At Home Testing

1. Pregnancy 

2. Frequent Urination (Polyuria)

3. Excessive Thirst (Polydipsia)

4. Increased Hunger (Polyphagia)

5. Unexplained Weight Loss

6. Fatigue and Weakness

7. Blurry Vision

8. Slow Healing of Wounds

9. Tingling or Numbness in Hands and Feet (Peripheral Neuropathy)

10. Frequent Infections

11. Darkened Skin (Acanthosis Nigricans)

1. People with Diabetes: The HbA1c test is frequently used to monitor blood sugar control in individuals diagnosed with diabetes, both type 1 and type 2. It provides information about long-term glucose levels and helps healthcare providers adjust treatment plans accordingly.

2. Individuals at Risk for Diabetes: People with risk factors for diabetes, such as obesity, family history of diabetes, sedentary lifestyle, or history of gestational diabetes, may undergo the HbA1c test as part of routine screening for diabetes or prediabetes.

3. Diabetes Screening: Healthcare providers may recommend the HbA1c test for individuals who exhibit symptoms of diabetes, such as increased thirst, frequent urination, unexplained weight loss, fatigue, or blurred vision, to aid in the diagnosis of diabetes.

4. Monitoring Treatment Efficacy: For individuals already diagnosed with diabetes, the HbA1c test is used to monitor the effectiveness of diabetes management strategies, including lifestyle modifications, medications, and insulin therapy, in controlling blood sugar levels.

5. Prevention and Management of Complications: Regular monitoring of HbA1c levels helps prevent or delay the development of diabetes-related complications, such as cardiovascular disease, kidney disease, nerve damage, and eye problems.

6. Pregnant Women: Pregnant women with risk factors for gestational diabetes, such as obesity, family history of diabetes, or previous gestational diabetes, may undergo the HbA1c test as part of prenatal screening for diabetes.

• Family History: If you have a family history of high cholesterol, heart disease, or stroke, you may be at increased risk and should consider getting tested.

• Age and Gender: Men over the age of 45 and women over the age of 55 are at higher risk of developing high cholesterol.

• Obesity or Overweight: Being overweight or obese can lead to elevated cholesterol levels and increase the risk of heart disease.

• Fatigue

• Dizziness or Lightheadedness

• Palpitations

• Swelling

• Nausea or Indigestion

• Sweating

• Coughing

• Chest Pain or Discomfort

• Shortness of Breath

Familial Hypercholesterolemia (FH): This is an inherited genetic disorder characterized by high levels of LDL cholesterol from birth. FH leads to early and aggressive atherosclerosis and increases the risk of heart disease at a young age.

Poor Diet: Consuming a diet high in saturated fats, trans fats, and cholesterol can contribute to high cholesterol levels. Foods such as red meat, full-fat dairy products, fried foods, and baked goods can raise LDL cholesterol levels.

Obesity and Overweight: Excess body weight, particularly abdominal obesity, can increase LDL cholesterol and decrease HDL cholesterol levels, leading to elevated total cholesterol levels.

Physical Inactivity: Lack of regular physical activity can lower HDL cholesterol levels and contribute to weight gain, obesity, and high cholesterol.

Smoking: Smoking damages the walls of blood vessels, leading to the accumulation of fatty deposits and narrowing of the arteries. It can also lower HDL cholesterol levels and increase LDL cholesterol levels.

Type 2 Diabetes: People with type 2 diabetes often have high levels of LDL cholesterol and triglycerides and low levels of HDL cholesterol. Insulin resistance and metabolic abnormalities associated with diabetes can contribute to dyslipidemia.

Hypothyroidism: Underactive thyroid gland (hypothyroidism) can lead to elevated levels of total cholesterol and LDL cholesterol due to decreased metabolism of fats.

Chronic Kidney Disease: Impaired kidney function can disrupt the balance of lipids in the blood, leading to dyslipidemia and elevated cholesterol levels.

Liver Diseases: Certain liver conditions, such as nonalcoholic fatty liver disease (NAFLD), can affect cholesterol metabolism and lead to high cholesterol levels.

Certain Medications: Some medications, such as corticosteroids, diuretics, beta-blockers, and certain immunosuppressants, can raise LDL cholesterol levels or lower HDL cholesterol levels.

Age and Gender: Cholesterol levels tend to increase with age, and men typically have higher cholesterol levels than premenopausal women. However, after menopause, women’s cholesterol levels tend to increase and may surpass those of men.

• Adults Over 40: As age is a significant risk factor for heart disease, individuals aged 40 and above may benefit from heart health tests, even if they do not have symptoms or known risk factors.

• High blood pressure

• High cholesterol, diabetes

• Obesity, smoking

• Sedentary lifestyle

• Unhealthy diet

• Family history

• Heart disease

• Previous history of heart attack or stroke

• Chest Pain or Discomfort

• Shortness of Breath

• Palpitations

• Fatigue

• Dizziness or Lightheadedness

• Swelling

• Nausea or Indigestion

• Sudden, Severe Headaches

• Cold Sweats

• Unexplained Weight Gain

• Coughing

• Cyanosis

Types of Heart Disease
Heart disease refers to several distinct heart and blood (cardiovascular) conditions. Types of CVD include the following:4

Congenital heart disease occurs when people are born with defects in their heart structure.
Coronary heart disease (coronary artery disease) is the most common type of heart disease; it’s characterized by a buildup of plaque and hardening of artery walls (atherosclerosis), which disrupts blood flow.
Heart attack (myocardial infarction) is often caused by CAD and occurs when blood flow is blocked, causing heart muscles to die.
Heart failure is a form of heart disease characterized by the heart not pumping enough blood; the heart is still working but not well enough.
Arrhythmia is an irregular heartbeat, which can impact your heart’s ability to pump enough blood; your heart may beat too fast (tachycardia), too slowly (bradycardia), or inconsistently.
Valvular stenosis occurs when one or more of the four valves of the heart do not open all the way; this can cause regurgitation, when blood leaks backward because the valve is closed.

1. Early Localized Stage (3 to 30 days after tick bite):

   • Erythema Migrans (Bull’s-Eye Rash): A characteristic rash often appears at the site of the tick bite, resembling a red expanding rash with a central clearing that resembles a bull’s-eye. However, not all people with Lyme disease develop this rash.
   • Flu-like Symptoms: Fever, chills, fatigue, headache, muscle and joint aches, and swollen lymph nodes may occur.

2. Early Disseminated Stage (days to weeks after tick bite):

   • Multiple Erythema Migrans Rashes: In some cases, multiple smaller rashes may appear on other parts of the body.
   • Neurological Symptoms: These may include facial paralysis (Bell’s palsy), meningitis (stiff neck, severe headache), numbness or tingling in the hands or feet, and weakness or paralysis in muscles of the face or elsewhere.
   • Heart Palpitations and Dizziness: Some individuals may experience heart palpitations, irregular heartbeat (arrhythmia), or dizziness.

3. Late Disseminated Stage (months to years after tick bite):

   • Arthritis: Episodes of swelling and pain, usually in large joints, especially the knees.
   • Neurological Symptoms: This may include numbness or tingling in the hands, feet, or back, memory problems, difficulty concentrating, and mood changes.
   • Chronic Fatigue: Persistent fatigue, muscle weakness, and sleep disturbances may occur.
   • Vision Changes: Some individuals may experience inflammation of the eye (ocular Lyme disease) leading to conjunctivitis, eye pain, or blurry vision.
   • Skin Manifestations: Rarely, Lyme disease may cause acrodermatitis chronica atrophicans, a skin condition characterized by redness and swelling followed by thinning and tightening of the skin, usually on the hands and feet.

Causes
Lyme disease is a tick- borne infection caused by four main species of bacteria: Borrelia afzelii, Borrelia garinii, Borrelia mayonii and borrelia burgdorferi.
In the United States, lyme disease is predominantly caused by Borrelia burgdorferi and Borrelia mayonii bacteria, carried primarily by certain species of ticks.
The risk factors include:
People who spend more time in outdoors such as wooded or grassy areas
Exposed skin
Not removing ticks immediately

Complications of severe Lyme disease include:

Arthritis
Neurological problems like meningitis, nerve inflammation
Heart problems
Facial nerve inflammation (Bell’s palsy)

1. Those with Symptoms of Stress-related Disorders: Individuals experiencing symptoms of stress-related disorders, such as:

   • Chronic stress
   • Anxiety or panic attacks
   • Post-traumatic stress disorder (PTSD)
   • Insomnia or sleep disturbances related to stress

2. Those with Symptoms of Sleep Disorders: People experiencing symptoms suggestive of sleep disorders, such as:

   • Excessive daytime sleepiness
   • Snoring
   • Frequent awakenings during the night
   • Gasping or choking sensations during sleep
   • Difficulty falling asleep or staying asleep
   • Restless legs or periodic limb movements during sleep
   • Daytime fatigue or irritability
   • Witnessed episodes of breathing cessation during sleep (sleep apnea)

3. Individuals with Suspected Sleep Apnea: Sleep apnea is a common sleep disorder characterized by pauses in breathing or shallow breathing during sleep. A sleep study, such as polysomnography (PSG) or home sleep apnea testing (HSAT), may be recommended for individuals suspected of having sleep apnea.

4. People with Insomnia: Insomnia is a sleep disorder characterized by difficulty falling asleep, staying asleep, or non-restorative sleep. Sleep studies or other assessments may be used to evaluate the underlying causes of insomnia and guide treatment.

5. Individuals with Excessive Daytime Sleepiness: Excessive daytime sleepiness can result from various sleep disorders, including sleep apnea, narcolepsy, or circadian rhythm disorders. Sleep studies or assessments may be used to evaluate daytime sleepiness and its underlying causes.

6. People with Shift Work Sleep Disorder: Shift work sleep disorder occurs when work schedules disrupt the body’s natural circadian rhythm, leading to difficulty sleeping or excessive sleepiness. Sleep studies or assessments may be used to evaluate sleep patterns and assess treatment options.

7. Individuals with Restless Legs Syndrome (RLS): RLS is a neurological disorder characterized by an uncontrollable urge to move the legs, usually accompanied by uncomfortable sensations. Sleep studies or assessments may be used to evaluate the impact of RLS on sleep and guide treatment.

8. People with Cardiovascular Disease or Hypertension: Chronic stress and poor sleep quality can contribute to cardiovascular disease and hypertension. Stress tests or sleep assessments may be used to evaluate the impact of stress and sleep disorders on cardiovascular health.

9. Individuals with Chronic Fatigue Syndrome (CFS): Chronic fatigue syndrome is a complex disorder characterized by extreme fatigue that is not relieved by rest. Sleep assessments or stress tests may be used to evaluate sleep quality, stress levels, and factors contributing to fatigue.

There are over 80 different types of sleep disorders. The most common include:

Chronic insomnia: You have trouble falling asleep or staying asleep most nights for at least three months and feel tired or irritable as a result.
Obstructive sleep apnea: You snore and have moments during sleep when you stop breathing that disrupt your sleep.
Restless legs syndrome: You have the urge to move your legs when you rest.
Narcolepsy: You can’t regulate when you fall asleep or how long you stay awake.
Shift work sleep disorder: You have trouble falling asleep and staying asleep and feel sleepiness at unwanted times due to your work schedule.
Delayed sleep phase syndrome: You fall asleep at least two hours after your desired bedtime and have difficulty waking up in time for school or work.
REM sleep behavior disorder: You act out your dreams while in the rapid eye movement (REM) stage of sleep.

What causes sleep disorders?
A disruption to your body’s cycle of sleep and daytime wakefulness causes sleep disorders. Specific things may cause this to happen and it varies based on the type of sleep disorder you have. They may include:

A symptom of a medical condition like heart disease, asthma, pain or a nerve condition.
A symptom of a mental health condition like depression or anxiety disorder.
Genetic factors (a mutation).
A side effect of a medication.
Working the night shift.
Substance use before bedtime like caffeine or alcohol.
Low levels of certain chemicals or minerals in the brain.
An unknown cause.

1. Women of Reproductive Age: Women who are of reproductive age, typically starting from adolescence through menopause, may benefit from regular well-woman exams to monitor their reproductive health, menstrual cycles, and overall well-being.

2. Sexually Active Women: Any woman who is sexually active, regardless of age or sexual orientation, may benefit from regular women’s health tests to screen for sexually transmitted infections (STIs), assess reproductive health, and discuss contraception options.

3. Women Planning Pregnancy or Currently Pregnant: Women who are planning pregnancy or already pregnant should undergo women’s health tests, including prenatal care and screenings, to monitor maternal and fetal health, identify any potential risks or complications, and promote a healthy pregnancy and childbirth.

4. Women with Gynecological Concerns or Symptoms: Women experiencing gynecological symptoms or concerns, such as abnormal vaginal bleeding, pelvic pain, menstrual irregularities, vaginal discharge, or discomfort during sexual intercourse, should seek medical evaluation and may require women’s health tests to diagnose and address underlying issues.

5. Women with Family or Personal History of Gynecological Conditions: Women with a family history or personal history of gynecological conditions, such as ovarian cysts, endometriosis, fibroids, or polycystic ovary syndrome (PCOS), may benefit from regular screenings and monitoring to detect and manage these conditions.

6. Women with Risk Factors for Breast Cancer: Women with risk factors for breast cancer, such as a family history of breast cancer, BRCA gene mutations, or prior history of breast abnormalities, may require women’s health tests, including breast exams, mammograms, and genetic counseling and testing.

7. Women with Risk Factors for Osteoporosis: Women with risk factors for osteoporosis, such as older age, family history of osteoporosis, low body weight, smoking, excessive alcohol consumption, or prolonged use of corticosteroids, may benefit from bone density testing to assess bone health and fracture risk.

8. Women with Chronic Health Conditions: Women with chronic health conditions, such as diabetes, hypertension, cardiovascular disease, autoimmune disorders, or mental health disorders, may require women’s health tests to monitor their overall health and manage any associated reproductive or gynecological issues.

9. Women with Menstrual Disorders or Menopause Symptoms: Women experiencing menstrual disorders, such as heavy or irregular periods, or menopause symptoms, such as hot flashes, night sweats, or vaginal dryness, may benefit from women’s health tests to assess hormonal levels, thyroid function, and overall health status.

10. Women Seeking Contraception or Reproductive Health Services: Women seeking contraception or reproductive health services, including birth control counseling, contraceptive methods (e.g., pills, patches, implants, intrauterine devices), or preconception counseling, may undergo women’s health tests to assess their reproductive health and discuss family planning options.

Hormones have such a powerful effect on your body that they can influence things like weight, energy levels, mood, sex drive, and more. Ever wonder why you’re tired all the time, for example? Your hormones might be one reason why.

Hormone levels can thus reveal a lot about your overall wellness, and checking a variety of hormones can give you more specific insights into your body’s well-being. For example, if you’re experiencing high estrogen symptoms or you’re having symptoms of a low progesterone level, taking an at-home hormone test will allow you to check for imbalances in these hormones and potentially find the cause of your symptoms.

And that’s exactly why our hormone test for women can be informative for a woman at any stage of life: it measures more than 10 hormones involved in reproductive health, weight, energy, and more.

Because the Everlywell Women’s Health Test measures more than 10 hormones involved in reproductive health, weight fluctuation, energy, and more, it can be informative for a woman at any stage of life.

Here’s a breakdown of the hormones this test checks, what they do in your body, and symptoms of hormone levels that may be out of balance.

Estradiol
What Estradiol Does in Your Body:
Estradiol – the main type of estrogen – supports the functions of female sex organs like the vagina, uterus, and breasts. Your estrogen level plays an important role in ovulation (release of an egg from an ovary) during the menstrual cycle.

If your blood estrogen levels are normal, then there is a good chance ovulation has taken place during the month of your sample collection. Testing your blood estrogen levels can help you see if this sex hormone is balanced to support reproductive health. If you’re experiencing low estrogen levels, your healthcare provider may recommend hormone replacement therapy to correct your body’s estrogen imbalance.

What If Estradiol Levels Are Out of Balance?
Low estrogen levels – which often occur during and after menopause – can result in menstrual irregularities, vaginal dryness, and reduced bone strength. If you have high estrogen levels, you might experience stomach pain and bloating, breast tenderness, mood swings, headaches, weight gain, and sleep disturbance. Estradiol levels that remain chronically high can also increase the risk of serious conditions like breast or uterine cancer. That’s why it can be a good idea to check if you have normal estrogen levels for your age.

Progesterone
What Progesterone Does in Your Body:
Your progesterone level is important for regulating menstrual cycles. Progesterone—another sex hormone—is also a top “pregnancy hormone” because it causes the uterine lining to thicken in preparation for a fertilized egg. The right level of progesterone is thus essential for a successful pregnancy.

What If Progesterone Levels Are Out of Balance?
If progesterone levels fall too low, you may have irregular bleeding during your menstrual cycle, your cycles might become more spaced apart, or you might not have any menstrual cycle at all. Miscarriage and ovulation problems are a couple other possible consequences of a progesterone hormone imbalance, as well as headaches, hot flashes, mood changes, and reduced libido.

And if you have high progesterone levels? You might experience common high progesterone symptoms like vaginal dryness, mood changes, and fatigue. To address these symptoms, your healthcare provider may recommend hormone therapy through progesterone supplements of some kind. If you’re looking for ways to test your hormone levels, consider our at-home hormone testing for women.

Luteinizing Hormone (LH)
What Luteinizing Hormone Does in Your Body:
The pituitary gland, a part of the brain, releases varying amounts of luteinizing hormone (LH) throughout the menstrual cycle. LH levels help control the menstrual cycle. An LH surge in the middle of your cycle triggers ovulation (egg release), and LH levels typically drop after ovulation.

What If Luteinizing Hormone Levels Are Out of Balance?
A low LH level suggests that your pituitary gland might be malfunctioning, preventing the LH surge that’s involved with menstruation. Higher-than-normal LH levels – when seen with high FSH levels – can be a sign of ovarian failure (which can result in infertility. Another possible cause of an elevated LH concentration can be a syndrome known as polycystic ovarian syndrome – or PCOS.

Follicle-Stimulating Hormone (FSH)
What Follicle-Stimulating Hormone Does in Your Body:
Follicle-stimulating hormone, or FSH, prepares ovarian follicles (which house the ovary’s eggs) for ovulation. FSH secretion (and thus levels) tend to increase as egg quantity decreases throughout your life. This is because FSH is involved in ovarian stimulation – as ovarian function declines, higher FSH levels are needed to support ovulation.

What If FSH Levels in Women Are Out of Balance?
There are several possible causes of a low FSH level. Certain kinds of pituitary disorder can cause low FSH secretion. A high FSH level suggests that your ovaries may not have very many eggs left. If high FSH levels occur alongside high LH secretion, your ovaries may have stopped working normally – which may indicate a depleted ovarian reserve, a sign that you may be nearing menopause.

Learn More Here: Why Measure FSH?
DHEAS
What DHEAS Does in Your Body:
Your adrenal glands and ovaries make DHEA, which is then quickly converted to DHEAS. DHEAS helps your body produce other hormones – like testosterone and estrogen. DHEAS is also important for sustaining a healthy amount of muscle mass.

What If DHEAS Levels Are Out of Balance?
DHEAS levels that are too low can result in chronic fatigue, low libido, and mood changes. High DHEAS levels – often accompanied by acne, infertility, an absence of a menstrual cycle, or increased body and facial hair – can be a sign of polycystic ovary syndrome (PCOS) or other problems with the adrenal glands.

Testosterone
What Testosterone Does in Your Body:
Testosterone helps control your body’s muscle-making and fat-burning activities, as well as other aspects of metabolism. EverlyWell’s Women’s Health Test measures free testosterone as opposed to total testosterone.

What If Your Testosterone Level Is Out of Balance?
Your testosterone level needs to fall within a normal range – not too high or too low – for optimal wellness. When testosterone gets too low, you might experience thinning hair, dry skin, mood changes, and – over the long-term – sexual dysfunction and bone loss.

What about too much testosterone? In this case, you might experience acne, menstrual irregularities, and hair growth in parts of your body that hair normally doesn’t grow. Over time, too much testosterone in a woman can contribute to diabetes, obesity, infertility, and more.

Cortisol
What Cortisol Does in Your Body:
Cortisol is known as the “stress hormone” because it aids in the fight-or-flight response. It provides the body with energy by controlling how much sugar your body burns for fuel. Well-balanced cortisol levels help you fall asleep at night and wake up in the morning.

What If Cortisol Levels Are Out of Balance?
When cortisol levels are too low, you’re more likely to be fatigued, have a loss of appetite (as well as weight loss), and sexual dysfunction. Too much cortisol can result in an irregular menstrual cycle, acne, weight gain, headaches, mood changes, and a hard time concentrating.

Thyroid Hormones
What Thyroid Hormones Do in Your Body:
The thyroid gland pumps two hormones into your bloodstream: T3 and T4. These thyroid hormones are extremely important to the body because they regulate key functions like metabolism and body temperature. They also help support normal menstrual cycles.

What If Thyroid Hormone Levels Are Out of Balance?
An underfunctioning thyroid gland – a condition known as hypothyroidism – can cause low thyroid hormone levels. Women are 5 to 8 times more likely than men to develop a thyroid disorder. A low amount of thyroid hormones can produce symptoms like weight gain, menstrual cycle irregularities, hair loss, constipation, and feeling cold.

Low Thyroid Hormone Levels
If thyroid hormone levels get too high, your heart might beat faster, you may have a hard time sleeping, and you may feel more restless or nervous – among other symptoms, like weight loss and thinning hair.

High Thyroid Hormone Levels
Thyroid-Stimulating Hormone (TSH)
What Thyroid-Stimulating Hormone Does in Your Body:
The thyroid gland releases hormones that control many of the body’s functions, such as metabolism (as mentioned above). Thyroid-stimulating hormone (TSH), which also comes from the pituitary gland in our brains, regulates the amount of hormones the thyroid makes.

What If Thyroid-Stimulating Hormone Levels Are Out of Balance?
Abnormal TSH levels suggest that the thyroid is releasing too many or too few hormones – which can harm a woman’s fertility. Signs of a TSH imbalance include anxiety, trouble sleeping, weight loss or gain, fatigue, and an irregular menstrual cycle.

What TSH Levels Indicate
TPOab
What TPOab Does in Your Body:
Thyroid peroxidase antibodies (TPOab) are a kind of antibody. The immune system uses antibodies to eliminate germs that invade your body. TPOab, however, can attack your thyroid gland – hurting or destroying its function – if your immune system malfunctions (this is known as an autoimmune disease).

What If TPOab Levels Are Out of Balance?
Elevated amounts of TPOab – along with low thyroid hormone levels – can mean that your thyroid gland isn’t working well because of an autoimmune disorder called Hashimoto’s disease. Weight gain, an irregular menstrual cycle, fatigue, and hair loss are all clues that an autoimmune condition might be hurting your thyroid gland.

1. Occupational Exposure: Workers in certain industries, such as mining, manufacturing, construction, agriculture, metalworking, and electronics, may be at risk of occupational exposure to heavy metals. Jobs involving the use of heavy metals or exposure to metal dust, fumes, or vapors increase the risk of heavy metal toxicity.

2. Environmental Exposure: People living in areas with high levels of environmental pollution, such as near industrial sites, mining operations, waste incinerators, or contaminated water sources, may be at risk of environmental exposure to heavy metals. Exposure can occur through air, water, soil, or food contaminated with heavy metals.

3. Dietary Exposure: Consumption of contaminated food or water is a common route of exposure to heavy metals, particularly mercury, lead, cadmium, and arsenic. Certain foods, such as fish (especially large predatory fish), shellfish, rice, and vegetables grown in contaminated soil, may contain elevated levels of heavy metals.

4. Fishermen, Seafood Consumers, and Hunters: Individuals who consume large amounts of fish or seafood, especially those caught in contaminated waters, may be at risk of mercury poisoning. Hunters who consume game meat may also be at risk of lead exposure from lead ammunition.

5. Dental Work: Certain dental materials, such as dental amalgam fillings containing mercury, can release small amounts of heavy metals into the body over time. Individuals with a history of extensive dental work or concerns about dental materials may require testing for heavy metals.

6. History of Metal Implants or Prosthetics: People with metal implants, prosthetics, or medical devices (e.g., joint replacements, dental implants) may be at risk of metal exposure if the implants degrade or corrode over time. Testing may be recommended to assess metal levels in the body and monitor for potential toxicity.

7. Children and Pregnant Women: Children and developing fetuses are more susceptible to the adverse effects of heavy metals due to their smaller size and developing organ systems. Pregnant women and young children may require testing for lead and other heavy metals to assess exposure levels and prevent developmental problems.

8. Symptoms of Heavy Metal Toxicity: Individuals experiencing symptoms suggestive of heavy metal toxicity may require testing to identify the underlying cause. Symptoms of heavy metal toxicity can vary depending on the type of metal and level of exposure but may include fatigue, weakness, abdominal pain, nausea, vomiting, headaches, cognitive difficulties, mood changes, and neurological symptoms.

9. Chronic Illness or Unexplained Symptoms: Chronic illnesses or unexplained symptoms that do not respond to conventional treatments may be associated with heavy metal toxicity. Testing for heavy metals may be considered as part of a comprehensive diagnostic evaluation for these individuals.

What is heavy metal poisoning?
Heavy metal poisoning occurs when microscopic molecules of metals accumulate within your body after exposure. Heavy metals attach to your cells and prevent them from performing their functions, which causes symptoms that could be life threatening without treatment.

What metals cause heavy metal poisoning (toxicity)?
Several metals can be toxic to your body. The most common toxic metals are:

Lead. Contaminated water from lead pipes, batteries, paint, gasoline, construction materials.
Mercury. Liquid in thermometers, lightbulbs, dental amalgam (“silver”) fillings, batteries, seafood, topical antiseptics.
Arsenic. Topical creams, herbicides, insecticides, pesticides, fungicides, paints, enamels, glass, contaminated water, seafood, algae.
Cadmium. Cigarette smoke, metal plating, batteries.
Thallium. Rodenticides, pesticides, fireworks.
How does someone get heavy metal poisoning?
You can get heavy metal poisoning by exposing yourself to heavy metals. Heavy metals form naturally within the Earth’s crust. We interact with small amounts of heavy metals every day, like when you check the temperature of your thermometer, which uses mercury. Heavy metal poisoning occurs when metals get into your body. This can happen if you’re exposed to a large amount of metal including:

Eating a lot of food that contains metals (fish).
Drinking water from older water supply systems.
Working with metals on the job.
Taking medications or supplements with high amounts of metallic elements.
Handling metals or products made with a large amount of metal (like paint or pesticides) without using personal protective equipment.
Most metals that cause poisoning are in a microscopic (molecular) form when they enter your body. They are so small, you won’t be able to see them. Heavy metals can enter your body by:

Absorbing into your skin.
Breathing in or inhaling tiny metal molecules.
Eating or drinking (ingesting) the metal from food or water.
Who does heavy metal poisoning affect?
Heavy metal poisoning can affect anyone who has exposure to heavy metals. This most often affects people who:

Drink water from pipes made of older metals (lead).
Work with metals.
Take more than the prescribed dosage of medicine or supplements that contain metal.
Live in an environment with high air or water pollution.
Eat a lot of foods that contain metal.
Consume a non-edible product made with metal (paint).
Children are at a higher risk of heavy metal poisoning because their bodies are still developing and they are more sensitive to the harmful effects of heavy metals.

1. Individuals with Unexplained Weight Changes: People experiencing unexplained weight loss or weight gain may benefit from metabolic testing to assess their metabolic rate and energy expenditure. Abnormalities in metabolism can contribute to changes in body weight.

2. Patients with Obesity or Overweight: Individuals who are obese or overweight may undergo metabolic testing to assess their resting metabolic rate (RMR) and determine the number of calories their body burns at rest. This information can help guide weight management strategies and caloric intake recommendations.

3. People with Difficulty Losing Weight: Individuals who have difficulty losing weight despite adhering to a calorie-restricted diet and engaging in regular physical activity may benefit from metabolic testing to identify potential factors contributing to metabolic resistance to weight loss.

4. Athletes and Fitness Enthusiasts: Athletes and individuals involved in intense physical training may undergo metabolic testing to assess their metabolic efficiency, optimize training programs, and improve athletic performance. Understanding energy metabolism can help tailor nutrition and exercise plans to meet specific performance goals.

5. Patients with Diabetes or Prediabetes: People with diabetes or prediabetes may undergo metabolic testing to assess glucose metabolism, insulin sensitivity, and other metabolic parameters. This information can help optimize diabetes management and guide lifestyle interventions to improve metabolic health.

6. Individuals with Thyroid Disorders: Thyroid disorders, such as hypothyroidism or hyperthyroidism, can affect metabolism and energy expenditure. Metabolic testing may be recommended to assess thyroid function and metabolic rate in individuals with suspected thyroid disorders.

7. Patients with Hormonal Imbalances: Hormonal imbalances, such as polycystic ovary syndrome (PCOS) or adrenal insufficiency, can affect metabolism and metabolic health. Metabolic testing may help evaluate hormonal influences on metabolism and guide treatment strategies.

8. People with Cardiovascular Risk Factors: Individuals with risk factors for cardiovascular disease, such as high blood pressure, high cholesterol, or a family history of heart disease, may benefit from metabolic testing to assess metabolic risk factors, such as insulin resistance and lipid metabolism.

9. Patients with Chronic Fatigue or Fatigue Disorders: Chronic fatigue syndrome, fibromyalgia, and other fatigue disorders may be associated with abnormalities in metabolism and energy production. Metabolic testing may help identify metabolic dysfunctions contributing to fatigue symptoms.

10. Individuals with Gastrointestinal Disorders: Certain gastrointestinal disorders, such as malabsorption syndromes or inflammatory bowel disease (IBD), can affect nutrient absorption and metabolism. Metabolic testing may help assess nutrient utilization and guide nutritional support in individuals with gastrointestinal disorders.

What causes metabolic disorders?
You can develop a metabolic disorder if certain organs — for instance, the pancreas or the liver — stop functioning properly. These kinds of disorders can be a result of genetics, a deficiency in a certain hormone or enzyme, consuming too much of certain foods, or a number of other factors.

There are hundreds of genetic metabolic disorders caused by mutations of single genes. These mutations can be passed down through generations of families. According to the National Institutes of Health (NIH)Trusted Source, certain racial or ethnic groups are more likely to pass on mutated genes for particular inborn disorders. The most common of these are:

sickle cell anemia in African Americans
cystic fibrosis in people of European heritage
maple syrup urine disease in Mennonite communities
Gaucher’s disease in Jewish people from Eastern Europe
hemochromatosis in Caucasians in the United States
Types of metabolic disorders
Diabetes is the most common metabolic disease. There are two types of diabetes:

Type 1, the cause of which is unknown, although there can be a genetic factor.
Type 2, which can be acquired, or potentially caused by genetic factors as well.
According to the American Diabetes Association, 30.3 million children and adults, or about 9.4 percent of the U.S. population have diabetes.

In type 1 diabetes, the T cells attack and kill beta cells in the pancreas, the cells that produce insulin. Over time, a lack of insulin can cause:

nerve and kidney damage
eyesight impairment
increased risk of heart and vascular disease
Hundreds of inborn errors in metabolism (IEM) have been identified, and most are extremely rare. However, it’s estimated that IEM collectively affects 1 in every 1,000 infants. Many of these disorders can only be treated by limiting dietary intake of the substance or substances the body cannot process.

The more common types of nutritional and metabolic disorders include:

Gaucher’s disease
This condition causes an inability to break down a particular kind of fat, which accumulates in the liver, spleen, and bone marrow. This inability can result in pain, bone damage, and even death. It’s treated with enzyme replacement therapy.

Glucose galactose malabsorption
This is a defect in the transport of glucose and galactose across the stomach lining which leads to severe diarrhea and dehydration. Symptoms are controlled by removing lactose, sucrose, and glucose from the diet.

Hereditary hemochromatosis
In this condition, excess iron is deposited in several organs, and can cause:

liver cirrhosis
liver cancer
diabetes
heart disease
It’s treated by removing blood from the body (phlebotomy) on a regular basis.

Maple syrup urine disease (MSUD)
MSUD disrupts the metabolism of certain amino acids, causing rapid degeneration of the neurons. If not treated, it causes death within the first few months after birth. Treatment involves limiting the dietary intake of branched-chain amino acids.

Phenylketonuria (PKU)
PKU causes an inability to produce the enzyme, phenylalanine hydroxylase, resulting in organ damage, mental retardation, and unusual posture. It’s treated by limiting the dietary intake of certain forms of protein.

1. People with Allergy Symptoms: Individuals experiencing symptoms of allergic reactions to environmental allergens may benefit from allergy testing. Common symptoms of allergies include:

   • Sneezing
   • Runny or stuffy nose
   • Itchy or watery eyes
   • Nasal congestion
   • Coughing
   • Wheezing
   • Shortness of breath
   • Skin rash or hives
   • Itchy skin

2. Seasonal Allergy Sufferers: People who experience seasonal allergy symptoms, such as hay fever or allergic rhinitis, during specific times of the year, such as spring (tree pollen), summer (grass pollen), or fall (weed pollen), may benefit from allergy testing to identify specific triggers.

3. Perennial Allergy Sufferers: Individuals who experience allergy symptoms year-round, regardless of the season, may have allergies to indoor allergens, such as dust mites, pet dander, mold spores, or cockroach allergens. Allergy testing can help identify indoor allergens that contribute to year-round symptoms.

4. People with Asthma: Individuals with allergic asthma, a type of asthma triggered by allergens, may benefit from allergy testing to identify specific allergens that exacerbate asthma symptoms. Identifying and avoiding asthma triggers can help improve asthma control and reduce the risk of asthma attacks.

5. Patients with Atopic Dermatitis: People with atopic dermatitis (eczema), a chronic inflammatory skin condition, may have allergic reactions to environmental allergens that worsen skin symptoms. Allergy testing can help identify allergens that contribute to eczema flare-ups.

6. Individuals with Suspected Allergies: People who suspect they have allergies but are unsure of the specific triggers may benefit from allergy testing to confirm suspected allergies and identify specific allergens.

7. Those Seeking Allergy Immunotherapy (Allergy Shots): Individuals considering allergy immunotherapy, such as allergy shots or sublingual immunotherapy (allergy drops), may undergo allergy testing to identify allergens for personalized immunotherapy treatment plans.

8. Children and Adults: Allergy testing can be performed in both children and adults. Children with recurrent allergy symptoms or suspected allergies may undergo allergy testing to identify triggers and develop appropriate management strategies.

9. People with Family History of Allergies: Individuals with a family history of allergies, asthma, or atopic conditions (such as eczema or allergic rhinitis) may be at increased risk of developing allergies themselves and may benefit from allergy testing for early detection and management.

Symptoms and Causes
What are the symptoms of environmental allergies?
Environmental allergy symptoms include:

Congestion (feeling stuffy).
Postnasal drip.
Coughing.
Dark circles under your eyes (allergic shiners).
Fatigue.
Headache.
Hives.
Itchy and runny nose.
Red, itchy and watery eyes (epiphora).
Sneezing.
Wheezing (difficulty breathing, usually with a whistling or gasping sound).
Seasonal allergies can also trigger an asthma attack.

What causes environmental allergies?
Environmental allergens include many different substances, including:

Pollen. Pollens are microspores from trees, grass or weeds that appear as a fine dust. Pollen may be many colors, including yellow, white, red or brown. Plants release pollen to fertilize other plants for reproduction. Pollen levels are usually highest in the morning. Pollen levels increase on warm, windy days.
Molds. Molds are tiny fungi (singular, fungus). They have spores that float in the air. Mold is common in damp areas with little or no airflow. These areas may include your basement, kitchen or bathroom. Mold also grows outdoors in leaf piles, grass, mulch, hay or under mushrooms. Mold spore levels are highest during hot, humid weather.
Pet dander and saliva (spit). Pet dander is tiny scales from your pet’s skin, hair or feathers. Your pet’s sweat glands secrete proteins through their skin, which collect in their skin and fur and may cause an allergic reaction. Your pet’s spit (saliva) also contains these proteins.
Dust mites. Dust mites are tiny, eight-legged relatives of spiders. They’re too small to see with your eyes. They live on bedding, mattresses, carpets, curtains and upholstered (fabric) furniture. They feed on the dead skin cells that you and your pets shed. Dust mites live on every continent except Antarctica, but they thrive in hot, humid environments. They don’t bite you. Breathing in the proteins from their urine (pee), feces (poop) and dead bodies may cause allergic reactions.
Cockroaches. Cockroaches are reddish-brown or black insects that are 1.5 to 2 inches long. Male cockroaches have two pairs of wings. Many female cockroaches don’t have wings. If they have wings, they aren’t strong enough to allow flight (vestigial wings). The proteins in their poop, spit, eggs and dead body parts may cause allergic reactions.
Examples of environmental irritants that cause non-IgE reactions include:

Smoke. Smoke of any kind can trigger a non-IgE reaction. The chemicals in these products can cause irritation that’s similar to an allergic reaction. Examples include tobacco product smoke — including cigarettes, vapes and cigars — and marijuana and scented candle smoke.
Dust. Dust is a combination of tiny particles of matter. Dust may include dead skin cells, hair, pollen, clothing fibers, dust mites, dead insect pieces, dirt, bacteria and tiny pieces of plastic.

1. People with Digestive Symptoms: Individuals experiencing chronic digestive symptoms, such as bloating, gas, abdominal pain, diarrhea, constipation, or indigestion, may have food sensitivities contributing to their symptoms.

2. Patients with Irritable Bowel Syndrome (IBS): IBS is a common gastrointestinal disorder characterized by abdominal pain, changes in bowel habits, and bloating. Certain foods may exacerbate symptoms in individuals with IBS, and food sensitivity testing may help identify trigger foods.

3. Individuals with Suspected Food Allergies: Individuals with suspected food allergies but negative results on traditional allergy tests (such as skin prick tests or IgE blood tests) may have food sensitivities or intolerances. Food sensitivity testing can help identify non-IgE-mediated reactions to foods.

4. People with Skin Conditions: Some skin conditions, such as eczema (atopic dermatitis), acne, or urticaria (hives), may be exacerbated by food sensitivities. Food sensitivity testing can help identify potential dietary triggers contributing to skin symptoms.

5. Patients with Chronic Fatigue Syndrome (CFS) or Fibromyalgia: Chronic fatigue syndrome and fibromyalgia are complex conditions characterized by persistent fatigue, muscle pain, and other symptoms. Food sensitivities or intolerances may contribute to symptoms in some individuals, and testing can help identify trigger foods.

6. Individuals with Autoimmune Disorders: Certain autoimmune diseases, such as rheumatoid arthritis, systemic lupus erythematosus (SLE), or Hashimoto’s thyroiditis, may be associated with food sensitivities. Identifying and avoiding trigger foods may help alleviate symptoms in some individuals.

7. People with Neurological Symptoms: Certain neurological conditions, such as migraine headaches, neuropathy, or attention deficit hyperactivity disorder (ADHD), may be linked to food sensitivities. Identifying and avoiding trigger foods may help manage neurological symptoms in some individuals.

8. Individuals with Inflammatory Bowel Disease (IBD): Individuals with inflammatory bowel diseases, such as Crohn’s disease or ulcerative colitis, may have food sensitivities that exacerbate gastrointestinal inflammation. Testing for food sensitivities can help identify potential triggers for symptom flare-ups.

9. Patients with Non-Celiac Gluten Sensitivity (NCGS): Non-celiac gluten sensitivity is a condition characterized by adverse reactions to gluten-containing foods in individuals without celiac disease or wheat allergy. Food sensitivity testing may help identify other trigger foods besides gluten.

10. Those with Chronic Headaches or Migraines: Some individuals may experience headaches or migraines triggered by specific foods. Food sensitivity testing may help identify potential dietary triggers for headaches or migraines.

Common Causes
Food intolerance usually is experienced in the digestive tract. Problems digesting certain foods is thought to be caused by genetics, lack of digestive enzymes, digestive disorders, or sensitivity to food additives. It can also be caused by toxins in the foods we eat.

Genetics
While research has linked genetics with food allergies, less is known about its relation to food intolerance.3 However, some metabolic food disorders such as lactose intolerance can be inherited. Lactose intolerance is considered an inherited deficiency of the enzyme lactase.4

People with Asian, African, and Native American heritage are more prone to lactose intolerance than other populations.5

Lack of Digestive Enzymes and Enzyme Defects
Digestive enzymes are secreted by the gastrointestinal (GI) system. They help with digestion by breaking down fats, proteins, and carbohydrates. Digestive enzymes also aid in nutrient absorption.6

Some food intolerance stems from a lack of digestive enzymes.2 For example, a person with lactose intolerance often lacks enough of the digestive enzyme lactase. Lactase breaks down lactose commonly found in dairy products such as milk.7

Fructose intolerance, also known as hereditary fructose intolerance, is another condition caused by a lack of digestive enzymes. It is thought to be caused by mutations in the ALDOB gene, which aids in making the aldolase B enzyme found in the liver. Aldolase B is responsible for breaking down fructose to allow it to be used by the body for energy.8

Non-Celiac Gluten Sensitivity
The exact cause of non-celiac gluten sensitivity remains unknown. However, researchers define it as a nonallergic, non-autoimmune condition characterized by gastrointestinal symptoms caused by consuming gluten-containing grains.9

Gluten intolerance is often confused with Celiac disease, but they are not the same. A person with gluten intolerance experiences gassiness, bloating, or diarrhea after consuming foods like wheat, barley, or rye. In contrast, Celiac disease is an inherited autoimmune condition that causes damage to the small intestine.10

Intolerance to Chemicals in Foods and Additives
There are many chemicals in the foods we eat. Although many people do not have difficulty digesting chemicals found in food, some people do.

While the cause is not completely understood, the following food chemicals are believed to cause unwanted gastrointestinal symptoms in some people:11

Salicylates are compounds found in plant foods such as green apples, carrots, cucumbers, and herbs. They are thought to overstimulate leukotriene production, which may lead to increased inflammation and smooth muscle contraction.
Amines (histamines) can be found in ripe cheese, cured and processed meat, and wine. People who cannot effectively process a large amount of histamine at a time may exhibit gastrointestinal symptoms after consuming foods that are high in amines.
Monosodium glutamates (MSG) is a common flavor enhancer in many foods. It’s commonly found in Chinese food, processed foods, and meats. It’s also found naturally in cheese and tomatoes. The exact cause of this intolerance remains unknown. However, studies have shown that removing MSG from the diets of patients with irritable bowel syndrome (IBS, a common disorder affecting the large intestine) resolves over 30% of symptoms in 84% of patients.11
Caffeine increases adrenaline production, which gives you energy. It also suppresses a chemical called adenosine, which helps you sleep. When your body does not digest caffeine properly, it can magnify the effect on your endocrine system, leading to restlessness, bloating, and abdominal pain.12
Toxins and Food Poisoning
Some foods have natural toxins or chemicals that can cause toxic effects and lead to symptoms similar to a food intolerance.

Toxins and bacteria in foods like mushrooms, potatoes, and spoiled fish are among the most common toxic food intolerances.1

Gastrointestinal Disease
Food intolerance appears to be more common in those with underlying digestive disorders. According to one study of people with IBS, 84% reported symptoms of intolerance to at least one food product. The most common food intolerance reported was to dairy products, beans, lentils, and histamine-releasing foods such as milk, wine, and beer.13

Additionally, people with inflammatory bowel disease (IBD) are likely to also have a food intolerance. In a survey given to patients with IBD, an estimated 66% with Crohn’s disease (inflammation found anywhere in the wall of the digestive tract) and 64% of patients with ulcerative colitis (inflammation of the lining of the large intestine) reported food intolerance. Common foods causing intolerance in these groups include chocolate, artificial sweeteners, fats, and dairy.14

Lifestyle Risk Factors
Research shows the late introduction of solids in an infant’s diet may also cause a food intolerance or allergy to develop later in life.15
Hicke-Roberts A, Wennergren G, Hesselmar B. Late introduction of solids into infants’ diets may increase the risk of food allergy development. BMC Pediatrics. 2020;20(1):273. doi:https://doi.org/10.1186/s12887-020-02158-x

Additionally, those who have a history of weight loss surgery, such as Roux-en-Y gastric bypass surgery, may experience difficulty tolerating certain foods.16

Common Trigger Foods
Trigger foods commonly associated with food intolerance include:1

Cheese
Eggs
Nuts
Fish
Shellfish
Onions
Garlic
Citrus fruits
Fried foods

1. Vegetarians and Vegans: People who follow vegetarian or vegan diets may be at risk of B vitamin deficiencies, particularly vitamin B12. Vitamin B12 is primarily found in animal products, so individuals who avoid or limit animal-derived foods may need to monitor their B12 levels.

2. Elderly Individuals: Aging can affect the body’s ability to absorb certain nutrients, including B vitamins. Older adults may be at increased risk of B vitamin deficiencies due to decreased stomach acid production and changes in gastrointestinal function.

3. Pregnant or Breastfeeding Women: Pregnant and breastfeeding women have increased nutrient requirements, including B vitamins, to support fetal growth and development and milk production. Low B vitamin levels during pregnancy or breastfeeding can have adverse effects on both the mother and baby.

4. People with Malabsorption Disorders: Conditions that affect nutrient absorption in the gastrointestinal tract, such as celiac disease, inflammatory bowel disease (IBD), Crohn’s disease, or surgical removal of part of the stomach or intestines, can lead to B vitamin deficiencies.

5. Chronic Alcoholics: Chronic alcohol consumption can interfere with the absorption, metabolism, and utilization of B vitamins, particularly thiamine (vitamin B1). Alcoholics are at increased risk of developing thiamine deficiency, which can lead to serious neurological complications, such as Wernicke-Korsakoff syndrome.

6. Individuals with Certain Medications: Certain medications, such as proton pump inhibitors (PPIs), metformin, anticonvulsants, and oral contraceptives, can interfere with B vitamin absorption or increase B vitamin requirements. Individuals taking these medications may require monitoring of B vitamin levels.

7. People with Certain Health Conditions: Certain medical conditions, such as diabetes, kidney disease, liver disease, autoimmune disorders, and genetic disorders affecting B vitamin metabolism (e.g., MTHFR gene mutations), can increase the risk of B vitamin deficiencies.

8. Individuals with Symptoms of B Vitamin Deficiency: Symptoms of B vitamin deficiency may include fatigue, weakness, pale skin, shortness of breath, tingling or numbness in the hands and feet, memory problems, mood changes, and poor concentration. Individuals experiencing these symptoms may require testing to evaluate their B vitamin status.

9. People Following Fad Diets or Restrictive Diets: Individuals following fad diets, extreme weight loss diets, or restrictive diets that exclude certain food groups may be at risk of B vitamin deficiencies if they do not consume an adequate variety of nutrient-rich foods.

Causes
It occurs due to decreased intake of the vitamin, increased requirements or poor absorption.
Decreased intake :
People in a strict vegan diet
Decreased absorption:
In the elderly especially due to lack of intrinsic factor that aids in B-12 absorption (pernicious anemia)
In people who have undergone surgery involving removal of the section of the bowel responsible for B-12 absorption
Atrophic gastritis
People on metformin for diabetes
People on chronic use of anti-acid drugs and protein pump inhibitors
The risk factors include:
Vegans
Pregnancy
Alcohol
Certain medications which block absorption of vitamins

Complications
If untreated for a prolonged period it may lead to

Vascular disease including stroke, pulmonary embolism due to elevated homocysteine
Memory loss
Ataxia
Peripheral neuropathy
depression

1. People with Chronic Digestive Symptoms: Individuals experiencing chronic digestive symptoms, such as abdominal pain, bloating, gas, diarrhea, constipation, or indigestion, may have food sensitivities or intolerances contributing to their symptoms.

2. Individuals with Irritable Bowel Syndrome (IBS): IBS is a common gastrointestinal disorder characterized by abdominal pain, changes in bowel habits, and bloating. Certain foods may exacerbate symptoms in individuals with IBS, and food sensitivity testing may help identify trigger foods.

3. Patients with Functional Gastrointestinal Disorders: Functional gastrointestinal disorders, such as functional dyspepsia (indigestion), functional bloating, or functional diarrhea, may be associated with food sensitivities. Testing for food sensitivities can help identify potential triggers and guide dietary management.

4. People with Suspected Food Allergies: Individuals with suspected food allergies, but negative results on traditional allergy tests (such as skin prick tests or IgE blood tests), may have food sensitivities or intolerances. Food sensitivity testing can help identify non-IgE-mediated reactions to foods.

5. Patients with Non-Celiac Gluten Sensitivity (NCGS): Non-celiac gluten sensitivity is a condition characterized by adverse reactions to gluten-containing foods in individuals without celiac disease or wheat allergy. Food sensitivity testing may help identify other trigger foods besides gluten.

6. Individuals with Skin Conditions: Some skin conditions, such as eczema (atopic dermatitis), acne, or urticaria (hives), may be exacerbated by food sensitivities. Comprehensive food sensitivity testing can help identify potential dietary triggers contributing to skin symptoms.

7. People with Autoimmune Disorders: Certain autoimmune diseases, such as rheumatoid arthritis, systemic lupus erythematosus (SLE), or Hashimoto’s thyroiditis, may be associated with food sensitivities. Identifying and avoiding trigger foods may help alleviate symptoms in some individuals.

8. Patients with Chronic Fatigue Syndrome (CFS) or Fibromyalgia: Chronic fatigue syndrome and fibromyalgia are complex conditions characterized by persistent fatigue, muscle pain, and other symptoms. Food sensitivities or intolerances may contribute to symptoms in some individuals, and testing can help identify trigger foods.

9. Individuals with Neurological Symptoms: Certain neurological conditions, such as migraine headaches, neuropathy, or attention deficit hyperactivity disorder (ADHD), may be linked to food sensitivities. Identifying and avoiding trigger foods may help manage neurological symptoms in some individuals.

10. People with Inflammatory Bowel Disease (IBD): Individuals with inflammatory bowel diseases, such as Crohn’s disease or ulcerative colitis, may have food sensitivities that exacerbate gastrointestinal inflammation. Testing for food sensitivities can help identify potential triggers for symptom flare-ups.

Symptoms and Causes
What causes food intolerance?
People with food intolerances often don’t make enough of a particular enzyme that the digestive system needs to break down a certain food or ingredient. Experts aren’t sure why some people develop food intolerances.

Certain gastrointestinal conditions may make you more prone to food sensitivities. These conditions include:

Celiac disease.
Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis.
What are the symptoms of a food intolerance?
Symptoms of a food intolerance include:

Abdominal (belly) pain.
Diarrhea.
Gas and bloating.
Headaches or migraines.
Heartburn.
Nausea.
Upset stomach.

1. Individuals with Symptoms of Celiac Disease: People experiencing symptoms suggestive of celiac disease may benefit from screening tests. Common symptoms of celiac disease include:

   • Digestive symptoms: Diarrhea, abdominal pain, bloating, gas, constipation, nausea, vomiting.
   • Non-digestive symptoms: Fatigue, unexplained weight loss, iron deficiency anemia, bone or joint pain, dermatitis herpetiformis (itchy skin rash), mouth ulcers, delayed growth in children, infertility, depression or anxiety.

2. People with a Family History of Celiac Disease: Individuals with a first-degree relative (parent, sibling, or child) diagnosed with celiac disease have an increased risk of developing the condition themselves. Screening tests may be recommended for family members of individuals with celiac disease, especially if they are experiencing symptoms suggestive of the condition.

3. Patients with Autoimmune Disorders: Celiac disease is associated with other autoimmune diseases, such as type 1 diabetes, autoimmune thyroid disease (Hashimoto’s thyroiditis, Graves’ disease), autoimmune liver disease, and autoimmune pancreatitis. Screening tests may be recommended for individuals with autoimmune disorders due to the increased risk of celiac disease.

4. Individuals with Down Syndrome or Turner Syndrome: Down syndrome (trisomy 21) and Turner syndrome (monosomy X) are genetic conditions associated with an increased risk of celiac disease. Screening tests may be considered for individuals with Down syndrome or Turner syndrome, especially if they are experiencing symptoms suggestive of celiac disease.

5. Patients with Unexplained Iron Deficiency Anemia: Celiac disease can lead to malabsorption of nutrients, including iron, leading to iron deficiency anemia. Screening tests may be recommended for individuals with unexplained iron deficiency anemia, especially if other causes have been ruled out.

6. People with Dermatitis Herpetiformis: Dermatitis herpetiformis is a skin condition characterized by a chronic, itchy rash that is associated with celiac disease. Screening tests may be recommended for individuals with dermatitis herpetiformis to confirm the diagnosis of celiac disease.

7. Patients with Unexplained Chronic Fatigue or Fibromyalgia: Chronic fatigue syndrome (CFS) and fibromyalgia are conditions associated with fatigue, muscle pain, and other symptoms. Celiac disease may contribute to these symptoms in some individuals. Screening tests may be considered for patients with unexplained chronic fatigue or fibromyalgia, especially if other causes have been ruled out.

8. Women with Unexplained Infertility or Recurrent Miscarriages: Celiac disease may be associated with reproductive issues, including infertility and recurrent miscarriages. Screening tests may be recommended for women with unexplained infertility or recurrent miscarriages, especially if other causes have been ruled out.

9. Individuals with Unexplained Neurological Symptoms: Celiac disease can affect the nervous system and lead to neurological symptoms such as peripheral neuropathy, ataxia, seizures, or migraine headaches. Screening tests may be considered for individuals with unexplained neurological symptoms, especially if other causes have been ruled out.

.

Causes
Celiac disease is an autoimmune disorder where the body shows an extreme reaction to foods containing gluten. The exact cause is not known. Both genetic and environmental factors play role.
Genetic testing shows that almost all people (95%) with celiac disease have HLA-DQ2 or HLA-DQ8 variants of human leukocyte antigens.
It is sometimes triggered after pregnancy, childbirth, surgery, or viral infection.
The risk factors include:
Family history of Celiac disease
Down syndrome or Turner syndorme
Type 1 Diabetes
Autoimmune thyroid disease
Addison’s disease
Symptoms & Reports
Complications
Complications associated with celiac disease are:

Lactose intolerance: once the intestinal lining is damaged, eating dairy products can also cause problems like abdominal pain, diarrhea, etc.
Malnutrition: As the villi are damaged, nutrients cannot be absorbed and this leads to malnutrition & weight loss
Cancer: People with celiac disease who do not maintain gluten free diet are at high risk of developing cancer
Neurological problems: Seizures or peripheral neuropathy is observed in some people
Loss of calcium and bone density: Loss of calcium absorption can lead to bone damage
Infertility & miscarriage

1. People with Symptoms of Food Allergies: Individuals experiencing symptoms suggestive of food allergies after consuming certain foods may benefit from food allergens testing. Common symptoms of food allergies include:

   • Skin reactions (e.g., hives, itching, eczema)
   • Gastrointestinal symptoms (e.g., abdominal pain, nausea, vomiting, diarrhea)
   • Respiratory symptoms (e.g., nasal congestion, runny nose, sneezing, coughing)
   • Oral allergy syndrome (itching or swelling of the mouth, lips, or throat)
   • Anaphylaxis (severe allergic reaction characterized by difficulty breathing, swelling of the throat, rapid heartbeat, dizziness, and loss of consciousness)

2. Individuals with Known Food Allergies: People with a known history of food allergies or previous allergic reactions to specific foods may undergo food allergens testing to confirm allergen sensitivities and identify additional trigger foods.

3. Children with Suspected Food Allergies: Infants and young children who develop symptoms suggestive of food allergies, such as eczema, colic, reflux, or failure to thrive, may require food allergens testing to identify allergen triggers and guide dietary management.

4. Patients with Eosinophilic Esophagitis (EoE): EoE is a chronic inflammatory condition of the esophagus characterized by difficulty swallowing, food impaction, and other gastrointestinal symptoms. Food allergens testing may help identify trigger foods contributing to EoE flare-ups.

5. People with Oral Allergy Syndrome (OAS): OAS, also known as pollen-food syndrome, is a condition characterized by allergic reactions to certain raw fruits, vegetables, or nuts that cross-react with pollen allergens. Food allergens testing may help identify specific foods causing OAS symptoms.

6. Individuals with Exercise-Induced Food Allergies: Some individuals may experience allergic reactions to certain foods when consumed before or after exercise. Food allergens testing can help identify trigger foods associated with exercise-induced food allergies.

7. Patients with Atopic Dermatitis (Eczema): Atopic dermatitis, also known as eczema, is a chronic inflammatory skin condition that may be exacerbated by food allergies. Food allergens testing may help identify trigger foods contributing to eczema flare-ups.

8. People with Gastrointestinal Disorders: Certain gastrointestinal disorders, such as eosinophilic gastroenteritis, celiac disease, or inflammatory bowel disease (IBD), may be associated with food allergies or intolerances. Food allergens testing may help identify trigger foods exacerbating gastrointestinal symptoms.

9. Individuals with Chronic Respiratory Symptoms: Some respiratory conditions, such as asthma or allergic rhinitis (hay fever), may be triggered or worsened by food allergies. Food allergens testing may help identify specific foods contributing to respiratory symptoms.

10. Patients with Unexplained Symptoms: Individuals experiencing unexplained or recurrent symptoms that do not respond to conventional treatments may undergo food allergens testing to identify potential underlying food allergies as a contributing factor.

Causes of Food Allergy
Food allergies typically develop because the immune system malfunctions and misinterprets a food protein as dangerous. When the immune system is exposed to allergens, it produces a type of antibody called immunoglobulin E (IgE). (Allergens are molecules that the immune system can identify and that can stimulate a response by the immune system). The IgE antibodies trigger cells of the immune system to release substances (such as histamine, prostaglandins, and leukotrienes) that cause swelling or inflammation in the surrounding tissues. Such substances begin a cascade of reactions that continue to irritate and harm tissues. These reactions range from mild to severe.

Almost any food or food additive can cause an allergic reaction. The most common triggers vary by age group.

Infants and young children with food allergies tend to be allergic to the most common allergy triggers (allergens), such as those in the following:

Eggs

Milk

Wheat

Peanuts

Soybeans

For older children and adults, the most common triggers are allergens in

Nuts

Seafood, including shellfish

Being exposed to other allergens that are similar to those in foods (such as pollen) may trigger the production of antibodies to substances in food, resulting in a food allergy. This process is called sensitization. For example, children with peanut allergy may have been sensitized to peanuts when topical creams containing peanut oil were used to treat rashes. Also, many people who are allergic to latex are also allergic to bananas, kiwis, avocados, or a combination. Latex and these fruits contain similar allergens.

Food allergies are more common among children whose parents have food allergies, allergic rhinitis, or allergic asthma.

Alpha-gal syndrome
Alpha-gal syndrome is a rare form of allergy to red meat. Alpha-gal is a sugar that occurs in most mammals but not in fish, birds, reptiles, or people. Lone star ticks, which are present mostly in the southeastern United States, have alpha-gal in their saliva. When a lone star tick bites a person, it transmits alpha-gal to the person. Sometimes the immune system then produces antibodies to alpha-gal, resulting in an allergy to alpha-gal. Because alpha-gal is present in many red meats (such as pork, beef, lamb, and venison) and in foods produced from mammals (such as dairy products and gelatin), people with these antibodies may have an allergic reaction to these foods.

Symptoms of alpha-gal syndrome include an itchy rash, indigestion, constipation, nausea, and anaphylactic reactions. Unlike other food allergies, symptoms of alpha-gal syndrome frequently do not occur until 3 to 8 hours after eating.

Oral allergy syndrome
Oral allergy syndrome (pollen food allergy syndrome) occurs in people who are allergic to pollen. Certain proteins in pollen are similar to some proteins in food. Thus, people with oral allergy syndrome also have an allergic reaction to foods that contain these similar proteins (called cross-reactivity). The foods involved are often nuts and raw fruits and vegetables. People can usually eat these foods if they are cooked because heat changes the protein structure so that the food proteins no longer resemble the pollen proteins.

People who are allergic to certain pollens are often also allergic to specific foods as follows:

Birch pollen: Apples, almonds, carrots, celery, cherries, hazelnuts, kiwi, peaches, pears, and plums

Grass pollen: Celery, melons, oranges, peaches, and tomatoes

Ragweed pollen: Bananas, cucumbers, melons, sunflower seeds, and zucchini

When the food is eaten, the mouth and throat feel itchy. Although severe allergic reactions (anaphylactic reactions) are unlikely, they can occur.

Doctors can usually diagnose oral allergy syndrome when people who have pollen allergies have allergic symptoms after eating certain foods. Skin prick tests are sometimes done to confirm the diagnosis.

Often, oral allergy syndrome can be managed by not eating the problem food raw and/or thoroughly cooking the food. Doctors advise people with this allergy to carry a prefilled, self-injecting epinephrine syringe.

Eosinophilic gastroenteropathy
Eosinophilic gastroenteropathy is an unusual disorder causing pain, cramps, and diarrhea. The number of eosinophils, a type of white blood cell, is increased in the blood and the digestive tract. People may have a protein-losing enteropathy (in which too much protein leaks into the intestines, usually as a result of a separate long-term condition such as Crohn disease) and a history of allergies (in which the immune system over-reacts to a trigger).

Eosinophilic esophagitis may occur in people with eosinophilic gastroenteropathy or occur in isolation. Eosinophilic esophagitis is characterized by chronic inflammation of the esophagus and deposition of eosinophils in the esophagus. It may cause difficulty swallowing, food getting stuck in the throat or, in children, feeding intolerance and abdominal pain. Diagnosis is based on the results of an endoscopy and biopsy.

Symptoms of Food Allergy
Symptoms of food allergies vary depend on which food causes the allergy and how old the person is.

In infants, the first symptom of a food allergy may be a rash such as eczema (atopic dermatitis) or a rash that resembles hives. The rash may be accompanied by nausea, vomiting, and diarrhea. By about age 1 year, the rash tends to develop less often, but children may start to react to inhaled allergens (such as pollen) and have asthma symptoms. They may wheeze, feel short of breath, or get a runny nose when they eat the food that triggers their allergy. By about age 10, children rarely have asthma symptoms after the food is eaten.

When food allergies persist in older children and adults, reactions tend to be more severe. In adults, food allergies cause itching in the mouth, hives, eczema, swelling (angioedema), and, occasionally, a runny nose and asthma. Food allergies sometimes cause symptoms such as light-headedness or fainting.

For some adults with a food allergy, eating a tiny amount of the food may trigger a sudden, severe reaction. A rash may cover the entire body, the throat may swell, and the airways may narrow, making breathing difficult—an anaphylactic reaction, which can be life threatening.

For some people, allergic reactions to food (especially wheat or shrimp) occur only if they exercise immediately after eating the food (called exercise-induced allergic reactions).

Some allergic reactions to food take hours to develop and cause symptoms such as abdominal pain, nausea, cramping, and diarrhea.

1. People with Symptoms of Vitamin D Deficiency: Individuals experiencing symptoms suggestive of vitamin D deficiency may benefit from testing. Common symptoms of vitamin D deficiency include:

   • Fatigue
   • Muscle weakness or pain
   • Bone pain or tenderness
   • Bone fractures or osteoporosis
   • Depression or mood changes
   • Impaired wound healing
   • Hair loss

2. Patients with Risk Factors for Vitamin D Deficiency: Individuals with risk factors for vitamin D deficiency may undergo testing to assess their vitamin D status. Risk factors include:

   • Limited sun exposure (due to geographical location, season, sunscreen use, clothing coverage)
   • Dark skin pigmentation
   • Older age
   • Obesity
   • Malabsorption disorders (e.g., celiac disease, Crohn’s disease, cystic fibrosis)
   • Renal insufficiency or chronic kidney disease
   • Medications that affect vitamin D metabolism (e.g., corticosteroids, anticonvulsants)

3. Patients with Chronic Inflammatory Conditions: Individuals with chronic inflammatory conditions, such as rheumatoid arthritis, inflammatory bowel disease (IBD), lupus, or psoriasis, may undergo testing to assess markers of inflammation, such as C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR), and vitamin D levels. Low vitamin D levels and elevated inflammatory markers are common in these conditions.

4. People with Autoimmune Disorders: Autoimmune diseases, such as multiple sclerosis, type 1 diabetes, Hashimoto’s thyroiditis, and Sjögren’s syndrome, may be associated with vitamin D deficiency and inflammation. Testing may be recommended to assess vitamin D levels and inflammatory markers in individuals with autoimmune disorders.

5. Patients with Chronic Pain Conditions: Chronic pain conditions, such as fibromyalgia, chronic fatigue syndrome, or chronic low back pain, may be associated with vitamin D deficiency and inflammation. Testing may be considered to evaluate vitamin D status and markers of inflammation in individuals with chronic pain.

6. Individuals with Cardiovascular Risk Factors: Vitamin D deficiency and inflammation are associated with an increased risk of cardiovascular disease. Testing may be recommended for individuals with cardiovascular risk factors, such as hypertension, dyslipidemia, diabetes, or obesity, to assess vitamin D levels and inflammatory markers.

7. Patients with Mental Health Disorders: Low vitamin D levels and inflammation have been linked to mental health disorders, such as depression, anxiety, and schizophrenia. Testing may be considered for individuals with mental health disorders to evaluate vitamin D status and inflammatory markers.

8. Women with Polycystic Ovary Syndrome (PCOS): PCOS is a hormonal disorder associated with insulin resistance and inflammation. Testing may be recommended for women with PCOS to assess vitamin D levels and markers of inflammation.

9. Individuals with Bone Health Concerns: Vitamin D plays a crucial role in bone health, and deficiency can lead to conditions such as osteomalacia or osteoporosis. Testing may be recommended for individuals with bone health concerns to assess vitamin D status and bone turnover markers.

10. Patients with Gastrointestinal Disorders: Malabsorption disorders, such as celiac disease, Crohn’s disease, or ulcerative colitis, can lead to vitamin D deficiency and inflammation. Testing may be recommended for individuals with gastrointestinal disorders to evaluate vitamin D levels and markers of inflammation.

Symptoms and Causes
Signs of vitamin D deficiency in adults may not be obvious, but they include muscle cramps, mood changes fatigue and more.
Anyone can have vitamin D deficiency, including infants, children and adults.
What are the signs and symptoms of vitamin D deficiency?
Severe lack of vitamin D in children causes rickets. Symptoms of rickets include:

Incorrect growth patterns due to bowed or bent bones.
Muscle weakness.
Bone pain.
Deformities in joints.
This is very rare. Children with a mild vitamin deficiency may just have weak, sore and/or painful muscles.

Lack of vitamin D isn’t quite as obvious in adults. Signs and symptoms might include:

Fatigue.
Bone pain.
Muscle weakness, muscle aches or muscle cramps.
Mood changes, like depression.
However, you may have no signs or symptoms of vitamin D deficiency.

What causes vitamin D deficiency?
In general, the two main causes of vitamin D deficiency are:

Not getting enough vitamin D in your diet and/or through sunlight.
Your body isn’t properly absorbing or using vitamin D.
There are several specific causes of vitamin D deficiency, including:

Certain medical conditions.
Weight loss-surgeries.
Certain medications.
Several different biological and environmental factors can also put you at a greater risk of developing vitamin D deficiency, such as older age and the amount of melanin (pigment) in your skin.

Medical conditions that can cause vitamin D deficiency
Medical conditions that can cause vitamin D deficiency include:

Cystic fibrosis, Crohn’s disease and celiac disease: These conditions can prevent your intestines from adequately absorbing enough vitamin D through supplements, especially if the condition is untreated.
Obesity: A body mass index greater than 30 is associated with lower vitamin D levels. Fat cells keep vitamin D isolated so that it’s not released. Obesity often requires taking larger doses of vitamin D supplements to reach and maintain normal levels.
Kidney disease and liver disease: These conditions reduce the amount of certain enzymes (hepatic enzyme 25–hydroxylase from your liver and 1-alpha-hydroxylase from your kidneys) your body needs to change vitamin D to a form it can use. A lack of either of these enzymes leads to an inadequate level of active vitamin D in your body.
Weight-loss surgeries and vitamin D deficiency
Weight-loss surgeries that reduce the size of your stomach and/or bypass part of your small intestines, such as gastric bypass surgery, make it difficult for your body to absorb sufficient quantities of certain nutrients, vitamins and minerals.

If you’ve had weight-loss surgery, it’s important to see your healthcare provider regularly so they can monitor your vitamin D levels and other nutrient levels. You’ll likely need to take vitamin D supplements and other supplements throughout your life.

Medications that can cause vitamin D deficiency
Certain medications can lower vitamin D levels, including:

Laxatives.
Steroids (such as prednisone).
Cholesterol-lowering drugs (such as cholestyramine and colestipol).
Seizure-preventing drugs (such as phenobarbital and phenytoin).
Rifampin (a tuberculosis drug).
Orlistat (a weight-loss drug).
Always tell your healthcare provider about your medications and any supplements and/or herbs you take.

1. Individuals with Limited Sun Exposure: People who have limited exposure to sunlight due to factors such as living in regions with long winters, spending most of their time indoors, or consistently using sunscreen may have a higher risk of Vitamin D deficiency.

2. People with Darker Skin Pigmentation: Individuals with darker skin produce less Vitamin D upon exposure to sunlight compared to those with lighter skin. Consequently, people with darker skin may have a higher risk of Vitamin D deficiency, especially if they live in areas with limited sunlight.

3. Elderly Individuals: As people age, their skin becomes less efficient at synthesizing Vitamin D when exposed to sunlight. Additionally, older adults may spend more time indoors and have reduced dietary intake, further increasing their risk of Vitamin D deficiency.

4. Individuals with Obesity: Vitamin D is fat-soluble, and it can become sequestered in fat tissues, reducing its bioavailability. Therefore, people with obesity may have lower circulating levels of Vitamin D and may benefit from testing.

5. Patients with Malabsorption Disorders: Certain medical conditions, such as celiac disease, inflammatory bowel disease (IBD), cystic fibrosis, or bariatric surgery, can impair the absorption of Vitamin D from the diet or supplements, leading to deficiency.

6. People with Chronic Kidney Disease: Impaired kidney function can affect the conversion of Vitamin D into its active form, leading to decreased Vitamin D levels in the body.

7. Individuals with Hyperparathyroidism or Hypoparathyroidism: These conditions can disrupt calcium and Vitamin D metabolism, leading to abnormalities in Vitamin D levels.

8. Breastfed Infants: Breast milk is not a significant source of Vitamin D, and exclusively breastfed infants may require Vitamin D supplementation. Pediatricians may recommend testing to assess Vitamin D status in infants who are exclusively breastfed or have limited sun exposure.

9. People with Symptoms of Vitamin D Deficiency: Individuals experiencing symptoms suggestive of Vitamin D deficiency, such as fatigue, muscle weakness, bone pain, frequent infections, or depression, may benefit from testing to confirm the diagnosis.

10. Patients with Osteoporosis or Osteomalacia: Vitamin D plays a crucial role in bone health, and deficiency can lead to conditions such as osteoporosis or osteomalacia. Testing may be recommended for individuals with bone health concerns to assess Vitamin D status.

11. Pregnant and Lactating Women: Pregnant and lactating women have increased Vitamin D requirements to support fetal and infant development. Testing may be recommended to ensure adequate Vitamin D levels during pregnancy and breastfeeding.

12. People Taking Certain Medications: Some medications, such as anticonvulsants, glucocorticoids, antiretrovirals, or weight-loss medications, can interfere with Vitamin D metabolism and increase the risk of deficiency.

Symptoms and Causes
Signs of vitamin D deficiency in adults may not be obvious, but they include muscle cramps, mood changes fatigue and more.
Anyone can have vitamin D deficiency, including infants, children and adults.
What are the signs and symptoms of vitamin D deficiency?
Severe lack of vitamin D in children causes rickets. Symptoms of rickets include:

Incorrect growth patterns due to bowed or bent bones.
Muscle weakness.
Bone pain.
Deformities in joints.
This is very rare. Children with a mild vitamin deficiency may just have weak, sore and/or painful muscles.

Lack of vitamin D isn’t quite as obvious in adults. Signs and symptoms might include:

Fatigue.
Bone pain.
Muscle weakness, muscle aches or muscle cramps.
Mood changes, like depression.
However, you may have no signs or symptoms of vitamin D deficiency.

What causes vitamin D deficiency?
In general, the two main causes of vitamin D deficiency are:

Not getting enough vitamin D in your diet and/or through sunlight.
Your body isn’t properly absorbing or using vitamin D.
There are several specific causes of vitamin D deficiency, including:

Certain medical conditions.
Weight loss-surgeries.
Certain medications.
Several different biological and environmental factors can also put you at a greater risk of developing vitamin D deficiency, such as older age and the amount of melanin (pigment) in your skin.

Medical conditions that can cause vitamin D deficiency
Medical conditions that can cause vitamin D deficiency include:

Cystic fibrosis, Crohn’s disease and celiac disease: These conditions can prevent your intestines from adequately absorbing enough vitamin D through supplements, especially if the condition is untreated.
Obesity: A body mass index greater than 30 is associated with lower vitamin D levels. Fat cells keep vitamin D isolated so that it’s not released. Obesity often requires taking larger doses of vitamin D supplements to reach and maintain normal levels.
Kidney disease and liver disease: These conditions reduce the amount of certain enzymes (hepatic enzyme 25–hydroxylase from your liver and 1-alpha-hydroxylase from your kidneys) your body needs to change vitamin D to a form it can use. A lack of either of these enzymes leads to an inadequate level of active vitamin D in your body.
Weight-loss surgeries and vitamin D deficiency
Weight-loss surgeries that reduce the size of your stomach and/or bypass part of your small intestines, such as gastric bypass surgery, make it difficult for your body to absorb sufficient quantities of certain nutrients, vitamins and minerals.

If you’ve had weight-loss surgery, it’s important to see your healthcare provider regularly so they can monitor your vitamin D levels and other nutrient levels. You’ll likely need to take vitamin D supplements and other supplements throughout your life.

Medications that can cause vitamin D deficiency
Certain medications can lower vitamin D levels, including:

Laxatives.
Steroids (such as prednisone).
Cholesterol-lowering drugs (such as cholestyramine and colestipol).
Seizure-preventing drugs (such as phenobarbital and phenytoin).
Rifampin (a tuberculosis drug).
Orlistat (a weight-loss drug).
Always tell your healthcare provider about your medications and any supplements and/or herbs you take.

1. Women with Symptoms of STDs: Women experiencing symptoms suggestive of STDs should seek medical evaluation and testing. Common symptoms of STDs in women may include:

   • Unusual vaginal discharge (color, odor, consistency)
   • Genital itching or irritation
   • Pain or burning during urination
   • Pain during sexual intercourse
   • Lower abdominal pain or pelvic discomfort
   • Genital sores, ulcers, or blisters
   • Irregular menstrual bleeding

2. Sexually Active Women: Any woman who is sexually active, whether with one or multiple partners, may consider regular STD testing as part of her sexual health care routine. Testing frequency may vary based on individual risk factors, such as the number of sexual partners, condom use, and history of STDs.

3. Women with New or Multiple Sexual Partners: Women who have recently started a new sexual relationship or who have multiple sexual partners may have an increased risk of contracting STDs. Regular testing is essential to detect and treat STDs early.

4. Women with a History of STDs: Women who have previously been diagnosed with an STD may require regular testing for recurrence or to prevent reinfection. Some STDs, such as herpes simplex virus (HSV) or human papillomavirus (HPV), can remain dormant in the body and recur over time.

5. Pregnant Women: Pregnant women should undergo STD testing as part of prenatal care to protect their health and the health of their unborn child. Untreated STDs during pregnancy can lead to serious complications, including preterm birth, low birth weight, neonatal infections, and congenital disabilities.

6. Women with Risk Factors for STDs: Certain factors may increase a woman’s risk of contracting STDs, including:

   • Having unprotected sex (not using condoms)
   • Having a history of STDs or previous exposure to STDs
   • Having a sexual partner with a history of STDs or high-risk behaviors
   • Engaging in high-risk sexual activities (e.g., sex work, intravenous drug use)
   • Using drugs or alcohol before or during sexual activity, which may impair judgment and increase risky sexual behaviors

7. Women Planning to Change Birth Control Methods: Some forms of birth control, such as intrauterine devices (IUDs) or contraceptive implants, do not protect against STDs. Women who are considering switching birth control methods or who are discontinuing the use of condoms should consider STD testing.

8. Women with Concerns about Their Sexual Health: Any woman who has concerns about her sexual health, including questions about STDs, contraceptive options, or safe sex practices, should consult a healthcare provider. Open communication with a healthcare provider can help address concerns, provide education, and facilitate appropriate testing and treatment.

Symptoms
STDs can have a range of symptoms, including no symptoms. That’s why sexually transmitted infections may go unnoticed until a person has complications or a partner is diagnosed.

STI symptoms might include:

Sores or bumps on the genitals or in the oral or rectal area.
Painful or burning urination.
Discharge from the penis.
Unusual or odorous vaginal discharge.
Unusual vaginal bleeding.
Pain during sex.
Sore, swollen lymph nodes, particularly in the groin but sometimes more widespread.
Lower abdominal pain.
Fever.
Rash over the trunk, hands or feet.

Causes
Sexually transmitted infections can be caused by:

Bacteria. Gonorrhea, syphilis and chlamydia are examples of STDs that are caused by bacteria.
Parasites. Trichomoniasis is an STD caused by a parasite.
Viruses. STDs caused by viruses include human papillomavirus (HPV), the herpes simplex virus, and the human immunodeficiency virus (HIV), which causes AIDS.

1. Sexually Active Men: Any man who is sexually active, whether with one or multiple partners, may consider regular STD testing as part of his sexual health care routine. Testing frequency may vary based on individual risk factors, such as the number of sexual partners, condom use, and history of STDs.

2. Men with New or Multiple Sexual Partners: Men who have recently started a new sexual relationship or who have multiple sexual partners may have an increased risk of contracting STDs. Regular testing is essential to detect and treat STDs early.

3. Men with Symptoms of STDs: Men experiencing symptoms suggestive of STDs should seek medical evaluation and testing. Common symptoms of STDs in men may include:

   • Genital discharge (color, odor, consistency)
   • Pain or burning during urination
   • Genital itching, irritation, or rash
   • Pain or discomfort in the genital area
   • Swollen or tender testicles
   • Sores, ulcers, or blisters on the genital or anal area

4. Men with a History of STDs: Men who have previously been diagnosed with an STD may require regular testing for recurrence or to prevent reinfection. Some STDs, such as herpes simplex virus (HSV) or human papillomavirus (HPV), can remain dormant in the body and recur over time.

5. Men in High-Risk Groups: Certain factors may increase a man’s risk of contracting STDs, including:

   • Having unprotected sex (not using condoms)
   • Having sex with multiple partners or anonymous partners
   • Engaging in high-risk sexual activities (e.g., sex work, intravenous drug use)
   • Using drugs or alcohol before or during sexual activity, which may impair judgment and increase risky sexual behaviors
   • Having a sexual partner with a history of STDs or high-risk behaviors

6. Men with Concerns about Their Sexual Health: Any man who has concerns about his sexual health, including questions about STDs, contraceptive options, or safe sex practices, should consult a healthcare provider. Open communication with a healthcare provider can help address concerns, provide education, and facilitate appropriate testing and treatment.

7. Men Planning to Change Birth Control Methods: Some forms of birth control, such as vasectomy or withdrawal, do not protect against STDs. Men who are considering changing birth control methods or who are discontinuing the use of condoms should consider STD testing.

Some STIs are easy to treat and cure. Others are more complicated. Treatment is important so you don’t spread the disease. Treatment also can help prevent fertility trouble, organ damage or some cancers.

Chlamydia symptoms
Chlamydia is an infection of the genital tract. Germs called bacteria cause it. Early on, chlamydia infections often cause few or no symptoms. If you get symptoms, they usually start 5 to 14 days after you’ve been exposed to chlamydia germs. The symptoms may be mild.

Signs and symptoms may include:

Painful urination, which may feel like burning.
Pain in the lower part of the stomach area, also called the abdomen.
Lower back pain.
Fever.
Vaginal discharge.
Discharge from the penis.
Vaginal pain during sex.
Bleeding between periods.
Testicle pain or swelling.
Rectal pain, discharge or bleeding.
Gonorrhea symptoms
Gonorrhea is an infection of the genital tract. Germs called bacteria cause it. Symptoms of infection in the female genital tract tend to appear within 10 days of exposure to the germs. Symptoms of infection in the male genital tract often start within five days after exposure.

Gonorrhea symptoms can include:

Thick, cloudy or bloody discharge from the penis or vagina.
Pain or burning sensation when urinating.
Heavy menstrual bleeding or bleeding between periods.
Painful, swollen testicles.
Painful bowel movements.
Pain in the pelvis or stomach area.
Anal itching.
Rectal discharge, soreness or bleeding.
Painful bowel movements.
Gonorrhea germs also can grow in the mouth, throat, eyes and joints such as the knee. Gonorrhea symptoms in body parts beyond the genitals can include:

Eye pain, itching, sensitivity to light and discharge.
Throat soreness or swollen glands in the neck.
Joint warmth, swelling or pain when moving.
Trichomoniasis symptoms
Trichomoniasis is a common sexually transmitted infection caused by a parasite that is too tiny to see with the eyes. The parasite is called Trichomonas vaginalis. This organism spreads during sex with someone who already has the infection. It often infects the vagina, vulva or cervix. It also tends to infect the tube through which urine leaves the penis or vagina, called the urethra.

When trichomoniasis causes symptoms, they may appear within 5 to 28 days after being exposed to the parasite. The symptoms range from mild irritation to serious swelling called inflammation.

Trichomoniasis symptoms can include:

Clear, white, greenish or yellowish vaginal discharge.
Discharge from the penis.
Strong vaginal odor that may smell fishy.
Vaginal itching, burning, soreness or irritation.
Itching or irritation inside the penis.
Pain during sex.
Painful urination.
Rarely, pain in the lower stomach area.
HIV symptoms
HIV is an infection with the human immunodeficiency virus. HIV interferes with the body’s ability to fight off viruses, bacteria and fungi that cause illness. Without treatment, it also can lead to AIDS, a chronic, life-threatening disease.

The symptoms of HIV vary by how long you’ve had the disease and whether you get treatment for it.

Early symptoms
Most often, HIV causes flu-like symptoms about 2 to 4 weeks after being infected. These symptoms may last for a few days or for weeks. During this time, the virus makes copies of itself fast. The risk of passing the disease to sexual partners is high.

Early HIV symptoms can include:

Fever.
Chills.
Headache or muscle aches.
Sore throat.
Swollen lymph glands.
Rash.
Fatigue.
Night sweats.
Mouth ulcers.
The only way you know if you have HIV is to be tested.

Chronic or middle-stage HIV symptoms
Over time, the HIV virus keeps making copies of itself, but at lower levels. This is called the chronic stage of infection. You might not have any symptoms during this time. If you take HIV medicines called antiretroviral therapy exactly as prescribed, you might stay in this stage for life.

Swollen lymph nodes, which are often one of the first signs of HIV infection.
Diarrhea.
Weight loss.
Fever.
Cough and shortness of breath.
AIDS Symptoms
Without HIV treatment, the chronic stage of HIV infection may progress to AIDS in about 10 years. AIDS is life-threatening. Symptoms of AIDS can include:

Fever.
Weakness.
Fast weight loss.
Extreme tiredness.
Soaking night sweats.
Fever that keeps coming back.
Ongoing swelling of lymph nodes in the armpits, groin and neck.
Diarrhea that lasts longer than a week.
Sores in the mouth, anus or on the genitals. Discolored blotches on or under the skin, or inside the eyelids, nose or mouth.
Memory loss.
Depression.
Infections such as pneumonia.
Genital herpes symptoms
Genital herpes is a sexually transmitted infection that spreads easily. It’s caused by a type of the herpes simplex virus (HSV). The virus enters the body through small breaks in the skin or mucous membranes. Most people with HSV never know they have it. That’s because they have no symptoms or symptoms are too mild to be noticed. If there are symptoms, they tend to appear within 12 days of being exposed to HSV.

If you notice herpes symptoms, the first time you get them tends to be the worst. Some people never get symptoms again. For others the symptoms come and go over many years.

Genital herpes symptoms can include:

Small red bumps, blisters called vesicles or open sores called ulcers. These symptoms often show up around the genitals, rectum and mouth. They may take a week or longer to heal.
Pain or itching around the genital area, buttocks and inner thighs.
A feeling of pressure in the stomach area.
Vaginal discharge.
Ulcers can make urination painful. People may have pain and tenderness in the genital area until the infection clears. During a first bout of symptoms, you may have flu-like symptoms as well. Those symptoms can include a headache, muscle aches and fever, as well as swollen lymph nodes in the groin.

Sometimes, the infection can be spread even when sores aren’t present.

Human papillomavirus (HPV) infection and genital warts symptoms
HPV infection is one of the most common types of sexually transmitted infections. Some forms of HPV greatly raise the risk of cervical cancer. Other forms cause genital warts. Most often, HPV has no symptoms.

Symptoms of genital warts include:

A small bump or group of bumps in the genital area. These can be large or small, and raised or flat.
Several warts close together that take on a cauliflower shape.
Itching or discomfort in the genital area.
Bleeding with sex.
Rarely, warts can also grow in the mouth or throat of a person who has had oral sex with an infected person.

Hepatitis symptoms
Hepatitis A, hepatitis B and hepatitis C are all contagious infections that affect the liver. They each are caused by a different virus. Hepatitis B and C are more serious than hepatitis A. But each can inflame the liver.

Some people never get hepatitis symptoms. For those who do, the symptoms may happen weeks after exposure to one of the hepatitis viruses.

Hepatitis symptoms can include:

Fatigue.
Upset stomach and vomiting.
Pain or discomfort in the stomach area, especially in the area of the liver on the right side beneath the lower ribs.
Loss of appetite.
Fever.
Dark urine.
Stool that’s the color of clay.
Muscle or joint pain.
Itching.
Yellowing of your skin and the whites of your eyes, also called jaundice. Yellowing may be harder to notice on brown or Black skin.
Syphilis symptoms
Syphilis is an infection caused by germs called bacteria. The disease affects the genitals, skin, mouth and anus. It also can involve many other parts of the body, including the brain and heart.

The symptoms of syphilis may happen in three stages — primary, secondary and tertiary. Some people also have syphilis without symptoms, but syphilis germs are still found in the blood. This is called latent or inactive syphilis.

During the first stage of syphilis, one or more small, painless sores called chancres form where the germs entered the body. Usually they form in the genitals, rectum, tongue or lips. Often, a chancre is painless, firm and round.

As syphilis becomes worse, the symptoms can include:

Rash marked by rough discolored spots over any area of the body, including the palms and soles. The rash often doesn’t itch.
Fever.
Swollen lymph nodes.
Fatigue and a vague feeling of discomfort.
Headaches or muscle aches.
Loss of patches of hair.
Weight loss.
Sore throat.
Without treatment, syphilis bacteria can spread. This can lead to serious internal organ damage and death years after the original infection.

Some of the symptoms of late-stage syphilis include:

Lack of coordination or loss of feeling from nerve damage.
Paralysis.
Blindness.
Dementia.
Deafness.
If a pregnant person with syphilis passes the germs to the unborn infant, it’s called congenital syphilis. This condition can be disabling or even life-threatening. So, it’s important for pregnant people with syphilis to be treated.

Other types of syphilis
At any stage, syphilis can spread and affect:

The brain and spinal cord, also called neurosyphilis.
The eyes, called ocular syphilis.
The ears, called otosyphilis.
Brain and spinal cord symptoms
Neurosyphilis symptoms can include:

Serious headaches.
Muscle weakness and trouble with muscle movements.
Confusion, trouble focusing or behavior changes.
Neurosyphilis also is linked with a group of symptoms called dementia that affect memory, thinking and social skills.

Eye symptoms
Ocular syphilis symptoms can include eye pain and changes in vision, including blindness.

Ear symptoms
Otosyphilis symptoms can include:

Hearing loss.
Ringing, buzzing or hissing in the ears, also called tinnitus.
Dizziness.
Feeling like you or the room around you is spinning.
Preventing sexually transmitted infections
You can help prevent sexually transmitted infections (STIs). Steps that lower the risk of getting or spreading STIs are to:

Get key vaccines. Vaccines can help prevent hepatitis B and human papillomavirus infections passed through sexual activity.
Limit your number of sexual partners. You can lower your risk of STIs by having sex with just one partner who only has sex with you.
Get tested for STIs. Both you and your partner should get tested by your healthcare professionals before you have sex for the first time. Talk with each other about your test results.
Use medicine to help prevent HIV if needed. If you might be at risk of HIV, talk with your healthcare professional. You may be prescribed medicine called pre-exposure prophylaxis (PrEP), which lowers your risk.
Use condoms. Make sure that you or your partner puts on a new condom every time you have sex.
Don’t drink too much alcohol or use street drugs. Having lots of alcohol or using illegal drugs can cloud judgment. Both raise the chances of risky sexual behavior that could lead to an STI.
Consider not having sex. This is the surest way to prevent STIs. The choice not to have sex is called abstinence.

1. Individuals with Symptoms: People experiencing symptoms suggestive of chlamydia or gonorrhea infection should seek medical evaluation and testing. Common symptoms of chlamydia and gonorrhea may include:

   • Abnormal genital discharge (e.g., discharge from the penis or vagina)
   • Pain or burning sensation during urination
   • Genital itching or irritation
   • Pain during sexual intercourse
   • Lower abdominal pain or discomfort
   • Genital sores or ulcers (less common)

2. Sexually Active Individuals: Anyone who is sexually active, regardless of age or sexual orientation, may benefit from regular testing for chlamydia and gonorrhea.

3. Individuals with New or Multiple Sexual Partners: People who have recently started a new sexual relationship or who have multiple sexual partners are at an increased risk of contracting chlamydia or gonorrhea.

4. Women Under 25 Years Old: Young women under the age of 25 are at a higher risk of chlamydia and gonorrhea infections. The Centers for Disease Control and Prevention (CDC) recommends annual testing for chlamydia and gonorrhea for sexually active women under 25 years old.

5. Men who Have Sex with Men (MSM): Men who have sex with men have a higher risk of contracting chlamydia and gonorrhea. The CDC recommends annual testing for chlamydia and gonorrhea for sexually active MSM, including those who are HIV-positive.

6. Sexual Partners of Infected Individuals: Individuals who have had sexual contact with someone diagnosed with chlamydia or gonorrhea should be tested, even if they do not have symptoms.

7. Pregnant Women: Pregnant women should be tested for chlamydia and gonorrhea during their first prenatal visit, as untreated infections can lead to serious complications during pregnancy, such as preterm birth and neonatal infections.

8. Individuals with a History of STDs: People who have previously been diagnosed with chlamydia or gonorrhea may require regular testing, as reinfection is possible.

9. People with HIV Infection: Individuals who are HIV-positive have an increased risk of contracting chlamydia and gonorrhea. The CDC recommends annual testing for chlamydia and gonorrhea for sexually active HIV-positive individuals.

10. Individuals with Risk Factors for STDs: Certain factors may increase a person’s risk of contracting chlamydia and gonorrhea, including:

    • Having unprotected sex (not using condoms)
    • Having multiple sexual partners
    • Engaging in high-risk sexual activities (e.g., sex work, drug use during sex)
    • Using drugs or alcohol before or during sexual activity, which may impair judgment and increase risky sexual behaviors

Chlamydia and gonorrhea are both sexually transmitted infections (STIs) caused by bacteria. They can be contracted through oral, genital, or anal sex.

The symptoms of these two STIs overlap, so if you have one of these conditions, it’s sometimes hard to be sure which one it is without having a diagnostic test at a doctor’s office.

Some people with chlamydia or gonorrhea may have no symptoms. But when symptoms occur, there are some similarities, such as an abnormal, bad-smelling discharge from the penis or vagina, or a burning feeling when you pee.

Chlamydia is more common than gonorrhea. According to a 2017 report, over 1.7 million cases of chlamydia were reported in the United States, while just over 550,000 cases of gonorrhea were documented.

Read on to learn about how these two STIs are different, how they’re similar, and how you can reduce your risk for these infections.

How do the symptoms compare?
People of any anatomy can contract chlamydia or gonorrhea and never develop any symptoms.

With chlamydia, symptoms may not appear for a few weeks after you’ve contracted the infection. And with gonorrhea, people who have female anatomy may never experience any symptoms at all or may only show mild symptoms, while people who have male anatomy are more likely to have symptoms that are more severe.

A couple of the most telltale symptoms of these STIs overlap between the two, such as:

burning when you pee
abnormal, discolored discharge from the penis or vagina
abnormal discharge from the rectum
pain in the rectum
bleeding from the rectum
With both gonorrhea and chlamydia, people with male anatomy may also experience abnormal swelling in their testicles and scrotum, and pain when they ejaculate.

You may also develop symptoms that affect your throat if you engage in oral sex with someone who has one of these conditions. This can cause mouth and throat symptoms, including sore throat and a cough.

Chlamydia symptoms
With chlamydia, people with female anatomy may experience more severe symptoms if the infection moves upward to the uterus and fallopian tubes. This can cause pelvic inflammatory disease (PID).

PID can cause symptoms such as:

fever
feeling sick
vaginal bleeding, even if you’re not having a period
intense pain in your pelvic area
Seek emergency medical help if you think you may have PID.

Gonorrhea symptoms
With gonorrhea, you may also notice rectal symptoms like itching, soreness, and pain when you defecate.

People with female anatomy may also notice heavier bleeding during their periods and pain during sex.

What causes each condition?
Both conditions are caused by an overgrowth of bacteria. Chlamydia is caused by an overgrowth of the bacteria Chlamydia trachomatis.

Gonorrhea is caused by an overgrowth of bacteria called Neisseria gonorrhoeae.

How is each condition transmitted?
Both STIs are caused by bacterial infections that are transmitted through unprotected sexual contact, meaning sex without using a condom, dental dam, or another protective barrier between you and your partner during vaginal, anal, or oral sex.

It’s also possible to contract the infection through sexual contact that doesn’t involve penetration. For example, if your genitals come into contact with the genitals of someone who’s contracted the infection, it’s possible to develop the condition.

Both STIs can also be contracted through protected sex with a condom or other barrier if you don’t use protection properly, or if the barrier breaks.

Either STI can be contracted even if you aren’t showing visible symptoms. Both STIs can also be transmitted to a child at birth if the mother has either condition.

Who’s at increased risk for these conditions?
You’re at increased risk for developing these and other STIs if you:

have multiple sexual partners at one time
don’t properly use protection, such as condoms, female condoms, or dental dams
regularly use douches which can irritate your vagina, killing healthy vaginal bacteria
have contracted an STI before
Sexual assault can also increase your risk of both chlamydia or gonorrhea.

1. Individuals with Symptoms: People experiencing symptoms suggestive of syphilis infection should seek medical evaluation and testing. Common symptoms of syphilis may include:

   • Painless sores or ulcers on the genitals, mouth, or anus (primary stage)
   • Skin rash, particularly on the palms of the hands or soles of the feet (secondary stage)
   • Flu-like symptoms, such as fever, headache, sore throat, and muscle aches (secondary stage)
   • Swollen lymph nodes
   • Patchy hair loss
   • Neurological symptoms, such as numbness, tingling, or vision changes (late stage)

2. Sexually Active Individuals: Anyone who is sexually active, regardless of age or sexual orientation, may benefit from regular testing for syphilis.

3. Individuals with New or Multiple Sexual Partners: People who have recently started a new sexual relationship or who have multiple sexual partners are at an increased risk of contracting syphilis.

4. Men who Have Sex with Men (MSM): Men who have sex with men have a higher risk of contracting syphilis. The Centers for Disease Control and Prevention (CDC) recommends annual testing for syphilis for sexually active MSM, including those who are HIV-positive.

5. Pregnant Women: Pregnant women should be tested for syphilis during their first prenatal visit, as untreated syphilis can lead to serious complications during pregnancy, such as stillbirth, miscarriage, or congenital syphilis in the newborn.

6. Sexual Partners of Infected Individuals: Individuals who have had sexual contact with someone diagnosed with syphilis should be tested, even if they do not have symptoms.

7. People with HIV Infection: Individuals who are HIV-positive have an increased risk of contracting syphilis. The CDC recommends annual testing for syphilis for sexually active HIV-positive individuals.

8. Individuals with a History of STDs: People who have previously been diagnosed with syphilis or other STDs may require regular testing, as reinfection is possible.

9. Individuals with Risk Factors for STDs: Certain factors may increase a person’s risk of contracting syphilis, including:

   • Having unprotected sex (not using condoms)
   • Having multiple sexual partners
   • Engaging in high-risk sexual activities (e.g., sex work, drug use during sex)
   • Using drugs or alcohol before or during sexual activity, which may impair judgment and increase risky sexual behaviors

Syphilis is an infection caused by bacteria. Most often, it spreads through sexual contact. The disease starts as a sore that’s often painless and typically appears on the genitals, rectum or mouth. Syphilis spreads from person to person through direct contact with these sores. It also can be passed to a baby during pregnancy and childbirth and sometimes through breastfeeding.

After the infection happens, syphilis bacteria can stay in the body for many years without causing symptoms. But the infection can become active again. Without treatment, syphilis can damage the heart, brain or other organs. It can become life-threatening.

Early syphilis can be cured, sometimes with a single shot of medicine called penicillin. That’s why it’s key to get a health care checkup as soon as you notice any symptoms of syphilis. All pregnant people should get tested for syphilis at their first prenatal checkup too.

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Symptoms
Primary syphilis
Primary syphilis
Enlarge image
Syphilis develops in stages. The symptoms vary with each stage. But the stages may overlap. And the symptoms don’t always happen in the same order. You may be infected with syphilis bacteria without noticing any symptoms for years.

Primary syphilis
The first symptom of syphilis is a small sore called a chancre (SHANG-kur). The sore is often painless. It appears at the spot where the bacteria entered your body. Most people with syphilis develop only one chancre. Some people get more than one.

The chancre often forms about three weeks after you come in contact with syphilis bacteria. Many people who have syphilis don’t notice the chancre. That’s because it’s usually painless. It also may be hidden within the vagina or rectum. The chancre heals on its own within 3 to 6 weeks.

Secondary syphilis
You may get a rash while the first chancre heals or a few weeks after it heals.

A rash caused by syphilis:

Often is not itchy.
May look rough, red or reddish-brown.
Might be so faint that it’s hard to see.
The rash often starts on the trunk of the body. That includes the chest, stomach area, pelvis and back. In time, it also could appear on the limbs, the palms of the hands and the soles of the feet.

Along with the rash, you may have symptoms such as:

Wartlike sores in the mouth or genital area.
Hair loss.
Muscle aches.
Fever.
Sore throat.
Tiredness, also called fatigue.
Weight loss.
Swollen lymph nodes.
Symptoms of secondary syphilis may go away on their own. But without treatment, they could come and go for months or years.

Latent syphilis
If you aren’t treated for syphilis, the disease moves from the secondary stage to the latent stage. This also is called the hidden stage because you have no symptoms. The latent stage can last for years. Your symptoms may never come back. But without treatment, the disease might lead to major health problems, also called complications.

Tertiary syphilis
After the latent stage, up to 30% to 40% of people with syphilis who don’t get treatment have complications known as tertiary syphilis. Another name for it is late syphilis.

The disease may damage the:

Brain.
Nerves.
Eyes.
Heart.
Blood vessels.
Liver.
Bones and joints.
These problems may happen many years after the original, untreated infection.

Syphilis that spreads
At any stage, untreated syphilis can affect the brain, spinal cord, eyes and other body parts. This can cause serious or life-threatening health problems.

Congenital syphilis
Pregnant people who have syphilis can pass the disease to their babies. Unborn babies can become infected through the organ that provides nutrients and oxygen in the womb, called the placenta. Infection also can happen during birth.

Newborns with congenital syphilis might have no symptoms. But without fast treatment, some babies might get:

Sores and rashes on the skin.
Fever.
A type of discolored skin and eyes, called jaundice.
Not enough red blood cells, called anemia.
Swollen spleen and liver.
Sneezing or stuffed, drippy nose, called rhinitis.
Bone changes.
Later symptoms may include deafness, teeth problems and saddle nose, a condition in which the bridge of the nose collapses.

Babies with syphilis also can be born too early. They may die in the womb before birth. Or they could die after birth.

1. People with Symptoms of HIV Infection: Individuals experiencing symptoms suggestive of acute HIV infection should seek medical evaluation and testing. Common symptoms of acute HIV infection may include:
2. • Fever
   • Fatigue
   • Sore throat
   • Swollen lymph nodes
   • Rash
   • Muscle and joint pain
   • Headache

3. Sexually Active Individuals: Anyone who is sexually active, regardless of age or sexual orientation, may benefit from regular testing for HIV.

4. Individuals with New or Multiple Sexual Partners: People who have recently started a new sexual relationship or who have multiple sexual partners are at an increased risk of contracting HIV.

5. Men who Have Sex with Men (MSM): Men who have sex with men have a higher risk of contracting HIV. The Centers for Disease Control and Prevention (CDC) recommends annual testing for HIV for sexually active MSM.

6. Individuals with a History of Injection Drug Use: People who have a history of injecting drugs or sharing needles are at an increased risk of HIV infection.

7. Pregnant Women: Pregnant women should be tested for HIV as part of routine prenatal care to prevent mother-to-child transmission of HIV. Early detection and treatment can significantly reduce the risk of transmitting HIV to the baby during pregnancy, childbirth, or breastfeeding.

8. Sexual Partners of Infected Individuals: Individuals who have had sexual contact with someone diagnosed with HIV should be tested, even if they do not have symptoms.

9. People with a History of STDs or Other Risk Factors for HIV: Individuals who have previously been diagnosed with other sexually transmitted infections (STIs) or who have engaged in high-risk sexual behaviors (e.g., unprotected sex, having multiple sexual partners, exchanging sex for money or drugs) should consider HIV testing.

10. People with a History of Blood Transfusions or Organ Transplants: Individuals who have received blood transfusions, organ transplants, or other blood products before the implementation of routine screening for HIV may be at risk of HIV infection and should consider testing.

11. Individuals with Tuberculosis (TB) or Hepatitis: People with tuberculosis or hepatitis may have an increased risk of HIV infection due to shared risk factors or modes of transmission. HIV testing may be recommended as part of their medical evaluation.

12. Healthcare Workers: Healthcare workers who may be exposed to HIV-infected blood or body fluids through occupational accidents or needlestick injuries should undergo HIV testing as part of post-exposure prophylaxis (PEP) protocols.

Symptoms
The symptoms of HIV and AIDS vary depending on the person and the phase of infection.

Primary infection, also called acute HIV
Some people infected by HIV get a flu-like illness within 2 to 4 weeks after the virus enters the body. This stage may last a few days to several weeks. Some people have no symptoms during this stage.

Possible symptoms include:

Fever.
Headache.
Muscle aches and joint pain.
Rash.
Sore throat and painful mouth sores.
Swollen lymph glands, also called nodes, mainly on the neck.
Diarrhea.
Weight loss.
Cough.
Night sweats.
These symptoms can be so mild that you might not notice them. However, the amount of virus in your bloodstream, called viral load, is high at this time. As a result, the infection spreads to others more easily during primary infection than during the next stage.

Clinical latent infection, also called chronic HIV
In this stage of infection, HIV is still in the body and cells of the immune system, called white blood cells. But during this time, many people don’t have symptoms or the infections that HIV can cause.

This stage can last for many years for people who aren’t getting antiretroviral therapy, also called ART. Some people get more-severe disease much sooner.

Symptomatic HIV infection
As the virus continues to multiply and destroy immune cells, you may get mild infections or long-term symptoms such as:

Fever.
Fatigue.
Swollen lymph glands, which are often one of the first symptoms of HIV infection.
Diarrhea.
Weight loss.
Oral yeast infection, also called thrush.
Shingles, also called herpes zoster.
Pneumonia.
Progression to AIDS
Better antiviral treatments have greatly decreased deaths from AIDS worldwide. Thanks to these lifesaving treatments, most people with HIV in the U.S. today don’t get AIDS. Untreated, HIV most often turns into AIDS in about 8 to 10 years.

Having AIDS means your immune system is very damaged. People with AIDS are more likely to develop diseases they wouldn’t get if they had healthy immune systems. These are called opportunistic infections or opportunistic cancers. Some people get opportunistic infections during the acute stage of the disease.

The symptoms of some of these infections may include:

Sweats.
Chills.
Fever that keeps coming back.
Ongoing diarrhea.
Swollen lymph glands.
Constant white spots or lesions on the tongue or in the mouth.
Constant fatigue.
Weakness.
Rapid weight loss.
Skin rashes or bumps.
When to see a doctor
If you think you may have been infected with HIV or are at risk of contracting the virus, see a healthcare professional as soon as you can.

1. People with Symptoms of Hepatitis: Individuals experiencing symptoms suggestive of acute hepatitis C infection should seek medical evaluation and testing. Common symptoms of hepatitis C may include:

   • Fatigue
   • Jaundice (yellowing of the skin and eyes)
   • Abdominal pain or discomfort
   • Nausea and vomiting
   • Loss of appetite
   • Dark urine
   • Clay-colored stools
   • Joint pain
   • Fever

2. People with Known Risk Factors: Individuals with known risk factors for hepatitis C infection should consider hepatitis C testing. These risk factors may include:

   • Injection drug use or sharing needles
   • Receiving a blood transfusion or organ transplant before routine screening for hepatitis C
   • Being born to a mother infected with hepatitis C virus
   • Having a sexual partner who is infected with hepatitis C
   • Working in healthcare settings with potential exposure to blood or bodily fluids
   • Having tattoos or body piercings performed with unsterile equipment
   • Receiving medical procedures or healthcare in countries with high rates of hepatitis C infection
   • Receiving long-term hemodialysis treatment

3. People with Chronic Liver Disease: Individuals with chronic liver disease, such as cirrhosis or fatty liver disease, should be screened for hepatitis C infection, as hepatitis C can exacerbate liver damage.

4. Baby Boomers (Individuals Born Between 1945 and 1965): The Centers for Disease Control and Prevention (CDC) recommends one-time hepatitis C testing for all adults born between 1945 and 1965, regardless of known risk factors. This population has a higher prevalence of hepatitis C infection compared to other age groups.

5. People with HIV Infection: Individuals who are HIV-positive are at an increased risk of hepatitis C co-infection. Hepatitis C testing may be recommended as part of routine medical care for HIV-positive individuals.

6. Individuals with a History of Injection Drug Use: People who have a history of injecting drugs or sharing needles are at an increased risk of hepatitis C infection and should consider hepatitis C testing.

7. People with a History of STDs or STI Testing: People who have previously been diagnosed with sexually transmitted infections (STIs) or who have undergone STI testing may be considered for hepatitis C testing, as hepatitis C infections can be transmitted through sexual contact.

8. Healthcare Workers: Healthcare workers who may be exposed to blood or bodily fluids in occupational settings should undergo hepatitis C testing as part of routine screening protocols.

9. Household Contacts of Infected Individuals: Individuals living with someone diagnosed with hepatitis C may be recommended for testing to assess their own infection status and prevent transmission within the household.

10. People Planning to Travel or Immigrate: Individuals planning to travel to regions with high rates of hepatitis C infections or immigrate from regions where hepatitis C is endemic may be advised to undergo hepatitis C testing as part of pre-travel or immigration health assessments.

If you do develop symptoms, you will notice them 2-12 weeks after infection with the virus. Signs can include:

Dark urine or clay-colored stools
Feeling tired
Fever
Joint pain
Loss of appetite
Nausea, stomach pain, throwing up
Yellow skin or eyes (jaundice)
People with chronic hepatitis C are usually asymptomatic, meaning they do not have symptoms, or have general symptoms like chronic tiredness or depression. Yet even people without symptoms can spread the virus to others.

Signs and Symptoms of Hepatitis C
How it spreads
Hepatitis C is spread when blood from an HCV-infected person — even microscopic amounts — enters the body of someone who is not infected. Because of how it spreads, certain life circumstances, jobs, and behaviors can increase your risk for hepatitis C.

It’s important to know that even people who have cleared or been cured of the virus can be re-infected.

Did you know?
There is no evidence that hepatitis C can spread from food handlers, teachers, or other service providers without blood-to-blood contact.

There is no evidence to suggest that hepatitis C is spread by sharing eating utensils, hugging, kissing, holding hands, coughing, sneezing, or through food or water.

You can still go to work, school, childcare or other places even if you have hepatitis C because you can’t spread the virus during daily interactions.

1. Men with Symptoms of Trichomoniasis: Men experiencing symptoms suggestive of trichomoniasis infection should also seek medical evaluation and testing. Common symptoms of trichomoniasis in men may include:

   • Urethral discharge (clear or white)
   • Itching or irritation inside the penis
   • Pain or discomfort during urination or ejaculation
   • Redness or inflammation of the penis
   • Testicular pain or swelling (less common)

2. Women with Symptoms of Trichomoniasis: Women experiencing symptoms suggestive of trichomoniasis infection should seek medical evaluation and testing. Common symptoms of trichomoniasis in women may include:

   • Vaginal discharge (yellow-green, frothy, or foul-smelling)
   • Genital itching or irritation
   • Pain or discomfort during urination or sexual intercourse
   • Abdominal pain or discomfort
   • Vaginal bleeding or spotting (less common)

3. Sexually Active Individuals: Anyone who is sexually active, regardless of age or sexual orientation, may benefit from regular testing for trichomoniasis.

4. Sexual Partners of Infected Individuals: Individuals who have had sexual contact with someone diagnosed with trichomoniasis should be tested, even if they do not have symptoms. Trichomoniasis is a sexually transmitted infection, and sexual partners may transmit the parasite to one another.

5. Pregnant Women: Pregnant women should be tested for trichomoniasis as part of routine prenatal care. Untreated trichomoniasis during pregnancy can lead to complications, such as preterm birth or low birth weight.

6. Individuals with a History of STDs: People who have previously been diagnosed with other sexually transmitted infections (STIs) or who have engaged in high-risk sexual behaviors may be considered for trichomoniasis testing.

7. People with HIV Infection: Individuals who are HIV-positive have an increased risk of trichomoniasis. Trichomoniasis testing may be recommended as part of routine medical care for HIV-positive individuals.

8. Individuals with Risk Factors for STDs: Certain factors may increase a person’s risk of contracting trichomoniasis, including:

   • Having unprotected sex (not using condoms)
   • Having multiple sexual partners
   • Engaging in high-risk sexual activities (e.g., sex work, drug use during sex)
   • Using drugs or alcohol before or during sexual activity, which may impair judgment and increase risky sexual behaviors

Causes
An infection caused by protozoa, Trichomonas vaginalis
It is transmitted through sexual contact
In women, it causes infection in urethra (a tube which empties urine from the bladder), vagina or both
In men, infection occurs only in urethra
Risk factors include:
Multiple sexual partners
Unprotected sex
Other sexually transmitted infections
Symptoms & Reports
Contact your provider if experiencing new, severe, or persistent symptoms.
Common symptoms in women include:

White, grey or yellow vaginal discharge, with an unpleasant smell
Vaginal spotting or bleeding
Genital burning or itching
Genital redness or swelling
Frequent urge to urinate
Pain during urination or sexual intercourse
Common symptoms in men include:

Urge to urinate frequently
Burning during urination or after ejaculation
Discharge from the urethra

1. Women Over 30 Years Old: HPV testing is often recommended for women aged 30 and older as part of cervical cancer screening, particularly in conjunction with a Pap smear (Pap test). Co-testing with both HPV testing and Pap smear is preferred in this age group to improve the detection of cervical abnormalities and reduce the risk of cervical cancer.

2. Women with Abnormal Pap Smear Results: Women who have had abnormal Pap smear results, such as ASC-US (atypical squamous cells of undetermined significance) or LSIL (low-grade squamous intraepithelial lesion), may require HPV testing to assess the presence of high-risk HPV strains that are associated with cervical cancer.

3. Women with a History of Cervical Cancer or Precancerous Lesions: Women with a history of cervical cancer, precancerous cervical lesions (e.g., cervical dysplasia), or treatment for such conditions may undergo HPV testing as part of surveillance to monitor for recurrence or persistence of HPV infection.

4. Women with HIV Infection or Immunosuppression: Women who are HIV-positive or immunocompromised may have an increased risk of persistent HPV infection and cervical abnormalities. HPV testing may be recommended as part of cervical cancer screening for this population.

5. Women with Risk Factors for Cervical Cancer: Women with risk factors for cervical cancer, such as a history of smoking, multiple sexual partners, early onset of sexual activity, or a weakened immune system, may benefit from HPV testing as part of cervical cancer screening.

6. Men Who Have Sex with Men (MSM): MSM may have an increased risk of HPV infection, particularly oral and anal HPV infections. HPV testing may be recommended for MSM who have symptoms suggestive of HPV-related conditions or who have had sexual contact with partners diagnosed with HPV-related diseases.

7. People with Genital Warts or HPV-Related Conditions: Individuals diagnosed with genital warts (condylomata acuminata) or other HPV-related conditions, such as recurrent respiratory papillomatosis (RRP), may require HPV testing to identify the specific HPV strains involved and guide management and treatment decisions.

8. Sexual Partners of Infected Individuals: Partners of individuals diagnosed with HPV-related conditions, such as cervical dysplasia or genital warts, may undergo HPV testing to assess their own infection status and inform preventive measures and treatment options.

9. People Receiving Anal or Oral HPV Screening: Individuals undergoing screening for anal or oral HPV infection, particularly those at increased risk due to sexual behaviors (e.g., receptive anal intercourse, oral-genital contact), may undergo HPV testing to detect HPV-related abnormalities or precancerous lesions.

Symptoms
In most cases, your body’s immune system defeats an HPV infection before it creates warts. When warts do appear, they vary in appearance depending on which kind of HPV is involved:

Genital warts. These appear as flat lesions, small cauliflower-like bumps or tiny stemlike protrusions. In women, genital warts appear mostly on the vulva but can also occur near the anus, on the cervix or in the vagina.

In men, genital warts appear on the penis and scrotum or around the anus. Genital warts rarely cause discomfort or pain, though they may itch or feel tender.

Common warts. Common warts appear as rough, raised bumps and usually occur on the hands and fingers. In most cases, common warts are simply unsightly, but they can also be painful or susceptible to injury or bleeding.
Plantar warts. Plantar warts are hard, grainy growths that usually appear on the heels or balls of your feet. These warts might cause discomfort.
Flat warts. Flat warts are flat-topped, slightly raised lesions. They can appear anywhere, but children usually get them on the face and men tend to get them in the beard area. Women tend to get them on the legs.

Common warts can grow on your hands or fingers. They’re small, grainy bumps that are rough to the touch.

Plantar warts are caused by the same type of virus that causes warts on your hands and fingers. But, because of their location, they can be painful.

Flat warts are smaller and smoother than other warts. They generally occur on the face or legs and are more common in children and teens than in adults.

Genital warts are a common sexually transmitted infection. They can appear on the genitals, in the pubic area or in the anal canal. In women, genital warts can also grow inside the vagina.

Genital warts are a common sexually transmitted infection. They can appear on the genitals, in the pubic area or in the anal canal.

Cervical cancer
Nearly all cervical cancers are caused by HPV infections, but cervical cancer may take 20 years or longer to develop after an HPV infection. The HPV infection and early cervical cancer typically don’t cause noticeable symptoms. Getting vaccinated against HPV infection is your best protection from cervical cancer.

Because early cervical cancer doesn’t cause symptoms, it’s vital that women have regular screening tests to detect any precancerous changes in the cervix that might lead to cancer. Current guidelines recommend that women ages 21 to 29 have a Pap test every three years.

Women ages 30 to 65 are advised to continue having a Pap test every three years, or every five years if they also get the HPV DNA test at the same time. Women over 65 can stop testing if they’ve had three normal Pap tests in a row, or two HPV DNA and Pap tests with no abnormal results.

1. Women Experiencing Menopausal Symptoms: Women in their late 30s, 40s, or early 50s who are experiencing symptoms commonly associated with perimenopause may undergo evaluations. These symptoms may include:

   • Irregular menstrual cycles (changes in cycle length, flow, or duration)
   • Hot flashes
   • Night sweats
   • Vaginal dryness
   • Mood swings
   • Sleep disturbances
   • Decreased libido
   • Fatigue
   • Memory problems or difficulty concentrating
   • Joint or muscle aches

2. Women with Menstrual Irregularities: Women who have noticed changes in their menstrual cycles, such as irregular periods, heavier or lighter bleeding, or skipped periods, may undergo evaluations to determine if these changes are related to perimenopause or other underlying conditions.

3. Women with Risk Factors for Early Menopause: Women with risk factors for early menopause, such as a family history of early menopause, history of cancer treatment (e.g., chemotherapy, pelvic radiation), autoimmune disorders, or surgical removal of the ovaries (oophorectomy), may be evaluated for signs of perimenopause at an earlier age.

4. Women with Medical Conditions or Medication Use: Women with certain medical conditions or undergoing treatments that affect hormonal balance (e.g., thyroid disorders, polycystic ovary syndrome, hormonal contraceptives, hormone replacement therapy) may experience perimenopausal symptoms and may benefit from evaluations to assess hormonal levels and menstrual patterns.

5. Women with Fertility Concerns: Women who are considering pregnancy or have concerns about fertility may undergo evaluations to assess ovarian reserve, hormonal levels, and reproductive health status during perimenopause.

6. Women with Severe or Disruptive Symptoms: Women experiencing severe or disruptive symptoms during perimenopause that significantly impact their quality of life, work, or relationships may undergo evaluations to explore treatment options and symptom management strategies.

What causes perimenopause?
Perimenopause is a natural process caused when your ovaries gradually stop working. Ovulation may become erratic and then stop. The menstrual cycle lengthens, and flow may become irregular before your final period.

Symptoms are caused by the changing levels of hormones in the body. When estrogen is higher, you may have symptoms like you might have with PMS. When estrogen is low, you may have hot flashes or night sweats. These hormone changes may be mixed with normal cycles.

What are the symptoms of perimenopause?
No two women will experience perimenopause in the same way. These are the most common symptoms:

Mood changes

Changes in sexual desire

Trouble concentrating or with memory

Headaches

Night sweats

Hot flashes

Vaginal dryness

Trouble with sleep

Joint and muscle aches

Heavy sweating

Having to pee often

PMS-like symptoms

The symptoms of perimenopause may look like other health conditions. Always talk with your healthcare provider for a diagnosis.

1. Women Trying to Conceive: Women who have been actively trying to conceive for at least 12 months (or 6 months for women aged 35 and older) without success may consider undergoing fertility testing to assess their reproductive health and identify potential factors contributing to infertility.

2. Women with Irregular Menstrual Cycles: Women with irregular menstrual cycles, including cycles shorter than 21 days or longer than 35 days, or irregular ovulation patterns, may undergo fertility testing to evaluate hormonal balance, ovarian function, and ovulatory disorders.

3. Women with Known Risk Factors for Infertility: Women with known risk factors for infertility, such as advanced maternal age (typically over 35), previous pelvic surgery or infection, endometriosis, polycystic ovary syndrome (PCOS), thyroid disorders, or a history of chemotherapy or radiation therapy, may undergo fertility testing to assess their reproductive potential and identify any underlying issues.

4. Women with Reproductive Health Concerns: Women with concerns about their reproductive health, including recurrent miscarriages, previous unsuccessful fertility treatments, or family history of infertility, may undergo fertility testing to identify potential causes and explore treatment options.

5. Women Planning for Future Pregnancy: Women who are planning for future pregnancy or considering delaying childbearing may undergo fertility testing to assess ovarian reserve, egg quality, and reproductive potential, providing valuable information for family planning decisions.

6. Women Considering Assisted Reproductive Technologies (ART): Women considering assisted reproductive technologies, such as in vitro fertilization (IVF) or intrauterine insemination (IUI), may undergo fertility testing as part of the pre-treatment evaluation process to optimize treatment outcomes and guide personalized treatment plans.

7. Women with Male Partners with Fertility Concerns: Women with male partners who have known fertility issues, such as low sperm count, poor sperm motility, or abnormal sperm morphology, may undergo fertility testing to assess their own reproductive health and determine the most appropriate treatment approach for achieving pregnancy.

8. Women Undergoing Cancer Treatment: Women undergoing cancer treatment, such as chemotherapy or radiation therapy, that may impact ovarian function and fertility may consider fertility testing and fertility preservation options, such as egg freezing or embryo cryopreservation, before starting treatment.

9. Women with Unexplained Infertility: Women diagnosed with unexplained infertility, where no specific cause can be identified after initial evaluation, may undergo further fertility testing to explore potential underlying factors contributing to infertility and guide treatment decisions.

Causes
For pregnancy to occur, every step of the human reproduction process has to happen correctly. The steps in this process are:

One of the two ovaries releases a mature egg.
The egg is picked up by the fallopian tube.
Sperm swim up the cervix, through the uterus and into the fallopian tube to reach the egg for fertilization.
The fertilized egg travels down the fallopian tube to the uterus.
The fertilized egg attaches (implants) to the inside of the uterus and grows.

Ovulation disorders
Ovulating infrequently or not at all accounts for most cases of infertility. Problems with the regulation of reproductive hormones by the hypothalamus or the pituitary gland or problems in the ovary can cause ovulation disorders.

Polycystic ovary syndrome (PCOS). polycystic ovary syndrome (PCOS) causes a hormone imbalance, which affects ovulation. PCOS is associated with insulin resistance and obesity, abnormal hair growth on the face or body, and acne. It’s the most common cause of female infertility.
Hypothalamic dysfunction. Two hormones produced by the pituitary gland are responsible for stimulating ovulation each month — follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Excess physical or emotional stress, a very high or very low body weight, or a recent substantial weight gain or loss can disrupt production of these hormones and affect ovulation. Irregular or absent periods are the most common signs.
Primary ovarian insufficiency. Also called premature ovarian failure, this is usually caused by an autoimmune response or by premature loss of eggs from your ovary, possibly as a result of genetics or chemotherapy. The ovary no longer produces eggs, and it lowers estrogen production in women under age 40.
Too much prolactin. The pituitary gland can cause excess production of prolactin (hyperprolactinemia), which reduces estrogen production and can cause infertility. This can also be caused by medications you’re taking for another condition.
Damage to fallopian tubes (tubal infertility)
Damaged or blocked fallopian tubes keep sperm from getting to the egg or block the passage of the fertilized egg into the uterus. Causes of fallopian tube damage or blockage can include:

Pelvic inflammatory disease, an infection of the uterus and fallopian tubes due to chlamydia, gonorrhea or other sexually transmitted infections
Previous surgery in the abdomen or pelvis, including surgery for ectopic pregnancy, in which a fertilized egg implants and develops somewhere other than the uterus, usually in a fallopian tube
Endometriosis
Endometriosis occurs when tissue that typically grows in the uterus implants and grows in other places. This extra tissue growth — and the surgical removal of it — can cause scarring, which can block fallopian tubes and keep an egg and sperm from uniting.

Endometriosis can also disrupt implantation of the fertilized egg. The condition also seems to affect fertility in less-direct ways, such as damage to the sperm or egg.

Uterine or cervical causes
Several uterine or cervical causes can interfere with the egg implanting or increase the risk of miscarriage:

Benign polyps or tumors (fibroids or myomas) are common in the uterus. Some can block fallopian tubes or interfere with implantation, affecting fertility. However, many women who have fibroids or polyps do become pregnant.
Problems with the uterus present from birth, such as an unusually shaped uterus, can cause problems becoming or remaining pregnant.
Cervical stenosis, a narrowing of the cervix, can be caused by an inherited malformation or damage to the cervix.
Sometimes the cervix can’t produce the best type of mucus to allow the sperm to travel through the cervix into the uterus.
Unexplained infertility
In some cases, the cause of infertility is never found. A combination of several minor factors in both partners could cause unexplained fertility problems. Although it’s frustrating to get no specific answer, this problem can correct itself with time. But you shouldn’t delay treatment for infertility.

More Information
Fallopian tubes: Is pregnancy possible with only one?
Hypothyroidism and infertility: Any connection?
Risk factors
Certain factors may put you at higher risk of infertility, including:

Age. The quality and quantity of a woman’s eggs begin to decline with age. In the mid-30s, the rate of follicle loss speeds, resulting in fewer and poorer quality eggs. This makes conception more difficult, and increases the risk of miscarriage.
Smoking. Besides damaging your cervix and fallopian tubes, smoking increases your risk of miscarriage and ectopic pregnancy. It’s also thought to age your ovaries and deplete your eggs prematurely. Stop smoking before beginning fertility treatment.
Weight. Being overweight or significantly underweight may affect ovulation. Getting to a healthy body mass index (BMI) might increase the frequency of ovulation and likelihood of pregnancy.
Sexual history. Sexually transmitted infections such as chlamydia and gonorrhea can damage the fallopian tubes. Having unprotected sex with multiple partners increases your risk of a sexually transmitted infection that may cause fertility problems later.
Alcohol. Excess alcohol consumption can reduce fertility.

1. Women Trying to Conceive: Women who have been actively trying to conceive for at least 6-12 months without success may consider undergoing ovarian reserve testing to assess their fertility potential and identify any potential issues affecting their ability to conceive.

2. Women Planning for Future Pregnancy: Women who are planning for future pregnancy or considering delaying childbearing may undergo ovarian reserve testing to assess their reproductive potential, ovarian function, and egg quality, providing valuable information for family planning decisions.

3. Women with Known Risk Factors for Infertility: Women with known risk factors for infertility, such as advanced maternal age (typically over 35), previous pelvic surgery or infection, endometriosis, polycystic ovary syndrome (PCOS), thyroid disorders, or a history of chemotherapy or radiation therapy, may undergo ovarian reserve testing to assess their reproductive potential and identify any underlying issues.

4. Women Undergoing Assisted Reproductive Technologies (ART): Women considering assisted reproductive technologies, such as in vitro fertilization (IVF) or intrauterine insemination (IUI), may undergo ovarian reserve testing as part of the pre-treatment evaluation process to optimize treatment outcomes and guide personalized treatment plans.

5. Women with Unexplained Infertility: Women diagnosed with unexplained infertility, where no specific cause can be identified after initial evaluation, may undergo ovarian reserve testing to assess their ovarian function and determine the most appropriate treatment approach for achieving pregnancy.

6. Women with Male Partners with Fertility Concerns: Women with male partners who have known fertility issues, such as low sperm count, poor sperm motility, or abnormal sperm morphology, may undergo ovarian reserve testing to assess their own reproductive health and determine the most appropriate treatment approach for achieving pregnancy.

7. Women Considering Fertility Preservation: Women undergoing medical treatments, such as chemotherapy or radiation therapy, that may impact ovarian function and fertility, may consider ovarian reserve testing and fertility preservation options, such as egg freezing or embryo cryopreservation, before starting treatment.

Conditions linked to high FSH levels include:

In women:
Ovaries that never developed normally
Primary ovarian insufficiency (POI)
Polycystic ovary syndrome (PCOS)
Menopause or perimenopause
An ovarian tumor
Thyroid diseases or adrenal gland disorders
A chromosomal disorder, such as Turner syndrome
In men:
A germ cell tumor (a tumor that starts in the cells that become sperm)
Mumps
A physical injury to the testicles
A chromosomal disorder, such as Klinefelter syndrome
In women and men, damage to the ovaries or testicles, which may be caused by:
Autoimmune disease
Radiation therapy and/or chemotherapy

Lower than normal levels of FSH in women and men are often a sign of a problem with the pituitary gland or hypothalamus. These problems may make it hard for your body to make FSH and LH.

In women, low FSH levels may also be linked to rapid weight loss, being very underweight, or extreme exercise.

Generally, in children with signs of early sexual development (before age 8 in girls or age 9 in boys):

High levels of FSH and LH mean the child has early puberty, also called precocious puberty. In most cases, the cause is unknown. But in certain cases, the cause is a problem in the brain, such as:
A brain tumor
A past brain injury
A past brain infection, such as meningitis or encephalitis
Normal levels of FSH and LH mean the child has a type of early puberty called peripheral precocious puberty. This often means that a disorder in the testicles, ovaries, or adrenal glands is causing higher than normal levels of estrogen or testosterone. Severe hypothyroidism and exposure to medicines that contain sex hormones may also cause this type of early puberty.
Generally, in teens with no signs of sexual development by age 13 for girls or age 14 for boys, low or normal levels of FSH and LH usually mean delayed puberty. Many teens with delayed puberty are healthy and go through normal puberty at a later age. But delayed puberty may be caused by certain medical conditions, such as:

Poor nutrition from a long-term illness or eating disorder
Hypogonadism, which is when the ovaries or testicles make little or no hormone. It may be caused by:
Certain genetic disorders, including Kallmann syndrome
Tumors in the brain or pituitary gland
Turner syndrome in girls
Klinefelter syndrome in boys
Certain autoimmune disorders
Radiation therapy or chemotherapy

1. Women Who Have Undergone Menopause: Women who have ceased menstruation for at least 12 consecutive months and have completed the menopausal transition are considered postmenopausal. Postmenopausal testing may be recommended to assess hormonal levels, bone density, cardiovascular health, and other aspects of postmenopausal health.

2. Women Experiencing Postmenopausal Symptoms: Women experiencing symptoms associated with menopause and the postmenopausal period, such as hot flashes, night sweats, vaginal dryness, mood changes, sleep disturbances, or changes in libido, may undergo testing to evaluate hormonal status and assess the impact of menopause on overall health and well-being.

3. Women at Risk for Osteoporosis: Postmenopausal women, particularly those with risk factors for osteoporosis, such as advanced age, family history of osteoporosis, low body weight, smoking, excessive alcohol consumption, or prolonged use of corticosteroids, may undergo bone density testing (DEXA scan) to assess bone health and fracture risk.

4. Women with Risk Factors for Cardiovascular Disease: Postmenopausal women, especially those with risk factors for cardiovascular disease, such as hypertension, dyslipidemia, diabetes, obesity, sedentary lifestyle, or family history of heart disease, may undergo cardiovascular testing (e.g., lipid profile, blood pressure monitoring, electrocardiogram) to assess heart health and evaluate cardiovascular risk.

5. Women with Vaginal Symptoms or Concerns: Postmenopausal women experiencing symptoms related to vaginal atrophy, such as vaginal dryness, itching, burning, or pain during sexual intercourse, may undergo vaginal health assessments (e.g., vaginal pH testing, vaginal cytology) and may benefit from treatment options to alleviate symptoms and improve vaginal health.

6. Women with Genitourinary Symptoms: Postmenopausal women experiencing symptoms related to genitourinary syndrome of menopause (GSM), such as urinary frequency, urgency, dysuria, or recurrent urinary tract infections, may undergo urological evaluations and testing to assess urinary and pelvic health.

7. Women with Breast Health Concerns: Postmenopausal women with breast health concerns, such as breast pain, breast lumps, nipple discharge, or changes in breast appearance, may undergo breast imaging studies (e.g., mammography, breast ultrasound, breast MRI) and breast health evaluations to assess breast health and detect any abnormalities.

8. Women with Hormonal Imbalance Symptoms: Postmenopausal women experiencing symptoms suggestive of hormonal imbalance, such as mood swings, weight gain, fatigue, or hair loss, may undergo hormonal testing (e.g., thyroid function tests, sex hormone levels) to evaluate hormonal status and identify any underlying hormonal disorders.

9. Women with Gynecological Health Concerns: Postmenopausal women with gynecological health concerns, such as abnormal vaginal bleeding, pelvic pain, or pelvic organ prolapse, may undergo gynecological evaluations and testing to assess reproductive and pelvic health and identify any gynecological disorders or conditions.

Symptoms and Causes
What are the symptoms of postmenopause?
Many people in postmenopause feel lingering symptoms from menopause, although the symptoms are usually less intense. Lingering symptoms occur due to low levels of reproductive hormones. Some people have no symptoms in postmenopause.

If you have symptoms, some of the most common are:

Hot flashes and night sweats.
Vaginal dryness and pain during sex.
Depression.
Changes in sex drive (low libido).
Insomnia.
Dry skin.
Weight changes.
Hair loss.
Urinary incontinence.
If your symptoms become more intense or interfere with your daily life, talk with your healthcare provider. They can recommend treatment or order tests to determine what may be causing your symptoms.

Can you have hot flashes after menopause?
Yes. Some people still experience hot flashes in the years after menopause. Low estrogen levels cause postmenopausal hot flashes. If your hot flashes are bothersome or intensify, speak with your healthcare provider to rule out other causes.

What causes postmenopausal bleeding?
Vaginal bleeding during postmenopause isn’t a normal side effect of decreasing hormone levels. In some cases, the dryness in your vagina could cause some light bleeding or spotting after sex. In other cases, it could indicate a condition like endometrial hyperplasia, uterine fibroids, endometritis or cancer. Contact your healthcare provider if you experience postmenopausal bleeding.

Are there any health complications in postmenopause?
People in postmenopause have a higher risk for health conditions like osteoporosis, cardiovascular disease and genitourinary syndrome of menopause (formerly called vaginal atrophy).

Osteoporosis
You lose bone density more rapidly after menopause due to decreased levels of estrogen. You can lose 25% of your bone density or more after menopause (approximately 1% to 2% per year). Losing too much bone increases your risk of developing osteoporosis and bone fractures. Bone mineral density testing, also called bone densitometry, can see how much calcium you have in certain parts of your bones. The test helps detect osteoporosis and osteopenia.

What can I do to prevent osteoporosis?
Osteoporosis isn’t entirely preventable, but you can take steps to strengthen your bones. Eating foods high in calcium — like cheese, yogurt, spinach or fortified cereals — can help boost calcium intake. Adding a calcium supplement can also help. Some people also need a vitamin D supplement because it helps their bodies absorb calcium.

Cardiovascular disease
Before menopause, your body’s own estrogen helps protect against cardiovascular diseases like heart attack, heart disease and stroke. Risks for these conditions increase after menopause. It’s also common for people in postmenopause to become more sedentary, which contributes to high cholesterol and high blood pressure.

What can I do to prevent cardiovascular disease after menopause?
The best ways to prevent cardiovascular diseases are to eat healthy and nutritious foods, get regular physical activity and avoid tobacco products. Managing chronic conditions like high cholesterol, diabetes and high blood pressure are also essential to lowering your risk for cardiovascular diseases.

Genitourinary syndrome of menopause
Decreased estrogen levels cause the tissues in your vagina to become thin and dry. People in postmenopause may continue to struggle with vaginal dryness for years after their last period. Using vaginal lubricants can help ease your discomfort. Using lubrication and topical creams or getting laser therapy to your vagina may help with vaginal dryness. Decreased estrogen levels can also impact your urinary tract and bladder and make leaking pee a problem. Your healthcare provider should evaluate you if you have persistent dryness, painful intercourse or leak pee uncontrollably.

Mental health issues in postmenopause
People in postmenopause may experience moodiness, anxiety and depression. Things like stress, sexual tension or other life challenges can cause mental health disruptions. You may feel sad that your reproductive years are over or long for the days of your youthfulness. Hormone levels can also affect your mood. It might help to talk with a therapist or counselor about what you’re feeling to see if they can offer ways to cope with this new phase of your life.

• Reduced sexual desire (libido) and activity
• Breast discomfort (gynecomastia)
• Loss of body (axillary and pubic) hair, reduced shaving
• Very small or shrinking testes
• Inability to father children, low or zero sperm count
• Height loss, low trauma fracture, and/or low bone mineral density
• Hot flushes and sweats
• Decreased energy, motivation, initiative, and self-confidence
• Poor concentration and memory
• Reduced muscle bulk and strength
• Increased body fat

Symptoms of Elevated Androgens

If you suffer from any of these symptoms, consider the possibility of high testosterone and/or DHEA:

Acne
Hair loss (primarily on top on the head)
Increase in face and body hair.
Increase levels of triglycerides.
Polycystic ovarian syndrome (PCOS)
High androgen levels for too long will also increase the risk of breast cancer, heart disease, and metabolic syndrome.

High androgen levels can happen at any age, while androgen deficiency is more common as women age since both testosterone and DHEA decrease with age. Many of the common menopause symptoms come from the changing levels of DHEA and testosterone. Far too many women suffer from uncomfortable symptoms as they age, but this does not have to be the case. If you suffer from any of these symptoms, consider working with a practitioner to determine if androgen deficiency may be contributing.

Symptoms of Androgen Deficiency

lack of motivation
decreased libido, sexual receptivity
osteoporosis and osteopenia
Decreased mood and decreased mental clarity
Incontinence
body aches
fatigue
insomnia
fibromyalgia
hot flashes
vaginal dryness
Cortisol
This hormone is most well known as the stress hormone for which it sometimes gets a bad wrap. However, it is important to understand how cortisol has two modes.

Proactive mode:

Coordinates sleep/wake cycle
Regulates food intake
Supports attention and integration of sensory information
Reactive mode:

Increases in stress to provide the “fight or flight” response
Promotes learning and memory processes
Due to the chronic nature of stress that most people experience, the body can be in the reactive mode all the time. This is called stress adaptation. This can occur when cortisol levels are chronically high or chronically low. When the body adapts to stress so often for so long the body becomes vulnerable to damage which is how stress can actually make you sick. The adrenal and hormone system is combined with neurotransmitters and the immune system. When these systems are constantly on high alert they adapt by becoming either less responsive or hyper-responsive. This leaves these systems either unable to read their normal signals or so fatigued it can do nothing about it.

The reactive mode of the cortisol response is what becomes adrenal fatigue. Even though there are many different patterns of cortisol dysregulation many of the symptoms remain the same.

Symptoms of cortisol dysregulation:

Unexplained weight loss or gain
Body aches
Fatigue
Blood pressure issues (high or low)
Salt and sugar cravings
Blood sugar imbalances- shakiness or lightheadedness between meals
Dizziness
Feeling tired, but unable to calm the brain (tired and wired)
Sleep difficulty
Low libido
Severe allergies

• Reduced sexual desire (libido) and activity
• Breast discomfort (gynecomastia)
• Loss of body (axillary and pubic) hair, reduced shaving
• Very small or shrinking testes
• Inability to father children, low or zero sperm count
• Height loss, low trauma fracture, and/or low bone mineral density
• Hot flushes and sweats
• Decreased energy, motivation, initiative, and self-confidence
• Poor concentration and memory
• Reduced muscle bulk and strength
• Increased body fat

Who does low testosterone (male hypogonadism) affect?
Male hypogonadism is a medical condition that can affect people with testicles at any age from birth through adulthood.

Low testosterone is more likely to affect people who:

Are older.
Have obesity.
Have poorly managed Type 2 diabetes.
Have obstructive sleep apnea.
Have chronic medical conditions, such as kidney dysfunction or cirrhosis of the liver.
Have HIV/AIDs.
How common is low testosterone?
It’s difficult for researchers to estimate how common low testosterone is since different studies have different definitions for low testosterone.

Data suggest that about 2% of people AMAB may have low testosterone. And other studies have estimated that more than 8% of people AMAB aged 50 to 79 years have low testosterone.

Symptoms and Causes
What are the symptoms of low testosterone?
Symptoms of low testosterone can vary considerably, particularly by age.

Symptoms that highly suggest low testosterone in adults assigned male at birth include:

Reduced sex drive.
Erectile dysfunction.
Loss of armpit and pubic hair.
Shrinking testicles.
Hot flashes.
Low or zero sperm count (azoospermia), which causes male infertility.
Other symptoms of low testosterone in adults AMAB include:

Depressed mood.
Difficulties with concentration and memory.
Increased body fat.
Enlarged male breast tissue (gynecomastia).
Decrease in muscle strength and mass.
Decrease in endurance.
Symptoms of low testosterone in children
Low testosterone before or during puberty for children assigned male at birth can result in:

Slowed growth in height, but their arms and legs may continue to grow out of proportion with the rest of their body.
Reduced development of pubic hair.
Reduced growth of their penis and testicles.
Less voice deepening.
Lower-than-normal strength and endurance.
What causes low testosterone?
There are several possible causes of low testosterone. The two types of male hypogonadism are:

Primary hypogonadism (testicular disorder).
Secondary hypogonadism (pituitary/hypothalamus dysfunction).
Causes of primary and secondary hypogonadism are also divided into either congenital (at birth) or acquired (developed later in childhood or adulthood).

Causes of primary male hypogonadism
Primary hypogonadism happens when something is wrong with your testicles that doesn’t allow them to make normal levels of testosterone.

Another name for primary hypogonadism is hypergonadotropic hypogonadism. In this type, your pituitary gland produces more luteinizing hormone (LH) and follicle-stimulating hormone (FSH) (known as gonadotropins) in response to low testosterone levels. The high levels of these hormones would normally tell your testicles to produce more testosterone and sperm. However, if you have damaged (most commonly related to prior chemotherapy) or missing testicles, they can’t respond to the increased levels of gonadotropins. As a result, your testicles make too little or no testosterone and sperm.

Sometimes in primary hypogonadism testosterone levels are within the normal range and gonadotropins are high. Your specialist will help you understand if you need treatment, even with normal testosterone levels.

Congenital conditions that affect your testicles and can lead to primary hypogonadism include:

Absence of testicles at birth (anorchia).
Undescended testicles (cryptorchidism).
Leydig cell hypoplasia (underdevelopment of Leydig cells in your testicles).
Klinefelter’s syndrome (a genetic condition in which people AMAB are born with an extra X chromosome: XXY instead of XY).
Noonan syndrome (a rare genetic condition that can cause delayed puberty, undescended testicles or infertility).
Myotonic dystrophy (part of a group of inherited disorders called muscular dystrophies).
Acquired conditions that affect your testicles and can lead to primary hypogonadism include:

Testicle injury or removal.
Orchitis, which is inflammation of one or both testicles. This is most often the result of a bacterial infection, such as a sexually transmitted infection, but it can be due to viral infections, such as mumps.
Chemotherapy or radiation therapy to your testicles.
Certain types of tumors.
Anabolic steroid use.
Causes of secondary male hypogonadism
Conditions that affect how your hypothalamus and/or pituitary gland cause secondary hypogonadism. This is known as hypogonadotropic hypogonadism because there are low levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Those low levels cause decreased testosterone and sperm production.

Congenital conditions that can lead to secondary hypogonadism include:

Isolated hypogonadotropic hypogonadism (a condition that causes low levels of gonadotropin-releasing hormone from birth).
Kallmann syndrome (a rare genetic condition that causes loss of the development of nerve cells in your hypothalamus that produce gonadotrophin-releasing hormone. It can also cause a lack of smell.).
Prader-Willi syndrome (a rare genetic multisystem disorder than can cause hypothalamus dysfunction).
Acquired conditions that can lead to secondary hypogonadism include:

Hypopituitarism (This condition may result from an adenoma, infiltrative disease, infection, injury, radiation therapy or surgery that affects your pituitary gland.).
Hyperprolactinemia.
Iron overload (hemochromatosis).
Brain or head injury.
Cushing’s syndrome.
Cirrhosis of the liver.
Kidney failure.
HIV/AIDS.
Alcohol use disorder.
Poorly managed diabetes.
Obesity.
Obstructive sleep apnea.
Certain medications, including estrogens, psychoactive drugs, metoclopramide, opioids, leuprolide, goserelin, triptorelin and newer androgen biosynthesis inhibitors for prostate cancer.
Late-onset hypogonadism (LOH) is a type of secondary male hypogonadism that results from normal aging. As males age they have a deterioration of hypothalamic-pituitary function and Leydig cell function that decrease testosterone and/or sperm production.

LOH and low testosterone are more common in people AMAB who have Type 2 diabetes, overweight and/or obesity.

In one study, 30% of people AMAB who were overweight had low testosterone, compared to only 6% of those with weight in the normal range. In another study, 25% of people AMAB with Type 2 diabetes had low testosterone, compared to 13% of those without diabetes.