Pregnancy is accompanied by a lengthy list of do's and don'ts—take prenatal vitamins, no alcohol, exercise carefully, and eat well. But what about when an unplanned health issue presents itself, such as the necessity for a mammogram? For most women, this might not even be something they think about until they are in a position where breast cancer screening is an option.

Perhaps you're over 40 and in need of your yearly mammogram, or perhaps you have a history of breast cancer in your family and you want to keep your screenings current. More emergently, you've found a lump in your breast. So, can you have a mammogram when pregnant? The answer is yes, but there are several things to consider.

Pregnancy creates substantial hormonal changes that affect the body, as well as breast tissue. Estrogen and progesterone's rise causes the breasts to expand and condition to produce milk, which results in denser tissue. This increased density is more challenging to detect any abnormalities with using mammograms. Even post-delivery, should the woman be breastfeeding, milk-filled glands can also make the breasts denser and, as a result, make mammogram readings less clear.

While 3D mammograms have improved imaging technology to help navigate dense breast tissue, doctors often suggest postponing routine screening mammograms until after pregnancy if there are no symptoms or high-risk factors. However, if a lump or abnormality is found, your doctor may recommend immediate diagnostic imaging.

When Is a Mammogram Necessary During Pregnancy?

Mammograms are not done routinely if a woman becomes pregnant, yet there are specific situations where one might be unavoidable. Breast cancer in pregnancy does occur—1 in 3,000 times—but it's not common. If a lump is detected by a woman, she has constant breast pain and no explanation, or she is at high risk (e.g., strong history of breast cancer in her family or genetic defect such as BRCA1 or BRCA2), a physician will order a mammogram.

The process itself takes very little radiation exposure. The radiation employed by a mammogram is concentrated on the breast, and there is little to no radiation that reaches other areas of the body. A lead apron is also placed over the belly to shield the unborn child.

Alternative Breast Imaging Options During Pregnancy

For pregnant women requiring breast imaging, physicians may initially suggest an ultrasound. In contrast to a mammogram, an ultrasound is not done with the use of radiation and is deemed safe for pregnant women.

An ultrasound of the breast can establish whether a lump is a fluid-filled cyst or a solid tumor that needs further investigation. Yet ultrasounds are not always diagnostic, and in certain instances, a mammogram or biopsy is needed to determine or rule out cancer.

Magnetic Resonance Imaging (MRI) is also an imaging choice but has some drawbacks. The majority of breast MRIs employ a contrast material called gadolinium, which is able to pass through the placenta and to the fetus. Although risks are not entirely clear, physicians usually do not use MRI with contrast unless necessary. Some practitioners may offer an MRI without contrast as an option.

What If You Find a Lump In Your Breast During Pregnancy?

Breast changes throughout pregnancy are normal, but finding a lump should never be taken lightly. If you notice a lump, alert your medical provider right away. They will conduct a clinical breast exam and potentially have you get an imaging study such as an ultrasound or mammogram to see whether anything needs to be done.

If imaging indicates a suspicious mass, a biopsy can be suggested. Core needle biopsy is the most frequently used and is safe during pregnancy. It consists of numbing the skin with local anesthetic and inserting a hollow needle into the area to obtain a small sample of tissue to be tested.

Breast Cancer Treatment During Pregnancy

In the extremely uncommon event of a diagnosis of breast cancer while pregnant, therapy will be determined by the nature and extent of cancer and by how far along in pregnancy one is. The most frequent form of treatment is surgery—either mastectomy (surgical removal of the entire breast) or lumpectomy (surgical removal of the lump)—which is usually safe while pregnant.

Chemotherapy is also possible but usually only attempted after the first trimester, when it can damage developing fetal tissue. Radiation therapy is not used during pregnancy and is typically deferred until after giving birth. Hormonal therapy and targeted therapies are also omitted until after giving birth.

Can I Get a Mammogram While Breastfeeding?

Yes, you can have a mammogram while you are breastfeeding. The radiation in a mammogram does not impact breast milk or hurt the baby. But breast density is still high during lactation, and this might complicate detection of abnormalities. To enhance image quality, physicians usually advise breastfeeding or pumping 30 minutes prior to the mammogram.

Routine screening mammograms are usually delayed in pregnancy unless there is a high-level concern.

If a lump is detected, an ultrasound is typically the initial imaging study done, with a mammogram being a consideration if additional assessment is necessary.

• Pregnancy mammograms utilize minimal radiation and are safe when required.
• Breast MRI with contrast is usually avoided in pregnancy.
• Breast biopsy, when necessary, is safe during pregnancy.

If breast cancer does develop during pregnancy, there are available treatment options that can be adjusted to keep the mother and infant safe.

Pregnancy is a period of significant change, and health issues particularly those involving breast health, are anxiety-provoking. Routine mammograms are typically postponed until after giving birth, but diagnostic testing can be done if necessary. The best you can do is discuss changes you notice in your breasts with your healthcare provider in an open manner. Early detection and prompt treatment can make a very big difference in the health of both mother and fetus.

It is difficult to determine emotions because of the neurological differences, the surrounding in childhood, the psychological ways of survival, and absence of emotional training.

Alexithymia or "emotional blindness" is the neuropsychological trait associated with severe problems with identification, recognition, and description of the person's emotions. Alexithymia is not a psychiatric disease but a personality trait.

It is characterized by the inability to identify and distinguish emotions and body sensations, difficulty of finding the words to express feelings, inability to understand facial expression and body language of another person and emotional detachment during stressful situations.

It is diagnosed in people with autism spectrum disorder, depressive disorder, generalized anxiety disorder and after traumatic brain injuries. It can be inherited or acquired as a result of childhood trauma, abuse or neurological damage.

The Brain Science Behind Alexithymia

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The cause of alexithymia is the brain wiring and neurological differences. Therefore, there is impaired interception, which is the inability of the brain to recognize its own physical sensations. Also, an unusual structure of the brain regions like amygdala and insula, that regulate emotions, makes difficult to decode emotional signals.

Early childhood environment and emotional competence must be developed in childhood, because, without that, there can be emotional neglect and emotional vocabulary deficiency. Due to the inability to interpret emotional data, the person misses the compass that directs decisions and self-calming. This leads to emotional outburst, panic, hyperarousal, social and psychological consequences.

How Alexithymia Differs From Emotional Numbness

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Emotional numbness is the transient psychological state caused by acute trauma, deep grief or burnout.

The lack of emotional intelligence is the lack of social and emotional competence, when the person feels his emotions correctly, but he cannot control temper, lacks empathy, makes inappropriate social decisions or do not know what kind of effect his behaviour causes on the room.

But alexithymia is different since it is long-term personality trait and the person is unaware of the particular emotion.

In terms of neurodevelopment, the insular cortex and the anterior cingulate cortex (ACC) are the structural core of the brain's salience network. They work as a translator, transforming chaotic physical sensations into recognizable emotional experience.

Although there isn't any cure for alexithymia, one can improve his emotional awareness through certain measures. Interoceptive training where individuals are taught how to associate physical body sensations (such as tightness in the chest) with particular emotions (such as stress).

The use of emotion wheel or list of emotional words to bridge the link between vague physical sensation and precise description. Mindfulness, which involves observing oneself without judgment or without trying to suppress those internal feelings right away. And it is always good to seek professional help from a psychologist or a counselor.

By Dr. Arun Shah, Director - Neurosciences, Sir H.N. Reliance Foundation Hospital

Urine leakage after pregnancy is a common occurrence in many women. It is considered a normal part of motherhood. However, it doesn't have to be. Urine leakage can occur after childbirth, but persistent symptoms should not be ignored or tolerated just because you feel that it is not a big deal. It will be imperative for women to consult a pelvic health physiotherapist to examine the pelvic floor and guide women with the help of personalised rehabilitation for improving bladder control and recovering quickly.

Pregnancy and childbirth lead to changes in a woman's body. However, there can also be an impact on the muscles and tissues that support the bladder, uterus, and bowel. Hence, many women can experience urine leakage while coughing, sneezing, laughing, exercising, or lifting their baby after delivery. Vaginal delivery, prolonged labour, multiple pregnancies, a larger baby, excess weight, and chronic constipation can also cause pressure on the pelvic floor. So, the pelvic floor is a group of muscles that supports the pelvic organs and also contributes to bladder and bowel control.

During pregnancy, these muscles carry load, and childbirth can further stretch or affect their strength and even coordination. Hence, stress urinary incontinence is seen in women post-pregnancy, wherein the urine leaks during activities that increase pressure inside the abdomen. Some women may experience urinary urgency, difficulty controlling urine, pelvic heaviness, or discomfort during physical activity. Even signs such as vaginal pressure and heaviness, urinary leakage during exercise, or difficulty controlling gas can also indicate pelvic floor dysfunction.

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Why Pelvic Floor Recovery Is More Than Just Kegel Exercises

Pelvic floor recovery is more than just doing Kegel exercises: Pelvic floor muscle exercises, commonly known as Kegels, will help to enhance muscle strength and bladder control if done as recommended by the expert. However, not everyone will need the same type or intensity of pelvic floor exercise. Some women tend to have weak pelvic floor muscles, while others may have muscles that are poorly coordinated. So, a pelvic health physiotherapist will help to assess pelvic floor strength, relaxation, coordination, breathing patterns, posture, and abdominal muscle function.

The expert will also help women to understand how the pelvic floor responds to activities such as coughing, lifting, or exercise. The aim will be to have a stronger pelvic floor contract and relax muscles when the body needs it. Breathing and pressure management within the abdomen will also be crucial for women during exercise and doing daily activities. Women may need guidance before returning to running, jumping, gym workouts, or other high-impact activities. Recovery should also be gradual.

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What Women Can Do To Support Pelvic Floor Health

What women should know: It will be important for women to maintain an optimum weight, exercise daily, quit smoking, avoid constipation by having fiber in the diet and staying hydrated. Quit smoking, use appropriate lifting techniques to reduce unnecessary strain on the pelvic floor, and don’t hold urine for a long time. Women who opted for a Caesarean section should also ensure they prevent pelvic problems.

Pregnancy itself causes pressure on the pelvic floor, so pelvic floor rehabilitation can be recommended for women with a C-section. Motherhood should not mean silently living with bladder problems. So, pelvic floor rehabilitation can improve bladder control and confidence in women.

Standing up suddenly from your bed, sofa or chair can sometimes cause a brief “head rush”, you may feel light-headed, notice your vision dimming, feel weak or even slightly unsteady. While this can feel alarming, there is a simple physiological explanation for why it happens.

When you stand up, gravity causes some of your blood to temporarily move towards your legs and abdomen. This reduces the amount of blood returning to the heart. Within seconds, the autonomic nervous system usually steps in by tightening the blood vessels and adjusting the heart rate to maintain blood pressure and ensure enough blood reaches the brain.

When A Sudden Drop In Blood Pressure Becomes A Concern

A brief drop in blood pressure during this transition can be normal. However, if the drop is too significant or the body is unable to compensate properly, it can lead to dizziness, blurred vision, weakness and, in some cases, fainting. Orthostatic hypotension is clinically defined as a sustained fall in systolic blood pressure of at least 20 mmHg or diastolic blood pressure of at least 10 mmHg within three minutes of standing.

Several factors can contribute to this, including dehydration, heat, prolonged inactivity, blood loss and medications that lower blood pressure. Recurrent episodes can also be linked to problems with the autonomic nervous system, including autonomic involvement in Parkinson’s disease and other neurodegenerative disorders.

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How To Prevent The Head Rush And When To Seek Help

One simple precaution is to avoid changing positions too quickly, especially after lying down for several hours. Sitting on the edge of the bed for a few moments before standing gives the cardiovascular system time to adjust. Moving your feet or tightening your leg muscles before getting up may also help improve blood flow back to the heart. If you start feeling dizzy, it is safer to sit or lie down rather than trying to walk through it.

An occasional, very brief episode may simply be the body’s normal response to a sudden change in posture. However, frequent episodes, fainting, falls, palpitations or persistent dizziness should not be ignored and warrant medical assessment, particularly in older adults or people taking multiple medications.

Dr Sachin Adukia Sr Consultant M.B.B.S., MD (General Medicine), DNB (Neurology), LH Hiranandani Hospital