Many of us may have taken ibuprofen, sometimes two pills at once, especially when we are struggling with menstrual cramps. Well, as good these pills may be in treating the pain, they are not recommended for your health, especially if you are someone who consumes it on a daily basis or frequently. Gastroenterologist Trisha Pasricha, MD, writes in The Washington Post about why should you avoid taking nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen, naproxen and aspirin.

What happens when you consume pain killers?

She writes that NSAIDs are great in treating short term pain. They comprise of a group of drugs that inhibit the production of prostaglandins, which serve as a variety of purposes in the body. Some of which also includes contracting the uterus during menses and regulating blood flow in our vessels.

While one to two doses every now and then is okay, following a regular dosage routine, which could range from several times a month, or twice in an hour or so could lead to health risk. NSAIDs are well known to increase intestinal permeability. This means, these painkillers could damage the lining of your gut.

A 2018 review by Ingvar Bjarnason et. al., also writes about how NSAIDs can reduce the blood flow in the tiny vessels that feeds our guts. It can also disrupt the intestinal cells forming a barrier between the outside world and your insides.

What can be done?

While people with conditions like migraines, chronic back pain or bad period cramps can find NSAIDs to be helpful. It is always advisable to have a chat with your physicians to explore NSAID alternatives.

Pasricha suggests acetaminophen.

However, if someone is in dire need of NSAID, her tip is to take the pill right at the start of your symptoms. She says that the drug can do a far better job at stopping things at the source than chasing after all prostaglandins.

Why is it a concern?

NSAIDs are available as over the counter drug, which means people do not need a prescription for it and can make medical decision about them without the guidance of a physician.

A 2018 study published in the Official Journal of the International Society for Pharmacoepidemiology by David W Kaufman, et.al., found that 15% of adult ibuprofen users in the US have exceeded the maximum recommended daily dose. The study also mentions that more than a third of ibuprofen users were taking other NSAIDs, like aspirin and naproxen, while consuming ibuprofen at the same time. Out of these, 61% did not realise that they were using NSAIDs.

Pasricha talks about how it ruptures the gut wall, as she herself has rushed to the hospital in the middle of the night "far more times than" she can count "to perform an emergency endoscopy on someone who was bleeding profusely from an ulcer caused by NSAID".

Another 2009 study published in the American Journal of Gastroenterology states that as many as 1 in 4 chronic NSAID users will get an ulcer and about 4% will bleed or rupture through the gut wall.

An older study from 2005 titled A quantitative analysis of NSAID-induced small bowel pathology by capsule enteroscopy, found that as 75 percent of people regularly using NSAIDs develop low-grade inflammation in their small bowels. NSAIDs can also lead to development of fatty liver disease. This happens because your gut lining becomes more permeable, more toxins and bacteria from the outside world enters your liver and leads to inflammation.

A 2011 study titled Haemoglobin decreases in NSAID users over time: an analysis of two large outcome trials, states that as many as 6% of people taking NSAIDs regularly have found their blood count dropping within a few months of starting the medicines, this suggests that this is due to the small, slow amount of bleeding in the gut overtime.

Breast cancer remains one of the most common and fatal cancers among women worldwide, and early detection is proven to play a crucial role in improving outcomes. While mammography remains the most effective screening tool, knowing when to start and how often to get screened can be confusing.

The changing medical guidelines, as with the new screening guidelines from the American College of Physicians (ACP), can also leave women confused about when to start mammograms and how often to repeat them. HealthandMe spoke to experts to understand the correct timing.

So, What Do The ACP Guidelines Say?

The new guidance statement developed by ACP's Clinical Guidelines Committee urged mammography screening once every two years in asymptomatic, average-risk adult females, instead of the annual recommendation.

The ACP guidelines further state that all average-risk females ages 50 to 74 must undergo biennial mammography. It added that women aged 75 years or older with asymptomatic and average-risk can also discuss stopping routine screening with their doctor.

In sharp contrast, the United States Preventive Services Task Force (USPSTF) urges starting annual screening at age 40 to save lives.

What You Should Follow

“Some cancer societies like the American Cancer Society say biennial, while NCCN says annually. We prefer annually starting at age 40 till the woman is in good health, as biennial screening may delay early diagnosis in some cases,” Dr. Ashwani Kumar Sharma, Vice Chairman - Manipal Comprehensive Cancer Centre and Onco Robotic Surgeries, Manipal Hospitals, Gurugram, told HealthandMe.

NCCN, or the National Comprehensive Cancer Network, is an alliance of 34 cancer centers in the US.

Dr. Sharma added that a practical and balanced approach would be to do biennial mammography from 40 to 50 years of age and annual mammography after 50 years of age for maximum benefit.

What Are Mammograms?

A mammogram is a low-dose X-ray that captures detailed images of breast tissue, capable of identifying cancers before any physical symptoms appear.

In women with a BRCA1 or BRCA2 gene mutation who are referred to as "high risk" or with a history of radiation to the chest between ages 10 and 30, screening may start as early as age 30 and include annual breast MRIs alongside mammograms.

Mammograms: What Do India’s Guidelines Say?

Breast cancer in India is usually diagnosed at an advanced stage due to poor health awareness. But of late, there has been an increase in awareness, and more and more women are reporting in their earlier stages with a breast lump.

“Sometimes even this is too late. Breast cancer screening would help us diagnose this disease at an even earlier stage to help increase the chances of a cure from this deadly but treatable disease with the help of simple tests,” Dr Abhijit Kotabagi, Senior Consultant, Department of Surgical Oncology, Yatharth Hospital, Noida, told HealthandMe.

“I would endorse screening and women’s health awareness in our Indian population for women above 40 years after discussion of the pros and cons of screening with a clinician,” he added.

The Indian Council of Medical Research (ICMR) and other health organizations recommend the following guidelines:

1. Women Aged 30-40 Years

• Clinical Breast Examination (CBE) every 1-3 years by a doctor.
• Self-Breast Examination (SBE) every month to check for lumps or changes.

2. Women Aged 40-50 Years

• Annual Clinical Breast Examination (CBE).
• Mammogram (X-ray of the breast) every 2 years if advised by a doctor.

3. Women Above 50 Years

• Mammogram every 2 years (or as recommended by a doctor).
• Continue monthly self-exams and yearly clinical exams.

India is in the peak of summer, with heatwave conditions affecting several parts of the country. The India Meteorological Department (IMD) has predicted that these extreme heat conditions will continue over the next few days, especially across North and Central India.

According to IMD's latest bulletin, heat wave conditions are likely in isolated pockets of Bihar, Haryana-Chandigarh-Delhi, Punjab, East Rajasthan, Vidarbha, Chhattisgarh, and Jharkhand.

The IMD has also forecast a yellow alert for heatwave conditions at isolated places in Delhi from today, with maximum temperatures expected to climb between 41 °C and 44 °C through April 24. The state government has issued guidelines for all schools, focusing on hydration and safety measures.

As temperatures rise, health experts highlighted the disproportionate burden of heat on women and the related physical, social, and financial effects. Studies show women often have higher heat-related mortality rates and suffer from increased fatigue, dehydration, and reproductive health issues.

Women typically face higher risks during heatwaves than men due to

• physiological factors (higher body fat, lower sweat rate),
• hormonal changes (menopause, pregnancy),
• social roles.

How Heatwaves Affect Women Differently

Heat stress is known to interfere with the endocrine system, which disrupts hormonal balance. This means that severe heat can cause delay or interrupt menstrual cycles, causing heavier or more painful periods, and, in severe cases, absence of menstruation. Women with conditions like PCOS or endometriosis face compounded stress.

"Many women report feeling unusually tired, irritable, or drained during heat waves, and hormones can play a role," Dr. Tripti Raheja, Director - Obstetrics & Gynecology at the CK Birla Hospital (R), Delhi, told HealthandMe.

Women are more likely to feel this during certain hormonal phases, such as menstruation, PMS, pregnancy, perimenopause, or menopause.

“Women’s core temperatures rise after ovulation. That, combined with a higher surface area-to-mass ratio, means they absorb heat more quickly,” Mike Tipton, professor and leading expert in applied physiology at the University of Portsmouth, was quoted as saying to Thisdaylive.com.

Women in perimenopause or menopause may experience hot flashes, night sweats, and sleep disturbances, making heat waves exhausting.

Also read:Heatwave Hassles: What Body Odour Could Say About Your Health

Iron deficiency or heavy bleeding can also lower energy levels, and extreme heat may worsen weakness.

Pregnant women naturally have higher metabolic demands, so dehydration and fatigue can set in faster.

Without sufficient hydration, blood flow to the placenta might be reduced, potentially harming the baby. Heat exhaustion in pregnancy can cause early labor or stillbirth. Thyroid disorders and PCOS can also contribute to fatigue and reduced overall energy levels, Dr. Raheja said.

"Long exposure to high temperatures can disrupt the balance between hormones such as estrogen, progesterone, and thyroid hormones, which regulate energy, mood, and metabolism," Dr. Sakshi Goel, Senior Consultant Obstetrics & Gynecology at Rainbow Children's Hospital, Delhi, told HealthandMe.

Dehydration further worsens this by affecting circulation and temperature control, leading to exhaustion, headaches, and dizziness.

Moreover, sleep disturbances from hot nights can impair melatonin production and disrupt overall hormonal rhythms. This leads to poor recovery and low energy the next day.

How Women Can Protect Their Health From Heatwaves

Read: Excessive Energy Drinks Damaging Young Adults’ Livers, Experts Warn

Understanding how heat affects hormonal health lets women take steps to manage fatigue and maintain overall well-being during extreme weather.

To cope better, the experts suggested prioritizing hydration and including ORS when needed.

Dr. Goel noted that even mild fluid loss can hurt circulation and lower the body’s ability to regulate temperature. This can lead to exhaustion, headaches, and dizziness. Other preventive measures include:

• Avoiding long sun exposure during peak hours.
• Eating lighter, balanced meals and avoid stepping out during peak afternoon heat.
• Wearing breathable clothing and ensure adequate sleep in a cool environment.
• Gentle movements, such as walking or stretching, can improve circulation and mood.
• If fatigue is severe, persistent, or associated with dizziness, palpitations, irregular periods, or excessive weakness, it is important to seek medical evaluation rather than dismissing it as just the weather.

In this hot summer period, with rising temperatures, those working outdoors are among the groups most susceptible to developing health problems, especially those related to kidney health. Construction workers, delivery workers, traffic officers, farmers, and sanitation workers all work for long periods outdoors in the sun, which adds continual strain on their bodies. While heat exhaustion and dehydration have been discussed frequently, a less visible but very significant concern is the increasing risk of kidney damage.

In an interview with Health and Me, Dr Anupam Roy, Additional Director – Nephrology and Kidney Transplant, Aakash Healthcare Multi-Speciality Hospital, Dwarka, spoke about the silent impact of the heatwave on outdoor workers.

With continued exposure to heat, there is increased sweating, which results in the insensible loss of a considerable amount of fluid and electrolytes from the body. If this is not matched by adequate fluid replacement, dehydration will set in. Dehydration reduces the amount of blood circulating throughout the body’s systems; therefore, the amount of blood flowing to vital organs, including the kidneys, will be diminished. As a result, the ability to filter waste from the body and maintain an adequate fluid balance is impaired. Reduced circulation to the kidneys will eventually impair their function altogether, thus leading to a greater likelihood of the worker developing an acute kidney injury (AKI).

How does a heatwave affect the kidneys?

There is a continuum of challenges that arise when kidney damage occurs as a result of internal heat stress due to poor hydration. The earliest signs are usually fatigue, dizziness, muscle weakness and/or cramps, or reduced urine production. Many people mistakenly believe these symptoms are due to their duties in hot conditions, or they dismiss them as something that will go away with time. By the time they begin to recognise an increase in the severity of their symptoms (for example, a lack of strength or confusion), significant damage to the kidneys may have already developed. Because of this delay in recognising kidney damage, the ability to treat and manage the condition becomes much more difficult.

Chronic dehydration

Chronic dehydration and heat stress also have additional long-term effects on the kidneys. Research has shown that prolonged exposure to heat is linked to a higher incidence of kidney stones and urinary infections in those frequently exposed to high temperatures. Both individuals with traditional risk factors for kidney disease (for example, diabetes or hypertension) and those without such risk factors can develop chronic kidney disease. Many agricultural and manual labour workers have been shown to develop this condition in hot climates.

Working and living conditions can further exacerbate the risk of developing chronic kidney disease due to dehydration and heat-related illness. Limited or no access to clean drinking water, a lack of restroom or food breaks, and the expectation to maintain high productivity can reduce workers’ ability to hydrate themselves appropriately. Additionally, many workers may resort to medications such as pain relievers due to discomfort. When such medications are consumed alongside dehydration, they can aggravate kidney damage.

How to protect your kidneys amid a heatwave?

To help prevent heat-related damage to the kidneys, awareness and practical measures are essential. Staying hydrated at all times is the most important step, and workers should drink sufficient water even when not thirsty. Employers and agencies must ensure that all employees have easy access to safe drinking water on-site, along with regular breaks to rest in shaded or cool areas. Furthermore, workers should wear lightweight, breathable clothing and have access to shade, hats, and sunscreen to reduce exposure to extreme heat.

Several simple steps can help protect this workforce from the hidden effects of extreme heat. These include avoiding work during the hottest parts of the day, rotating job responsibilities, providing education about the signs of heat-related illnesses, and conducting regular health assessments to monitor kidney health so that any issues are detected early.