hormonal therapies have] been used for cisgender kids for decades. Now that it’s being publicized that trans kids are doing this also, there’s moral panic,” Hoffman says.If lawmakers were actually concerned about children’s health—and not simply trying to exacerbate prejudice and to oppress transgender youth—they’d likely try to ban hormonal therapies for everyone, which they aren’t. For instance, a bill introduced by Tennessee lawmakers in November proposes a ban on hormonal therapies (and other forms of gender-affirming care) when given to transgender youth—claiming that the “state has a legitimate, substantial, and compelling interest in encouraging minors to appreciate their sex, particularly as they undergo puberty”—but makes exemptions for the very treatments they’re trying to outlaw in other circumstances (such as for the treatment of a “congenital defect, disease, or physical injury.”) The bill also echoes lies often used by GOP lawmakers, stating that gender-affirming care is “harmful” even though, as Hoffman notes, “every major medical association in the United States that has looked at the issue has endorsed gender-affirming care as appropriate care for adults and minors.”Though anti-trans legislation skyrocketed last year, mainstream media outlets have focused less on the question of safe medical care being taken away from thousands and more on a flawed moral argument. The New York Times, for instance, recently published a piece called “When Students Change Gender Identity, and Parents Don’t Know,” which raised the question of whether parents should know if their child has socially transitioned, but barely touched on the possibility that some children’s safety may be jeopardized if their family members, or other people in their community, knew they’d done so. The Atlantic also recently published an article called “Take Detransitioners Seriously,” which, as writer Evan Urquhart points out, centers on the story of a former Navy Seal with ties to the Christian nationalist movement who has expressed anti-trans sentiments.What fearmongering lawmakers drafting legislation banning gender-affirming care fail to acknowledge is that outlawing this medical care will be dangerous. “Gender affirming-care essentially means that you are providing an environment that is validating and affirming, which each and every person deserves,” Dr. Matouk says. “[It] is a necessary protective factor against the higher rates of anxiety, depression, suicidal ideation, and self-harm that [trans and gender nonbinary] folks experience, compared to cisgender peers.”The obsessive anti-trans coverage does more than damage teenagers’ mental health, Dr. Matouk says: The rhetoric spread by opponents of gender-affirming care—including lawmakers and those who vocalize support for their agendas—will have a ripple effect, especially if bans are established. “Denying or even criminalizing gender-affirming care has a significant negative impact,” she says. “Not only does restricting care directly threaten the mental and physical health of [trans and nonbinary] folks, it also exacerbates prejudice, discrimination, and violence against the community.”In the hate-filled political and cultural climate we’re currently living in, research like the new NEJM study adds sound science to the conversation, Dr. Matouk says: “It helps challenge laws that are contesting and denying basic human rights with scientific evidence and informed practice.”Related:

When symptoms are present, they may vary from person to person, depending on the area that’s infected; gonorrhea symptoms can also be mistaken for other common health issues, like a urinary tract infection. These are the most common signs to be aware of, per the CDC: Painful or burning sensation when peeingIncreased vaginal dischargeWhite, yellow, or green discharge from the penisVaginal bleeding between periodsPainful or swollen testiclesAnal itching, discharge, soreness/pain, or bleedingThe rise of drug-resistant gonorrhea doesn’t mean there are no treatments available—but the options are limited.Gonorrhea used to be treated with a class of antibiotics called fluoroquinolones, but is now primarily treated with cephalosporins (which include the aforementioned ceftriaxone). Currently, the primary treatment for gonorrhea is a single, 500-milligram injection of ceftriaxone, and, because reinfection is common, the CDC recommends being retested three months after treatment. So far, ceftriaxone has been an effective cure for the strains of gonorrhea that have been detected in the US, Thomas Russo, MD, a professor and the chief of infectious diseases at the University at Buffalo in New York.If that initial injection of ceftriaxone doesn’t beat the bacteria, a doctor should prescribe a higher dose, potentially with another “second-line” antibiotic, Dr. Russo says. “This is why culture and susceptibility testing is important,” he explains. “It may identify alternatives.”However, the CDC warns that if a strain of gonorrhea that’s resistant to cephalosporins eventually emerges, it would “significantly complicate” our ability to treat the STI successfully—there are few antibiotic options left that are “simple, well-studied, well-tolerated, and highly effective” against the bacteria. That doesn’t mean we suddenly have no options, but it does mean that our options are becoming limited. Experts are studying the efficacy of new drugs to treat gonorrhea, but they may take years to reach the market. And quick, effective treatment is pretty crucial: Untreated gonorrhea can potentially lead to serious complications for some people, including pelvic inflammatory disease, an infection of the uterus, fallopian tubes, or ovaries that can raise a person’s risk of infertility, according to Dr. Russo. In rare cases, untreated gonorrhea can also become life-threatening if the infection spreads to your bloodstream or joints.The best way to avoid any issues that gonorrhea may give you is to try to avoid the STI in the first place—which, of course, is up to both you and your sexual partner(s). This starts with having open, honest communication about sex. Using a barrier method (like a condom, diaphragm, or dental dam) correctly will help reduce your risk of contracting or spreading various STIs (again, you or your partner(s) may not even be aware that you have an infection, so using protection is important even if you don’t have symptoms). Dr. Adalja also says it’s “critical” for any sexually active person to get tested for STIs regularly to ensure early detection; the CDC recommends at least once a year for gonorrhea, syphilis, and chlamydia, or more frequently—at least every three to six months—if you recently had sex with a new partner or multiple partners. If you’re not totally sure how often you should get tested, don’t hesitate to bring it up with your doctor. (You can find an STI testing site in your area here, or you can visit your local Planned Parenthood for these services.)If you happen to develop any symptoms that feel out of your norm—pain, discharge, just a general feeling that something is “off”—don’t wait to see your primary care doctor, ob-gyn, or even a provider at your urgent care clinic, Dr. Russo says: “Fast and effective treatment is important.”Related:

Retail pharmacies, like CVS and Walgreens, will be allowed to fill prescriptions for mifepristone—the first of two pills used for a medical or medication abortion—for the first time in the United States, according to a recent update provided by the Food and Drug Administration (FDA). The permanent regulatory change is expected to increase abortion access throughout the country following the Supreme Court’s decision to overturn Roe v. Wade last year; the landmark case guaranteed the federal right to abortion since 1973 and was officially reversed in June 2022.Before this regulatory change, which was confirmed by the FDA on January 3, people who wanted or needed a medication abortion—which accounts for more than half of all abortions in the US—were only able to access mifepristone from doctors’ offices, clinics, or a few mail-order pharmacies. With the new change, you still need a prescription from a certified provider to get mifepristone, but retail pharmacies that agree to carry the drug and follow certain criteria can dispense the pills, either in person or via mail order. (Misoprostol, the second pill needed for a medication abortion that is also used for other conditions, hasn’t faced the same restrictions and can be picked up at pharmacies with a prescription.)This change is a pretty big deal, according to Lauren Streicher, MD, a clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine. “It’s all about telehealth,” she tells SELF. Prior to this, there was a requirement that mifepristone had to be dispensed in person; currently, in 18 states, the prescribing clinician also needs to be physically present when the medication is taken. One reason for that? There is a “ridiculous” concern that someone would be prescribed the medication and give it to someone else, Dr. Streicher says, noting that most other medications don’t have this type of restriction. Requiring people to get or take abortion pills in person, typically in a doctor’s office or clinic, has always been problematic for various reasons, but it “was a huge barrier” if you were trying to get a prescription via telehealth in particular, Dr. Streicher says. Now, depending on where you live and your access to care, you can get the medication prescribed via telehealth, go to a certified pharmacy of your choice (or request a mailed order), and “take the pill in the privacy of your own home,” she says. Another perk: “This change also means that someone else can pick up the prescription for you,” Dr. Streicher adds. (Note: It’s always a good idea to read up on your state’s abortion stance to familiarize yourself with local legislation first.)The research we have on medication abortions supports the FDA’s decision, Gopika Krishna, MD, an ob-gyn in New York and fellow with Physicians for Reproductive Health, tells SELF. “Despite years of medical research showing that medication abortion, and specifically mifepristone, is safe and effective, there have been medically unnecessary restrictions on how mifepristone can be prescribed,” she says. “The decision by the FDA follows the science by removing unnecessary barriers to safe and evidence-based medical care.” Remember: People will still receive prescriptions from certified prescribers, meaning their providers will discuss all the benefits and risks to be aware of, and the patient will still get to ask questions to ensure they feel comfortable and confident about their decision.

Every month, for about two to three days before my period, I experience terrible brain fog. It’s similar to the feeling I get when I oversleep: I can’t think as quickly or clearly as I normally can, my memory is a bit fuzzy, and I’m just kind of out of it. Experts use the term brain fog to describe a range of temporary “cognitive difficulties,” like trouble focusing, forgetfulness, and mild confusion. Brain fog isn’t a medical diagnosis; rather, it’s a symptom associated with a slew of health conditions, including pregnancy, depression, long COVID, and, yes, PMS (premenstrual syndrome). The research on PMS-related brain fog is limited, but anecdotally, going through it can be a slog, Jennifer Roelands, MD, an ob-gyn who specializes in holistic medicine, tells SELF. For example, the mental cloudiness and impaired concentration may hurt your performance at work, as SELF previously reported, and research suggests that PMS symptoms, including cognitive ones like confusion, can also impact personal relationships. For me, the easiest tasks—like sending an email—suddenly feel difficult, and sometimes I feel like I lack the wherewithal to navigate even simple conversations. “To deal with that every single month is pretty miserable, but there are definitely things you can do to help,” says Dr. Roelands. More on that soon, but first… Why might menstruation trigger brain fog?I’ve always chalked premenstrual brain fog up to hormonal fluctuations that occur during my cycle. I figured the mental sludge had something to do with cyclical changes in estrogen and progesterone. That’s possibly not too far off, according to Dr. Roelands. Menstruation can cause all sorts of drastic and rapid hormonal changes that are associated with an array of symptoms (a.k.a. PMS), as SELF previously reported. It’s known that estrogen and progesterone also play a role in brain function and cognition, but how, specifically, changes in those hormones may directly contribute to brain fog is somewhat unclear, Cheruba Prabakar, MD, ob-gyn and chief medical advisor for wellness-ingredient company Purissima, tells SELF. The evidence has been mixed: A small 2017 study concluded that there is no relationship between brain fog and the hormonal changes that take place leading up to menstruation, while a 2020 analysis suggests that it’s just too early to declare, either way, if and how menstrual-related hormone changes impact cognitive functioning. Though the research on PMS and brain fog is inconclusive, many reproductive health specialists, including the ones SELF talked to for this story, say that, anecdotally, people commonly report experiencing brain fog both before and during menstruation. The going theory, according to both Dr. Roelands and Dr. Prabakar: The mentally fuzzy feeling is likely due to all of the significant changes in hormones, neurotransmitters, and insulin levels that happen during your menstrual cycle. And there are some data that support this theory: Research shows that estrogen and progesterone influence neurotransmitters like dopamine and serotonin that deal with executive functions (a group of complex cognitive abilities that includes working memory and problem solving). Studies have also linked low estrogen levels to cognitive impairment and higher estrogen levels to improvements in memory and learning. There are estrogen receptors all over the brain, says Dr. Roelands, so it makes sense why your cognitive function is affected by the estrogen dip that happens during PMS. Experts also know that cognitive issues are common in menopausal people who have chronically low estrogen levels.