Is it safe to conceive while on blood pressure medication?

Dr Flo,

I am 40 years old. I take blood pressure medicine.

Is there any harm in trying to conceive when on these drugs?

Jane

Dear Jane,

There are many types of blood pressure medication and they work in different ways. Some are dangerous for a developing pregnancy, while some are perfectly safe.

If the medication is not safe for use during pregnancy, your gynaecologist can recommend a change to something that is safe. However, you may need monitoring for a while after you start on new medication to see if it works as well as the previous drug.

Please also note that in some people, high blood pressure worsens during pregnancy, and you will need to be under close monitoring throughout the pregnancy.

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Dr Flo,

I was diagnosed with duodenal ulcers in 2014 and I took medication for almost a year. After that the pain went away for six months then it returned with a vengeance. I now feel much more pain than before. What can I do?

Dennis

Dear Dennis,

A duodenal ulcer is part of peptic ulcer disease. Peptic ulcers are open sores in the lining of the stomach, the lower part of the oesophagus or the duodenum (first part of the small intestines). They form due to the action of acid and imbalance of some digestive enzymes. Risk factors for the development of ulcers include excessive alcohol intake, smoking, prolonged use of some painkillers (non-steroidal anti-inflammatory drugs [NSAIDs] e.g. aspirin, ibuprofen, diclofenac, mefenamic acid), infection with the Helicobacter pylori bacteria, serious illness, radiotherapy in the stomach or stomach tumours that produce a lot of acid. Some people seem to be genetically predisposed to produce a lot of stomach acid, while in others, no cause is ever identified. When you have an ulcer, you may have a burning feeling, or stabbing pain on the upper part of your abdomen, which when severe, can go all the way to the back, or even cause chest pain. The pain may be associated with hunger, or may come just after eating, or it may be worse at night. You may also experience heartburn, a lot of gas in the stomach, nausea or vomiting. If the ulcer is very severe, you may have blood in vomit, dark coloured stool, weight loss and severe pain.

The symptoms usually recur from time to time, especially when triggered e.g. by taking some painkillers or binge drinking. In rare cases, the ulcer can worsen with time leading to perforation, severe bleeding or even blockage of the stomach outlet or the small intestines due to formation of scars or due to swelling. All these are medical emergencies that need urgent intervention, as they can lead to death.

To manage the ulcer and prevent complications, stop taking alcohol, stop smoking; avoid use of NSAIDs, and any other foods or drinks that worsen the pain. There are also medications that help to manage the symptoms, including proton pump inhibitors, sucralfate, antacid syrups, and antibiotics (if you have the H.pylori infection).

Endoscopy (passing a small tube with a camera at the end into the stomach) can be done to diagnose the ulcer, and also to treat minor bleeding, if present. Surgery can be done to manage complications like perforation, blockage or severe bleeding.

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I am a 30-year-old woman. My hands and feet are always very cold even when the weather is hot.

People always ask me why my hands are cold when I shake hands with them. I have to wear socks to sleep at night and I even carry socks in my bag to wear in the office. When I don’t wear socks, I get muscle cramps; my toes get stiff and I feel so much pain, I can barely walk.

I usually try to ease the pain by pulling my toes and trying to massage them, but this doesn’t help much.

I often use a hot water bottle to warm my hands and feet, especially at night. Surprisingly, the rest of my body is usually warm. Is this normal?

Elizabeth

Dear Elizabeth,

What you are experiencing is called Raynaud’s phenomenon. The “muscles” in your blood vessel walls contract and reduce blood flow to your hands and feet, making you feel cold, your skin may change colour to white or blue, and you may get numbness, pain or pins and needles in the affected areas.

When blood flow returns, you may notice pain, reddening and swelling of the toes or fingers. This reaction usually happens in response to cold, stress or anxiety. Other parts of the body can be affected e.g. the ears, the nose, the lips or the nipples.

The condition is more common in women, and affects between four and 20 per cent of adults. Most people begin to experience it while in their teens, 20s and 30s. There are two types – primary and secondary. Primary Raynaud’s is the most common. It has no known cause, and is usually not dangerous.

The symptoms are more annoying, than serious, and they improve on their own. Secondary Raynaud’s occurs due to the presence of another illness, usually auto-immune disorders. These are illnesses where one’s immune system attacks its own tissues leading to diseases like lupus, rheumatoid arthritis, systemic sclerosis, etc. Tests can be done to determine if you have primary or secondary Raynaud’s.

Rarely, secondary Raynaud’s can lead to severe restriction of blood flow, leading to formation of ulcers, scars, darkening of the skin and even death of the tissue in the affected area (gangrene).

Some other factors that may trigger this include some medications (beta blockers, cold medicines with pseudoephedrine, chemotherapy drugs); repetitive use of the hands e.g. typing, playing piano, using hand tools; hand injuries, diseases of the arteries e.g. artherosclerosis, where blockage is caused by plaque deposits; and smoking.

To manage the symptoms, avoid the cold, wear socks and gloves, run warm water over the affected area, stop smoking, reduce caffeine intake, take a hot meal or drink, exercise, and learn how to manage stress. It may take around 15 minutes to recover after you warm yourself. When the symptoms are severe, medication can be used to relax the blood vessel walls e.g. nifedipine, a calcium channel blocker.

If you have secondary Raynaud’s, then the underlying problem needs to be managed.

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