Think about how much you rely on your business-critical data, such as customer details, quotes, orders, and payment details. Now imagine how long you would be able to operate without them.

All businesses, regardless of size, should take regular backups of their important data, and make sure that these backups are recent and can be restored. By doing this, you’re ensuring your business can still function following the impact of flood, fire, physical damage or theft. Furthermore, if you have backups of your data that you can quickly recover, you can’t be blackmailed by ransomware attacks.

This section outlines 5 things to consider when backing up your data.

Tip 1: Identify what data you need to back up

Your first step is to identify your essential data. That is, the information that your business couldn’t function without. Normally this will comprise documents, photos, emails, contacts, and calendars, most of which are kept in just a few common folders on your computer, phone, tablet or network.

Tip 2: Keep your backup separate from your computer

Whether it’s on a USB stick, on a separate drive or a separate computer, access to data backups should be restricted so that they:

• are not accessible by staff
• are not permanently connected (either physically or over a local network) to the device holding the original copy

Ransomware (and other malware) can often move to attached storage automatically, which means any such backup could also be infected, leaving you with no backup to recover from. For more resilience, you should consider storing your backups in a different location, so fire or theft won’t result in you losing both copies. Cloud storage solutions (see below) are a cost-effective and efficient way of achieving this.

Tip 3: Consider the cloud

You’ve probably already used cloud storage during your everyday work and personal life without even knowing – unless you’re running your own email server, your emails are already stored ‘in the cloud’.

Using cloud storage (where a service provider stores your data on their infrastructure) means your data is physically separate from your location. You’ll also benefit from a high level of availability. Service providers can supply your organisation with data storage and web services without you needing to invest in expensive hardware up front. Most providers offer a limited amount of storage space for free, and larger storage capacity for minimal costs to small businesses.

Tip 4: Read our cloud security guidance

Not all service providers are the same, but the market is reasonably mature and most providers have good security practices built-in. By handing over significant parts of your IT services to a service provider, you’ll benefit from specialist expertise that smaller organisations would perhaps struggle to justify in terms of cost. However, before contacting service providers, we encourage you to read the NCSC’s Cloud Security Guidance. This guidance will help you decide what to look for when evaluating their services, and what they can offer.

Tip 5: Make backing up part of your everyday business

We know that backing up is not a very interesting thing to do (and there will always be more important tasks that you feel should take priority), but the majority of network or cloud storage solutions now allow you to make backups automatically. For instance, when new files of a certain type are saved to specified folders. Using automated backups not only saves time, but also ensures that you have the latest version of your files should you need them.

Many off-the-shelf backup solutions are easy to set up, and are affordable considering the business-critical protection they offer. When choosing a solution, you’ll also have to consider how much data you need to back up, and how quickly you need to be able to access the data following any incident.

Malicious software (also known as ‘malware’) is software or web content that can harm your organisation, such as the recent WannaCry outbreak. The most well-known form of malware is viruses, which are self-copying programs that infect legitimate software.

This section contains 5 free and easy-to-implement tips that can help prevent malware damaging your organisation.

Tip 1: Install (and turn on) antivirus software

Antivirus software – which is often included for free within popular operating systems – should be used on all computers and laptops. For your office equipment, you can pretty much click ‘enable’, and you’re instantly safer. Smartphones and tablets might require a different approach and if configured in accordance with the NCSC’s EUD guidance, separate antivirus software might not be necessary.

Tip 2: Prevent staff from downloading dodgy apps

You should only download apps for mobile phones and tablets from manufacturer-approved stores (like Google Play or Apple App Store). These apps are checked to provide a certain level of protection from malware that might cause harm. You should prevent staff from downloading third party apps from unknown vendors/sources, as these will not have been checked.

Staff accounts should only have enough access required to perform their role, with extra permissions (i.e. for administrators) only given to those who need it. When administrative accounts are created, they should only be used for that specific task, with standard user accounts used for general work.

Tip 3: Keep all your IT equipment up to date (patching)

For all your IT equipment (so tablets, smartphones, laptops and PCs), make sure that the software and firmware is always kept up to date with the latest versions from software developers, hardware suppliers and vendors. Applying these updates (a process known as patching) is one of the most important things you can do to improve security – the IT version of eating your fruit and veg. Operating systems, programmes, phones and apps should all be set to ‘automatically update’ wherever this is an option.

At some point, these updates will no longer be available (as the product reaches the end of its supported life), at which point you should consider replacing it with a modern alternative. For more information on applying updates, refer to the NCSC’s guidance on Vulnerability Management.

Tip 4: Control how USB drives (and memory cards) can be used

We all know how tempting it is to use USB drives or memory cards to transfer files between organisations and people. However, it only takes a single cavalier user to inadvertently plug in an infected stick (such as a USB drive containing malware) to devastate the whole organisation.

When drives and cards are openly shared, it becomes hard to track what they contain, where they’ve been, and who has used them. You can reduce the likelihood of infection by:

• blocking access to physical ports for most users
• using antivirus tools
• only allowing approved drives and cards to be used within your organisation – and nowhere else

Make these directives part of your company policy to prevent your organisation being exposed to unnecessary risks. You can also ask staff to transfer files using alternative means (such as by email or cloud storage), rather than via USB.

Tip 5: Switch on your firewall

Firewalls create a ‘buffer zone’ between your own network and external networks (such as the Internet). Most popular operating systems now include a firewall, so it may simply be a case of switching this on. For more detailed information on using firewalls, refer to the Network Security section of the NCSC’s 10 Steps to Cyber Security.

Mobile technology is now an essential part of modern business, with more of our data being stored on tablets and smartphones. What’s more, these devices are now as powerful as traditional computers, and because they often leave the safety of the office (and home), they need even more protection than ‘desktop’ equipment.

With this in mind, here are 5 quick tips that can help keep your mobile devices (and the information stored on them) secure.

Tip 1: Switch on password protection

A suitably complex PIN or password (opposed to a simple one that can be easily guessed or gleaned from your social media profiles) will prevent the average criminal from accessing your phone. Many devices now include fingerprint recognition to lock your device, without the need for a password. However, these features are not always enabled ‘out of the box’, so you should always check they have been switched on.

Tip 2: Make sure lost or stolen devices can be tracked, locked or wiped

Staff are more likely to have their tablets or phones stolen (or lose them) when they are away from the office or home. Fortunately, the majority of devices include free web-based tools that are invaluable should you lose your device. You can use them to:

• track the location of a device
• remotely lock access to the device (to prevent anyone else using it)
• remotely erase the data stored on the device
• retrieve a backup of data stored on the device

Setting up these tools on all your organisation’s devices may seem daunting at first, but by using mobile device management software, you can set up your devices to a standard configuration with a single click.

Tip 3: Keep your device up to date

No matter what phones or tablets your organisation is using, it is important that they are kept up to date at all times. All manufacturers (for example Windows, Android, iOS) release regular updates that contain critical security updates to keep the device protected. This process is quick, easy, and free; devices should be set to automatically update, where possible. Make sure your staff know how important these updates are, and explain how to do it, if necessary. At some point, these updates will no longer be available (as the device reaches the end of its supported life), at which point you should consider replacing it with a modern alternative.

Tip 4: Keep your apps up to date

Just like the operating systems on your organisation’s devices, all the applications that you have installed should also be updated regularly with patches from the software developers. These updates will not only add new features, but they will also patch any security holes that have been discovered. Make sure staff know when updates are ready, how to install them, and that it’s important to do so straight away.

Tip 5: Don’t connect to unknown Wi-Fi Hotspots

When you use public Wi-Fi hotspots (for example in hotels or coffee shops), there is no way to easily find out who controls the hotspot, or to prove that it belongs to who you think it does. If you connect to these hotspots, somebody else could access:

• what you’re working on whilst connected
• your private login details that many apps and web services maintain whilst you’re logged on

The simplest precaution is not to connect to the Internet using unknown hotspots, and instead use your mobile 3G or 4G mobile network, which will have built-in security. This means you can also use ‘tethering’ (where your other devices such as laptops share your 3G/4G connection), or a wireless ‘dongle’ provided by your mobile network. You can also use Virtual Private Networks (VPNs), a technique that encrypts your data before it is sent across the Internet. If you’re using third party VPNs, you’ll need the technical ability to configure it yourself, and should only use VPNs provided by reputable service providers.

Your laptops, computers, tablets and smartphones will contain a lot of your own business-critical data, the personal information of your customers, and also details of the online accounts that you access. It is essential that this data is available to you, but not available to unauthorised users.

Passwords – when implemented correctly – are a free, easy and effective way to prevent unauthorised users accessing your devices. This section outlines 5 things to keep in mind when using passwords.

Tip 1: Make sure you switch on password protection

Set a screenlock password, PIN, or other authentication method (such as fingerprint or face unlock). The NCSC blog has some good advice on passwords. If you’re mostly using fingerprint or face unlock, you’ll be entering a password less often, so consider setting up a long password that’s difficult to guess.

Having said this, password protection is not just for smartphones and tablets. Make sure that your office equipment (so laptops and PCs) all use an encryption product (such as BitLocker for Windows) using a Trusted Platform Module (TPM) with a PIN, or FileVault (on macOS) in order to start up. Most modern devices have encryption built in, but encryption may still need to be turned on and configured, so check you have set it up.

Tip 2: Use two-factor authentication for ‘important’ accounts

If you’re given the option to use two-factor authentication (also known as 2FA) for any of your accounts, you should do; it adds a large amount of security for not much extra effort. 2FA requires two different methods to ‘prove’ your identity before you can use a service, generally a password plus one other method. This could be a code that’s sent to your smartphone (or a code that’s generated from a bank’s card reader) that you must enter in addition to your password.

Tip 3: Avoid using predictable passwords

If you are in charge of IT policies within your organisation, make sure staff are given actionable information on setting passwords that is easy for them to understand.

Passwords should be easy to remember, but hard for somebody else to guess. A good rule is ‘make sure that somebody who knows you well, couldn’t guess your password in 20 attempts’. Staff should also avoid using the most common passwords, which criminals can easily guess. The NCSC has some useful advice on how to choose a non-predictable password.

Remember that your IT systems should not require staff to share accounts or passwords to get their job done. Make sure that every user has personal access to the right systems, and that the level of access given is always the lowest needed to do their job, whilst minimising unnecessary exposure to systems they don’t need access to.

Tip 4: Help your staff cope with ‘password overload’

If you’re in charge of how passwords are used in your organisation, there’s a number of things you can do that will improve security. Most importantly, your staff will have dozens of non-work related passwords to remember as well, so only enforce password access to a service if you really need to. Where you do use passwords to access a service, do not enforce regular password changes. Passwords really only need to be changed when you suspect a compromise of the login credentials.

You should also provide secure storage so staff can write down passwords for important accounts (such as email and banking), and keep them safe (but not with the device itself). Staff will forget passwords, so make sure they can reset their own passwords easily.

Consider using password managers, which are tools that can create and store passwords for you that you access via a ‘master’ password. Since the master password is protecting all of your other passwords, make sure it’s a strong one, for example by using three random words.

Tip 5: Change all default passwords

One of the most common mistakes is not changing the manufacturers’ default passwords that smartphones, laptops, and other types of equipment are issued with. Change all default passwords before devices are distributed to staff. You should also regularly check devices (and software) specifically to detect unchanged default passwords.

Steps to help you identify the most common phishing attacks. In a typical phishing attack, scammers send fake emails to thousands of people, asking for sensitive information (such as bank details), or containing links to bad websites. They might try to trick you into sending money, steal your details to sell on, or they may have political or ideological motives for accessing your organisation’s information.

Phishing emails are getting harder to spot, and some will still get past even the most observant users. Whatever your business, however big or small it is, you will receive phishing attacks at some point. This section contains some easy steps to help you identify the most common phishing attacks, but be aware that there is a limit to what you can expect your users to do.

Tip 1: Configure accounts to reduce the impact of successful attacks

You should configure your staff accounts in advance using the principle of ‘least privilege’. This means giving staff the lowest level of user rights required to perform their jobs, so if they are the victim of a phishing attack, the potential damage is reduced. To further reduce the damage that can be done by malware or loss of login details, ensure that your staff don’t browse the web or check emails from an account with Administrator privileges. An Administrator account is a user account that allows you to make changes that will affect other users. Administrators can change security settings, install software and hardware, and access all files on the computer. So an attacker having unauthorised access to an Administrator account can be far more damaging than accessing a standard user account.

Use two-factor authentication (2FA) on your important accounts such as email. This means that even if an attacker knows your passwords, they still won’t be able to access that account.

Tip 2: Think about how you operate

Consider ways that someone might target your organisation, and make sure your staff all understand normal ways of working (especially regarding interaction with other organisations), so that they’re better equipped to spot requests that are out of the ordinary.

Common tricks include sending an invoice for a service that you haven’t used, so when the attachment is opened, malware is automatically installed (without your knowledge) on your computer. Another is to trick staff into transferring money or information by sending emails that look authentic. Think about your usual working practices and how you can help make these tricks less likely to succeed. For example:

• Do staff know what to do with unusual requests, and where to get help?
• Ask yourself whether someone impersonating an important individual (a customer or manager) via email should be challenged (or have their identity verified another way) before action is taken.
• Do you understand your regular business relationships? Scammers will often send phishing emails from large organisations (such as banks) in the hope that some of the email recipients will have a connection to that company. If you get an email from an organisation you don’t do business with, treat it with suspicion.
• Think about how you can encourage and support your staff to question suspicious or just unusual requests – even if they appear to be from important individuals. Having the confidence to ask ‘is this genuine?’ can be the difference between staying safe, or a costly mishap.

You might also consider looking at how your outgoing communications appear to suppliers and customers. For example, do you send unsolicited emails asking for money or passwords? Will your emails get mistaken for phishing emails, or leave people vulnerable to an attack that’s been designed to look like an email from you? Consider telling your suppliers or customers of what they should look out for (such as ‘we will never ask for your password’, or ‘our bank details will not change at any point’).

Tip 3: Check for the obvious signs of phishing

Expecting your staff to identify and delete all phishing emails is an impossible request and would have a massive detrimental effect on business productivity. However, many phishing emails still fit the mould of a traditional attack, so look for the following warning signs:

• Many phishing scams originate overseas and often the spelling, grammar and punctuation are poor. Others will try and create official-looking emails by including logos and graphics. Is the design (and quality) what would you’d expect from a large organisation?
• Is it addressed to you by name, or does it refer to ‘valued customer’, or ‘friend’, or ‘colleague’? This can be a sign that the sender does not actually know you, and that it is part of a phishing scam.
• Does the email contain a veiled threat that asks you to act urgently? Be suspicious of words like ‘send these details within 24 hours’ or ‘you have been a victim of crime, click here immediately’.
• Look out for emails that appear to come from a high-ranking person within your organisation, requesting a payment is made to a particular bank account. Look at the sender’s name. Does it sound legitimate, or is it trying to mimic someone you know?
• If it sounds too good to be true, it probably is. It’s most unlikely that someone will want to give you money, or give you access to some secret part of the Internet.

Email filtering services attempt to send phishing emails to spam/junk folders. However, the rules determining this filtering need to be fine-tuned for your organisation’s needs. If these rules are too open and suspicious emails are not sent to spam/junk folders, then users will have to manage a large number of emails, adding to their workload and leaving open the possibility of a click. However, if your rules are too strict, some legitimate emails could get lost. You may have to change the rules over time to ensure the best compromise.

Tip 4: Report all attacks

Make sure that your staff are encouraged to ask for help if they think that they might have been a victim of phishing, especially if they’ve not raised it before. It’s important to take steps to scan for malware and change passwords as soon as possible if you suspect a successful attack has occurred.

Do not punish staff if they get caught out. It discourages people from reporting in future, and can make them so fearful that they spend excessive time and energy scrutinising every single email they receive. Both these things cause more harm to your business in the long run.

If you believe that your organisation has been the victim of online fraud, scams or extortion, you should report this through the Action Fraud website. Action Fraud is the UK’s national fraud and cyber crime reporting centre. If you are in Scotland contact Police Scotland on 101.

Tip 5: Check your digital footprint

Attackers use publicly available information about your organisation and staff to make their phishing messages more convincing. This is often gleaned from your website and social media accounts (information known as a ‘digital footprint’).

• Understand the impact of information shared on your organisation’s website and social media pages. What do visitors to your website need to know, and what detail is unnecessary (but could be useful for attackers)?
• Be aware of what your partners, contractors and suppliers give away about your organisation online.
• Help your staff understand how sharing their personal information can affect them and your organisation. This is not about expecting people to remove all traces of themselves from the Internet. Instead support them as they manage their digital footprint, shaping their profile so that it works for them and the organisation.
• CPNI’s Digital Footprint Campaign contains a range of useful materials (including posters and booklets) to help organisations work with employees to minimise online security risks.

Why eye checks are important

The sooner any eye problem is found, the sooner you and your child will be able to get any treatment and support needed.

Children may not realise they have a vision problem so, without routine tests, there’s a risk a problem may not be spotted. This may affect their development and education.

If you have any concerns about your child’s vision see a GP or go to an opticians.

When will my child’s eyes be checked?

Your child’s eyes may be checked a number of times throughout the first hours, weeks and years of their life.

• Within 72 hours of birth

  Your child’s eyes will be checked for any obvious physical problems as part of the newborn physical examination.

• Between 6 and 8 weeks old

  This is a follow-up physical examination to check for any obvious problems that were not picked up soon after birth.

• Around 1 year, or between 2 and 2-and-a-half years

  You may be asked if you have any concerns about your child’s eyesight as part of your child’s health and development reviews. Eye tests can be arranged if necessary.

• Around 4 or 5 years old

  Your child’s eyes may be examined soon after they start school. This is called vision screening and it checks for reduced vision in one or both eyes. The aim is to detect any problems early so that treatment can be given if needed.

  Vision screening is usually carried out in your child’s school. However, this does not happen in all areas. If your child’s vision is not checked at school, take them to your local opticians for an eye examination.

Speak to a GP or go to an opticians if you have any concerns about your child’s vision at any stage.

What tests may be carried out?

A number of tests may be carried out to check for vision or eye problems in babies and children.

Attention to visual objects

Causes of eye problems in babies and children

There are a number of different eye problems that can be detected during eye tests, including:

• childhood cataracts – cloudy patches in the lens of the eye that are present from birth
• lazy eye (amblyopia) – where the vision in one eye does not develop properly
• squint (strabismus) – where the eyes look in different directions
• short-sightedness (myopia) – where distant objects appear blurred, while close objects can be seen clearly
• long-sightedness (hyperopia) – where you can see distant objects clearly but nearby objects are out of focus
• astigmatism – where the transparent layer at the front of the eye (cornea) is not perfectly curved
• colour vision deficiency (colour blindness) – difficulty seeing colours or distinguishing between different colours; this is more common in boys than girls

Spotting signs of an eye problem

Although your child should have regular eye tests as they grow up, it’s still important to look out for signs of any problems and get advice if you have any concerns.

For babies, the checklist in your baby’s personal child health record (red book) can be used to help you check if your child’s vision is developing normally.

In older children, signs of a possible eye problem can include:

• the eyes not pointing in the same direction
• complaining of headaches or eye strain
• problems reading – for example, they may need to hold books close to their face and they may lose their place regularly
• problems with hand-eye co-ordination – for example, they may struggle to play ball games
• being unusually clumsy
• regularly rubbing their eyes
• sitting too close to the TV

The GP surgery can refuse registration for reasons such as they are not taking new patients or it’s too far away from your home and you need home visits.

How to register with a GP practice outside your area

When you’ve chosen a GP surgery, ask if they’re accepting registrations outside of the area and ask for a registration form.

Find out more about how to register with a GP surgery

The surgery will decide if they can accept you as a regular patient or accept you without home visits.

Because of the distance to your home, the GP surgery might not be able to offer home visits.

If you are not well enough to go to the GP surgery, other arrangements might be made.

Registering with a practice further away from home can affect decisions about referrals for hospital tests and treatment, or access to community health services. Speak to the GP about your options.

How to book, change or cancel an appointment

You should be able to book or change an appointment at your GP surgery:

• online, find out more about how to start using online services
• by phone
• in person, by going into the surgery and talking to the receptionist

In some GP surgeries, you may also be able to have a consultation online or over the phone. Speak to your GP surgery for more information about online and phone consultations.

Call your GP surgery if you need an urgent appointment. If your GP surgery is closed, a recorded message will tell you who to contact.

Booking, changing and cancelling appointments online

If you are registered with a GP surgery, you can use their online services to book, check or cancel appointments with a GP, nurse, or other healthcare professional.

If you have already signed up to online services, log in to your usual service provider and book one of the available appointments.

To change an appointment online, you will need to cancel the appointment you already have and book a new one.

Read more about how to start using online services, if you are not signed up to them already.

Evening and weekend appointments

You can now see a GP or nurse on:

• weekday evenings between 6.30pm and 8pm
• Saturdays and Sundays

Call your GP surgery or use their online services to book evening and weekend appointments. You may be able to get an appointment on the same day.

You may be offered an appointment at:

• your GP surgery
• another local GP surgery
• another local NHS service

If you’re not registered with a GP

You can call any GP surgery to get emergency treatment for up to 14 days if you are not registered with a GP or are away from home.

If your treatment will last longer than 14 days, you’ll have to register as a temporary or permanent resident. Read more about:

• how to register as a temporary resident with a GP
• how to register with a GP surgery

Other services

Before you make an appointment to see your GP, think about what other services might be able to help.

• Go to a pharmacy for advice and treatment for minor conditions that do not need a prescription. Read about services you can get from a pharmacist.
• Call NHS 111 if you have an urgent medical problem, but you’re not sure what to do.
• Visit 111.nhs.uk for urgent medical advice for people aged 5 and over only.
• Visit a sexual health service for testing for sexually transmitted infections and contraception advice.

You do not have to make an appointment or register for these services.

Paracetamol is a common painkiller used to treat aches and pain. It can also be used to reduce a high temperature.

It’s available combined with other painkillers and anti-sickness medicines. It’s also an ingredient in a wide range of cold and flu remedies.

Paracetamol is widely available as tablets and capsules.

For people who find it difficult to swallow tablets or capsules, paracetamol is also available as a syrup or as soluble tablets that dissolve in water to make a drink.

Key facts:

• Paracetamol takes up to an hour to work.
• The usual dose of paracetamol is one or two 500mg tablets at a time.
• Do not take paracetamol with other medicines containing paracetamol.
• Paracetamol is safe to take in pregnancy and while breastfeeding, at recommended doses.
• Brand names include Disprol, Hedex, Medinol and Panadol.

Most people can take paracetamol safely, including pregnant and breastfeeding women.

However, some people need to take extra care with paracetamol.

Paracetamol and pregnancy

How and when to take it

Paracetamol can be taken with or without food.

Adults can take a maximum of 4 doses (up to eight 500mg tablets in total) in 24 hours. Wait at least 4 hours between doses.

Overdosing on paracetamol can cause serious side effects. Do not be tempted to increase the dose or to take a double dose if your pain is very bad.

What if I take too much?

Taking 1 or 2 extra tablets by accident is unlikely to be harmful, as long as you do not take more than 8 tablets in 24 hours.

Wait at least 24 hours before taking any more paracetamol.

Get help from 111 now if you take:

What if I forget to take it?

If you take paracetamol regularly and miss a dose, take it as soon as you remember. However, skip the missed dose if it’s nearly time for your next dose.

Never take double doses of paracetamol. Do not take an extra dose to make up for a missed one.

Taking paracetamol with other painkillers

It’s safe to take paracetamol with other types of painkiller that don’t contain paracetamol, such as ibuprofen, aspirin and codeine.

Do not take paracetamol alongside other medicines that contain paracetamol. If you take 2 different medicines that contain paracetamol, there’s a risk of overdose.

Before taking any other medicines, check the label to see whether they contain paracetamol.

Side effects

Paracetamol very rarely causes side effects if you take it at the right dosage.

For a full list of possible side effects, see the leaflet inside your medicines packet.

If you’re worried about a side effect or notice anything unusual, talk to your pharmacist or doctor.

In rare cases, it’s possible to have a serious allergic reaction (anaphylaxis) to paracetamol.

Call 999 or go to A&E if:

Cautions with other medicines

It’s safe to take paracetamol with most prescription medicines, including antibiotics.

Paracetamol isn’t suitable for some people. Talk to your doctor if you are unsure.

Check with your doctor or pharmacist if you’re taking St John’s wort (a herbal remedy taken for depression) as you may need to reduce your paracetamol dose.

Otherwise, paracetamol isn’t generally affected by also taking herbal remedies or supplements.

For safety, tell your doctor or pharmacist if you’re taking any other medicines, including herbal remedies, vitamins or supplements.

Ibuprofen is an everyday painkiller for a range of aches and pains, including back pain, period pain and toothache. It also treats inflammation such as sprains and strains, and pain from arthritis.

It’s available as tablets, capsules, granules and as a liquid that you swallow. It also comes as a gel, mousse and spray that you rub into your skin.

Ibuprofen is combined with other painkillers in some products. It’s an ingredient in some cold and flu remedies, such as Nurofen Cold and Flu.

You can buy most types of ibuprofen from pharmacies and supermarkets. Some types are only available on prescription.

Key facts

• Ibuprofen works by reducing hormones that cause pain and swelling in the body.
• It takes 20 to 30 minutes to work if you take it by mouth, and 1 to 2 days to work if you put it on your skin.
• Ibuprofen is typically used for period pain or toothache. Some people find ibuprofen better than paracetamol for back pain.
• Always take ibuprofen tablets, capsules, granules and liquid with food or a drink of milk to reduce the chance of an upset stomach. Do not take it on an empty stomach.
• If you’re taking tablets, capsules, granules or liquid, take the lowest dose to control your pain for the shortest possible time. Do not take it for more than 10 days (or 3 days if you’re under 18) unless you’ve spoken to your doctor. Do not use the gel, mousse or spray for more than 2 weeks without talking to your doctor.

Who may not be able to take ibuprofen?

Do not take ibuprofen by mouth or apply it to your skin if you:

• have ever had an allergic reaction or symptoms like wheezing, runny nose or skin reactions after taking aspirin, ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen
• are pregnant

Tablets, capsules, granules and liquids

To make sure ibuprofen tablets, capsules, granules or liquid is safe for you, tell your doctor or pharmacist if you:

• have ever had bleeding in your stomach or a hole (perforation) in your stomach caused by an NSAID
• have had a hole (perforation) in your stomach, bleeding in your stomach or a stomach ulcer more than once
• have a health problem that means you have an increased chance of bleeding
• have severe heart failure, severe kidney failure or severe liver failure
• are trying to get pregnant
• have high blood pressure that’s not under control
• have heart disease or mild to moderate heart failure, or have ever had a stroke
• have kidney or liver problems
• have asthma, hay fever or allergies
• have Crohn’s disease or ulcerative colitis
• have chickenpox or shingles – taking ibuprofen can increase the chance of certain infections and skin reactions

If you’re over 65, ibuprofen can make you more likely to get stomach ulcers. Your doctor will prescribe you a medicine to protect your stomach if you’re taking ibuprofen for a long-term condition.

Always follow your doctor or pharmacist’s advice, and the instructions that come with your medicine.

Dosage

• Each ibuprofen tablet or capsule contains 200mg, 400mg or 600mg of ibuprofen. Slow-release tablets and capsules contain 200mg, 300mg or 800mg of ibuprofen.

• Each sachet of granules contains 600mg of ibuprofen.

• If you’re taking ibuprofen as a liquid, 10ml contains either 200mg or 400mg. Always check the label.

• The usual dose for adults is one or two 200mg tablets or capsules 3 times a day. In some cases, your doctor may prescribe a higher dose of up to 600mg to take 4 times a day if needed. This should only happen under supervision of a doctor.

• If you’re taking granules, the usual dose for adults is one sachet 2 or 3 times a day. Some people might need to take it 4 times a day.

• If you take ibuprofen 3 times a day, leave at least 6 hours between doses. If you take it 4 times a day, leave at least 4 hours between doses.

• If you have pain all the time, your doctor may recommend slow-release ibuprofen tablets or capsules. You’ll usually take these once a day in the evening or twice a day. Leave a gap of 10 to 12 hours between doses if you’re taking ibuprofen twice a day.

How to take tablets, capsules, granules and liquid

• Swallow ibuprofen tablets or capsules whole with a drink of water, milk or juice. Do not chew, break, crush or suck them as this could irritate your mouth or throat.

• For people who find it difficult to swallow tablets or capsules, ibuprofen is available as a tablet that melts in your mouth, granules that you mix with a glass of water to make a drink, and as a liquid.

• If you’re taking the tablet that melts in your mouth, put it on your tongue, let it dissolve and then swallow. You do not need to drink any water.

• Take ibuprofen granules by emptying the contents of the sachet into a glass full of water to make an orange flavoured fizzy drink, stir and drink straight away.

• If you’re taking liquid, it will come with a plastic syringe or spoon to measure your dose. If you do not have a syringe or spoon, ask your pharmacist for one. Do not use a kitchen spoon, as it will not measure the right amount.

• Take ibuprofen tablets, capsules, granules or liquid with a meal or snack, or with a drink of milk. It will be less likely to upset your stomach. If you take it just after food, ibuprofen may take longer to start working.

How long to take it for

If you’re taking ibuprofen for a short-lived pain like toothache or period pain, you may only need to take it for a day or two.

You may need to take ibuprofen for longer if you have a long-term health problem, such as rheumatoid arthritis.

If you need to take ibuprofen for more than 6 months, your doctor may prescribe a medicine to protect your stomach from any side effects.

If you forget to take ibuprofen tablets, capsules, granules or liquid

If you are prescribed ibuprofen as a regular medicine and forget to take a dose, take the missed dose as soon as you remember, unless it’s almost time for your next dose. In this case, skip the missed dose and take your next dose at the usual time.

Never take a double dose to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

If you take too much ibuprofen tablets, capsules, granules or liquid

Taking too much ibuprofen by mouth can be dangerous. It can cause side effects such as:

• feeling and being sick (nausea and vomiting)
• stomach pain
• feeling tired or sleepy
• black poo and blood in your vomit – a sign of bleeding in your stomach
• ringing in your ears (tinnitus)
• difficulty breathing or changes in your heart rate (slower or faster)

Urgent advice: Contact 111 for advice now if

Common side effects of tablets, capsules, granules and liquid

These common side effects of ibuprofen taken by mouth happen in more than 1 in 100 people. There are things you can do to help cope with them:

• Headaches

  Make sure you rest and drink plenty of fluids. Try not to drink too much alcohol. It’s important not to take any other medicines for pain to help with headaches. Talk to your doctor if the headaches last longer than a week or are severe.

• Feeling dizzy

  If ibuprofen makes you feel dizzy, stop what you’re doing and sit or lie down until you feel better. Avoid coffee, cigarettes and alcohol. If the dizziness does not get better within a couple of days, speak to your pharmacist or doctor. Do not drive or ride a bike while you’re feeling dizzy.

• Feeling sick (nausea)

  Stick to simple meals. Do not eat rich or spicy food. Always take ibuprofen tablets, capsules, granules or liquid with a meal or snack or with a drink of milk.

• Being sick (vomiting)

  Have small, frequent sips of water to avoid dehydration. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat vomiting without speaking to a pharmacist or doctor.

  If you take contraceptive pills and you’re being sick, your contraception may not protect you from pregnancy. Check the pill packet for advice.

• Wind

  Try not to eat foods that cause wind (like lentils, beans and onions). Eat smaller meals, eat and drink slowly, and exercise regularly. There are pharmacy medicines that can also help, such as charcoal tablets or simeticone.

• Indigestion

  If you get repeated indigestion stop taking ibuprofen and see your doctor as soon as possible. If you need something to ease the discomfort, try taking an antacid, but do not put off going to the doctor.

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Ibuprofen gel, mousse or spray

To make sure ibuprofen applied to the skin is safe for you, tell your doctor or pharmacist if you have:

• kidney problems
• asthma, hay fever or allergies
• a stomach ulcer

Always follow your doctor or pharmacist’s advice, and the instructions that come with your medicine.

Dosage

The amount of ibuprofen you put on your skin depends on the product you’re using. Check the package leaflet carefully for how much to use.

How to use ibuprofen gel, mousse or spray

Gently massage the ibuprofen into the painful area 3 or 4 times a day. Leave at least 4 hours between applications.

Most products must not be used more than 4 times in 24 hours. Check the instructions that come with the medicine to see how many times a day you can use it.

Never use ibuprofen gel, mousse or spray on your eyes, mouth, lips, nose or genital area. It may make them sore. Do not put it on sore or broken skin.

Do not put plasters or dressings over skin you’ve applied ibuprofen to.

Wash your hands after using it, unless you are treating your hands.

Do not smoke or go near naked flames as clothes that have been in contact with ibuprofen gel, mousse or spray burn more easily, even if they have been washed.

If you forget to put it on

Do not worry if you occasionally forget to use ibuprofen gel, mousse or spray, just carry on using it when you remember.

If you put on too much ibuprofen gel, mousse or spray

Putting too much ibuprofen on your skin is unlikely to cause problems.

If you swallow the gel, mousse or spray

If you swallow ibuprofen gel, mousse or spray, you may get symptoms including:

• headaches
• being sick (vomiting)
• feeling sleepy or dizzy

Urgent advice: Contact 111 for advice now if

Common side effects of gel, mousse and spray

You’re less likely to have side effects when you apply ibuprofen to your skin than with tablets, capsules, granules or liquid because less gets into your body. But you may still get the same side effects, especially if you use a lot on a large area of skin.

Applying ibuprofen to your skin can sometimes cause your skin to become more sensitive than normal to sunlight. Speak to your doctor if this is a problem.

Immediate action required: Call 999 or go to A&E now if:

Serious allergic reaction

In rare cases, it’s possible to have a serious allergic reaction (anaphylaxis) to ibuprofen.

Immediate action required: Call 999 or go to A&E now if:

Long term side effects

Ibuprofen can cause ulcers in your stomach or gut, especially if you take it by mouth for a long time or in big doses. If you need to take it for a long time your doctor may also prescribe a medicine to help protect your stomach.

Other side effects

These are not all the side effects of ibuprofen tablets, capsules and syrup. For a full list see the leaflet inside your medicines packet.

For more information on taking ibuprofen alongside herbal supplements, visit the NHS website.

Paracetamol is a common painkiller for children. It’s often used to treat headaches, stomach ache, earache, and cold symptoms. It can also be used to bring down a high temperature (fever).

Paracetamol tablets (including soluble tablets), syrup and suppositories are available on prescription and to buy from shops and pharmacies.

Who can and cannot take paracetamol

Children can take paracetamol as:

• a liquid syrup – from the age of 2 months
• suppositories – from the age of 2 months
• tablets (including soluble tablets) – from the age of 6 years
• Calpol Fast Melts – from the age of 6 years

Do not give paracetamol to babies younger than 2 months old, unless it is prescribed by a doctor.

Check with your doctor or pharmacist before giving your child paracetamol if they:

• are small for their age, as a lower dose may be better
• have had liver or kidney problems
• take medicine for epilepsy
• take medicine for tuberculosis (TB)
• take warfarin (a blood-thinning medicine)

Dosage and how often to give it

Paracetamol tablets, syrup and suppositories come in a range of strengths. Children need to take a lower dose than adults, depending on their age.

Ask your doctor or a pharmacist for advice if your child is small or big for their age and you’re not sure how much to give.

Syrup dosages for children

Infant syrup (sometimes called “junior syrup”) is for children under 6 years old. A 5ml dose contains 120mg of paracetamol.

Infant syrup: 120mg/5ml

Age	How much?	How often?
3 to 6 months	2.5ml	Max 4 times in 24 hours
6 to 24 months	5ml	Max 4 times in 24 hours
2 to 4 years	7.5ml	Max 4 times in 24 hours
4 to 6 years	10ml	Max 4 times in 24 hours

Six plus syrup is for children aged 6 years and older. A 5ml dose contains 250mg of paracetamol.

Six plus syrup: 250mg/5ml

Age	How much?	How often?
6 to 8 years	5ml	Max 4 times in 24 hours
8 to 10 years	7.5ml	Max 4 times in 24 hours
10 to 12 years	10ml	Max 4 times in 24 hours

Do not give your child more than 4 doses of paracetamol in 24 hours. Wait at least 4 hours between doses.

Dosage instructions are different for babies over the age of 2 months (see Giving paracetamol to babies from 2 months).

Tablet dosages for children

Tablets usually come as 500mg. For lower doses break up the tablet to give your child a smaller amount.

Do not give your child more than 4 doses of paracetamol in 24 hours. Wait at least 4 hours between doses.

How often to give paracetamol

If your child needs help with pain day and night for several days (usually up to 3 days), give a dose of paracetamol every 6 hours. This will help to relieve the pain safely without the risk of giving too much paracetamol.

If your child has pain that comes and goes, give a dose of paracetamol when they first complain of pain. Wait at least 4 hours before giving another dose.

What if they take too much?

If you give your child 1 extra dose of paracetamol by mistake, wait at least 24 hours before giving them any more.

Get help from 111 now if:

When to use 111

How to give paracetamol to your child

Paracetamol can be taken with or without food.

How to give syrup

How to give tablets

How to use suppositories

Find out more information about giving paracetamol to babies from 2 months including treating a high temperature after vaccinations

Giving paracetamol with other painkillers

Ibuprofen is the only safe painkiller to give children alongside paracetamol. However, do not give paracetamol and ibuprofen at the same time.

You need to give these medicines 1 at a time (unless your child’s doctor or nurse gives you different instructions).

For high temperature

For pain (including teething)

Other medicines containing paracetamol

Do not give your child another medicine with paracetamol in it. If they take 2 different medicines that contain paracetamol, there’s a risk of overdose.

Paracetamol is an ingredient in lots of medicines that you can buy from the pharmacy or supermarket. These include some cough and cold medicines, so check the ingredients carefully.

Side effects in children

Paracetamol rarely causes side effects if you give it in the right doses.

If you’re worried about a side effect or notice anything unusual, talk to your pharmacist or doctor.

Serious allergic reaction

In rare cases, it’s possible to have a serious allergic reaction (anaphylaxis) to paracetamol.

Call 999 or go to A&E if:

You can report any suspected side effect using the Yellow Card safety scheme.

Cautions with other medicines

In general, paracetamol doesn’t interfere with prescription medicines, including antibiotics.

However, paracetamol isn’t suitable for some children.

Check with a doctor or pharmacist before giving any herbal remedies or supplements to your child.

Ibuprofen is a common painkiller for children. It’s often used to treat cold symptoms, teething and toothache.

Ibuprofen also treats inflammation, such as aches and pains after an injury like a sprain, or because of a health problem like childhood arthritis. It can also be used to bring down a high temperature (fever).

For children aged 3 months to 12 years, ibuprofen comes as a liquid syrup.

For children aged 7 years or older, ibuprofen is available as tablets, capsules and granules that you dissolve in water to make a drink.

You can buy most types of ibuprofen from pharmacies and supermarkets. Some types, such as ibuprofen granules, are only available on prescription.

Key facts

• Ibuprofen works by reducing hormones that cause pain and swelling in the body.
• It takes 20 to 30 minutes to work if you take it by mouth, and 1 to 2 days to work if you put it on your skin.
• Ibuprofen is typically used for period pain or toothache. Some people find ibuprofen better than paracetamol for back pain.
• Always take ibuprofen tablets, capsules, granules and liquid with food or a drink of milk to reduce the chance of an upset stomach. Do not take it on an empty stomach.
• If you’re taking tablets, capsules, granules or liquid, take the lowest dose to control your pain for the shortest possible time. Do not take it for more than 10 days (or 3 days if you’re under 18) unless you’ve spoken to your doctor. Do not use the gel, mousse or spray for more than 2 weeks without talking to your doctor.

Who can and can’t take ibuprofen

Children can take ibuprofen as:

• a liquid syrup – from the age of 3 months
• tablets and capsules – from the age of 7 years
• chewable tablets – from the age of 7 years
• granules – from the age of 12 years

Ibuprofen is not suitable for some children. Check with your pharmacist or doctor if your child:

• has had an allergic reaction to ibuprofen or any other medicines in the past
• has asthma
• has liver or kidney problems
• has a health problem that means they have an increased risk of bleeding
• has an inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis
• is small or big for their age, as a lower or higher dose may be better

Do not give ibuprofen for chickenpox unless it has been recommended by a doctor – it can cause a serious skin reaction.

Dosage and how often to give it

Ibuprofen is usually given to children 3 or 4 times a day. Your pharmacist or doctor will tell you how often to give it.

If you’re not sure how much to give a child, ask your pharmacist or doctor.

If you give it:

• 3 times in 24 hours, leave at least 6 hours between doses
• 4 times in 24 hours, leave at least 4 hours between doses

Ibuprofen syrup dosages for children

Ibuprofen tablet dosages for children

If your child has pain all the time, your doctor may prescribe slow-release tablets or capsules. These are given once or twice a day.

What if I forget to give it?

Give the missed dose as soon as you remember. If it’s nearly time for their next dose, skip the missed dose and give their next dose as the usual time.

Never give a double dose to make up for a forgotten one.

What if they take too much?

If you give your child 1 extra dose of ibuprofen by mistake, wait at least 12 hours before giving them any more.

Urgent advice: Get help from 111 now if:

If you need to take your child to hospital, take the ibuprofen packaging or leaflet plus any remaining medicine with you.

How to give ibuprofen to your child

It’s best to give ibuprofen to children with food or milk so they do not get an upset tummy.

Syrup

Shake the bottle well and measure out the right amount using a plastic syringe or spoon. These come in the medicine packet. If you do not have a syringe or spoon, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not give the right amount.

To hide the taste of the syrup, you can give the child a drink of milk or fruit juice straight after the medicine. But do not mix ibuprofen syrup with juice or milk as it may mean they do not get the right dose if they do not finish the drink.

Tablets and capsules

Tablets and capsules should be swallowed whole with a glass of water or juice. Tell your child not to chew, break, crush or suck them as this could irritate their mouth or throat.

Children taking chewable tablets should chew them before swallowing.

Granules

Sprinkle or stir the granules into a small amount of soft food (such as yoghurt) or a small drink, or you can mix them with a spoonful of cold water. Do not mix the granules with warm food or liquid.

Your child should then swallow the food or drink it straight away without chewing. Make sure they take it all. Do not keep the granule/food mixture to give later.

Giving ibuprofen with other painkillers

Paracetamol is the only safe painkiller to give children alongside ibuprofen. However, do not give ibuprofen and paracetamol at the same time.

You need to give these medicines 1 at a time (unless your child’s doctor or nurse gives you different instructions).

For high temperature

If you’ve given your child ibuprofen and they still have a high temperature after 1 hour, you could try paracetamol instead.

If this helps bring down their temperature, carry on giving them paracetamol only (following the instructions that come with the medicine).

Call your doctor if you’ve tried both paracetamol and ibuprofen and they have not helped.

Do not alternate between paracetamol and ibuprofen to treat a high temperature without advice from a doctor or nurse.

Do not give more than the maximum daily dose of either medicine.

For pain (including teething)

If you’ve given your child ibuprofen and they’re still in pain 2 hours later, you could try giving paracetamol as well.

If this works, you can alternate paracetamol and ibuprofen, giving only 1 medicine at a time.

Do not give more than the maximum daily dose of either medicine.

See your doctor if you’ve tried alternating paracetamol and ibuprofen and they have not helped. Also see your doctor if you don’t know what is causing your child’s pain.

Never give aspirin to a child under the age of 16, unless their doctor prescribes it.

Side effects in children

Ibuprofen can cause side effects. To reduce the chance of side effects, give your child the lowest dose for the shortest time to control their symptoms.

Common side effects

The common side effects of ibuprofen, which happen in more than 1 in 100 children, are:

• indigestion, heartburn or feeling or being sick (nausea or vomiting) – you can reduce this by giving ibuprofen with food

If these symptoms carry on or get worse, they may be signs of irritation of the gut or stomach. Talk to your doctor or pharmacist if these side effects bother your child or do not go away.

Serious side effects

Contact a doctor straight away if your child:

• gets severe stomach pains, vomits blood, or their poo is very dark or black – these may be signs of a stomach ulcer
• stops peeing or there’s blood in their pee – there may be a problem with their kidneys
• hears ringing in their ears

Ibuprofen may make asthma worse in some children, but this is uncommon. Talk to your doctor if you’re worried.

In rare cases, it’s possible for your child to have a serious allergic reaction (anaphylaxis) to ibuprofen.

Immediate action required: Call 999 or take your child to A&E if:

These are not all the side effects of ibuprofen. For a full list see the leaflet inside your medicines packet.

You can report any suspected side effect using the Yellow Card safety scheme.

Ibuprofen does not mix well with some prescription medicines.

Tell your doctor or pharmacist if your child is taking any other medicine, including herbal remedies, vitamins or supplements.

Antihistamines are medicines often used to relieve symptoms of allergies, such as hay fever, hives, conjunctivitis and reactions to insect bites or stings.

They’re also sometimes used to prevent motion sickness and as a short-term treatment for insomnia.

Types of antihistamine

There are many types of antihistamine.

They’re usually divided into 2 groups:

• antihistamines that make you feel sleepy – such as acrivastine, chlorphenamine (Piriton), hydroxyzine and promethazine
• non-drowsy antihistamines that are less likely to make you feel sleepy – such as cetirizine, cinnarizine, diphenhydramine, fexofenadine and loratadine

They also come in several different forms – including tablets, capsules, liquids, syrups, creams, lotions, gels, eyedrops and nasal sprays.

Which type is best?

There’s not much evidence to suggest any particular antihistamine is better than any other at relieving allergy symptoms.

Some people find certain types work well for them and others do not. You may need to try several types to find one that works for you.

Non-drowsy antihistamines are generally the best option, as they’re less likely to make you feel sleepy. But types that make you feel sleepy may be better if your symptoms stop you sleeping.

Ask a pharmacist for advice if you’re unsure which medicine to try as not all antihistamines are suitable for everyone.

Who can take antihistamines

Most people can safely take antihistamines.

But speak to a pharmacist or GP for advice if you:

• are pregnant or breastfeeding
• are looking for a medicine for a young child
• are taking other medicines
• have an underlying health condition, such as heart disease, liver disease, kidney disease or epilepsy

Some antihistamines may not be suitable in these cases. A pharmacist or doctor can recommend one that’s best for you.

Loratadine is usually recommended if you need to take an antihistamine in pregnancy. Loratadine or cetirizine are usually OK to take while breastfeeding.

How to take antihistamines

Take your medicine as advised by the pharmacist or doctor, or as described in the leaflet that comes with it.

The advice varies depending on the exact medicine you’re taking. If you’re not sure how to take your medicine, ask a pharmacist.

Side effects of antihistamines

Like all medicines, antihistamines can cause side effects.

Side effects of antihistamines that make you drowsy can include:

• sleepiness (drowsiness) and reduced co-ordination, reaction speed and judgement – do not drive or use machinery after taking these antihistamines
• dry mouth
• blurred vision
• difficulty peeing

Side effects of non-drowsy antihistamines can include:

• headache
• dry mouth
• feeling sick
• drowsiness – although this is less common than with older types of antihistamines

Check the leaflet that comes with your medicine for a full list of possible side effects and advice about when to get medical help.

Taking antihistamines with other medicines, food or alcohol

Speak to a pharmacist or GP before taking antihistamines if you’re already taking other medicines.

There may be a risk the medicines do not mix, which could stop either from working properly or increase the risk of side effects.

Examples of medicines that could cause problems if taken with antihistamines include some types of:

• antidepressants
• stomach ulcer or indigestion medicines
• cough and cold remedies that also contain an antihistamine

Try not to drink alcohol while taking an antihistamine, particularly if it’s a type that makes you drowsy, as it can increase the chances of it making you feel sleepy.

Food and other drinks do not affect most antihistamines, but check the leaflet that comes with your medicine to make sure.

The leaflet that comes in the packet with your medicine will have detailed information about it, including how to take it and what side effects you might get.

You may also find information on individual antihistamines on the Medicines and Healthcare products Regulatory Agency (MHRA): patient information leaflets website.

Aspirin is an everyday painkiller for aches and pains such as headache, toothache and period pain. It can also be used to treat colds and flu-like symptoms, and to bring down a high temperature.

Aspirin is known as an acetylsalicylic acid. It also belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs).

Aspirin combined with other ingredients is also available in some cold and flu remedies.

You can buy most types of aspirin from pharmacies, shops and supermarkets. Some types are only available on prescription.

Aspirin comes as tablets or suppositories – medicine that you push gently into your anus (bottom). It also comes as a gel for mouth ulcers and cold sores.

If you’ve had a stroke or heart attack, or are at high risk of a heart attack, your doctor may recommend that you take a daily low-dose aspirin. Some women may also be prescribed low-dose aspirin while they’re pregnant.

This is different to taking aspirin for pain relief. Only take low-dose aspirin if your doctor recommends it.

Key facts

• It’s best to take aspirin with food. That way, you’ll be less likely to get an upset stomach or stomach ache.
• Never give aspirin to children under the age of 16 (unless their doctor prescribes it). It can make children more likely to develop a very rare but serious condition called Reye’s syndrome.
• You should start to feel better 20 to 30 minutes after taking aspirin.
• Aspirin is an ingredient in combined medicines such as Anadin Original, Anadin Extra, Alka-Seltzer Original, Alka-Seltzer XS and Beechams Powders.
• Aspirin as a mouth gel has the brand name Bonjela. Like other aspirin products, it’s only for people aged 16 and over. Bonjela Teething Gel and Bonjela Junior Gel do not contain aspirin, so you can give them to children under 16.

Who can and cannot take aspirin

Most people aged 16 and over can safely take aspirin.

Aspirin is not suitable for some people.

To make sure aspirin as a painkiller (including mouth gel) is safe for you, tell your doctor or pharmacist if you:

• have ever had an allergy to aspirin or similar painkillers such as ibuprofen
• have ever had a stomach ulcer
• have recently had a stroke (although depending on the kind of stroke you’ve had, your doctor may recommend that you take low-dose aspirin to prevent another one)
• have high blood pressure (hypertension)
• have indigestion
• have asthma or lung disease
• have ever had a blood clotting problem
• have liver or kidney problems
• have gout – it can get worse for some people who take aspirin
• have heavy periods – they can get heavier with aspirin
• are pregnant, trying to get pregnant or breastfeeding

Taking aspirin for pain

The dose of aspirin that’s right for you depends on the kind of aspirin you’re taking, why you’re taking it and how well it helps your symptoms.

Aspirin tablets

Different aspirin tablets and how to take them

Dosage and strength of aspirin tablets

Aspirin suppositories

How to use aspirin suppositories

Dosage and strength of aspirin suppositories

Apsirin mouth gel

How to use aspirin mouth gel

How long to take it for

If you’re taking aspirin for a short-lived pain, like toothache or period pain, you may only need to take it for 1 or 2 days.

If you’ve bought it from a shop, supermarket or pharmacy and need to use aspirin for more than 3 days, ask your doctor or pharmacist for advice.

If your doctor has prescribed your aspirin, take it for as long as they recommend.

If you take too much

Taking or using 1 or 2 extra tablets or suppositories is unlikely to be harmful.

The amount of aspirin that can lead to overdose varies from person to person.

Contact 111 for advice now if:

Side effects

Like all medicines, aspirin can cause side effects although not everyone gets them.

It’s best to take the lowest dose that works for you for the shortest possible time. That way, there’s less chance that you’ll get unwanted side effects.

For a full list see the leaflet inside your medicines packet.

Common side effects

These common side effects of aspirin for pain relief happen in more than 1 in 100 people. There are things you can do to help cope with them.

• Mild indigestion

  Take your aspirin with food to prevent this. If you still get indigestion or it does not go away, it could be a sign that the aspirin has caused a stomach ulcer. Talk to your doctor as they may prescribe something to protect your stomach or switch you to a different medicine.

• Bleeding more easily than normal

  Be careful when doing activities that might cause an injury or a cut. It might be best to stop doing contact sports such as football, rugby and hockey, while you’re taking aspirin. Wear gloves when you use sharp objects like scissors, knives, and gardening tools. Use an electric razor instead of wet shaving, and use a soft toothbrush and waxed dental floss to clean your teeth. See a doctor if you’re worried about any bleeding.

Talk to your doctor or pharmacist if the side effects bother you or do not go away.

Serious side effects

It happens rarely, but some people have serious side effects after taking aspirin.

Call your doctor or contact 111 now if:

Ready to be a menopause trailblazer?

As your long-term partner, we can provide you with the following menopause support services:

As a psychosexual and relationship therapist I have worked with many couples who have struggled through the menopause, not knowing why their relationship has changed or what they can do about it. One of the issues we often talk about, is the changes around intimacy and how to regain an intimate connection.

The effects of the menopause be it physical, hormonal, emotional or psychological, often all four, can cause a change to the way women think about their body and their own sexuality. It is rare to find a woman who easily glides through the menopause without experiencing some sort of change.

We might become more emotionally sensitive, and our energy could take a dive. Perhaps we become more aware of our bodies, how it feels to us and what it’s like to be touched by our partner.

On a physical level our oestrogen will be dropping resulting in the thinning of the vaginal walls and a reduced flow of natural lubricant. This causes penetrative sex to be painful. Some of my clients have described it as feeling like the vaginal walls are being rubbed with sandpaper.

With so many changes going on that directly influence our inclination for physical intimacy, it is little wonder our libido disappears, and we can feel the connection with our partner drifting away.

The intimate links to a positive sex life

We might instantly think of sex when intimacy is mentioned, but there is so much more to it than that. If we lack a psychological closeness, in other words if we find it difficult to understand one another’s opinions and actions or we feel our own are not respected, this will affect our psychological intimacy.

Similarly, if our emotions are not recognised and accepted, we will likely feel dismissed or lacking in worth to our partner.

If our lives are too busy for us to connect as partners and lovers, it could be that our physical intimacy will be lacking in meaning and volume.

These are all links to intimacy that directly affects our sex life and how we feel about one another. The natural changes of the menopause often emphasise these missing links and they tend to become clearer and likely to have more power over how we experience our connection.

I’m sure there is a book ready to be written about menopause and relationships, but for now I will talk about a snippet of it all: how to build and maintain an intimate connection during and beyond the menopause.

Developing intimacy during menopause

There are two sides to developing intimacy during the menopause: a personal nurturing side and the relationship side. Because there are a lot of information about nurturing yourself during every stage of the menopause, I have instead chosen some of the subjects my clients have found useful to explore and that will help you and your partner deepen the intimacy in your relationship.

The intimate links to a positive sex life

We might instantly think of sex when intimacy is mentioned, but there is so much more to it than that. If we lack a psychological closeness, in other words if we find it difficult to understand one another’s opinions and actions or we feel our own are not respected, this will affect our psychological intimacy. Similarly, if our emotions are not recognised and accepted, we will likely feel dismissed or lacking in worth to our partner. If our lives are too busy for us to connect as partners and lovers, it could be that our physical intimacy will be lacking in meaning and volume. These are all links to intimacy that directly affects our sex life and how we feel about one another. With the changes that come with the menopause these missing links tend to become clearer and are likely to have more power over how we experience our connection.

Menopause will be affecting your partner too

One of the reasons why the menopause has been kept a taboo subject for so long is because it’s been named a woman’s issue, men need not pay attention. But, if we think about the symptoms that we experience, it is clear that while we are the ones going through it, what we experience is bound to affect our relationship and our partner.

Find time to talk

Talking about how you both experience the menopause will help you and your partner understand and accept what it is going on for you both. Making it clear that your experience might change from one conversation to the next and that you might not know exactly what is going on. This will help to create an understanding of what is going in on your relationship.

Build a better team

Pulling together as a team will deepen your relationship and allowing yourself to be honest and open not just about your experiences but about the kind of support you need, will give your partner a chance to come on this journey with you.

Introduce moments of playfulness

Laughter and light-heartedness are some of the ingredients of a happy intimate connection with your partner. These are some suggestions that have helped some of my couples:

• Taking it is turns to choose a piece of music to play for one another. See how your conversation develops from this
• Have a regular games night. There is plenty of choice: computer games, card games, board games or maybe you already have your favourite game to play.
• Take it in turns to cook for one another. If you can’t cook, provide a surprise take-away.
• Watch a movie together. Whether it’s in the cinema or Netflix, try to watch a movie of your partner choice and visa versa.
• Spontaneously instigate a dance with your partner.
• While it can be a test during the menopause, taking a lighter view of life can bring smiles for both of you.

Foreplay begins the moment you wake in the morning

Foreplay, as I often talk about in therapy and in my writing, starts the moment you open your eyes in the morning.

I don’t mean that you have to be touching each other up or that you need to get ‘in the mood’. What I mean is this: the way we treat one another from the moment we awake and throughout the day and evening, will pave the way for how we communicate and feel about each other. Being nice to one another is the link to feeling emotionally close. Here are some suggestions:

• When you wake up, say ‘good morning’ and notice each other before you pick up your mobile phone to check what has come in overnight.
• Kiss each other goodbye, on the mouth, as you leave the house.
• Send a short, pleasant text message during the day just to say hello or I love you.
• Seeking out one another on returning home.
• Sharing the workload at home and being willing to help.
• Noticing the effort, you both put into your life together.
• Making time to be together just the two of you.

This is not the complete list, there are many more suggestions and perhaps you have your own suggestions that mean a lot to how you feel in your relationship.

Sex can be functional

If we for many years have swept the links to intimacy to one side in favour of the demands of life, we can end up with a sex life that is functional; if we are lucky, it satisfies a physical need but that is about all. Having an enjoyable sex life takes time, energy and willingness to talk and have fun together.

The menopause brings an extra aspect to physical intimacy; with a decrease in oestrogen in a woman’s body, comes thinning of the vaginal walls and a decrease in the natural lubrication. Consequently, penetrative sex becomes less enjoyable and for many, painful. A client once told me that penetration was like having her vagina rubbed with sandpaper.

If this resonates with you, then seeing your doctor to get a hormonal vaginal cream, will help enormously with this aspect, but I’m guessing you want more than just the ability to have penetrative sex.

Make intimacy something to rediscover

If any or all of what I have mentioned so far resonates with you, the menopause will likely highlight this as our sensitivity increase and we as women begin to rediscover ourselves and our needs. This increased sense doesn’t have to be a bad thing, it can be a prompt to rediscover your relationship and to build something that is fun and nurturing for you both.

Perhaps you by now are thinking that your partner won’t be interested. Well, I wouldn’t be so certain. When working with couples, I frequently hear partners say that they too have been missing the connection that they used to feel when they first met. Now might be the time to start the conversation and see where it might lead.

So, these are my suggestions:

1. Begin by setting time aside to be together.

This is a time where the two of you can talk and explore with curiosity, how you experience intimacy, the effect of the menopause and what you would might like to change. This is usually a time when couples begin to express unfulfilled needs and that is ok too, though try to talk about our wishes rather than your disappointments. Wishes you can work with, disappointments tend to spark blame and defensiveness.

Imagine having a conversation where your partner is accepting of your experiences without having to take them on as theirs to sort out. Expressing understanding and a willingness to know more about one another, without needing to agree or to blame. This is some of the most non-confrontational and sensual ways of communicating.

2. Connect physically on a regular basis.

Hugs and tactility can be incredibly nurturing. A touch on a shoulder or an arm around a waist, maybe a kiss as you pass each other in the corridor or kitchen. Perhaps a foot massage, one of my favourites. These small gestures can do magic for turning up the intensity of your connection.

Making an appointment with one another, or if you prefer, plan a time each week when you can make space for nurturing your intimate connection. Here is how:

3. Sex can be fulfilling without penetration.

Non-penetrative sex is not a requirement, though it can be a wonderful experience and very enjoyable. Removing the pressure to perform penetrative sex or even to have an orgasm, can ironically ease the way to developing a more intense physical intimacy. Imagine being free to enjoy one another’s nakedness, without feeling the need to sexually satisfy or to reach an orgasm. What would that be like?

Touching, stroking, kissing and exploring one another’s bodies, I don’t mean just the sexual organs, but the whole body giving each part the same attention: try giving a head massage, stroke the ear lopes, kiss the inside of the elbows, and so on. And, while doing this notice what it’s like and how our partner reacts to the touch. This can spark many giggles and soften the connection between you.

It may be that a man gets physically aroused. Being prepared for this and knowing that an erection doesn’t have to control the intimacy shared, might be quite a relief. The focus doesn’t have to be on stimulation to orgasm.

Many women, while enjoying sex, reports that for them it is the physical closeness that is most important, not the penetration or the orgasm. This view and need seem to increase with the menopause. In my experience working with couples, there are many men who have similar feelings. For them it is ok to self-satisfy if they feel the need, as long as they are able to have a physical connection.

Is this Christmas a time for you to reconnect?

So, this Christmas might be the perfect time to seek out the first steps to building a stronger intimate connection between you.

• Notice and enjoy the small moments of emotional, physical or psychological connection throughout the day and evening
• Find regular time to connect and make it a regular event
• Try feeling good about just touching without paying specific attention to sexual satisfaction
• Be patient with each other, developing intimacy take time.

If all else fails, psychosexual and relationship therapy will help you to create a deeper connection. I can recommend looking at qualified therapists on COSRT, the member association for Psychosexual and Relationship Therapists.

Wishing you a very happy Christmas and an intimate New Year.

Menopause, alongside menstruation, has often been used as the punchline to jokes and a way to humiliate and degrade women. While hormonal changes might be funny to some, they are normal bodily changes that most women have to experience. Unfortunately, they can come with some difficult side effects that women should be supported through, not made fun of for. This is not new and it is an issue around the world. Did you know in Arabic the word menopause means Age of Despair and in some Asian countries, there is no word for menopause?

Clearly menopause is still a taboo topic. It shouldn’t be. It is a natural change that a lot of women go through and they all deserve support as they do so. The stigma that shrouds menopause in secrecy is having a negative impact on everyone.

The common knowledge of menopause is fairly patchy. Most people know it’s when a woman no longer gets her period. Some might know that hot flushes are a symptom. But knowledge beyond that is lacking even though accurate information is necessary for women to be able to deal with menopause in the first place.

Menopause isn’t a silent change. According to Engender, ‘Up to 65% of women in UK experience menopause transition symptoms, up to 45% find them distressing and around 10% report them as severe’.

Experiencing bodily and emotional changes without knowing the reason behind it is scary. Without being able to join up the dots women can’t get the help they need to deal with this period of their life as easily as they can do. Facts are empowering and right now not enough women know them, never mind the other people in their life that should be supporting them through this time. This knowledge gap has an extremely negative impact.

Menopause is not a woman’s personal issue because it affects all aspects of her life. That’s how she interacts with her family and friends, how she behaves at work and her health. Even small changes like diet and exercise can make a massive difference. Ignoring menopause doesn’t benefit anyone. With open conversation, those experiencing menopause and those around them can put their best foot forward.

A lot of the shame around menopause is caused by negative attitudes towards women. Their objectification means when they are older and no longer fertile, they are seen as less valuable and are instead ‘washed up’. Menopause shouldn’t be seen as the end for women. Women should be just as respected as they were before.

Talking about it to gain support and simply be understood by other women with similar experiences can make a real difference. However, ‘a third cited embarrassment or difficulties in discussing the menopause with their employers and one in five mentioned criticism and even harassment from their Managers’. If we can overcome the negativity surrounding menopause, women can get the support they need and have a much better experience of menopause. The stigma and fear even seeps into medical consultations. A national poll found ‘Nearly half of all women over 50 experience urinary incontinence, but two-thirds haven’t talked to their doctor about it.’

Unless we take action to break down the stigma around menopause those going through it will continue to suffer necessarily in silence and in shame. An inclusive environment where menopausal women are listened to is essential. Remember going through menopause is nothing to be ashamed of.

Lesley Salem, founder of Over The Bloody Moon is on a mission to remove the stigma and muddle from menopause. Spurred on by her own poor mental health triggered by perimenopause, she’s seen first-hand the impact of not being able to have those difficult conversations with colleagues.

Only by sharing experiences can we learn how to support ourselves and each other. Only when we normalise menopause and other transitions and trauma of life can we truly create a cultural shift.

Those who may be in a vulnerable state find it hard to speak out so making menopause events, training and support available can help reduce the chances of women leaving the workplace and start to truly show we really want gender parity. Menopause is not the end for women. It is a new beginning.

Good health in the pelvic area requires a multifaceted approach.

Mental stress from women’s demanding lives (juggling a career, caring for ageing parents, navigating relationships, and parenting for some) also creates body stress. The more mental stress we experience, the lower our sex hormones impacting on libido but also pelvic health. Exercise can be another cause for pelvic health issues such as doing too little exercise or too much of the wrong type of exercise. This can put strain on the pelvic floor. And don’t underestimate the importance of diet. Not keeping hydrated, a diet low in fibre or eating processed foods, all can create constipation which is a major cause for incontinence. In addition, eating a low fat diet coupled with fluctuating hormone levels spikes levels of stress which may exacerbate symptoms. Previous pelvic health issues such as post childbirth injuries, 3rd degree tears, prolapse and faecal incontinence can also be exacerbated. No surprise then that 60% women will experience pelvic health issues post menopause.

Early warning signs

Symptoms may begin with fluctuating hormones in perimenopause (2 to 10 years before menopause), such as a relative reduction in progesterone, resulting in poor sleep, anxiety and aches and pains or oestrogen dominance resulting in hot flushes, breast tenderness, anxiety, and weight gain. This can be followed by oestrogen depletion as menopause ( ie 365 days after your last period) comes closer, causing vaginal dryness, atrophy ( thinning of the tissues), bladder irritation and incontinence, as well as a reduction in testosterone affecting libido and comfort during sex amongst other symptoms such as energy, bone density and muscle mass.

Good pelvic health requires attention, not only to your pelvic floor muscles but also to your sleep habits, mental health and stress management. It requires joyful connection with nature, friends and family. The good news is that through lifestyle choices, we can influence the health of our pelvis – healthy eating including protein, fibre, good fat, good carbohydrates, and supportive supplements plus exercise/build up to exercise as appropriate.

Seeking help

Many women put up with leaking urine when they sneeze or cough or deal with it by popping a pad in their knickers but issues now will likely worsen in our senior years. With specialist support, such as a women’s health physiotherapist, available on NHS or privately, in many cases, we can improve our pelvic health – in both the now and for our later years.

An integrative Pelvic Health physio will evaluate all of the above plus check for symptoms of pelvic organ prolapse, urinary frequency and urgency incontinence, cystitis, bladder or pelvic pain, stress urinary incontinence, prolapse pain with intercourse (dyspareunia) , constipation and faecal incontinence. A pelvic physio will evaluate your pelvic floor and teach breath coordination and pelvic floor training, including down-training if you have an overactive pelvic floor. You will be taught pressure management strategies, correct lifting techniques, as well as sleep hygiene, stress management, healthy eating and movement to complement your exercise needs and hormone balance.

Invictus Pelvic Health

Hi I am Nicky Travlos, founder of Invictus Pelvic Health. I use my expertise to work with Women who are struggling to juggle family, work and health and who are suffering from bladder and bowel and hormone issues, such as constipation, incontinence, prolapse, pain with intercourse and body aches and pains. I enjoy working with women to restore confidence in themselves, their bodies and their pelvic floor and use an integrative and holistic approach to improve their self care, lifestyles , energy levels, exercise regimes and bladder and bowel health. To sign up to an online course by Nicky, visit the website.

The NHS operates a residence-based healthcare system.

Most NHS services operates a residence-based healthcare system. Most NHS services are free to people who are ordinarily resident in the UK.

Being ordinarily resident is not dependent on nationality, payment of UK taxes, National Insurance (NI) contributions, being registered with a GP, having an NHS Number or owning property in the UK.

Ordinarily resident means living in the UK on a lawful and properly settled basis for the time being, and you’ll be asked to prove this.

Find out more about moving to England from EU countries or Norway, Iceland, Liechtenstein or Switzerland

Indefinite leave to remain (ILR)

If you’re subject to immigration control, you can only be considered ordinarily resident if you’ve been given the immigration status of indefinite leave to remain (the right to live here on a permanent basis).

But if you’re a family member of an EEA national who’s resident in the UK, you may not be subject to immigration control, even though you yourself are from outside the EEA.

Visit GOV.UK for more information about applying to join family living permanently in the UK

Family members of people of Northern Ireland

If you have a family member who is an eligible person of Northern Ireland and who lives in the UK, you may be able to join that person in the UK without paying the immigration health surcharge.

See GOV.UK for a definition of an eligible person of Northern Ireland

Otherwise you may be eligible to apply for pre-settled or settled status under the EU Settlement Scheme on the basis of that relationship. Once you have either pre-settled or settled status you will not be charged for your healthcare, as long as you live in the UK on a properly settled basis for the time being.

GOV.UK has more information about applying to join family living permanently in the UK

Immigration health surcharge

If you’re coming to the UK on a temporary stay of more than 6 months, you may be required to pay an immigration health surcharge at the time of your visa application.

The standard surcharge fee is:

• £470 per year per person for students and each of their dependants
• £624 per year per person for everyone else

The full amount will be paid upfront for the duration of your visa.

There are circumstances when you do not have to pay the surcharge, such as if you’re the dependant of a member of the forces who is not subject to immigration control.

You can find full details about healthcare surcharges, including exemptions, on GOV.UK

If you’ve paid the surcharge or were exempt from paying it, and your visa allows you to be here for more than 6 months, you’ll be entitled to free NHS hospital treatment in England on a similar basis to an ordinarily resident person.

This will apply from the date your visa is granted until it expires.

But any new course of treatment for NHS-funded assisted conception services will not be free to surcharge payers (or people exempt from paying it), unless another exemption applies.

If your visa is curtailed or ended earlier than planned by the Home Office, you can be charged for any further NHS hospital treatment from that date on, even if you have paid the surcharge.

You’ll also have to pay for any chargeable treatment you received before the start date of your visa.

If you apply for an extension of your visa, you might also have to pay a further surcharge.

If you apply for, and are granted, indefinite leave to remain, you will not have to pay the surcharge.

Paying the surcharge only gives you access to services the NHS provides. Paying the surcharge does not mean you’re treated faster.

Doctors will assess the urgency of your condition in the same way ordinarily resident patients are assessed and, if necessary, you’ll be placed on a waiting list.

Patients in England are required to make contributions towards the cost of their NHS care, such as paying prescription costs or dental charges. You’re required to make the same contributions.

Find out more about paying NHS charges

Visas applied for before 6 April 2015

The surcharge was introduced on 6 April 2015. If you’re in the UK now but applied for your visa before that date, you may still be eligible for free NHS hospital treatment in England on the same basis as someone who’s ordinarily resident.

The following must apply to you:

• you applied for a visa to come to the UK, or to stay in the UK, for more than 6 months before 6 April 2015
• your visa application was approved and your visa has not expired
• you’re in the UK now
• if you applied for your visa after 6 April 2015, you would have had to pay the surcharge, or you would have fallen into one of the exemption categories

If the bullet points apply to you, your care is covered from the date your visa is granted until it expires.

But if your visa is curtailed or ended earlier than planned by the Home Office, you’ll become chargeable for any further NHS healthcare from that date onwards.

If you then wish to apply for a further period of leave to remain, you’ll have to pay the surcharge, unless you fall into one of the exemption categories.

If you wish to apply for, and are granted, indefinite leave to remain, you do not have to pay the surcharge.

Children born in the UK to those here lawfully for more than 6 months

If you give birth to a child in the UK, your child will be entitled to free NHS hospital treatment in England on the same basis as someone who’s ordinarily resident up to 3 months of age, but only if they remain in the UK during that period.

You’ll also need to meet one of these criteria:

• you have a valid visa of more than 6 months and paid the surcharge for that visa
• you have a valid visa of more than 6 months, but were exempt from paying the surcharge
• you have a valid visa of more than 6 months, which you applied for prior to 6 April 2015

You should apply for a visa for your child during the 3-month period after your child’s birth.

If required, you may have to pay the surcharge for your child. Failure to do so means you may be charged for NHS services provided for your child after the 3-month period.

You do not need proof of address or immigration status, ID or an NHS number.

You might be able to register with a GP surgery that’s not in the area you live. Find out about registering with a GP surgery out of your area

GP surgeries are usually the first contact if you have a health problem. They can treat many conditions and give health advice. They can also refer you to other NHS services.

Registering with a GP

Find a GP that suits what you need. Some GP surgeries offer more services than others. You can look up GP surgeries to see what they offer and how they compare.

Because of coronavirus (COVID-19), try to avoid going into a GP surgery to register.

You can:

• check the GP surgery website to see if you can register online
• call or email the GP surgery and ask to be registered as a patient

You can download a GMS1 registration form on GOV.UK if you’re asked to complete one.

You do not need proof of ID to register with a GP, but it might help of you have one or more of the following:

• passport
• birth certificate
• HC2 certificate
• rough sleepers’ identity badge
• hostel or accommodation registration or mail forwarding letter

If you’re homeless, you can give a temporary address, such as a friend’s address, a day centre or the GP surgery address.

If you need to help registering with a GP surgery

If you need help registering or filling in forms, call the GP surgery and let them know.

You could also ask for help from:

• local organisations – for example if you’re homeless you could ask a centre that supports homeless people
• Citizens Advice
• your local Healthwatch

Can a GP surgery refuse to register me?

A GP surgery can refuse to register you because:

• they are not taking any new patients
• you live outside the practice boundary and they are not accepting patients from out of their area
• you have been removed from that GP surgery register before
• it’s a long way from your home and you need extra care, for example home visits

If you have problems registering with a GP surgery:

• they are not taking any new patients
• call the NHS England Customer Contact Centre on 0300 311 22 33
• contact your local Healthwatch

Changing GP surgeries

You can change your GP surgery if you need to.

This might be because:

• you have moved
• you have had problems with your current practice
• you were removed from the patient list

You should tell the GP surgery if you change address or move out of the area.

Using a GP surgery you’re not registered with

You can contact any GP surgery if you need treatment and:

• you’re away from home
• you’re not registered with a GP surgery
• it’s a medical emergency

You might need to register as a temporary resident or permanent patient if you need treatment for more than 14 days.

You can register as a temporary resident for up to 3 months. You’ll still be registered with your usual GP surgery if you have one.

Registering with a GP under the Mental Capacity Act

The Mental Capacity Act (MCA) is designed to protect and empower people over 16 who are unable to make decisions about their care and treatment.

If a person is unable to register with a GP because they cannot make decisions about their care, registration can be done by:

• a relative
• the main carer
• a lasting power of attorney
• a person appointed by a court under the Mental Capacity Act

As a psychosexual and relationship therapist I have worked with many couples who have struggled through the menopause, not knowing why their relationship has changed or what they can do about it. One of the issues we often talk about, is the changes around intimacy and how to regain an intimate connection.

The effects of the menopause be it physical, hormonal, emotional or psychological, often all four, can cause a change to the way women think about their body and their own sexuality. It is rare to find a woman who easily glides through the menopause without experiencing some sort of change.

We might become more emotionally sensitive, and our energy could take a dive. Perhaps we become more aware of our bodies, how it feels to us and what it’s like to be touched by our partner.

On a physical level our oestrogen will be dropping resulting in the thinning of the vaginal walls and a reduced flow of natural lubricant. This causes penetrative sex to be painful. Some of my clients have described it as feeling like the vaginal walls are being rubbed with sandpaper.

With so many changes going on that directly influence our inclination for physical intimacy, it is little wonder our libido disappears, and we can feel the connection with our partner drifting away.

The intimate links to a positive sex life

We might instantly think of sex when intimacy is mentioned, but there is so much more to it than that. If we lack a psychological closeness, in other words if we find it difficult to understand one another’s opinions and actions or we feel our own are not respected, this will affect our psychological intimacy.

Similarly, if our emotions are not recognised and accepted, we will likely feel dismissed or lacking in worth to our partner.

If our lives are too busy for us to connect as partners and lovers, it could be that our physical intimacy will be lacking in meaning and volume.

These are all links to intimacy that directly affects our sex life and how we feel about one another. The natural changes of the menopause often emphasise these missing links and they tend to become clearer and likely to have more power over how we experience our connection.

I’m sure there is a book ready to be written about menopause and relationships, but for now I will talk about a snippet of it all: how to build and maintain an intimate connection during and beyond the menopause.

Developing intimacy during menopause

There are two sides to developing intimacy during the menopause: a personal nurturing side and the relationship side. Because there are a lot of information about nurturing yourself during every stage of the menopause, I have instead chosen some of the subjects my clients have found useful to explore and that will help you and your partner deepen the intimacy in your relationship.

The intimate links to a positive sex life

We might instantly think of sex when intimacy is mentioned, but there is so much more to it than that. If we lack a psychological closeness, in other words if we find it difficult to understand one another’s opinions and actions or we feel our own are not respected, this will affect our psychological intimacy. Similarly, if our emotions are not recognised and accepted, we will likely feel dismissed or lacking in worth to our partner. If our lives are too busy for us to connect as partners and lovers, it could be that our physical intimacy will be lacking in meaning and volume. These are all links to intimacy that directly affects our sex life and how we feel about one another. With the changes that come with the menopause these missing links tend to become clearer and are likely to have more power over how we experience our connection.

Menopause will be affecting your partner too

One of the reasons why the menopause has been kept a taboo subject for so long is because it’s been named a woman’s issue, men need not pay attention. But, if we think about the symptoms that we experience, it is clear that while we are the ones going through it, what we experience is bound to affect our relationship and our partner.

Find time to talk

Talking about how you both experience the menopause will help you and your partner understand and accept what it is going on for you both. Making it clear that your experience might change from one conversation to the next and that you might not know exactly what is going on. This will help to create an understanding of what is going in on your relationship.

Build a better team

Pulling together as a team will deepen your relationship and allowing yourself to be honest and open not just about your experiences but about the kind of support you need, will give your partner a chance to come on this journey with you.

Introduce moments of playfulness

Laughter and light-heartedness are some of the ingredients of a happy intimate connection with your partner. These are some suggestions that have helped some of my couples:

• Taking it is turns to choose a piece of music to play for one another. See how your conversation develops from this
• Have a regular games night. There is plenty of choice: computer games, card games, board games or maybe you already have your favourite game to play.
• Take it in turns to cook for one another. If you can’t cook, provide a surprise take-away.
• Watch a movie together. Whether it’s in the cinema or Netflix, try to watch a movie of your partner choice and visa versa.
• Spontaneously instigate a dance with your partner.
• While it can be a test during the menopause, taking a lighter view of life can bring smiles for both of you.

Foreplay begins the moment you wake in the morning

Foreplay, as I often talk about in therapy and in my writing, starts the moment you open your eyes in the morning.

I don’t mean that you have to be touching each other up or that you need to get ‘in the mood’. What I mean is this: the way we treat one another from the moment we awake and throughout the day and evening, will pave the way for how we communicate and feel about each other. Being nice to one another is the link to feeling emotionally close. Here are some suggestions:

• When you wake up, say ‘good morning’ and notice each other before you pick up your mobile phone to check what has come in overnight.
• Kiss each other goodbye, on the mouth, as you leave the house.
• Send a short, pleasant text message during the day just to say hello or I love you.
• Seeking out one another on returning home.
• Sharing the workload at home and being willing to help.
• Noticing the effort, you both put into your life together.
• Making time to be together just the two of you.

This is not the complete list, there are many more suggestions and perhaps you have your own suggestions that mean a lot to how you feel in your relationship.

Sex can be functional

If we for many years have swept the links to intimacy to one side in favour of the demands of life, we can end up with a sex life that is functional; if we are lucky, it satisfies a physical need but that is about all. Having an enjoyable sex life takes time, energy and willingness to talk and have fun together.

The menopause brings an extra aspect to physical intimacy; with a decrease in oestrogen in a woman’s body, comes thinning of the vaginal walls and a decrease in the natural lubrication. Consequently, penetrative sex becomes less enjoyable and for many, painful. A client once told me that penetration was like having her vagina rubbed with sandpaper.

If this resonates with you, then seeing your doctor to get a hormonal vaginal cream, will help enormously with this aspect, but I’m guessing you want more than just the ability to have penetrative sex.

Make intimacy something to rediscover

If any or all of what I have mentioned so far resonates with you, the menopause will likely highlight this as our sensitivity increase and we as women begin to rediscover ourselves and our needs. This increased sense doesn’t have to be a bad thing, it can be a prompt to rediscover your relationship and to build something that is fun and nurturing for you both.

Perhaps you by now are thinking that your partner won’t be interested. Well, I wouldn’t be so certain. When working with couples, I frequently hear partners say that they too have been missing the connection that they used to feel when they first met. Now might be the time to start the conversation and see where it might lead.

So, these are my suggestions:

1. Begin by setting time aside to be together.

This is a time where the two of you can talk and explore with curiosity, how you experience intimacy, the effect of the menopause and what you would might like to change. This is usually a time when couples begin to express unfulfilled needs and that is ok too, though try to talk about our wishes rather than your disappointments. Wishes you can work with, disappointments tend to spark blame and defensiveness.

Imagine having a conversation where your partner is accepting of your experiences without having to take them on as theirs to sort out. Expressing understanding and a willingness to know more about one another, without needing to agree or to blame. This is some of the most non-confrontational and sensual ways of communicating.

2. Connect physically on a regular basis.

Hugs and tactility can be incredibly nurturing. A touch on a shoulder or an arm around a waist, maybe a kiss as you pass each other in the corridor or kitchen. Perhaps a foot massage, one of my favourites. These small gestures can do magic for turning up the intensity of your connection.

Making an appointment with one another, or if you prefer, plan a time each week when you can make space for nurturing your intimate connection. Here is how:

3. Sex can be fulfilling without penetration.

Non-penetrative sex is not a requirement, though it can be a wonderful experience and very enjoyable. Removing the pressure to perform penetrative sex or even to have an orgasm, can ironically ease the way to developing a more intense physical intimacy. Imagine being free to enjoy one another’s nakedness, without feeling the need to sexually satisfy or to reach an orgasm. What would that be like?

Touching, stroking, kissing and exploring one another’s bodies, I don’t mean just the sexual organs, but the whole body giving each part the same attention: try giving a head massage, stroke the ear lopes, kiss the inside of the elbows, and so on. And, while doing this notice what it’s like and how our partner reacts to the touch. This can spark many giggles and soften the connection between you.

It may be that a man gets physically aroused. Being prepared for this and knowing that an erection doesn’t have to control the intimacy shared, might be quite a relief. The focus doesn’t have to be on stimulation to orgasm.

Many women, while enjoying sex, reports that for them it is the physical closeness that is most important, not the penetration or the orgasm. This view and need seem to increase with the menopause. In my experience working with couples, there are many men who have similar feelings. For them it is ok to self-satisfy if they feel the need, as long as they are able to have a physical connection.

Is this Christmas a time for you to reconnect?

So, this Christmas might be the perfect time to seek out the first steps to building a stronger intimate connection between you.

• Notice and enjoy the small moments of emotional, physical or psychological connection throughout the day and evening
• Find regular time to connect and make it a regular event
• Try feeling good about just touching without paying specific attention to sexual satisfaction
• Be patient with each other, developing intimacy take time.

If all else fails, psychosexual and relationship therapy will help you to create a deeper connection. I can recommend looking at qualified therapists on COSRT, the member association for Psychosexual and Relationship Therapists.

Wishing you a very happy Christmas and an intimate New Year.

Menopause, alongside menstruation, has often been used as the punchline to jokes and a way to humiliate and degrade women. While hormonal changes might be funny to some, they are normal bodily changes that most women have to experience. Unfortunately, they can come with some difficult side effects that women should be supported through, not made fun of for. This is not new and it is an issue around the world. Did you know in Arabic the word menopause means Age of Despair and in some Asian countries, there is no word for menopause?

Clearly menopause is still a taboo topic. It shouldn’t be. It is a natural change that a lot of women go through and they all deserve support as they do so. The stigma that shrouds menopause in secrecy is having a negative impact on everyone.

The common knowledge of menopause is fairly patchy. Most people know it’s when a woman no longer gets her period. Some might know that hot flushes are a symptom. But knowledge beyond that is lacking even though accurate information is necessary for women to be able to deal with menopause in the first place.

Menopause isn’t a silent change. According to Engender, ‘Up to 65% of women in UK experience menopause transition symptoms, up to 45% find them distressing and around 10% report them as severe’.

Experiencing bodily and emotional changes without knowing the reason behind it is scary. Without being able to join up the dots women can’t get the help they need to deal with this period of their life as easily as they can do. Facts are empowering and right now not enough women know them, never mind the other people in their life that should be supporting them through this time. This knowledge gap has an extremely negative impact.

Menopause is not a woman’s personal issue because it affects all aspects of her life. That’s how she interacts with her family and friends, how she behaves at work and her health. Even small changes like diet and exercise can make a massive difference. Ignoring menopause doesn’t benefit anyone. With open conversation, those experiencing menopause and those around them can put their best foot forward.

A lot of the shame around menopause is caused by negative attitudes towards women. Their objectification means when they are older and no longer fertile, they are seen as less valuable and are instead ‘washed up’. Menopause shouldn’t be seen as the end for women. Women should be just as respected as they were before.

Talking about it to gain support and simply be understood by other women with similar experiences can make a real difference. However, ‘a third cited embarrassment or difficulties in discussing the menopause with their employers and one in five mentioned criticism and even harassment from their Managers’. If we can overcome the negativity surrounding menopause, women can get the support they need and have a much better experience of menopause. The stigma and fear even seeps into medical consultations. A national poll found ‘Nearly half of all women over 50 experience urinary incontinence, but two-thirds haven’t talked to their doctor about it.’

Unless we take action to break down the stigma around menopause those going through it will continue to suffer necessarily in silence and in shame. An inclusive environment where menopausal women are listened to is essential. Remember going through menopause is nothing to be ashamed of.

Lesley Salem, founder of Over The Bloody Moon is on a mission to remove the stigma and muddle from menopause. Spurred on by her own poor mental health triggered by perimenopause, she’s seen first-hand the impact of not being able to have those difficult conversations with colleagues.

Only by sharing experiences can we learn how to support ourselves and each other. Only when we normalise menopause and other transitions and trauma of life can we truly create a cultural shift.

Those who may be in a vulnerable state find it hard to speak out so making menopause events, training and support available can help reduce the chances of women leaving the workplace and start to truly show we really want gender parity. Menopause is not the end for women. It is a new beginning.

Good health in the pelvic area requires a multifaceted approach.

Mental stress from women’s demanding lives (juggling a career, caring for ageing parents, navigating relationships, and parenting for some) also creates body stress. The more mental stress we experience, the lower our sex hormones impacting on libido but also pelvic health. Exercise can be another cause for pelvic health issues such as doing too little exercise or too much of the wrong type of exercise. This can put strain on the pelvic floor. And don’t underestimate the importance of diet. Not keeping hydrated, a diet low in fibre or eating processed foods, all can create constipation which is a major cause for incontinence. In addition, eating a low fat diet coupled with fluctuating hormone levels spikes levels of stress which may exacerbate symptoms. Previous pelvic health issues such as post childbirth injuries, 3rd degree tears, prolapse and faecal incontinence can also be exacerbated. No surprise then that 60% women will experience pelvic health issues post menopause.

Early warning signs

Symptoms may begin with fluctuating hormones in perimenopause (2 to 10 years before menopause), such as a relative reduction in progesterone, resulting in poor sleep, anxiety and aches and pains or oestrogen dominance resulting in hot flushes, breast tenderness, anxiety, and weight gain. This can be followed by oestrogen depletion as menopause ( ie 365 days after your last period) comes closer, causing vaginal dryness, atrophy ( thinning of the tissues), bladder irritation and incontinence, as well as a reduction in testosterone affecting libido and comfort during sex amongst other symptoms such as energy, bone density and muscle mass.

Good pelvic health requires attention, not only to your pelvic floor muscles but also to your sleep habits, mental health and stress management. It requires joyful connection with nature, friends and family. The good news is that through lifestyle choices, we can influence the health of our pelvis – healthy eating including protein, fibre, good fat, good carbohydrates, and supportive supplements plus exercise/build up to exercise as appropriate.

Seeking help

Many women put up with leaking urine when they sneeze or cough or deal with it by popping a pad in their knickers but issues now will likely worsen in our senior years. With specialist support, such as a women’s health physiotherapist, available on NHS or privately, in many cases, we can improve our pelvic health – in both the now and for our later years.

An integrative Pelvic Health physio will evaluate all of the above plus check for symptoms of pelvic organ prolapse, urinary frequency and urgency incontinence, cystitis, bladder or pelvic pain, stress urinary incontinence, prolapse pain with intercourse (dyspareunia) , constipation and faecal incontinence. A pelvic physio will evaluate your pelvic floor and teach breath coordination and pelvic floor training, including down-training if you have an overactive pelvic floor. You will be taught pressure management strategies, correct lifting techniques, as well as sleep hygiene, stress management, healthy eating and movement to complement your exercise needs and hormone balance.

Invictus Pelvic Health

Hi I am Nicky Travlos, founder of Invictus Pelvic Health. I use my expertise to work with Women who are struggling to juggle family, work and health and who are suffering from bladder and bowel and hormone issues, such as constipation, incontinence, prolapse, pain with intercourse and body aches and pains. I enjoy working with women to restore confidence in themselves, their bodies and their pelvic floor and use an integrative and holistic approach to improve their self care, lifestyles , energy levels, exercise regimes and bladder and bowel health. To sign up to an online course by Nicky, visit the website.