DEAR DR. MONA: I’m pregnant, due very soon. I’d like to have an epidural for the pain but have been told that, since I have a tattoo on my lower back, it may not be possible. Can you inform me on this? — Maya

DEAR MAYA: Don’t worry and proceed with your plans of having an epidural. In the public, there seems to be some misconception that women with tattoos on their back can have problems with epidurals or spinals. The concern is that the ink from the tattoo will migrate into the spinal space.

There is no medical evidence or study to support this myth. The ink used in these tattoos is inert and once deposited in the skin it is fixed in the layers once healed.

Moreover, when the epidural is administered, a stylette (or hollow needle) is used and is removed only when the needle has passed through the superficial skin. Then a thin plastic catheter is introduced to deliver the anesthetic; no needles stay in the back.

A fresh tattoo is another issue; many anesthesiologists refuse to place epidurals or spinals in a fresh wound because of the possibility of infection, but healed ones are not a problem.

DEAR DR. MONA: I am 27 and have a lot of breast pain around the time of my periods. I try to stay physically fit, but it is uncomfortable for me to exercise or even touch my breasts, for that matter. Is there anything I can do for this? — Ashley

DEAR ASHLEY: Breast tenderness just prior to the menstrual period during the reproductive years is very common. Because the pain occurs just at the time of your menses and in both breasts it is most probably related to hormonal changes (estrogen and progesterone). This is called cyclic mastalgia. Ibuprofen (or other over-the-counter pain killer) usually works rather well to relieve these symptoms. Additionally, use of a good bra with firm support may also provide some relief.

In the second half of the menstrual cycle, both estrogen and progesterone levels are high. Since any breast pain can worsen premenstrual due to hormonal changes, it is important to make sure that there is not pain that persists throughout all or most of the menstrual cycle.

There is a condition called noncyclic mastalgia referring to breast pain that is NOT related to the menstrual cycle. This usually occurs in women over 40 and in only one breast rather than both. A mammogram, thorough history and breast examination are important when this occurs to rule out more serious conditions.

So Ashley, try the painkillers before you exercise and just know that as you age, your symptoms will not be as severe.

Dr. Mona Alqulali is a board certified OB-GYN.

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