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The idea of “recovery” is not a new concept, people have always got better from depression, but it is only recently that the mental health field has started paying attention to how people with conditions such as depression recover. On 16th December 2004 the Scottish Recovery Network launched in Glasgow to investigate and promote the idea of recovery.

Recovery is about individuals

Work and research in other countries has already shown that expectation of recovery among individuals and professionals working with them can impact strongly on the person’s prospects for recovery and their life. . Believing you can recover is important – depression is a very treatable illness. Recovery extends to medical treatment but also to acceptance by family and friends, employers, teachers and the wider community. The attitudes of others, whether close to you or not can make a negative or positive impact on your recovery.

What does recovery mean to you?

Do you believe you can, or you have recovered from depression? Recovery is an individual journey

• For one person it may mean being able to visit the corner shop on their own
• For another it might mean no longer needing any treatment, or the use of mental health services.
• For someone else it might mean being able to sleep at night and in their own bed rather than a hospital ward.
• For another it might mean working 35 hours a week and having a busy social life
  

What an individual considers to be “recovery” could depend on how long, difficult and serious their personal struggle through depresion has been. Your concept of recovery may change. Somebody who used to think recovery would be the ability to get up in the morning before noon, may decide after acheiving this they can recover further and aim to stop using mental health services. It is also possible to have partial recovery, for example to go back to work but to continue to have counselling or attend a Depression Alliance Scotland self-help group.

The meaning of recovery from depression for families/friends

We often hear from carers who want to know what they can do best to help. Depression can make people very negative about themselves, others and even the world around them; they may forget this is the depression talking and not the person they care about. Caring for someone with depression can be frustrating but knowing the fact that recovery is more than likely is important to a carer when he or she considers their future relationship with their relative or partner.

It is important that people hear the facts. Depression is very treatable and the great majority will recover.

Seasonal Affective Disorder or SAD is a form of depression which develops in the autumn and improves in the spring. Many of the symptoms associated with depression in general are similar – low mood and difficulty in concentrating. However many affected by general depression may have poor and broken sleep, whereas those who have SAD in particular, may oversleep and still feel tired. In general depression some people lose their appetite and experience subsequent weight loss, whereas in SAD the person may experience cravings for more food and calories.

SAD affects about 5% of people in the UK – one in twenty of us. Many people without SAD find they dislike the dark mornings and early evenings of autumn and winter, preferring the longer outside light of the other seasons. Increasing exposure to sunlight is one way you can help to reduce symptoms. In the less frequent drier autumn days, if you can, it can help to get outside as often as possible. If you are also able to take part in regular physical exercise, such as swimming or walking, you may also find your symptoms of SAD getting better.

As with any form of depression, if you are not feeling your symptoms getting better, it is always advisable to speak to your doctor to ensure that you are correctly diagnosed and to ensure he/she suggests referring you for other treatments as appropriate.

For those who are fortunate enough to afford a winter holiday in the sun, good sunlight but not excessive heat, can be of great benefit. However, recent research indicates that concentrating on increasing light exposure by artificial means is also able to reduce the effects of SAD

Light boxes are being proven to help people affected by SAD There are no absolute contra-indications for not using light boxes, although it is important to talk to your doctor to be sure you do not have any possible risk factors such as any eye diseases or problems like diabetes mellitus which can cause problems in the eyes or are taking any medication which might make you more photosensitive.

Most people with Depression will also have unpleasant Anxiety symptoms and many will have these symptoms badly enough to be diagnosed as having Generalized Anxiety Disorder or Panic Disorder. Fortunately, antidepressants generally have an “anxiolytic” effect; that is they tend to reduce the symptoms of anxiety, as well as having an antidepressant effect. These effects typically take 2-4 weeks to kick in. If you've already been on your antidepressant for a couple of weeks and are still having problems with anxiety return to your GP. If you find that the thought of visiting your GP makes you anxious ask a friend or relation to go with you.

Your doctor may be able to help in various ways, for example:

• by adjusting your medication
• by helping you to identify stresses in your life that may have contributed to your illness and advising on ways of reducing these stresses
• by looking for any “triggers” that cause your panic attacks and helping you to identify ways of avoiding them
• by advising you on changes in your life style that would help you to reduce your anxiety
• and he or she may also be able to give you specific advice on relaxation techniques or put you in touch with an agency providing this form of help.
  

Sometimes, when Anxiety and Panic problems are persisting, a course of counselling or psychological help might be beneficial and your doctor will also advise you on this. Anxiety often causes physical symptoms such as tiredness, palpitations, sweating and pain (usually from muscle tension). These symptoms can be severe and greatly increase your Anxiety.. Don't be frightened to discuss them with your doctor. You will wonder what you can do yourself to help reduce your levels of anxiety. The following suggestions may help:

• avoid drinks that contain caffeine such as cola, coffee and tea
• drinks such as hot chocolate or chamomile tea can be useful to relax you, particularly at bedtime
• if you are a smoker, try hard to reduce the number you smoke – nicotine, like caffeine, is a stimulant drug
• do not self medicate with alcohol, or other sedative drugs, to help you relax or get to sleep – this is a very dangerous pathway
• try to keep to a regular daily routine of tasks to be done, meals, time in bed etc
• even though you may feel tired, try to take regular exercise – perhaps somebody could go for walks with you and, if you like swimming, this is particularly relaxing
• look regularly at the things you've got to do and try to set a reasonable plan for what you can manage each day – consider which are the important tasks and which ones can be left
• be open about your feelings with anybody close to you – sharing your problems with another person is very important.
  

Anxiety and Depression are very real illnesses and not just a failure to cope, as some people wrongly believe. Fortunately, they are very treatable and, however bad things seem at present, with appropriate help there is every prospect that you will make a full recovery.

The best way to treat Depression is holistically with a variety of approaches. The main thing to note is that what helps one person with Depression doesn’t always help everyone. This is true of anti-depressants as well as therapies and other solutions. Do not give up if the first thing you try does not work for you. You may feel like giving up but this is part of the illness. Depression can do its best to tell you that everything is hopeless, whereas in actual fact it is a treatable illness, and there are many roads to get to the place of recovery.

For most people, the first step is to approach your GP for help. In many cases your GP will often prescribe an antidepressant initially, although in some areas of Scotland such as parts of Renfrewshire you may be referred to see a psychologist. Some areas have schemes where GPs can prescribe exercise and in other areas, such as Glasgow Southside and East Ayrshire, you can be recommended self-help books (bibliotherapy). If you have particularly severe depression, your GP may refer you to see a psychiatrist, who may prescribe different medication or who may refer you for talking therapy such as counselling, cognitive therapy or other psychotherapy.

Tips for speaking to your GP or Psychiatrist

• When you are making the appointment, ask if any of the GPs at the surgery have a particular interest or expertise in depression.
• Write down exactly how you are feeling and how it is affecting your daily life and show this to your GP.
• Take a family member or friend you trust along for moral support and who can help you explain to the doctor how Depression has been affecting your life
• Make a list of any antidepressants you have been on before and how successful they were. If you’ve had Depression previously and have been on a drug that works, it may work again, so tell your doctor about it.
• Ask your GP about non-pharmacological solutions. Some GPs can prescribe sessions at the gym, others may be able to refer you to a counsellor.
  

Research

Don’t just rely on your GP. Become an expert in your own illness. Do your own research on the Internet, go to the library and borrow books on Depression, get information leaflets on Depression and treatment from organisations such as ours. The Royal College of Psychiatrists also has some useful factsheets (Tel: 020 7235 2351 www.rcpsych.ac.uk) as does the Scottish Association for Mental Illness (SAMH) (Tel: 0141 568 7000 www.samh.org.uk).

Counselling

Look into counselling or therapy. If there is a long waiting list to get help in your area, maybe there is a voluntary organisation offering counselling free or at a low cost. It may be with a trainee, but these are usually well supervised. Some counsellors offer a sliding scale of charges depending on your ability to pay. You can find counsellors in your area from the British Association of Counselling and Psychotherapy tel: 0870 443 5252 website www.bacp.co.uk. Cognitive therapy has been found to be effective in treating Depression. You can find a cognitive therapist from the British Association for Cognitive and Behavioural Therapists 01254 875277 website www.babcp.org.uk. Alternatively, if you’ve got internet access, why not try Living Life to the Full, an online life skills course designed by Dr Chris Williams using the cognitive behavioural approach www.livinglifetothefull.com.

Self-help

Another source of help you could consider is joining a self-help support group where you will be able to talk to people who have had similar experiences to you and share hints and tips on coping with Depression. Joining a group can help you to feel less isolated and alone with your Depression. DAS runs groups in certain areas of Scotland, you can get more information on the groups page If there isn’t a DAS group in your area, there might be a group run by your local association for mental health. If you contact us on 0131 467 3050 or email info@dascot.org, we can give you more information on local groups.

Alternatives

Do some research into alternatives to mainstream therapy. Some people find acupuncture helps them. You can get more information and a list of acupuncturists in your area from The British Acupuncture Council www.acupuncture.org.uk, email: info@acupuncture.org.uk tel: 020 8735 0400. A useful book on acupuncture is “The Web That Has No Weaver” by Ted J Kaptchuk. Rider Publications, ISBN 0712602811-X

Diet

Diet is another area receiving a lot of attention. The Mental Health Foundation and Sustain recently did some research that found that diet has a key role in maintaining good mental health. You can view their report at www.mentalhealth.org.uk. This website also contains hints and tips on foods to eat to beat depression and useful recipes. Recent research has also found that Omega 3 fatty acids found in fish oils can be helpful for people who are depressed. These can be taken as supplements or they can be found in foods such as oily fish. Vitamin supplements may also be good to take, especially if your appetite has changed and you find it difficult to eat enough.

Exercise

If you can exercise, it can help lift your mood. If you don’t feel like you can do exercise, even doing something small like walking to the end of your road is a good start. There is a lot of evidence that exercise can really help in lifting depression, but it is common to find that the illness makes it hard, feelings of lethargy and tiredness can be present and sometimes it can seem hard to leave the safety of your house.

How many times do we see a mother with a baby on the bus or walking by with a pram and say, “What a lovely baby! Enjoy this time as it goes so quickly and is so precious. I wish I could go back to this time”? Society expects mothers, and fathers, to be happy, to be enjoying life with their adorable baby. Yet 10-15% of new/recent mothers have Post Natal Depression, which blights their lives and ruins their time of getting to know and enjoy their child in these early and important developmental months.  Post Natal Depression is sometimes described as the ‘smiling’ depression. This is not because it is an ‘easier’ kind of depression, but rather because the sufferer feels she MUST be happy because everyone else is telling her that she should.

“You think you should be happy because you’ve got a baby and everyone else is happy but you’re not coping” Mother with PND

At Depression Alliance Scotland, we often hear from mothers who have been diagnosed with PND who believe they are bad parents; that any problems are their fault; that other parents they meet are all coping and don’t have fractious babies. We hear from mothers who feel guilty and ashamed at feeling like this; frightened to mention it to anyone, especially health professionals, fearing they might even have their child taken away. However the simple facts are that mums with PND and some new dads who develop depression in the first 15 months of parenthood, are just as good and loving and caring as any other parent and do not need to feel guilty in having an illness which can and does happen to anyone.

What is Post Natal Depression?

PND includes the symptoms of depression in general, such as low mood; constant sadness without reason, appetite problems and general neglect of self and weeping. Babies usually wake in the night, tiring any mum and in addition depression often causes difficulty in sleeping leaving the mum even more exhausted. They may lack interest in the baby – again adding to the guilt. Some mothers fear they may harm their baby, but do not want to do so and it’s important to reassure the mothers on this and encourage them to discuss this with their health visitor or other local healthcare staff.

Post Natal Depression should not be confused with the ‘baby blues’ where a mother may feel tearful in the first few days after the birth (though those having the baby blues may be at more risk of developing PND later). About 2-3 mothers in every 100 may develop the very serious puerperal psychosis in the first few days after birth and treatment for this may mean admission to hospital. Currently there is only one mother and baby unit in Scotland.

Having PND after the first baby does not necessarily mean it will recur with subsequent births (though extra support should be available). Indeed the mum may not have PND with the first baby but it may happen after a subsequent birth when extra pressures to ensure care of all children is given. Changes in hormones can contribute towards PND in some mothers but the illness can also arise because of various ‘losses’ when becoming a parent:

• Loss of confidence – looking after your baby can be a very steep learning curve involving the baby’s character too! A mother may have been skilled in her job of work and it is not easy to adapt to this completely different role.
• Loss of identity – we all carry and are seen to have various roles in our lives from daughter to friend to worker to partner – the role of motherhood is perhaps the most powerful role away from self.
• There can be financial loss from leaving work and from costs of the childs ’s needs.
• Loss of time and space, including during the night are not easy (depression can in itself be a major cause of sleeplessness making for sheer exhaustion).
  

Other contributing factors can include:

• A difficult pregnancy.
• Body image changes both during and after pregnancy.
• A difficult labour.
• Perhaps, for some mothers, problems in trying to breast feed when it isn’t being established easily and feeling she MUST be able to breastfeed or she will be failing her baby because of pressure, adding to her feelings of being a bad mother.
• A crying baby –the baby may have colic – it can always seem that the baby seems to stop crying if someone else picks the baby up.
• Unresolved issues or childhood trauma.
• Family, friends telling you how lucky you are and to pull yourself together and count your blessings.
• The ultimate fear of not being a good mother and having your baby, taken into care.
• Poor relationship.
• Other unresolved problems.
  

“I spent the first few months feeling disappointed and guilty and felt frustrated by the demands of my baby. I had turned into a person I barely recognised. I kept telling myself I should just get over it. This was how it was going to be, and yet that made me feel worse.”

Treatments for PND

Post Natal Depression is a very treatable illness. Treatment(s) may or may not include antidepressants (taking into account if the person is pregnant or breastfeeding) and may or may not include counselling. It may also help to find extra child care for the child to give the mum a break. Some areas of Scotland screen newly pregnant mothers for depression and have a debriefing session after the birth in case the mother has concerns. The Post Natal Depression Project based in Edinburgh provides individual counselling, therapy groups and crèche facilities. These are in addition to access to art therapy, infant massage and telephone support, all of which can be a lifeline as well as helping the often isolated mum to know she is not alone in having the illness. Groups also run in the Borders and Linlithgow. Mothers can self-refer or are referred by professionals.

It is common for mothers with Post Natal Depression to be put off seeking help for fear of having their child taken into care. However, these are irrational thoughts typical of depression. If you are concerned about PND do not be afraid to speak to your health visitor about it.

“Slowly things began to get better. I found myself crying less and beginning to enjoy life again. It was such a relief to find that life could be different and that I was going to get through this.”

Men Suffer Post Natal Depression too

It is an issue that is often neglected but a study published in the Lancet on the 24th June found that up to one in twenty five men also suffers from postnatal depression. The study examined parents taking part in the Children of the Nineties project in Bristol, which is following the fortunes of thousands of families. It examined more than 8,000 fathers and found that eight weeks after the birth of their child, 3.6 per cent appeared to be suffering from depression. Researchers from Oxford University said "Although our findings need to be confirmed and expanded, we believe that after the birth of a child, depression in fathers, as well as depression in mothers, should be actively considered."

What is counselling?

The feelings you experience as you go through your caring journey can be some of the most confusing and overwhelming you will ever encounter. Medical health staff such as your GP should be able to help with the majority of practical issues relating to the condition of the person you're caring for, but what about the emotional considerations; it's easy to forget it, but emotional wellbeing is every bit as important as the more physical issues. For many, family and friends can help 'lend an ear' (and more often than not a hand too), and can be an invaluable resource in unburdening yourself of the emotional stresses that caring invariably brings about. Someone to listen to you is very important, your local carers' services, social services, or the message boards on this site all offer a place where you can offload. Perhaps, though, for whatever reason, you may not be able to discuss such matters with those you are close to, or feel that you need further support. If this is the case a professionally trained counsellor may be the person to help.

How can it help?

Counselling can help you make sense of your new or ongoing life as a carer, whether in specific areas such as dealing with bereavement or separation from a loved one, or with the more general feelings of stress, anxiety and depression you experience in your caring role. A counsellor could help you to resolve any conflict that exists between you and the one you're caring for and others you are close to, as well as the many other issues affecting the emotional and mental wellbeing of carers. The counselling process varies from one counsellor to another: some may just listen, especially in the early stages, as getting your problems out in the open can be a crucial step towards resolving them. Some may help you along the decision making process by examining with you the options available to you, so that you can make better informed decisions. The type of support you get will be a combination of the particular problems you face and the counsellor's own style.

Finding a counsellor that is right for you

Your local carers centre, GP or social services should be able to give you further advice on counselling and help you to find a counsellor, but how do you know that the one you choose is right for you? Well, on top of the more fundamental considerations like whether or not your counsellor has recognised academic qualifications, adheres to a professional code of conduct and has a complaints procedure, you should check whether they have the necessary experience in the area in which you require support. Some charities for specific illnesses offer counselling and support groups aimed at those affected by the specific condition; you may find the empathy and experience of such support more beneficial in getting to the root of your problems. Finally, you should meet or speak with the counsellor before committing yourself, to make sure you feel at ease with them, as you will probably be discussing personal and often sensitive information.

Alternatives sources of counselling and support

Attending a support group, where you discuss your feelings with other carers whose lives have been affected by the same problems, can be a great way to work through your troubles, realise you're not alone, and make new friends along the way. Telephone support lines such as the service offered by The Samaritans is another alternative that many carers prefer who feel uncomfortable discussing their problems in a face-to-face environment. You shouldn't expect counselling to solve all your problems all at once, but as a part of a wider network of support, it can help you to cope with the problems you do have. Finally, with counselling, like with most things, more often than not you get out what put in. If you can frankly and honestly discuss your problems and make the most of the advice and support on offer you may find counselling an important part of how you cope with caring.

About stress

Experts say that short periods of stress in our daily lives are actually good for us. Continual stress, however, can cause health problems, which may not always appear to be stress related and can not only affect you, but also those closest to you, not least the one you're caring for. As a carer you are in a situation that can be a constant cause of stress – there are many additional responsibilities and frustrations for you to cope with, so feelings of anger and hopelessness are not uncommon.

You should try to be aware of and identify any symptoms of stress you may experience. It may be unusual behaviour such as overreacting to situations, a short temper, shouting at people or a constant feeling of being unable to cope. Lack of appetite, poor sleeping patterns and headaches are other typical reactions to stress. For carers in particular, stress is usually mental or emotional rather than physical and the effect is that the body is constantly 'keyed up', sometimes without any physical activity as a release (see our exercise section for help relieving stress).

Stress is not only harmful to your health and wellbeing – it can also harm relationships – so it is vital to identify the causes of stress and address them as soon as possible. The problem is often that the cause of stress may not always be the most obvious, and there is often more than one. You could be worried about money, the future, the health of the person you care for or the activities of other members of the family, or you may feel guilty – another common source of stress.

Stress can strain relations, and it's not just your relationship with the person you are caring for that can be affected. For example, caring for an elderly parent can place enormous strain on a marriage because of the continual stress experienced by the carer and the perceived lack of support from your partner.

Dealing with stress

No matter how well you deal with your caring role there will inevitably come a time when you experience higher than normal levels of stress. To enable you to continue your caring role effectively – and to ensure your own health does not suffer – it is important to try and deal with your stress.

Possible ways of doing this are:

• Using friends and family for discussion and support
• Using the carers' boards on this site in the community section to talk to other carers, or attending local support groups of carers
• Taking through situation with appropriate professionals face-to-face or by telephone
• Seeking help and advice from GPs, pharmacists and other health professionals you may know
  

Taking time out to do what you want to do is very difficult when you are a carer, but it is extremely important. For some ideas to help you get some quality time for yourself click here.

Human Immunodeficiency Virus (HIV) and Acquired ImmunoDeficiency Syndrome (AIDS) are serious medical conditions throughout the world today. Left untreated, AIDS is 100% fatal; however, life-prolonging antiretroviral drugs have begun to transform HIV from an inescapable death sentence into a manageable condition.

The well-documented ways in which HIV is spread are: by sexual contact with an infected person, by sharing needles and/or syringes (primarily for drug injection) with someone who is infected, or, less commonly (and now very rarely in countries where blood is screened for HIV antibodies), through transfusions of infected blood or blood clotting factors. Babies born to HIV-infected women may become infected before or during birth or through breast-feeding after birth.

One of the best places for those with HIV/AIDS to be cared for is at home, surrounded by the people who love them. Many people living with the virus can lead an active life for a very long time, and most of the time they do not need to be in a hospital. Being at home is often cheaper, more comfortable, more familiar, and gives those with HIV/AIDS more control of their life. In fact, people with AIDS-related illnesses often get better faster and with less discomfort at home with the help of a carer.

If you are caring for someone at home, remember that each person reacts to the virus in different physical and psychological ways. Regular updates from the person's doctor or nurse on what kind of care is needed can and should be sought. Many times what is needed is not medical care, but help with both coming to terms with emotional issues and the carrying out of the normal chores of life: shopping, paying bills, cleaning the house, and so on.

Caring for someone with HIV/AIDS is a serious responsibility, which can create a situation as stressful for you as for the person who is sick, so taking care of yourself as well as the person with AIDS is important (see respite care and taking care of yourself). You will have to work with the person to decide what needs to be done, how much you can do, and when additional help is needed. It may not feel like it sometimes, but rising to the challenges of caring for someone with the HIV infection and AIDS can be an emotionally rewarding experience for you both.

The links on the right will be a valuable source of information and support, as can your local carers centres, other charitable organisations and your social services; you may also like to meet people in the same situation by posting a message on our discussion boards or visiting our online chat room.

Down's Syndrome is a condition someone is born with which causes learning disabilities, caused by an extra 'number 21' chromosome. It can come from either the mother or the father and there is no way to predict it. Down's Syndrome is the most common cause of developmental disability and there are currently around 30,000 people with Down's Syndrome in the United Kingdom alone, 200,000 in Western Europe, and more than 2 million worldwide.

There are thought to be up to 120 features of Down's Syndrome, but many children experience no more than a handful of these. Aside from several physical traits (see accompanying resources for more), the main mental symptoms include a slower rate of learning new skills, meaning those affected often meet their 'developmental milestones' such as walking or talking later.

Parents or other carers of those with Down's Syndrome can feel extremely stressed, especially immediately after diagnosis. It is important during this time to seek help; usually a community midwife and health visitor will visit the family at home early on, offering emotional support and advice on practical ways of coping with difficulties such as feeding problems. The help they provide, as well as that provided by other organisations and support groups, can lead to a period of positive adjustment and optimism as the realisation sets in that people with Down's Syndrome can live a life every bit as full and rewarding as anyone else.

As the child grows up meetings with the health visitor should be ongoing, and can really help to look after the health of the family as a whole. A speech therapist, physiotherapist and occupational therapist may well have important roles too, both from a very young age and later during the child's schooling. There are a great many avenues of support that parents or carers of people with Down's Syndrome can investigate, from respite care, to benefits and other financial support (social services benefits could include, for example, Disability Living Allowance).

Carers may also wish to meet other families who have a child with Down's syndrome. They can do this through their local branch of the The Down’s Syndrome Association. The The Down’s Syndrome Association, and other organisations such as those listed on the right, will also have information available on their website on support available for adults with Down's Syndrome. Finally, we would encourage carers who wish to make contact with other families with experience of Down's Syndrome to visit our discussion boards and chat room facility.

Travelling by air

There is a description of facilities for disabled people in most airport passenger information leaflets and websites. All major terminals in the UK are equipped with ramps, dropped kerbs, automatic doors, lifts, accessible toilets, restaurants and shops, and low-level telephones. But again it is important you let the airline know in advance if you think you might need any specific help well in advance.

Getting to and from the airport

There are accessible public transport links at several airports including Heathrow, Gatwick, Stanstead, Manchester and Newcastle, but again check to see what facilities they have. If you are going to travel by train, you need to book in advance.

Parking

If you are planning to drive to the airport, you could call them to find out about parking arrangements. Most airports have bays for disabled badge holders in short-term car parks, which are closer to the terminal. Advance warning may be required for long-term parking or for transfer to the terminals by courtesy coach.

Other special requirements

If you are travelling with someone who needs special handling, or has special dietary requirements, you should speak directly to the airline. This applies even if you have booked through and explained the situation to a tour operator, just to confirm details of such requirements have got through.

Procedures at the airport

Procedures at airports vary depending on the authority, the airline and its handling agent. Again you should check directly with the airport if you are worried about anything. Almost every Airport globally has a website and you can email them.

On the aircraft

If you need extra leg room, ask; the cabin crew will try to assist you. You might get an upgrade if you enquire. Some airlines carry an aisle chair on every flight, which can be used to move the one you are caring for from their seat to the toilets. If you require one, you should request it when making your reservation. It's also important to find out from the airline about the accessibility of the toilets themselves. If you think it will be difficult for the person you are caring for to use their facilities, perhaps alternative arrangements can be made – including catheters, but do check with the airline.

Travelling by sea

Access to ferries/cruise liners may be a problem, so check with the port and ferry company, as they will arrange assistance if you feel you need it. Facilities on both ferries and cruise liners will vary, but there should be accessible lifts, toilets, and wheelchair access to public areas on all but a few. However, on older vessels some areas may be inaccessible to wheelchairs – and assistance from crew or travelling companions may be required to negotiate storm sills (in doorways), heavy doors or service lifts. For information on cabin accessibility you should speak to the travel operator direct.

Travelling with equipment

Always try to keep the equipment that you take with you on holiday to a minimum. Take only what is essential; the destination country may have places where you can hire equipment or gain access to things like mechanical services. It is impossible to be prepared for every eventuality but, in the event of serious difficulties, emergency assistance should be available locally.

If you need specialist repairs, foreign disability organisations will probably be able to help. You should be able to obtain phone numbers for these from the appropriate embassy or possibly your travel company – so it's probably an idea to find these and keep them handy just in case. If you use electrical equipment such as a ventilator, check the voltage supply in the country you are visiting and carry a supply of spare batteries.

Travelling with medicine

A complete set of the regular medicines used by the person you care for should be stowed in each piece of luggage, so that the loss of one suitcase is not as serious as it could be. You should also ensure that you have enough to last the one you're caring for through any possible delays. If travelling by air, medicines should be carried in your hand luggage with additional supplies in your suitcase. Carry a doctor's note if entering countries with strict drug controls and be ready to show this to customs officers, and you should remember to research any potential health hazards associated with the country you are travelling to.

An estimated 1 in 5 of the population of Scotland will experience depression at some point in their lives and the World Health Organisation (WHO) predicts that depression will soon be the second biggest cause of illness world-wide. In 2004-5, 321,000 people in Scotland consulted a doctor for depression and research has shown that as many again had depression but did not present themselves for medical help. On top of the people affected personally, it also affects their friends and family, neighbours, employers. Depression will affect us all in one way or another.

The exact cause of depression is not known although medical researchers have a number of ideas. For some people it can occur for no apparent reason, others can pinpoint a trigger such as a difficult life event, a bad time in their past or some sort of trauma. It appears that in some families there can be a genetic element. Whatever the cause, it is important to remember that depression is an illness as there is a lot of stigma around it and somebody may feel weak or ashamed to have depression. There is no need to - it is as much an illness as cancer or diabetes.

How does depression affect someone?

Depression varies in severity and can present itself in different forms such as postnatal depression, bipolar disorder (formerly know as ‘manic depression’) and seasonal affective disorder. In addition, experiencing depression can create specific issues for different sectors of society such as children, teenagers, men, women, ethnic minorities and older people. As this website is developed we will be looking at all these different aspects of depression.

Depression affects everything in a person’s life:

Physical symptoms

We may find our sleep patterns changing, our appetite is different and we may have aches and pains that are not explained by a physical illness. We may feel tired and drained and lacking in energy most of the time.

Mood and emotions

Many people with depression have a persistant low mood and even doing things that would normally cheer us up does not improve it Depression can make us more irritable than usual or we may feel numb and unable to feel any emotion. We may cry a lot or feel like we are unable to cry at all even though we may want to. The depression is often accompanied by anxiety which can become overwhelming at times.

Thoughts

depressed manDepression also affects how we think about ourselves, about others, about our work, our home, our friends and family and everything else in our life. We become preoccupied with negative thoughts and are often bleak and pessimistic about the future. We feel bad about ourselves and lose our confidence and belief in ourselves and our own abilities. It is common for us to have suicidal thoughts and in severe depression we may become actively suicidal or simply lose the will to live. People are often affected in different ways by depression, one person may find that they want to sleep all the time, another may get insomnia and not be able to get to sleep at all or wake at an early hour. It can make normal everyday tasks like getting dressed or doing the shopping feel like an impossible mountain to climb.

A list of common symptoms of depression

Symptoms may include:

• Feelings of hopelessness
• Inadequacy
• Anxiety
• Self-hatred
• Negativity
• An inability to enjoy things which were once pleasurable in life
• Guilt
• Agitation
• Weight loss or weight gain
• Loss of energy or motivation
• Loss of sex-drive
• Disturbed sleep
• Poor concentration, indecisiveness
• Irritability, anger
• Social withdrawal
• Unexplained aches and pains
• Self-harm
• Recurring thoughts of death or suicide

Long-term illness or disability may have a significant impact on even the healthiest of physical relationships. Once the initial feelings of shock subside, many couples find themselves going through a period of mourning, a time when they are coming to terms with changes in lifestyle, personal identity and all aspects of their relationship, not least sexual. It can feel like an emotional rollercoaster, with anger, guilt, sadness, loss, frustration and yearning all playing a part. When couples are able to talk openly about these emotions, it can bring them closer together. But many find they are dealing with the myriad of distressing emotions alone and may find themselves feeling isolated and resentful. If this sounds familiar, click here to find out how counselling might help you through this time.

Sexual relationships

When caring, all sorts of areas of life are affected in different ways. The one area that receives little, if any, attention is that of sexual relationships. One of the most common questions carers have is whether or not it is safe to have sex with their partner, for example, if their partner has had a heart attack or stroke. Doctors and health visitors can often provide the answers. If you don't feel able to discuss such matters face-to-face, you could contact any of the websites listed below, or the website dealing with the specific condition relevant to your circumstances.

If your partner has received an injury that restricts mobility then finding a comfortable position may be a problem. Again, because this is dependent on each individual case, there is no one answer. However, there are a number of organisations that can provide a range of information on issues related to sexual relationships. Some are listed at the bottom of this page.

Another issue that carers can find difficult is the loss of their wider physical relationship. By this they often don't just mean sexual intercourse, they mean the physical contact that is part of an intimate relationship, the hugs and cuddles that make us feel wanted and attractive. Again this is a loss and needs to be acknowledged as such. Recognise that your partner may be missing that comfort as well. If you can talk about it and share that loss you may be able to find new ways of expressing those intimate and meaningful gestures. Even if you cannot talk to your partner about any of this you can talk to someone yourself. Counselling is available and it can help.

Changing roles

Some couples find that taking on the role of carer and the person cared for can feel a bit like becoming a parent and child. Finding ways to adapt to a new model of partnership will help you to ensure you fulfil your relationship. It's important that you are both able to maintain a sense of independence. To ensure you are taking advantage of all opportunities to develop your partnership, you could sit down together and create a list of possibilities, either things you'd like to continue doing or anything new you'd like to try.

Friends and lovers

For most couples, physical intimacy is a crucial part of the relationship. A common misconception is that the onset of illness or disability automatically means the end of any kind of sexual relationship. But this needn't be the case. Many couples enjoy finding new ways to be sensual together and regain physical intimacy. Assuming your GP has no medical objections, you can experiment with a range of sexual activities and positions that will suit you both. Some couples have found that the increased creativity required in their sex life has actually made it better than ever before! There are a wide range of medical interventions available today to help with sexual problems, so do speak to your GP about potential options. And remember, even if you can't have sexual intercourse together anymore, you can still be sensual. Touch is an essential part of being human, so take every opportunity to get a little closer.

Sources of Help

Many couples find that working through their problems together brings them closer. Some are able to do this on their own, but many others choose to consider counselling. Relate has been offering relationship counselling and support for over 60 years. As well as offering face-to-face appointments, Relate has a number of options for individuals and couples who are unable to attend one of their centres.

Here's some great advice from Duke University Medical Center for starting to exercise:

See your doctor

Especially if you haven't been active in a long time, or haven't had a checkup recently, it's a good idea to have your doctor identify any concerns before you start a challenging exercise program.

Identify your goals and preferences

Do you want to lose 10 pounds? Participate in a 5K run? Or simply take up a healthy habit? Your goals can help you decide whether you need a challenging or more moderate exercise program. Be sure to choose an activity you like to do, whether it's walking, swimming, or even dancing‹you'll be more likely to stick with the program.

Consider starting with mini-workouts

A good first goal is to accumulate 30 minutes of moderate physical activity most days of the week‹the current recommendation for good health. You can realize significant health benefits by squeezing in just five or ten minutes of exercise several times throughout the day. Try parking your car a good distance from the door or getting off the bus a couple of blocks early. Make your office inefficient: put the trash can far away from your desk, and get a cordless phone so you can walk around while you talk. At home, mopping and other active chores count. You can also give up your remote control‹the walk from sofa to TV translates into an average of four miles a week. And if you get up and move during the commercials, in just three hours of TV time you'll have done 50 minutes of exercise.

If you'd like to start a more formal exercise program, walking or running are great choices‹you don't need fancy equipment and you can exercise almost anywhere. Here's a plan for success:

Stretch after workouts to prevent soreness and injury and increase flexibility. Hold each stretch for 20-30 seconds. Five to 10 minutes makes a big difference.

Drink plenty of fluids

Drink at least two cups of water both before and after exercise, even if you're not thirsty (a sign of dehydration). If it's hot, humid, or you're exercising vigorously, drink a cup of water every 15 minutes during your workout as well. Weigh yourself before and after a workout‹if you've lost five percent or more of your body weight, you're dehydrated and need to replenish your fluids.

Wear the right attire

While you don't need special clothing, do dress appropriately for the weather‹and buy good shoes to prevent injury. We recommend going to a store that specializes in walking and running equipment, where trained staff can help you find a shoe that fits your particular needs.

Challenge yourself--but slowly

Start off walking for 20 to 30 minutes four days a week at a comfortable pace. Begin alternating 2-5 minutes of brisk walking with 2-5 minutes of easy walking, gradually increasing the ratio of brisk to easy. Once you've worked up to 30 minutes of brisk walking, you could add in running if you like. At first, run 30 seconds, then walk 90 seconds, and repeat for 30 minutes. When that's comfortable, move to 45 seconds of running and 75 seconds of walking, then 75 walking/45 running, then 90 running/30 walking, until you're running for 30 minutes. The whole process could take anywhere from eight weeks to four months‹listen to your body and don't feel pressured to go too fast.

Consider adding strength training to your aerobic exercise (like walking and running) if you have time. We recommend doing strengthening exercises with weights for 15 to 20 minutes two to three times a week. For efficiency, do one set of 8 to 12 repetitions for each of the major muscle groups (8 to 10 exercises). Work to muscle fatigue‹if you can finish the set easily, use heavier weights.

Each year, more than 65 million Americans are affected by back pain. The back is second only to the head as the most frequent location for pain in the body, and this is no surprise considering the many nerve endings contained in the disks, ligaments and muscles that surround the spine. Simple everyday activities can lead to back pain. The most common causes are strained muscles, tendons, and ligaments or inflamed joints. These are usually due to improper or heavy lifting, poor posture, or improper stretching. Other causes of back pain include ruptured or herniated disks, arthritis, scoliosis (curvature of the spine), and spondylolisthesis (shifting vertebrae).

To help prevent back pain from occurring and/or recurring, try these tips:

• Exercise regularly. A program that includes 30 minutes of low-impact aerobic activity such as walking, cycling and water aerobics several times a week will help tone back muscles.
• Build muscle strength. Conditioning exercises that focus on your back, abdomen, hips, and legs can help support your spinal region.
• Lift heavy objects with your legs. You can avoid straining your back by squatting and bending your knees, and then moving straight up and down. Do not lift objects and twist your body simultaneously.
• Watch your weight. If you are at all overweight, you can decrease the stress on your lower back dramatically by just losing a few pounds, which can help prevent and ease back pain.
• Maintain good posture. Don't slouch or bend forward when sitting or driving, and try to avoid remaining in one sitting or standing position for long periods of time.
• Sleep on a firm mattress. Sleep on your back or side, and avoid using a pillow that forces your neck into a severe angle.

Millions of people pursue exercise regimens to help them stay physically fit as they age. But what can you do to help your mind stay resilient and youthful as you grow older? The good news is, quite a lot. Here's advice from Duke University Medical Center on how to do it. Just as you can exercise your body to fight off the effects of physical aging, you can keep your brain stronger longer with special mental exercises. These exercises, which I call "Neurobics," are based on the latest findings from leading neurobiology labs at Duke and around the world.

Brain cells learn by literally making new connections with one another. For a long time, it was assumed that these connections could only be established during youth. But new scientific evidence shows the opposite: Even quite late in life, the brain has quite a lot of residual capacity to reorganize and "rewire" itself. Because a huge area of our brain is devoted to processing sensory inputs, Neurobics uses the full range of senses (often marginalized by modern conveniences and daily routines) to help forge new connections among the different sensory structures of the brain. The exercises are easy, fun, and simple. Yet, if done on a regular basis, they will help keep your mind fit to meet any challenge--whether it's remembering a name, mastering a new computer program, or staying creative in your work.

To be a Neurobic exercise, an activity must involve one or more senses in a novel way, engage your attention, and add an unexpected element to a routine activity. Try some of the following, and discover the value of "cross-training your brain."

• Wake up and smell the vanilla. Instead of waking to the usual smell of freshly brewed coffee, try smelling something different--such as vanilla, peppermint, or rosemary. Linking this new aroma with your morning routine will activate new neural pathways.
• Go through your morning rituals--such as combing your hair, brushing your teeth, styling your hair, applying makeup, getting dressed, eating your breakfast, and so on, using your nondominant hand.
• Shower with your eyes closed. Locate the taps, soap, and so on, adjust water temperature and flow, and wash yourself using just your tactile senses. Also try closing your eyes as you get into your car, find your keys, and start the car--and when finding your keys and opening the door when you return home.
• Make a "sensory canister" containing such aromatic substances as sage, thyme, or cloves and take a whiff when you dial a certain phone number. See if it helps you remember the number.
• Learn the Braille numbers for the various floors in the elevator of your office building.
• Turn the pictures on your desktop or shelf upside down.
• Go to new markets, such as an ethnic market, farmers' market, or bakery, to experience new sights and aromas.
• When traveling abroad, rent a car, figure out the roads and drive to a small town where you don't speak the language, stay in a local bed-and-breakfast, and try unfamiliar foods.

The organs of sexual reproduction are the gonads , which are the ovaries in females and the testes in males. Females produce female gametes, (eggs); males produce male gametes, (sperm).

Fertilisation

When a female is born, each of her ovaries has hundreds of thousands of eggs, but they remain dormant until her first menstrual cycle, which occurs during puberty. At this time, during adolescence, the pituitary gland secretes hormones that stimulate the ovaries to produce female sex hormones, including oestrogen, which helps the female develop into a sexually mature woman. Every 28 days or so from puberty until menopause, between one and three eggs, the size of the head of a pin, are released from the ovaries. A complex set of hormonal events trigger the release of eggs and send them on their way down the fallopian tubes towards the Uterus. This whole process takes about three minutes and is known as ovulation. Sexual reproduction is the fertilization of a female gamete by a male gamete. Before ovulation, the cervix produces a special mucous for about 3 to 9 days. This mucous is as crucial to fertility as ovulation because without it, the male’s sperm cannot survive nor be transported inside the female to fertilize the eggs. When mucous is present, it nourishes and protects sperm allowing them to live for 3 to 5 days.

Reproduction

Human reproduction is much the same for all mammals. It is the hallmark of life – essential for the cycle of living things. Conception refers to fertilisation of the female egg by the male sperm. When an egg is released from one of the ovaries at ovulation, between day 9 and day 16 of the menstrual cycle, it makes its way down the fallopian tube to the already prepared uterus. During intercourse, the male ejaculates; about one tenth of an ounce of semen is deposited into the vagina. Between 200 and 300 million sperm are in this small amount of semen. If a female and male have sexual intercourse within several days of ovulation, fertilization can occur. The sperm travels through the cervix into the upper part of the uterus and then into the fallopian tubes where the sperm meets the egg. If the sperm manages to enter the egg, it becomes fertilised and a new life can begin. It takes only one sperm to fertilize the egg.

The development of a baby

About a week after the sperm has fertilized the egg, the egg has become a multicelled blastocyst, a pinhead-sized hollow ball with fluid inside, now present in the uterus. The blastocyst burrows into the thickened endometrium, which is the lining of the uterus. It is the Oestrogen that causes the endometrium to thicken and become rich with blood, and progesterone, another hormone released by the ovaries, keeps the thickness of the endometrium constant so that the blastocyst can attach itself securely to the uterus and continue to absorb nutrients from it. This process is called implantation. The egg grows and develops inside the uterus (womb) over the next 40 weeks under the protection of the newly developed placenta. The egg develops into an embryo and then at eight weeks, it is a foetus with recognisable features such as hands, feet and eyes.

The placenta

The placenta, which is soft and filled with the embryo’s blood, begins to form and grow during the first 4 weeks. The wall of the placenta is very thin which allows the mother’s blood supply to come alongside the foetus but their blood does not mix. Food and oxygen is passed from the mother to the foetus, and the waste and carbon dioxide is passed back from the foetus to the mother by the umbilical cord, which connects the baby to the mother’s placenta. The developing foetus does not breathe inside the uterus, but instead it uses the placenta to get what it needs to develop and survive.

Birth

After about 40 weeks, the baby is ready to be born. Birth is much easier if the head presents itself first into the vagina. There are muscles in the uterus that contract gently to start with and then the contractions get very strong in order to push the baby out of the mother’s body. The mucus that has formed a plug in the cervix loosens, and with amniotic fluid, comes out through the vagina when the mother's "water" breaks. The early contractions cause the cervix to relax and widen to approximately 10 centimetres, enough for the baby to come through, and can take many hours. The muscles eventually start to push the baby down through the cervix and then through the vagina, which also enlarges slightly to become the birth canal.

The baby is still attached to the uterus by the umbilical cord and the placenta. Once the baby is in the open air, it is able to breath for its self. The placenta is not needed now and is also passed through the vagina. This is called the afterbirth. The umbilical cord is cut and clamped, and as there are no nerves in the cord, it is painless. The mark left is of course, the belly button.

Without the female reproductive system, there would be no continuation of our species. The female is dependent on the male for fertilization of her egg, but it is she who carries the developing baby through pregnancy and childbirth. If people didn't reproduce, families would die out and humans would cease to exist. Humans, like other organisms, pass on certain characteristics of themselves to the next generation through their genes, the special carriers of human traits. The genes that parents pass on to their children are what make children similar to others in their family, but they are also what make each child unique. These genes come from the father's sperm and the mother's egg, which are produced by their respective reproductive systems. Girls and boys have different sex organs. Only girls and women have vulvas and only boys and men have penises.

Female Reproductive Organs

Unlike the male, the female reproductive system is almost entirely hidden within the pelvis. It consists of organs that enable a woman to produce eggs (ova), to have sexual intercourse, to nourish and protect the fertilized egg (ovum) until it is fully developed, and to give birth.

Female Reproductive Organs

Females have external sex organs, positioned between the legs, collectively called the vulva. The outer parts of the vulva cover the entrance to a narrow canal called the vagina. The fleshy area found above the top of the opening of the vagina is called the mons pubis. A delicate piece of tissue, called the hymen, partially covers the opening of the vagina. The labia made up of two pairs of skin flaps, surround the vaginal opening. The clitoris, which is located toward the front of the vulva where the folds of the labia join, is a small cylindrical structure similar to the male penis; it also contains erectile tissue. Inside the labia are openings to the urethra, (which is the canal that carries urine from the bladder out of the body), and vagina. The outer labia and the mons pubis are covered by pubic hair in the sexually mature female.

The internal sex organs include the vagina, uterus, fallopian tubes, and ovaries. The vagina is between 7 and 15 centimetres in length, and is a closed, tubular structure that extends from the opening of the vagina to the uterus. The vagina has muscular walls lined with mucous membranes, which serves as the female organ of copulation (sexual intercourse) as well as the birth canal. The vagina connects with the uterus, which is shaped like an inverted pear. This muscular, expandable organ with thick walls is also called the womb, which holds the developing foetus during pregnancy. At the lower part of the uterus is the cervix, which opens into the vagina. At the upper part, the fallopian tubes connect the uterus to the ovaries. The ovaries are two oval-shaped organs that lie either side of the uterus. They produce, store, and release eggs through the fallopian tubes into the uterus. The ovaries also produce the hormones oestrogen and progesterone. The breasts are also part of the reproductive system. Mammary glands inside the breasts secrete milk after childbirth.

Becoming a young woman

Having periods means that you are now at an age when you are fertile. This is a difficult time for girls and boys. Hormones are rising and you will be attracted to boys in a more sexual way. It is a difficult time because physically girls are ready to have babies, but emotionally and socially, it is not the time to be producing children, so you have to manage the feelings and urges of a mature adult whilst coping with the issues of growing up. Being aware of your body and recognising the changes is an important part of being in control of your emotions. Take a look at the Monthly Matrix to learn more about the changes that take place in your body each month.

Girls tend to know less about their genitals because mostly, they are hidden inside our bodies. Take time to check yourself out by using a mirror because it makes sense to learn by looking, especially if you are trying to use a tampon for the first time. The vagina is an opening in the female body that is directly below the opening from where you pee (the urethral opening). Two folds of skin (the labia) meet to form the vulva, which is the entrance to the vagina. The labia, clitoris, urethra, and the opening of the vagina, are all part of the vulva. Internally, it is more difficult, but remember that the vagina is not a gap or cavity inside of you but a “potential” space because the muscular vaginal walls are normally touching each other rather than being an open canal as depicted in diagrams. When something enters the vagina, the body makes room for it no matter how small or large it may be. This is important to keep in mind when using a tampon. The vagina is able to change its size to hold a tampon in place, to allow the penis to enter for reproduction, and to let a baby pass through when giving birth.

The vagina is connected to the uterus (also called the womb) at an angle. This muscular sac, where a baby develops, has a rich blood lining called the endometrium. The uterus leads to the fallopian tubes and the ovaries. At the meeting of the vagina and the neck of the uterus, there is a ring of muscle called the cervix. The bladder and the tube that allows urine to pass out of the body (the urethra), sits in the space just in front of the uterus, and is completely separate from the reproductive system. However, the urethra opens into the vulva in front of the vaginal opening.

Becoming a young man

Boys also go through puberty when their bodies change and develop. This is normally between the ages of 11 and 14 when their voices deepen and squeak a little. Remember that boys are as sensitive as girls about the changes they are going through, so avoid the temptation to joke about their voices. Their armpits grow hair and they may start to develop spots on their face and backs. Their shoulders broaden and they start to develop muscles, but just like many girls, they may become self-conscious about their bodies and their skin whilst some become much more confidant.

During this time, the penis and testicles start to grow bigger and pubic hair starts to appear. Two testicles hang beneath the penis in a sac called the scrotum. The testes are the male glands that make the microscopic, tadpole-shaped sperm cells that fertilise the female eggs. The female glands are the ovaries where the pinpoint-size egg cells are stored until being released each month.

Menstruation, better known as a Period, is the final proof that a girl is becoming a woman. You may have already started having your periods. If you have, you could be a great “buddy” for a friend who has not yet started, by discussing what happens to you each month during your period. If your period has not started yet, you are probably anxious about the subject or concerned that your friends’ periods have started and you have no obvious signs. Remember that not everyone is the same. Our bodies develop at different rates and so menstruation can start anytime between the ages of 8 and 16. Your periods may be a bit irregular at first because your body needs time to fine-tune the menstrual cycle. The loss of menstrual blood and tissue can vary also. Everyone is different so learn about what is normal for you. Some girls get cramps in their abdomen just before and during the first few days of a period. This cramping is usually caused by your body’s response to a hormone called prostaglandin, which cause the muscles in the uterus to contract. The same hormone can also cause you to get a headache before your period. Over the counter pain relievers will help if the pain prevents you from doing your usual activities.

As your period gets closer, it is possible to feel very emotional, moody or even angry. You may even prefer to eat only certain foods, and most likely, crave chocolate. This is called Premenstrual Syndrome or PMS for short. The hormones changing during your cycle cause it, which affects you both physically and mentally. Feeling bloated is due to water retention, but when your period starts, all these symptoms will go away. Certain foods can make the PMS worse, so if you think you are suffering, keep a check on your calendar what foods you think make you feel worse. Supplements such as B6, essential fatty acids and Vitamin E can help to alleviate the symptoms of PMS. If you are badly affected, speak to your doctor about it. Many girls get some spots before their period starts and for a few days into the cycle. It is normal and most girls get them, so don’t let them affect you.

Why do periods happen?

Each month during puberty, special chemicals inside of you, called hormones, cause the body to release an egg from one of the two egg sacks, called ovaries. This is where all of your eggs are stored and usually each month, about 10 to 20 tiny eggs called ova start to ripen but only one or two eggs are released. The egg then travels onwards to the womb via the Fallopian tubes. The womb, also called the Uterus, prepares for the egg by laying down extra tissue and blood vessels, ready to support and nourish the growing foetus. Only if the egg meets sperm released from a boy during sex will it be fertilised and slowly develop over 9 months into a baby. If the egg is not fertilised or implanted, it passes right through and just dissolves. The spiral arteries of the lining created in the womb close off, stopping blood flow to the surface of the lining. The blood pools into "venous lakes" which, once full, burst and with the endometrial lining, forms the menstrual flow, which escapes through the vagina. This is what you experience as your period.

How long do periods last for?

The Menstrual cycle will happen nearly every month except when being pregnant or until there are no more eggs to release, usually between the ages of 45 and 55. The cycle can be as short as every 21 days, or as long as every 35 days. It can last 2 to 3 days or as many as 6 to 7 days. Not all girls are the same, and neither are their periods. Some girls will have very light periods and some will have heavy periods and sometimes they will vary according to your hormones, your age, how much stress you are experiencing, and even how much training you do.

What different sanitary pads and tampons are there to use?

Sanitary pads fit inside your pants by means of a sticky strip, which keeps the pad in place. There are different types of pad and it is a matter of choice, which style you use. There are pads with and without wings. Some are for the earlier days of your period when the blood loss is heavier, and others for less heavy days towards the end of your period. You should read the packaging carefully to try to find out what the pads are made from because some materials used in many pads can be irritating to the skin. The pads should be changed regularly and disposed of in a bin.

Tampons are also available in different sizes to suit the amount of blood lost during a period. Some tampons you insert using only your index finger, and other tampons have a cardboard or plastic applicator to help you to insert it into the vagina. There is a cord that hangs outside of the body to help you to remove the tampon when you need to change it. It may not be easy to see when a tampon needs to be changed, but you should change the tampon at least every four hours. You need to make sure that you wash your hands before and after doing so. Always remember to remove the tampon before inserting a new one. At the end of a period when there will be only a very small amount of blood, it is better to use a pad rather than a tampon. Some practice is needed before you get used to putting in a tampon, but you should not use a tampon unless you are having a period. Using them when you do not have a period can cause dryness and irritation, and will absorb the protective mucous that your vagina produces to keep it clean.

It is important to make sure that you read the instructions and the safety information before using tampons. You should not use a tampon during the night when you are asleep because you are likely to then have a tampon inside of you for over eight hours without it being changed. It makes sense to only use tampons when you really need to, but choosing to use a mixture of pads and tampons is the most sensible thing to do.

Looking after your body?

You should read the packaging carefully to try to find out what the tampons and pads are made from because most are made from synthetic materials that are bleached with harsh and environment damaging chemicals called chlorines that produce toxic chemicals in the environment called Dioxin. Try to avoid tampons made from synthetic materials like rayon and viscose and pads that use lots of plastic, and synthetic materials that claim to be “cotton-like” as they are largely made from synthetic materials that are almost impossible to dispose of in the environment. If you would like to find out more information about the types of materials used to make feminine hygiene products like sanitary pads and tampons, take a look at the Citizenship projects. Organic cotton tampons and plastic and chemical-free pads are recommended by many gynaecologists in order to avoid the risk of allergic reaction caused by exposure to synthetic materials and chemicals.

When your periods start for the first time, it is important to start checking your breasts each month so that you learn what is normal for you so that if something unusual is noticed you can get it checked out straight away by a doctor. Look at the diagrams and the instructions on how to examine the breasts and start the routine of checking your breasts after your period has finished each month.

Growing up is about many things and involves changes from the way you choose to spend your free time to the shape of your body. Growing up doesn’t happen all at once, and some changes you will hardly notice at all because they take time to develop. This time of change is called adolescence and is the in between time of being a child and becoming an adult. Puberty can begin between the ages of nine to fourteen and there are some changes that only happen to boys and some happen only to girls. It is your hormones that cause your body to change.

Hormones are natural chemicals that control all sorts of changes in your body. Growth hormones make you grow taller and sex hormones control the changes in both girls and boys. In girls, these hormones cause the ovaries to make other hormones called oestrogen and progesterone. You will start to become curvier at this time and your breasts will start to develop by gradually growing and getting fuller, so you may need to start wearing a bra, especially if you are playing sports because this will support them and stop them from feeling uncomfortable. Often, one breast grows a little quicker than the other. Some girls’ breasts grow more quickly than other girls, and some remain small all their adult life. Also during puberty, your waist becomes narrower and your hips rounder, and soft hair will start to appear under your armpits, on your legs and you will gradually develop pubic hair. The pubic area in girls is made up of the Vulva, which contains the Labia, Clitoris, Urethra and the opening of the Vagina.

Female reproductive system

You will also start to put on a little more weight. Hormones are also the reason why you feel emotional. You may feel angry, sad and feel moody and lose your temper easily. This is natural, but if you feel that you are not able to cope with these strong emotions, talk to a parent, your teacher or your doctor about how you feel. Remember that not everyone develops at the same rate or at the same time, so some of your friends may already have gone through these changes while others may not have even begun them. Speak to your friends or set up a “buddy network” to share experiences. Puberty also means that you will soon begin menstruating – or having your period. This is one of the most important changes because it means that you are becoming a woman and it is nature’s way of letting you know that you are now physically able to have babies. The parts that can make a baby are inside our bodies and are called the reproductive organs.

Reproductive organs

Girls have two ovaries that hold thousands of tiny eggs. These eggs would have been inside you when you were still developing as a baby inside your mother’s womb. About once a month, one of your ovaries releases an egg that passes into one of the fallopian tubes and onwards towards the uterus. This is called ovulation and is very important because this is the time that an egg can become fertilised and develop into a baby. Before an egg is let go, the uterus creates a rich lining of tissue and blood vessels, which is important to keep a fertilised egg alive. Usually, an egg breaks apart before it reaches the uterus, but if sperm from a boy or man’s penis meets the egg on its way to the uterus, it can fertilise the egg and pregnancy begins when this fertilised egg attaches itself to the lining of the uterus.

When the unfertilised egg breaks apart, the lining is no longer needed, so it flows out of the uterus, through the cervix, down the vagina and out of the body. This is the menstrual flow. To protect your clothes from this flow of tissue and blood, you will need to use sanitary pads or tampons. A period can last from 3 to 7 days and the menstrual cycle repeats itself approximately every 28 days until the age of between 45 and 55, with the exception of when becoming pregnant.

Periods are a sign that you have reached puberty. The first period usually happens between the ages of 12 or 13, but could begin as early as aged 8 or as late as aged 17. A period lasts between 2 to 5 days and involves a small amount of blood loss from the vagina that is only about the amount of about 4 to 6 tablespoonfuls. The time between one Period to the next is called the Menstrual Cycle. This usually lasts between 28 to 32 days, but your body will need to get used to the new routine over a year or two before the menstrual cycle becomes more regular. You will need to use either sanitary pads or tampons to protect your underwear. Pads soak up the blood as it leaves your body and tampons fit inside your vagina and absorb the blood before it leaves your body. It is for you to choose which is the easiest and most comfortable to use.

Why do periods happen?

Each month during puberty, special chemicals inside of you, cause the body to release an egg from one of the two egg sacks, called ovaries. This is where all of your eggs are stored. The egg then travels onwards to the womb. Only if the egg meets sperm released from a boy during sex will it slowly develop over 9 months into a baby. Usually, the egg just passes right through without being fertilised and just dissolves. Since the womb no longer needs to be ready to grow the egg, it sheds the extra blood and tissue it made out through the vagina. This loss of tissue is called menstruation or the period. This cycle will happen nearly every month except when being pregnant or until there are no more eggs to release, usually between the ages of 45 and 55.

The menstrual cycle is actually a very special and very complicated process that happens because many parts of the body are working together. The body, including the brain, all have to work together properly to make this cycle work. This includes:

• Releasing an egg each month from the ovaries.
• Preparing the body by making a special lining in the womb in case the egg is fertilised and develops into a baby.
• Making the womb discard this special lining if the egg has not been fertilised
  

Females are truly amazing!
Keeping a menstrual diary helps you to work out when your next period should start. It is also very important to learn how to examine your breasts each month. This is good practice for life so that you get to know what is normal for you.

What different sanitary pads and tampons are there to use?

Sanitary pads fit inside your pants by means of a sticky strip, which keeps the pad in place. There are different types of pad and it is a matter of choice, which style you use. There are pads with and without wings. Some are for the earlier days of your period when the blood loss is heavier, and others for less heavy days towards the end of your period. You should read the packaging carefully to try to find out what the pads are made from because some materials used in many pads can be irritating to the skin. The pads should be changed regularly and disposed of in a bin.

Tampons are also available in different sizes to suit the amount of blood lost during a period. Some tampons you insert using only your index finger, and other tampons have a cardboard or plastic applicator to help you to insert it into the vagina. There is a cord that hangs outside of the body to help you to remove the tampon when you need to change it. It may not be easy to see when a tampon needs to be changed, but you should change the tampon at least every four hours. You need to make sure that you wash your hands before and after doing so. Always remember to remove the tampon before inserting a new one. At the end of a period when there will be only a very small amount of blood, it is better to use a pad rather than a tampon. Some practice is needed before you get used to putting in a tampon, but you should not use a tampon unless you are having a period. Using them when you do not have a period can cause dryness and irritation, and will absorb the protective mucous that your vagina produces to keep it clean.

Looking after your body

You should read the packaging carefully to try to find out what the tampons and pads are made from before buying because most are made from synthetic materials that are made without care for the environment. Try to avoid tampons made from materials like rayon and viscose which are man made (synthetic) and pads that use lots of plastic, and synthetic materials that claim to be “cotton-like” as they are largely made from synthetic materials that are almost impossible to get rid of in the environment. If you would like to find out more information about waste disposal and feminine hygiene products like sanitary pads and tampons, take a look at the Citizenship projects.

Organic cotton tampons and plastic and chemical-free pads are recommended by many gynaecologists in order to avoid the risk of allergic reaction caused by exposure to synthetic materials and chemicals. Try to choose natural products whenever possible. When your periods start for the first time, it is important to start checking your breasts each month so that you learn what is normal for you so that if something unusual is noticed you can get it checked out straight away by a doctor. Look at the diagrams and the instructions on how to examine the breasts and start the routine of checking your breasts after your period has finished each month.

Step 1

Look at your breasts in the mirror with your shoulders straight and your arms on your hips.

This is what to look for:

• breasts that are their usual size, shape, and colour.
• breasts that are evenly shaped without visible distortion or swelling.
  

If you see any of the following changes, visit your doctor:

• dimpling, puckering, or bulging of the skin.
• a nipple that has changed position or a nipple that is pushed inwards instead of sticking out (an inverted nipple).
• redness, soreness, rash, or swelling.
  

Step 2

Next, raise your arms above your head, lightly grip your fingers and look for the same changes.

Step 3

Lightly squeeze each nipple between your finger and thumb and check for any discharge that looks like a milky or yellow fluid or blood oozing from the nipple.

Step 4

Lie on your back with your right arm raised and your hand tucked underneath your head. With the left hand, check your right breast using the first few fingers of your hand with a firm, smooth touch, keeping the fingers flat and together. Cover the entire breast from top to bottom, side to side—from your collarbone to the top of your abdomen, and from your armpit to your cleavage. Follow a pattern to be sure that you cover the whole breast. Begin at the nipple, moving in larger and larger circles until you reach the outer edge of the breast. You can also move your fingers up and down vertically, in rows. Be sure to feel all the breast tissue: just beneath your skin with a soft touch and down deeper with a firmer touch. Begin examining each area with a very soft touch, and then increase pressure so that you can feel the deeper tissue, down to your ribcage. Repeat for the left breast, tucking your left hand under your head and use the right hand to examine the left breast in the same way as above.

Step 5

Now stand or sit on the edge of a chair and examine your breasts again. It might also be easier to examine your breasts when the skin is wet so you could do this step in the shower. Be sure to cover the entire breast, using the same hand movements described in Step 4.

As caring parents you know that the changes that your daughter is going through are part of her journey towards womanhood. Whilst you see her as a child, her body is making changes inside her body and out. Everyone goes through these changes at different ages and at different rates. The average age is about 13, but some girls can begin puberty as young as 8 or as old as 16 and this is quite normal. The start of puberty is usually noticed when your daughter suddenly begins to grow taller. The arms and legs grow quicker than her body, so she will seem to be a bit more awkward or clumsy than before. This growth spurt is a sign that her periods will start in about 6 months to a year’s time.

Her breasts will also gradually start to develop. First they grow as small bumps, called breast buds, then continue to develop gradually over the next 2 to 3 years. It is normal for one breast to grow quicker than the other, so your daughter may need to be reassured that this is normal. You may want to start to look at training bras for your daughter, especially if she plays lots of sport. It is important to make sure that she gets a correct fitting bra for both comfort and self-confidence. When your daughter’s period begins, it is very important to show your daughter how to check her breasts each month. This is good practice for life so that she learns what is normal for her.

6 months after her growth spurt beginning, she will start to go through a stage where she cannot get enough to eat and will start to put on weight, which is normal. 50% of ideal adult body weight is gained in puberty. In girls, the proportion of body weight in fat increases from about 16% to almost 27%. This gain in body fat will make her appear curvier around her hips. This is also a time when she will need to make sure that she gets plenty of calcium for her developing bones and muscles.

During puberty, special hormones from the brain cause the ovaries to release an egg, which is called an ovum. The ovaries then produce other special hormones called oestrogen and progesterone that cause the eggs in the ovaries to develop so that they are ready to be released.

Each month, one egg leaves one of the ovaries travelling down one of the fallopian tubes on its way to the uterus. Meanwhile, the uterus, also called the womb, starts to get prepared for the egg by building up a thicker lining of special tissue that is called the endometrium. If the egg arrives at the uterus as a fertilised egg, one that has been met by sperm from the male, it attaches itself to this cushion-like wall, and goes on to use the extra blood and tissue to nourish itself as it slowly develops over 9 months into a baby. Usually, the egg just passes right through without being fertilised and just dissolves. Since the uterus no longer needs the thicker lining, it sheds this extra blood and tissue through the vagina. This loss of tissue is called menstruation or the period. This cycle will happen nearly every month until the ovaries stop releasing eggs, usually between the ages of 45 and 55.

The menstrual cycle is actually a very special and very complicated process that happens because many parts of the body are working together. The brain, ovaries and other hormone producing glands in the body, all have to work together properly to make this cycle of producing an egg, making the uterus ready for it, and then shedding the special lining work. Not to mention the extra-complicated work that happens if the egg does get fertilised and develops into a baby. Females are truly amazing!

Here is one simple physical method which is designed to be useful in everyday situations: it doesn't aim at deep relaxation or require you to lie down for half an hour! Rather, it aims to reduce unnecessary levels of tension, so that you can continue with your current activity more effectively. It can be used just about anywhere - sitting in a lecture or examination, walking down the street, or going to sleep in bed.

How it works

In the early part of this century it was recognised that when people first tense up and then relax muscle groups, they end up more relaxed than when they began. In fact this is a natural process that we all use, for example when we stretch, or yawn.

But the key to this particular method lies in two factors:

• that we learn the difference in the sensations of being tense and being relaxed, and
• that it gives signals to the subconscious and "automatic" parts of our system (the autonomic nervous system) that "all is well", "there is no need to be tense any longer", and it is your autonomic nervous system which will do the real work by slowing down your heart rate, stopping the release of adrenaline into your blood stream, etc. - things which we do not normally have under our conscious control.
  

Hence the exercises themselves are deceptively simple. Don't be fooled - they do work; but like all relaxation methods, it takes time and practice for this to be useful in real-life stressful situations.

The method

For each of the areas of the body described, it is suggested that you tense up and then relax muscle groups. Do each exercise three times. As you get better with time at relaxing these areas, try using less tension before relaxing.

Hands

Hands are commonly one of the first parts of our body to show tension. When they tense up, they tend to either clench up into a fist, or to hold tight onto something, such as the arm of a chair, or to clasp each other. Instead, try stretching out your hands so that your fingers are straight and spread out. Hold that position for a moment and feel the tension across your palms and the back of your hands. Then let your hands relax and flop beside you, or on your lap. Resist the urge to hold onto something; just let them hang loosely beside you, or let them rest on your lap. When hands are relaxed, the fingers are gently curved, neither tightly curled nor straight, and are "floppy", not stiff.

Shoulders

When we are tense our shoulders are commonly raised i.e. hunched. Instead, pull your shoulders down; feel the tension under your arms and up your neck. Hold that position for a moment. Then let them relax and return to a natural position (i.e. not hunched ).

Head and neck

The neck muscles can only relax when they don't have to support the weight of your head - i.e. if you are lying comfortably with your head supported in a straight line with your spine, or, if you are standing or sitting, with your head balanced and looking straight ahead - neither angled to one side, nor looking up or down. Academics and people who work at desks or keyboards tend to spend a lot of time looking down, either reading, typing or writing, or looking through a microscope. So instead, try looking right up, and feel the tension in your neck; then allow your head to return to the straight ahead, balanced position.

Face

There are many muscles in our face - used, of course, for speaking, eating, facial expression... This is one of the areas most likely to show tension. As with other muscle groups, it is possible to tense up and then relax these muscles. However, do not do this if you wear either contact lenses or dentures as they could be damaged. So here is an alternative method, which has the additional advantage of being less obtrusive in company. Let all expression go from your face: let your forehead become smooth, your jaw sag with your teeth just apart (though your lips may still be closed), your eyes looking straight ahead and into the distance, and not squinting. It may help you to do this if you think of a word which describes this particular expression - "vacant"; "empty"; "relaxed"; "gormless" are some possibilities! Put this particular expression on your face.

Breathing

When you are tense, your breathing tends to become faster and shallower. So, allow your breathing to come from lower down in your abdomen (this doesn't mean inhaling a lot of air - rather, just a little air, but from low down) and this will help you to slow your breathing down a little (but don't actually hold your breath). Let it become gentle, easy and regular. Once it is comfortable, you may be able to slow your breathing a little more.